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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The Thing with Rare Diseases…

is that they happen to someone else.  At least that’s what I thought.  What are the odds of my little family being struck by some random illness that nobody has heard of? Well, I’ll tell you. 8:100,000. Those are the odds. 8 in every 100,000 children in the UK are diagnosed with this condition every year. The illness is called Kawasaki Disease. My daughter is Freya.

Today is National Rare Disease Day, so I thought I would focus on that for the subject of my latest blog post. I want to tell you what it means to have a rare disease enter your world.

The thing with a Rare Disease is…

They like playing hard to get.  Some of them are so well-disguised that they masquerade as a number of more common illnesses.  Take Kawasaki Disease.  You take your child to your GP with the symptoms of KD and you’ll most likely be sent home with the word ‘virus’ ringing in your ears. You’ll be told to give four-hourly paracetamol, interspersed with the same regular dose of ibuprofen; antipyretics to keep that troublesome fever down.  Days will pass, but you’ll believe the drugs will eventually do their work once the virus has run its course.  How many days do you let it run its course for? 3 days? Maybe more?  Did you know that there’s a UK medical protocol for dealing witha child  who has presented with a fever for more than 5 days? You’ll tell yourself that the rash that appeared after a couple of days is simply viral.  The eyes look bloodshot; wow this cold really has taken it’s toll on them. And your child is irritable and lethargic all at once, but aren’t all kids when they are poorly? You might even return to the GP, get a course of antibiotics, keep on with those painkillers to take the heat off the discomfort, literally.  Your GP might diagnose Scarlet Fever, or perhaps hand, foot and mouth.  Chances are, your child will not receive a diagnosis of KD until it’s too late. Until the vasculitis that has inflamed every blood vessel in your child’s body has managed to reach their little heart.  Coronary artery dilation and/or coronary artery aneurysms. There’s really only one thing that can cause those in a kid. Kawasaki Disease.

That’s not quite how it happened with us. We were one of the ‘lucky’ ones in that our daughter’s age and the day of the week played a huge part in getting her in the right place at the right time.  At 7 weeks old she was too young for Calpol, and on a Sunday there’s no GP to get it wrong. That said, Kawasaki Disease disguised itself as bacterial meningitis for the first week of Freya’s illness, and then decided to affect her body atypically, making the job of reaching a diagnosis all the more challenging.

It’s quite often a rebel without a cause. Where KD is concerned the cause is yet to be discovered. Without a cause, and with so many children presenting with the illness in a very independent way – not all children get the same symptoms at the same time – there’s no diagnostic test.  The treatment for the disease is effective, but we’re not really sure why.  Knowing the cause of this disease would open the door to swifter diagnosis and better treatment.  With KD it’s a bit of a race against time.  There’s a magical 10-day window within which to treat in order to improve the chances of the heart getting off a bit more lightly. Outside of that, the disease can get too much of a head start. Freya’s heart went from normal to screwed within 5 days.  The disease hid itself well for nearly 2 weeks, until on day 13 (unlucky for some) it went “ta-daa” on an echocardiogram. Nice move KD.

Rare means your doctor probably hasn’t seen it. They may not have even heard of it. So they’re most definitely not looking for it. I’ve spoken with GP’s who have not yet seen a case in their 20 year career. Naturally, doctors will work through the most likely culprits first. They’re not on high alert for some disease that quite frankly sounds ridiculous with its made-up name that conjures images of motorbikes (it’s not actually made up, it is named after Dr Tomasaku Kawasaki, who discovered the disease a few decades ago). But it sounds it. Some rare disorders don’t even have a name. In order to reach a diagnosis for a rare disorder, the medical professionals will have to go through a process of elimination with the more common illnesses that bear the same or similar symptoms. They will test for countless infectious diseases but draw a blank. Do you know, I actually thought they would take my daughter’s blood, put it into a computer and out would come the answer. I had no idea before this, that there were things you couldn’t test for. Silly really. Sometimes the Drs will try certain drugs, only to be baffled by the body’s lack of responsiveness. Our daughter had 4 different IV antibiotics entering her tiny little body, and yet she became more and more sick as the days went on. I couldn’t understand why the Drs weren’t making her better. But our child was diagnosed on day 13 and was treated accordingly. There are people out there with illnesses yet to be named, perhaps even discovered. Those people could wait years for a diagnosis. Two weeks felt like torture. I cannot imagine how that would have felt multiplied into months, let alone years.

