Monthly Archives: September 2018

Cuddly Black-and-White Bears, or Blood Sucking Worms?

Posted on by findingmykid
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“PANDAS. I have a gut feeling. It sounds like PANDAS,” said my friend Stacey.

“But he’s never been a PANDAS kid,” I replied. “Plus, it didn’t come on that fast. The doctor thinks it’s parasite-related, thinks he picked up something new in Costa Rica. He’s always been susceptible to parasites.”

“Doctors can get stuck on one idea and want to make you fit that box. All I’m saying is to make sure you also look into PANDAS.”

“I hear you,” I said. “Can you get me the info on which tests to run for PANDAS? I’ll see if I can get them done before our appointment.”

This discussion, which could only have taken place between biomed parents, was about what’s been going on with Martin. Poor Martin is not in a good place. The troubles (the exciting new troubles, atop the quotidian troubles) started in Costa Rica, maybe halfway through July. I began to notice that Martin wanted to go to the bathroom all the time. Sometimes he would go to the bathroom, brush his teeth to leave, then need the bathroom again before we could get out the door. He started spending a long time on sitting on the toilet, too. Near the end of July he developed a tic: He thrusts one index finger simultaneously into each nostril—briefly, with no rooting around or picking, thank heavens—and then immediately puts his fingers into his mouth. The whole action is over within a couple seconds, but it’s noticeable, and recurring, and out of Martin’s control. Next came the eye rubbing. Since our return to the States, Martin has been rubbing his eyes compulsively. He asks, “Why is this happening? Why can’t I stop rubbing my eyes?” As we made our way into September, he started night-waking, and having trouble getting to sleep.

None of the symptoms dissipated as the new ones arose. As of today, Martin is sleeping poorly, rubbing his eyes till they look red and sore, patterning his index fingers into his nose and mouth constantly, and using the restroom multiple times per hour, sometimes staying in there 10 minutes or more.

Wait—did I mention touching his private parts? Now he’s doing that, too. If we gently remind him to watch his hands, he complains that it is hard.

I’ve already received several reports from school. Martin seems distracted (even more than usual, I assume). Martin walked into a wall. (Yes. That was one report.) Martin is signing out of the classroom to go to the bathroom several times an hour.

When the bathroom issues and first tic arose, in Costa Rica, I thought that oxalate sensitivity might be at play. I reduced oxalates in his diet, which was not easy, as he loves potatoes and sweet potatoes, and making a meal for the whole family (I’m vegan) usually means using some nuts, or legumes. A few weeks of reduced oxalates brought no change, unless you count a worsening of the symptoms.

Back in the States, I brought Martin to his pediatrician, to rule out a UTI. His urine showed no trace of problems. The pediatrician thought Martin might be constipated, which can cause frequent urination, so I worked prunes and pears into his daily diet. No change.

Martin is prone to parasites, so I gave him a course of Alinia, which has worked in the past. No change.

I called Martin’s primary doctor for autism issues. She suspected parasites also. Together, we decided to move Martin’s previously scheduled appointment from the end of October to this coming Monday.

Then I went out to dinner with Stacey, and we had the conversation with which I began this post. I agreed to get testing done for PANDAS, but to be honest, I was skeptical. Martin has never been a PANS or PANDAS kid. I can’t recall flares, or his behavior changing those few times when he’s been on antibiotics. Later Stacey texted me a link to basic information on PANDAS and wrote: “Seriously please read this because it does state urinary frequency as a sign of PANS and/or PANDAS. I would really look into this as a potential cause. I could be totally off base but I have just a gut feeling.” I opened the link, and one specific reported symptom of PANDAS struck me: poor handwriting.

Though I hadn’t thought much about it, or connected it to the urination and tics (probably because I’m bone-headed), I’ve noticed that Martin’s handwriting has been abysmal since he returned to school. Not just shaky or unplanned, as his handwriting usually is, but truly abysmal. Almost illegible.

PANDAS? Stacey’s gut feelings tend to be reliable.

Parasites? Martin’s doctor for autism issues knows him pretty well.

His mother’s opinion? Confused.

