Tag Archive | health

Fish out of water Part duex…

Ask and you shall receive, maybe not the first try, but try, try again we did! We recently reached out asking for advice from our readers about their knowledge and/or experience with nevus owners overheating. We received a lot of good information but nothing lined up with Mermaid’s “LEN” so I began doubting the cause. I started researching and honestly, came up a bit empty handed so I went back to ground zero and looked at her biopsy again. I often forget that the official pathology report came back as Epidermolytic Hyperkeratosis WITH Linear Epidermal Nevus, not vice versa so I restarted my search on the EHK and wouldn’t you know, it was everywhere!

EHK is a form of Ichthyosis and the information linking the two with potential overheating was abundant. It was relieving to know that my original gut feeling that the cause was related to her genetic disease but a small piece of me needed validation. After all, what if I was wrong and ignored signs of some other underlying condition. The chances seemed slim since she has otherwise been a healthy thriving child but I reached out anyway.

Our first (and I anticipated only) connection was with Mermaid’s general dermatologist. I was shocked that without a doubt not only did he say that her LEN had zero connection but he stated that I possibly misunderstood her biopsy and she did not in fact have EHK. I spoke to him about a plethora of information we had received from the children’s hospital directly related to her EHK and he admittedly stated that this was out of his wheelhouse but stood by his stance that there was no connection. Perplexed and frustrated I reached out to her Primary Care Doctor as the dermatologist advised to begin the search for an underlying cause.

Primary Care seemed as equally perplexed as I was and again eluded to this being a bit out of their wheelhouse, they were slightly taken back at us being directed to them but did some research and found a few possibilities. There were a few “conditions” that also had links to dermatological conditions that could be the underlying cause so we agreed to go forward with testing. Her PCP felt obligated to search for anything he could and being that we were led his direction we were going to travel that road with him without question. That same night with the promise of SEVEN new toys (thank the lord for the dollar store) I carted a screaming Mermaid in for blood tests and her chart was sent to neurology for a chart review. Most of the tests were straight forward and results poured in less than 24 hours later. Negative after negative after negative. I was happy, but still felt frustrated to have no concrete answer or validation.

The following morning as soon as I started seeing the negative results I made one last attempt at answers and reached out to Oregon Health and Science University where the Pediatric specialist for dermatology we previously met with resides. On our luck he had a same day appointment and off we went.

I left happy, aggravated yet understanding on all fronts. On our third connection we were assured that yes, Mermaid DOES in fact have a bit of a double whammy. She has EHK & LEN, just as I thought, EHK is a form of Ichthyosis and BOTH of them have the potential to cause overheating depending on the location. The vast majority of Mermaids fills her left armpit and as a result has clogged her sweat glands preventing her body from cooling itself properly. Essentially it causes her to internally heat up quicker. I suppose this sheds a small light on my midget sized nudist.

So now what? Well, the PNW has had some higher than normal temps and we have definitely learned that above 90 in direct sun she enters her danger zone. In the absence of a body of water we are limited to where we go if it the heat reaches that range. We started using Tazorac for a few weeks to see if we can thin the thickening near her sweat pores to allow some breathing room. There is no guarantee but smack dab in the middle of summer, any small relief is a huge feat. We followed up with all entities to ensure them it was in fact a direct result of her genetic disease and also advised that a body temperature above 105 is directly to the ER opposed to attempting to cool her ourselves at home. I guess I should replace that thermometer she broke.

We appreciate everyone that reached out to us and shared your wisdom, I can assure you that the moment you see your little one turn purple, vomit and fall asleep so deeply it’s hard to wake them, you too would be in a bit of a panic. I can’t possibly begin to imagine how she felt. I compare it to those of us without an underlying condition attempting to run a marathon in 105 degree weather while wearing a sweat suit and no water to drink. I’m so proud of how smart my Mermaid is to recognize when she has been out in the sun long enough. She is very vocal in telling me it has been enough and time to go, brings herself inside to cool off knows to continue staying hydrated. She has had so much to learn about in her short 4 years on this earth and always adjusts without a hitch. Maybe Mermaid’s are smarter than we ever knew!

d88ab58facc45d63fd8fd20c81bef343

Here’s to hoping we have an otherwise eventless summer!

