Wednesday, March 8, 2017

Happy Rare Disease Day. -- Happy? ? ? Yeah, no.

Rare Disease Day was February 28.  I usually make a post to my social media accounts to spread awareness but this year I missed it.  I saw the other posts scrolling by in the newsfeeds and enjoyed seeing all the beautiful faces of kiddos who are battling life-threatening, rare diseases.



When you have a child with a rare disease or disorder it’s such a very different world.  You want to spread awareness but it’s almost impossible to explain what we go through on a day-to-day basis. The disparity of emotions, trying to keep your child alive, battling insurance companies, fighting for services, trying to find the appropriate education plan, and then just trying to be parents to your other kids and a wife to your husband!

Willy had lissencephaly which is a neuromigrational disorder – not a disease.  But those terms are used interchangeably in the context of Rare Disease Day. Lissencephaly is a disorder in which the brain of a fetus does not develop properly at the end of the first trimester. Whereas a neuro-typical brain develops folds or grooves which gives you motor skills, a lissencephaly brain lacks grooves.  There can be a wide range of groove depth resulting in different variations of lissencephaly.  Willy is even rarer than other lissencephaly cases because he’s not missing the gene that has been linked.


Willy was on the more serious side because his brain was super smooth like a bowling ball.  He also had pockets of water in his brain called hydrocephalus. The result was a Willy with very little (read: almost non-existent) motor skills.  In general, he presented with the cognition and motor skills of a three to four month old. In other words, he was our big baby.

He didn't walk or talk or grasp things in his hands. He lost the ability to suck and swallow so he took his nutrition via a stomach tube. He had daily seizures which caused him to stop breathing. We had a pulmonology routine that took hours each day and night. Trying to keep him suctioned out and his airway clear was a full-time job. (Breathing isn’t option, right?)

He was happy though. He loved to snuggle. He cooed. He watched movies. He listened to music. When my other two kids got “too old” for mom snuggles, Willy was always willing and able. I enjoyed watching him grow through the years and do things we thought he wouldn’t do.  He had wonderful school teachers and therapists who worked with him day in and day out to teach him things.

Willy was on home hospice the last two years of his life. He still went to school and had a good quality of life but we stayed out of the hospital.  We lived a more “natural” life. We still gave him antibiotics if the need arose and we had all his prescriptions and oxygen and breathing treatments but we had decided no more resuscitation or aggressive interventions.

Truth is, the 11 years Willy was here on this planet were some of the best, if not hardest, of my life. It changed my heart. My entire being. I look at life so differently now, especially towards those who are different. I’ve advocated, sat on boards, moderated groups, started a 501c3, testified in congress both in Michigan and on the national level and more. I’ve tried to make some positives out of what could be perceived as a huge negative. (Not Willy, but his disorder.) I have tried to keep up a sunny attitude and am able to do so for the most part.

But face it. Lissencephaly sucks. Rare diseases suck. Rare disorders suck. And rare only means it doesn’t get the funding that cancer and other more prolific disorders and diseases do.  In art, rare is good. In diseases, rare is not. It just means no one will ever know what you’re talking about.  It means you will have to educate many of the professionals, doctors included, who will work with your child. (Yes, I’ve had medical doctors not know anything about lissencephaly.) It means there won’t be much funding or money available for research or assistance.

So Happy Rare Disease Day – late.  











Thursday, March 2, 2017

Bi-Partisan Action and Pediatric DNR's in an Educational Setting

Thursday, January 26, 2017 I went to Lansing to meet with state Senator Rick Jones along with Dr. Ken Pituch, Willy's hospice doctor and a pediatrician with the University of Michigan, Maureen Giacomazza, a nurse consultant with the University of Michigan Pediatric Palliative Care Program, Debra Chopp, University of Michigan law professor and attorney, and two University of Michigan law students Russell Busch and Dorian Geisler.  Russell and Dorian have been working diligently to prepare a case for us and my hat is off to them.

Our goal for the meeting was for the Senator to hear our appeal to amend Michigan's DNR Procedures Act so that it clearly and fully covers children in school--and then decides to more or less immediately introduce our proposed amendments as a bill into the Michigan legislature.  The bill then passes, and then the law is changed: Parents can get DNR's for their children explicitly by law, and schools need to respect those DNR's explicitly by law.

Background:


There is one statute in Michigan that covers DNR's which was passed over twenty years ago.  It's called the Michigan DNR Procedures Act.  It says nothing about parents' ability to make DNR's for their minor children and it says nothing about schools.  This creates ambiguity and uncertainty for both parents and schools.  

We want to amend the act by adding language that explicitly says that parents can get DNR's on behalf of their minor children and explicitly mentions schools as a context in which DNR's need to be respected.

We're trying to frame this change as a "win-win," a way to clarify the law so everyone is on the same page.  We want bi-partisan support.  We've spoken to Right to Life of Michigan.  Other lobbyists have spoken to the Catholic Coalition.  Almost all the signs we've gotten from people we've talked to have been positive.   

The potential obstacle is school districts and their lawyers--who, understandably, are worried about liability.  The act would cover a huge diversity of schools all over Michigan, both now and (theoretically) twenty, even fifty years from now.  Districts and their lawyers are trying to be careful and anticipate something that might go wrong (and get them sued) in the future.  

It's a win-win because we are also willing to add language to the DNR Procedures Act so that it says explicitly that teachers or staff who act responsibly (and who perform comfort care measures, say) are immunized from liability.  The win-win: parents explicitly get the ability to have DNR's for their kids in schools, schools explicitly get immunity if their personnel are doing the right thing.


Of course, there are still lots of little complex details--about how a student's DNR might fit in with her IEP, for example--but that's the basic idea.  We are willing to work with the Senator and other Michigan legislators so that the language about all the little things is just right.  But that's a concern for after we get the Senator on board.  Our first goal is to make the Senator think that (1) this issue is a good cause and (2) that actually passing these amendments, in some form, is politically doable--that there's enough support.

I was sitting right next to Senator Jones and when it was my turn to present, I turned my chair so I was facing him and read my statement.  For that moment, it was just the two of us in the room and I was telling him about Willy. He listened earnestly and was very compassionate.  When I was done he shared with me that although it wasn’t quite the same, he too had a special needs son.  In that minute, he wasn’t a Republican and I wasn’t a Democrat.  He wasn’t a senator and I wasn’t a constituent.  We were simply two parents sharing about our special needs children.

(Interesting twist: Unbeknownst to us, Scott Menzel, Washtenaw Intermediate School District Superintendent, had just days earlier met with Senator Rebekah Warren and she had started the process of sponsoring a similar bill.)

The end result of the meeting was that he was very happy to either sponsor, co-sponsor with Senator Warren, or help in any way he could. Follow-up emails to his office assured us they had already contacted Senator Warren’s office to discuss assisting.

As the bill goes through the legislative process there will be more meetings, committee hearings, and testimony so I will keep everyone posted.


In a time where our country is more divided than ever, it felt good to sit with Senator Jones and see the wheels of democracy in action. 


http://www.mottchildren.org/profile/1132/kenneth-pituch-md

https://www.law.umich.edu/clinical/pediatricadvocacyclinic/Pages/default.aspx

http://www.senatorrickjones.com/

https://www.legislature.mi.gov/(S(izncxegpu4xl2mqzb3v3ru45))/documents/mcl/pdf/mcl-Act-193-of-1996.pdf