After meeting with the surgeon in February, we decided it was time to get a second opinion. We never felt the need to get a second opinion on the diagnosis, but we wanted to make sure that it was the right time for surgery. So, we made an appointment with the GI doctor that the surgeon recommended to us. We finally saw him the end of March. (This post is way overdue! Sorry!)
Dr. M was very nice and, more importantly, actually has experience with FAP patients. He has both pre and post surgery FAP patients which makes him a good bit more experienced than Dr. B. We shared Wesley's story with him. Like most of the other medical professionals we've met along this FAP journey, he was quite interested to hear the story of Wesley's diagnosis.
Dr. M told us he would recommend holding off on surgery for the time being. Surgery would become necessary when the polyp count is around a thousand. We were a bit surprised to hear that since the surgeon said 20 polyps! He asked us to request a copy of the biopsy results for him to look at before he made a final decision, but from what we told him about the verbal results he said we could wait. Personally, I was happy to hear this. We know the time for surgery will come eventually, but I would like to see Wesley stay whole for as long as possible.
Dr. M also said he was glad to see Wesley was already taking Sulindac since research shows it can slow polyp growth. I was happy to hear that as well because insisted Dr. B put him on it even though he didn't think it would really help. He did suggest a different antacid to go along with it, so we got a prescription for that.
The plan now is to follow up with Dr. M in July. At that time he'll do an exam and see how things are going. If all is well, we will schedule another colonoscopy in December. Having Dr. M do the colonoscopy this time will get us another (second) opinion on the polyp count and how best to proceed. Good news... he does procedures right in his office so we won't have to go to the hospital. We were super pleased to find that out.
We were on the surgeon's schedule for May 2nd, but called and cancelled. Well, it's really more of a reschedule with an unknown date. We had been working really hard to stay on track with school work so we could have it all done before the surgery. Praise God, now we can use that time to swim or read some fun books! Keep praying and stay tuned.
Quick update: Jerry and I finally got our genetic test results. There were no surprises. Both of us tested negative. This doesn't change anything as far as Wesley's treatment goes. It just means the chances of any of the other kids having FAP are pretty much zero. Knowing this we have decided not to test any of them. Of course, we will keep watch for CHRPEs or osteomas or any other issues plus probably suggest earlier than recommended colonoscopy for them in the future.
Showing posts with label medical stuff. Show all posts
Showing posts with label medical stuff. Show all posts
Friday, May 5, 2017
Monday, February 6, 2017
FAP Update - Met with the Surgeon
We met with a surgeon last Wednesday per Dr. B's request. Dr. N walked in shook our hands then turned to me and said, "So, you're the doctor who came up with the diagnosis?" Yes, yes I am!
There were really no surprises. The surgeon said, generally speaking, the surgery should be done once the patient has 20+ polyps. Wesley is well past that point. He said it is a good time to do it. Wesley is healthy.
One of my questions for him was if he knew of anyone in the Phoenix area who specializes in FAP (or at least knows a bit more about it). We all like Dr. B, but he is the first to admit that he doesn't have a lot of experience with this disease. He has recommended getting a second opinion several times. I never felt the need to get a second opinion regarding the diagnosis. I always thought I'd save the second opinion for surgery timing. Looks like that time has come. We got a name and made an appointment, but we can't get in until late March. We would like to see that doctor before surgery so that pushes things out until at least April or May.
Although we had already read about it, it was good to hear Dr. N explain the surgery. It will take place in two parts each requiring an approximate 5 day hospital stay. During the first surgery, they will laparoscopically remove Wesley's large intestine (total colectomy). The surgeon will form a "j-pouch" with the far end of the small intestine. However, this pouch needs some time to heal before it can hold feces so they will temporarily run Wesley's small intestine to a hole or stoma on his abdomen where his waste can flow out into a bag. This is called an ileostomy.
After about 8 weeks, when things are sufficiently healed, they will perform another surgery connecting the small intestine to the j-pouch section and close the stoma. Feces will then be able to come through the small intestine and j-pouch. It will always be more liquid and more frequent than that of a normal person. The surgeon said there really aren't any particular dietary restrictions with a j-pouch, but patients learn what causes things to move through more quickly and avoid them if they won't be near a bathroom.
Wesley will continue to need ongoing "surveillance" of his remaining digestive tract. Endoscopy to keep an eye on his stomach and duodenum as well as the remaining part of his rectal area.
Wesley continues to feel great. I don't think he was really surprised by what the surgeon said, it was all things we had talked about ahead of time. He doesn't have too many concerns at this time, he's most concerned about being in the hospital for so long. Can't say I blame him! As always, continued prayers are appreciated.
This year National Dress in Blue Day for colon cancer awareness is Friday, March 3rd. Wear blue and post a photo to Facebook and tag me or Wesley. He sure enjoyed all the photos our friends and family posted last year!
There were really no surprises. The surgeon said, generally speaking, the surgery should be done once the patient has 20+ polyps. Wesley is well past that point. He said it is a good time to do it. Wesley is healthy.
One of my questions for him was if he knew of anyone in the Phoenix area who specializes in FAP (or at least knows a bit more about it). We all like Dr. B, but he is the first to admit that he doesn't have a lot of experience with this disease. He has recommended getting a second opinion several times. I never felt the need to get a second opinion regarding the diagnosis. I always thought I'd save the second opinion for surgery timing. Looks like that time has come. We got a name and made an appointment, but we can't get in until late March. We would like to see that doctor before surgery so that pushes things out until at least April or May.
Although we had already read about it, it was good to hear Dr. N explain the surgery. It will take place in two parts each requiring an approximate 5 day hospital stay. During the first surgery, they will laparoscopically remove Wesley's large intestine (total colectomy). The surgeon will form a "j-pouch" with the far end of the small intestine. However, this pouch needs some time to heal before it can hold feces so they will temporarily run Wesley's small intestine to a hole or stoma on his abdomen where his waste can flow out into a bag. This is called an ileostomy.
After about 8 weeks, when things are sufficiently healed, they will perform another surgery connecting the small intestine to the j-pouch section and close the stoma. Feces will then be able to come through the small intestine and j-pouch. It will always be more liquid and more frequent than that of a normal person. The surgeon said there really aren't any particular dietary restrictions with a j-pouch, but patients learn what causes things to move through more quickly and avoid them if they won't be near a bathroom.
Wesley will continue to need ongoing "surveillance" of his remaining digestive tract. Endoscopy to keep an eye on his stomach and duodenum as well as the remaining part of his rectal area.
Wesley continues to feel great. I don't think he was really surprised by what the surgeon said, it was all things we had talked about ahead of time. He doesn't have too many concerns at this time, he's most concerned about being in the hospital for so long. Can't say I blame him! As always, continued prayers are appreciated.
This year National Dress in Blue Day for colon cancer awareness is Friday, March 3rd. Wear blue and post a photo to Facebook and tag me or Wesley. He sure enjoyed all the photos our friends and family posted last year!
Tuesday, January 17, 2017
FAP Update - January 2017
Wesley had his second colonoscopy Friday, January 13th. The prep on Thursday went well. Thankfully, Wesley doesn't really mind the clear liquid diet. He even felt confident enough to go to his Latin class.
Mid-day Thursday, I got a call from the doctor's assistant letting us know Wesley was being bumped back on the schedule from 9am to noon due to the doctor needing to squeeze in two younger patients. The later time slot made the drive easier as far as traffic goes, but it made for a longer time of complete fasting which is, understandably, Wesley's least favorite part.
We got to the hospital for registration right on time at 10:30am. When they called to do some of the pre-admission paperwork I had asked about parking because I couldn't remember what we did last time. The gal I spoke with made it sound simple... but there was basically NO parking and we ended up having to valet park. Which, once we got there, I remembered is exactly what we did last time! Note to self: Skip the driving around and just valet park.
Since we valet parked we walked through a few hospital hallways to get to registration. The lady at the registration desk felt really bad about the high out-of-pocket cost that came up on her screen. Guess that's the downside of high deductible plans. She didn't even know that worst of it... our HSA account had several thousand dollars in fraudulent charges last summer and we didn't notice until it was too late to make a claim and recover it. So our health savings account was pretty much empty!
Once all that was settled, we were off to the Endoscopy department. They got Wesley checked in and all set up much quicker than last time. In addition to the usual check-in business, they put in an IV. Wesley had a bad experience with getting an IV during a CT scan and he was not happy they didn't let him wait until he was out before putting it in this time. I was watching his heart rate on the monitor as she was putting the IV in. It went up a good 40 beats per minute! He was tough and, thankfully, it only took her one try.
All that was a bit of "hurry up and wait" though. We spent a longer time waiting in the prep area this time. We got to overhear lots of interesting conversations while we waited (the lady next to us wasn't prepped correctly). Wesley was getting a bit irritable and he was too distracted to pass the time reading. The nurse offered a portable DVD player, but the movie choices weren't anything he was interested in.
It turned out they weren't able to get a hold of one of the young patients who was supposed to be ahead of Wesley. I think they were just going to send him back when she showed up. They asked Wesley if it was okay if she still went first and he said that was okay. I think he felt good about his decision when the little four year old girl wheeled by. With a tear in his eye he said, "She's even younger than Annabeth." God blessed him with a big heart for little kids!
He didn't have to wait too long before it was his turn to be wheeled back. I gave him a kiss and headed to the waiting room. The procedure ran well over the "hour" the nurse said it would take, but this time I was expecting it. Dr. B came out to the waiting room to give me the results before Wesley was even settled in recovery.
The results were nothing unexpected or too surprising. Wesley still has many, many polyps throughout his large intestine. They seem to be really concentrated in the rectum. The doctor said polyps pretty much "carpeted" his intestinal lining in that area. There were fewer polyps than last year in the distal parts of the large intestine which was good to hear. Although the ones he did see were larger than before, guess that is to be expected since they have been growing longer.
I was not happy to hear the doctor found some polyps in his stomach and duodenum (the beginning portion of the small intestine) during the EGD this time. The EGD last time was all clear. The doctor said those polyps have a smaller chance of turning cancerous which is good since they can't take out the whole digestive tract!
Many of the polyps were "burned" or removed and sent for biopsy. Please continue to pray those results are good.
So right now the plan for Wesley is...
