Living with a Broken Heart

I have written many blog posts over the last two years, sharing our journey with Kawasaki Disease, but it struck me this morning that I have never really been able to articulate how living with this disease day-to-day feels for a parent.  It is a feeling I have become so accustomed to now, that it almost feels normal, and that is why I think I find it hard to describe.  My goal today is to try, so that I might share with you a glimpse into how our world changed in June 2015.

In a nutshell, Kawasaki Disease is a form of vasculitis, causing inflammation in the medium to large blood vessels when it strikes.  It is generally contained to children, mainly affecting those aged between 2 and 5 years old, though not exclusively (my daughter was 7 weeks old).  It is characterised by a number of symptomspersistent fever, red eyes, rash, swollen extremities, sore/cracked lips or strawberry-type tongue, and swollen lymph glands in the neck.  With no known cause, there is no diagnostic test to differentiate Kawasaki Disease from other similar childhood diseases (Scarlet Fever looks very similar and is a common misdiagnosis), and therefore a diagnosis is reached based on presentation of the afore mentioned symptoms.  Given that these symptoms don’t always show up at once, and sometimes not all of them are present, Kawasaki Disease can be a tricky illness to diagnose quickly.  And the speed of diagnosis is important, as research has shown that treatment within 10 days of onset of symptoms can dramatically reduce the risk of heart damage in affected children.  You see, 75% of children who get the disease will recover without long-term complications, whilst the remainder will sustain permanent damage to their heart if not treated (this reduces to around 5% with timely treatment).  Sadly, this means that no matter how good the doctors are at diagnosing the disease, 5% of children who get Kawasaki Disease will suffer heart damage that will remain with them for life.

Whilst mortality rates for KD are considered low, at around 1% of cases, I’ve always felt that the statistic gives unreasonable hope to those of us with children whose hearts were damaged.  I would be willing to bet that any deaths resulting from Kawasaki Disease are exclusively related to heart damage.  So if there are 100 cases of Kawasaki Disease, the statistics say that 1 of those children will die.  But when you consider that, with timely treatment, just 5 of those 100 children would suffer permanent heart damage, and you factor in the 1 child who will lose their fight, suddenly the numbers seem very different – especially if your child is one of the 5%.  Suddenly that 1%, when factored into the heart population alone, becomes 20%.  Now, whilst those numbers give the fear some perspective, I don’t want to cause unnecessary alarm for those of you living with a child with a broken Kawasaki heart – another bet I would place is that the majority, if not all, of the deaths resulting from Kawasaki Disease occur from misdiagnosis, or no diagnosis at all.  Like the little girl who was diagnosed with rhinovirus and died 6 weeks later when her heart failed her.

So, I guess that sheds light on a couple of things:

  1. My daughter is one of the 5%.  Unfortunately at just 7 weeks old when she became sick, she was in the high risk category for heart damage.
  2. It took 13 days to diagnose Freya, and therefore treat her (outside of the ‘magic’ window).  Add that to the high risk factor,  and she didn’t really stand a chance.
  3. Under the circumstances, it is pretty normal for me to feel afraid.

Thanks to Kawasaki Disease, my now 22-month old daughter Freya has a heart condition.  She was born with a healthy heart, and after just 7 weeks in the world, and 13 days with a mystery illness, Kawasaki Disease broke it.

Looking back I don’t think it was the diagnosis that changed our lives.  Hearing that the doctors had actually reached a diagnosis after two weeks of tests and various failing treatments, was a huge relief.  Even when they told me that it was the damage to Freya’s heart that provided them with the conclusion, I didn’t realise they were talking about something that would stay with her forever.  I presumed the damage to her heart was a symptom, one that would go away with the treatment.  I was wrong about that.  A week after celebrating Freya’s diagnosis I would be sitting in a room with a Cardiologist and a nurse as they told me that if my daughter’s coronary arteries (which had dilated to over 5 times the size of a normal baby) ruptured, she would die.  They could not prevent it, and they would not be able to save her.  That is what changed our lives.  Until then I had never considered the possibility of losing a child.  Facing that possibility head on, with no sugar coating, rocked the very foundations on which I had built my perfect, indestructible life.  Of course, nothing is promised, there are no guarantees, life is fragile (and all those other clichés you see on Social Media memes), but I really didn’t think any of that applied to me. Stuff always happens to other people, doesn’t it…

20 months post-diagnosis, and I think I can dare to say that we are in a pretty good place (frantically touches wood).  Freya’s coronary arteries showed significant improvement in the months following her diagnosis.  Her heart function appears normal, her coronaries have remodelled to within ‘normal’ parameters and she shows no signs or symptoms of anything troubling going on in there.  Good news, right? I guess that’s how we take it for now.  The thing is though, that dealing with Freya’s heart is one thing, but add in the complications that come with ‘rare’ (KD affects just 8:100,000 children in the UK each year) and you find that ahead of you is a lot of uncertainty, confusion and contradiction.