Hives

Posted on by findingmykid
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Martin is allergic to horses. He didn’t always present as allergic to horses. When he was four and five years old, he did hippotherapy weekly, without problems. When he was eight years old, on a visit to Costa Rica, we went horseback riding on the beach: Martin, Adrian, my brother-in-law Pancho, and I. We rode for an hour. I was second in line; Martin, wearing shorts and a small t-shirt, was third. Every few minutes I turned around to glance at him, make sure he was still riding comfortably. I saw no issues. But when we arrived back at the stables, and I was able to see Martin up close, I could see that he was covered in a red rash. Rashed on his arms. Rashed on his legs and, I soon discovered, on his chest and belly. Most of all, rashed on his face, which was red and bumpy. “What’s wrong with me?” he exclaimed and burst out crying. I checked his breathing (it was okay), took him back to our rental house, and put him in the shower. With good scrubbing and an antihistamine, the rash dissipated.

After the Costa Rica experience, I asked Martin’s allergist—a mainstream doctor, not focused on ASD—to test Martin for a reaction to horses. The doctor agreed, though he had to order a special skin test. When it was finally available and administered, the test left no doubt: Martin’s forearm immediately swelled into a red bump. No more horses.

On that same Costa Rica trip (August 2016), we discovered Martin had become allergic to red meat.Sixteen months earlier, in February 2015, in South America, Martin was eating beef with roast potatoes when a red rash formed around his mouth.(That trip, however, he’d ridden horses with his cousins, no problem.) Still I didn’t realize that red meat, which he rarely ate, was the issue; of the Costa Rica trip, I wrote: “He had two allergic reactions, one to a horse that left his face bumpy and itchy, and one to an unidentified food irritant (restaurant) that caused a rash to spread from the corners of his mouth down his neck.” Subsequently I put the pieces together and stopped letting Martin eat beef—but it would be more time yet before I figured out that all red meats were problematic, not just beef. (That discovery, in a “bison incident,” is described here.)

This summer, in Costa Rica again, Martin’s day camp was having an activity in which the kids rode horses to a remote waterfall. I wondered: The allergy came on when Martin was already six (or seven? or eight?) years old. Does he still have it? These Johnny-come-lately allergies—do they stick around? I wanted Martin to be able to participate in the horseback-riding activity, and not to experience one more factor differentiating him from other kids.

So I acted recklessly. (Maybe?) I told the camp director that Martin is allergic to horses. I told her about Martin’s reaction two years earlier, also in Costa Rica. I said I was going to dress Martin in long sleeves, long pants, and high socks, and send him to camp. I asked her to let Martin give the activity a try and see what happened. I reminded her that Martin always carries antihistamine in his backpack, just in case.

Mid-morning, I received a message from the camp director. Martin had only been on the horse a few minutes when he got a terrible rash. She took him off the horse immediately and administered his antihistamine. The reaction was severe enough that she also took him directly to a shower to wash. Thankfully, he was better within a short time.

That’s that. Martin has become allergic to horses, possibly permanently, just as he has become allergic to cats and dogs and has become allergic to red meat.

I am, of course, back to pondering why Martin has developed allergies as he continues to heal. I still think the most likely explanation is that he had these allergies (with the possible exception of red meat, which may or may not be related to Lyme disease) all along, but previously his immune system was neither strong nor responsive enough to mount the proper response. Whereas allergies themselves represent flaws in immune function, perhaps one day Martin’s full recovery will mean the allergies dissipate along with the remaining vestiges of autism.

Today, let’s not dwell on the allergies, and what they might mean. Instead, let’s focus on this: According to the camp director in Costa Rica, Martin didn’t freak out, not even when he was covered in a rash and pulled away from the other kids. She said he was upset for a minute or two, then calmed down. Two weeks later, when the activity again was horseback riding, I offered Martin a choice: He could go to camp and play games or surf while the other kids rode (the director had offered this alternative), or he could take the day off and go to the beach with Uncle Eddie. Martin contemplated for a while, then chose to take the day off. It seemed like a reasonable choice, and it wasn’t a big deal.

Because now, not everything has to be a big deal.

