A Long Overdue Update

This has been the first update on Paul that we have given since his fourth surgery done in October 2013. He is potty trained, talking in sentences, and has been thriving to learn and enjoy his siblings! His name for mostly everyone is "Little Turd" haha.

Pauly was seizure free for two years. In November 2015 my mother and my grandmother noticed his eyes deviate to the right and stay for a while. They asked him what was wrong and he giggled and said "Nothing". They then thought that this was nothing. It was fairly subtle. This happened several times and my family and I continued to pass it off as nothing. I didn't want to believe that this could possibly be seizures. A few weeks later Paul began having these episodes once a day. They progressively got stronger where his head and eyes jerk to the right along with his arm---they even began causing him to fall. Now we are having up to five clusters of these a day lasting up to 13 minutes. The minimum we have caught in a day has been two. His right eye is becoming a nagging problem for him---and he lets us know about it (not fully sure why it is just his right eye---we have never dealt with the seizures bothering them). About five minutes after a seizure he will say while pointing at his eye "Now I can see things again". He has gotten weaker on his left side as well and during his seizures almost all mobility is gone on his left side. The weakness has definitely caused some frustration with his mobility and lots of extra scrapes.

We absolutely hate seeing that fogged over look in his eyes again...a look that we all tried to forget and hoped we wouldn't see again. We worry about regression and night time seizures. He has one that we know of around the middle of the night so we stay up and wait for it. His siblings have readjusted, once again, to looking for his seizures and making sure he sits down with them so he doesn't fall and hurt himself. ...even his two year old little sister sits with him and asks if he is done with his seizure. We are a very emotional house right now waiting----impatiently----to see which hospital can see Pauly the soonest and hopefully remove the dysplastic areas of brain so he can enjoy his life without all of these seizures.

We will be updating more often as things get along with Paul. We will also try our best to keep up with his overall development in the future in hopes of helping other families!

Into the Hundreds!!!

So we are well over 100 days seizure free now (123 or so days) which BY FAR stumps all of our previous records. We have had a few hiccups along the way. We have been hospitalized once to find that his EEG isn't exactly clean BUT we have seen no signs of the extreme debilitating seizures he had been experiencing. Does this mean he is in the clear for no future surgeries? No, but for now we are going to soak up this valuable time and enjoy it! He is now down to only TWO medications! Yes, that's right two! He takes clonazepam and trileptil two times a day and melatonin at night to help him sleep. Keppra and Topomax seemed to really be hurting him with speech and cognition since without them he has made strides...granted that could also just be lack of constant beating seizures also! Amazing, we go from once taking 32 pills a day and being on the keto diet, to now only being on two meds only twice a day! 

Right now our biggest battle is dealing with PJ's motor/movement problems. An area where Parkinson's disease is found has been damaged/removed causing some "Parkinson's like" symptoms. They are not extremely drastic but they are definitely there. This is causing his speech A LOT of problems. We continue to work with him but the progress is very slow. He is extremely determined and very eager to receive help and to try which makes me so very proud but can be very heart wrenching to watch. He is very outgoing, which is wonderful and totally new for him, but brings on another obstical --communication beyond the word "Hi". He will initiate a conversation and then quickly will get lost and really knows no other understandable word after that but "yeah".  As far as the speech world goes, We are also tackling global apraxia, dysarthria, auditory processing, and possible auditory neuropathy. All of which can make speech very difficult....as of right now we are trying to tackle the apraxia portion of it all. Progress is slowwww and steady but as long as he continues trying and pushing forward then we will keep pushing with him.

Cognitively there is no comparing the PJ now from the PJ back in October. He is sharp as a tack!! He knows exactly who his brother and sister is. He knows a couple of shapes, he is TRYING to understand colors, he knows how to count to five (not really understandable past three BUT he gets the concept), he understands turn taking during games, he knows around six or seven animal sounds...he also knows what is his favorite shows; Doc MCstuffins, Mickey Mouse, Sophia, and Jake and the Neverland Pirates. He even tries to say their names when the shows come on and tries very hard to sing the songs. I am utterly amazed by how smart he is even with missing over two years, almost three years actually, of development. 

