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Running 31 Days in October

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Mick sits one desk across from Mikaere’s Grandad, and today marks the end of the unbelievable challenge he’s set himself. Mick ran every single day in October, on every single one of those 31 days. And he did it for #teamMikaere and NKH Research.

There’s something incredibly powerful about someone running for our son. Knowing Mick has been out every day, convincing himself out in all weathers for us – you guys. There is something so supportive, so genuinely heartfelt when your day to day is encouraging others to do hard, challenging things, to keep on keeping on.  From a recent post, he said “While getting out and doing this every day has been a challenge, it’s been great to have such variety – and of course when we think about why I’m doing it, the challenge I’ve given myself is nothing compared to the challenges others are forced to face every day. Hats off to #teamMikaere.”

The acknowledgement of our day to day, the support and the act – not just words or platitudes, but the physicality of running every day, committing to it, following through and fundraising an amazing amount – that has made a huge difference to how connected we feel. We feel seen. We feel heard. We feel like we’re not alone. We’re here with Kaikai, and we know that without fail, every day this month Mick has been out running for us. What a guy. Plus today, on his last run, he ran in fancy dress (!)

Mick has raised over £2k for NKH Research – a phenomenal amount of money. It works out to over £70 per run (blows your mind a bit, doesn’t it?)

I know we ask, repeatedly, over and over. But if ever there was a fundraiser to donate to, please donate to this one: justigiving.com/mick-holton

Thank you Mick. What an amazing month, what an amazing effort. We are genuinely appreciative of your support, and are glad you’re on #teamMikaere.

On being in the A&E

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Mikaere’s had the once over by several people. His nurses have taken bloods, he’s had a nebuliser and is on o2. His gas and air look good (his lactates especially), his temp is holding steady and we had a visit from a PICU Nurse we know who came in to say hey.

So no red giant flags, and I have a chance between consultants to go get breakfast.

And as I’m walking down the familiar halls to M&S I think Saturdays are the best days to be here. There are less people in the hospital today. We had the bonus of coming in early, just after the shift change but before all the other kids had enough time to hurt themselves and fill up the a&e waiting room.

Is it weird that I think all this? That I know the time shift change happens? That I know when the lulls and peaks of our a&e are? That I come armed with a cheat sheet that answers 99% of the nurses/drs questions, and the two questions I’m asked (what is blood test for glycine on the system as – amino acid blood profile – and what colour is the bottle – green) – I can answer without really thinking about.

Our last a&e visit was months ago. MONTHS ago. I guess this is the winter season kicking off, right after a week of appointments and therapies after the summer break. I’m not happy we’re here, but now that we are I’m not panicking about it, too much. I’m hopefully we’ll make it home this afternoon sometime.

—-

A few hours later and I’m worried. We’re still in the A&E majors, Mikaere’s still on o2 and sleeping, but he’s not holding his o2 levels above 92%. We need 94% or higher. We up the rate to 1L. That’s the borderline dose. It’s not a super high dose of o2… but any higher and we’re staying over.

The nurse notes say they’ve booked a bed upstairs on the ward (just in case) and I’m positive that if this was any other kid, or if I hadn’t expressed my concerns about the risks of being on the ward we’d be up there already for observation rather than down here. But down here is safer. Down here the A&E majors is filled with broken bones and a girl with ENT drama. There are no other chest infections or mystery illnesses in our room. The ward I know is probably filled with more things that pose a risk.

So we wait, we see. The idea is that the longer on o2 he is the easier it’ll be for him. His body won’t have to work so hard, he’ll have more in the tank for recovery. Or so we hope.

I’m worried though. I don’t want to go up to the ward. That’s the start of the path towards deterioration and I’m scared that each escalation will mean a step toward terminal.

But we’re not there yet. We’re not. We’re just in A&E still, just in observation. We’ll see.

