Day Three was a mixed bag. We finished up earlier than any of the previous days, around 3pm. Pacific had an audiology appointment, which confirmed for their records the normal hearing screen he had at Seattle Children’s a few weeks ago. The rest of the day was spent going over test results and getting education on XP.
Pacific’s neurological tests all came back with good news. He is developing as he should, and his brain structure looks mostly normal. The lab tests we already received were normal, and we should get the results for those yet to come back soon. One of the most important things they are checking is his Vitamin D levels. Because he is protected from sunlight at all times, he requires daily supplementation to keep him healthy. (With us being from Seattle, Vitamin D supplementation is par for the course for most residents already, but it is particularly crucial for him.) Speaking of Seattle, the doctors said that they have previously recommended our city as the best place in the US to live for patients with XP due to the low UV index.
We learned about the genes that are a part of the DNA repair process. There are 8 genes, each with a slightly different job, such as identifying damaged DNA, cutting away damaged DNA, and repairing sections that have been damaged. When one gene is defective, the entire process is disrupted, and the remaining damaged DNA can cause cancer. The doctors have found that Pacific most likely has xeroderma pigmentosum type D. It is the second most common in the US. It also is the source of most XP patients who have neurological issues. About 50% of those with Type D have some sort of neurological issues, from mild to severe, while half are completely unaffected by those problems. Some people have these issues present in infancy, while occasionally there won’t be issues until adulthood. The median age of neurological issues coming into play is between 7 and 12 years old. We’ll be getting Pacific enrolled in early intervention services soon so that any potential problems can be identified and addressed.
Wes and Arcadia took a shuttle bus with other Children’s Inn residents to the Renwick Gallery for the rest of the afternoon after we finished up our appointments. When they got back, the whole lot of us walked into Bethesda to a CVS and dinner. The Tastee Diner was an unexpectedly unique experience. We apparently stumbled into a local favorite through laziness and indecision, and had some of the best waitstaff I’ve experienced in years. The NIH campus is a giant maze, so on our way back we took the scenic route to say the least. Thankfully campus is gorgeous, and we even got to see a doe with her two yearlings.
Day Four at the clinic was blissfully short. We came in early for rounds at 8am (5am Seattle time). Fifty or so medical students and doctors filed in in groups of four to look at Pacific, and pictures from his time in the hospital. We were instructed not to answer their questions, as after leaving our room, they conferenced to discuss what the diagnosis might be for a patient with his symptoms. Several definitely appeared to be on the right track by the questions they tried to get us to answer and the specific things they were examining. We ended our time at the clinic with hugs from the medical team we’ve been working with, and promises to keep in touch.
We’ll be heading off in a shuttle for the airport shortly, and should be back in Seattle just before 10pm. I’m hoping to spend as much of the day as possible tomorrow doing absolutely nothing. I’m so grateful that we were able to come out here and both get answers for our family about Pacific’s condition, and to help the researchers find answers for all those with XP, both now and in the future.
Yesterday was exactly 6 months since Pacific was burned. 6 months since the last time I traveled. 6 months since my life changed forever. He’s officially spent more of his life hidden from the sun than not at this point. What a place to be on the anniversary of the day things changed for our family.
Today the girls were able to go exploring with Nama (my mom). We left for our appointments while they were still sleeping. We started off the day with Neuropsychology. This appointment was a piece of cake. With my early childhood background, I have been able to be confident about Pax hitting his milestones on time, and the visit mostly consisted of me answering questions about what markers he has hit in the social, physical, and other domains.
After this, we checked out the playroom on the NIH campus until our next appointment. Pax had the room all to himself with three grownups and loved getting all the attention. We headed back up to our base on the 13th floor after this, and met with a psychologist who specializes in families coping with major medical issues. I learned the challenges of attempting to keep an 11 month old perfectly still for a CT scan without the use of a papoose board or anesthesia (finally padding the area around his head thoroughly and using Coban tape and a soothing rendition of “The Wheels on the Bus” to keep his head in place for the few seconds it took to run the scan.) Neurology was next, and was a simple appointment, testing basic functions and again talking to us about what milestones he had reached.
