June 14, 2012

Fighting for Autistic Children: The Endless Battles

Award Winning Non-Fiction Blogs - BlogCatalog Blog DirectoryWhen Warrior Moms Fight for Autistic Children

Just when I think I can lay down the sword, another battle begins.

Moving safely through our healthcare system has never been easy. Whenever my son, Jamey, goes into a hospital setting I find myself blocking and intercepting incoming assaults to his health and safety.

Albeit this latest medical fiasco isn’t as bad as before (as in the time a doctor ordered Haldol for self-injurious behavior and nurses didn’t notice our son in subsequent severe retrocollis or having an olygyric crisis, to which I had to demand cogentin to reverse—a situation that, to this day, still gives me nightmares). What if I hadn’t caught this?

Anyway, last week, Jamey gets what we thought was a spider bite on his leg. Self-injurious behaviors and vocalizations rise. He refuses to walk on leg. We take him to doctor’s office.

Doctor diagnoses wound as cellulites (severe inflammation of subcutaneous layers of skin). Gives IM (intramuscular injection) of Benadryl and IM of anti-biotic Rocephin. Prescribes Septra PO (by mouth). After appointment, Jamey is laughing, trying to run around house, not hitting self, everything seems great. I’m always on edge when things are great. Before bed, he gets dose of Septra.

That night, Jamey develops a fever. Home health nurse on duty applies ice packs. Gives Advil. Two hours pass. Nurse texts me around 4:30am, says wound is hot and swollen. Around 5am, Jamey goes into a tonic clonic seizure. Then another. Then another. Nurse administers home rescue medications. Doesn’t stop seizures. Temperature is now 101.5.

We call 911. Paramedics transport Jamey to hospital, administering medication for yet another seizure, en route.

Jamey gets to hospital. This is where it always begins.

Me, becoming the mother from h#@! I don’t want to be the mother from H!@#. I don’t like the term mother from h#@!. To me, it’s more like warrior angel mothers from heaven, because we’re there to perform a God given duty: to protect our children from harm in a fallen world, in this case fumbled medical care that could kill our children. Not a threat you can just downplay and right off as a non-serious threat. Haven’t we all seen enough investigative news reports showing, when things go wrong, hospitals errors or mismanagement can kill you?

So I get to Emergency Room. I find Jamey screaming. Right away, I know he’s been given too much Ativan. Ativan is good for stopping seizures, but once it’s past 6 mg, it triggers self-injurious behavior. Jamey’s autistic brain resists being sedated.

So here we are. Five nurses surround him, trying to stop him from punching his head. The second they see me, “Mom’s here.” Three split. I notice 2 IV lines have been blown in his arms, which isn’t necessarily anyone’s fault. When Jamey’s upset, he’ll twist in strange positions. It’s tough to get an IV to stay in. I notice blood pours from one IV site, which is left UNCOVERED.  How difficult is it for one of the five nurses to slap a Band-Aid on?

A nurse pumps more Morphine, Benadryl and Ativan in his IV tube. “Whoa!” I say. “If you give too much ativan it will have a paradoxical effect...a rebound effect and he’ll lose his mind.” She looks at me as if there is no such thing as a paradoxical effect. Hey, I warned them.

Nobody was monitoring his respirations, despite ample Morphine on board. I looked at monitor. Respirations were 10. Nurses had temporarily split to handle another patient. Alone, I noticed MY oxygen mask from home, which paramedics had taken, was attached to hospital’s oxygen supply on wall. Well, hey, nobody’s here, his respirations are down, it’s my friggin mask, and I’m not waiting. I apply mask, turn on oxygen @ 10 -lpm and watched his respirations slowly climb to 11, 12, 13, 14.

Nurse came back. “Oh, you put oxygen on?” she inquired. Hey, a mom’s gotta do what she has to do. It’s not like I’ve never applied oxygen.

Always ask questions. Know what’s going on. Marvin Gaye....What’s going on? What’s going on?  Central IV lines...symptoms and signs....don’t punish James with the same old sames... “How many drugs has my son been given since he’s been postictal (time after seizures stop),” I ask.

