“Mum, remember when you thought you might not get to see me grow up? Bet you feel silly now?!”
They say that you shouldn’t wish for your children to grow up, that you should will them to slow down because in the blink of an eye your once tiny baby is all big and independent and doing things you never thought possible. Well, in a way Peanut that is true. But as bad as it may sound, there’s a huge part of me wanting you to hurry up! Hurry up and talk, hurry up and walk, hurry up and grow big and strong so that I can be sure to have had the chance to see it all in case it is taken away from me. I’m scared. Scared that I won’t get the chance to know you like I should. Scared that Kawasaki Disease has not finished with you just yet.
Today we took you to the hospital for your cardiology follow-up appointment. You were last seen three months ago, where the cardiologist remarked that the speed of which your coronary arteries have been remodelling is concerning, and they would like to carry out an angiogram to take a closer look. I knew she was referring to possible stenosis; that the reduction in the internal diameter of your coronaries might not be healthy, and is more likely to be the result of a build up of scar tissue or layered blood clots that have effected the change. But I have read that stenosis can take decades to cause any ill effects, and as such I felt it would be prudent to give you more time. More time to grow, so that less invasive procedures might tell them what they want to know. Apparently an MRI or CT scan isn’t as effective in giving a true picture in such a young child, and an angiogram is the only option that will show them what is really going on in that little heart of yours. I asked the opinion of 3 experts, all of whom concurred with my view that there would be no harm in waiting, perhaps even up to a year, and carrying out a less invasive procedure. I put that question to your cardiologist, but she seemed pretty keen on pushing forward and continued to voice a preference for carrying out an angiogram a year post-diagnosis; June.
I decided to wait until your next appointment to understand more fully why the consultant was so eager to press on. That appointment was today.
We arrived at the hospital just in time for your appointment, and were sent straight down the corridor for an ECG. It took the cardiographer 20 minutes to get a reading from your heart because you were wriggling so much! We had to bribe you with ‘sweets’ (little fruit things that we call sweets because they’re as close as we will let you get to confectionary at your young age!) to get you to sit still for long enough! You’re not as easy a patient as you were last year, this time pulling off the electrodes and yanking on the wires, but he got there in the end! Nothing was said about the result, and I am guessing that means that, as usual, the ECG showed normal heart function. Next it was time to weigh and measure you (you weigh 8.46kg and are 74cm in height), and then you were called into the examination room.
It wasn’t your cardiologist that called us in; it was a registrar. She introduced herself and asked if we had any concerns since the last appointment. We had none. She then asked us to take you over to the bed so she could perform an echocardiogram, and I asked if we were going to see your doctor today. She said that we would, and that she was just with another patient. I guess they were helping each other out so they might all finish the day at a reasonable time.
Surprisingly, you laid quite still for the echo. Okay, so you had to be given a probe of your own because you do like to take matters into your own hands, but she got there (with the help of a bottle of milk!). She didn’t say much, but as usual I clocked the numbers appearing on the bottom of the screen and was able to catch that your LCA (left coronary artery – the one that has caused the biggest worry on this journey so far) measured 2.8mm. Was that bigger than the last time? I seem to remember it being closer to 2mm, but what’s a fraction of a mm between friends, eh? Your consultant then entered the room, and continued the appointment with the registrar present.
She looked at the screen, and remarked that your RCA (right coronary artery) looked almost normal. She seemed happy with function and blood flow. It seemed that she was about to suggest a routine follow-up appointment and gave the impression that it would be a longer period next time, but the registrar mentioned that an angiogram was mentioned at the last appointment. Ah yes, remarked the consultant. I reminded her that she was considering the procedure because she was concerned about the extensive remodelling that your arteries have undergone in such a short space of time. Ah yes, she remarked, and commented that at worst, the diameter had measured 8mm. I corrected her. Unless I missed something along the way, the largest measurement was 5.2mm. Whilst small in comparison to some children affected by this disease, they were more than 5 times normal size and in a baby as young as you were was considered significant and cause for serious concern.
I told the consultant that I had a few questions, and pulled out my notebook (I know! I do like to make notes!) The first question I asked was why she felt it so important to carry out a risky, invasive procedure now? What benefit could it have? What was her thought process, and what were her concerns? I had thought that she might concede with a “perhaps we ought to wait” kind of statement. But instead she told me that she thinks it is highly likely that the remodelling has come about as a result of stenosis – anything other than that would be nothing short of a miracle. I asked if there wasn’t a chance that the remodelling has come about as a result of the aggressive treatment you received to stop the disease in it’s tracks (you received steroids and a dose of Infliximab when two doses of IVIG proved ineffective). She agreed that was possible, but didn’t seem convinced. An MRI/CT would be effective in providing a better picture of aneurysms, but in a child as young as you they would not be as effective in showing stenosis. I asked what would be gained by doing it now? Stenosis can take decades to develop before the arteries might close enough to prevent blood flow. And if the angiogram did show evidence of stenosis, how would that change the treatment plan? And then she used words that I had not considered would be used in your lifetime. Stent. Bypass surgery.
