I haven’t posted in a while, so thought I’d give an update
on our little peanut and how life has been.
Overall, Avery has been doing very well.
She’s had regular “hiccups” that keep us on our toes, but all-in-all,
the keto diet and meds are doing their job in keeping seizures at a
minimum. Over the past month especially, she is progressing
behaviorally, her physical energy is improving, and still hasn’t really
regressed as far as baseline academics. Her PT told me today that she has met all the goals they set back in March! From where we started the year, she's moved some major mountains. (And I’m superstitiously knocking on
wood now.)
Over the last six months, we have had some scattered ER
visits, surprise procedures and too many doctor appointments to count. Besides the relentless eye issues, our most
frequent problem has been whenever she gets sick, and how that tends to open a giant
can of worms. Whether it's a serious cause or a run-of-the-mill bug, it most likely means a trip to the hospital. Did she have a seizure, is it her shunt, is
it her cortisol levels, is it from the diet? We base our level of panic on how bad she’s acting. But regardless, if she isn’t keeping her meds down, she can’t
miss a dose, so needs to get them via IV. Being sick affects her adrenal disorder, her
hypoglycemia, and lowers her seizure threshold.
So basically, when she is sick, it’s chaotic.
She gave us a big scare in April, when she had a
tonic-clonic seizure (this is the type that most people think of when they
think of a seizure) the day after her 6th birthday. We were definitely caught off guard, so it
was a humbling reminder of how unpredictable and relentless epilepsy is. Thankfully, we caught it relatively quickly
and gave her emergency medicine. This
was a major learning experience, as it was our first encounter with a
“breakthrough” seizure since being home from her long hospital stay. When Avery was in the hospital January-February,
she had what is called intractable epilepsy, meaning, they couldn’t stop it
with any traditional methods. This can
cause irreversible brain damage and even a stroke. The induced coma plus the ketogenic diet were
able to break the continual subclinical seizures, but she is by no means
cured. So, we are to expect that “she
will likely have breakthrough seizures a handful of times per year*,” which is
what our Neurologist told us to prepare for.
The asterisk being that this is just a minimum expectation – epilepsy
follows no straightforward rules. No two
people are alike, and there are caveats to every prognosis. She may have 3-4 a year, or she could fall
back into intractable epilepsy tomorrow.
We have been told to expect anything.
There is scar tissue webbed throughout Avery’s brain (left from the
meningitis infection), she has a foreign device implanted, effects from rising
and falling pressure on her brain - in general her brain is classified as “abnormal”
in terms of structure and activity.
These are all factors that contribute to the misfiring that is
epilepsy. Since most of her seizures
were “subclinical,” meaning only visible if connected to EEG, we have had to
learn about the other kinds. Besides
that breakthrough seizure in April, we are only aware that she’s had at least
one Absence seizure, which are not convulsive, rather staring off and
unresponsive, followed by conking-out-sleeping (my technical terms). These were likely triggered by stress or heat. At this point, there are not many options for
combating her epilepsy. She is not a
candidate for surgery at this time, which is bittersweet when you’re in a
refractory situation. We hope that the
medicines she is on continue to work, but the seizures often find ways to get
around those over time. Sounds crazy,
and it is. Same with the diet. We are often asked how it’s going and how
long she’ll be on it. It’s not a definite,
like everything else. It is working
right now, and she could be on it for 2-3 years, in the hopes that her brain
will reprogram. But our expectations are
realistic. We have researched enough and
talked to enough people to know that at any given point, it can stop
working. We hope that isn’t the case,
but are prepared to shift course. We
pray for the best scenario – she becomes seizure-free (or close to it) for at
least a year, and we can wean her off medicine, the diet and maybe on to CBD
(cannabis) oil. The side-effects of the
drugs are almost as damaging over time as the actual seizures, so the goal is
always to wean off them. And the diet is
not a long term solution either.

She is a total champ with everything, though. She takes four medicines, multiple times a
day, in addition to her many eye drops.
All in pill form, because liquids contain sugar. We cut them up and she just takes them –
still amazes me. The seizure pills make
her really tired, but that seems to be getting better. And she actually eats these crazy keto
meals! I look back to where we started
and am very grateful things got better, because it was a nightmare in the
beginning. We are fortunate that she is
the way she is in regard to this diet, because she doesn’t completely
understand that everyone else is eating better foods – or maybe she does, and
is just quietly cooperating, which is just as likely! I always say that if Lucy was the one needing
to do it, I don’t know how long it would last.
Avery asked for other foods for the first few weeks, but has
adjusted. I did stop buying many of her
old favorite foods for “solidarity” purposes, and we try not to talk about
bread, cereal, ice cream, etc. in her ear shot.
Prepping meals, weighing everything and following the schedule has just
become part of our routine, and we are always figuring out new recipes and ways
to make it more palatable. And, we are
learning how to make the most of being on this type of diet. She is not an ideal age or on the ideal
version of keto - especially for a kid with growth issues to begin with - but
choosing the cleanest and most healthy fats that we can will hopefully reduce
all the downfalls of putting a small child on a restricted diet such as
this. Because we don’t have a choice
right now.
Epilepsy has come with a lot of new baggage that really
sucks. She has additional restrictions
on top of an already long list of restrictions.