—-

The bloods are back. The chest xray clear. But Dr Erin has a game plan. She called our apartment a mini hospital. We have suction, a stat monitor and oxygen. We have all the medical equipment that Mikaere’s currently making use of on A&E.

I think that’s our saving grace. Kai’s just barely managing to keep his stats up with o2, and we’re able to wean to 0.5L when he’s awake. It’s a small wean, but it’s enough. We’re  discharged with very strict instructions of what to look for and when to come back. We have nurses calling to check in, and with a discharge note we’re waved off.

Mikaere’s not any better than he was this morning, but he’s not any worse. I was right to put him on o2 it turns out + I’m grateful for the reassurance.

Kai’s ill. He’s not holding his o2 levels up by himself. But we’re home. Thank fuck for that.

On the first hospital visit of the season

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And just like that our little man is back on oxygen, working overtime to keep his o2 levels up (and failing). It’s the first stupid cold of the season. We had a nurse overnight and when I walked in this morning she was just getting ready to wake us – Mikaere’s o2 level was sitting at 89%. Typically it’s at 99% – 100%. 89% is LOW. Lower than I’d like, lower than anyone would like. And you could see it. My baby was struggling to breathe. His breath was fast and shallow, he had a tug and an intercostal pull. He was working overtime to breathe.

We have tanks of o2 sitting in the spare room for moments like this, and I pulled one out, grabbed an o2 mask. It’s been forever since he’s needed o2, and you can tell, because the mask is too tight on his face. He’s outgrown the paediatric baby o2 masks. Regardless, it does the job. I watch with relief as his o2 climbs back up to more normal levels, settling at 96%. In the safe zone. He relaxes a little, he doesn’t have to work as hard. Poor baby has a temperature, and we give him Calpol.

I take pause. Get dressed, say goodbye to our night nurse. Sam and I discuss whether we should go into hospital. He makes coffee and I think about calling our community nurse. His levels are fine on o2, but he hasn’t need o2 in I don’t know how long. He’s clearly got a cold of some kind. If it’s a cold, we probably could manage it just fine at home. We have o2, we have stat monitors and suction machines. He sounds a little rattly, but I’m pretty sure it’s all upper airway.

If I call our community nurse looking for reassurance, she’ll ask us to go into hospital. Go into hospital. Complex needs. Difficult case. Better safe than sorry. Go into hospital. They always tell us to go into hospital ‘just to be safe’. Everyone is scared of taking the chance to say does he really need to go right now? What are the risks? Benefits? It’s all go into hospital, and go now. The risks of being wrong is too high.

But the hospital isn’t safe for us. Mikaere could very well catch something else from the hospital. Something worse. Plus, it’s loud and tiring and disrupts our routine, and I’d really like NOT to spend our Saturday in the A&E.

In saying that… he hasn’t needed o2 in forever.

I make the call anyway, knowing she’ll send us in and alert the paeds registrar for us. Also, on a Saturday morning at 8am, none of the other kids have had a chance to hurt themselves yet. Their parents will just be waking up and they’ll take longer to decide to take their sick kids into the A&E. If we left in the next 15 minutes, we’d make it in just after the shift change when the paediatric A&E is quiet. I mean, if you’re going to go in, might as well time it for non-peak time, right?

Sure enough, our community nurse said to go in.  So off we go. We’re on our way into hospital. 🙁

On yoga and safe spaces to share

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I’ve started going to yoga. There’s a lady who does it in our local park for a fiver. When it’s warm enough, we go and we stretch and move and practise our yoga. I am not very good, but there is no judgement and my body feels better after. So off I go. Today there was a reading. I missed the beginning, I was in my own head.

But I caught the last bit, and it basically came down to don’t be afraid to feel what you’re feeling. Be vulnerable, explore your emotions.

I tend to bite down on my emotions. My logical, intellectual side is more mature than my emotional intelligence for sure. I usually only express those emotions in safe places, like therapy, or at home with Sam. Not in public. Definitely not in yoga.