As far as PT goes we do a TON of work at home. Stretching, obstacle courses, running, jumping, dancing, ect...ANYTHING to get that left side stronger and keeping the muscles loose. He uses a night splint every night but during the day we are now not using his orthotic hardly at all. He can jump four times in a row now and is back to running pretty well. He still can not ride a bike yet...he doesn't quite have the strength in his hip to complete the peddle motion. He tires out very quickly also...if he is walking for long distances ongoing without stopping he will start tripping and ask for help. Overall though he is doing remarkable in the physical aspect of it all. We are very lucky he has his brother and sister....those two make him move and encourage him to keep up. 

On the OT side of things he still has a considerable amount of left sided neglect. He can use that side with less accuracy but it is still functional...granted it has taken a lot of work for us to get him to do as well as he has. Constant nagging (us saying both hands or where is lefty?), partial constraint therapy while playing at home, stick on tattoos on that side of his body, massage, among other things happens basically daily at our house...even his brother and sister get in on the nagging haha! We did receive a spio suite which does seem to help with his body awareness on that side. He has compinsated well in terms of vision...there are still obvious deficits but he doesn't have near as many bumps as he once did. 

He throws fits like any other typical three year old now. Not fun but I'm glad to have something normal and totally expected and age appropriate out of him. It's so hard not to laugh at him sometimes when he gets opinionated and headstrong about doing something. We try really hard to keep the rules the same for all of them as far as punishments go but I still really struggle with it..I'm getting better about it now but I still find it hard sometimes to punish him when I am just so happy he is able to do the things he is doing. 

The hardest thing for us to deal with right now is PJ's new found love for sports. This kid will watch a whole football or basketball game with full on amazement and enthusiasm. Not only will he watch it but he will run to his room, get a ball (whichever sport is on is the ball he will get) and start copying the guys on the TV. My hope is that we will continue to work really hard with him and one day he will get to play. I don't doubt at all that with as much determination as this kid has that one day he will find a way to do whatever he wants. I swear by looking at him you would never ever know the trials this little guy has been through. I have some pictures I have taken over the last couple of months! Sister, as you can tell, doesn't get in the pictures much HaHa! She is just as stubborn as PJ! :) 

Month and a Half Post Fourth Surgery!

Life has been really nice these past couple of months without seizures. PJ is making huge strides cognitively, it's amazing! His memory was so bad prior to this surgery and now he knows what a cat, dog, lion, and pig say. All correctly...not only is that an awesome accomplishment in general for him buuut it's super awesome for a kiddo with global apraxia! His receptive language has sky rocketed as well, he is right in the middle of the normal range for his age....again amazing. His speech is still not there yet but we are working through that. He can make sounds and say a few words but those words have been programmed in to be used all the time. We are hopeful that now knowing he has apraxia and dysarthria we will be able to get him up to speed by approaching him correctly in ways that will help him develope speech. Right now prompt is a huge part of speech therapy.  He is off of his Topomax now, we are very relieved to be down to three seizure meds....THREE never in two years has he been down to only three. Without need for emergency drugs,Very happy parents over here!! We are having a hearing test scheduled here soon to make sure his hearing is good, just in case. Hopefully it's great and that'll be one less hill to climb for PJ. Although there is a concern that he may have some high frequency hearing loss. We will worry about that when and if there is a need too after his hearing test.

His Hemiplegia has caused him to be, what I like to describe, jellyfish like. He is very sloppy in his movements but we are working on getting that a bit better. His leg, arm, and hand are doing as good as they can. His leg is in worse shape then anything else. He can get around but trips a lot without his brace on. He actually likes wearing his brace...I think it is because he knows it helps him quite a bit. He still walks "sloppy" with it on because of the weakness in his knee and his hip. We are just thankful he is moving on his own :).   His arm gets postured sometimes, bends it at his elbow and cradles it some, but he still uses it when he has to....sometimes without being prompted. His hand is working marvelously. I don't see much of an issue with it although we haven't "compared" it to the other too much and haven't "pushed" it to do tedious tasks. His lack of support though is thought to be contributing to his apraxia so we have to keep trying to strengthen him up! There are plans on getting him into a physiatrist to see if medication may help reduce the tone in his shoulder and arm.