There are a number of long-term complications from Kawasaki Disease.  We often hear the words ‘normal’ from Freya’s cardiologist, we are also told by world leading specialists in this disease that Freya’s heart will never be ‘normal’.  We are told to celebrate remodelling, but warned of possible stenosis (narrowing of the previously dilated arteries).  We are told stenosis will take decades to occur, but read stories of emergency heart bypass surgery within months of diagnosis.  We are told to live a normal life, not to worry, but research shows that 80% of children who suffer significant damage to their hearts as a result of KD will require surgical intervention later in life.  Our doctors talk about what they see and know, but do not give confidence that they are familiar with all of the ways in which KD alters the child’s heart.  I won’t even pretend to fully comprehend all the possible risks associated with Freya’s heart.  I read about fibroblasts, myocarditis, and damage to the heart muscle, but I can’t begin to understand what those things mean in relation to Freya’s heart.  No matter how much I have learned and think I know about this disease, I didn’t spend years in school learning about human hearts.

When I allow myself to think positively about the prognosis for Freya, I believe she has a good chance of living a normal life.  But then I worry that I am becoming complacent.  Freya’s doctors have shared that they have a degree of anxiety over Freya’s condition, and need to take a closer look.  They’ve postponed that closer look until later in the year, and I worry about what changes might be occurring inside her heart in the interim.  Only a few days to wait for some reassurance on that score (Freya’s next cardiology follow-up is on Monday 13th March).

When I consider that there is a possibility (though perhaps not a probability) of Freya suffering a heart attack, for example, I find myself suffocated by the thought. It’s like there is no end to the suffocation because you never know when something like that will strike. And I know that can be said for anyone, but the worry is more tangible when you are faced with a known condition with associated risks. When I wake in the morning, I lay paralysed in my bed until I hear something through the baby monitor that will defy my worst fears – a rustle of a sheet, a snort or a murmur from my sleeping girl. Not until I hear a sound do I let out the breath that I’ve been holding since I opened my eyes.  I’m sure every mother could say the same, we all worry about our children don’t we.

Aside from my concerns for Freya’s future, the uncertainty that came with our daughter’s heart condition has caused me to question my own mortality too. I was never afraid of death before, I don’t think I gave it any thought. Now I am terrified. Until just now I thought it was just because I love my family so much that I am afraid of leaving them behind and missing out on what is yet to come. But actually I have come to realise that I am not afraid of dying, per se, I am afraid of dying too young. I have had to work so tirelessly, stay so strong, fight so hard to keep on the front foot with our daughter’s condition, that I fear for her future if I am taken from her too soon on her journey with this disease.  I am afraid that she will enter into adulthood not realising how important it is that she keeps her heart healthy, or how she may need to have a cardiologist on hand in labour if she ever has children of her own.  I worry that others will forget about all of this, because they can forget.  There are no visible reminders of what this disease did to Freya, so it wouldn’t be hard to put KD firmly in the past.  Me; I’ll never forget. The last 2 years are etched in my memory so deep that I can play the entire journey in my mind as if I were watching a video recording.  And my overactive imagination has managed to convert my fears into a DVD that plays for me over and over – I have ‘seen’ moments where life ended, clearly enough to feel the loss as if it were real.  Perhaps the intense fear that I have about losing my daughter is one of the lasting gifts that KD gave me?  Perhaps it has helped me to treasure what we have more than I may have done without it?

I think I would have been able to handle the effects of Kawasaki Disease better had it been more commonly known.  The rarity of the disease means that we don’t really know what the future holds.  We can guess, we can use the limited amount of information that is available from adult KD studies, we can trust that Freya’s doctors understand what they are dealing with.  We can have faith that it will all work out, that Freya is a little fighter,  a tough cookie, a miracle.

People tell me I should stop worrying.  They tell me that no amount of worrying will change the future.  Some tell me that the future is out of my hands, that ‘someone’ already has a plan for us and we should put our faith in ‘Him’. Some say that any one of us could get run over by a bus tomorrow or struck by illness.  They are all right of course.  Except accepting that something could happen, and knowing that something might happen, are two completely different things.  The fact is that the most important organ in my child’s body is faulty, and she only has one of them.   I am finding it easier to deal with that with each day that passes.  I find it easier to be optimistic about the future, even if only cautiously so.  But I won’t ever be completely free of the overwhelming sadness that this disease brought to my doorstep, and I will never stop being afraid of what this disease might yet have in store for Freya .

