Friday, June 27, 2008

Summer Fun


Kyla has had a fun day playing with her cousin Joy who is visiting for the weekend. Those two have put on a dance show, played inside, played outside on a slip'n slide and in the little kid pool.




Kyla is still on the weak side of her normal self, but she doesn't let a little weakness get her down. I would say she's functioning at about 75% of her pre-Mayo self. Once again, we've not seen any effects of the Albuterol, other than a noticeable case of the jitters this morning and afternoon.

Pictures from the zoo on Wednesday

We are home

After another uneventful day of travel, we arrived home last night at 9:30. Thank you to all who have prayed for this trip and for Kyla. We are blessed to have had no travel problems.

Kyla is now on day 3 of Albuterol. She is taking a pill form of Albuterol. On Wednesday, she took 1 mg (half a pill) at 8 am and another 1 mg at noon. Yesterday, she took 2 mg (one pill) at 8 am and 1 mg at noon. Today, she has already taken 2 mg at 8 am and will take another 1 mg at noon. We will work her up in the next couple of weeks, with a target goal of 2 mg at 8 am, 2 mg at noon, and 2 mg at 6 pm each day. So far, the only side effect we have seen is a case of the jitters. She is a little shaky this morning after taking the pill. However, it's hard to say that we've seen any change in her muscle strength at all. Our starting of the Albuterol was at the same time that we decreased Mestion from 5mL to 3 mL 3-4 times a day, so any advantages of the Albuterol have been more than negated by the significant weakness caused by the decrease in Mestinon. We'll continue to journal the effects of the medicine changes on Kyla and hope others find this helpful. If you are a CMS patient and take Albuterol, we'd love to hear from you (neely4606@hotmail.com). We had heard of Ephedrine as a treatment for CMS, but the use of Albuterol was a new one for us.
nc

Thursday, June 26, 2008

Going home today

We go home today. We drive to Minneapolis and fly out at 2:30 and will be at DFW at 5.

Kyla's Mestinon dose has gone from 5 mL to 3 mL 3-4 times a day on this trip. I pray that in the next week her body will adjust and we'll have our little Kyla back to where she was before we came. We would love to hear from other parents who have children with a CMS. My email address is neely4606@hotmail.com.
nc

The picture to the right is from yesterday.  The Internet connection here at this hotel was really slow last night, so I gave up on uploading it yesterday.

Wednesday, June 25, 2008

A final meeting with Dr. Engel and Dr. Selcen

We had our last meeting with the doctors today. We saw them together at 1:30. They agreed that Kyla is doing very well. They also agreed that Kyla's Mestinon dosage should be less and that we should continue trying the Albuterol. They recommended that we come back every two years or more often if we'd like.

This is Neely typing, so this is my opinion, not necessarily Sabrina's. I trust the doctors and want to do what is best for Kyla. However, we have given Kyla the lower dose of Mestinon only once last night and a three times today and she is noticeably weaker. I would say significantly weaker. I hoped and prayed we would leave here better than when we came. The opposite has happened and it's frustrating. The Albuterol seems to make her a little hyper, but doesn't seem to make her any stronger. We'll give it while to see if things change, but I'm a little discouraged right now. We just went swimming and her eyes we so droopy. It's like we've taken several steps backward.

On another note, last night we had to measure Kyla's oxygen saturation while she was sleeping. But, Kyla took it off in her sleep and there wasn't enough data to make the test legit. So, we get to repeat the test tonight. We're doing this because Kyla's oxygen saturation level went too low during the sleeping portion of her EEG yesterday. Hopefully, we'll get good data tonight and everything will be fine. We will consult with Kyla's pulmonologist at Cook's in Ft. Worth when we return if there is a problem with the test tonight.