We aren't sure what PJ sees at this point. It's obvious he has left sided peripheral loss in his eyes but to what degree is unknown. He has to turn excessively to really see what's going on towards the left causing his posture to get crazy! Most the time, at home, I can't tell there is even vision loss.  Therapists though have found it to be causing him some subtle problems. We will be seeing a developmental pediatric ophthalmologist soon though...hopefully!

Emotionally PJ is becoming a bit of a wreck and very unpredictable. He can be set off so easily and sometimes there seems to be no reason for it at all. He will throw himself down, kick, scream, hit, and is completely unconsolable. He wants me to hold him but doesn't at the same time. It can be pretty chaotic!  We have found that he has SPD (sensory processing disorder) which may be a huge cause to the fits. What is hard is he goes from being an extreme sensory seeker to shutting down and needing very very little stimulation. It varies from day to day. On top of that I'm sure it is extremely frustrating having things to say and not knowing how to say it.

Trick or treating went soooo well for him this year. Finally the kiddo was able to enjoy it and really seemed to finally understand what was going on. I loved seeing how happy he was!! I'm even more happy to see him this thanksgiving and Christmas eating all that good food without limitations from that awful ketogenic diet!! :)

Hopefully there will be no more seizures and no more surgeries for him. He really seems to be making such great improvements!  Now to find time to add some pictures in here!! 

Surgery Four Complete..With Some Minor Tweaking

We have had so much stuff go in every different direction it's been chaos! PJ had his fourth surgery last Thursday. It was delayed due to them squeezing in an MRI to see if they could visibly see the malformation. In the areas that were left there was deeper tissue still left behind that his surgeon wanted to try and see if, hopefully, it would stop the seizures without having to resort to the full hemi. We were very very leery of this as a fifth surgery just made our stomachs turn BUT we do truly trust his group of doctors and agreed it would be worth a shot. The surgery went very well and for once no blood transfusion was needed. He has more deficits now, which we expected and honestly they are not too bad at all in the grand scheme of things. PJ has some issues with his left arm and hand. He has a little tone throughout it and has caused some motor planning issues along with some left side neglect...all of which we should see some improvement on. He has some left side peripheral vision loss and possibly some visual neglect.  He has already began compinsating for the visual changes and doesn't seem to mind too much. His left foot has more tone in it and we are looking at possibly getting a night time splint and a better fitted brace for extra support. Another change is PJ has started the thickened liquids diet...he was having a lot of problems tolerating regular drinks and fought us every time we offered it to him. Well come to find out he needed thinkened liquids, now he is a much happier boy. Oh the drool this boy can put out now with the weakness on his left side being more predominate...it is rediculous and he is hilarious with his sneaky ways of trying to wipe it (usually on my clothes when he conveniently buries his head with a hug). Good news, so far, no seizures....and trust me, I watch for them! More good news, PJ is officially a make a wish kid they accepted him about a month ago and we met his sponsors...who were so very sweet!! Overall I think he is a very blessed kiddo and we are even more blessed to get to say we are the parents of this strong willed little guy! Hopefully more good news posts to come. :-) 

Round Four??

I feel like so much has happened since our previous blog entry that I don't feel like it is possible to even put it all into words. We had an overnight EEG that turned into a two night EEG. The results were not easy to read for his doctor with healing and things going on but PJ is having subclinical seizures as well as his other episodes. It is all right sided and isn't spreading to the left which is really good to know. Unfortunately the area that is showing as dysplastic is an area that will impair both his vision and his motor if removed. We are still weaning off of Topomax currently and maybe keppra but it is too dangerous, at this point, to take his clonazepam away.  He has been on it for nearly two years twice a day and taking it away could trigger seizures not related to his condition just purely from the withdraw. His trileptil is slowly on the rise though in hopes, that eventually, it will be his only medication. We talked to his neurosurgeon last week and he feels that the next step is a hemispherectomy for PJ. Our latest date for surgery is October 3 but he is amazing and said that if he can he will do it sooner. I am going through a lot of conflicting emotions regarding this decision, although I know it needs to be done.  I always have said "I'm not worried, I just want him seizure free." Deep down though I feel horribly sickened that we will have a new set of difficulties for PJ to overcome and suddenly all of this has become very very real to me. I am kind of feeling it is a lose lose situation but when thinking of what I would want I would pick better cognition and communication with no or drastically reduced seizures and impaired mobility over good physical mobility with multiple seizures and very impaired cognition and communication. Making the decision for my child though is nothing short of heartbreaking. Of course I am a worrier so I also can't help but worry about the left hemisphere which has always been perfect on tests but that "what if.." Always creeps up on me and gets me wondering if that other side is as good as the tests have shown. Ugh. My husband is so relaxed and together and keeps reminding me that just because PJ has a good day doesn't mean it's gone, and he is right. We were told numerous times that once this type of dysplasia becomes active it doesn't stop...we have always found this to be true even on good days he was having subclinicals and even more unnerving seizures not even readable through the EEGs. It's just tough and has proved to not get any easier on any of us. All we can hope and pray for is a successful surgery with no complications, that he does become seizure free, and that he has a speedy recovery.