But as our instructor urged us, I cautiously settled my mind, cleared my thoughts and gently took a peek. And then I slammed those feelings way way back into a tiny box and pushed it as far away from my brain as possible, bringing my thoughts back to the present immediately. The feel of the mat, where my body was grounded, the (more ragged than gentle) breath in and out. What I could hear. I thought frantically of what I was going to eat for lunch that day.

Fuck exploring those feelings at yoga.

There was only two of us, that day at yoga. And we chatted at the end. The reading came up, and the other girl said she really enjoyed it. It was helpful for her. She was feeling some residual conflict with an unbalanced friendship and was able to gently process her way through and let it go. I listened, fascinated. How amazing, genuinely, to have that be what needs processing. How healthy. I was jealous. Sure enough, the conversation turned to me, and what I thought of being vulnerable and open to feeling what I’m feeling.

I said it was difficult, because when I explored my feelings that morning what I got back was ‘please don’t die, please don’t die, please don’t die’ with such hope and desperation and love, it was overwhelming. My very rational fear of my son dying and it being a very real possibility is always right there just under the surface, it’s intense and overwhelming.

I had tears streaming down my face, and they were both taken back a bit. They clearly weren’t expecting this. They don’t know me very well, and they don’t really know me as the lady who has a son with a terminal metabolic disorder.

And then we did that dance. The not quite pity dance, but the ‘theres a definite need to comfort me but they don’t quite know what to say’ dance. The poor girl with the friendships felt that her problems weren’t problems (but they are, my problems don’t take away from anyone else’s problems) and they expressed how important it was that I look after myself and practise self care and how amazing and strong I am for parenting like I do.

I moved the conversation on to less emotional ground because that dance is awkward for everyone, despite the kindest of intentions (they really are the nicest of people).

Side note: if you’re at a loss for what to say, say “that sounds really hard. How are you feeling about that?” or if you don’t want to go deep and meaningful, “That sounds really hard. How is your son doing right now?” because chances are he’s fine and it gives me a chance to move the conversation to the positive.

We left shortly after, and my grief lingered all day. Long story short, yoga is not the place to explore all those emotions if you’re a special needs parent with a child who as a terminal disorder.

I’m grateful we have access to therapy and safe spaces to share. I definitely won’t be exploring all those feels in yoga again, that’s for sure.

On feeding into the world of pretend

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I talk a lot about the ‘what if’ daydream in my head.  The ‘what if Mikaere never had NKH’ daydream.  I think goes hand in hand with grief, with loss. When you grieve something has happened that you didn’t want to, the flip side is that there was another option, another path, another something that you expected/hoped for/wanted. For us, obviously, it’s that Mikaere didn’t have NKH. That he was neurotypical. That he didn’t have two little missense mutations in one tiny gene.

Daydreaming about what it would be like if Mikaere was neurotypical is a dangerous, dangerous past time. It’s like a sink hole, so I shy away from it. At the same time, I also want to confront what Mikaere is not – I want to rip that band aid off so that it doesn’t hurt so much the next time I’m faced with the gap. So that the developmental gap that’s widening by the day isn’t so unexpectedly large that it’s crippling.

So I straddle the line between hanging out with kids that are Mikaere’s age (thanks to our wonderful NCT friends and their gorgeous babes), the grief that he’s not developmentally where they are and imagining what it would be like.

I’ve noticed recently that when I’m having a hard day, when we have back to back appointments or Mikaere is projectile vomiting everything or the seizures are uncontrollable – I have a bad habit of leaning towards the daydream. If I’m writing posts, I’ll post the photo where Mikaere looks more neurotypical. That if you weren’t here behind the camera you wouldn’t even know. I like the photos where Mikaere looks neurotypical best.