1) to continue on his medication - the doctor said the meds may have contributed to seeing fewer polyps in the distal portions of the colon.
2) meet with a surgeon to get a plan in place for the future (and because Dr. B thinks a colorectal surgeon may have more experience with FAP than he does).
The rest of recovery was uneventful. Wesley was sitting up and sipping some apple juice within a few minutes. Shortly after that the nurse had the valet guy bring the car right to the door for us and we were on our way. We made a quick pit stop at McDonald's for a chocolate shake and drove on home.
We didn't arrange any secret mail this time, but our neighbor brought over a super cute candy bouquet and some sweet friends brought some goodies and a gift card as well. Thank you to everyone who prayed for Wesley and for all of us. Your prayers did not go unanswered. We really couldn't have asked for things to go better regarding the prep and procedure. We continue to praise God that we even know that Wesley has what could have been a silent killer!
UPDATE: Biopsy results came back with "mild dysplasia" which is similar to last years results. We have an appointment with a surgeon scheduled for the first week of February.
Mid-day Thursday, I got a call from the doctor's assistant letting us know Wesley was being bumped back on the schedule from 9am to noon due to the doctor needing to squeeze in two younger patients. The later time slot made the drive easier as far as traffic goes, but it made for a longer time of complete fasting which is, understandably, Wesley's least favorite part.
We got to the hospital for registration right on time at 10:30am. When they called to do some of the pre-admission paperwork I had asked about parking because I couldn't remember what we did last time. The gal I spoke with made it sound simple... but there was basically NO parking and we ended up having to valet park. Which, once we got there, I remembered is exactly what we did last time! Note to self: Skip the driving around and just valet park.
Since we valet parked we walked through a few hospital hallways to get to registration. The lady at the registration desk felt really bad about the high out-of-pocket cost that came up on her screen. Guess that's the downside of high deductible plans. She didn't even know that worst of it... our HSA account had several thousand dollars in fraudulent charges last summer and we didn't notice until it was too late to make a claim and recover it. So our health savings account was pretty much empty!
Once all that was settled, we were off to the Endoscopy department. They got Wesley checked in and all set up much quicker than last time. In addition to the usual check-in business, they put in an IV. Wesley had a bad experience with getting an IV during a CT scan and he was not happy they didn't let him wait until he was out before putting it in this time. I was watching his heart rate on the monitor as she was putting the IV in. It went up a good 40 beats per minute! He was tough and, thankfully, it only took her one try.
All that was a bit of "hurry up and wait" though. We spent a longer time waiting in the prep area this time. We got to overhear lots of interesting conversations while we waited (the lady next to us wasn't prepped correctly). Wesley was getting a bit irritable and he was too distracted to pass the time reading. The nurse offered a portable DVD player, but the movie choices weren't anything he was interested in.
It turned out they weren't able to get a hold of one of the young patients who was supposed to be ahead of Wesley. I think they were just going to send him back when she showed up. They asked Wesley if it was okay if she still went first and he said that was okay. I think he felt good about his decision when the little four year old girl wheeled by. With a tear in his eye he said, "She's even younger than Annabeth." God blessed him with a big heart for little kids!
He didn't have to wait too long before it was his turn to be wheeled back. I gave him a kiss and headed to the waiting room. The procedure ran well over the "hour" the nurse said it would take, but this time I was expecting it. Dr. B came out to the waiting room to give me the results before Wesley was even settled in recovery.
The results were nothing unexpected or too surprising. Wesley still has many, many polyps throughout his large intestine. They seem to be really concentrated in the rectum. The doctor said polyps pretty much "carpeted" his intestinal lining in that area. There were fewer polyps than last year in the distal parts of the large intestine which was good to hear. Although the ones he did see were larger than before, guess that is to be expected since they have been growing longer.
I was not happy to hear the doctor found some polyps in his stomach and duodenum (the beginning portion of the small intestine) during the EGD this time. The EGD last time was all clear. The doctor said those polyps have a smaller chance of turning cancerous which is good since they can't take out the whole digestive tract!
 |
| Polyps in the stomach |
Many of the polyps were "burned" or removed and sent for biopsy. Please continue to pray those results are good.
 |
| Polyps after coagulation |
So right now the plan for Wesley is...
1) to continue on his medication - the doctor said the meds may have contributed to seeing fewer polyps in the distal portions of the colon.
2) meet with a surgeon to get a plan in place for the future (and because Dr. B thinks a colorectal surgeon may have more experience with FAP than he does).
The rest of recovery was uneventful. Wesley was sitting up and sipping some apple juice within a few minutes. Shortly after that the nurse had the valet guy bring the car right to the door for us and we were on our way. We made a quick pit stop at McDonald's for a chocolate shake and drove on home.
UPDATE: Biopsy results came back with "mild dysplasia" which is similar to last years results. We have an appointment with a surgeon scheduled for the first week of February.
Saturday, October 8, 2016
FAP Update - October 2016
After a LONG wait, we finally had an appointment for Wesley with the genetic counselor and doctor team on Thursday, October 6th. I, personally, found it very interesting. (Wesley didn't!) I think they found US interesting as well. They usually help diagnose conditions like FAP in families so it was a different for us to go in knowing the genetic results already. They pretty much confirmed what we expected... they don't THINK Wesley inherited the FAP from me or Jerry, but the only way to know for sure is to test. So that is where we will start. If Jerry and I both test negative we will not test the rest of the kids as the chances of them having it are just about zero. If one of us tests positive, we will have to move quickly to get treatment. We'll start with getting insurance pre-approval for the testing and go from there.
The most interesting part to me was getting their help with interpreting the genetic testing results. There was a small piece of info in the results that I didn't realize was there. They know the exact spot on the gene where Wesley's genetic code went wrong. The gene runs from 0 to 1500 something. Wesley's error is at the 554 spot. They have actually done some studies on symptoms and these numbers. With his number, Wesley is in the middle range for time of onset of symptoms. Not surprisingly, he is in the number range where it is more common for patients have CHRPEs. It's fascinating to me that they figured this all out and have studied it. Apparently, people whose error is at 1309 have very severe and early symptoms so we were thankful to know that Wesley didn't have an error at that position.
So, in the next few months Jerry and I will have genetic testing done. Now that they know the exact spot of the "error" they can just go right to that spot on our genetic code and look. Wesley's next colonoscopy is scheduled for January 13th. We will know more about how to proceed once we know those results. Please continue to keep us in your prayers!
The most interesting part to me was getting their help with interpreting the genetic testing results. There was a small piece of info in the results that I didn't realize was there. They know the exact spot on the gene where Wesley's genetic code went wrong. The gene runs from 0 to 1500 something. Wesley's error is at the 554 spot. They have actually done some studies on symptoms and these numbers. With his number, Wesley is in the middle range for time of onset of symptoms. Not surprisingly, he is in the number range where it is more common for patients have CHRPEs. It's fascinating to me that they figured this all out and have studied it. Apparently, people whose error is at 1309 have very severe and early symptoms so we were thankful to know that Wesley didn't have an error at that position.
So, in the next few months Jerry and I will have genetic testing done. Now that they know the exact spot of the "error" they can just go right to that spot on our genetic code and look. Wesley's next colonoscopy is scheduled for January 13th. We will know more about how to proceed once we know those results. Please continue to keep us in your prayers!
Tuesday, July 26, 2016
FAP Update - July 2016
We had a follow up appointment with Wesley's GI doctor today. Last week, he ordered a thyroid ultrasound because FAP can cause cancer in other parts of the body, including the thyroid. The ultrasound was completely normal. It is something we will continue to check up on periodically.
The doctor didn't really have any new information for us. Thankfully, he agreed to schedule Wesley's next colonoscopy in January so we don't have to worry about it at Christmas time. He asked if we had gotten a second opinion, which we have not. We don't doubt the diagnosis. I think the second opinion will come in regards to the timing of his colectomy. He also asked if we had started the process of genetic testing for the rest of the family, which we have not. Although Jerry has called a few places. Genetic counselors are, surprisingly, hard to find even in a big metro area like Phoenix.
We will have to wait and see what the next colonoscopy shows before we make any surgery decisions. The average age of colectomy for FAP patients is late teens or early twenties. It seems those who know about it early tend to have the surgery earlier. I would like Wesley to keep his colon as long as possible, but the doctor reminded us they "are in the business of saving people, not colons."
I did ask him about a medication I had heard about called Sulindac. They usually give this to patients after they have their colon removed to help prevent polyps forming in the remaining parts of the digestive tract. However, there have been a few studies that showed fewer polyps in people who took it who haven't yet had surgery and I wondered if it was worth a try. It is not a cure. Just a possible way to slow down polyp growth. The doctor had heard of it and didn't think it would really help, but since the medication has basically no side effects (it's in the same family as ibuprofen - NSAIDs) he was willing to let him try it. So we got a prescription for that.
Wesley is feeling great. No issues at all, digestive or otherwise. According to today's measurement, he is 5 feet 7 inches tall! He will be starting his homeschool high school journey in a few weeks. Please continue to pray that he stays healthy and that it will be abundantly clear when the time is right for us to move forward with the colectomy.
The doctor didn't really have any new information for us. Thankfully, he agreed to schedule Wesley's next colonoscopy in January so we don't have to worry about it at Christmas time. He asked if we had gotten a second opinion, which we have not. We don't doubt the diagnosis. I think the second opinion will come in regards to the timing of his colectomy. He also asked if we had started the process of genetic testing for the rest of the family, which we have not. Although Jerry has called a few places. Genetic counselors are, surprisingly, hard to find even in a big metro area like Phoenix.
We will have to wait and see what the next colonoscopy shows before we make any surgery decisions. The average age of colectomy for FAP patients is late teens or early twenties. It seems those who know about it early tend to have the surgery earlier. I would like Wesley to keep his colon as long as possible, but the doctor reminded us they "are in the business of saving people, not colons."
I did ask him about a medication I had heard about called Sulindac. They usually give this to patients after they have their colon removed to help prevent polyps forming in the remaining parts of the digestive tract. However, there have been a few studies that showed fewer polyps in people who took it who haven't yet had surgery and I wondered if it was worth a try. It is not a cure. Just a possible way to slow down polyp growth. The doctor had heard of it and didn't think it would really help, but since the medication has basically no side effects (it's in the same family as ibuprofen - NSAIDs) he was willing to let him try it. So we got a prescription for that.
