A whole herd of zebras

My sister gave me a domain name for Christmas!  How cool is that?

This will just be a little introduction to explain the name of the blog and the main characters.  Katie (my sister) registered “Looking for Zebras” because our family seems to have an inordinate number of “zebras” in the family.  Zebras refers to the advice given by Dr. Woodward (a local guy, btw–he was at the University of Maryland School of Medicine, which could explain why both Katie and I take our kids to Johns Hopkins!*) to his medical students in the 1940’s. “When you hear hoofbeats,” he said, “think horses, not zebras.”

We’ve learned that in our family, you should look for the zebras first to save yourself some time.

For your Google pleasure, spend some time looking these diagnoses up: hyper IgM syndrome, Aicardi syndrome, and xeroderma pigmentosum.

Xeroderma pigmentosum was what our sister Kirsten had.  I don’t know how many doctors and specialists my parents took her to before they finally got the right diagnosis, but I’d imagine it wasn’t the first diagnosis to spring to mind when faced with a little girl who got crazy-bad sunburns with just a tiny bit of sun exposure.

Aicardi syndrome is the diagnosis my niece (Katie’s daughter) received when she was just a few months old.  That is Katie’s story to tell, and I hope this blog will be a way for both of us to keep people up-to-date on how our kids are doing. This disorder is enough of a zebra, though, that the names of all the girls who have it can fit on one t-shirt (and it doesn’t even cover the whole shirt).

And then there’s my son Connor. On day one of his life he had a bit of a fever so they started him on antibiotics.  At one of his first check-ups when he was just a few weeks old his pediatrician noticed his enlarged spleen.  When he was six or seven months old, he started getting infections.  Just normal childhood infections at first–mostly ear infections, a few pneumonias, then weird stuff like infected hair follicles and dangerous blood infections.  A wonderful nurse practitioner took a look at just the size of his file at the pediatrician’s office when he was 18 months old and sent us off to find some answers.  It wasn’t just his health that concerned us, but also his development–at 18 months old he was not talking at all.  We suspected this was mostly due to the number of ear infections he had, but when he still didn’t start talking after getting ear tubes put in (and btw he also didn’t stop getting ear infections when the tubes were in place, but it DID make it easier to diagnose and treat the infections) we added in testing from the Infants and Toddlers program through the county.  It took a long, long time to find answers, and I’ve long since lost track of how many doctors he saw and tests he took.  I do remember one poor developmental pediatrician who tried to find one answer to both the developmental and health problems.  She measured his head a lot.  A lot.  I think he has a big head, but as it turns out that was just because he has a big head and not because of anything wrong with him.

More than a year after we started all of this testing, we had our answer(s): Connor was diagnosed first with autism and then, within two months, with hyper IgM syndrome.  Hyper IgM syndrome is a primary immune deficiency disorder wherein your body can produce LOTS of IgM (the immunoglobin that responds first to any immune system attack) but the B cells can’t switch production to any other type of immunoglobin, so basically you have a crappy immune system with no memory to it so you can get the same virus over and over and over, vaccines don’t work on you, and you are really susceptible to bacterial infections. The most common form of hyper IgM syndrome is X-linked (meaning the faulty gene is passed from mother to son; and by “common” I mean that it happens in one birth of every 1,000,000) but Connor has an autosomal recessive version of the disorder, which is far more rare.  Apparently my husband Brian and I both carry the gene for this, and the chances of two people with this recessive gene finding each other, having a baby together, and having this baby each get the lousy gene instead of at least one good one is just so small that really we probably would have had a better chance of winning the lottery.  At one point we figured out the odds of having a child with both hyper IgM syndrome and autism and it was something like one in 2,000,000,000.

On diagnosis, Connor started receiving monthly infusions of gammaglobulin, which provided him with the IgG immunoglobins he can’t produce, but there is no way to replace IgA or (less importantly as anyone with allergies knows) IgE.  The IV gammaglobulin kept away the really nasty diseases and for many years this is where we stayed.  Still lots of bacterial infections, monthly IVs that were no fun at all for Connor, but overall things weren’t bad.

And then three years ago his immune system went whackadoo (and yes, one of the doctors did indeed use this term).  His lymph nodes started swelling up for no apparent reason, followed by his spleen, and along with this he was intensely itchy (and when I say intensely, imagine the worst poison ivy you’ve ever had, then triple the itchiness of that, and then have it NEVER HEAL.  Connor didn’t sleep through the night for about six months because the itchiness kept waking him up.  He’d take off his shoes to grind his feet into rough surfaces until his skin came off and he bled.  It was awful.).  Again with the testing, which really didn’t give us any answers but at least ruled out lymphoma, which is what his immunologist first thought it was (“he should see an oncologist like, yesterday” we were told).  The eventual treatment we landed on was a drug called Rituxan, which stopped the whackadoo-ness, and lots of steroids (which led to other forms of whackadoo behavior).  When the symptoms started up a year after we had stopped the treatment, we hit him again with Rituxan and all was well. But at that point our immunologist said that if this keeps coming back, we should consider a bone marrow transplant, which is the only way to cure a primary immune disorder.

That brings us up to this summer, when Connor stopped eating, lost a lot of weight, and then woke up one morning in August with his stomach bloated and one leg completed swollen.  Turns out the stomach (that looked for all the world like he was 6 months pregnant) was because his spleen was so enlarged and the leg was just because the swollen spleen was cutting off circulation within his lymph system.  Or something.  And this time the Rituxan didn’t do the trick, or at least not entirely.  And since we know that people with hyper IgM are at an increased risk of developing lymphoma, everyone involved agreed that the bone marrow transplant was our only option.

So that’s the backstory of Connor, his “zebra” diagnoses (although really autism can hardly be counted as a zebra), and where we stand at the beginning of 2014.

*I’m JOKING, University of Maryland School of Medicine!  I’m sure you’re a fine institution and that you’re very good at all kinds of diagnoses, zebras and horses alike!

2 thoughts on “A whole herd of zebras

  1. Thanks for all the background. Nice that zebras are so much more interesting than horses, isn’t it? Not so good for the zebras, tho. We’ll keep up with all the future developments.

  2. Have you “herd” that all of us at Relay are designated “Zebras for Connor.” We’re with you every day, all the way!

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