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Katie
01-28-2007, 06:12 PM
Posted for Melissa.
Photos available at http://BrysonsStory.tripod.com (http://brysonsstory.tripod.com/)

Bryson was born on September 2nd, 1992, and weighed in at 7 pounds 9 ounces. He was born after a long and problematic pregnancy, and a very difficult labor, but he was worth every second! He was also born with a rare genetic birth defect of the face and skull, called Pfeiffer Syndrome (also known as Acrocephalosyndactyly Type V; and/or Noack Syndrome). He has had a long and difficult road, but we’ve traveled it together.


My pregnancy was not "normal", and delivery was very difficult. I went into preterm labor twice at 7 months, and was put on full bedrest and medication to prevent further labor attempts. I also developed Placenta Previa, a dangerous condition where the placenta partially detaches and moves to a different position - luckily it moved back to a less dangerous position before birth. Our labor was long - around 20 hours total, with 4 hours of pushing, and Bryson was finally delivered by vacuum extraction when it was determined that he was in distress and he was stuck in the birth canal. When Bryson was born, he was blue and limp. The umbilical cord was wrapped around his neck twice, and he had basically strangled during delivery. His first APGAR score was a ‘3’, out of a possible ‘10’. (Most babies have an ‘8’ or ‘9’ for their first score.) His second APGAR score, taken at 5 minutes old, was still only a '7', but that was much better than a '3'. They worked on Bryson for several minutes (it seemed like forever) before they ever got him to take his first breath. He finally cried a gurgley little cry, and they wrapped him in a blanket and brought him to me for just a second - long enough for a picture - then whisked him off to the nursery. When he was first born, no one would tell me a thing, I just knew that babies were supposed to cry, and mine didn’t, and that my husband was very silent. Once we knew he was going to live, and they brought him to me, all I could see was a tiny circle of his face, and I remember thinking that something was wrong with his bottom lip, but that he’d be okay. (I found out later that, while he did have birth defects involving his face, his lip was not part of it - he’d just sucked it into his mouth and was chewing on it!)


After Bryson was born and had been taken off to the nursery for a bath and check-up, I was moved to a regular (non-delivery) room, and waited to see him. It was around 12 hours before I saw him again, and during that time a nurse had told us that he had a very high, cone-shaped, head, but that that was normal for babies born with the vacuum extractor. Later, after he was finally back in my arms, a doctor with a heavy foreign accent came to our room and rattled off a bunch of stuff that we didn’t understand. All we got was “baby”, “syndrome”, and “surgery”. The other words were too heavily accented for us to decipher. We were very upset, especially since after rattling all of that off, he just left the room. The nurse that was on duty at the time came in and told us that there was concern because his head had never gone back to normal proportions like it should have if it was from the vacuum extractor, and that they thought he might have a craniofacial syndrome, they just didn’t know what. She said that a wonderful geneticist would be coming to see us on Friday and could explain it all then. I’ll never forget, though, that she told us that we were going to be okay…and we have been.


We spent the next couple of days getting to know our new son, and loving on him. Bryson seemed very much like an old soul in a young body - his favorite thing was to look at the world with one finger laid beside of his mouth, like he was saying, "Hmmmm....", as he tried to figure out who and what we all were. It was quite cute... On Friday, Dr. Tal Thomas came to our room loaded down with computers & camera equipment. He had an accent, too, but he is Welsh and was a lot easier to listen to and understand. He made some measurements, looked Bryson over from head to toe, and asked lots of questions. Then he showed us some things on the computer. He said that Bryson had one of two things - he either had Kleeblatschadel (pronounced klee-blat-shay-del) or Pfeiffer Syndrome. Both syndromes cause the sutures of the skull to close prematurely, preventing the skull from growing correctly. In Kleeblatschadel, all four sutures are closed, and in Pfeiffer it can be anywhere from one to four, with all four being closed usually being among the worst cases. Bryson had all four sutures completely closed, so he had none of the soft-spots that babies normally have. They both also feature facial deformities. The main difference (other than rarity) is that in Pfeiffer the big toes are usually wider than normal, as are the thumbs. Bryson’s big toes were definitely larger, but his thumbs looked normal. Dr. Thomas said that he would watch him over the next few months before knowing for sure which he had. In the end it was decided that Bryson has Pfeiffer Syndrome, which at the time occurred in 1 out of every 500,000 live births. It has gotten a little more common in recent years (though it's still a rare disorder - just not quite AS rare as it was before), probably because of advances in medical care helping mothers carry to full term babies that might would have been miscarried before. One of the things that I loved about Dr. Thomas was the hope he gave us - he said that he was going to schedule an appointment for Bryson to see “the king of China”, his friend Dr. Argenta, and that everything was going to be okay. He also cared about us as a family, instead of just being clinical. He took pictures of our whole family together (not just medical pictures of Bryson), and would occasionally call just to see how Bryson was doing.