I’m told he’s been given, intravenously, a total of 12mg of Morphine, 4mg Zofran, 6mg Ativan (on top of 4 mg given prior by home nurse and paramedics, for a total of 10mg on board) and 100 mg Benadryl, within past 5 hours.

Can anyone say rebound effect? After 5 hours of episodic, intense head punching episodes: A nurse throws up her hands: “I CAN’T do this anymore!” she says. “He won’t stop hitting himself...I don’t know what to do.” I’ve never seen a nurse just give up. Welcome to our world honey, and you’ve only been in it for less than half a day. Try 21 years.

I felt for this frustrated ER nurse. She was a good nurse. A good nurse will get angry because they recognize a situation that is so nuts, so illogical, so beyond any media’s presentation of what severe autism really looks like, that they are ready to punch a wall from the acute shock and frustration. She wanted so much to make him stop hitting himself, but giving more drugs was having the reverse effect. She didn’t understand why. Welcome to the world of autism. Where the autistic person teaches us how much we really don’t know when we think we know, as if they’ve been sent here to spark a critical-creative- thinking revival among mankind.

A few minutes later, this same ER nurse got so stressed, she jokingly (was she joking?) said she was going to punch the pharmacist if he didn’t bring the 14mg Nicotine Patch, which was one of the last treatments of hope I suggested to REVERSE the over-sedation that was making him more self-abusive.

Jamey, as is inevitable during such times, was put in restraints. Naturally, this made him more angry and vocal, but was necessary because there weren’t enough nurses to hold his hands and prevent him from punching himself and I couldn’t sit there alone and do it, my arms were weakening from holding and blocking his fists from reaching his head.

After that last dose of Benadryl he almost did a back flip off the table, taking table with him. He also managed to get out of restraints 3 x.

Here she comes. “I’ve never seen anything like this,” commented a floater nurse, who apparently has worked there several years. Thanks NBC, ABC and XYZ for your fabulous job of representing the face of severe autism. I guess people expect Jamey to build a computer or predict the winning lottery numbers. “Does he have a special talent?” asked a technician helping nurses. Right now, he’d be a pretty scary contender in an MMA fight.

So poor Jamey, he’s off his routine, in a strange place. He’s freaking out. He’s pumped up on enough meds to fuel a rock star’s personal party. He just wants to feel better. And it’s not getting better. I feel his head. “He’s really hot,” I say. “Can you please check his temp?” Nurse monitors vitals. Heart rate is 115. Temperature 101.9. Nurse gives Tylenol suppository. Heart rate elevated?

Here’s a lesson I’ve learned from living with my son: When dealing with an autistic patient prone to self-injurious behavior: TREAT OFF baseline signs and symptoms. For instance, if heart rate is elevated when usually not elevated, bring heart rate down; because chances are acute rapid heart rate scares the autistic patient, as it was scaring my son. I could tell by looking at him (eyes squinted), and by the fact he was punching his chest. Though, he could’ve been punching chest because he had aspirated during seizure. I bet for both reasons.

A psychiatrist was called in. When psychiatrist suggested we try Haldol and Thorazine my ears started ringing and I felt dizzy. Then he suggested Depakote! Depakote is the seizure medication Jamey was taken off of a few years ago because it caused hyperammonia. Maybe there is a purgatory and I’m in it.

“Doctor,” I pleaded. “Why not bring heart rate down with Inderal (propranolol) which is a PRN med we have at home, that didn’t work in past for self-abuse, but that’s because last time we tried it, he didn’t have a racing heart.” Why I am always hyper verbal when battling for my son? My brain begins sorting information from stored memories and firing out information, as needed. Hearing more drug suggestions that have already been tried in past and failed, I felt myself becoming rude and defensive. They are here to help Kim. Here to help. Help them help Jamey. You can’t expect people, even experts to know everything about him in 5 hours, or while doing a drive by consult.

On phone now, “What is taking so long?” I heard the ER nurse arguing with the pharmacist. Nobody could understand why it was taking so damn long. Apparently, hospital was also out of IV diazepam, which I was grateful for, given the Ativan wasn’t working, so that wouldn’t have helped calm him, though it was also suggested.