Wesley is feeling great. No issues at all, digestive or otherwise. According to today's measurement, he is 5 feet 7 inches tall! He will be starting his homeschool high school journey in a few weeks. Please continue to pray that he stays healthy and that it will be abundantly clear when the time is right for us to move forward with the colectomy.
Sunday, January 3, 2016
The End for Now (FAP - Part 5)
Wait! Have you read the other posts? They are here... part one, part two, part three, and part four.
We got a call on December 23rd that that the biopsy results were normal. No dysplasia or cell changes at this time. That was good news! It doesn't mean he won't need surgery, it just means he doesn't need surgery immediately. The doctor wants to see Wesley again in six months to see how things are going and to check his thyroid and liver. FAP, especially Wesley's type, can have other non-colon issues like cancers of the thyroid and liver. The chance is small, but a greater risk for him than someone without FAP.
I asked the doctor if it would be "straight forward" from here on out now that we know for sure Wesley has FAP. He said no, nothing is straight forward about this. It is a rare and unpredictable disorder. He only saw it twice when he was in school and Wesley is his first patient to have it since he has been a doctor. There are doctors who specialize in FAP and other hereditary colon cancer disorders and he wouldn't be offended at all if we wanted to get a second opinion from one of them.
So, where do we go from here? The next step is meeting with a genetic counselor. FAP is usually inherited, although about 30% of cases are spontaneous gene mutations. We are pretty sure that neither Jerry or I have it because we would already have colon cancer if we did, but it is pretty much standard to have the whole family (parents and siblings) tested when there is a known affected family member.
Beyond that, Wesley will have another colonoscopy in a year. We will see how many polyps he has at that time. When there are more polyps than the doctor can remove during a colonoscopy then it will be time to think about a colectomy (colon removal). Our goal is to keep him whole as long as possible without putting him at risk for cancer. Every FAP patient is different and there really is no exact timeline.
Please let me know if you have any questions. I know this was a lot to read and take in especially for those of you who had no idea this was even going on. Thank you for "listening". Now that I'm all caught up, I will post any updates as they happen. Prayers, especially for Wesley, are always appreciated! The prayers we have received up to this point have made a huge difference! No matter what we know God is in control of it all and He knows what He's doing!
If you want to read more about FAP, here are some links for you:
Familial Adenomatous Polyposis (MD Anderson)
A Patient's Guide to FAP (HCC Takes Guts)
Gardner syndrome (cancer.net)
Familial Adenomatous Polyposis (cancer.net)
If you want to read more about hereditary colon cancer disorders (including Gardner syndrome and FAP) visit HCC Takes Guts. The gentlemen that runs this website calls people like Wesley cancer "pre-vivors" because they fight cancer in a special way - before it happens!
One last thing... I know it's a little ways off, but March is National Colorectal Cancer awareness month. It is also happens to be Wesley's birthday month! March 4 is Dress in Blue Day to help spread awareness about colon cancer. We'll all be wearing blue! Feel free to join us!
Future updates can be found by clicking... HERE!
We got a call on December 23rd that that the biopsy results were normal. No dysplasia or cell changes at this time. That was good news! It doesn't mean he won't need surgery, it just means he doesn't need surgery immediately. The doctor wants to see Wesley again in six months to see how things are going and to check his thyroid and liver. FAP, especially Wesley's type, can have other non-colon issues like cancers of the thyroid and liver. The chance is small, but a greater risk for him than someone without FAP.
I asked the doctor if it would be "straight forward" from here on out now that we know for sure Wesley has FAP. He said no, nothing is straight forward about this. It is a rare and unpredictable disorder. He only saw it twice when he was in school and Wesley is his first patient to have it since he has been a doctor. There are doctors who specialize in FAP and other hereditary colon cancer disorders and he wouldn't be offended at all if we wanted to get a second opinion from one of them.
So, where do we go from here? The next step is meeting with a genetic counselor. FAP is usually inherited, although about 30% of cases are spontaneous gene mutations. We are pretty sure that neither Jerry or I have it because we would already have colon cancer if we did, but it is pretty much standard to have the whole family (parents and siblings) tested when there is a known affected family member.
Beyond that, Wesley will have another colonoscopy in a year. We will see how many polyps he has at that time. When there are more polyps than the doctor can remove during a colonoscopy then it will be time to think about a colectomy (colon removal). Our goal is to keep him whole as long as possible without putting him at risk for cancer. Every FAP patient is different and there really is no exact timeline.
Please let me know if you have any questions. I know this was a lot to read and take in especially for those of you who had no idea this was even going on. Thank you for "listening". Now that I'm all caught up, I will post any updates as they happen. Prayers, especially for Wesley, are always appreciated! The prayers we have received up to this point have made a huge difference! No matter what we know God is in control of it all and He knows what He's doing!
If you want to read more about FAP, here are some links for you:
Familial Adenomatous Polyposis (MD Anderson)
A Patient's Guide to FAP (HCC Takes Guts)
Gardner syndrome (cancer.net)
Familial Adenomatous Polyposis (cancer.net)
If you want to read more about hereditary colon cancer disorders (including Gardner syndrome and FAP) visit HCC Takes Guts. The gentlemen that runs this website calls people like Wesley cancer "pre-vivors" because they fight cancer in a special way - before it happens!
One last thing... I know it's a little ways off, but March is National Colorectal Cancer awareness month. It is also happens to be Wesley's birthday month! March 4 is Dress in Blue Day to help spread awareness about colon cancer. We'll all be wearing blue! Feel free to join us!
Future updates can be found by clicking... HERE!
Saturday, January 2, 2016
The Procedures (FAP - Part 4)
Please read part one, part two, and part three before continuing on...
They always say the prep is worse than the procedure when it comes to colonoscopies, so that is what I kept telling Wesley. He wasn't that worried about it. A diet of clear liquids sounded kinda fun to him. The thought a camera visiting his insides didn't even him bother him that much. He was more worried about getting another IV than anything else!
Bowel prep for kids is, thankfully, milder than the adult prep. I bought two over-the-counter laxatives and a shopping cart full of clear liquids to have on hand. We made several batches of jello and Kool Aid ice cubes to turn into popsicles and slushies and got started.
It went well. It went really well. There were, of course, trips to the bathroom, but nothing too bad. Wesley is my lightest eater so he didn't even really feel deprived skipping meals. He really enjoyed the broth and jello and drinks of all kinds. Everyone else was jealous of his special treats! Even completely fasting from midnight until the procedure wasn't that bad for him. He was hungry, but didn't really complain too much about it.
We were supposed to be at the hospital at 9:30am for the 11am procedures. Traffic and parking went better than expected and we were checking into admitting at 9am. We were called back to the prep area about 10:30am. Wesley was weighed and measured and got to pick out a stuffed animal to keep with him. He chose an odd looking little brown Beanie Baby bird (the tag said his name was Beak). Then he changed into a hospital gown and had his vitals taken. We met with both the anesthesiologist and Dr. B before the procedure.
The anesthesiologist was kind of a character. He asked Wesley if this was his first time with anesthesia and when he said yes, he replied "Me too!" He let Wesley choose if he wanted the medicine to put him to sleep through a mask or an IV. Of course, Wesley chose the mask. He would still get an IV, but this way he wouldn't be awake for it!
I asked the nurse about how long the procedures would take. She said an hour, but not to worry if it went longer than that. Thankfully, they were running on time. I was able to stay with Wesley up until they wheeled him into the procedure room just before 11am. I gave him a kiss and a hug and went to wait in the waiting area.
I checked Facebook. I sent a few texts to Jerry and Roz. I read a couple magazines. I tried to read a book I brought. An hour passed. Then an hour and a half. Then two. Just when I was starting to pace and get really anxious they called me back to recovery. Wesley was still groggy. He tried to sit up a couple times, but we told him to just lay down and rest. He came around pretty fast and was sitting up and chatting with me before too long.
Dr. B came to talk with us. The good news: the endoscopy was completely normal. No issues at all. The bad news: the colonoscopy was not normal. There were already polyps. Lots of them. I think even he was surprised how many there were. He removed over 40 and he was sure there were some he missed. He said it was the ones he missed that worried him most.
There is no way for them to ever get all the polyps. It's not that he gave up taking them out, he got as many as he could see, but there were probably some hidden in intestinal folds that he didn't see. The polyps are very small (2mm) and the same color as the rest of his intestine so they are camouflaged and hard to see. They were not concentrated in any one area, but spread throughout the whole colon. He saw one right at the beginning and more around each corner all the way to where the large intestine meets up with the small.
On to the last post...
They always say the prep is worse than the procedure when it comes to colonoscopies, so that is what I kept telling Wesley. He wasn't that worried about it. A diet of clear liquids sounded kinda fun to him. The thought a camera visiting his insides didn't even him bother him that much. He was more worried about getting another IV than anything else!
Bowel prep for kids is, thankfully, milder than the adult prep. I bought two over-the-counter laxatives and a shopping cart full of clear liquids to have on hand. We made several batches of jello and Kool Aid ice cubes to turn into popsicles and slushies and got started.
It went well. It went really well. There were, of course, trips to the bathroom, but nothing too bad. Wesley is my lightest eater so he didn't even really feel deprived skipping meals. He really enjoyed the broth and jello and drinks of all kinds. Everyone else was jealous of his special treats! Even completely fasting from midnight until the procedure wasn't that bad for him. He was hungry, but didn't really complain too much about it.
We were supposed to be at the hospital at 9:30am for the 11am procedures. Traffic and parking went better than expected and we were checking into admitting at 9am. We were called back to the prep area about 10:30am. Wesley was weighed and measured and got to pick out a stuffed animal to keep with him. He chose an odd looking little brown Beanie Baby bird (the tag said his name was Beak). Then he changed into a hospital gown and had his vitals taken. We met with both the anesthesiologist and Dr. B before the procedure.
I asked the nurse about how long the procedures would take. She said an hour, but not to worry if it went longer than that. Thankfully, they were running on time. I was able to stay with Wesley up until they wheeled him into the procedure room just before 11am. I gave him a kiss and a hug and went to wait in the waiting area.
