It has been a little over 8 months since Freya was diagnosed with Kawasaki Disease following her hospital admittance on the 31st May 2015. She was 7-weeks old. Infants under 1 year are hit particularly hard by the illness, and are at greater risk of heart involvement. The magic window for treatment that has the highest odds for reducing the risk of coronary artery dilation and/or aneurysms is considered to be 10 days. Freya was diagnosed on day 13 when an echocardiogram showed significant dilation to her tiny coronary arteries, and she was transferred by ambulance to a specialist paediatric cardiac high dependency unit (HDU) in another hospital.
Since her diagnosis, Freya has had numerous ECG and echocardiograms performed at follow up appointments. Some of those appointments have shown no change, but two of those appointments showed some remarkable improvement that managed to incite a “Wow!” from her Cardiologist. In September we were advised that her right coronary artery (RCA) had improved to within normal parameters (around 2mm), leaving just the left coronary artery (LCA) and left anterior descending (LAD) with reduced, but significant, dilation. The aortic valve had ceased leaking some time before.
I remember at the time asking the cardiologist (who wasn’t our usual one due to a mix up in dates), whether the swift improvement was cause for concern in relation to longer-term issues, such as stenosis (narrowing of the coronary arteries), but he had said that there was no evidence to suggest that was the case. And so I made my peace (kind of) with the condition of Freya’s heart, and accepted that things were improving and that her prognosis looked good, regardless of how scary it all still was.
Her last appointment in our local hospital was a disaster. We were kept waiting for nearly 3 hours with no explanation before finally being seen by a consultant who felt under-qualified to deal with Freya’s case. Nevertheless, she performed an echo, the results of which suggested there had been no change since the previous echo. No change is good news in these cases – at least things hadn’t got any worse. Had she told me there was some improvement, however, I would not have believed it, and immediately contacted the original hospital to request that we be moved back under the previous cardiologist. Sometimes convenience isn’t the best option; I would travel 10 times the distance for Freya to be treated by someone that I trust and respect.
Today found us back in Leeds, back with the Cardiologist that first treated Freya, and has taken pretty good care of her ever since. She is the same Cardiologist who took me in a room and explained the risks of Freya’s condition back in June; the same Cardiologist who I went to battle with over not giving Freya Warfarin despite the treatment protocols suggesting that was what she should have. She made a strong case, one strong enough for me to put my trust in her. It was the hardest decision I have ever had to make, but it appears to have been the right one. Freya has been thriving since her diagnosis, she appears to show no adverse affects, no night terrors, no evidence of joint pain, none of the things I see mentioned in many social media forums.
So come on then, tell us the news….
Ok, so today Freya had an ECG and an echo. As usual, the ECG showed that heart function is all good. During the echo, the Doctor remarked that Freya’s heart function was “Beautiful!” She measured the arteries at their widest points and remarked that she could see two aneurysms on the RCA. I was surprised by this, as previously we had been advised that the RCA had normalised, and I wondered aloud whether as the artery had remodeled, could any ‘true’ aneurysms now be more noticeable (Freya’s arteries were significantly dilated all the way along, without the typical balloon shape aneurysm you expect to see when you use the ‘a’ word). The doctor went in to look again, and could not get the same image, or any image to show the aneurysms she believed she had seen. Perhaps it was a bad angle? Maybe Freya wriggled too much for her to get the same view? I’m not sure, but the Doctor concluded that all three coronary arteries (the RCA, LCA and LAD) appeared to have remodeled to within normal parameters! Wow! That’s cause for celebration!
During the acute stage of the illness, we were advised not to expect to see any improvement at all until Freya was at least one year old. To have seen her arteries reduce to near-normal levels in just 8 months is remarkable! She truly is a miracle. Or maybe this is just the case with tiny babies? Sure, they are hit hard by the illness and more of their little hearts suffer, but their organs are still developing and perhaps they just compensate for the damage and work harder to repair it? Who knows? Research is still very much in it’s infancy (thus my passion for fundraising for this cause).
We sat down, and I asked my husband to dress Freya whilst I asked the questions I had prepared before I went in. These are the questions I wanted to get answers for:-
- What do you consider to be the current risks?
- What are the exploratory steps we can expect for Freya?
- When would those next steps take place, i.e. at what age?
- What is the view on Reye’s Syndrome, and what are the suggestions in relation to aspirin during the Chicken Pox vaccination period?