When Bryson was 8 days old, we took him to see Dr. Argenta, a craniofacial surgeon who had recently moved to our local medical center from Michigan. He was, at the time, one of only 12 doctors in the US who had trained under Dr. Tessier, “the master” of craniofacial surgery, in Paris, France. We were so very lucky to have him nearby! He told us that because of the severity of Bryson’s skull (he had all of his cranial sutures closed completely with no room for brain growth - called "cloverleaf skull"), he would need to have surgery right away or he would die or become a vegetable for life. He sent Bryson for CT scans and blood work, and told us to go home and prepare for surgery. I have to say that we felt right from the beginning, and still feel, completely comfortable with Dr. Argenta. He has literally been a life-saver for our son, and a sanity-saver for us. He is a wonderful surgeon as well as a wonderful person.

(continued below)

Katie
01-28-2007, 06:12 PM
Over the next couple of weeks, we adjusted to life with a newborn. Bryson was a good baby - he didn't like to be left alone, and wanted to be with us all the time. We learned a lot together in those first few weeks - how little sleep the body can exist on, and how much love can be packed into your heart when your child is born. We also learned to watch out when changing diapers, LOL!


At 3 weeks old, Bryson had his first craniofacial surgery - a frontal craniectomy. Basically, they cut and removed the front portion of his skull and stitched him back up. Over the next few months, he completely regrew a new section of skull to fill in what had been removed. As hard as it sounds, it was necessary - doing this allowed room for Bryson’s brain to grow without being restricted. He was in Pediatric Intensive Care for a day and a half, and in a regular room for 3 ˝ more days. One of the really good things about this surgery is that it proved something that I had told Bryson’s pediatrician - that he was not breathing right when he was asleep. In PICU, a nurse noticed this same thing and Bryson was diagnosed with “apnea”. There are two types of apnea - central and obstructive. In obstructive apnea, something gets in the way of air movement - it could be the tonsils, adenoids, or something else. With central apnea, the brain just forgets to tell the body to breathe at times, usually during deep sleep. Bryson had lots of sleep tests and we found out that he had central apnea, which he eventually outgrew when he was 3 ˝ years old. Until that time, he was on an apnea monitor every time he went to sleep. If he stopped breathing (which sometimes happened 50-60 times a night) it would emit a shrill alarm which would startle him into taking a breath. If it hadn’t been for the nurse seeing him hold his breath in the PICU, and if they hadn’t sent him home with that monitor, I have no doubt in my mind that my son would have died during the night at some point.


As a baby, Bryson also had lots of feeding issues. Whenever we would feed him a bottle of formula, he would have projectile vomiting afterwards. This started in his first week of life and went on until he was around a year old or so. Since he was seeing the old pediatrician back then, we never actually got a diagnosis, but knowing what I know now I'd say that he either had an allergy to his formula (which coincidently was discontinued the year after he stopped using it), bad reflux, or a combination of the two. He also had lots of gas and stomach aches. The pediatrician's idea of how to fix it was to add baby cereal to his formula to thicken it - it didn't really do a whole lot except give him something thicker to splatter us with, but he did keep a little more down at a time. At least he was gaining instead of losing weight at that point, though not nearly on par with the amounts he should have been gaining. He still had the vomiting, gas, and stomach aches. He was never, at any point in his life, a "chubby baby". And today he is a very lean young man and probably always will be. Another feeding issue he had is that, because he has a "cathedral" palate (instead of rounded, his palate is high and pointed like the inside of a gothic-style cathedral) we had to use special nipples on his bottles, and then "cross-hatch" cut them so that he could get the thickened formula out. He also had a weaker suck than most babies, so the larger holes helped with that as well. Unfortunately, the holes in the base of his nostrils are small and the adenoids were completely blocking them which made it impossible for him to draw even the slightest breath through his nose, so he was not able to breastfeed at all.