I checked Facebook. I sent a few texts to Jerry and Roz. I read a couple magazines. I tried to read a book I brought. An hour passed. Then an hour and a half. Then two. Just when I was starting to pace and get really anxious they called me back to recovery. Wesley was still groggy. He tried to sit up a couple times, but we told him to just lay down and rest. He came around pretty fast and was sitting up and chatting with me before too long.
Dr. B came to talk with us. The good news: the endoscopy was completely normal. No issues at all. The bad news: the colonoscopy was not normal. There were already polyps. Lots of them. I think even he was surprised how many there were. He removed over 40 and he was sure there were some he missed. He said it was the ones he missed that worried him most.
There is no way for them to ever get all the polyps. It's not that he gave up taking them out, he got as many as he could see, but there were probably some hidden in intestinal folds that he didn't see. The polyps are very small (2mm) and the same color as the rest of his intestine so they are camouflaged and hard to see. They were not concentrated in any one area, but spread throughout the whole colon. He saw one right at the beginning and more around each corner all the way to where the large intestine meets up with the small.
This is why they will eventually have to take out his colon. They know they could never get them all and it only takes one they miss that could be the polyp that becomes cancerous. The polyps he did remove were biopsied and sent to the lab. If any of the biopsies come back already showing dysplasia (cancerous cell changes) then we will have to start thinking about surgery sooner rather than later. If they come back okay then we will wait and do a repeat colonoscopy in one year.
Despite some of the less than positive news, we know prayers were answered! Wesley did great throughout the whole thing - both prep and procedures couldn't have gone smoother. He had no trouble at all with the anesthesia. There was no pain or bleeding from the polyp removal. His only complaint was hunger and you couldn't blame him for that!
Once he was good and awake the nurse gave him a much needed apple juice to sip on. Not too long after that he was up getting dressed and we were on our way home! Well, we didn't go right home... we made a quick pit stop to grab me a late lunch and Wesley a milkshake. We were just following orders - a milkshake was actually suggested on his discharge paperwork as post-procedure food!
We had a little surprise waiting for him when he got home. We had asked family and friends to send a card. I had intercepted the mail all week so he wouldn't see them before he got home from the hospital. A few kind friends even secretly brought small gifts. Wesley was so surprised and thankful! He asked several times how we managed to keep it a secret! He spent some time on the couch opening his big stack of envelopes and reading everyone's notes.
He wanted to display them in his room, so we hung them all up on the wall where he could see them.
Special thanks to all of you who sent something! It really made him feel special and loved.Despite some of the less than positive news, we know prayers were answered! Wesley did great throughout the whole thing - both prep and procedures couldn't have gone smoother. He had no trouble at all with the anesthesia. There was no pain or bleeding from the polyp removal. His only complaint was hunger and you couldn't blame him for that!
Once he was good and awake the nurse gave him a much needed apple juice to sip on. Not too long after that he was up getting dressed and we were on our way home! Well, we didn't go right home... we made a quick pit stop to grab me a late lunch and Wesley a milkshake. We were just following orders - a milkshake was actually suggested on his discharge paperwork as post-procedure food!
We had a little surprise waiting for him when he got home. We had asked family and friends to send a card. I had intercepted the mail all week so he wouldn't see them before he got home from the hospital. A few kind friends even secretly brought small gifts. Wesley was so surprised and thankful! He asked several times how we managed to keep it a secret! He spent some time on the couch opening his big stack of envelopes and reading everyone's notes.
He wanted to display them in his room, so we hung them all up on the wall where he could see them.
On to the last post...
Friday, January 1, 2016
The Results (FAP - Part 3)
Read part one here and part two here, if you haven't already.
Ten days before the scheduled endoscopy and colonoscopy, I got a call from Dr. B. The final results of the genetic testing showed that Wesley does have FAP. The endoscopy/colonoscopy would remain on his schedule for the 18th, but he wanted to make Wesley the last case of the day so he could take his time and possibly remove any polyps that had already formed.
Ten days before the scheduled endoscopy and colonoscopy, I got a call from Dr. B. The final results of the genetic testing showed that Wesley does have FAP. The endoscopy/colonoscopy would remain on his schedule for the 18th, but he wanted to make Wesley the last case of the day so he could take his time and possibly remove any polyps that had already formed.
Jerry travels for work once or twice a year. He was on a plane when I got this call. I texted him and asked him to call home when he landed. I told him about the results as he walked to his next plane between flights. Then I told Wesley. He was upset, but took the news pretty well. We had already been talking about it and answering his questions for several weeks. I told him (and everyone else I talked to) over and over what a blessing in disguise it was that he had that lump on his jaw to alert us to what was going on! Not everyone with FAP has osteomas and/or CHRPEs and without those we would have never known!
There was one benefit to all the waiting. The whole thing had been such a slow process, spread out over months, that there was plenty of time to get used to one thing before moving on to the next. Since we were the ones to discover it in the first place there was never really a shock moment with a doctor where the doctor had to sit us down and break the news to us.
The hardest part for me was back when we were first waiting to see the ENT doc and I had an idea what was going on but didn't know for sure. I couldn't sleep or think about anything else, but when we got no answers, I moved from worried to angry and determined to get answers. Then with all the delays, we got to the point where there was nothing to do but wait and pray. So that's what we did. We shared what was going on with a few close friends and family members and asked them to pray too.
We are just really thankful that God left all these clues for us and we followed them. I truly believe God has a plan here, He has all along. The plan for us to find out about Wesley having FAP was set in motion as far back as 2008/2009 when the eye doctor found that CHRPE in Wesley's eye and took the time to explain it to me. If we didn't have one piece of the puzzle, or even if a different parent had taken Wesley to a past appointment, we wouldn't have figured this out. None of us wanted this, but we're grateful we found out now and not when it was full blown colon cancer in a few years.
Are we upset? Sad? Worried? Even a little mad? Yes! But here is the deal... Wesley has had this all along. From the moment he was conceived and his whole genetic code was written he has had this. We just know about it now. And it's much, much better to know about it!
The plan was to have Jerry take the day off and stay home with the rest of the kids when I took Wesley to hospital for his endoscopy and colonoscopy. Before we got the genetic test results, I have to admit I was a little worried about the fact that I would be alone when the doctor shared the news that Wesley did, in fact, have FAP. There was no need to worry about that now! Because of this phone call, I knew before we even went in. He definitely had it. The new unanswered question was: had the polyps already started to form?
We would have to wait until the 18th to find out.
Go on to part 4...
We would have to wait until the 18th to find out.
Go on to part 4...
Thursday, December 31, 2015
Hurry Up and Wait (FAP - Part 2)
If you haven't already, read part one here.
Up until this point, Jerry and I kept Wesley in the dark about our FAP concerns. We didn't want him to worry unnecessarily. Even at this point we didn't tell him everything, we told him we thought maybe something else was going on and we wanted to see another doctor.
Thankfully, we only had to wait a week until the GI specialist appointment. This time Jerry and I took Wesley together. Filling out the paperwork we didn't check off any of the GI problems listed on the history form. Wesley had no issues - no pain, no bleeding, nothing. It was strange taking your seemingly perfectly healthy child into a GI specialist to say we're here because of these two odd (non GI) symptoms and mom's intuition.
We were called back to the exam room where we met Dr. B. He was a nice (young) guy. He didn't act like we were totally insane when we told him our concerns, but I also didn't get the feeling he was convinced Wesley had this condition. Fortunately, this disorder does have a simple genetic blood test available. He said he would order the genetic testing to help us find out for sure.
Unfortunately, genetic testing sometimes doesn't have hard and fast results. There are variations of FAP and not all of them show up in the genetic testing, so a negative result didn't necessarily mean he doesn't have the disorder. Wesley could have a version they haven't mapped the gene for yet or we could have a false negative. We could go through the testing and still not get a firm answer. It could be that these two odd things are just weird, unrelated quirks. That was our prayer!
The doctor said he would "clinically follow" Wesley even if the results came back negative. This meant even if the results came back negative Wesley would probably be scheduled for a colonoscopy at some point. Personally, even with negative results, I wouldn't feel like Wesley was "in the clear" until he is 30 years old and had no polyps.
The doctor said he would "clinically follow" Wesley even if the results came back negative. This meant even if the results came back negative Wesley would probably be scheduled for a colonoscopy at some point. Personally, even with negative results, I wouldn't feel like Wesley was "in the clear" until he is 30 years old and had no polyps.
We didn't know it at the time, but Dr. B's main nurse was out of the office that day. The nurse or assistant who helped us didn't know there were some special instructions for ordering genetic testing. We didn't follow the correct procedure and it would end up delaying the whole process. Not knowing this, Jerry took Wesley to the lab to get his blood drawn. We knew it may take "up to a month" to get the results so we waited patiently. When a month had passed and we hadn't heard anything we called. This is when we found out the tests weren't ordered correctly. One test came back showing "no deletions or duplications" (which was good!), but the other tests were lost. For those we had to start all over.
Since we were starting all over the nurse suggested we get pre-approval from our insurance since genetic testing is expensive. That delayed things even more - Jerry had to call several times to get the right info either to or from the doctor to the insurance. Eventually, we did get approved and took Wesley to the lab again. Then we had to wait "up to a month" again for the results.
A few weeks in, the preliminary results were showing some abnormal results. The nurse said Wesley was "at increased risk" for FAP. Based on that, the doctor suggested we schedule an endoscopy and colonoscopy. The only way to know for sure what was going on in there was to take a look around. Once again, this wouldn't necessarily give us a final answer. If they went in and everything looked good it was no guarantee that it would be that way in a year or two or ten. Either way we would just have to be patient and take it one step at a time because it could be years before we have a firm answer either way.
The colonoscopy was scheduled for December 11th. I couldn't send Wesley into a colonoscopy without explaining why so I sat down with him and explained everything as best I could in a kid-friendly way. He was pretty upset and even hyperventilated a little bit. At that time he was more worried about getting another IV than anything else (thanks CT scan guy!). The more he thought about it though, the more questions he had. I answered them as best I could. Unfortunately, no one could answer the question we all wanted to know the answer to... does he actually have FAP?
Then they called and bumped the colonoscopy back a week to December 18th. Great. More waiting!
Go on to part 3...
Go on to part 3...