Before I had the chance to ask my questions, the Doctor started to answer the first. She exclaimed that the improvement was indeed remarkable, but that the speed at which Freya’s arteries had remodeled was unexpected and gave her cause for concern. She knew that I understand that an echo can only see approximately 3mm of the length of the coronaries, and explained that she was concerned about what was happening beyond what she could see. She aired the same concern that I had raised back in the Summer when I told another Cardiologist that I was worried that the swift remodeling could result in higher risk of stenosis. Sometimes I wonder if I am bloody psychic! She said that she would be happier if she could take a closer look at Freya’s heart to satisfy herself that the whole picture was as good as what she could see.
So, what’s the good news?
Ok, so the good news is that Freya’s heart has shown remarkable improvement, basically remodeling itself to where it should be, or would have been under normal circumstances. If the next steps prove that the bigger picture is the same, the Cardiologist feels she would be comfortable to stop the aspirin. That means that Freya would continue to be monitored into adulthood, that further tests (exercise stress testing, MRI, etc) would continue to take place during that period of monitoring, but that she would be treatment free. Fantastic! That would be almost ‘normal’. Wouldn’t it? Wouldn’t that just be normal?
Yeah, so that’s sweet isn’t it? What’s there to feel bitter about?
Alright, alright, I know what you are thinking! For months I’ve suffered mentally over the prognosis for Freya and the fear that comes with having a child with a heart condition. I should be unconditionally happy, right? It’s just that the way they want to find out what is going on with the bigger picture is to carry out an angiogram.
“An angiogram is a test that’s used to find out more about your heart. It can help to show if blood vessels called coronary arteries, which supply blood to your heart, are narrowed or blocked. If they are, it can show where and how severely they are affected. It can also see how well your heart is pumping blood.” http://www.bupa.co.uk/health-information/directory/a/angiogram
Whilst a CT or MRI are preferable in a child as young as Freya because they are non-invasive procedures, an angiogram is considered (by our Doctor) superior to a cardiac CT or MRI scan in that it provides a clearer image where the arteries concerned are very small, like in a young child. The procedure involves inserting a catheter (a thin tube) into an artery in the groin or wrist and guiding the catheter to the coronary arteries where dye is inserted and a number of x-ray images are then taken. Freya would need to be sedated, likely to go under general anaesthetic. Not only is it invasive, but it is a procedure where the risks are greater the younger the child.
It is considered pretty standard practice to carry out an angiogram, or other exploratory test, a year after diagnosis with KD. However, an angiogram is not performed in very young children without careful consideration. We were told that the catheter that is used is kind of a one size fits all; they will use the same sized tube to enter Freya’s tiny arteries that they would use on an adult. We were also advised that young babies’ arteries are quite sticky, and have been known to grasp onto the catheter, causing the artery to spasm. This can cause a heart attack. The Cardiologist said that the hospital will be reluctant to carry out the procedure on Freya at such a young age (she will be 14 months old when she is a year post-diagnosis), but said that she feels that Freya is a special case and that it is important that this step be taken. She says she will convince them to do the procedure. I replied, “Thank you…I think. I mean, on the one hand you are keen to move things forward and a clear result could end with us stopping the aspirin. But you are expediting a potentially risky procedure and I am not sure how I feel about that.”
But I do trust her. I think. Didn’t stop me from e-mailing the world’s leading Kawasaki Disease expert for her opinion though…
And that’s where I am right now. I’ve written this down to provide an update, but mainly to try and work out how I feel about it all. I’m not sure, I feel quite numb. So I am just going to dump all the crappy thoughts that are running through my head right now, and hopefully the answers will come to me over the coming days or weeks. Excuse the rantings of a confused mind…
- Here we go again, as soon as I let my guard down and ignore my instincts, someone goes and throws a curveball!
- I knew this was going to happen!
- I knew that there was a chance that the fast improvement was too good to be true.
- What if I lose her after all?
- What if I can’t bear to watch her go under general anaesthetic again? It was like watching her die on that table.
- What if she doesn’t wake up from the anaesthetic?
- What if she has a heart attack?
- What if she dies?
- What if she dies because of the procedure and they tell me everything was ok anyway?
- What if there are signs of stenosis? They can’t operate on her this young anyway.
- What if there are no signs of stenosis, but it happens when they’re not looking and she dies?
- What if we say no to the procedure? How much potential danger would we be putting her in?
I think that’s about all I can figure out from the fog right now. Somewhere in there, though, there is a tiny voice of hope. ‘Ant’ is doing her best to drown her out, but I hear her. She sounds how I imagine Freya to sound in a year or so. I see those eyes through the fog too. They are looking at me, huge and wide, and they are saying “I’m going to be ok, Mummy.” This kid is miraculous. She is made of something stronger than you and I were made of. Maybe, just maybe, she is going to prove them all wrong. Maybe, (and I don’t consider myself religious so this just came as a huge surprise to me, hitting me like a juggernaut and reducing me to sobs), just maybe, someone heard my prayer….