When he was around 2 years old, Bryson developed an allergic reaction to latex, such as balloons and medical gloves. My mom and I had taken him to a store and he was playing with a punch balloon - he used to love those - and all of a sudden his face started turning red and swelling. We had no idea what was going on, so we rushed him to an "urgent care" doctors office nearby...by the time we got there, even the tissues in his eyes had swollen and you could see the individual striations in them. His face looked like the balloon he'd been playing with. They rushed him back and gave him a dose of Benadryl and maybe something else, and after a little bit he was okay. They told us then that children who have a lot of contact with latex (like Bryson has had with his operations) can develop an allergy to it. His particular reaction was anaphylactic, and the next stage would have been that his airway would have swelled closed. Had we gotten in the car and just driven home, he probably would have died. Now we are very careful about latex, and Bryson has a MedicAlert bracelet that he wears to notify medical personnel of his allergy, as well as his other medical conditions. An anaphylactic reaction to latex is an allergy that he will never outgrow.


Another breathing problem Bryson developed is what our (current & wonderful) pediatrician termed "chronic croup". Basically, Bryson has a narrow airway, and whenever he would get sick, he would get the barky cough, like croup, but his airway would swell shut. When he was a baby it happened every couple of months - if he got the sniffles, he got croup. We made a ton of calls to 911, took numerous ambulance rides, and watched him go blue more times than I want to think about. We almost lost him several times. He still has episodes on occasion, but we now have good medicines at home that help counteract it. One of the first moves his current pediatrician made when we switched to him was to prescribe us a nebulizer for at home. (Another first move was to call his surgeon and learn everything he possibly could about Pfeiffer - just one reason why we love the guy so much!) At first we used saline through the nebulizer and also kept Dechadron (massive steroid, I think) and Epinephrine on hand. We never had to use the Epi, though, because the Dechadron would usually work well enough for us to get him to the ER, where they gave him breathing treatments and such. Then research came out that Pulmicort was working well for similar episodes. At the time, Pulmicort was mostly used for long-term asthma maintenance, not for quick-acting use in other situations. Our doctor prescribed it anyway - he said that the research showed that for croup it DID provide a very quick remedy, and it has been a life-saver, literally. Over the years since Bryson was put on Pulmicort (only used if an attack seems immanent or has already started), we've seen the episodes go from every other month or so to maybe 2-3 a year. We haven't watched him turn blue, called 911, or ridden in an ambulance in several years. We've only been to the hospital with it once in the past 2 or 3 years. As soon as he feels that his airway is getting tight (or "tickly"), we drag out the nebulizer and prepare a dose of Pulmicort. It usually starts working a little bit right away, and usually within 15 minutes he is feeling a lot better, without having gotten to the really bad stage in between.

Katie
01-28-2007, 06:13 PM
Over his first few years, Bryson would have many operations. By the time he turned 3 ˝ years old, he had had 11 operations including the craniectomy + 5 cranial vaults (skull remodeling), a hernia repair, a shunt placement, ear tubes, a broken metal plate removed from his skull, and a tonsillectomy/adenoidectomy. The shunt placement was a surprise, as no problems had ever been found with his brain. One night when he was 6 months old we were sitting on the couch watching as his forehead swelled. He had had a cranial vault done a couple of months before, which had left him with some man-made soft spots...when we were watching the swelling, we saw the previously flat soft spots bulge out until it looked like he would explode. I called his pediatrician, who told me that I was imagining it. (At that time we were still seeing Bryson's original pediatrician, but we switched immediately after this incident.) As soon as the hospital offices opened the next morning, I was waiting at Dr. Argenta’s office with Bryson - he took one look and said that he’d developed Hydrocephalus - a dangerous build up of cerebrospinal fluid in the brain, which has been sometimes known as “water on the brain”. He sent us for a consult with the neurosurgeon and CT scans, and Bryson had the shunt placed two days later to drain the fluid. Most people who develop Hydrocephalus have a slow build-up of fluid over the course of weeks and months, but for some reason Bryson had a "rapid onset" type that built up rapidly right before our eyes. His doctor said that had we waited a week to bring him in, he probably would have been brain damaged to the point of needing to live in a nursing home situation. Like I said, we switched pediatricians after that!


