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<DIV style=3D"TEXT-ALIGN: center"><B><FONT class=3DApple-style-span =
size=3D4>What You=20
See and What You Don't:</FONT></B></DIV>
<DIV style=3D"TEXT-ALIGN: center"><B><FONT class=3DApple-style-span=20
size=3D4>Diagnosing Niemann Pick, Type C</FONT></B></DIV>
<DIV style=3D"TEXT-ALIGN: center; FONT-SIZE: small">by Jill =
Flinton</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Oh the joy of a newborn! &nbsp;Everyone =
oohing and=20
aahhing over the cute little features of the new arrival and trying to =
figure=20
out whose ears or nose or eyes the new one has. &nbsp;Those features are =

genetic, but so are all the internal parts too--all the organs and all =
the=20
cells.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Do you really know what you are passing =
along to=20
your child? &nbsp;Heart disease and high cholesterol are likely =
hereditary.=20
&nbsp;So are genetic diseases such as Huntington's. &nbsp;But there are =
so many=20
others that are unknown.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"TEXT-ALIGN: center; FONT-SIZE: small"><IMG=20
src=3D"http://articles.complexchild.com/dec2011/decpics/jill1.jpg"></DIV>=

<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">When I offered to write this article, my =
son=20
Daniel had recently been diagnosed with a very rare genetic condition =
called=20
Niemann Pick Disease, Type C. &nbsp;By the time I sat down to write it, =
he was=20
dead. &nbsp;It took us 4.5 years to get a diagnosis and 4.5 months to =
live with=20
it.&nbsp;</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small"><B>Progression and Regression</B></DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Some genetic diseases are able to be =
diagnosed in=20
utero. &nbsp;Down Syndrome is one example. &nbsp;Some are diagnosed at =
birth=20
with the newborn blood screening test that almost every state requires, =
with=20
some states testing for more diseases than others. &nbsp;Your state =
department=20
of health can tell you which tests are performed. &nbsp; But some =
diseases=20
require specialized tests, and in many cases the doctors don't think =
about those=20
tests until symptoms appear.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">By all appearances I had a healthy baby =
boy.=20
&nbsp;Although born a few weeks early and on the smaller side, all =
indications=20
were fairly normal. &nbsp;At his initial physical exam, he was found to =
have a=20
large spleen and liver. &nbsp;A few days later he became jaundiced and =
needed=20
antibiotics and light therapy. &nbsp;A three week NICU stay did not =
yield a=20
diagnosis. &nbsp;He came home on an anti-seizure drug that is also used =
to clear=20
blockages in the liver.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Over the next year or so we not only had =
the=20
routine pediatrician appointments, but we were also seeing a geneticist =
who was=20
attempting to determine which lysosomal storage disorder he had. =
&nbsp;Due to=20
his size, we had to prioritize blood tests due to the volume of blood =
needed.=20
&nbsp;But everything was negative.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Generally Daniel met his developmental =
milestones=20
on time. &nbsp;Whatever wasn't on time was attributed to being a =
preemie.=20
&nbsp;His first noticeable delays were at one year, as he wasn't =
standing on his=20
own and wasn't "talking." &nbsp;But no one was really concerned. =
&nbsp;By age=20
two there were more noticeable delays--no noticeable words, unable to =
follow one=20
step commands, unable to identify body parts. &nbsp;Again, there were no =
answers=20
from anyone, including the geneticist or hematologist. &nbsp;We =
repeatedly heard=20
it could be this, it could be that. &nbsp;But every test was normal or =
negative.=20
&nbsp;The blood cell structure looked good, and there were no obvious=20
deformities in his cells or body.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">By age three we started speech, =
occupational and=20
physical therapies because we finally had some documented developmental =
delays.=20
&nbsp;But we still had no real diagnosis other than global developmental =
delay.=20
&nbsp;Then Daniel got sick. &nbsp;It was the first time he was ever =
really sick.=20
&nbsp;He may have had a common cold every now and then, but just for a =
few days.=20
&nbsp;He never had an ear infection. &nbsp;But now he had diarrhea, =
vomiting,=20
and breathing trouble. &nbsp;We started him on asthma breathing =
treatments and=20
antibiotics. &nbsp;</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">He never really recovered. &nbsp;His =
milestones=20
started disappearing more and more. &nbsp;His walking gait became =
unsteady and=20
he wobbled side to side. &nbsp;He babbled less and less. &nbsp;He slept =
more and=20
more. &nbsp;He became dehydrated a few times and we went to the =
emergency room=20
for IV fluids, chest X-rays and abdominal ultrasounds to check his =
spleen and=20
liver, which were still larger than they should be. &nbsp;But still, no =
answers.=20
&nbsp;An increase in therapies (speech, occupational, and physical) =
didn't yield=20
any corresponding increase in skills. &nbsp;On the contrary, he seemed =
to be=20
going backward more and more. &nbsp;He couldn't even walk to the door to =
greet=20
me when I got home from work any more.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small"><B>The Road to Diagnosis</B></DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">After being shuffled from specialist to=20
specialist--including genetics, hematology, and gastroenterology without =
an=20
answer--we wound up at neurology. &nbsp;At age three and a half a =
swallow study=20
showed an increased risk of aspiration. &nbsp;An MRI showed decreased=20
myelination. &nbsp;Myelin is the "insulation" on the "wires" in the =
brain.=20
&nbsp;The amount of insulation was not what it should be for a child of =
his age.=20
&nbsp;</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">After a few visits, we were referred to =
neurology=20
at Boston Children's Hospital. &nbsp;Since the decreased ability to walk =
was the=20
most obvious sign, it was expected that the muscles or nerves in his =
legs=20
weren't communicating with his brain. &nbsp;But again, the anticipated =
result to=20
the electromyography--a technique for evaluating and recording the =
electrical=20
activity produced by skeletal muscle--never materialized. &nbsp;His =
muscles and=20
nerves were working perfectly, as was the connection from his muscles to =
his=20
brain. &nbsp;So again, no answers.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"TEXT-ALIGN: center; FONT-SIZE: small"><IMG=20
src=3D"http://articles.complexchild.com/dec2011/decpics/jill2.jpg"></DIV>=

