An Uncertain Future

I guess we all have one of those don’t we – not many of us know what lies ahead of us.  Some know what might be in their path, but nobody knows exactly how or when those things will happen. That’s why it is important to live life, not take things for granted, and do your very best to be the best you can be. And all the other clichés about living life to the full that might seem flippant, but are actually really true.

But how many people lose sleep worrying about what might lie ahead in our futures? People with anxiety, sure.  Anxiety makes you worry about almost everything.  I imagine the majority of people think about their future, but worrying about what might happen next year, in five years, in twenty years… I don’t think that is common.  Amongst the rare disease community uncertain futures are a given.  Many people living with rare diseases don’t have a diagnosis for their ailments and spend years searching for answers and fighting for treatment.  Some have a diagnosis, even treatment, but have no idea how their lives might take shape with the disease they are living with.  Kawasaki Disease is one of those.

Take Freya.  I think most people think that she is okay now.  She had this disease that made her really sick, but she got treatment and now she is at home living a ‘normal’ life and looks perfectly healthy, like any other kid her age.  And in the most part that would be true, except for the ‘normal’ part.  You see, if you weren’t already aware from my previous blog posts, Freya was one of the 6% of children with Kawasaki Disease who sustained damage to her heart despite treatment.  The disease causes inflammation of the small to medium arteries throughout the child’s body, and if treated quickly enough heart damage can be prevented.  In those cases where treatment is delayed, due to misdiagnosis (or a lack of diagnosis altogether) Kawasaki Disease is allowed to continue on its destructive path and cause damage that may never be reversed.  Once an aneurysm forms, the child’s heart will never be ‘normal’ again, even if the coronary arteries remodel and aneurysms regress to within otherwise normal parameters.  This leads to complications throughout the child’s life and into adulthood, which is why long-term care and life-long follow up are so vitally important.

The good news in Freya’s case is that her arteries have remodelled quite dramatically from when she was at her most sick.  There are no obvious aneurysms any more, and the arteries that had expanded to over 5 times the normal size for a baby of her age, have now regressed to what would be considered normal in a child that hadn’t been touched by heart disease.  The bad news is that the extent of the remodelling has her Cardiologist feeling a bit anxious.  They are concerned with what might be causing the narrowing of her arteries, and whether that narrowing might continue to progress until Freya’s arteries are too narrow to allow the flow of blood.  When blood can’t get around your heart, that’s when a heart attack occurs.  Sure, Freya takes aspirin every day to try and help keep the blood flowing, but nothing can get through an occluded artery.

That said, do I think that she is at immediate or short-term risk of a heart attack? Hesitantly I say ‘No’.  I say it hesitantly because whilst I have this pretty good feeling that Freya might just be some kind of miracle success story, my experience with this disease is not to let your guard down.  Complacency has no place where this disease is concerned.  Let’s say that I hope that she is not at immediate risk.  We will find out more in the Autumn when Freya will undergo the cardiac catheter angiogram that she was meant to be having last year.  It has been delayed to allow her more time to grow, so that she might be stronger to outweigh some of the risks associated with the procedure.  The rapid remodelling of her arteries has led me in the meantime to insist that Freya receives regular follow up between now and then so that we don’t miss something while we wait.  An echocardiogram won’t show what is happening with the arterial walls, but you can see the diameter of the arteries (up to a point – an echo can only see about 3mm into the artery) so you can get a view of whether they are continuing to narrow.

So what are my fears for Freya’s future?  

Of course I am anxious about the angiogram, but I’ll worry about that more when the time comes around.  I am confident in the ability of the intervention cardiologist, and am happy that it is a relatively low risk procedure.  I’m not too excited about her going under a general anaesthetic – I’ve seen that once before and it felt like I was watching my baby die.  I would prefer never to see that again, but that’s the reality and I will always be there by her side when she goes to sleep, no matter how hard I find it.