While this may not seem like a lot of appointments in an entire day, we didn’t stop moving from the time we woke up until collapsing into our hotel room around 4:30. There aren’t many moments when we aren’t expected to be 100% on to talk to doctors, nurses, and specialists. We have an exhausted baby who isn’t sure what a schedule is any more, and parents who would think that with jet lag, they would be wanting to go to bed three hours late, not three hours early, but that isn’t the case.
I’m incredibly glad that we have this resource available to us. I feel less alone in some ways. I’ve met other parents who have children with incredibly rare life-threatening genetic conditions. I’ve met patients who are getting life-saving experimental treatments. I’ve met medical professionals who know each of their patients by name, along with their parents, siblings, and stories. Our nurse has dedicated the past 10 years of her life to work to working with patients with XP, and has been with us from the beginning of each day until we go back to the Children’s Inn, when she continues at the hospital for hours more.
There’s a lot of processing to do. I’m grateful for the quiet moments when Wes or my mom takes charge of the kids and I can sneak away to update this website and recharge for a bit. I’m grateful for the restaurant that will be delivering us some dinner shortly. I’m grateful for all of the people thinking of us back home.
After a day of travel, today was our first day at NIH, and what a day!
The National Institutes of Health study a number of rare conditions, including xeroderma pigmentosum. While there currently is no cure, they hope that by studying individuals who have this diagnosis, they will one day be able to treat it. We feel so grateful that NIH was able to bring my mom and the girls out to NIH with us. After their donation of some blood for XP research, they’ll be able to explore DC whenever they don’t need to be at the clinic with us.
We left Seattle at 8:10am yesterday (requiring us to be at the airport at 6:10am). This was Wes’ first time flying with kids, and Pacific’s first time flying in general. We were disappointed that Pax’ seat near the window had UV reads too high for our comfort once we got above Seattle’s cloud cover, but he was generally agreeable and even napped twice while we were in flight. After a 4+ hour flight, we landed in Washington DC in late afternoon, followed by my mom’s flight getting in within an hour of ours. After catching a shuttle, we arrived at the National Institutes of Health campus around 7pm local time.
We took care of hospital admissions early, and were able to settle into The Children’s Inn, a special facility that is set up for families receiving care at NIH. Various businesses and community groups provide dinner to families staying there several times a week, and despite the late hour, we found taco fixings in a community fridge, along with a pantry stocked with things we could eat for breakfast.
With darkness already set in, but us on West Coast time, all three kids (okay, and the parents too) got to explore the amazing playground outside. This was Pax’s first time playing on the swings and other such things since the day he was burned, 5 months ago. I never would have pictured our life taking us here 6 months or a year ago, but at that moment as I watched my kids play, life felt right again.
We were up bright and early for our first day of appointments, starting at 9am local time (6am for those of us from the other Washington!) We were greeted by the wonderful Nurse Debby Tamura, who had been the one to give us our presumptive diagnosis over the phone, and talked us through many of our questions. There were the usual consent forms and history taking, which took up the majority of the morning. Wes and I had skin biopsies taken so that they can grow skin samples. The entire family, including Nama, had blood drawn and their skin checked for any abnormalities. The afternoon ended with a photo session of all of us with closeups of the little guy in order to track any future changes. Nurse Debby was with us the entire day, guiding us from one appointment to another. I had heard such wonderful things about her from my friends in the XP Family Support Group, and they were all proved true today!
One expected, but disappointing part of the day, was hearing that they have found difference’s in Pacific’s DNA. There are 8 different types of XP, and we will likely find out what type Pacific was born with on Wednesday. This most importantly should give us a better idea of the likelihood of neurological issues as he gets older, enabling us to better plans for his needs.
Tonight we again ate a community provided dinner, and Wes took the provided shuttle to the grocery store for a few needed items. The kids made their rounds of the playroom, outdoor playground, games room, craft room, and toddler play area. Arcadia is honing her skills in air hockey against her mother and sister. The Children’s Inn has even more spaces than this, including a learning center for those with longterm stays, a teen room, exercise room, reading areas, quiet rooms, and more.
Tomorrow we delve into the workings of the brain- seeing neurology, neuropsychology, and a CT scan among others. Much of this is to establish baselines for Pacific so that we can track any changes that may occur as he grows. The girls will be able to take the Metro from the NIH campus and get their homeschool work in for the week exploring national monuments and museums.