<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">By age four his regression became very=20
significant. &nbsp;Daniel wouldn't walk unless he was holding your hand. =

&nbsp;His ability to feed himself was seriously diminished, and he was =
drinking=20
more than eating, still using spouted, lidded sippy cups. &nbsp;Most of =
his=20
discernible babbling sounds were gone. &nbsp;Daniel put less and less =
weight on=20
his legs and walked less and less. &nbsp;He napped more and more. =
&nbsp;He spent=20
more time sitting in his chair or being carried. &nbsp;He couldn't walk =
up steps=20
or to his room to go to and from bed. &nbsp;This was the first time a =
doctor=20
mentioned testing him for Niemann Pick Disease, Type C. &nbsp;</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">He started experiencing osteoporosis or =
thinned=20
bones, requiring a significant increase in vitamins and calcium rich =
food.=20
&nbsp;But it didn't seem to help. &nbsp;We started keeping a food log =
and=20
noticed that over four months he dropped from 1000 calories a day down =
to 800=20
calories. &nbsp;Two months later he weighed less than 22 pounds, down =
from 35=20
pounds. &nbsp;He was choking on almost everything--liquids, purees, =
solids.=20
&nbsp;It was taking him two hours to eat four ounces of yogurt and then =
he would=20
nap for three hours. &nbsp;</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Another trip to Boston Children's =
resulted in a=20
three week hospital stay with an admitting diagnosis of dehydration,=20
malnutrition and an inability to swallow. &nbsp; An NG tube, EEG, MRI, =
blood=20
tests, urine tests, and skin biopsies were all done. &nbsp;The NG tube =
became a=20
G tube before we were discharged. &nbsp;At the end of the second week, =
on June=20
24, 2011, we got the diagnosis that we feared. &nbsp;Our son had Niemann =
Pick,=20
Type C. &nbsp;</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small"><B>Niemann Pick, Type C</B></DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Our first question was what is Niemann =
Pick, Type=20
C (NPC)? &nbsp;It is widely known as "childhood dementia," but it is =
more than=20
that. &nbsp;It is a lipid storage disease that can appear in infants, =
children=20
or adults. &nbsp;This autosomally recessive genetic disorder causes =
progressive=20
deterioration of the nervous system. &nbsp;It typically affects children =
by=20
interfering with their ability to metabolize cholesterol, allowing =
cholesterol=20
to accumulate in the liver, spleen, and brain. &nbsp;</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Both my husband and I are carriers. =
&nbsp;We=20
didn't know we were carriers until after Daniel's diagnosis. &nbsp;If we =
decide=20
to have another child we run a 25% chance of having another child with =
the same=20
disease. &nbsp;But this child will be tested at birth so we can start =
active=20
therapy early. &nbsp;</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Type C most often strikes school-aged =
children,=20
but can also start during infancy or early childhood. &nbsp;Children =
experience=20
a wide range of symptoms including jaundice after birth, enlarged liver =
and=20
spleen, difficulty with upward and downward eye movement, unsteady gait, =