Thanks for walking with us today!

Mermaid’s Mommy

Advertisements

A new beginning to an old problem…

 Those of you that have been following us since day One, know that we have had our ups and downs with our healthcare system regarding Mermaid’s nevus. For the most part we feel taken care of and have access to care in many forms. However, we do not have access to a pediatric dermatologist or one who specializes in “Genetic skin diseases”; which has left us perplexed at times and receiving a variety of responses and care plans that range from aggressive to very passive. Several years ago I requested to see a specialist at Oregon Health and Science University and was denied. In recent months Mermaid has developed new spots and symptoms that sent us searching for another avenue to make our way up the hill.

This past week, our persistence and patience paid off. At the recommendation of a fellow Nevus Mommy’s pediatric Dermatologist on the East Coast, we got our day with Dr. Kroll. A pediatric Dermatologist that specializes in genetic skin diseases. Leading up to today I knew what we wanted answered specifically and got those answers, plus some. The main concerns I wanted addressed were… What are these new spots that don’t appear to be nevus? Will she have to have surgery at school age? Despite the biopsy not showing ILVEN, is it still a possible diagnosis? and what is her real risk factor for a Wilm’s Tumor?

I will start with what we learned followed by the answers to our questions and then our treatment plan.

Mermaid’s main diagnosis was Epidermolytic Hyperkeratosis (EHK) with Linear Epidermal Nevus (LEN). We have always focused on the LEN and put little to no thought into the EHK, aside from it being a bit more rare than the LEN. Well, news to us… the EHK comes with its own potential complications. We learned that sometimes, a female with EHK on one side of the body may have it on that parallel ovary. If/when she chooses to have children she runs the risk of passing on that gene in a full body form called Ichthyosis to her children. This is a small possibility, studies have shown that it’s a 2-10% chance but we were advised to have her be seen in genetics as a late teen to further discuss this and they hope with medical advancements that they will have a test to better diagnose whether or not the disease is actually on her ovary.

He felt certain that she does not now, nor ever will she, have any of the larger complications of her LEN resulting in the syndrome. Those symptoms typically arise at a very early age, with the exception of potential learning disabilities such as delayed speech, which has never been an issue, trust me – she speaks just fine and knows more than she should to be only 4!  He reminded us that any small lump beneath the skin should be checked as there is a risk for squamous cells to develop.

As we already knew, he reiterated that there is no effective preventative medical treatment, we should see the extent of her disease by puberty and along the way there are two different laser treatments that may help in minimizing some of her nevus but the only true treatment would be complete excision with the trade-off of scars.

With some new and old but reassuring information we got the chance to clarify some of our burning questions…

What are Mermaid’s new spots that don’t appear to be nevus?

Unfortunately, Mermaid got cursed with two genetic diseases. What we originally thought was eczema, then a potential reaction to a soy allergy has now been confirmed as Psoriasis.

2017-02-24-21-22-46

At the time of her appointment Mermaid had roughly 27 spots like the one above spanning head to toe. Including her face. If you saw our previous post about the mystery spots, it was also confirmed that the scales beneath her eye are Psoriasis.

Eye#1

Will she have to have surgery at school age?

The long and short of this question is still, we don’t know. The area of concern is Mermaid’s hand. Her Nevus grows thickest at her wrist and top of her left  hand. This is also the only area that has cracked and bled. When her Nevus breaks open she is at risk of further infection. It can also cause pain and limited movement when it grows over the joints. His initial feeling is no, we will NOT be doing surgery next year. This was a huge relief, the thought of putting my child under and performing a very painful excision at such a young age was worrisome. The reason we cannot get a direct yes or no to the surgery question is that Mermaid’s form of Nevus grows with no rhyme or reason and putting a definitive answer on the future is nearly impossible. If it remains as is or has only a small amount of growth we are in the clear. If it grows extensively in the next year we run a higher chance of following through with surgery. One of my fellow Nevus Mommy friends shared pictures and experiences of her daughter’s hand surgery and it truly broke my heart. She is incredibly strong and did great but it was far from a pleasant experience for her or Mom.  Please, please, please… keep your fingers crossed!

