Tuesday, January 13, 2015

Seizing Hypochondria

I have a problem.

Scratch that-- I have a problem baby.  It's not his demeanor or anything, in fact he's an unbelievably smiley and happy guy when he's not demanding my complete and total attention whilst I make dinner, break up an argument between his brothers, apply a band-aid, and stop the dog from eating too much play-doh.

It's not even a lack of sleep.  Since we started sleep training him, he's back to snoozing through the night, and even though the kid won't nap longer than 20-30 minutes during the day, I'm rested enough to handle the frustration without resorting to spiking my morning Diet Dr. Pepper.

In fact, the problem is the baby himself.  Perhaps it was his questionable gestation that makes me examine his every move, but since his birth, Adler has turned me into a hypochondriacal parent.  

What is that spot on his leg?
Is that spot a rash?
Can a rash cause gangrene?
How often does gangrene require amputation?
How much does a leg amputation cost?
Is WalMart hiring?

In my defense, several of my concerns about Adler have been rational (not like what turned out to be a fleck of dried banana on his outer thigh, and thankfully did not require amputation).  But after investigating his restricted grown in utero, his potentially fused skull, his umbilical hernia, his potential reflux and his occasionally red and puffy eye, it should have come as no surprise to me when Joel and I found ourselves back at the University of Iowa Hospital, trying to distract ourselves as we waited in Pediatric Neurology.  

Adler getting a skull x-ray in September 2014

If you read last week's year in review post, you may have caught the mention of a pediatric EEG, but what I didn't share were the details of that visit.  Nearly two months ago, I began noticing my problem baby exhibiting some strange behaviors.  When he would get excited or upset, he would tense up the muscles in his upper arms and shoulders while making a strange grimace that appeared to be involuntary.

The first time was kinda funny.  The second time was weird.  But by the third, fourth and twenty-ninth time, I knew something wasn't right.  By the time we visited our family doctor, who agreed that these weren't normal movements for a six month-old and gave us a referral to a neurologist, Adler was making these small spasms up to fifteen times a day.  So what did I do?

I googled.

I know, I know, hitting the internet was probably a poor decision, but I wanted to know if there were other babies out there making the same movements and what diagnoses had been given.  And, subsequently, how many of those parents had resorted to spiking their Diet Dr. Peppers from the stress of it all.

After doing some reading and watching some YouTube videos of children with the same problem (and one about a giant snake that can open doors) I was left with two conditions to consider.  The first was Infantile Spasms, which are much more cyclical than Adler's movements, more severe, and terribly damaging.  Thankfully, I was quite confident that he was not suffering from these spasms, but something more innocuous, which lead me to Benign Myoclonus of Infancy.  (Check out this confirmed case to see the similarities.) And the more I read, the more lightbulbs started to go off.

"Benign myoclonus of early infancy... ...is a paroxysmal phenomenon of the first 2 years of life which occurs in neurologically healthy infants during wakefulness, and is usually triggered by excitement or frustration.  ...the phenomenon is characterized by a shudder-type, paroxysmal motor manifestation involving mainly the trunk and sometimes the head, associated with tonic limb contractions of variable intensity, from hardly noticeable to more sustained."

They could have written, "This is what Adler Foreman has."

"...(In studies,) the EEG counterpart never showed modifications, the polygraphic study demonstrated a brief tonic limb contraction. The clinical manifestation should not be confused with the spasms of epileptic infantile spasms syndrome, or with tonic reflex seizures of early infancy. Although the phenomenon is already widely known, its polygraphic recording is rarely reported in literature."  (Taken from the abstract of this article.)

When our appointment time came, I, with all of my advanced knowledge and education in neurology and epilepsy, was certain of what was plaguing my little one.  The doctor, on the other hand, wasn't exactly sure what "Benign Myoclonus of Infancy" was, or that Adler wasn't just playing me like a fiddle.  

Like a very expensive fiddle with a high insurance out-of-pocket maximum.

But just to be safe, the doctor had us return for an hour-long infant EEG, which may sound fascinating but is little more than an emotional roller coaster with very smelly adhesive.  Of course, Adler did not have an episode during the EEG, and I was contacted later that afternoon to let me know that the results were normal, no further testing was needed, and his episodes must have been behavioral.  

Translation:  Back off, Mom, your kid is fine.

I always knew he was fine, actually.  Benign Myoclonus of Infancy tapers off shortly after it emerges, and the children it affects go on to have completely normal lives with completely normal brains and completely exasperated mothers, just like everyone else.

So while the medical community may disagree, I will go on believing that I hit the proverbial nail on the head.

And what a sweet, healthy head it is.

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