I am anxious about what is going on in that heart.  I’d love to have a window to look through so we could check in on it every now and again.  We assume from outward appearances and general health that nothing too sinister is going on, but the fact is we just don’t know.  I’ve read many stories from other KD parents who have experienced dramatic turns of events with their children, resulting in the need for heart surgery.  Sadly, some children have lost their lives to this disease – mostly those that were not diagnosed in time, or at all, but often because the changes in their hearts happened quickly and in spite of regular follow up and treatment.  Nothing is promised.  Do I spend every day worrying that Freya will have a heart attack? No.  Does my heart leap into my throat when I wake in the night and can’t hear her breathing on the baby monitor? Every time.

I am worried about what the angiogram might find, and whether there is any likelihood of Freya needing surgery in the future – around 80% of children who suffer giant coronary aneurysms will require intervention later in life, whether it be a stent or bypass surgery, for example.

I am worried about whether Freya’s diet is sufficiently ‘heart-healthy’ to protect her heart from disease.

I think about when Freya might decide to have children of her own.  Seems like a long way off to be worrying about it, but the truth is that she will most likely need to have a cardiologist involved in her ante-natal care.  There have been cases of heart attacks during labour where the mother had KD in childhood – there’s a whole medical paper dedicated to this subject (yes, I have a copy!).  I even worry about whether I will still be here when she enters that stage in her life and whether she will remember that she needs to consider her medical history.

And this one you might think of as really strange, but I worry about them telling me everything is ok, and that she can stop the medication and live a normal life, with KD firmly in her past.  You would think that should be something I would hope for, and be pleased about.  But, first of all, I will never forget the words of Professor Jane Burns, World Leading Kawasaki Disease specialist, that once a child’s heart has been damaged by KD it is never considered healed, or normal again.  So if  a doctor tells me everything is normal, and tries to send us on our way, then I will be putting up a pretty big fight!  Freya, and all the other children like her, need to be monitored for the rest of their lives.  Rady Children’s Hospital recommend obtaining a CT calcium score 10 years post-diagnosis to help identify and prevent further complications, for example.  It may just be a check-up once a year to make sure there have been no changes over time, but it is the peace of mind that we all need to ensure that there are no hidden issues lurking that might cause a serious problem later on.  Complacency is a killer.

“Oh Jo, you’re so dramatic!” I hear you say.  But you need to understand that I read stories, comments and messages every single day from someone who has been touched by Kawasaki Disease and suffered terrible consequences and devastating loss.  Every time I feel like I will never make a difference where KD is concerned, I remind myself of those stories, or I stumble across a new member of the Kawasaki community and the fire in my belly is reignited.  It is one such story that got me thinking again about the future, and reminded me that although I can hope for positive change in Freya’s condition, I must never allow my own complacency, or that of the medical profession, to create a false sense of security.  The story is that of Lisa Connelly. Her sister Amy has given me permission to share it in the hope that it might help to raise awareness of this disease and the devastating consequences when we get it wrong.

Lisa Connelly was diagnosed with Kawasaki Disease at the age of three.  By age five she had been given the all clear, following an angiogram that showed no persistent damage to her coronary arteries.  I can only imagine the elation of the family as they put KD firmly in the past, and watched Lisa to grow and live a normal, heathy life.  She was very active growing up, and was an avid runner.  She had a beautiful son, Levi, and was very much loved by her family and friends.  Described as “the kind of person you want to be like”, she had a heart of gold and was the first to come to your aid if you were in need.

Out of the blue, on the 25th November 2015, 37-year old Lisa had symptoms of a heart attack. The hospital performed an echocardiogram and Lisa underwent a stress test, both of which cleared her of any issues. Four days later, on November 29th 2015, Lisa passed away as a result of a massive heart attack.

The pathology report on Lisa’s heart showed that her coronary arteries had muscle cell tissue build up on the arterial walls, which caused restriction of blood flow to her heart, thus causing a heart attack.  The family had no idea that Lisa would ever have to deal with Kawasaki disease again, and even after the heart attack they did not consider it might be linked to an illness that she had when she was a child.