Wednesday, December 30, 2015
Begin at the Beginning (FAP - Part 1)
"Begin at the beginning," the King said, very gravely,"and go on till you come to the end: then stop."- Lewis Carroll, Alice in Wonderland
I guess the best place to begin this post is the beginning. Fair warning though: this will be a multi-post story, so sorry in advance if it runs long or I leave you with a cliff hanger at some point.
The very beginning of this story is a regular eye exam for Wesley back in 2008 or 2009. It was his first. Everything was fine, no prescription needed, but when looking in his eye the doctor mentioned he had a birthmark called a CHRPE (pronounced "chirpy") on his retina. CHRPE stands for congenital hypertrophy of the retinal pigment epithelium. The doctor said they weren't too common and it was good to know he has had this since he was a child because when he sees a CHRPE in an adult he sends them right to a GI doctor because they almost always have colon cancer. In Wesley's case though, he was just born with it and it wasn't a concern.
Fast forward several years... near the beginning of this year, Wesley noticed a small bump on his jaw back near his ear. I wasn't too concerned. It didn't bother him at all. It was hard and immovable so I was pretty sure it wasn't an infection or something going on with the soft tissue. We decided to just keep an eye on it for a bit to see if it changed or went away on it's own.
When it came time for his well check in June we asked the doctor about it. He wasn't sure what it was either and decided to refer us to an ENT doctor. Jerry took Wesley across town (the ENT would only see first time patients at his home office) for the appointment. The ENT didn't give us an exact name for the bump, he said it was probably just a "benign bone growth" and he wanted to do a CT scan to be sure. I googled several variations of "benign jaw bone lump/growth/tumor" and came up empty handed.
The CT scan was scheduled for July 29th, and since the scan was closer to home, I took Wesley this time. When we checked in at the hospital, they gave us some paperwork. I looked at it and was interested to see this benign bone growth did have a name: osteoma. I snapped a photo of the paper so I could remember the name and made a mental note to look that up when I got home.
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| The photo I snapped while waiting to go into the CT scan |
[Side story: The CT scan was ordered with intravenous contrast so Wesley had to get an IV. It was not a very good experience. The tech wasn't the greatest and struggled a bit to get the IV in before finally calling a nurse to do it. By then Wesley, who was already nervous, was pretty upset. The nurse got the IV right away and the scan was over in a few minutes, but the whole experience left Wesley with a new hatred of IVs!]
Later that evening, I sat down and googled osteoma. Of course, the top hit was just a generic page on Wikipedia. There wasn't much info and the little that was there pretty much said what the ENT had said - they are a "benign neoplasm" usually with an unknown cause. No big deal. Then it said "Osteomata are also found in Gardner's syndrome." So I followed the hyper link to "Gardner syndrome" and went down the rabbit hole.
I had never heard of Gardner syndrome before so I started reading. Nothing really caught my eye, but I kept reading anyway because I'm a sucker for interesting medical stuff. When I got to the part about diagnosis I couldn't believe my eyes. It said:
People with Gardner syndrome can have both osteomas of the jaw and CHRPEs? What are the chances Wesley also had both these two weird things? I told Jerry about what I read and he said we should be sure to ask the ENT about it at our follow up appointment.Gardner syndrome can be identified based on oral findings, including multiple impacted and supernumerary teeth, multiple jaw osteomas which give a "cotton-wool" appearance to the jaws, as well as multiple odontomas, congenital hypertrophy of the retinal pigment epithelium (CHRPE), in addition to multiple adenomatous polyps of the colon.
I started researching more about Gardner syndrome. The more I learned the more worried I got. Gardner syndrome is a subtype of familial adenomatous polyposis (FAP). The main issue with FAP is that it causes lots (like hundreds and eventually thousands) of polyps to form in the colon at a very young age. That many polyps, if left unattended, have a 100% chance of turning into colorectal cancer. There is no cure. The main treatment is to have the large intestine removed so the polyps never have a chance to become cancerous.
There were several nights I stayed up reading all I could find about it online and then I couldn't sleep. The follow-up with the ENT couldn't come soon enough. My fear was that the ENT (having never heard of this rare disorder) would tell us not to worry and send us on our way. And that is exactly what happened. The ENT doctor said the CT scan showed it was just a benign bone growth and not to worry. Even when we asked him outright if it could be a sign of something more serious or related to colon cancer, he said it wasn't.
Now what? I wasn't sure what to do. I didn't want to be accused of fabricating an illness and seeking unneeded medical attention. Parents get their kids taken away for things like that! (Munchausen by Proxy Syndrome, anyone?) But I also could NOT just ignore these two symptoms knowing that if it was this rare disorder Wesley could be developing colon cancer right this very minute. So, I followed my gut and emailed his primary doctor. Knowing how doctors feel about patients diagnosing themselves with Google, I carefully worded my my email. I just laid out the facts and let him connect the dots. He emailed me back the next day saying he was "impressed with my research" and gave us a referral to a pediatric GI specialist.
That made me feel much better! I was so thankful that he didn't just brush me off as some crazy Googling mom! We made the appointment with the GI specialist and waited.
Go on to part 2...
Sunday, August 10, 2014
You'll Shoot Your Eye Out
Yesterday, poor JD was accidentally shot in the eye with an airsoft gun. The little neighbor boy was messing around and didn't realized the gun had a BB in the barrel. Our neighbor friend Noah brought Pickle to one of the neighborhood parents who drove him home.
We couldn't figure out why his glasses didn't protect his eye. He may or may not have had his glasses pushed up to his forehead. Either way, there wasn't much we could do. We put ice on it and let the offending child's mom know he needs an airsoft gun safety refresher.
We'll keep an eye on it and take him to the eye doctor if it doesn't look better or if it gets increasingly worse in the next few days.
And the next time the kids want to go play airsoft, I just might pull a Mrs. Parker from 'A Christmas Story' and tell them, "No, you'll shoot your eye out!"
Tuesday, May 28, 2013
Long Weekend
It was a long weekend and not in a good way. Memorial Day weekend is usually one of my favorites of the year. When we lived in Wisconsin it was the official start of summer filled with fireworks, parades, and our annual birthday bash. Here in Arizona it's not as much fun, but at least I had a weekend of swimming and my birthday to look forward to, right?
After eating cake we went for an evening swim. As we were getting out, I grabbed the camera to take a picture of the moon rising over the mountains. I need a better camera. This is a terrible shot of a beautiful moon rise.
I did get this cute photo while I had the camera out though...
Saturday morning weburned disposed of some weeds and took care of some yard work, refreshing ourselves in the pool as needed! Annabeth wanted to be like Daddy and wear a hat and sunglasses while doing yard work.
Annabeth enjoys the pool for about 5 minutes before she asks for a towel and a snack. After getting such a cute shot the night before I thought I'd try again. I really liked this first one, but silly JD photobombed in his undies!
Jerry said he'd take me out to dinner (just us!) on my birthday Saturday night so we had cake a day early on Friday. In hindsight, I'm really glad we did this! Wesley was nice enough to make my cake for me since Roz wasn't here this year to do it. He really did it by himself too. I just put it in and took it out of the oven, he did everything else on his own. We had a quick dinner and then the gang sang to me and we had cake.
After eating cake we went for an evening swim. As we were getting out, I grabbed the camera to take a picture of the moon rising over the mountains. I need a better camera. This is a terrible shot of a beautiful moon rise.
I did get this cute photo while I had the camera out though...
Saturday morning we
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| "These glasses need adjusting..." |
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| "Still not quite right..." |
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| "What?! They still aren't straight?!" |
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| The Fore |
We swam a bit more in the afternoon and then got cleaned up for dinner. Grandma Joddy and Grandpa Steve were kind enough to come and watch the kids so Jerry and I could go out. I chose Monti's La Casa Vieja. We have always loved Monti's. We have had many a delicious meal there. This was the first time we had been back since the return move to Arizona and it did not disappoint! We enjoyed our dinner (except for the call from Papa John's Pizza - somebody who just turned 40 so maybe he really is getting old accidentally placed the pizza order for the kids under "carryout" - but we got it all figured out and no one starved).
We didn't stay out late. Grandma and Grandpa left and we got everyone to bed. I wasn't feeling so hot. Jerry wasn't either. We decided to go to bed early. We weren't even asleep an hour before Wesley got sick. We got him settled and fell back asleep and then Eli got sick. We got him settled and then I got sick (it was after midnight though - so, technically, I wasn't sick on my birthday). Thankfully, that was it for me, because I was up once an hour with either Eli or Wesley all night long. Jerry got up and gave the non-sick children breakfast but didn't even make it through clean up before he got sick.
That left Justus (fifth in line) in charge. Yikes! That's like getting to the President Pro Tempore of the Senate in the presidential line of succession! I must say, he did a pretty good job. They played (mostly) quietly and watched videos. Jerry had said he would run to the store to grab some Gatorade, but didn't make it before he got sick. One of our nice neighbors ended up bringing us some Gatorade and soda to sip. And did we need it! That's all the four of us had all day. Jerry and I took turns dragging ourselves to the kitchen so the other kids didn't starve, all the while counting down the minutes until Annabeth's nap at 1pm. As soon as she went down so did the four of us. We all slept until she woke up at 3:30pm.
We were all feeling a bit better at that point and did our best to make it through the day and make it to bedtime. We all slept great! When we woke up this morning everyone was feeling better, but we decided to just take it easy for the day. I had plenty of laundry to catch up on. I had given myself the day off, laundry-wise, on my birthday which meant by Sunday, with the extra sick laundry, I was waaaaaay behind.
So today we stuck close to home. Jerry and I made the rounds with bleach. The boys played with their neighbor friends and we went swimming a couple times. Thank goodness for the pool! I guess even an otherwise cruddy weekend can be redeemed when you can just step out in your back yard and swim! But, even if you ignore the getting sick part, I still think Memorial Day weekends are more fun in Wisconsin. Perhaps we'll try and plan a visit next year...
Side note: If anyone has any ideas why we have gotten sick so many times this year, I would love to hear them! We are normally such a healthy bunch. We have been sick more in 2013 than all the other years combined. The water test for our area just came back and it is fine, so it's not that. We just can't figure it out!