Pushing Forward

After speaking with Paul's doctor we are beginning to wean him off of all but, hopefully, one medication. We have upped his trileptil and significantly lowered his Topomax all the others are staying the same for now. We did find out he is having up to 8 seizures a day. All the extreme fits I have seen of him crying in pain that I thought could be pressure is in fact seizures from the motor/sensory area. They are wanting to do an overnight EEG but want to try to get him on one medication first but if things get really out of control we will go in sooner. Along with his fits from his seizures triggering pain he is having tonic clonic appearing seizures every other day (except for this weekend he had one every day). Not sure what the next step is but at this point the medication has made absolutely zero difference. What is most frustrating is knowing there is something causing this yet we still try to medicate the issue...I know we have to try but we know it isn't the answer as it has never previously worked so why in the world would it now?

We also put in to see if PJ could get a wish through the Make a Wish Foundation. All his life at this point has been seizures, tests, medication, surgeries, therapies, and doctors....I would really love to have him have something done for him that is full of fun and far from all the things he has become accustomed to. He needs some fun times with his siblings!

Spoke Too Soon...

PJ is back to 0 with his awesome record. Had a seizure during nap time. :(

Five Weeks Seizure Free!

We are coming up on a new record!! Post op with his first surgery he went six weeks seizure free so we are almost there. It has been a very nice break for all of us in this household! We did go in a week ago for some concerns regarding hydrocephalus (extra fluid on his brain). They did a haste MRI which is done just as the name says...hastily.  He was swaddled and the MRI took a quick two minutes tops. The results came back with him having extra fluid but not enough to cause concern right now. We go in again here soon for another haste MRI to check on the fluid.  Most importantly what we discovered from that trip from Dr.Oxford (an AMAZING neurosurgery resident) that we were totally informed incorrectly about PJ's EEG. It was, in fact, abnormal but only from the all the empty areas which should be abnormal. He said in the thirty minute read there wasn't anything that seemed seizure related!! Big, HUGE, relief!! So for now, he is good to go! :-D

He also gets his orthotic this coming week to help his left foot. He is a little tight still on that side and is turning his foot in again until it has been worked out...then it straightens out but then the muscles are exhausted and he can't clear his toes from the ground with every step so he is accident prone right now. He is very very smart though and has already learned to compensate for his left "apraxic" side...it really looks to be causing him minimal difficulties, from what we see anyway.

In the speech world PJ has made improvements. He is making tons more sounds. He has "words" but not all are exactly correct words for things.  He can make most single sounds (a,b,d,e,h,I,m,n,o,p,s,t,w, and y) he struggles with a couple of them but can do them. Putting two sounds together is very very tough for him right now. He has a handful of words that are more complex but getting him to say new things is like pulling teeth. We have started using Talk Tablet and it seems to help...he repeats whatever button he pushes (as best as he can) and with every repetition he does sound a bit better.  It has also helped us test his cognition by asking him to find a certain picture...best App we could have gotten (Thanks Mom and Dad!!!).

Overall, we couldn't have asked for a better outcome for PJ with everything he has been through. Next hurdle is keeping an eye on his fluid and seeing how his body responds to it...hoping it will start regulating it.

