>Post Endoscopy & Colonoscopy…….

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Yasmin got through the endoscopy and colonoscopy safely. Our thanks for all the well-wishes from many good friends, it gave us strength. Though she was admitted on a Thursday, the scope was scheduled on Friday. When it was time, I carried Yasmin down to the OR, dressed in her little surgical gown. The anesthetist placed the gas mask over her face, she struggled a little but quickly succumbed. Paul and I waited outside for a while and later the doctor invited us in to take a look at the monitor. It was hard to tear my eyes away from Yasmin lying unconscious on the table, meanwhile the doctor showed us several parts of her large intestine.

He did not use a pill-cam even though we requested for it. According to other pediatric GI specialists in the UK and USA, they commonly use pill-cams for young patients even 3 year olds. However, I guess things are different here in Malaysia. Due to the traditional cam scope, the doctor is not able to check the small intestines. However, he did a thorough check on the entrance into the small intestines. The endoscopy was then over, and it was time for the colonoscopy. We then waited outside again, and were invited back into the OR once the doctor had gone into the colon. He showed us her colon and as before, he kindly explained where and what we were seeing and findings he had.

Overall, the up close and personal look at Yasmin’s inside was a revelation. She was absolutely perfect! Everything was pink and healthy as it should be. There were no signs of inflammation, lesions, polyps or anything else out of the ordinary. Paul and I are immensely relieved that she did not have any of the GI diseases we initially suspected. It was good to know that she is not in the kind of awful pain that was reported in many children in GI literature.

Once the procedure was over, I carried Yasmin to the recovery room. Once her condition was deemed stable, we brought her up to her room. It took a long time for her to wake up from the general anesthesia, nearly 2 hours. Even then, we tried several methods to wake her up. We were warned that some patients when coming out of GA tend to act aggressively, cry or act weird. We were prepared for that, but Yasmin was totally fine apart from being groggy, sleepy and a bit uncoordinated, as was expected. The doctor discharged us soon after and Yasmin was happy to be home though tired. We were relieved to be home on Friday night, I was not looking forward to another night in hospital. Caring for a child in hospital is hard enough, even though it was only for 2 days. However, this was during Ramadhan, it was harder to go through it physically, mentally and emotionally while fasting. In the next few days, we expected to see signs of side effect from the anesthesia. However, again we were lucky there wasn’t any lingering side-effects or other concerns.  

The only thing abnormal was that she had constipation and night awakenings for 3 weeks after that. Initially we thought the constipation was due to the scope and it was taking some time for her bowels to get back to normal. However, take note that she had constipation and night awakenings 3 weeks prior to the scope anyway. We had done a stool test for yeast a few weeks before with our pediatrician, it turned out positive. However, we did not address it as we wanted to wait for the scope first in case it affected the outcome of the scope. Because she had recently undergone the procedure, we were advised to take it slow and give her body time to adjust. However, when she was constipated for 3 consecutive days, we gave her Lactulose, a stool softener/laxative. After that, we increased her fluid intake, fibre, vitamin C, magnesium and probiotics. However, it didn’t work. At times we had to use the laxative, to me constipation more than 3 days running needs to be addressed immediately.

I put her on therapeutic doses of S.Boulardii and ThreeLac as anti fungal treatment however there were no changes or improvements. On the advice of our biomed doctor, Yasmin is now on Nystatin and extra Bifido strains of probiotics on top of her usual supplements. Those with constipation may require additional Bifidos temporarily, this worked for both my girls sometimes. Within 2 days, her constipation is reduced, she has a bowel movement every 2 days. Previously she required laxatives. Hopefully, the further we get along with the anti fungal treatment, she will be back to her normal daily bowel movements. And best of all, she now sleeps through the night. Yasmin has slept through the night consistently for the past 1 year unless during times of illness or infections. No more broken sleep for the whole household.      

So, now that our suspicions of colitis has been ruled out, where does that leave us? First and foremost, this is good news indeed. Colitis or any kind of Inflammatory Bowel Disease is terrible in anyone, especially a 3 year old child. Having hard physical evidence that ruled this out is worth it. We are glad that we went through with it, even with all the trauma and possible side effects of the general anesthesia, it was worth the risk. Since the scope has ruled out colitis, IBD (Inflammatory Bowel Disease) and other bowel diseases, the GI specialist based on the symptoms diagnosed Yasmin with IBS (Irritable Bowel Syndrome) instead. IBS is diagnosed based on clinical observations and symptoms, there is no test for it. As usual, I take everything with a pinch of salt. I have read that many Irritable Bowel symptoms are similar to symptoms associated to Clostridium infection. I will look further into this as well as any viral infections, Yasmin regressed ever since the Rotavirus infection, so it makes sense to look into her immune system as well as viruses.