Missing Pieces

Posted on by findingmykid
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When my sister and her daughters were visiting us in Costa Rica, I got to take care of my almost-two-year-old niece, Julie, for a half-day. My sister, her older daughter, my brother, and Martin were taking a long canopy tour. We dropped them off at 1:30 pm. I carried little Julie as she waved bye to the canopy-tour crew, then strapped her into her car seat and drove to our local supermarket, a noisy cement-floored warehouse kind of place. Julie let me set her in the grocery cart’s child seat and “helped” me shop. I handed her boxed or bagged items, which she clutched (sometimes gnawed) until she tired of them, then tossed into the cart and stretched her arms out to ask me for something new. I saw a yogurt drink my sister gives Julie, so I bought one and letter her have it on the way home. She and I laughed together when we arrived home and I discovered most of the yogurt drink on her shirt.

I didn’t want to rummage through my sister’s suitcases to find a clean shirt, so I let Julie run around shirtless. Julie seemed to do only charming things. As I used the food processor to julienne vegetables for an Asian chopped salad, she pushed a cardboard box around the floor like a train. She put items in the box and unloaded them elsewhere in the house. Whenever I announced I was putting a new vegetable into the food processor, she marched into the kitchen and demanded a sample. We went out back to swing in the hammock and dip our feet in the pool. I put a motorcycle helmet on Julie, sat her on the rugged ATV I kept for short trips through the jungle, and took photos to send her (mildly overprotective) father back in the States, to freak him out. Julie was a good sport, smiling and posing. When, after four hours of fun, it came time to pick up the canopy-tour crew, I put one of Martin’s t-shirts on Julie. It was of course wildly oversized, like a dress that brushed the floor as she tried to walk. Julie delighted in this. She giggled and danced as she lifted the shirt to her knees.

I’ve written before about the fact that I will never parent a typically developing child through the earliest years. Spending the afternoon with Julie shifted made me think less about my own loss and more about Martin’s. As I watched Julie explore her world, learn from touch, and interact with and imitate me, I grieved for Martin. He was just about turning two when Adrian and I finally realized (first-time parents!) that he was not progressing on the same track as his peers. Martin did not investigate; he stimmed by pushing a car back and forth. I did not get to prepare dinner while Martin played train with a box and stopped by the kitchen out of curiosity; if I needed to occupy him, I pulled the upright vacuum to the center of the living room. Honestly. The way to occupy Martin for an hour was to let him stare at the vacuum from different angles. Martin did not delight in new experiences, or play with me; he screamed with terror when he transitioned activities, and bolted from my grasp.

Even today, Martin cannot smile intentionally for a photograph. Instead, he grimaces and presses his tongue against his front teeth. When we try to practice for photographs, he says, “Smiling is hard. Do all kids have trouble smiling?”

Months ago, I had this exchange with a friend whose son is recovering from ASD and whose daughter, her younger child, is typically developing. They live in another country, so we don’t see each other much. She wrote of her experience parenting her daughter:

My friend:

Neurotypical development is mind blowing—the kids learn all the time & all on their own at a rapid pace

Parents do zilch compared to what we do for our ASD kids

[My daughter] thinks & speaks in 2 languages, knows so many songs & rhymes, colors, etc.

Vocabulary, questions, observations

Unbelievable

I didn’t respond. When my friend prodded me, weeks later, I wrote:

I have been meaning for a while to respond to your last set of messages. Honestly, they got me down a little bit. Martin is still not as far along as [my friend’s recovering son], but in many areas it feels like we are getting so close to typical, and I have faith that we will be there eventually. It is difficult to hear about these differences between neurotypical kids and ours, because it makes me feel that no matter how successful recovery is, there may always be differences, simply based on the developmental milestones that were lost along the way

And of course I want to believe that once he is fully recovered, it will not be evident that so much of his childhood was spent recovering from this disorder

[ . . . ]

I think what is tough for me is the idea that other children can be constantly learning. I worry that they will outpace him

My friend:

It is heart-rending to watch the [NT] language acquisition, social & attention

Just like a button is always on

By listening to me talking on the phone she will guess who I am talking to and contribute to the call

It seems to flow without effort

Even making puzzles etc., learns by watching the other kid

Me again:

I get it! That’s the type of stuff that makes me feel sad

My friend:

I get it—though both are mine I feel sad a lot for [the older]

That’s it. I feel sad. Martin has missed so much. He’s already 10 and, even as he becomes ever-more typical, has missed the chance to experience the world with a toddler’s wonder. To learn simply by playing, as learning should occur.

For both of us, some pieces will remain missing.

I took this our last evening in Costa Rica. That’s Martin, on the left, going a different direction.