There’s one photo I love. Friends of ours have a son that was born on the same day as Mikaere and we went to visit. I lay Mikaere down on the floor where he’s most comfortable and T roamed, as a toddler who has independent mobility is want to do. But there was a moment where T lay down next to Mikaere and they both laughed.

I love that photo. I love that T lay down and was the sweetest little guy. That he wanted to do what Mikaere was doing, with zero knowledge of disability or difference or anything. I’ll forever love T for that tiny tiny moment.

But I realised I love that photo because it looks like, just for a minute, what a neurotypical life could be like with Mikaere. It feeds into the world of pretend, if you weren’t there – it looks like two boys playing together. The reality is they’re not. T had a wonderful, kind moment with Mikaere before he toddled off and Mikaere had a moment of awareness that T was there, but the truth is they didn’t play together.

It’s insane how to the very depth of all I am I wish they had been. How much I wish Mikaere was neurotypical. He’s not, I know. But I struggle with the cognitive dissonance of knowing he’s not, and the emotional intensity with which I wish it was otherwise.

It’s been almost two years of this cyclic grief. Over and over and over again I battle with this. Over and over again I’m faced with such grief that Mikaere suffers. And when he’s not suffering, when he’s happy and content and smiling at us and making small gains – that his life will never be as full or as varied as a neurotypical life.

That he will never love romantically, to know those butterfly feelings when you meet someone. He’ll never know what it’s like to travel independently, to delight in discovering a new place with new people living differently to you. He’ll never know what it’s like to work hard and be considered an expert at something, he’ll never know the satisfaction of when your peers recognise something you’ve achieved. He’ll never know what it’s like to snowboard, to pick a line, to make fresh tracks down a powder black run on a bluebird day (Its been a long time since I’ve been to the snow, but it remains one of the greatest joys I’ve ever had). He’ll never know what it’s like to kite surf, or boogie board or cook an amazing meal for the glory of it. He’ll never sit in a side restaurant in Japan eating the best oyster of his life, or jump off the back of boat into crystal clear waters in Croatia. He’ll never be able to introduce someone he loves to the things he loves. He’ll never adventure with a group of friends, getting up to mischief. He’ll never feel the satisfaction of creating something others can’t.

These are my life highlights. I’m devastated the highlights of his life will be smaller than mine. And I know that these are all just the highlights, and he’ll also never experience the downsides of a broken heart or the culture shock of being somewhere out of your depth or break a wrist taking a jump with a bad landing. But fuck, aren’t the highlights worth it?

And the hard thing, the thing I really struggle with – this grief is cyclic. It’s never ending. For as long as Mikaere lives – and past that, I suspect for as long as I live this is something I’m going to carry. This big dark grief that my child will never have the opportunities I did, that he’ll not live a live as full as others and he’ll forever be disabled.

I know for certain it’s this grief that pushes me to fundraise. That pushes me to figure out the next thing I can do to raise more money for NKH Research. That this big, dark stupid grief fires that ‘do something about it’ tick I have. And so I push and I design and I build websites and read research papers and oh god, the whole time I’m furiously wishing my son wasn’t disabled.

He is though. So onwards we go.

PS – if you want to donate, as always, we’re fundraising at justgiving.com/team-mikaere. All funds go to Prof. Nick Greene, who is researching a cure for NKH.

On the hip X-ray

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Kids with low tone are susceptible to scoliosis (this is where there ends up being a sideways curve in your spine), hip subluxation (otherwise known as a partial dislocation) or hip dysplasia (where the socket doesn’t fully cover the joint) – it’s not awesome.  Apparently all three are painful (womp) and scoliosis can cause all sorts of eating problems (with your insides being stretched/squished by your spine).