He’s over sedated. Paradoxical response. Will somebody please listen? I know my son! NO more sedation. NO more morphine. No more Benadryl. I suggested giving him 5 mg of Ritalin to bring his brain to baseline. Shoot, he had so much ativan on board there’s no way Ritalin would lower seizure threshold at this point.

The psychiatrist suggested clonidine patch. Fine. That might work.

At this point, clonidine wasn’t on board, nor was Inderal, so Jamey was still screaming. Apparently, the word STAT doesn’t always help deliver meds faster to ER staff.
Jamey still in restraints and still managing to Houdini himself out of restraints, nurse was losing her mind. I was losing my mind. The constant screaming, dear God, please Jamey stop screaming. Jamey was ready to fly off the table, rocking his body back and forth so hard I thought he’d pull the restraints off again. “Call for consult!” yelled nurse. “He needs to be intubated and sedated!” INTUBATED and SEDATED? What the hell? NO!

Thank GOD the psychiatrist intercepted that one. I wanted to hug him. He told ER nurse NO WAY. “We are not intubating this patient.” This psychiatrist understood what intubating an autistic patient with self injurious behavior would’ve created: an extremely dangerous situation where Jamey would’ve ended up pulling out tube or worse. For sure, it would’ve caused more problems. I recall time Jamey was scoped for an exam and he woke up while tube was in throat—despite ungodly amounts of sedation. A total nightmare experience for all involved. I had never seen him look so terrified and helpless.

Finally, @ 1530 the Nicotine patch arrives. 14 mg patch placed on shoulder. @ 1611, 1 mg Inderal IV given. Within 20 minutes, he was calmer. Fell asleep. Heart rate down. Temperature still up, but would start dropping within an hour. Later, Clonidine patch applied @0005. No more morphine, Benadryl or ativan. Inderal, Clonidine and nicotine did the trick. Kept him stable. 

Jamey was later admitted and placed in Intensive Care Unit, probably because they wanted to monitor for seizures. They put him in one of those restraint beds. I promptly warned everyone that I didn’t want to have happen what has happened before: LEAVING him in restraint bed with restraints on, without monitoring him. They didn’t place restraints on him. The bed was good, though, as it prevented him from repeatedly getting out of bed and possibly falling off bed. And he liked looking at the small circles in the mesh lining.

Nurses up in ICU were really great. One RN, at my suggestion, went the extra few minutes to call an occupational therapist to bring Jamey a chew tube.

I had earlier asked doctor to prescribe one to one sitter, so that was in place, thank God. I couldn’t stay there every second. I was physically and mentally burned out beyond the normal burn out you get during times like this. Shooting pains pounded my body. I normally don’t get headaches, but lighting bolts were going off along the sides of my temples...

When I felt Jamey was stable, and that I had finally (after repeated calls to cafeteria and asking nurse to make sure it was done) got the pureed diet he needed, I went home to take a nap. Then I hiked for 30 minutes and felt much better. Just shows how extreme stress can attack your body. I can’t imagine how Jamey was feeling. I needed to get him out as soon as possible and back on his routine, which required his leg wound was cultured so we could see if it was a staph infection.

The phone rings. It’s a doctor I’ve never met. He’s arguing and arguing about doing a culture on Jamey’s wound. He goes on and on about how he’s the educator for Staph aureus/MRSA infections, which is apparent since he’s lecturing me about what staph is, as if I don’t know and I’m some listener in an audience.

I don’t understand irrelevant information. If I already know something it drives me nuts if someone tells me it as if I’m just learning about it. My brain shuts down. Blocks unnecessary incoming information. I become agitated. My brain wants only to hear facts. Concrete specific facts. Vague ambiguous information torments me. I just want to handle a situation in the most effective and aggressive way possible to help my son. Anything that gets in the way of this target goal really ticks me off, especially nonsensical talk.