Since Lisa’s passing, her sister Amy has done everything she can to raise funds and awareness to prevent another tragedy like this.  Professor Jane Burns has said that conducting a CT calcium test earlier in Lisa’s life may have prevented further complications from occurring.  It was from a Facebook post sharing a medical paper which discusses the importance of a CT Calcium Score that I found Amy, and I am honoured that she has allowed me to share her family’s story in my blog.

Amy said:

“My sister was truly a beautiful light in this world. My sister had a great smile and loved to see others smile. She helped so many people while she was living and we know she continues to help even today.  Our hope is that somehow she helps in the research efforts of KD. So, my prayer is that your blog post reaches someone that takes the information and gets the proper treatment they need to live a long, healthy and hopefully happy life. We’re making beauty from ashes…My mom and dad’s grief has been almost unbearable this past year. And the hardest part for my mom is that the cause of the heart attack was from KD.” 

As well as raising awareness of the devastating consequences of this disease, Lisa’s family have made sure that her legacy lives on, and donated some of her heart tissue samples to Dr. Jane Burns and Dr. Anne Rowley, leading KD experts in the US. Lisa’s organs have also helped to save the lives of four people, and the family are in touch with the gentleman who received her liver.

I know how important it has been to me to make sure that Freya didn’t suffer this awful disease in vain.  We still have our daughter here with us, and thanks to the awareness that Amy is continuing to raise about the potential long-term and hidden consequences of Kawasaki Disease, we can hope that Freya will long outlive us.  I don’t know if I would have had the strength to fight had the unimaginable happened in the Summer of 2015.  As we were starting to get our lives back on track that year, a family was being torn apart by the loss of a truly beautiful person.  I join Amy in their hope that this story might reinforce the need to ensure that Kawasaki Disease survivors are given appropriate attention from the medical profession throughout their lives, and shines a bright light on the insidious nature of Kawasaki Disease.

Writing this, I felt my heart break all over again.  This is Lisa.

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The World keeps Turning

What’s in a date? According to the dictionary, a date is “the day of the month or year as specified by a number.” It’s that simple.  And yet dates mean so much to so many people.  Every day of every year marks something significant in somebody’s life; a birth, a death, a wedding, a break-up, the anniversary of good and bad events that have occurred in a lifetime.

For us, today brings mixed emotions.  It would have been almost impossible not to face today with some sadness at the memories of this day last year when we watched our 7-week old daughter slip away from us with the fear that we may not ever get her back.  It is the day she became critically ill, and marks the beginning of our journey with Kawasaki Disease; Freya’s Story.   It feels somewhat surreal to be sat here today, putting the washing on, clearing up the aftermath of the children’s lunch, normal everyday things that a parent has to get on with.  A year ago today our lives were changed forever.  Changed in so many ways, some bad some good.  How did last year change me for the worse? Well, for one it altered my perspective on this thing we call life.  We all believe we have the right to live our lives how we choose, and rarely stop to consider the consequences of the actions that we take.  Being faced with the possibility that your child might actually die turns your entire belief system on it’s head.  I had never considered my own mortality before then – why would you? You just coast through this life taking it for granted that it is yours for as long as you want it.  But there are much stronger forces at work than any of us are able to prepare ourselves for, or protect ourselves against.  People get sick.  Kids get sick.  This world is full of illnesses and diseases that affect everyone else, and we read stories about them in the News or on Social Media, and think “poor them”, but we rarely stop to consider that the trials we see other people facing from a distance may land themselves on our own doorsteps one day.

I had never felt so much anxiety about the brevity and uncertainty of life before the events of last year.  Now I find myself living a confused life, where on the one hand I wish to grasp it with everything I have whilst I have it – make memories, move mountains – and on the other hand I face it with a fear of the unknown, and a desire to stop time so that we might be able to let go of that fear, just for one day.  Wherever I walk I see beauty in everything, magnified like I’m seeing through the wondrous eyes of a child, but out of the corner of my eye I can always see a shadow lurking and I imagine that the Grim Reaper is sharing every moment with us.  I am reminded of that movie, Final Destination; you can’t cheat death, can you?