At 3 ˝ years old, Bryson started with operations on his mid-face. Since that area of his face is really regressed, it caused his eyes to ‘bulge’, called proptosis. There was concern for the safety of his eyes, so over the next 2 years Dr. Argenta did several LeFort I and III operations, and fitted him with an RED device several times. RED stands for Rigid External Distraction, and was a halo type of device that attached to the outside of Bryson’s face. The idea was to turn a pair of screws that were attached to his cheekbones each day, and to allow new bone to grow in to fill the gap. Way back then, the RED was a new device and not perfected like it is today. It was very painful and extremely scary for both of us, and in the end we didn’t get as good results as we, or Dr. Argenta, had hoped. Bryson had the RED system a total of 4 times, resulting in 7 more operations over those next two years. He was only 5 ˝ years old when they finished with the mid-face operations, and he had had a total of 18 operations. While he didn’t get the results we’d wanted, it did move his mid-face enough to help support his eyes, so that was good.


At age 6, Bryson had a laryngoscopy performed at our hospital, and they found that his airway is smaller than normal, which explained previous issues with intubating him, and why his throat is so likely to swell closed when he has the Chronic Croup episodes. We were never told that there was anything (other than time and growth) that could help with this, but at least now we know 'why' it happens, and we also know to tell the anesthesia team or emergency personnel to use a smaller size intubation tube than they would normally use, if he needs to be intubated.


Over the next 5 1/2 years, Bryson would have 8 more operations. Some were for things like ear tubes to drain the fluid that built up in his ear canals and caused hearing loss. Some were to implant cartilage grafts on his cheeks to offer more support under his eyes, and to restructure the eyelids themselves in hopes of allowing them to fully close. One was another cranial vault. This put him at 26 operations at the age of 11 ˝ years old.


Beginning when he was around 10, Bryson started to develop learning disabilities and other issues. He would get confused fairly easily, forget things, have problems comprehending his work, etc. And his hearing loss intensified greatly, from “mild” to “moderate”. We were told at one point that the only thing left to do was exploratory surgery on his ears. The tubes were no longer needed (no fluid build-up), and because of test results the doctors weren’t optimistic that even a bone-conduction hearing aid would help. We left that decision up to Bryson because one of the main risks of the exploratory surgery was that he could be left totally deaf. Since it was his body, and he was quite mature about medical issues, we let him make the call - he chose not to have the surgery.


By the time he turned 13 years old, things had grown very bad indeed. Bryson was struggling in school and had been put in Learning Disabled Inclusive classes. He was thought to have ADD, the “inattentive” form, because of problems concentrating. He was not hyper at all, but he struggled to pat attention and learn. At the beginning of 7th grade I asked Dr. Argenta if he could do scans or tests, or whatever, to see if there was a physical basis for the problems Bryson was having. He sent him for CT scans, and we got the answer, in a way. They found a “shadow” on the CT and sent him for an MRI. The MRI showed that Bryson had developed Chiari Malformation - a condition in which the cerebellum (back parts of the brain), specifically the cerebellar tonsils, slips into the space where the spinal cord travels into the skull. This crowding can cause the CSF (cerebrospinal fluid) to not flow properly between the spine and the brain. Along with the Chiari, Bryson had developed a syringomylia - a pocket of CSF built up on his spinal column that could cause paralysis. At the time, the neurosurgeon said that the problems we’d been seeing were not related to the Chiari, and that the syringomylia was “okay for now”, but would need to be operated on within the year. We planned to have the surgery done when school let out for the summer, and tried to find other ways to deal with Bryson’s learning disabilities. Medication for the supposed ADD made him ill, and even put him in the ER once (with a heart rate of 150!), so that wasn’t an option. He struggled and struggled, and just kept getting worse. We rescheduled the operation for the end of March - 3 months earlier than planned - because he was having such a rough year that we decided to just get it over with and let him be able to have a good summer vacation, instead of doing the operation over vacation. Since the healing time was supposed to be 4 weeks before he could return to school, and he was already doing so poorly, we just planned for him to repeat 7th grade the next year.