So, how do we treat Yasmin’s issues now? We are maintaining her usual supplements of vitamin C, B complex, minerals, probiotics and cod liver oil. I want to address her immune dysregulation as this is the core reason why she gets recurrent infections. Since we started 4Life Transfer Factor 1 month ago, neither girls have fallen ill. We also give her Klaire Labs Galactomune, a prebiotic formula containing betaglucan  to support TH1 immunity. We also supplement with Vitamin D3, also beneficial to the immune function.

Apart from immune modulating supplements, I also give her Culturelle daily for maintenance against clostridia. I also include Milk Thistle to maintain healthy liver and kidney function. I reintroduced L-Glutamine a couple of months back, this helps with leaky gut. Since we started her on L-Glutamine again, she is much happier, with good appetite and always cheerful. The biggest change of all, previously Yasmin has rarely been as close to her Daddy compared to Maya. She always has great fun with Paul whenever they are playing together but she rarely seeks him out for company. Since restarting L-Glutamine, Yasmin constantly seeks out Paul, always looking for him when he’s gone, she is very loving and attached to her Daddy compared to before. It is heartwarming to see how she dotes on him and vice versa. I al
so introduced 5-HTP to help her with sleep, melatonin did not help when her yeast issues are flaring up. We also never forget Epsom salt baths daily.

I look forward to our next appointment with our biomed doctor for more insights on what else we can do for Yasmin. But for now, we are pleased to have a cheerful, illness-free girl again.        

>The Rash Incident…..

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The past couple of months have been very taxing for our younger daughter. She had several rounds of fevers, colds and coughs on top of her chronic diarrhea which has been going on for 9 months now. There were also 2 absolutely horrendous weeks of hive-like rashes called urticaria. It started from her legs and progressively spread all over her body, the itching intensifying every day. Initially, the rash and itching was isolated, but everyday there was a little bit more. In the first week, with the help of our local GI paediatrician, we managed to control the discomfort whilst investigating the cause. However by the 8th day, my little girl was in absolute agony. She would cry and scream trying to scratch herself and not finding any relief.

This is the first time this has every happened, I don’t recall this kind of rash happening to either girls before. Paul and I felt so helpless, watching our little girl covered from head to toe in huge red welts, her hands and arms were swollen. During that 2 week period, we went to see a doctor just about every single day, we ended up seeing 4 different doctors. It seemed that nothing seemed to help, the antihistamines, painkillers and other remedies or drugs did not reduce the swelling nor provide relief for the itching.

In the 2nd week, for days and nights Yasmin would cry nonstop and madly scratching herself. We used calamine lotion, 3 types of antihistamines each stronger than the previous and other treatments. For the first 3 days there was some vomitting and mild fever. But later, there was no more vomitting but with intermittent high fever that doesn’t recede with ibuprofen or panadol. Only voren suppositories could bring down the fever.We did a blood test for kidney and liver function and mycoplasma, they turned out to be negative, but the markers were slightly elevated in one of the liver function profile.

Everytime Yasmin was not in an air conditioned room, the itch intensified and her fever spiked. The 1st week of rashes also coincided with the day of the conference in Singapore, which Paul and I were looking forward to. We didn’t want to miss hearing Dr James Partington and Dr Kenneth Bock’s talk, it’s a rare opportunity to hear world-class Autisms expert talk for 3 hours each. But neither could I bear to leave my sick child at home even though my parents were willing to take care of her.

Paul and I decided to pack up the whole family and drove down to Singapore the day before the conference. We also managed to get a quick consult with the girls’ regular doctor there and get a 2nd opinion. We managed to keep Yasmin somewhat comfortable though we could see the rashes were still bad.Nontheless, the girls love going to Singapore and especially love staying in hotels. They were happy enough and we didn’t feel too bad about taking Yasmin away on a trip, even though we should never take a sick child travelling. Right or wrong, it was a choice that Paul and I made.

The next morning, it was hard to concentrate on the presentation. I was incredibly tired from repeated sleepless nights caring for Yasmin plus I had bronchitis. God, please forgive me for spreading my germs to the other parents who attended the conference. Though I had heard both Dr Partington and Dr Bock just a couple of weeks before that in Hong Kong, it was still incredibly beneficial. You just can’t learn enough I feel. It was also good to meet new friends and catch up with old ones, though in the back of my mind I was incredibly worried about Yasmin. She was never far from my thoughts even though I was chatting to people or concentrating on the biochemistry lesson courtesy of Dr Bock. Paul was kind enough to stay with the kids and our nanny while I went to the conference first for Dr Partington’s lecture. He made sure Yasmin was stable enough and that he could safely leave them for a few hours with our nanny. Paul managed to join in for Dr Bock’s portion. Our hotel was only a few minutes drive away so we knew that in case of an emergency phone call from the nanny, we could rush back to our girls quickly.