Wednesday, April 10, 2013
Round Two
Unfortunately, we had another round of a tummy bug. This one seems a little less severe than the last time around. It has slowly worked it's way through all the boys except Wesley. He complained of not feeling so hot but never actually got sick. Thankfully, Annabeth seems to have been spared yet again. I'm not sure why. She still nurses once a day so maybe she's getting some extra immune support from me. Although last time my immune system didn't even protect me!
JD and Eli ended up being sick for part of the weekend. Being sick is no fun. Being sick on the weekend is the worst. You don't even get out of school work AND you miss playing outside all day.
Eli was pretty upset that he couldn't go outside and play with his friends even though he insisted he was feeling better. Wesley (and Annabeth) kept him company by playing a round of Trouble with him.
Annabeth thought the colorful, noisy board was pretty interesting. And just in case you're wondering... Wesley won!
JD and Eli ended up being sick for part of the weekend. Being sick is no fun. Being sick on the weekend is the worst. You don't even get out of school work AND you miss playing outside all day.
Eli was pretty upset that he couldn't go outside and play with his friends even though he insisted he was feeling better. Wesley (and Annabeth) kept him company by playing a round of Trouble with him.
Annabeth thought the colorful, noisy board was pretty interesting. And just in case you're wondering... Wesley won!
Saturday, February 16, 2013
Hayden's Frenectomy
This is a catch up post from 2/16/13
Warning: Medical Post ahead. If you are squeamish feel free to skip this one!
At his last dentist appointment, the dentist recommended we have an oral surgeon look at Hayden's mouth to determine if he needed an upper lip (aka Maxillary Labial) frenectomy. Hayden has always had a gap between his two front teeth. We thought that extra space might come in handy when his big teeth came in, but it turns out that wasn't the case. Apparently, that band of tissue can affect big teeth too. So we took him to the oral surgeon.
The oral surgeon said this was similar to being tongue tied and that he needed to have that tissue cut. We had two choices: 1) do it now and hope his front big front teeth come in nicely or 2) wait and do it later when he gets braces. Since there is a chance that it will help his teeth come in nice and straight we decided to just go ahead and do it.
The bummer thing was they wanted to put him under to do it. We decided to go with IV sedation over gas which made Hayden a little nervous. He wasn't too fond of the idea of an IV. He did great though! They let me sit with him until he was under sedation. He, of course, doesn't remember anything which was the whole point. The doc said he did great and expected him to up and running around like normal within a few hours and... he was!
After he was done the doctor carried him from the procedure room to the little recovery area. I would guess he doesn't do that for his adult patients! When they brought me back Hayden was a little disoriented. He kept asking what time it was since he felt like he hadn't been there very long and he was already finished. He said his lips were dry so they gave him his very own fruity chapstick. When it was time to go home, he got to ride in a wheelchair out to the van. He thought that was so funny. I think it was the highlight of his trip.
He was groggy for a bit afterwards. Not too groggy to remember I promised him a shake from Sonic on the way home though. I gave him some ibuprofen just in case but didn't even bother to fill the prescription for the stronger pain reliever they gave us. There were, thankfully, no dietary restrictions. He was tender so he didn't eat anything that made it hurt for a few days.
On the upper lip where they could stretch the tissue he got two dissolvable stitches. Down on the gum area where it was tight they cauterized it. He goes back next week for a quick check to make sure it is all healing nicely.
Here are a few before and after pictures (look away now if you're squeamish):
Warning: Medical Post ahead. If you are squeamish feel free to skip this one!
At his last dentist appointment, the dentist recommended we have an oral surgeon look at Hayden's mouth to determine if he needed an upper lip (aka Maxillary Labial) frenectomy. Hayden has always had a gap between his two front teeth. We thought that extra space might come in handy when his big teeth came in, but it turns out that wasn't the case. Apparently, that band of tissue can affect big teeth too. So we took him to the oral surgeon.
The oral surgeon said this was similar to being tongue tied and that he needed to have that tissue cut. We had two choices: 1) do it now and hope his front big front teeth come in nicely or 2) wait and do it later when he gets braces. Since there is a chance that it will help his teeth come in nice and straight we decided to just go ahead and do it.
The bummer thing was they wanted to put him under to do it. We decided to go with IV sedation over gas which made Hayden a little nervous. He wasn't too fond of the idea of an IV. He did great though! They let me sit with him until he was under sedation. He, of course, doesn't remember anything which was the whole point. The doc said he did great and expected him to up and running around like normal within a few hours and... he was!
After he was done the doctor carried him from the procedure room to the little recovery area. I would guess he doesn't do that for his adult patients! When they brought me back Hayden was a little disoriented. He kept asking what time it was since he felt like he hadn't been there very long and he was already finished. He said his lips were dry so they gave him his very own fruity chapstick. When it was time to go home, he got to ride in a wheelchair out to the van. He thought that was so funny. I think it was the highlight of his trip.
He was groggy for a bit afterwards. Not too groggy to remember I promised him a shake from Sonic on the way home though. I gave him some ibuprofen just in case but didn't even bother to fill the prescription for the stronger pain reliever they gave us. There were, thankfully, no dietary restrictions. He was tender so he didn't eat anything that made it hurt for a few days.
On the upper lip where they could stretch the tissue he got two dissolvable stitches. Down on the gum area where it was tight they cauterized it. He goes back next week for a quick check to make sure it is all healing nicely.
Here are a few before and after pictures (look away now if you're squeamish):
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| Before |
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| Before |
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| After |
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| After |
Sunday, February 10, 2013
Sick Day
After Hayden, Justus, and JD were sick we thought we were in the clear. Turned out it was just an incubation time. We got another wake up call Saturday night. This time Eli had gotten sick. We got him settled in our room and got to work cleaning up the mess. Jerry started the washing machine with the bedding while I scrubbed the wall and the bed.
It was a long night for all of us. Unlike the others, Eli didn't just throw up once or twice. He was up several times. Poor kid. By morning he was feeling much better and was disappointed to hear he wouldn't be able to eat the same breakfast as the others or go outside to play.
The rest of the week was uneventful and, once again, we thought it was over. One of the boys asked if we would finally be able to go to church since we have missed several weeks because of this and I joked and said, "Yes, unless Wesley gets sick." Famous last words! Late Friday night we got yet another call from the boys room. Wesley had his turn. What a difference a few years makes as far as being able to get to the bathroom. No mess to clean up this time.
Wesley had a long night similar to Eli's. While the rest of the gang started their day, Wesley took it easy in our room. Since he is a bit older I felt comfortable letting him rest without staying right in the room. My mom (who is here visiting) took on a little project outside (cleaning the outdoor lights that surround our whole house) so I went out to assist. Both Jerry and I were in and out checking on him.
By the time lunch rolled around I didn't feel so good. Jerry fed the boys and the baby. I decided to skip lunch. I continued to help my mom and started to feel worse and worse. I put the baby down for her nap a little before 2pm and laid down on the couch. That is pretty much the last thing I remember until Monday morning.
At some point I moved to my bed. I know various people came in to our room to check on me. I hate throwing up and will do anything I possibly can to avoid it. The best way for me to avoid it is to sleep. That's why I take lots of naps when I have morning sickness. Noises also bother me when I am nauseous. Thankfully, I only threw up once Saturday night. Since the boys seemed to recover so quickly I was hoping I would wake up Sunday morning feeling better. Unfortunately, that was NOT the case. I stayed in bed and slept most of the day. No Super Bowl fun for me.
Jerry made a few of the game day snacks we had planned and my parents joined him and the boys for a bit too. I did not watch one minute of the game or see one commercial. I did manage to drag myself to Annabeth's room to nurse her before bed. She only nurses twice a day now and I had skipped two. I didn't want my illness to be the reason she weaned. I'm not sure she got anything. Since at that point I am sure I was pretty dehydrated having not had anything to eat or drink since Saturday at breakfast. She is still nursing so it worked out fine.
Having slept all day, I wasn't sure I would be able to sleep Sunday night. But, thankfully, I slept great. It was slow going Monday when Jerry went back to work. It took me a long to time to get breakfast ready and I worked up a sweat cleaning up afterward. Thankfully, my mom was here to help a bit.
Tuesday I was finally feeling a little more myself. It was a speedy recovery from then on. It's been a week now and no one else has gotten sick or had a relapse. Only Jerry and Annabeth were spared. I am so glad the baby didn't get it. It is so hard for little ones since you can't really explain what is going on.
I don't want to do that again for at least a couple years!
It was a long night for all of us. Unlike the others, Eli didn't just throw up once or twice. He was up several times. Poor kid. By morning he was feeling much better and was disappointed to hear he wouldn't be able to eat the same breakfast as the others or go outside to play.
The rest of the week was uneventful and, once again, we thought it was over. One of the boys asked if we would finally be able to go to church since we have missed several weeks because of this and I joked and said, "Yes, unless Wesley gets sick." Famous last words! Late Friday night we got yet another call from the boys room. Wesley had his turn. What a difference a few years makes as far as being able to get to the bathroom. No mess to clean up this time.
Wesley had a long night similar to Eli's. While the rest of the gang started their day, Wesley took it easy in our room. Since he is a bit older I felt comfortable letting him rest without staying right in the room. My mom (who is here visiting) took on a little project outside (cleaning the outdoor lights that surround our whole house) so I went out to assist. Both Jerry and I were in and out checking on him.
By the time lunch rolled around I didn't feel so good. Jerry fed the boys and the baby. I decided to skip lunch. I continued to help my mom and started to feel worse and worse. I put the baby down for her nap a little before 2pm and laid down on the couch. That is pretty much the last thing I remember until Monday morning.
At some point I moved to my bed. I know various people came in to our room to check on me. I hate throwing up and will do anything I possibly can to avoid it. The best way for me to avoid it is to sleep. That's why I take lots of naps when I have morning sickness. Noises also bother me when I am nauseous. Thankfully, I only threw up once Saturday night. Since the boys seemed to recover so quickly I was hoping I would wake up Sunday morning feeling better. Unfortunately, that was NOT the case. I stayed in bed and slept most of the day. No Super Bowl fun for me.
Jerry made a few of the game day snacks we had planned and my parents joined him and the boys for a bit too. I did not watch one minute of the game or see one commercial. I did manage to drag myself to Annabeth's room to nurse her before bed. She only nurses twice a day now and I had skipped two. I didn't want my illness to be the reason she weaned. I'm not sure she got anything. Since at that point I am sure I was pretty dehydrated having not had anything to eat or drink since Saturday at breakfast. She is still nursing so it worked out fine.