But, the 31st May is just a date.  It doesn’t really matter what the date was, Freya got sick.  It doesn’t matter what date we got our diagnosis, Freya had Kawasaki Disease.  It doesn’t matter what date they told us her heart was damaged, Freya’s heart suffered.  Even so, it is hard not to see these dates as milestones, those first hurdles you have to get over after any loss.  And I know I should be grateful that we didn’t have to suffer true loss, but this is still part of a grieving process, and I do grieve for the loss of that perfectly healthy, normal little girl that I was holding in my arms on the 30th May 2015 and all of the 50 days before it.  Some would say I am ungrateful, that I should get over it already.  I don’t blame them if they haven’t been through something like this.  And it isn’t like I don’t want to let it go.  Of course I do – that’s why I see a counsellor every week to help me with the trauma of the last year (as well as a few other troublesome things).  If anyone thinks that I want to be stuck in this perpetual limbo between sadness and joy, that I get any gratification from feeling tears prick at my eyes every time my youngest daughter shows me just how special she is, is mistaken.  I want to be able to move forward, forget the last year, make plans for the wonderful future that I promised myself for my family.  But KD doesn’t let you do that.  It doesn’t just leave, like a cold, or a sore throat; KD leaves permanent scars, physically and metaphorically.

I will allow myself to feel what I feel on these dates, these first milestones.  The day of her diagnosis (12th June) is likely to bring up a lot of the same emotions.  Hopefully I will be better prepared and can plan to do something that will change the memory of that day.  I had hoped to do something today that would give me a new memory of the 31st May, but the awful weather and the restrictions I place upon Freya’s indoor activities (I don’t want her in an indoor play area, during half term, in chicken pox season!) put a stop to that notion. So instead I have tried to distract myself with the children and the chores.  But I sat for a moment and watched the raindrops run down the window, an image that my eyes immediately chose to mimic, and it has left me feeling wretched.  Out there new memories are being made and new anniversaries created and the world just keeps on turning.  And I keep breathing in and out, and whispering to my heart, “It will get better one day.”

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Merry Christmas, Grandad

I had only lived a third of this life when I lost my Grandad on Christmas Eve. I was 13 years old, it was my first loss and I have never experienced another loss like it since.

Twenty-seven years have not altered my memories of one of this world’s most wonderful men. I wish he had stayed here long enough for my children to have met him.

I wrote a poem that was read at his funeral, which from memory went something like this…

You will never be forgotten, Grandad.  Merry Christmas xxx

The Reality of Kawasaki Disease

When the phone rang at around 9:30pm last night and my mother-in-law was on the end of the line telling me to tune into ITV because an episode of Doc Martin was showing a case of Kawasaki Disease, my stomach did a little somersault.  A prime-time TV programme mentioning KD? I could hardly believe it. I switched over a little too late so set the programme to record on ITV+1.  As more and more comments and messages came into the various Kawasaki support group pages on Social Media sites, including Freya’s Story, the adrenalin was pumping.  You could almost feel a collective buzz as parents of children who have suffered at the hands of Kawasaki’s from all over the UK tuned in to witness KD getting a voice.