Kawasaki Disease didn’t just break Freya’s heart.  It broke mine too.

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On why I might once have been angry…

I had a conversation recently with a Paediatrician at our local hospital, who whilst discussing a current medical issue brought up that he was concerned that he had heard that I was angry at the hospital for failing to diagnose my daughter when she became sick in the early Summer of 2015.  He mentioned that I had taken my folder with me to our last visit, and that the staff had commented that I was very angry at the time.  I am not sure when he was referring to, as our recent visit when I took the file was actually a positive experience, and I was impressed by the communication between the three hospitals involved in Freya’s care.  Yes, I took my folder with me, but I take it with me everywhere.  That folder contains the letters from every clinic appointment Freya has had in the last 18 months – Rheumatology, Cardiology, Immunology.  I take it everywhere with me in case a medical professional needed to see the history, and actually it was useful because the hospital hadn’t been copied in on the letters and took copies from me while we were there.

The fact that the doctor brought it up has been niggling me for a little while, so I thought I would try and capture why in this blog post and try to explain why a parent might act in a certain way when their child has been critically ill.

When Freya became sick in May 2015, she was immediately admitted to hospital and her condition very quickly deteriorated.  Within hours of being admitted, she went into septic shock. When the first doctor who saw her decline started to take action, I felt like she was in good hands.  They moved swiftly but calmly as they got her into the High Dependency Unit to administer fluid resuscitation.  I remember the Consultant giving out instructions to the doctor and the nurses in the room, and they responded quickly, without any alarm.  I could feel the tension in the room, and I watched through the bars at the end of the cot in quiet disbelief at what was happening in front of my eyes.  But I watched in awe, not really knowing what they were doing, but feeling that it was right, whatever it was.

For 6 days, Freya was treated with a number of antibiotics.  The main suspect was meningitis, but she was too sick and weak to have a lumbar puncture to diagnose it.  During that first week, Freya displayed a fever that would not abate with the usual paracetamol and ibuprofen combination.  She had sore, red, cracked lips – with hindsight that was a symptom of Kawasaki Disease, but it was attributed to dehydration at that time.  She developed a rash all over her body, but in the first week that would disappear almost as quickly as it came.  Her hands and feet looked puffy and swollen, another symptom of Kawasaki Disease, but with KD being so far from everyone’s minds with her being such a tiny baby, it was put down to swelling at the cannula sites.  Numerous blood tests were taken in an attempt to identify whatever it was that was making Freya so sick, but nothing except the common cold virus (Rhinovirus) would show up in that first week.  That wasn’t enough to make my little girl so very poorly.  A lumbar puncture on day 6 would be inconclusive – elevated white blood cells, but no definitive sign of meningitis.  Perhaps the cocktail of different antibiotics delivered intravenously in that week had dealt with it? So why wasn’t she getting any better?

Apart from one locum doctor who visited Freya in the HDU and suggested we stop all the medication rather than find a new cannula site (I know, right?!), every nurse and doctor that took care of Freya in our local hospital was fantastic.  Not only did they take care of Freya, but they took time to take care of me too.  They treated Freya as if she were one of their own children, and they showed an interest in me, listened to me and showed me nothing but respect.  Some of the faces I can’t even remember, but there are a few that stand out and are etched in my memory, even if I can’t remember all their names.  There were moments too, that I’ll not forget. The time that one of the senior nurses removed all of the equipment from the room so that we could allow my other children to visit without frightening them, that was a highlight.

I hope that the nursing staff know how much I appreciated how they took care of Freya.  If I had any complaints at all they were tiny – it bothered me that the syringe packaging was sometimes left at the end of Freya’s cot.  It didn’t cause anyone any harm, just paper and plastic, but it made me feel bad because her cot wasn’t a dustbin.  The time the heart monitor failed in the night and they replaced it, but left the broken one at the foot of the cot; it was my baby’s bed, and although she took up very little room in it, I didn’t want those things left discarded like it didn’t matter.  And that’s it really, my only criticism.  And I know it might sound petty to share, but I hope that any nurses reading might think about how such a small oversight even when they’re obviously run off their feet, could make a new mother feel when she has too much time to think.