Despite the biopsy not showing ILVEN, is it still a possible diagnosis?

In the big scheme of things the difference in diagnosises is minimal and doesn’t mean a whole lot. So why would I care? Up until now, I have been told that ILVEN can be treated with steroids to reduce discomfort, redness and inflammation. I have asked before about using it for her bothersome areas but was told it is not a treatment used for LEN. Being seen on the hill was my goal because they are the specialists and just as I originally suspected, he said that even IF another biopsy showed ILVEN, it would NOT change the treatment plan. He stated that ILVEN & LEN are treated the exact same and we would begin treating it today.

and last but certainly not least… That lingering fear since Day one of her diagnosis…

What is her real risk factor for a Wilm’s Tumor?

The very first day Mermaid was diagnosed we were told point-blank that we needed to be aware of something called a Wilm’s tumor, childhood kidney cancer. She would be at risk until age 5. Since that day I have probably prayed harder than any Mom out there for her 6th birthday. I have vowed it would be the party of the century because that day, she would no longer be at risk and I could lay my anxieties surrounding this cloud to rest. Along the way the other dermatologists did not all agree but they also didn’t dispel the possibility. Nobody seemed to have numbers or facts supporting it so we continued to be aware.

Dr. Kroll finally put a stop to the worry. He seemed a bit surprised as we told him about this and very matter of fact stated that he has never heard this, especially in an otherwise healthy child without the syndrome. He said that if she had some of the big components of the syndrome such as one side of her body being larger or boney structures there may be a study or two to support a link, but in her case, No.

I’m sure you can imagine both my frustration and relief. Letting go of my frustration was easy, after all; this is why we pushed to be seen there.

So overall we learned of some potential side effects Mermaid’s EHK, that LEN & ILVEN can be treated the exact same, that we will continue to watch her hand’s growth over the next year, that she is now the proud owner of EHK, LEN, AND Psoriasis and best of all, that the risk of a wilm’s tumor is no higher than that of any other child.

Up until now we have not treated her skin issues in any way. We have done a few prescription strength creams such as Nystatin and 1% Hydrocortisone but mostly use home remedies to doctor what we can. That has all changed.

Hanging on my fridge is a crazy calendar marking out what medications need applied what day. We are starting a retinoid called Tazorac to be used specifically on her wrist and hand 2-3 times a week, Triamcinolone Ointment for her torso twice daily and Tacrolimus Ointment on her face and neck 5 days on 2 days off.

In one month we will re-evaluate its effects and create a plan from there. It’s a lot, it feels slightly daunting but I am beyond thankful that we are finally beginning a treatment plan and hopefully bringing her some relief. I am also thankful for our amazing insurance that covered the $750 cost of a months medications.

I have no doubt that in a few short weeks we will be reporting about success!

Moving forward we will now be followed @ OHSU for annual check ups and any major changes. For non urgent concerns and medication refills we will still utilize her other dermatologist. It feels like we are finally on a satisfying path.

Stayed tuned for happy updates!

Thanks for walking with us today,

Mermaid’s Mommy

A new shell…

This is my life book. It has been by my side for almost 6 years now. It is always near me. I carry it in my bag and it’s rare the two of us are far apart. When I get to work, I take it out of my bag and set it next to my computer.

20170217_205226-1

It’s tattered, torn and hanging by a thread, but you know what – it’s full of so much love. Inside this book are my ideas. Those pop in your head, don’t want to lose them ideas. It has over 5 years of finances carefully listed and checked off month after month. It has party invites, my step son’s 8th grade graduation program, Mermaid’s official pathology report from September 2015, a picture of a friend I just lost, stuck through the back pages is a guardian angel pin gifted to me. Some of the pages are burnt as I was writing in it one night by the fire when I was pregnant and a hot ash caught it on fire. It holds a card my husband made me, a goodbye note from a Physician & friend I highly respected that moved away, a list of all the places I want to visit and a recipe my Mom hand wrote.