EEG Spot Check Results

We got the results from PJ's spot check EEG and in the 30 ish minutes of recording he had no seizures that they could see. It unfortunately still showed abnormal on the right side.  It also showed signs of some swelling which doesn't come as such a shock to us with the surgery being done about three weeks ago.  We were told that it had improved...I had to chuckle with that being said as nearly all that side was removed so it better had improved! We have an MRI and an appointment with his neurosurgeon in a month and in the meantime we will watch and wait for seizures since with it reading abnormal we are thinking that it is most likely due to more dysplastic brain---at least until we are told otherwise anyway. I was really hoping to have them begin lowering meds but with his EEG not being clean I am not thinking that they will...who knows what will be said next month though..got to try and be a little optimistic!! :)

Two Week Post Surgery Neurosurgery Check Up

PJ had his two week check up today and his wound looks great, no concerns there. There are some concerns however with his twitches happening throughout the night more frequently, predominately on the left side from facial twitches all the way down to his toes. His right leg is now also showing random bouts of extra tone causing him to trip which is odd.  He is getting an AFO soon, for now as he heals, for his left leg and we were told that it looks as though,now, he may need one on both legs as his usage of both of his ankles seem pretty unpredictable (left more then right). He is being scheduled for an EEG to see if his motor strip is acting up any and perhaps causing some of these issues (twitching and right ankle tone).  He is also complaining of his head hurting towards the back and is unconsolable at times and these episodes stop abruptly.  They are not too concerned about this right now though as it could be a result of the recent surgery and could happen up to a month after surgery.  Even still though if his occipital (visual) lobe was/is acting up an EEG would (hopefully) pick up the abnormal waves. We are hoping his reading comes back clean but also know that if it doesn't its okay because we know there are other options to get PJ to lead a more normal life.  Blah, tests. They are so great for getting answers but such a pain for a two year old.

PJ and his "sissy" holding hands while he sleeps :)

Home 40 Hours After Surgery

The surgeon made his rounds yesterday morning and was so impressed by PJ's accomplishments that he released us home. It is so shocking the small amount of deficit he has physically compared to the large amount of improvements we already notice in other areas....now, like last time, we know to keep a close eye on things since he showed tons of signs last time that he was still seizing.  For having nearly all his right side removed he is just blowing us away!

Physically what we have noticed: He walks with a bit of a lean to the left and has still been consistently dragging his toes on his left foot. We are working hard at getting him to use his left hand but at this point he is doing a great job of forgetting about it being there. When he uses it he is able to pinch at things but it seems considerably weaker then his right hand. But we are only two day out of surgery so we know things could get a little better quickly as he heals.

Positive things we have seen: PJ is not flushing so far and his twitching during his sleep is very minimal. He has already started saying the few words he spoke before surgery and his response time has been very quick when answering "uh huh" (or nodding) or "uh uh" (or shaking his head). He is also saying thank you (more humming it then pronouncing it, but he does it consistently when somebody does something for him or we tell him to say thank you).  He has started more "baby babbles" which is a good sign of him trying to communicate more. He is also back to using two words together. We are hoping since he is doing this so soon after surgery that soon or at least eventually he might start spitting out some more words!

It is so amazing the amount of trauma a child can go through and still pull through without skipping a beat.

 This kid is our miracle.

The Day After

PJ is doing remarkably well. His surgeon came by to check on him and told us that by looking at the post op scans it doesn't look like PJ should be using his arm and leg yet he was moving around all four limbs.  Today Paul took things even further and WALKED! He is dragging his toes pretty bad but is still walking unassisted. His grip has improved a bit but is still weak with his left hand. His surgeon is not worried about the seizure PJ had since the motor strip left had quite a bit of trauma during the surgery, he seemed to kind of expect it. This does not mean we stop being on our toes....we know now that only time will tell us if this surgery did the trick or not. On another great note, he hasn't thrown up at all, which makes us happy and he is eating and drinking well. Now we wait for him to poo. We are so amazed at how well he is doing :)