Even though the first hospital failed to reach a confirmed diagnosis, I do not feel anger towards them.  It is easy for me to sit here now and say that Freya’s symptoms were clearly indicative of Kawasaki Disease, but hindsight is indeed a wonderful thing, and I don’t know that they could have done anything differently.  In fact the Paediatrician said that he could understand my anger had Freya been diagnosed within hours of her transfer to the children’s hospital, but it took them a further week to diagnose her, so it was clearly not an easy undertaking.  I said that they had looked for KD on the first day in the new hospital and he said that was right, because it was he who had suggested that was what they should look for.  And now it makes sense why when they told us they were moving Freya, that they mentioned a heart scan.  I thought it was just a routine thing, but clearly they had a suspicion that needed to be confirmed outside of their own local facilities.  And that’s probably my one and only criticism of the doctors of our local hospital –  I wish they had told me what they were considering.  The problem is I never really asked them what they were looking for.  I was naive.  I thought they could just take her blood, plug the results in and hey presto! technology would have the answer.  So I let them do their work, and didn’t ask a thing.  The only question I wanted answering was one that I didn’t have the courage to ask.  I gave that task to my husband; is she going to die?

Had the doctors mentioned Kawasaki Disease, would it have changed anything? Well, you know that is a question that has haunted me since Freya’s diagnosis.  My instincts tell me that I would have read about the disease and asked more questions.  I would have asked the most important question of all, “Why isn’t it Kawasaki Disease?” And when they told me she didn’t have some of the symptoms I would have cried, “Yes! Yes she does, see?!”  They would have reached a diagnosis and given Freya the treatment on day 8, not day 13 when the damage had already been done.  We would have left the hospital, emotionally bruised, but with a child that had been very ill but was now well.  And we would have gone back to our normal lives…

The reality isn’t quite so straightforward.  Would I really have come to the conclusion that the doctors couldn’t, simply by reading what I could find on Google? I have heard of cases that have been diagnosed entirely because of the parent’s knowledge.  Would I have done that? Or would I have read about this obscure disease with it’s stupid motorbike name, laughed and moved on?  I guess even if I had helped them to reach a conclusion, even if they had managed to give her the treatment within that magic 10-day window, Freya was in the category with the highest risk of heart damage – a neonate, female, displaying severe symptoms which we now believe was KDSS.  When she finally got the treatment, she was resistant to both doses, and needed much more aggressive treatment to finally halt the path of the disease.  Maybe she was biologically destined to be one of the unlucky ones?

That said, I wish the doctors had told me about Kawasaki Disease.  It might not have come as so much of a shock when it was finally diagnosed, I might have been better prepared.  The Children’s Hospital decided not to mention it too – had they told me that was what they were looking for when they did the first echocardiogram on day 9 which showed them a reasonably healthy heart (a small murmur) and led them to rule it out as a prime suspect, perhaps I would have reminded them of the symptoms they hadn’t seen for themselves the previous week when we were at the local hospital?  And perhaps I would have had more respect for the doctors in the first week had I known that they suspected it first, but weren’t in a position to confirm it.  That’s why they moved Freya.  They wanted the Children’s Hospital to confirm or deny their hunch.  The Children’s Hospital did an echo and the results lead them to turn their investigations elsewhere.

I felt angry about that for a long time, in fact I’m not sure if a part of me is still angry.  I was initially angry at the local hospital for not getting it in that first week. Let’s face it, when we finally got the diagnosis and learned that Freya’s heart had sustained permanent damage, we were angry at the whole bloody world.  Now I know that the local hospital had KD on their radar, I feel less angry.  I only wished they’d told me.  So how do I feel about the Children’s Hospital?

Much like my experience locally, I met some really fantastic nurses during our stay.  In fact in all three hospitals (Freya would be moved to a Cardiac Unit in another hospital upon diagnosis) we met some of kindest, most caring people I have ever had the pleasure to meet.  I guess that’s why they do the job that they do.  It was a much busier hospital, so there was less time for chit-chat and the nurses seemed run off their feet moving from patient to patient to carry out observations and deliver medication. We were in a private room with Freya so were quite out of the way, which was isolating at times.  There were a couple of issues with medication – an oversight that meant she nearly didn’t get the second half of the drug that was meant to be saving her life and was only pointed out by me when I awoke to see there was no IV going in; that was a big one.  A lot of the time I felt like we were more of a number than we had felt at the previous hospital, but I’ll play Devil’s advocate that they were just so busy.  The majority of the nursing staff were wonderful, especially with Freya, which is what matters.  The nurses that came to talk to me in the night when I lay there crying on the foldaway bed, those that rocked Freya to sleep when I didn’t have the energy or the heart, they’re the ones that have stayed with me since our ordeal.  The actions of the nurse who accompanied us on a transfer to the cardiac unit when the ambulance didn’t arrive to return us until well after her shift will never be forgotten.  She saw it as her absolute duty to care for Freya and made arrangements to ensure that Freya’s medication and observations were carried out in that delay.  She had finished her shift hours before and had her own child to get back to, but all she could think about was keeping Freya safe – it distressed and frustrated her that she was unable to care for her patient, and she did something about it.