Having slept all day, I wasn't sure I would be able to sleep Sunday night. But, thankfully, I slept great. It was slow going Monday when Jerry went back to work. It took me a long to time to get breakfast ready and I worked up a sweat cleaning up afterward. Thankfully, my mom was here to help a bit.
Tuesday I was finally feeling a little more myself. It was a speedy recovery from then on. It's been a week now and no one else has gotten sick or had a relapse. Only Jerry and Annabeth were spared. I am so glad the baby didn't get it. It is so hard for little ones since you can't really explain what is going on.
I don't want to do that again for at least a couple years!
Thursday, January 24, 2013
Stomach Bug
Most of the time, I enjoy having lots of kids. One time I don't... when more than one gets sick. Thankfully, we are pretty healthy bunch overall, but once in awhile germs get the best of us.
Tuesday morning we got a 5am wake up call from the boy's room. Hayden threw up. We cleaned up the small mess (he pretty much made it to the bathroom) and brought him into our room. Bad news, the commotion had everyone else awake. Good news, they all went back to sleep (truly a small miracle) and then slept until about 7am or so. Hayden spent the day on my bed napping and playing quietly on the iPad. He seemed to be feeling better by mid-afternoon, but he stayed on bedrest and bland diet the rest of the day just in case.
The rest of us carried on with our normal business. After lunch Justus said he wasn't feeling very good. Being the mean mom I am, I assumed that was a ploy to get out of his spelling lesson, but told him to take a bowl and go lay in bed just in case. A few minutes later he was sick too. Since he had been up and eating meals he had a bit rougher time. He is also a lot like me and really hates to throw up. Poor kid. Hayden moved to the couch and Justus took over the spot on my bed.
Eli and JD said they didn't feel so hot around bedtime so we sent everyone to bed with buckets and bowls. Just before 10pm, Justus came running out to report that JD was the next victim of this nasty bug. The littler they are the bigger mess they seem to make. He wasn't able to use the bowl. So, Jerry gave him a warm shower and new jammies while I cleaned up the (big!) mess in the bed. We got him settled in our room and I prepped myself for a long night. I am happy to report he (and therefore I) slept great all night. He woke up pretty much his usual happy self. He joined the ranks of resting and bland diets.
I pretty much cancelled school for the day since over half of my students were sick. Wesley, who was feeling fine, still did his independent work AND everyone's chores. He is such a great helper! He won't be a doctor or nurse though, he is completely grossed out by watching others get sick.
Despite his complaints of not feeling well, Eli did not actually get sick so I allowed him a normal lunch when he said he was feeling better. He was disappointed that he couldn't go play at the neighbors, but we don't want to spread our germs.
Annabeth, thankfully, has been unaffected. Jerry and I are feeling fine as well. We're thankful that this seems to be very short lived - only about 12 hours. We are also hoping this nasty bug moves on and leaves the rest of us alone instead of incubating a few days and then reappearing.
Tuesday morning we got a 5am wake up call from the boy's room. Hayden threw up. We cleaned up the small mess (he pretty much made it to the bathroom) and brought him into our room. Bad news, the commotion had everyone else awake. Good news, they all went back to sleep (truly a small miracle) and then slept until about 7am or so. Hayden spent the day on my bed napping and playing quietly on the iPad. He seemed to be feeling better by mid-afternoon, but he stayed on bedrest and bland diet the rest of the day just in case.
The rest of us carried on with our normal business. After lunch Justus said he wasn't feeling very good. Being the mean mom I am, I assumed that was a ploy to get out of his spelling lesson, but told him to take a bowl and go lay in bed just in case. A few minutes later he was sick too. Since he had been up and eating meals he had a bit rougher time. He is also a lot like me and really hates to throw up. Poor kid. Hayden moved to the couch and Justus took over the spot on my bed.
Eli and JD said they didn't feel so hot around bedtime so we sent everyone to bed with buckets and bowls. Just before 10pm, Justus came running out to report that JD was the next victim of this nasty bug. The littler they are the bigger mess they seem to make. He wasn't able to use the bowl. So, Jerry gave him a warm shower and new jammies while I cleaned up the (big!) mess in the bed. We got him settled in our room and I prepped myself for a long night. I am happy to report he (and therefore I) slept great all night. He woke up pretty much his usual happy self. He joined the ranks of resting and bland diets.
I pretty much cancelled school for the day since over half of my students were sick. Wesley, who was feeling fine, still did his independent work AND everyone's chores. He is such a great helper! He won't be a doctor or nurse though, he is completely grossed out by watching others get sick.
Despite his complaints of not feeling well, Eli did not actually get sick so I allowed him a normal lunch when he said he was feeling better. He was disappointed that he couldn't go play at the neighbors, but we don't want to spread our germs.
Annabeth, thankfully, has been unaffected. Jerry and I are feeling fine as well. We're thankful that this seems to be very short lived - only about 12 hours. We are also hoping this nasty bug moves on and leaves the rest of us alone instead of incubating a few days and then reappearing.
Saturday, September 1, 2012
Broken Toe
Guess what else I did on Annabeth's first birthday? I broke my left pinky toe. It's all my mom's fault really. She had called to wish Annabeth a "Happy Birthday"
while we were out. When I called her back she was busy and said
she'd call me back in a few minutes. So I got up to hang up the wet swim
suits while I waited for her to call back and basically kicked the corner of the wall
coming out of my bathroom. I heard a crack and saw stars. If only my
mother could have talked to me... I would've sat to chat instead of
getting up and breaking my toe! Thanks a lot, Mom! ;)
I took this picture to send to my mom the next morning as her ticket on the guilt trip I wanted to send her on.
There's not much you can do about a broken toe. So I iced it and moved
on with my life. Moving on included my first ever shopping trip to Ikea. And I will say Ikea is a very good distraction! There was so much to see I barely had time to think about my toe!
[Update: As of 9/7/12, the bruising has almost faded away but it still hurts. You never realize how much you move a toe until it hurts with every movement!]
Funny side note: I broke my pinky toe on the opposite foot back in January 2008.
Well, at least now they match now!
I took this picture to send to my mom the next morning as her ticket on the guilt trip I wanted to send her on.
It got worse over the next few days as the bruise spread across the top of my foot, but at least the swelling went down.
[Update: As of 9/7/12, the bruising has almost faded away but it still hurts. You never realize how much you move a toe until it hurts with every movement!]
Funny side note: I broke my pinky toe on the opposite foot back in January 2008.
Well, at least now they match now!
Monday, March 21, 2011
Makena and Big Government
This is part III, for some background read part I & part II first.
"I'm from the government and I'm here to help." President Reagan called these the some of the scariest words in the English language. The newly FDA approved drug Makena is a clear example of just how right Reagan was.
My wife and I are expecting our 7th child. Since my wife has a history of premature labor, we were hoping this time around that she would be treated using a form of progesterone known as 17P. This drug was not specifically made for treatment of premature labor, but in recent years its use for this purpose has increased following some studies demonstrating its effectiveness. Also, 17P was relatively inexpensive, in some cases costing as little as $10/dose. Sadly, our plan has been called into doubt due to a recent development. Under a federal law known as the Orphan Drug Act, KV Pharmaceuticals sought and won FDA approval for their version of 17P, known as Makena. Along with this approval comes 7 years of market exclusivity (that is, only KV can sell this drug) and the announcement that KV would sell Makena for $1,500/dose.
You can read my previous post on why the moral outrage over this dramatic price increase should be directed at KV, a distressed company that saw an opportunity to get healthy with a safe bet on Makena. But who created the conditions that allowed them to make the bet in the first place? Clearly in this case, the answer is the federal government.
Whether or not my wife is treated with Makena, the $1,500 price tag will mean that some women who need it won't get it. Some people will look at circumstances like these and think they require a government intervention, but it was government intervention that allowed for the price increase in the first place. Some problems are not the result of "greedy business" or "heavy-handed government," but are actually the result of these two elements combining. The Orphan Drug Act, a federal law, allowed KV to become the sole supplier of a drug that was widely available at a relatively low cost simply by pushing it over the finish line of FDA approval. Many people fear, and are willing to denounce, the market distortions that come with private monopolies, why shouldn't we be just as concerned over those created through government intervention?
Even if you prefer markets over government solutions, there is no need to demonize the federal intervention in this case. It is not at all hard to believe that the lawmakers who crafted the Orphan Drug Act did so with the best of intentions in an effort to promote drug development for rare diseases. Because these diseases affect a relatively small number of people, markets for these drugs may not be large enough to entice private investment in research and development (I'm not sure premature birth really qualifies as rare). But the result in this case is not a victory for anyone except KV Pharmaceuticals, since they will benefit from a government granted monopoly.
Unfortunately, what should be a cautionary tale about unintended consequences and the dangers of government intervention, will likely be used to call for even further government involvement (of one from or another) in this case. This is a response that simply boggles my mind. The opportunity for KV to profit from the marketing of Makena was a direct result of government intervention, so now we need more intervention to try and correct what went wrong the first time around? It kind of reminds me of that children's song about the old lady who swallowed the fly.
I believe that markets are superior to government planning when it comes to deciding what we produce as a society and how much what we produce costs. That is not to say the government can't or won't ever be involved in markets, it will. When we contemplate government action we need to recognize that there will be unintended consequences. Some of which we will be good at anticipating and some of which will come as a complete surprise. Given the power of markets and the potential dangers of government intervention, there should be a very high bar for government involvement in markets and an even higher one for times when the government is going to grant monopoly powers to a private business.
The story of Makena will have a human cost. It will be reflected in the children born too soon because their mothers never received 17P, which just a few weeks ago was widely available at a fraction of the current price. It is also the story of a private business seeking extra profits by using the power of the government. Finally, it is a story that will be repeated many times over whenever big business sees an opportunity to use big government as a weapon to be deployed in pursuit of profits that would never exist in a competitive market place.
"I'm from the government and I'm here to help." President Reagan called these the some of the scariest words in the English language. The newly FDA approved drug Makena is a clear example of just how right Reagan was.