While it was never recommended she be in high heat for a long period of
time due to hydrocephalus, it is much stricter with the risk of seizures. Her body doesn’t seem to regulate temperature
like it should. And in general, heat and
high humidity, for whatever reason, are triggers for seizures, so we are
limited on hot days. Instead, we take
her to her favorite indoor places, or go out for short periods of time. The times we have kept her out longer than
usual, we see an obvious difference in her behavior, so it’s a precaution we
take very seriously. Anything we can do
to prevent a visit to the ER, we will do.
In addition to heat, she can’t participate in pretty much anything
involving food, which breaks our hearts.
Birthday cake, going out for ice cream this summer, eating at a
restaurant, etc., are just not options.
And we don’t feel right doing them in front of her, despite the fact
that she’d probably not see or notice anyway.
It’s something we are working on making as “fair” as possible. She isn’t interested in other rewards, such
as stickers or getting to pick out new toys.
We have to be creative with her, and follow very unconventional methods
of rewarding, entertaining and passing time.
The diet also limits her energy and contributes to her hypoglycemia, so
it’s not like she can run around for hours.
Then there’s all the “extras” – the side-effects of her issues as a
whole: behavior and sensory issues, and being developmentally delayed. While they’re secondary to our immediate
concerns, they affect daily life for all four of us.
I’m sure it’s noticeable when we come to a barbeque or
gathering that things are different or we seem distracted. Or we just don’t come. Or half of us come. And I can see how it can be misunderstood for
being antisocial or stand-off-ish, but it's really not. I am an admitted helicopter
mom with Avery, and being that I’m completely not with Lucy, shows that it’s
because of the very different experiences I’ve had with my two children. We have to be mindful of so many things when
we’re out of our house and it often contributes to how we’re acting. With her limited vision, and still learning
to properly use her cane, we have to make sure she doesn’t wander off, bump
into something, fall down stairs, etc.
With her other health issues, we have to make sure she isn’t grabbing
food somewhere, or that another child isn’t giving her food because they don’t
know she can’t have it. If it’s hot, we
have to make sure she is staying cool and taking breaks. And since her diet provides limited energy
from food, she can’t burn her “reserves” by over-exerting herself. It's a lot to keep up with, while still letting her be a kid. We
struggle every single day with finding balance between living life and being
safe. Some days we go overboard. Some days it’s hard to come to events. It’s been six months since we took a child
home from the hospital that we were told may not ever leave her bed. It’s scarring and takes time to adjust
to. And each time a hiccup happens, we
are a bit more guarded. We aren’t even
at a point now where leaving a 20-mile radius of Children’s Hospital is a smart
option. What seems to be the hardest
point to convey is that this lifestyle isn’t changing for us; Avery doesn’t
have the types of disorders that go away.
But how we handle it hopefully will get better. We just need practice and time to loosen
up. She has evolved over the last six months –
sometimes taking two steps forward, then one step back. I know her body language when it’s becoming
too overwhelming or too exhausting. And
I know her body language when something is just not right. So it’s important to me to explain because I
want those close to us to understand a little better.
Our newest concern (as if the kid needed another thing) is
her left eye – which is her only working eye – and it is having glaucoma issues
again. To put off surgery, we tried
another med, but she had a horrible reaction to it, so that's not an option. We try to avoid surgery at all cost, but sometimes it’s the only option to save her remaining sight. She had a procedure last week to determine if
the tube in her eye is filtering fluid properly, or if there is a need for a
second tube. It was a good and bad
outcome in that they were able to fix the present tube, but the pressure shot
way down, which can potentially cause other issues. We have been in the office many times since
to ensure her eye is recovering properly, and during one visit, we learned of
an additional issue on the surface of her cornea. This cornea has been stable for three years,
so that’s another devastating kick to the gut.
Keeping this eye functional is Avery’s only shot at sight. No, it’s not life-threatening, but to take
away the limited vision she has would seriously impact her life. It took her months to slowly regain the lost vision effects of the seizures, so she just doesn’t need another road
block. And, any anesthesia is a bigger
pain in the neck these days, so it’s all more complicated. Your prayers and positive thoughts are much
appreciated, as always.
Despite all the challenges, as of today, we really are doing
well. Or better than expected, not sure
what’s more accurate :) We’ve been able to
get into a (new) new normal with daily routines and juggling everything that is
our life. Spending quality time with the
girls is a priority, any way we can make that happen. Lucy is a wonderful little sister, and as of
last week, is officially potty-trained!
Such a relief to check that off our list. She’s also starting to understand more why
Avery sometimes gets more attention, or why she has to stay at (insert one of our generous helper’s name)’s
house while we go to the doctor with her sister. She already is and is going to be a great
protector. She and I were able to get
away for a few days up to Charlevoix, so that was a nice break for both of
us. John’s turn next J
If you are one of the people we’ve had to cancel on,
reschedule with, or just say “no” to plans with in the last 6 years, know we
are sorry and hope you understand. We
make every decision around Avery and her needs, from whether we can go
somewhere, how we can both keep up our work schedules, and in making plans for
the future. We appreciate everyone’s
patience, understanding and support as we navigate this. We aren’t as available, reliable or fun as we
want to be – but please know that we really do want to be more of those
things. As the kids are saying these
days, the struggle is real…with good days and bad days. We are very thankful for a stretch of good
days. As with most things in life, it could always, always be worse. Try not to sweat the small stuff or take your health for granted...it is the most important thing. Thank you for following her story and your
support for our family!
-Ann
Keywords: epilepsy, intractable epilepsy, ketogenic diet, Peter's Anomaly, glaucoma, cornea transplant, pediatric seizures, hydrocephalus