The Doctor’s at the Children’s Hospital were always around, either popping in to check on Freya, discuss possibilities.  They always seemed to be busy looking at the files, searching for answers and I don’t doubt that they lost many winks of sleep trying to work out why this beautiful little girl wasn’t getting any better.  I didn’t know until way after her diagnosis that KD had been considered and ruled out.  I wish they had told me at the start.  But again, maybe it wouldn’t have changed anything.  I would like to ask them now why they didn’t think it could be KD, and not just because the first echo was clear – you can’t diagnose KD from an echo.  They believed that Freya’s only symptoms were the fever and a rash.  I believe that her cracked, red lips and the swollen hands and feet were also symptoms – enough symptoms to confirm a diagnosis.  Had they understood more about the disease, might they have also known that whilst KD is very uncommon in young babies, young babies are more likely to suffer from Kawasaki Disease Shock Syndrome? Had they considered that, might they have realised that whilst thrombocytopenia (low platelet count) is not a common symptom in KD (in fact is is usually very high), it is a characteristic of KDSS?  Might they have looked back over the previous week and seen that everything about her was synonymous with a KDSS diagnosis?

Perhaps my expectations of them are too high – they cannot possibly know every single childhood ailment in detail.  There are over 7000 rare diseases in this world and KD is just one of them.  Some doctors won’t ever have seen a case in their career.  They spend most of their career dealing with ‘horses’ and are not on the look out for the odd zebra that might turn up.  Is it only hindsight that allows me to see now what they couldn’t then?  I do know that they have learned from Freya, that she has taught them a lot about the disease.  I do know that they are less likely to make the same ‘mistakes’ again.  Again, I just wish they had told me what they were looking for, and why it couldn’t be Kawasaki Disease.  Because when they ruled it out, for whatever reason, no matter how unusual Freya was, they got it wrong.  They got it wrong, and I will never know if that decision was responsible for the damage that KD did to her little heart.  I cannot change the past, though, and so I have to be thankful for the doctor who came to see her when the rash appeared on day 12 and suggested she be sent for another echo.  That echo showed the damage that confirmed it had to be Kawasaki Disease.  That doctor may just be responsible for saving Freya’s life.

So let me get back to the point of me writing this blog.  I guess I wanted people to understand that I may well have been angry at times, but that my anger does not mean that I do not appreciate everything that all those medical professionals did and have continued to do in taking care of my daughter.  At the time I wanted someone to blame for breaking Freya’s heart. And mine.  I was angry at life.  I was angry at a God that I’m not even sure I believe in.  I know now that no amount of anger or blame was going to change anything, but it is one of the stages of grief.  I could not believe that I had taken my perfectly healthy child to hospital with what looked like a virus, and took her home with a heart condition.  That had to be someone’s fault, didn’t it?  Who knows.  Nothing is going to change.

Do I think that a diagnosis might have been reached sooner? Yes, I do.  Do I wish that they had asked me what I thought, told me about Kawasaki Disease and asked me if I could think of anything that they might have missed? Absolutely.  Do I consider myself lucky that Freya fell ill on a Sunday at 7 weeks old and was therefore too much of a risk to leave to chance? That I didn’t have to face countless appointments with GP’s who might have sent us home with the usual ‘virus’ diagnosis? Yes, yes, and yes – when Freya went into shock, she was absolutely in the right place; what if that had happened at home?  Do I thank my lucky stars that regardless of all that anger and confusion, regardless of whether it was ‘too late’ or not, that the right doctor walked in at the right moment on the right day and helped them to reach the right decision? Yes, a million times yes.

I have found peace with that part of our journey now.  I am just grateful that Freya was strong enough to fight, and that she is here, bold and bright and beautiful.  I used to refer to her as ‘damaged’, ‘broken’.  I don’t see her that way anymore.  The hidden faults within her heart are no longer what defines her for me.  And whilst I can’t change the path that we have been down, I can make a difference to the future of Kawasaki Disease by sharing our experience and never giving up when it comes to raising awareness.

I hope you will continue to support us.

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Then and now…

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