If you’ve not heard of it, it can’t be that bad. Right? That’s what I thought. The day before Freya was diagnosed with KD she had a bone marrow aspirate taken in theatre under general anaesthetic. The moment they mentioned bone marrow, I knew they were looking for the ‘C’ word. What they found instead was a whole lot of healthy cells, and she was cleared of that. Relief.  But then the next morning you’re told that they’ve found it! You can’t quite believe it because the last 2 weeks have seemed like an eternity and now the wait is over! They tell you your child has Kawasaki Disease and you actually feel the tension in your shoulders disappear. Aren’t we lucky it’s only Kawasaki Disease. Never heard of that one so it can’t be a bad one. No, the bad stuff everyone has heard of. Leukaemia, meningitis…they’re the baddies aren’t they. No this Kawasaki Disease had to be ok. If it was that bad I’d have heard about it. Wouldn’t I? Except that it is that bad, but you don’t hear about it because your local children’s hospital has probably only seen 4 cases in the last year, and they all looked different.

Rare means there are so many unknowns.  If an illness is rare, it might not have been around for very long.  There might not be many known patients with the disease. Which makes treatment more tricky.  There is no standard UK protocol for the diagnosis and treatment of Kawasaki Disease.  That means you really are at the mercy of the doctors that you are dealing with. Again, I believe we were ‘lucky’.  From the moment a diagnosis was reached they worked tirelessly to aggressively handle this disease. NHS England gave permission for certain drugs to be used on Freya that had not been agreed for use in an infant.  They referred to her case as “a very severe presentation of Kawasaki Disease” remarking that the illness is particularly troublesome in very young babies.

Unknowns are hard to deal with, especially if you’re a bit of a control freak like me. I like to have all my ducks in a row. There’s no chance of that with this. And just as you begin to think things are looking up, KD throws you another curveball.   Long term prognosis is sketchy. But in all fairness, what long term studies have been carried out suggest that Freya might just come through this ok.

Rare is lonely. When you or your child is diagnosed with something pretty obscure you literally feel like the only person in the universe that is going through what you are. Because nobody had heard of KD it felt (still does sometimes) like they didn’t really appreciate the seriousness of it.  Even now, with everything I have shared through Freya’s Story, people ask “So, is she ok now then?”  Never quite quite how to answer that one.  Usually with a “Yes she’s doing really well..” When actually what I want to say is “Yeah, unless you count the fact that’s she now has a heart condition and we don’t know what’s around the corner…”  And it’s not just the general public either. You feel very alone when you’re dealing with Drs that can’t answer your questions because they just don’t know.

That’s where support groups come in. Through the various groups on Facebook I have connected with other parents like me who too have felt scared and lonely. Whilst all of our experiences might have differed slightly, one thing that unites us all is an understanding of the fear when you watch your child begin to slip away from you, and the sheer devastation of hearing that your child has been damaged by this disease. And let’s face it,  the heart is a pretty important organ.

Rare changes you. Since Freya’s illness, I have changed.  I suffer with anxiety, and was recently diagnosed with PTSD. I see a counsellor once every week for cognitive behavioural therapy to help me deal with the trauma of the last year. I find it hard to be around people who don’t understand, or don’t make the effort to. I probably find more comfort in chatting to a fellow ‘Kawamum’ online than I would get from a closest friend.  This experience has left me questioning everything I believed about my role in protecting my child.  I grieve for the healthy baby I gave birth to; the one with the perfect heart. And I am very much aware of our own mortality now. I am scared of dying, and I am scared of loss.

There is an upside. I have met some amazing and lovely people along the way. This experience has taught me that life really is precious and that you should embrace opportunities as they arise. I don’t have the strength for disappointment these days, so I have probably reduced my circle for now, a kind of damage limitation.  I take a lot of joy in meeting people who have been touched by Freya’s Story.   I get messages from strangers that remember when she has a medical appointment, or ask me how I got on at my counselling session. The well wishes and words of encouragement from those people has lifted me from the darkest of moods.

The support from friends and local businesses with prizes for a raffle that we will be drawing on Freya’s 1st birthday has been overwhelming. People are so generous, and I am very grateful to them. I may never come to terms with the fact that this happened to us, to our baby girl. But knowing that Freya has touched the hearts of so many has made this journey a little easier to travel.

So on this Rare Disease Day 2016, I would like to thank everyone out there who is helping to shine a light on Freya by sharing her story and supporting us with our ambition to raise awareness and much needed funding for research. Thank you ☺️

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You can follow Freya’s Story with updates on her progress and other KD news at http://www.facebook.com/freyasstory