“Can you please stop?” I asked the doctor. “I don’t need to hear over and over about what staph is, how it started, what the statistics are...I know what staph is. What I need to know, what you need to find out is what TYPE of staph strain my son’s wound has. Can you please do a culture?”

When I asked for a wound culture, it’s as if I asked the doctor for his first born child.

He became defensive and combative. “We treat staph empirically,” he kept saying.

Ironically, a 2004 report, titled, “Get it Right from the Start or Get a Call from Infectious Disease,” by Dr. Burke A. Cunha of the Infectious Disease society of America, says, “Empirical therapy is about getting it right from the start, to optimize outcome, minimize therapeutic failure, minimize potential resistance, and avoid serious side effects in a cost-effective manner..”

With appropriate empirical therapy for bacteremia, the lesson is to get it right from the start so that recommendations for subsequent corrective changes in therapy become unnecessary or to get a call from the infectious disease consultant”

WITHOUT a wound culture, the doctor was GUESSING which anti-biotic would target the strain of staph Jamey had. Strains are bacteria that exist within the same species.

Hence, empiric therapy for a case of staph in a case like my son is absurd. He can’t talk. He can’t tell us if he’s feeling better. He is already vulnerable due to having epilepsy. Any infection lowers seizure threshold.

Despite this reality, the doctor kept arguing that since he prescribed Clindamycin, a broad spectrum anti-biotic, it “should” take care of any staph strain Jamey had. It should? Sorry, it should is not good enough. I want an anti-biotic that is KNOWN to target and eradicate the specific staph infection he has, not one a doctor THINKS he has.

My brain does not understand illogical crap. My brain sees that given the reality specific strains of staph respond to SPECIFIC drug therapies, if you prescribe clinadmyacin to a staph strain that is RESISTENT to clindamyacin, the infection gets WORSE, thereby jeopardizing my son’s health and safety and leading to chronic infection and worsening of staph infection, which research shows can have lethal consequences..

Why the hell wouldn’t a doctor want to know the exact strain so you could prescribe the appropriate anti-biotic?

Could the spread of MRSA—the more aggressive strain of staph aureus be spreading because many doctors aren’t identifying the specific type of strain involved before they prescribe anti-biotics? I submit the spread and rise of staph is rooted in doctors NOT doing wound cultures to identify the specific strains that would be susceptible to specific pharmacological agents.

Let’s look at what is happening to Jamey right now. As of June 8th, Jamey has been given, by medical professionals who have seen (in the absence of doing a wound culture) an Intra muscular injection of anti-biotic Rocephin, pills of Septra, then at ER, a doctor changed it to IV of Levoquin, then another doctor changed it to IV Flagyl and then the doctor that was arguing with me about doing a culture changed therapy over to pills of Clindamycin.

At some damn point you’d think someone would’ve taken a culture to make a proper diagnosis. There are several strains of staph. Giving the wrong anti-biotic makes the staph evolve into a more aggressive strain. An untreated staph infection kills people. Getting it right from the start could mean difference between healing and ending up in the morgue. So pardon me if I seem like a bitch of a mother, but it’s only my child’s life I’m talking about here, doctor.

To make matters worse, while I’m begging doctor to do a wound culture, he says, “Look, I really have to go now...I have to get to a patient’s birthday party.” Nurse ended up getting a culture when the wound broke open.

Before Jamey is discharged, RN asks if he could give Jamey the "Pneumovax 23" or "pneumococcal 23-valent vaccine". "No, absolutely not," I say. "He has a seizure disorder and an infection. His body doesn't need anymore insults." RN wrote in chart, vaccine "not given pt's mother refused," as if that's a bad thing. Research shows you shouldn't give vaccines to people with epilepsy or patients with a current infection. It further compromises immune system. Another interception. 

A day after Jamey was discharged from hospital, I get a call from his regular doctor, who tells me “I got the results of the wound culture...we need to stop the Clindamycin and start James on Doxycycline.” 

June 5, 2012

Kids cured of, lose and grow out of autism diagnosis

Award Winning Non-Fiction Blogs - BlogCatalog Blog DirectoryLast week I was at the health food store and ran into a woman I’ve known for some years, whose son is diagnosed “autistic.” It has never been easy to understand why her son has this diagnosis. He’s not autistic.