I guess I knew what her concerns were before I asked them. I mean, she isn’t likely to put you through an unnecessary procedure, is she! I told her that I would prefer to wait, but that if she felt that waiting would put you at risk I would trust her judgement. She said that she would really like to get a look, and it dawned on me that you are quite the case of interest. One of the youngest cases to be handled, aggressively treated, showing almost too-good-to-be-true recovery. Yes, of course they would like to get a look. I said I appreciated the medical interest in understanding what has been happening with your heart, but that you are not a specimen, you are my baby. She reluctantly agreed to see you again in three months, and noted that whilst there was a great deal to be learned from you, that she would not consider the procedure for medical knowledge alone. She agreed to discuss your case with at the next MDT meeting (multi-disciplinary team) with a view to negotiating with me further then. She has already discussed your case with the surgeon, and they too believe it would be prudent to do an angiogram sooner rather than later. That said, she still agreed to give us another 3 months (which will end up being more if the waiting list is as long as I expect), on the strict proviso that if we see any evidence of angina we are to contact her.
Let me take a moment to tell you about the symptoms of angina;
- Chest pain or discomfort (not sure how you will tell me about that!)
- Pain in your arms, neck, shoulder or back accompanying chest pain (ditto!)
- Nausea (won’t generally know that one until you actually throw up!)
- Fatigue (hmm, should I be concerned that you sleep through the night?)
- Shortness of breath (you don’t get above a fast crawl yet, and I’ve not seen you panting!)
- Sweating (nope)
- Dizziness (again, how would I know?)
So apparently the only way I might be able to tell if you are suffering with angina would be if you are playing one minute, and then go quiet, and maybe glaze over for a moment. This could be interesting
It would seem we are not yet out of the woods, my darling. Just when I thought that there could be a future where KD becomes nothing but a distant memory, here it is threatening to place a dark cloud over the years to come. The only thing I can hold onto is hope, but that is so hard when I feel like I am fighting a losing battle with this disease. I have no control over it, none. It came, it messed you up real bad, and it just won’t leave us alone. I know there is a chance that they could do the angiogram and discover that you are indeed the miracle I had started to believe in. But I also fear the worst. And I know that there are far more complicated procedures happening to very sick babies, with huge success, every single minute of every single day. But they are not happening to my baby. And I so want to bury my head in the sand like an ostrich and pretend that this isn’t our life, that this isn’t your life. Today for the very first time I saw ahead of me just how complicated your life might be, and it has made me incredibly sad.
And because with this disease the hits just seem to keep on coming, I returned home to a voicemail from your GP. We were given the green light to crack on with catching you up on the routine immunisations, and also later given the go ahead to give you the MMR vaccine. It was unclear, however, what timing/order the Immunologist felt these should be given in. You’ve had the 8 and 12 week immunisations now, and I was hoping that we might be able to intersperse them with the MMR, Chicken Pox and Flu vaccines rather than wait any longer than necessary. This family needs a holiday far, far away from here.
Sadly, the advice was more disappointing than I had anticipated. The instruction has been to wait until after the final routine vaccinations have been given (around June). Because you are a unique case, they are not comfortable in progressing to the remaining vaccines until 3 months after that. So at best, you will get the MMR in September. No mention has been made of the Chicken Pox or Flu vaccines, but I can only guess they will want to wait longer for those too. I just wanted us to do some normal stuff, Freya. Mix with other kids, in places where normal kids go. Jump on a plane to somewhere warm where we can forget all about this for a time. I am sick of being restricted by my fear, but I cannot knowingly expose you to illnesses that have the ability to take more from you than KD already has. I’m talking about Reye’s. And yes, I know it’s rare, and it hasn’t yet been linked to low doses of aspirin, but it’s a risk I cannot bring myself to take. What were the odds of you getting KD at 7 weeks old?? Exactly.
I’m sorry, my tone is getting quite unpleasant isn’t it? And I am sorry for burdening you with this worry. Almost a year ago I asked a God I don’t believe in to prove the doctors wrong. If he’s listening, this is his chance to show me what he can do. I can only hope that if you are reading this, it means that you have already proven yourself to be the miracle that we all hope you will be. I don’t want to live in a world without you in it.