Katie
01-28-2007, 06:13 PM
During the time leading up to March, we watched our son deteriorate rapidly. His hearing loss got worse, as did the ringing in his ears. He was unable to concentrate, had problems with his vision/reading, couldn’t pay attention, and had a lot of short-term memory loss. He would ask a question and then ask it again 10 minutes later because he had not only forgotten the answer, but had forgotten that he’d asked already. He was having anger issues, and was upset a lot because he couldn't figure out what was happening or why. When his surgery date finally rolled around, we sent him off to the OR for his 27th operation with lots of hugs and kisses. We didn’t know what would happen, or what he would be like when he came out. After surgery he was taken to a room and was in intense pain. Morphine helped with some aspects of the pain, but gave him a “morphine hangover” because it wore off too quickly and he couldn’t have another dose. We finally got his pain under control and he came home 4 days later. By that point we had already started to see a few changes - even though he was in pain, he seemed more “with it”. The next week proved to be a miracle - the ringing in his ears was gone, the hearing loss was greatly improved (from the worse end of moderate loss to mild loss - I'm glad we didn't push him to have that exploratory surgery they wanted to do, since it would have done no good), and his memory was better than it’d been in many years! The anger issues were gone - I think some of that may have been frustration, but I think some may have been from the intracranial pressure, too, because he said that after the operation he felt 'different', like the anger had been turned off like a lightswitch. It was like we had our real child back again, and it was wonderful. At two weeks post-op, Bryson went back to school - way before the docs had expected him to, but as they said, “If he feels up to it and wants to go, then send him”. We did, with some restrictions, and he was able to not only keep up, but he caught up - and passed 7th grade with a lot of help from his teachers.


At the end of 7th, after he had healed from his Chiari operation, the school tested him for any and all learning disabilities and found that he does have some, but nothing like he had early in 7th grade. He has mild dyslexia, and a condition known as Irlen Syndrome, which is simply a condition where his brain has difficulty deciphering what his eyes are seeing if he tries to read black type on white paper under bright lights. The glare causes comprehension issues. So, the Irlen specialist who tested him gave him a gray colored laminate sheet that he can place over the page he’s reading and it reduces glare by making the white paper appear gray, as well as providing a more matte finish that helps with glossier papers. A simple fix. He also needed reading glasses, which he now has. Bryson still has some issues with attention and comprehension, but we are trying to learn to deal with them, and overall he is a lot better than before the operation.


Bryson also still has a few physical issues to deal with, but they are also mild compared to a lot of what he's already gone through in life. At one point he had issues with both eyes working together, but through exercises he has overcome most of that problem. He still has constrictures of the muscles at his knee and elbow joints that make it difficult for him to fully straighten his legs or arms, but he has learned to adapt.


Today, the day I am writing all of this down, is October 30th, 2006. Bryson is now 14 years old, and in 8th grade. He is mostly healthy, though any virus (cold, flu, etc) still hits him really hard, and we're just heading into cold/flu season.

Throughout this accord, I have dealt mostly with the medical, and less with the “normal life” things, so I should address those before I end. Bryson has been our miracle, and he will always be my hero. He has gone through all of these medical issues, the learning issues, the operations, the blood work, the constant doctor visits, etc, with a strength that very few people (who don’t have to go through things like this) have. There have been tears, and questions, but we’ve traveled the road together and there have been way more good times than bad. Bryson does not feel sorry for himself for going through all of this, for the most part - he will be the first to tell you that he is just a “normal teenager” who’s had some things to go through. As a baby, he smiled all the time, as a toddler he was into everything he could get into - just like every other toddler. As a young child starting school, he was independent and charged right into the classroom and made friends. There have been stares, and comments, and at one point he felt bad about his appearance and operations, but we taught him that he has just as much value as every other person walking this planet, and he now has fairly good self-esteem. He has quite a few friends, loves sports (especially football), skateboards, swims, plays video games, etc. He has a younger brother (age 11), who does not have the same medical condition - though he’s had a few things of his own (like asthma, and catching measles when he was little). They have normal sibling rivalry and argue a lot, but love each other very much deep down inside. My hope is that this website will give Bryson's full story to those who wish or need to know it - it's a long story, but I hope you enjoyed reading it... <!--"''"-->