Surgery Three Completed

PJ came out of surgery today like a trooper! He heard my voice and said "momma up" reaching towards my voice (his eyes were already swollen shut). They wrapped his head this time around which is kinda nice also. Sadly PJ had a seizure about two-three hours after surgery. It showed all the signs of PJ's old seizures minus the staring spell before it. The areas he has remaining on that side is his motor area and his occipital lobe.  He did get as close as he could though to his motor as he could without totally wiping him out. Unfortunately we knew that there was a decently high possibility of  more surgeries but will wait in high hopes of seeing nothing more---but also totally accepting the possibility of needing another.  we were told during this surgery once they got through to the insula(r) lobe that it appeared to be the most obviously malformed. It was all scar tissue from "burning itself out"-- it was also constantly firing off deep in there.  They also let us know finding dysplasia there like they did was very rare. Good news is PJ didn't stroke from what they could see on his scan after surgery but the vessels supplying blood to the motor area were, from how I understood it, pulled away from abnormal tissue so we are hoping they don't start "spazzing out" on him.  The deficit on his left side currently is more pronounced but we anticipate it getting a little better before we see his new baseline since healing will take a bit of time. Will be updating as PJ comes around more, thank you to all our friends and family for the support and prayers!

Round Three...

Seizures have increased to up to 20 visible episodes a day. Most of them occurring at night and during nap time....Leaving PJ, daddy, and I to be horribly sleep deprived. We have been giving midazolam almost daily and sometime twice a day with little relief. They upped his Topamax drastically to try and slow things down which has worked a little allowing us to give him a break from his midazolam.  Paul's neurosurgeon wanted to see him ASAP last week to discuss another surgery so we met up the day after I called letting them know the severity of things (so thankful they moved so quickly). He let us know upfront that this may take four or five surgeries (depending on whether or not seizures return again) to get the dysplasia as it "acts up" because  he is really wanting to try and spare as much of that right side as he can. The only lobe that will be left alone this time is his occipital lobe (vision) and maybe a part of the periatal lobe depending on whether or not it reads clean once they are in there.  The temporal, part of the periatal, and an area really deep in the brain called the insula lobe has to be remove. The insula lobe puts him in a very high risk for stroke which will essentially cause the same damage to Paul's physical abilities as a full hemispherectomy would cause but there is still that chance that he won't stroke and he will have fewer issues physically and that is what his surgeon is aiming for. We aren't afraid of any of this though because we know he is in very good hands and these seizures must be stopped so he can cognitively and verbally progress. Every day is one day closer to helping PJ. Our other two blessings are taking everything so well. They have sacrificed so very much during all this...makes me happy that they are all so young I think they don't know any different right now and don't have a clue that this isn't normal.

PJ's third surgery is scheduled for this Friday the 5th. Praying hard that my baby comes out of surgery as well as he has in the past. My only fear, with either living with seizures or surgery, is losing my baby. I hope and pray this gives my little PJ some relief from all these seizures.

And We Start Again..

 

It has been a while since I have updated...We had an overnight EEG last week that turned into a two night EEG. Sadly PJ is still seizing from the right side. He had multiple seizures the first night we were recording with one physical episode. They asked us to stay to try and get more information and information they received...PJ had his worst night, with seizures mimicking the ones he use to have before his first surgery.  It was long and stimulation set him into a hard physical seizure. Needless to say, I was a petrified mess. We were told that his seizures are remaining on the right side and, at this point, not spreading to the left. His flushing episodes are seizures and his extreme fits could be seizures or repercussions of a seizures. Right now the big bulk of his seizures are happening at bed time and nap time but abnormal waves remain steady from everywhere remaining except the occipital lobe (or at least from what the EEG reads anyway). Right now there is a possibility that he is seizing more deeply in the remaining right side making it also undetectable on regular EEG like before.  Right now we are at a place where a hemispherectomy is Paul's best shot at living a normal seizure free life....We are very aware that chipping away at that side doesn't seem to be doing the trick and we don't want to put him through more surgeries then necessary and our gut is saying this is PJ's cure. God has a big plan for this sweet little boy. He has taught us so much already and I pray that PJ and all of us can look back at these couple years and smile knowing how far we have come. We should be hearing back from the hospital this week for further appointments and are really hoping that things roll as quickly as they did last time. We are also, possibly, going to be taking away some more medications sometime soon...but we will see how that all turns out.  It just breaks our hearts seeing PJ suffer.