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Tag Archives: absent csp

He’s still working on me

31 Wednesday Jul 2013

Posted by Mama Laughs in pregnant, twins

≈ 12 Comments

Tags

absent csp, acc, dandy walker, no termination, second opinion

(Update as of 27 weeks)

This update will start positive, take a negative dip, then end positively again.  Hang in there.

We went to Columbus today in search of a second opinion from a different Maternal Fetal Medicine (MFM) Specialist.  We were not hoping for better news, or different news.  We were just hoping to find someone who would deliver the news with the intent of educating and empowering us, rather than discussing termination options.  Someone we could partner with going forward.  Because we ARE moving forward.

During the 6 hour appointment, we met with a genetic counselor.  No huge revelations there, but she understood our hesitation in doing an amniocentesis, and agreed we could get that information in a few weeks once the boys have safely arrived.

We then had a two-hour ultrasound where we took a much closer look at the boys’ brains.  She did an awesome job of talking us through what we were seeing, or not seeing.  Here’s where it gets interesting.  Remember that Absent CSP?  Perhaps it was just tardy, but it was there today.  In both babies.  Now…just like its absence wasn’t particularly ominous…its presence isn’t particularly promising.  But nonetheless…it was present today.

Also present today?  Signs of the corpus callosum.  We were previously told that the corpus callosum wasn’t there (also known as complete agenesis of the corpus callosum / ACC.)  Today…at least a partial presence was detected.  So we may still be dealing with an incomplete corpus callosum…but we are thrilled that there are at least SOME pathways present, even if they are incomplete or malformed.

Remember that gap in the cerebellum?  Well, it’s still there.  But when the previous doctor used a scrap piece of paper to explain it to us he made it appear as if there were two spheres that weren’t touching.  That missing connection, known as the vermis, IS partially there after all.  The top part in particular has some connectivity, although the gap was still clearly identified in both boys toward the bottom of their cerebellum.

I’ll let all that soak in.

In all three brain malformations…we received better news today than we did last time.

You can decide whether we were just led to a more prepared ultrasound tech, or if God is still at work in these little brains.  But either way…the news was slightly different this time, and there ARE communication pathways in the brain where we previously feared there were none.  In terms of potential that feels HUGE.

Now…all that said, (and that is a LOT)…the diagnosis didn’t change.  We are still looking at Dandy Walker Malformation.  And in the end, the expectation of some form of handicap or delay is still there with no real way to predict severity.  Fatality seems highly unlikely to this doctor, which is fantastic.  But she still fears some level of mental retardation to an unknown extent.  So while we’re in the same place we were, with a lot of unknowns, it feels more hopeful.

Overall, we were very pleased with this staff.  Before we had a chance to bring it up, they discussed partnering with the pediatric neuro team, and how important early intervention would be.  That’s a far cry from “there’s not much I can do for you now” or “I’m sorry the news isn’t better” which was the message last Tuesday.  We appreciate their interest in looking forward and upward, and have decided to shift our comprehensive care there going forward.

In other news, L is 25% bigger than N.  And there was a bit of a jump in that gap since last week.  I will return to this doctor in two weeks, and if that gap is the same, or larger, they will keep me overnight for observation and consider intervention.

In other other news, 36 weeks will be the max they will allow us to go.  However, given the increased amniotic fluids in both sacs, I am likely to go in to labor earlier.  She said not to worry about bed rest at this time.  In fact she preferred I stay active, mentally busy, and hydrated.  Just…not to overdo it.

Shew!  What an update!

The overall message from today’s update is…God is at work here.  And we can feel it.  When I pictured their little brains still fighting to form some of these missing parts or to make their presence known, an old song from early Sunday School days started to roll through my head…”He’s still working on me…”   If this God can make the moon and the stars in a week, just imagine what he can do in a couple of tiny brains in a couple of months.

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Why Am I Telling You This?

28 Sunday Jul 2013

Posted by Mama Laughs in pregnant, twins

≈ 5 Comments

Tags

absent csp, acc, dandy walker

There are a number of reasons.

1) Writing helps me cope.  So maybe that’s a selfish one, but it’s a reason nonetheless.

2) I feel led to.  I can’t explain that one further, it’s just true.

3) I picture another family somewhere out there getting similar news and having the same trouble we did finding information, finding someone who understood.  Finding a story of hope.  And I hope that if they land here, they will know they are not alone.

