A Family’s Battle with Chiari Malformation

Meet the Matthews family! Tamara has graciously agreed to share her family’s journey with rare diseases and how they manage a busy and happy household with two children.
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In November 2003, our happy family (mom, dad and 3 year old son) became complete with the birth of our beautiful baby girl. The NICU respiratory team was ready for her as complications were expected – she’d been an “unresponsive” baby in utero. An amniocentesis was performed to see if her lungs were mature enough, and she was delivered via C-section at 38 weeks.
The problems that kept her in the NICU, (fever, sepsis, extreme jaundice, apneas) were a vivid reminder of the fears when her brother was born, full term, with an unexplained brain hemorrhage.
Though much of her early years were spent traveling to various specialists, and receiving speech, physical and occupational therapy, overall she was a contented and cheerful child. At age 6, we found that she suffered from “congenital panhypopituitarism”, a big term that means she lacks all hormones, and needs supplementation daily, including daily growth hormone injections.
Prior to beginning growth hormone treatment, all children must have a brain MRI to be sure there are no tumors that are obstructing the pituitary gland. Thankfully no tumors were found, but a “Chiari malformation” was discovered. This occurs when part of the brain, the cerebral tonsils, descend into the spinal column. This cuts off the normal flow of cerebral spinal fluid. Subsequent MRI’s showed “syringomyelia” from 3 syrinx – bubbles of built up CSF in the spinal cord. Brain decompression surgery is the only treatment.
Our daughter never had the “classic Chiari headaches” that form at the base of the skull, or upon sneezing or coughing. Yet, when her skull was opened, her surgeon said her skull was actually wearing away from the inside out due to all of the pressure! The symptoms of nausea, dizziness, and fatigue, previously attributed to the pituitary issues, were actually symptoms of Chiari. We were very fortunate that this condition was discovered before permanent damage was done. The longer the syrinx remain, the more damage they do to nerves in the spinal cord, and the placement of hers would also lead to scoliosis.
Some patients lose control of their bladder and bowels, and live in extreme and permanent pain, unless there is early intervention. So at age 6, our precious little girl went to Johns Hopkins Hospital in Baltimore, MD, for brain surgery. It was the most terrifying time of our lives. Fortunately, we were blessed to have the care and expertise of Dr. Ben Carson.
He removed part of the rear portion of her skull and vertebrae, creating more space for the cerebral tonsils. Recovery was difficult due to her other health complications, but after a couple of months, we saw our joyful child blossom! Tears came to my eyes the first time I saw her skip, and sing a song while taking a walk. I was not consciously aware that those things had been missing, but realized how much better she felt when I saw her do them for the first time!
Lightning struck twice when in December 2012, our son was also diagnosed with Chiari and syringomyelia. There was no real reason, just a “mother’s instinct” that caused me to ask for an MRI for him. He was watched for a couple of years, but surgery was done when he began to have some slight and intermittent finger tingling. This is something that would normally not be bothersome, but having had the MRI’s, the pediatric neurosurgeon could see that the syrinx lay right at the nerve that affects the fingers.
My son then also had a brain decompression surgery with laminectomy and duraplasty – a procedure in which the outer covering of the brain is opened slightly and a patch is put in to allow for more space. We still do not know if Chiari had any part in his very unusual brain hemorrhage at birth.
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Living with Panhypopituitarism and Adrenal Insufficiency

Meet this amazing family and their little girl who lives with multiple conditions, including Adrenal Insufficiency.

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I’m Eilidh’s mom, Amory. Our family includes myself, Eilidh’s daddy, Craig, her super awesome big brother, Miles, her beautiful, smart big sister, Raven, and Eilidh, of course.

We live in Texas just north of Austin. We moved here when Eilidh was 10 months old. We have 3 big dogs. Harley (14 yo Black Lab), Kato (2 year old Plott/Pitt mix), and Lady (2 yo Black Lab – who is Eilidh’s service dog).

If Eilidh had her choice, I would probably still be pregnant with her! At 42 weeks, on a Tuesday afternoon, she finally graced us with her presence. It was September 14th and Eilidh was born peacefully at home with the assistance of a midwife. Her big brother slept through the entire (3 hours) labor and was pleasantly surprised to have a sister when he finished his nap. In the beginning, we had no reasons to think there was anything amiss. She was over 7 pounds and cute as a ladybug’s ear.