20170217_205312

Just last week the entire cover started tearing off and I taped it up with scotch tape. One would think I could just go buy a new one but it holds sentimental value. As I was taping it up I thought to myself, this is kind of like my life right now. Barely held together, full of so much love, but in need of a new shell.

You see, these past few weeks have been more trying than I can even begin to explain. Mermaid had what I thought was nevus starting to grow on her face, the moment it started to bleed I finally took her to urgent care, with no answers we were led back to dermatology and thank the Lord, it just ended up being eczema but we are now battling that. I have had some challenges at work and been faced with making very difficult decisions, I have had to allow myself to be vulnerable, fight anxiety and search within for what was the right thing to do. A few days ago I woke up overcome with grief. I sat down in the shower and sobbed, missing my friend who passed a few months ago. Her passing is still fresh and has completely altered my life. I barely made it to work and while there, I wished I cold just get in my car and drive to heaven to have a cup of coffee with her. That being completely unrealistic, I contemplated driving anywhere, just going, clear my head, but I didn’t. I stayed, I held up my responsibilities and tried to power through.

Mid-week I told myself to shake it off. I have so many blessings and hard times will come and go. Find a new shell.

That morning when I got to work, there was a package from a friend. It contained a Mermaid journal, a coffee card and a letter with 9 reasons why she sent it to me. So once again, I sat there crying. This time, happy tears. She spoke to work, my Mermaid and the loss of my friend, but #9 was my favorite. “Just because!”

2017-02-17 20.57.31.jpg

She didn’t know about my life book until I told her that morning, she just knew I was struggling to find peace.

She gave me my new shell.

When  I told her how much it meant, she kindly said “See, people are listening.”

It’s easy to forget our blessings, to dwell and struggle to find our footing; and that’s ok because somewhere along the way, something small will remind you. Give you a breathe of fresh air and a chance to start new.

I put some of my hard decisions in motion, I started yet another nightly routine for Mermaid’s skin and I talked to my friend driving home that day. Ok, so I talked to myself, but I know she heard me. I told her to help me find a way to let go, not forget, just let the grief go.

Yesterday Mermaid was suppose to be cleaning her room but instead she made me a bracelet. She was so proud of herself and asked me to wear it to work. When we got home today she found it on the table and said “Mommy, you forgot to wear your bracelet to work” – ashamed, I apologized. A few minutes later she came out of her room with a different bracelet and said it’s ok, you can wear this one, it’s your favorite. This was not my favorite bracelet, it’s not even mine, it’s hers. She can’t possibly remember where it came from and why she said that, or chose it, I can’t explain; but I remember where it came from. A few year’s back, my friend that passed, gave it to her while we were visiting in Seattle. Maybe it was her small way of reminding me of the good times, telling me it’s ok and that she heard me.

840358-r1-037-17_019-1

This weekend as I transfer my life book to it’s new shell I will embrace the new beginning and here are 9 reasons why:

1.Because I have an amazing family that supports my every move.

2.Because I know deep down inside, the hardest decisions are often the right decisions.

3.Because as of now, Mermaid has no complications as a result of her disease & we can jump any other hurdles thrown our way.

4.Because I have 18 amazing years of memories with my late friend to smile about, not cry about.

5.Because when we think nobody is listening, they are.

6.Because today, I felt the sunshine on my face for the first time in a while and it reminded me that the clouds always clear.

7.Because the positives I gain through work outweigh all the negatives.

8.Because I am slowly learning, 35 years into this life, that it’s ok to stumble as long as you get back up.

and

9. Just Because!

My Dear Kathy – I thank you for my new shell and your humorous but powerful words. I thank you for listening. I thank you for reminding me of the good. My promise to you is to listen to someone else, and when they least expect it, send them a new shell.

Today, you are an honorary Mermaid.

Thanks for walking with us today!

Mermaid’s Mommy

…And… We are back!

Well hello there! Welcome to 2017! We last left you a note that we were taking the holiday season off and that’s just what we did; but it’s time to dive back into things. As I’m sure you all know, the holiday season can be all encompassing. We wanted some time to focus on another project and be present in all the winter festivities. Some things went as planned and we promise to share about that later but honestly, life had a different plan for us these past few months and we went through some personal struggles regarding loss. That too, we will share down the road but I’m not quite ready to go there.