4) It’s easier to appreciate the height of a mountain when you have experienced the depth of a valley.  We are experiencing the valley, and will treasure any climb upward we can get.  I want those who care about L and N to understand their valley as well, so that we can fully rejoice on the hills and mountain tops together.

I realize many of you are interested in less detail.  Maybe you would prefer we left some of the sadder more ominous parts out and focused on the good news.  It’s easier to read about a nursery update, or see a belly pic than to hear technical terms, survival rates, or medical updates.

But then I wouldn’t be telling the whole story.  And the way I see it…God is the author of this story, I’m just the one telling it.

The scariest part about telling you a story I’m not writing is…I don’t know how this ends.  Even worse…I’m not sure what this story is about.  I hope it is about a miracle.  I hope it is about the strength of two young boys who science had counted out.  Maybe it is about a mom and dad who were warned of the worst but hoped for the best.  Maybe it is about the strength of prayer, or the importance of love and support in the face adversity.  And in that way, each of you are part of this story as well.

So while the ending is unknown, and the plot line isn’t clear to me.  This chapter is about hope and faith.   And we thank you for reading it along with us.

The Technical Overview

26 Friday Jul 2013

Posted by Mama Laughs in pregnant, twins

≈ 2 Comments

Tags

absent csp, acc, dandy walker

I’ve been a little vague so far about the boys’ condition.  That is for a number of reasons.  We aren’t even sure what their condition is.  If it is what we think it is, we don’t understand the severity yet.  And with the limited time we’ve spent researching and talking to doctors, I don’t feel equipped to provide educated answers.  So bear in mind this is just our best assessment at the current time.  I will correct and update as we learn more.

But I want you to hear what we are hearing.

So…here’s the technical side of what we are looking at:

At the follow up ultrasound with the specialist, we uncovered these anomalies:

-Absent Cavum Septum Pellicidum (Absent CSP)

In isolation, this does not have to be a huge issue in and of itself, but is often a marker that some other brain malformation exists.

-Agenesis of the Corpus Callosum (often called ACC)

The CC divides the brain in to hemispheres, and helps each side communicate with the other.  It transfers motor, sensory, and cognitive information between the brain hemispheres. It is also involved in eye movement, and maintaining attention.

-A gap in the Cerebellum (often referred to as Dandy Walker Malformation)

The largest role of the cerebellum appears to be motor related.  Although it may also play a role in some cognitive functions (attention and language)

In addition, their amniotic fluid levels are “too high”.  I don’t have a number for that, and that can be an indicator of a number of things, but ours is likely due to the brain issues.

The most likely diagnosis seems to be Dandy Walker.  I don’t know whether we should call it the full blown syndrome or not.  I think in order to be diagnosed with the syndrome, a given number from a certain list of other things must be present.   Some of those “others” we know for a fact our boys do not suffer from, and for others it is too soon to tell.

The overwhelming thing about Dandy Walker is the wide range of severity.  On the mild side, you might not even realize someone has it.  Perhaps they missed a few milestones early on, but they eventually met them.  Perhaps they’ve had a learning disability, but they are high functioning enough that you didn’t realize how hard they were working at it.  On the serious side, the brain might have such low function that the communication to the organs isn’t even keeping up, or the brain continually fills with fluid and requires draining to sustain life.  And sometimes…life just isn’t sustainable.

We are quietly being led to believe that the facts aren’t lining up for us to be on the mild side.  The boys’ ACC appears to be completely missing, as opposed to partially missing.   And since they both have it, we are dealing with a rare chromosomal fluke that was set in motion the second the sperm and egg met, not some malformation that occurred in utero.  We keep reading of success stories.  Those success stories are not without challenges and road blocks.  But there are people out there with the DW diagnosis who are walking, talking, laughing, loving, and living amongst us.   And like us, many of them weren’t given any hope early on either.

Next steps include looking at the blood work (mostly to rule out other things, like Downs or similar trisomies).  We have an MRI on Tuesday, where we will get a better look at the boys’ brains.  What other issues exist?  Did the ultrasound potentially miss things that ARE present after all?  Etc.

We are also meeting with another MFM specialist in Columbus soon and we plan to get in contact with a pediatric neurologist as well.

We are going to talk with someone from our pastoral staff.

In the meantime, we’ve decided to be as open and as honest as we can be.  This is not a burden we can bear alone.  The next few weeks will be long as we wait to meet these precious boys, but our hope is that if we reach far and wide, everyone who hears of L and N will speak to God on their behalf, and ask for a miracle.

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