She didn’t have much interest in sucking, but my lactation consultant assured me that this was completely normal for some babies. We rested all afternoon and evening and I tried diligently to get her to suck. I pumped colostrum and dripped it into her mouth just waiting for her to have an interest in nursing. I completely credit having Eilidh at home with the reason she is alive today.

It was 4am and I was holding her, steadily dripping colostrum into her sweet little mouth. My parents were sleeping in the living room, my three year old was sound asleep in his room, and my husband was snoring softly next to us. Eilidh’s lips puckered as if she was sucking on a lemon and she stopped breathing.

My educational background is in family and child development. I have taken child and adult CPR for health professionals more times than I can count. However, when my brand new baby stopped breathing at 12 hours old, I needed the 911 operator to say “Have you started CPR?” for me to move on life saving protocol. Maybe it was new mom hormones or exhaustion from labor and no sleep, but I’m so incredibly thankful for her asking that simple question.

Our house was less than 1 mile from a fire station. It was raining that September night. When EMS receives a call that a baby has stopped breathing, it doesn’t matter who you are, they call in the cavalry. Within 3 minutes of us getting on the phone with the dispatcher, Eilidh started to breathe again (Thank you, Jesus!) and there were 15 very large men surrounding my baby while I sat next to her on the floor in my husband’s old tshirt and Depends. Glamorous!

The chief of police, every available EMS member, 3 fire trucks and 2 ambulances were at our house. They checked her vitals and hooked her up to oxygen. She was stable. Because she was stable, we had options. We were able to make the 30 minute trip into Dallas to Medical City as opposed to a smaller community hospital on the east side of Dallas.

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When we arrived at Medical City, they took Eilidh and began running tests. They also wanted to get lines into her umbilical stump and that required a bit of work that Craig and I could not be right with her for. During this procedure, her breathing became unstable and she was intubated.

Preliminary labs came back and her glucose was 1. While this was very shocking to everyone, the not breathing factor outweighed her measly glucose numbers and the attending that night had probably never dealt with a kiddo quite like Eilidh. Hindsight, right?

Over the next several days she was intubated, not intubated, on scheduled IV feeds, on continuous feeds, testing this and testing that. Inborn Error of Metabolism was thrown around. I had to Google that. Sheesh!

Test after test and still nothing. Her acid levels were high, but she was breathing over the vent and brain activity and echo were all normal. The MRI and EEG were both normal. Newborn screening blood test was also normal. Glucose levels were still wonky at times, but nothing like on admission.

On day 5, additional blood testing showed low thyroid enzymes. They started her on syntroid immediately and said this could be the cause for all of the issues. Later in that same day, the IVs in her arms were infiltrated.

The neonatologist on the day shift thought this would be a good time to try to come off of continuous IV feeds since despite their efforts they were not able to immediately replace those IVs. The plan was to check glucose every three hours before starting a new feed.

Just before I was getting ready to go home for the night, the nurse checked her glucose and it was 48. The neonatologist was on point. He immediately started barking orders at the nurse to draw labs for glucose, cortisol, insulin, and growth hormone. He assured me that they would keep her glucose up via NG tube through the night and if that became problematic, they would do a surgical line for an IV.

He told me that he thought she may have a central hormone issue. They would get the necessary labs and we could consult with endocrine the next day. He affirmed that the hormone issue would be manageable but lifelong. On that note, I went home terrified and hopeful with nothing concrete to Google. Day 6. The blood work showed deficits in cortisol at 0 and Thyroid Stimulating Hormone (TSH) was 4. The endocrinologist came and gave me a down and dirty endocrine anatomy and physiology lesson explaining that this tiny little Master Gland was causing all of our issues. Eilidh’s official diagnosis was congenital Panhypopituitarism. Say WHAT?

Panhypopituitarism (PHP), for Eilidh, includes growth hormone deficiency, hypothyroidism, and adrenal insufficiency. An ophthalmologist was also brought in to determine if her optic nerves were properly formed and if she had any vision impairments, which can be a part of PHP. Thankfully, she passed that test with flying colors. We spent another 21 days in the NICU. It took her several more days to catch on to feeding orally. On October 11th, we went home.

Managing Rare Diseases

Eilidh was the happiest baby you could ever meet. As she grew, however, there were several bumps in the road. She would have 3-4 episodes a week of being awake for 4 hours in the middle of the night. This continued until she was almost 3. She didn’t begin walking until she was 23 months old. She has low muscle tone around and in her mouth and in her core.