I couldn’t help but feel a sense of pride in being part of this campaign for raised awareness.  I cannot claim credit for the inclusion in this TV programme, or the coverage in The Daily Mirror last week, but I would like to think that somewhere along the way there will be a link with Freya’s Story and the small bit I have done to help raise Kawasaki’s profile.  I can claim credit of over 300 signatures on the Kawasaki Support Group UK petition (change.org/kawasaki), and I know that a lot of the 500+ people who now follow Freya’s Story on Facebook and Twitter will not have heard about Kawasaki Disease before;

“This evenings episode of Doc Martin includes a case of Kawasaki disease, wouldn’t have known what it was without this page and good coverage to help raise awareness.” (Posted by Facebook user on http://www.facebook.co/freyasstory)

“I saw the Mirror, I have read nearly all of Freya’s story, I have cried for you and smiled at the lovely pictures. It’s amazing though what you have done, I knew you were strong and raising the awareness is fantastic.” (Friend, and follower of Freya’s Story on Facebook)

But I’m not doing this for praise or thanks.  I’m doing it because I don’t want another parent to have to go through what we did, what so many parents have, because of a lack of knowledge and understanding of this disease.

So, what did I really think of last night’s episode of ITV’s Doc Martin?  Initially, I was excited and amazed that Kawasaki Disease had even managed to make in into the public eye in such a dramatic way.  One of the nation’s most prolific TV channels mentioning something much of the country has never even heard about! Fantastic!  And then I watched it.

What were the positives?  Well, you get to understand the symptoms of the disease.  The little girl has a temperature, a red tongue and a rash on her body.  They allude to the fact that she may have peeling skin on her hands when a little boy remonstrates about having to hold the sick child’s hand on a school outing.  The child eventually collapses, and the show’s ‘hero’ appears.  After one look at the child, he makes a rather pompous statement, which went something like “this child hasn’t been eating sweets, she has Kawasaki Disease”.  And just like that, after seconds of seeing the child, he makes his diagnosis and drives the child at high-speed (she may die within 30 minutes apparently) to get her the treatment she needs to avoid the risks of a coronary artery aneurysm.  Amazingly the medication is waiting for them on arrival at the hospital and the child receives the treatment.  In terms of the programme, this whole thing took 3 minutes.  Remarkable.

So why the long face? It didn’t take long for the celebratory feelings to wear off once I let what I had just watched sink in.  Part of me still wants to believe that no matter how the issue was covered, any coverage is good for raising awareness of a disease that most haven’t heard about.  But (you could see that but coming couldn’t you!) it was scripted in such a glib and blasé manner that I wouldn’t be surprised if the message was lost on most viewers.  I suspect many won’t even remember the name of it today, let alone the symptoms.  And if they did remember it, I do not believe that anyone who hasn’t experienced KD first hand will have one iota of an idea about how serious, or how scary this disease is.

I know that the ITV would argue that Doc Martin is a medical comedy drama series; it does not profess to deliver messages in a serious manner (that can be left for the likes of Panorama and Casualty who gave KD some airtime about 20 years ago, in the mid-90’s).  We can be grateful that such a rare disease has even made it on the ITV radar, I guess.  But when you’ve watched your child battle with this disease, you can’t help but be left with a sour taste in your mouth after watching the episode.  In fairness to the programme, however, I am not a regular viewer so am unfamiliar with the usual format and scripting, and I know that they are likely to come under attack from victims of all manner of illnesses that they cover; they’re never going to please everyone.

If you watched the programme, and you think that Kawasaki Disease is a funny sounding illness, maybe even fictitious, then please know that it is very real, and is the leading cause of acquired heart disease in children.  If you think that it is easy to diagnose on first look at a few symptoms, please know that is not the case and often the symptoms come and go, disappearing just when you needed them to be seen.  In fact in many cases, not all the symptoms are present.  If you agree with Doc Martin’s assessment of the child’s parent being negligent by not noticing the signs, then please know that most medical professionals in our country have never heard of Kawasaki Disease, and many mis-diagnose the illness, sometimes with catastrophic results.  If you think that the treatment is readily available, please know that intravenous immunoglobulin is in short supply, and it is expensive.  It’s a product derived from human blood; we’ve probably all seen the marketing campaigns from various blood donation schemes recently – there is not a bottomless pit full of blood that we can all tap into at any time.  And if you think that all cases of Kawasaki Disease have a happy ending, you’ve just got to be a part of the support groups on social media sites to know that isn’t the case.  There are children currently fighting for their lives, and many that have lost their fight altogether.