There is a not a lot of prevention that can be done in kids with low tone… all the of the early intervention strategies are movement, exercise and positioning. But with kids that are like ours… what do we do? The NHS promotes positioning with things like sleep systems and regular (read: constant) repositioning throughout the day but really – that doesn’t prevent much. Exercise and strengthening the muscles that support the spine is whats needed, but that’s not helpful

Mikaere has low tone. He’s at risk of scoliosis and hip subluxation/dysplasia as a result. And you can see it, in the way he holds himself, how he struggles to stack his body the way that we do naturally – just how easy it would be for things just to misalign.

We spend all day everyday repositioning. It’s in how we hold him and how we move him and how we put him down, feed him and play with him. (There was a point in our first few days at hoe where I felt we were literally being taught how to be with our boy.  Every single moment with him is an physio/ot/development moment where we teach his body and reposition his body with an eye to prevention. Holding his wrists, repositioning his knees, encouraging him to turn his head one way over the other, it’s never ending).

Positioning is one of the many things we think about constantly. Because that’s what’s there is for scoliosis prevention – repositioning and supportive seating. That’s to say, it’s the only treatment until you get to full body torso braces and surgery.

So we reposition. We stuff supportive pillows and tubes and straps down the backs of chairs and his carseat and line them along side his cribs.  And every six months to a year he gets a spine/hip X-ray. So we go (if I’m clever I’ve paired the appointments with something else in the hospital). We X-ray. And we wait for results.

Our Physio knows it’s coming but we’re not ‘bad’ enough yet for a referral to orthotics.

This time there was no news. His hips don’t show any signs of sublaxation (hurrah) and his spine is still under the threshold for scoliosis treatment. Phew. We know that we’ll eventually be referred to orthotics, but we haven’t reached the ‘its bad enough for orthotics’ point yet. So we wait. We reposition. We put Mikaere in the stander. We hope.

So hey ho. Onwards we go.

On standing

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We’ve started a new exercise at our Monday Morning playgroup – standing. I don’t mean the standing that happens in the stander but proper standing, on his legs – not strapped in. It takes two people to support him and he’s always leaning against something (because head and core and legs is too much to think in one go) but you GUYS!

His feet are on the floor! His legs are straight (either with the help of us or gaiters) and he’s upright!! I’m glad this is a thing we’re working on. It feels like a step forwards. Its delightful to see how tall (!) Mikaere is, and it’s not hard to take that leap of imagination and think on what things could have been like if (there’s always that if and it’s a dangerous path to spend too much time on, but I let myself daydream for a moment or two).

I don’t know if we’ll ever get to unsupported standing, Mikaere needs a lot of encouragement (read: hands on his knees or leg gaiters and lots of cheering and big fusses) to straighten his legs. We currently have a floor baby – that’s his happy place, lying down on the floor. Where he can kick and wriggle and have some movement – the floor is where he does it. We always set up a safe space for him to wriggle, lugging about mats and baby blankets for him to lie on.

The idea that the world might be more accessible to an upright Mikaere, that standing is one of the (many) requirements of walking… standing is one of those gateway milestones for the hopes of a special needs Mama, obviously.

He’s not standing unsupported by any way, shape or form, but for a five minutes on a Monday morning Mikaere stands outside his standing frame. He’s standing, weight moving through his hips and legs and little wriggly feet. I’ll take it, absolutely.

On a hospice stay

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We’ve been working up to a hospice stay, overnight for ages. Technically Mikaere probably could stay overnight without us and be just fine. Probably. However my mama heart is NOT okay with him staying over alone at hospice. I’m just not. I have the fear, that fear of what if something happened and we weren’t there?! The guilt would be unbearable – the world of living with a terminal disorder is a bit shit. So I have the fear and we haven’t done an overnight at hospice since we left in March last year.

In kind of the same vein, I can also count on one hand the number of times I’ve been out with Sam without Mikaere. Date nights in are only so beneficial when you lived an adventurous always-out before-baby life. The mental refresh that comes with being out of the house is huge. Even more so when it’s without the mental strain of anticipating all the requirements that come with caring for a complex needs kid.