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When she was 2, she began having severe vomiting episodes. We were hospitalized several times for this. Test after test by allergy and gastroenterologists came up empty.

Her steroids were increased due to the almost daily vomiting and she began to gain excess weight. Her doctors were concerned about the weight gain and put her on a strict low carb 800 calorie/day diet. We cut all processed carbs. Within 2 days, she lost 2 inches around her waist and the gagging and vomiting stopped. We were told that she must be unable to process something that is in processed carbohydrates. It could be baking soda or baking powder or an unnamed ingredient that is added. Whatever it is, as long as she doesn’t get any processed carbs, she’s good.

Eilidh’s speech is delayed and she has cognitive delays. She tested around the level of a 2.5-3 year old at 5 years. She has fine and gross motor delays and benefits greatly from the help of a private Occupational Therapist, a Speech Therapist, and now a Physical Therapist.

For the past 3 year, she attended our local elementary school for 4 hours a day/5 days a week for Preschool Program for Children with Disabilities (PPCD.) She gets speech therapy there and occupational therapy.

This fall (2016), she will start Kindergarten in a special education classroom. We are so excited for this new adventure and Lady gets to go with her! In February of 2014, Eilidh had her first seizure. She was diagnosed with epilepsy after an EEG and continues to take antiepileptic medications in addition to her hormone replacements.

At this time, the epilepsy has not affected her Panhypopituitarism. For the most part, her epilepsy has been well controlled with seizure meds. We monitor her closely. We use a Sami Alert Camera at night that alarms when there is movement that lasts over a set amount of time. This has provided significant relief in night time stress for Craig and I.

Helpful Resources

We began fundraising to get a service dog for Eilidh (www.aservicedogforeilidh.com) in 2014. We just brought Lady home in July 2016 from All Purpose Canines. She is trained to detect low glucose levels (a symptom of Adrenal Insufficiency) and provides companionship for Eilidh during high stress times and seizures.

We are so grateful to the Magic Foundation for providing a support system for parents with of children with Panhypopituitarism. Eilidh was about 6 months old when I came across the Facebook group and joined a family of parents, of whom many have become lifelong friends. Eilidh continues to keep us on our toes and requires constant out of the box thinking. She is a bright light in our lives and brings joy to anyone she meets.

I used to joke that while pregnant, I had prayed and prayed for a baby with blue eyes. When she was born with blue eyes and no pituitary gland, I quickly offered to take another color eyes just to have that functioning pituitary. Her eyes are now green and hazel and we still don’t have a pituitary gland, but we’ve gained so much more in the lives and loves that we have encountered over the course of this journey with our girl. While we may not know what the future holds for Eilidh, we know that it will all work out for the good.

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#Wear4Rare365 Campaign Launching on Rare Disease Day, February 28, 2017

In case you missed it, The Mighty ran the CLF post on the need for an emergency treatment database for rare and chronically ill patients. We’ve seen some amazing traction from this post in the last few weeks and we’re thrilled with the number of organizations that have signed up for an awareness day.

If you haven’t already, please share information about our campaign with other patient groups you may be working with. Thank you!

The CLF is Pursuing a National Emergency Treatment Database for 30 million Americans

With over 30 million Americans living with a rare disease, it’s natural to wonder what Emergency Medical Services (EMS) look like for the 10% of the population affected.

For patients like Leonora, it doesn’t look good. A lack of consistent EMS education and coverage for her condition, Secondary Adrenal Insufficiency, means that in a medical crisis, trained EMS professionals might be unable to administer the life-saving medications she needs to survive a medical crisis. A vial of Solucortef costs approximately $8-$10 with a 5 year shelf life and the medical is easy to inject.

Sadly, Adrenal Insufficient patients are not the only rare disease population to need specific emergency treatment protocols. While rare disease patients can take all of the necessary steps to identify themselves for emergency medical treatment – like wearing medic alert bracelets, flagging their file with local EMS/hospitals, carrying medications, and identifying their vehicles – a lack of continuity in recognizing and enforcing these protocols means that rare disease patients are often prisoners in their own counties.

An opt-in National Emergency Treatment Database for Rare Disease Patients would prevent unnecessary medical delays and treatment errors while providing patients with national coverage of their protocols, regardless of where they travel.

Join the Cambria Lord Foundation as we kick-off our #Wear4Rare365 campaign to raise awareness for the rare disease community and the need for a National Emergency Treatment Database.