Other than the doctor's visit, we have just played today. We went to a really cool park this morning and the girls had a blast. After the doctor, we went to a little zoo about 10 miles from Rochester. The girls really enjoyed looking at the animals. Tonight, we went to Rochesterfest and had fried food, corn, and dippin dots. I got to enjoy some Cheese Curds and Mini-donuts, which were amazing. Kyla and Laura loved their hot dogs and dippin dots.  There were a ton of people there, so it was a little overwhelming for Laura.

Tuesday, June 24, 2008

A long day at the Mayo

We arrived at the Mayo at 8 am and didn't leave until 4 pm.  Kyla had a chest x-ray, urine test, and Electrocardiogram early on and Kyla did well through all of those tests.  Then came the EEG.  She did not like any part of it, and did not fall asleep, which was required in the test.  So, she had to be sedated for the last part of the test.  The nurse who administered the sedation was not eager to sedate her for some reason, so we spent a good bit of time just waiting for her.  And when she came in, she wouldn't sedate her because Kyla still had a blood test to go.  So, our EEG tech went to work and got orders for the sedation and we eventually were able to finish the test.  A 45 minute test took 2 and a half hours.  That was quite frustrating.  This is our second trip to Mayo and both times the EEG has been a terrible experience.  Anyway, after the EEG was over, Kyla had blood drawn and then we had lunch.  After lunch, we met with Dr. Selcen, a neurologist.  During this meeting, we discussed putting Kyla on another medication.  She agreed with Dr. Engel that 3,4 DAP is not worth the risk for Kyla, but she also suggested we try Albuterol, which Dr. Engel had mentioned yesterday.  This all deserves a little detail.
Kyla's problem is at the neuromuscular junction.  The nerve sends Acetylcholine to the muscle where it is received by Acetylcholine receptors.  Also in the junction is Acetylcholinesterase that cleans the Acetylcholine that remains in the neuromuscular junction (this is really a crude explanation, but it makes sense to me).  Kyla's problem is she is deficient in Rapsyn, which is crucial to proper function of the Acetylcholine receptors.  She currently takes Mestinon, which inhibits the Acetylcholinesterase, thus giving the Acetylcholine more opportunities to find the receptors.  This has been our miracle drug.  3,4 DAP helps send more Acetylcholine into the junction and has been positive in treating folks like Kyla.  There are risks with this, however, and we will not try this at this time.  Two other drugs have been clinically shown to help folks like Kyla, but both Dr. Engel and Dr. Selcen told us that it is not known why these two drugs work.  They are Ephedrine and Albuterol.  Ephedrine is almost impossible to get, but Albuterol is easy to get and seems to work better than Ephedrine.  So, we are going to start Albuterol tomorrow.  We also will try dialing back the Mestinon a little, as Dr. Selcen says our dose is too high.  We have no tests tomorrow, and will see both doctors tomorrow at 1:30.
The other big news of the day is that the EEG was normal, but when Kyla was sleeping during the test, her oxygen saturation level was low.  In fact, it was low enough that it should have woke her up, but it didn't.  So, we have a machine to measure her oxygen saturation while she sleeps tonight.  We'll see what happens with that.  
Even though it was a long day, we did have fun again tonight.  After an adventurous meal, we had ice cream and went swimming again.  Laura is finally starting to swim around a little and Kyla continues to have a blast in the pool.  
Thanks David and Stevo for the comments and your prayers.  Thanks to all who are praying for our little Kyla.  She bounces back from hard times very well and this trip has been no different.

The following slide show are pictures from the day.



  

Monday, June 23, 2008

No Mestinon

For those who didn't know Kyla before she started taking Mestinon, check out her eyes on this video. She took Mestinon at 11:30 am on Sunday, then didn't take it again until after the EMG. This was to see more accurately how the 3,4 DAP would react with Kyla. Anyway, this video was taken before the EMG and she was pretty droopy. Follow her right eye as the video progresses. Her right eye tends to turn out when she is sick or tired. Without Mestinon, it just turns out consistently. Her mouth also doesn't close in this video. She also has a hard time keeping her head upright.