We’ve been seeing a therapist who is attached to our hospice (because the special needs life is hard, yo) and this is one of things we talk about frequently. For a hospice stay to be helpful we, as parents have to be relaxed and trust the people caring for our child. The idea of being relaxed while my baby is not safe with either me or Sam is a contradiction. So we worked on trusting the hospice. We go regularly for swims and visit their preschool program. We enjoy the hospice at home visits and like the nurses.

You guys, our hospice is GOOD.

And so, after months and months of talking about it and visits and reassurance we booked in a one night stay. Kai would stay downstairs with the nurses, Sam and I would be up in a parents flat upstairs. It would be on a weeknight, so things are less busy and Sam and I would go to out to dinner in the town nearby. There was a preschool group the morning off, so went out early for that which was excellent. Mikaere fell in love with the man who played the ukelele. He enjoyed a fab time running his hands and feet through raspberry jelly (seriously, messy sensory play is so fun), we had a swim and he fell asleep for his afternoon nap pretty content.

The overnight part of the trip had a wobbly start. The handover which was meant to be at 3 wasn’t until 4:30, which meant that essentially I was looking after Mikaere right up until after his 6pm feeds and meds (so zero respite, considering I’d done all the hard work) but after handover finally finished, I kissed my baby goodbye and left with Sam.

Dinner was lovely, spending time with Sam was without a doubt the highlight of the whole trip. I’d missed being just us. But I wasn’t super settled. I shook that off as nerves and figured that’s just how I was going to be the whole night, so leaned in.

When we returned Mikaere was fine, sleeping like a champ in the nurses station with the nurses. (He sleeps where people can see him, because silent seizures are a bitch)

Everything went down hill the next morning. I got up early, showered and dressed for breakfast (and to check in on my boy). He was sleeping, fine as you can be. The problem is when I started doing handover. Packing up all his gear (which was all over the place). I knew we’d need a blend done – we weren’t going to make it home before his feed and meds were due. But I’m not allowed to blend in the kitchen (parents aren’t allowed in the kitchen, no exceptions) and the there wasn’t enough room in the milk room. I was directed to the coffee station – a small tiny kitchen with a bench big enough for making coffee. I wish I’d had the foresight then to say fuck no, but I didn’t. I trusted the nurses and off I went, blender and food in hand.

Fuck me. Every second person that walked by wanted a coffee. Some were polite and waited. Most weren’t, most were reaching over the top of the blender or across Kai’s food as I was prepping. There must have been at least twenty people trying to get around me, one after the other. They were very British (Oh excuse me, Sorry, if I could just, hope you don’t mind) but this was my kids food and strangers reaching over me constantly getting the way made me furious and stressed. Just fucking wait for your damn coffee!! I was raging. I’m raging just thinking about it.

By the time the blend was done I was ready to scream, I was well upset. Fuck the hospice, if I can’t blend in the kitchen (because parents aren’t allowed in the kitchen – which is the stupidest policy, considering I would have been supervised by the chef, or fuck, if the CHEF could have blended his feed that would have been even better) and the place I’ve been directed to is the coffee corner – fuck off. Never again.

That’s not the worst of it, though. What happened next makes me want to never go back. When I went to go check out the meds, we found two boxes were MISSING. Considering we had to sign each box in and it was kept in a locked cupboard there were alarm bells. I wasn’t too worried, because what was lost was a supplement and one was a med we rarely use, but if it had been one of Mikaere’s main meds which are notoriously difficult to order and get in (they’re on special order from our hospital only. One is shipped in from the states for us especially) I would have been livid. What were they going to do for the next med round?

Then I found out the nurse on that morning hadn’t followed the care plan in terms of his breakfast. Wtf. She just decided it wasn’t for her and so didn’t feed Mikaere the food that had been set out by both me and his dietician. WTF doesn’t even cover it. It was CLEARLY in the care plan, and the care plan is not optional. It’s not fucking optional! I’m grateful it was just the food they decided to ignore, because there could have been disastrous results if they’d chosen not to monitor him overnight or given him the wrong meds (or not given him meds at all). Fuck me.