My wife and I are expecting our 7th child. Since my wife has a history of premature labor, we were hoping this time around that she would be treated using a form of progesterone known as 17P. This drug was not specifically made for treatment of premature labor, but in recent years its use for this purpose has increased following some studies demonstrating its effectiveness. Also, 17P was relatively inexpensive, in some cases costing as little as $10/dose. Sadly, our plan has been called into doubt due to a recent development. Under a federal law known as the Orphan Drug Act, KV Pharmaceuticals sought and won FDA approval for their version of 17P, known as Makena. Along with this approval comes 7 years of market exclusivity (that is, only KV can sell this drug) and the announcement that KV would sell Makena for $1,500/dose.
You can read my previous post on why the moral outrage over this dramatic price increase should be directed at KV, a distressed company that saw an opportunity to get healthy with a safe bet on Makena. But who created the conditions that allowed them to make the bet in the first place? Clearly in this case, the answer is the federal government.
Whether or not my wife is treated with Makena, the $1,500 price tag will mean that some women who need it won't get it. Some people will look at circumstances like these and think they require a government intervention, but it was government intervention that allowed for the price increase in the first place. Some problems are not the result of "greedy business" or "heavy-handed government," but are actually the result of these two elements combining. The Orphan Drug Act, a federal law, allowed KV to become the sole supplier of a drug that was widely available at a relatively low cost simply by pushing it over the finish line of FDA approval. Many people fear, and are willing to denounce, the market distortions that come with private monopolies, why shouldn't we be just as concerned over those created through government intervention?
Even if you prefer markets over government solutions, there is no need to demonize the federal intervention in this case. It is not at all hard to believe that the lawmakers who crafted the Orphan Drug Act did so with the best of intentions in an effort to promote drug development for rare diseases. Because these diseases affect a relatively small number of people, markets for these drugs may not be large enough to entice private investment in research and development (I'm not sure premature birth really qualifies as rare). But the result in this case is not a victory for anyone except KV Pharmaceuticals, since they will benefit from a government granted monopoly.
Unfortunately, what should be a cautionary tale about unintended consequences and the dangers of government intervention, will likely be used to call for even further government involvement (of one from or another) in this case. This is a response that simply boggles my mind. The opportunity for KV to profit from the marketing of Makena was a direct result of government intervention, so now we need more intervention to try and correct what went wrong the first time around? It kind of reminds me of that children's song about the old lady who swallowed the fly.
I believe that markets are superior to government planning when it comes to deciding what we produce as a society and how much what we produce costs. That is not to say the government can't or won't ever be involved in markets, it will. When we contemplate government action we need to recognize that there will be unintended consequences. Some of which we will be good at anticipating and some of which will come as a complete surprise. Given the power of markets and the potential dangers of government intervention, there should be a very high bar for government involvement in markets and an even higher one for times when the government is going to grant monopoly powers to a private business.
The story of Makena will have a human cost. It will be reflected in the children born too soon because their mothers never received 17P, which just a few weeks ago was widely available at a fraction of the current price. It is also the story of a private business seeking extra profits by using the power of the government. Finally, it is a story that will be repeated many times over whenever big business sees an opportunity to use big government as a weapon to be deployed in pursuit of profits that would never exist in a competitive market place.
Saturday, March 19, 2011
Makena and the Orphan Drug Act
This is part II, you may want to go back and read part I for some background.
When my wife was a child she and her sister shared a beloved record of the the songs from the musical Annie. At some point, one of them, I'm not sure who, left it out in the summer sun and it melted. The fact that this story is still told, and told with no small measure of sadness, attests to just how traumatic the experience was. This week it's another kind of orphan that has my wife upset.
She is 13 weeks pregnant with our 7th child. She has had a spontaneous preterm delivery before. During this pregnancy my wife and her doctor had decided she would be treated with 17P injections from week 16 through week 36. 17P is a form of progesterone and is used to prevent premature delivery. Even at around $200 a dose when delivered in our home by a home health company, this cost seemed like a bargain compared to the cost, both monetary and emotional, of having a preemie. At 13 weeks, we are only about 3 weeks away from the beginning of the treatment. On Monday, I read this on one of my favorite economics blogs, Marginal Revolution:
First, it is important to remember what we are NOT talking about here. This is not a case where KV developed and brought to market some entirely new treatment that was previously unknown. The patent protection given to new drugs is a related issue, but it is not a factor in this case. As noted in the quote above, Makena has been given off-label for a long time. This means it hasn't been approved by the FDA as treatment of the condition for which it is being prescribed (in this case preterm delivery). Given the fact that it has been in wide use, it would seem the standard arguments about patent protection for new drugs wouldn't apply to Makena. Here is drug researcher Derek Lowe:
The Orphan Drug Act, under which KV has gained the exclusive rights to Makena, is a law intended to promote drug development for rare diseases. According to the March of Dimes more than half a million babies a year are born prematurely. Given those numbers, it's not clear to me how prematurity still qualifies as a rare disease.
Finally, there are the circumstances around the company now selling Makena at $1500/dose, KV Pharmaceuticals. This is from the St. Louis Post-Dispatch:
It is still not clear if we will be able to get a compounded form of 17P or if we will have to buy Makena at the new higher price. Even at the higher price, my wife will likely still get Makena. It just means we will hit our out of pocket maximum this year.
If there is any shame in this situation, and I believe there is, it belongs to KV and KV alone, but it would be a mistake to ignore the government's role in this. Without federal intervention in the form of the Orphan Drug Act, women would continue to get 17P and prematurity would have an effective and low cost treatment.
When my wife was a child she and her sister shared a beloved record of the the songs from the musical Annie. At some point, one of them, I'm not sure who, left it out in the summer sun and it melted. The fact that this story is still told, and told with no small measure of sadness, attests to just how traumatic the experience was. This week it's another kind of orphan that has my wife upset.
She is 13 weeks pregnant with our 7th child. She has had a spontaneous preterm delivery before. During this pregnancy my wife and her doctor had decided she would be treated with 17P injections from week 16 through week 36. 17P is a form of progesterone and is used to prevent premature delivery. Even at around $200 a dose when delivered in our home by a home health company, this cost seemed like a bargain compared to the cost, both monetary and emotional, of having a preemie. At 13 weeks, we are only about 3 weeks away from the beginning of the treatment. On Monday, I read this on one of my favorite economics blogs, Marginal Revolution:
Makena is a drug used for premature birth therapy. It’s been available off-label for a long-time but KV pharmaceuticals ran a clinical trial and applied for FDA approval under the Orphan Drug Act (ODA). Under the ODA, KV is entitled to seven years of market exclusivity, this is even stronger than a patent because it gives KV the right to exclude from the market any drugs (not just similar drugs) that treat the same condition.
Now that KV has a monopoly—enforced against compounding pharmacies by threats from the FDA—the price will rise from about $10 to a listed price of $1,500. Naturally a lot of people are outraged.I'm not exactly outraged, but I am a little bit sad since a treatment my wife and I had put so much hope in will now be substantially more expensive. As someone who comments on the consequences of public policy from time to time, it's not that hard for me to set aside my personal feelings for a minute and ask whether or not granting a monopoly to KV in this case makes sense, and I'm not sure that it does.
First, it is important to remember what we are NOT talking about here. This is not a case where KV developed and brought to market some entirely new treatment that was previously unknown. The patent protection given to new drugs is a related issue, but it is not a factor in this case. As noted in the quote above, Makena has been given off-label for a long time. This means it hasn't been approved by the FDA as treatment of the condition for which it is being prescribed (in this case preterm delivery). Given the fact that it has been in wide use, it would seem the standard arguments about patent protection for new drugs wouldn't apply to Makena. Here is drug researcher Derek Lowe:
What's irritating, to someone like me who works at a "find a new drug" type of company, is that these no-name generic outfits (KV in this case, URL Pharma for colchicine) are doing pretty much what critics of the industry think that we all do, all the time. That is, walk up to situations where other people have done a lot of the work, a good amount of it with public/NIH money, and step right in and profit. Now it's true that these companies have to basically run Phase II/Phase III trials to take the data to the FDA, and that's a significant amount of money. But their risks in doing so have been watered down immensely by the history of these drugs in the medical community.So KV has some risk in that they have to perform the final series of trials and then go through the FDA approval process, but is this cost proportional to the benefit? In this case seven years of exclusivity, and the tremendous run up in price that comes with it. History suggests that what KV added to the Makena story may not have been that valuable to anyone other than KV since the durg had been gaining popularity as a treatment for preterm labor at least since 2003 when a study demonstrated Makena's effectiveness.
The Orphan Drug Act, under which KV has gained the exclusive rights to Makena, is a law intended to promote drug development for rare diseases. According to the March of Dimes more than half a million babies a year are born prematurely. Given those numbers, it's not clear to me how prematurity still qualifies as a rare disease.
Finally, there are the circumstances around the company now selling Makena at $1500/dose, KV Pharmaceuticals. This is from the St. Louis Post-Dispatch:
Staring down at the former chief executive of KV Pharmaceutical Co. — what used to be among St. Louis' most successful companies — the federal judge portrayed Marc Hermelin as an example of capitalism gone awry.KV is a distressed company making a bet on Makena. But how much does KV really have at risk? Given the fact that 17P was in wide use and there were studies demonstrating its effectiveness, it would appear they weren't risking much.
"What I see when I see Mr. Hermelin is greed, abuse of power, recklessness," U.S. District Judge E. Richard Webber said Thursday. "He had this great company of 1,700 (employees), and once diverted, he was sending pills across the country that were twice the strength of their labels."
...By 2008, KV was considered one of the most successful publicly traded companies based in the St. Louis area. But the criminal case against Ethex resulted in a two-year shutdown of KV's production facilities and layoffs of three-quarters of its work force. Now, the drug company is hoping to revive itself with a new prenatal drug, Makena.
It is still not clear if we will be able to get a compounded form of 17P or if we will have to buy Makena at the new higher price. Even at the higher price, my wife will likely still get Makena. It just means we will hit our out of pocket maximum this year.
If there is any shame in this situation, and I believe there is, it belongs to KV and KV alone, but it would be a mistake to ignore the government's role in this. Without federal intervention in the form of the Orphan Drug Act, women would continue to get 17P and prematurity would have an effective and low cost treatment.
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