For now, let’s catch up on where we are at in the Nevus world. We gained some new followers during our break and fresh faces are always looking so I will give a quick reminder of why we are here.

My daughter was born with Epidermolytic Hyperkeratosis, specifically Aconthotic and hyperkeratotic epidermis with focal dyskeratosis including linear epidermolytic epidermal nevus and epidermolytic acanthoma, a hemangioma and a stork bite, also a form of nevus, on her neck. The hemangioma never grew, it’s the same size now as it was at birth but her stork bite, also a form of nevus, has continued to grow and her LEN has opted not to slow down. In comparison to others we feel blessed, her LEN remains light in color and relatively flat but continuously changing.

What does all of that even mean?

Broken down, it essentially means she has EHK and LEN.

Linear Epidermal Nevus (LEN) is a rare genetic skin disease effecting about 1 in 100,000 people that typically effects the limbs and torso. Her particular kind sticks to one side of the body, in our case, her left side. In infancy it is light tan and flat but will thicken, darken and often become warty as one ages. There is a possibility of skeletal, bone, ocular and neuro abnormalities that may develop; in which case it would be consider a “syndrome”; the lesions alone do not indicate a syndrome. There is a chance that the lesions may develop tumors, some benign, some cancerous. Open lesions are susceptible to infection, causing further health risks. About one in five people will experience a malignant cancer in their lesions.

There are many other forms of Nevus including Congenital, Sebaceous, giant, and closest in kind, ILVEN. It is caused by a genetic mutation in the ectoderm during gestation. At this time there is no “cure” – though there are potential medicines and procedures to help with discomfort and visualization. Occasionally, surgery will be warranted if the size or site indicate so. Excision is the only true “cure” for LEN or ILVEN. The rest is all maintenance so it all depends on how severe your specific case is.

The subtype of Epidermolytic Hyperkeratosis (EHK) is even rarer than LEN. It effects about 1 in 250,000 people and makes Mermaid’s skin fragile. There are two types of EHK, my daughter’s is the NPS type. We will explore that more this coming year. The dyskeratosis and aconthosis is a fancy way of saying there is an abnormalization of the skin keratin causing thickening.

So where are we today?

Currently, we are on our 3rd dermatologist and live day to day with what the future may hold. We have been blessed that thus far she has not developed any of the potential abnormalities and most likely wont, with one exception. Her vision, her eyes were checked about 1.5 years ago and they questioned her vision a little bit. As a result our new dermatologist recommended we follow up. We will be seeing the same pediatric opthomologist, which we LOVED,  for our second time in a few short weeks. The obvious things they are looking for are cataracts and colobomas, some people refer to an abnormality as a “key-hole.”

Additionally, Mermaid’s disease is growing on her hand, over the joints. Nothing has been set in stone but all 3 dermatologists have mentioned the potential of needing excision surgery near school age. We are a ways off from that so I can’t speak to that more than saying it is a possibility.

One of the first things we were told was to be aware of was the potential of developing “Wilm’s tumor” – childhood kidney disease. This has been controversial from source to source but nonetheless, is there. She will officially be in the clear at age 6.

Over the past few months Mermaid has developed a new spot on her back and the base of her skull that are itchy, raised and extremely bothersome. We are waiting them out to see if they progress but will probably go in to have them checked soon.

Where we are today is night and day to where we began. In the beginning I was scared, plagued with anxiety, confused and uneducated. I now have a good grasp on what we are dealing with and the anxiety has mostly subsided. I say “mostly” because there is always that lingering fear of cancer, be it in the form of melanoma or kidney cancer, that, I will never shake, though it is far from the forefront of my mind, more of a foot note.

We have grown so much as a result of my relentless research and support from everyone here at Mommy’s Mermaid.

To our new followers, we welcome you, and thank you for joining us, to those just browsing, thanks for stopping by, and for our long time friends and followers, we appreciate and love you all.

We look forward to spending the next year sharing our journey, hearing your stories and hopefully making progress and new discoveries in the nevus world.

Cheers to 2017!

Thanks for walking with us today!

Mermaid’s Mommy