I was already stressed af and this was the breaking point. Done. There is no trust anymore. I’m done. No more overnights at hospice. We have night nurses, we have support during the day. We don’t need overnights at hospice. They’re not us, the building is not home, meds are being lost and careplans aren’t followed and strangers are reaching over as Kai’s food is being prepped. Too many things went wrong on a single overnight stay, too many things went wrong when I let strangers take care of Mikaere. This may be their jobs, but this is our child. Too many mistakes happened for me to be comfortable doing it again.

I’m not saying hospice respite is terrible. I think hospice is awesome for those special needs kids who don’t need constant monitoring, who don’t have immune vulnerabilities and who are able to sleep in their own beds the whole night unattended without their parents wondering if their baby will still be alive the next morning.That is who I think hospice respite serves best.

That is not us. So. No more hospice overnights. I don’t want to repeat that experience again. Despite the wonderfulness of spending time with Sam, it was not worth the risk.

Instead we’ll ask our night nurses to babysit for a few hours and go to dinner somewhere local, somewhere less than five minutes away. Not yet, I’m still reeling from the hospice respite, but one day soon. Maybe. We’ll see.

On the developmental quotient

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One of the things newly diagnosed NKH parents worry about is severity. There is a range: Severe is at one end. Severe means that neither mutation is producing any protein that can be used by the body. Any protein that is made is probably unstable and falls apart to be recycled. Severe is what we’re primed for – disabled, seizures, developmental delay, early death. No walking, no talking, not eating. Perhaps smiling – a developmental milestone usually hit in the first few weeks – that’s the total brain development we’re told to expect of a severe child.

At the other end, there’s attenuated – that’s a whole different kettle of fish. Some children you wouldn’t even know have NKH. They’re walking and talking and going to school and are picture perfect (I met a boy who had very mild NKH in March. I literally couldn’t stop staring. I wanted to hug him, but as a stranger to this teenage boy, I refrained). It steps down in degree’s from there. Walking and running (or sometimes non-mobile) and/or talking up a storm (or non-verbal) and/or eating (or bolus only). There are a lot of other issues, too. ADHD, severe behavioural tantrums, autistic like behaviours, hyperactivity movement disorders (dystonia, chorea, ataxia).

As I understand it, it’s a huge range split across three categories: Attenuated Poor. Attenuated Intermediate. Attenuated Mild. You can’t tell which category is which until the child is much older (around 2), and they’re showing signs of development. The rate at which they develop – thats what defines which category you’re lumped in.

What this means first and foremost is that at the time of diagnosis (typically a few weeks after birth) it’s impossible to tell severe or attenuated, unless your child has two of the handful of mutations which have previously been expressed to show how much protein they produce. Regardless of this almost every parent is told their child is severe. If a doctor see’s your child as sleepy and lethargic (even if it’s just a bad day, or post seizure) they’ll lean towards severe. Severe is where we’re primed to be, and severe is what we fear in that newly diagnosed haze. Severe is the safe worst case scenario.

Thing is, it isn’t until our babes start developing that the severity of NKH comes to light.

There’s a slide in a talk done by one the NKH researchers that spits it out:

Attenuated Mild: Developmental Quotient 50-80
Attenuated Intermediate: Developmental Quotient 20-50
Attenuated Poor: Developmental Quotient <20

The Developmental Quotient is a score – it’s the developmental age divided by the chronological age. As the parent of a developmentally delayed child – that’s a scary score. In my ignorance, I know Mikaere’s delayed, but I don’t know *how* delayed. Very seems nice ambiguous score. I know he’s not even close to his peers, and he’s been passed by babies a year and a half younger than him, but there’s nothing concrete to latch on to.