I am disappointed in the programme, not only for its flippant handling of the illness, and think they could have done more to make it clear that this is a sinister disease that needs some real focus.  Many programmes include messages in the credits to support people who may have been a victim to the contents of an episode.  I think the ITV could have at the very least put up a public message about Kawasaki Disease, making it clear that this is very real, and even just supplying a link to NHS Choices for further information.

In order to reach a diagnosis, I had to watch a 7-week old Freya battle constant temperatures above 39 degrees for over 2 weeks.  Her heart rate was dangerously high.  She was resuscitated in a high dependency unit after her body started to shut down.  She had cannulae in every site possible in her tiny body, delivering a cocktail of various potent antibiotics, ibuprofen and paracetamol, and she was being fed through a tube.   She had blood taken every day for a period of 6 weeks, sometimes twice a day.  She had an MRI scan, ultrasounds, x-rays, ECG’s and echocardiograms.  She had 2 lumbar punctures, one under general anaesthetic which they performed at the same time as performing a bone marrow aspiration to test for Leukaemia.  She received a blood transfusion when her haemoglobin levels dropped dangerously low.  And she has received intravenous immunoglobulin – a product that is derived from thousands of blood donors – as well as a drug that shuts off the protein that is instrumental in the body’s fight against cancerous cells.  She is not even 6 months old yet.

Sounds shocking to read it all like that, doesn’t it? See all the tests that she underwent, just to try and work out what this illness was.  Kawasaki Disease threatened to take her life.  If the Rheumatology Consultant that came so see her on Day 12 of her illness had not suggested performing another echo “just as a precaution” the damage to her heart would have remained undetected, and her coronary arteries would have continued to dilate further and further until perhaps they wouldn’t have been able to stretch any more.  That means rupture.  Rupture means sudden, unavoidable, unpreventable death.

Now think about what you just read about Freya, and imagine now that her case is not the worst by far.  Yes she had a severe presentation of the disease, and her life was in very grave danger.  But as I type there are parents fighting against doctors won’t entertain a KD diagnosis, parents whose precious children have been in hospital for weeks struggling to fight off the disease, parents who still co-sleep with their children for fear of losing them, and worst of all there are parents sitting at home wondering how they will ever recover from the death of their child.

I cry every day.  I cry when I hold Freya in my arms and am overwhelmed with how much I love her.  I cry because I can’t shake the images in my head of how close we came to losing her.  I cry when I see other people happy, without a care in the world and no appreciation of just how lucky they are.  I cry because I am still heartbroken that this happened to my baby girl, before we had even had a chance to get to know her properly as Freya, just Freya.  I cry because I am so scared about the future.  I cry because I daren’t take Freya to baby groups for fear of her contracting chicken pox or the flu (as they can develop into another rare and potentially fatal disease, Reyes’ Syndrome) and I cry from guilt that she is missing out on a massive part of her development as a result.  When I visit the children’s ward at the local hospital where this all started, I have panic attacks.  Even this week, when I thought I’d be ok and felt no anxiety approaching the hospital, I was suddenly struck by uncontrollable sobs, and I couldn’t breathe.  I cry because I am grieving for the loss of my child’s health – she was perfect when she was born; Kawasaki stole that from me far too soon.  I cry because I feel the pain of every parent who is going through this, or something similar.  And I cry with frustration that more isn’t being done to improve the advice and support that is currently being offered by the medical profession.  Chances are I cry a lot because I sleep for less than 4 hours a night; not because I have a young baby – she sleeps through the night – but because I am permanently researching the illness or related issues, or communicating with parents and doctors on the other side of the world.  I cry because I am devastated, because I am sad, because I am frightened, because I am exhausted, because I am frustrated.  I cry because I cannot forget the journey we have been on, and am haunted by the playback of the last few months, which is constantly on repeat.