clumsiness and problems walking, difficulty in posturing limbs, slurred =
or=20
irregular speech, learning difficulties and progressive intellectual =
decline,=20
sudden loss of muscle tone often leading to falls, tremors accompanying=20
movement, and, in some cases, seizures. &nbsp;The speech and swallowing=20
difficulties eventually become disabling, making oral feeding =
impossible.=20
&nbsp;Death usually occurs in the late second or third decade from =
aspiration=20
pneumonia. &nbsp;There are less than 500 diagnosed cases in the United=20
States.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Our second question was what are the =
treatment=20
options? &nbsp;Unfortunately, there are very few. &nbsp;There is no =
approved=20
drug to treat NPC. &nbsp;There are some drugs that are being prescribed=20
off-label, and some that are being reviewed. &nbsp;All we could do is =
treat his=20
symptoms. &nbsp;There is no standard progression of the disease and no =
standard=20
treatment.&nbsp;</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small"><B>Final Decline</B></DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">My loving boy went from running around =
the back=20
yard playing on his swing set and babbling with bright eyes and a =
contagious=20
laugh to being non-verbal with a feeding tube and an inability to stand =
or walk=20
unassisted. &nbsp;All in less than two years. &nbsp;Looking back he had =
many of=20
the signs and symptoms, but no doctor identified them as being linked =
together.=20
&nbsp;Previously, even though he was choking and aspirating on most =
foods, he=20
still ate. &nbsp;Now he was tube-dependent. &nbsp;Nothing by mouth, not =
even=20
medications. &nbsp;He couldn't roll onto his tummy due to the tube. =
&nbsp;He=20
started choking on his saliva more and more. &nbsp;He was constantly =
congested,=20
but asthma and nebulizer treatments didn't help. &nbsp;He spent his days =
on the=20
couch watching TV and smiling less and less, laughing less and less, =
coughing=20
more and more, and sleeping more and more.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Four months after our diagnosis we got =
his PEG=20
changed to a Mic-key G button. &nbsp;It made it easier for him to roll =
on his=20
tummy and it was definitely less cumbersome. &nbsp;But he was becoming =
more and=20
more distant, and the seizure-like activity detected on his EEG was =
likely=20
progressing to seizures. &nbsp;The dementia was likely setting in. =
&nbsp;He was=20
aspirating on his own secretions, even with frequent suctioning.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Right around this time I was reading the =
blog of=20
another mother of a child with NPC who was dying. &nbsp;And I was seeing =
some of=20
the same signs--bloating with tube feeds, smelly dark urine no matter =
how=20
hydrated, constant suctioning and congestion, white thick secretions =
when=20
coughing. &nbsp;Although it was difficult to read my friend's blog and I =
cried=20
way too often for their family, I also knew what we were facing.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Less than two weeks after his G tube =
change, we=20
think Daniel had his first real seizure. &nbsp;With most of the =
seizure-like=20
activity we were seeing, we could hold him and talk to him and he would =
respond=20
to us within a few seconds. &nbsp;But this time I couldn't get him out =
of it.=20
&nbsp;His body shook, his eyes moved all the way to the left and were =
wide open,=20
his legs and arms were straight and tight. &nbsp;It must have lasted =
about a=20
minute or so. &nbsp;It was 7:45pm. &nbsp;When I picked him up, he was =
screaming=20
like he always did after these episodes, but he didn't seem "right." =
There were=20
no real words to describe what wasn't "right." &nbsp;</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">We went through our nighttime routine of =