And that was fine until in Boston I spoke to researcher, showed him a few videos of Mikaere and after a pause, he said Mikaere was unlikely to be severe, he was showing milestones that perhaps put him in the attenuated poor category. This same researcher had seen Mikaere a year before and had said without a doubt he was severe at his current presentation.

Attenuated Poor. That shocked me. What would attenuated poor mean for us? Would it mean more time with Mikaere? What would our future look like? Will I (dare I even hope) need to be looking at support and facilities and special needs schools? (Will we make that it that long?) – what kind of support will we need? Will we make it to the world of special needs vans and hoists and support with a teenage Mikaere (Can you even IMAGINE?!) Attenuated Poor threw me off my severe, live in the short term kind of mentality. What would attenuated poor mean for us as a family?

How do we make quality of life decisions for our family with such uncertainty in our future? You can see the kind of emotional mess my brain went to with the words ‘attenuated poor’.

But I’m also kind of a logical person, so my first port of call was can we confirm that Mikaere is, or isn’t right now, on the attenuated poor scale? Which is where that Developmental Quotient came in. It would tell me. There is a standardised test and a score and NUMBERS. I never wanted to know how delayed Mikaere was before and now it was all I could do to not do the test myself.

In the studies that discuss NKH Severity, there are three scales of development that could be used: the Bayley Scales of Infant Development, Mullen Scales of Early Learning, or Wechsler Scale of Intelligence. The Bayley Scales is the typical standardised measurement in the UK, and our physio was trained in assessment. So off we went. She came and Mikaere was assessed.

It’s heartbreaking to look at the long list of milestones by age and know your baby can’t do the majority of them. What a knock. Still, I cheered for everything Mikaere could do. We marked off some milestones, which is positive (he’s on the scale, you know?) and just – we got through. I had to remind myself that MIkaere hadn’t changed. Mikaere was still his happy little self and he couldn’t do anymore or any less than he was yesterday. He’s still just fine on his own little path.

Deep breath in. Slow breath out.

We got through the assessment and I put it out of my mind until the assessment report came.

Cognitive: Age equivalent: 3 months.
Language Receptive: Age equivalent: 3 months 10 days.
Language Expressive: Age equivalent: 6 months.
Motor Fine: Age equivalent: 2 months
Motor Gross: Age equivalent: <16 days

Mikaere was 21 months when we did the assessment with an average development of about 3 months. Oh my heart.

DQ Final Score: 3/21= 0.14 or 14%

But there we go. The numbers are pretty clear. Mikaere’s solidly in the Attenuated Poor Category.

On more weight gain

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I just did the first weigh in a month. At our last paeds appointment she said not to worry about his weight, he’s tracking close enough to the 20% line and that’s okay. I basically decided that if his medical team weren’t worried about his weight, I shouldn’t be.

My fear is based on the dietician making harsh calls about the blended diet based on his weight gain, which to be honest, shouldn’t be. As his parent if there is no concern from his paed and CCN, then I definitely shouldn’t be letting the dietician freak me out with some half baked comments (and let’s be honest, she can inform us, but as parents we decide what he eats).

I feel like in the world of high-medicalised special needs there can sometimes be a power imbalance between professional and parent. The professional doesn’t always acknowledge us as experts in our children in our own right and often there is the expectation that medical professionals know best. I learnt early on that no one other than the metabolic consultant anything about NKH, and often doesn’t alter their typical plan to include it. No one knows more than I do about my son, and no one is looking at the whole picture but me.

There is the other times though, when the power shifts the other way. I know how to advocate and have no fear entering conflict to achieve what I think is the best outcome for my son. Mostly, I don’t need to Mama Bear anything. I’ve learnt that being brash and loud is not always the best way to get results and sometimes it is. And then sometimes you can ignore an email for three months and it’s no big deal.

So I stopped weighing Mikaere for a month, and what do you know? Despite all the vomits there’s a modest increase. Good job us!