For example, he’s always been verbal, made jokes, interacts normally with siblings and friends and follows and engages in conversation around him. There are no ritualistic behaviors, hand flapping, echolalia or body rocking. Nor lack of eye contact or meltdowns during transitions. He plays with his siblings like a normal child. He attends birthday parties and other social functions with no problems. Yet, he's allegedly autistic. 

The only thing “different” about this child (now in his teens) is that he is hyperactive and has a few mood swings.

A few years ago, during half-time at a soccer game, I noticed the mother check her son’s blood sugar and give him insulin. As a result, he went from irritable and distracted to calm and focused.

Turns out he has, all along, had ADHD and diabetes. He’s “lost his diagnosis,” claims the mom. But she still demands the school funds his "autism behavioral services" and provide a one to one aide in his classroom. 

So, now we find children “losing the autism diagnosis.” Others are “cured” after they have a few ABA sessions, take some vitamins, ride horses with witchdoctors, eat gluten free foods or swim with dolphins.

In any event, here is a case of autism misdiagnosed with underlying etiology of “autistic behavior” being a direct result of uncontrolled blood glucose levels.  

The mom, by the way, is not concerned that her son was misdiagnosed with autism. Nor does she care that he received special education services under autism label, even after diagnosed with ADHD and diabetes. “It helped him get a one to one aide,” she said. “And many services he wouldn’t have qualified for under another diagnosis.” Like tutoring and assistive technologies intended for real autistic children. He was also involved, years ago, in an autism research study. No wonder autism research is stymied!

Yes, there are people who have autism and diabetes or other concomitant disorders. Yes, there are autistic people who improve. This kid isn’t one of them because he was never autistic. It’s not his fault. His parents are inconsiderate people who enjoyed the perks of receiving autism services for their non-autistic son.

It’s unclear why educational professionals never bothered to update his special education file AFTER he was diagnosed with ADHD and diabetes.

Maybe it’s because the mom is married to an attorney who storms into special education meetings, makes ridiculous demands and threatens to sue.  

So if you have an actual autistic child, either high or lower- functioning, and you’ve ever wondered WHY you have to fight so hard to get a piece of the autism pie for your child, remember this case.

This case is by no means is an anomaly.

There’s another parent I know, and he told me his son “grew out of his autism diagnosis,” as if autism is a pair of pants. They didn’t quite fit right, they were a little uncomfortable, they lost a button, so...., we tossed those pants and autism is all behind us now. We’re moving on.

Now isn’t that simple. How stupid of me! To think all this time I’ve been frantic and worried each time my autistic son has slammed his fists into his head, bloodied his nose, or had a tonic-clonic seizure...and all I had to do is say he could just grow out of,  lose or be cured of autism. 

Yes, It’s happening all over the USA: children who are not autistic, are being labeled autistic and lumped into the autism spectrum disorder, thereby compromising autism diagnosis and inflating the reported number of children with autism.

Although there is a spectrum, many professionals still haven’t learned to separate authentic autism from other conditions that temporarily or episodically present as autistic like behaviors.

You don’t lose an autism diagnosis. It’s not like hair. Or a ball game. And you aren’t cured of autism. It isn’t a disease. The hallmark trait of autism is being in your own world. A world of your own. That's why behavioral issues are common in autism. They are overwhelmed by the calamity and chaos of our world. Autistic people march to their own beat. They don't want to be swept up inside the daily waves and demands of this world. A non-autistic child or adult, however, will not routinely resist the conventional order of things. Nor will a non-autistic person be hyper-sensitive to gustatory, tactile, auditory and visual surroundings. To casually assign the autism diagnosis to children who aren't autistic has created chaos and confusion in the autism community. 

That's not to say those children misdiagnosed with autism don't need help. And their parents need services to get the respite they need. They do need help. But to adequately help someone, you must know what they really need. If kids aren't really autistic, providing them with services intended for autistic children, isn't helping find a cure or better treatment for people with authentic autism.