medications and feedings. &nbsp;Daniel kept curling up in a fetal =
position in=20
bed and burying his head in blankets. &nbsp;He was fine at 12:15am. =
&nbsp;At=20
1:45am his apnea sensor was blaring--20 seconds without movement. =
&nbsp;By the=20
time we got into his room he was unresponsive. &nbsp;CPR yielded fluid =
in his=20
lungs and we got a little of it out, most of which was the feeding =
formula.=20
&nbsp;Then some blood. &nbsp;We knew, but we had to try. &nbsp;An hour =
later the=20
team of doctors in the local emergency room asked us what we wanted to =
do.=20
&nbsp;We told them it was OK to let him go. &nbsp;</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">My only child was dead! &nbsp;And there =
was=20
nothing we could do! &nbsp;It was Veteran's Day--three and a half weeks =
before=20
he would have been five. The final picture I have of him is in the =
emergency=20
room after they cleaned him up. &nbsp;He was finally at peace, and it =
looked=20
like he was holding the blanket they put at his waist. &nbsp;The only =
thing I=20
wanted was Niemann Pick Disease to be on his death certificate. &nbsp;My =
son's=20
death was not to be glossed over with a general cause of death. =
&nbsp;The doctor=20
granted my request. &nbsp;We don't know what actually caused his death, =
but we=20
believe it was another seizure.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Daniel's neurologist in Boston still =
wants to meet=20
with us at what would have been his next scheduled appointment in =
mid-December.=20
&nbsp;He already has most of his records, but I will make sure he has =
every=20
piece of paper I can get my hands on. &nbsp;I also will be bringing a =
video of=20
Daniel's life with me, because seeing is more important than reading the =
words=20
on the paper.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">Although my Daniel is gone, he will live =
on, by=20
teaching other doctors and parents about this disease and how early =
diagnosis is=20
essential. &nbsp;</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small">More information on this disabling =
disease is=20
available at the National Niemann Pick Disease Foundation website at <A=20
href=3D"http://www.nnpdf.org/">http://www.nnpdf.org/</A>.</DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV>
<DIV style=3D"FONT-SIZE: small"><I>Jill Flinton lives in upstate New =
York with=20
(now) a husband, two stepsons, a dog, and a cat.</I></DIV>
<DIV style=3D"FONT-SIZE: small"><BR></DIV></DIV>
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    vAlign=3Dtop><FONT size=3D2>&nbsp;Author: &nbsp;Jill =
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PADDING-TOP: 2px
}
#userLinks UL {
	BORDER-BOTTOM: #665d4a 1px solid; BORDER-LEFT: #665d4a 1px solid; =
PADDING-BOTTOM: 4px; BACKGROUND-COLOR: #fffcf5; LIST-STYLE-TYPE: none; =
MARGIN: 0px; PADDING-LEFT: 10px; PADDING-RIGHT: 10px; DISPLAY: block; =
COLOR: #404040; BORDER-TOP: #665d4a 0px solid; BORDER-RIGHT: #665d4a 1px =
solid; PADDING-TOP: 4px
}
#extraContent A {
	COLOR: #404040
}
#extraContent A:visited {
	COLOR: #404040
}
#userLinks UL A {
	COLOR: #404040
}
#userLinks UL A:visited {
	COLOR: #404040
}
#userLinks UL A:hover {
	COLOR: #403b2d
}
#extraContent A:hover {
	COLOR: #403b2d
}
#pageFooter {
	BORDER-BOTTOM: #4a5466 0px solid; BORDER-LEFT: #4a5466 0px solid; =
PADDING-BOTTOM: 5px; BACKGROUND-COLOR: #b8d1ff; PADDING-LEFT: 5px; =
PADDING-RIGHT: 5px; COLOR: #3a3c40; CLEAR: both; BORDER-TOP: #4a5466 1px =
solid; BORDER-RIGHT: #4a5466 0px solid; PADDING-TOP: 5px
}
#pageFooter H6 {
	MARGIN: 0px; PADDING-LEFT: 10px; FONT-SIZE: 90%; FONT-WEIGHT: normal
}
#siteNavigation {
	BORDER-BOTTOM: #665d4a 1px solid; BORDER-LEFT: #665d4a 0px solid; =
BACKGROUND-COLOR: #ffe7b8; WIDTH: 100%; BORDER-TOP: #665d4a 1px solid; =
BORDER-RIGHT: #665d4a 0px solid
}
#subPageBreaker {
	DISPLAY: none
}
#listBreaker {
	DISPLAY: block; CLEAR: both
}
#siteNavigation UL {
	PADDING-BOTTOM: 0px; LIST-STYLE-TYPE: none; MARGIN: 0px; PADDING-LEFT: =
0px; PADDING-RIGHT: 0px; PADDING-TOP: 0px
}
#siteNavigation UL LI {
	DISPLAY: inline
}
#siteNavigation A {
	PADDING-BOTTOM: 2px; BACKGROUND-COLOR: #ffe7b8; PADDING-LEFT: 10px; =
PADDING-RIGHT: 10px; WHITE-SPACE: nowrap; FLOAT: left; COLOR: #403e3a; =
FONT-SIZE: 90%; FONT-WEIGHT: bold; TEXT-DECORATION: none; PADDING-TOP: =
2px
}
#siteNavigation A:visited {
	PADDING-BOTTOM: 2px; BACKGROUND-COLOR: #ffe7b8; PADDING-LEFT: 10px; =
PADDING-RIGHT: 10px; WHITE-SPACE: nowrap; FLOAT: left; COLOR: #403e3a; =
FONT-SIZE: 90%; FONT-WEIGHT: bold; TEXT-DECORATION: none; PADDING-TOP: =
2px
}
#siteNavigation A:hover {
	BACKGROUND-COLOR: #fffcf5; WHITE-SPACE: nowrap; COLOR: #403e3a
}
#siteNavigation A.active {
	BACKGROUND-COLOR: #fffcf5; WHITE-SPACE: nowrap; COLOR: #403e3a
}
#siteNavigation H1 {
	DISPLAY: none
}
#bntag {
	TEXT-ALIGN: center; PADDING-BOTTOM: 2px; BACKGROUND-COLOR: #f5f9ff; =
MARGIN: 0px auto; PADDING-LEFT: 0px; WIDTH: 760px; PADDING-RIGHT: 0px; =
COLOR: #3a3c40; FONT-SIZE: 90%; PADDING-TOP: 2px
}

------=_NextPart_000_0000_01CCB4B4.557F49A0--