The day after the conference, before we drove back to KL, we also saw a pediatric immunologist in Singapore. We also wanted to make sure that Yasmin would be ok for the 4 hour drive home, to have some temporary solution so that Yasmin won’t be too uncomfortable during the car ride. The doctor was very concerned about her immune system and recommended that we see an immunologist in KL for further investigation. She suspects the fever and rash was a viral infection rather than an allergic reaction. She gave us some medication to control the fever and itchiness. The drive back to KL wasn’t too horrific, thank goodness.

Back in KL, we saw our regular pediatrician again and we also managed to get an appointment with the only pediatric immunogist in Malaysia. They are working together to investigate Yasmin’s condition, namely inflammatory bowel disease and her impaired immune system. Our consults and testing with the immunologist unfortunately could not bring us any closer to a resolution. But by then, he had identified enough that her immune system is compromised and everything led back to issues with her GI disorder. After all, 70% of our immune system lies in the GI tract. Again, the topic of endoscopy had come up.

Yasmin’s rashes and fevers went away after a course of antibiotic, our paediatrician prescribed it because the rashes were so bad that it caused swelling and infection of the fat layers of her skin. The Rash Incidence has been so traumatizing for us that it took me a long time to even be able to talk about it or write about it till now, 2 months later. Since then, based on the recommendations from our doctors, we have taken steps towards getting closer to healing Yasmin. We did an xray which confirmed fecal impaction, thus we put her on laxatives and enemas. This gave her much relief, her tummy was no longer bloated, her mood and behavior improved and her appetite was much better. However, after some time, the symptoms would return. We have also been battling constant colds, flus, fever and coughs. Till now, I dread the rash would return. The Rash Incident was more traumatizing for us compared to her previous hospitalizations, can you believe it?

I also finally had the time to read Dr Andrew Wakefield’s book Callous Disregard. This turned out to be very timely for me, as Dr Wakefield included many case studies of children he’s worked with. There were many references to bowel disease, immune dysfunction, chronic diarrhoea, behavioural issues  due to GI disease, endoscopies, gastrointestinal symptoms – everything that I was going through with right now. It is a huge loss to the medical world indeed and Autistic children worldwide that a gifted paediatric gastroenterologist was struck off the medical register due to biased misrepresentation, government blunders and the profit margins of vaccine manufacturers. Meeting him again in Hong Kong and listening to his lecture also gave me the resolve to go ahead with the endoscopy. Paul and I had many misgivings about doing the procedure for Yasmin, but now our fears have been allayed. I also read again Dr Elizabeth Lipsky’s book Digestive Wellness and anything else that related to IBD and GI diseases.

I am working closely with my pediatric GI doctor as well as the peadiatric GI surgeon who will do the actual procedure. We are in the midst of preparing for the endoscopy and possible colonoscopy, which will also include more consultation, scheduling and booking the operating theatre and anaesthesiologist, blood work and biopsy. All her symptoms and conclusions from the many doctors we consulted points t
owards IBD, Inflammatory Bowel Disease. So now we are STILL in the initial stages, which is getting a proper diagnosis of which type of IBD or another type of GI disease. However, I am hopeful that we are on the right path. Once the endoscopy and findings confirm it, we can then proceed with treatment. What the treatment will be depends on the diagnosis. And if everything comes up negative, I will deal with it when the time comes. Right now, diagnosis first……..

>GI Symptoms, Abnormal Stool and Endoscopy

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Yasmin was hospitalized recently, shortly after I returned from the DAN Conference. For nearly 2 days, she was complaining severely of “itchy bottom”. It was driving her insane to the point that she would strip off her pants and nappy in the middle of the night. She cried about the pain in her tummy, always pointing to the same spot. All day long she wept “I’m not feeling very well” over and over again. When she was admitted into hospital, a doctor tried to place an IV drip, however there was difficulty in finding a vein. After much poking and prodding with needles on 2 separate occasions, I demanded that they stop. After all, Yasmin was still able to drink and she was not vomiting or losing fluids, so an IV is not necessary. After all the trauma and screaming over the IV fiasco, Yasmin was still in pain.

The hospital had assigned an unknown pediatrician on Yasmin’s case, however I demanded a Pediatric Gastroenterologist who was familiar with Yasmin. Dr N is familiar with the GI disorders common in Autistic patients and she was aware of Maya’s issues. After physical exam, thorough history, looking over Yasmin’s lab results and much consideration, Dr N suggested we do an endoscopy. I immediately agreed as my research has led me to believe that an endoscopy will shed more light on Yasmin’s issues. Unfortunately, there was not much that the Dr could do in the meantime except to give Yasmin some panadol. It was heartbreaking to see her in pain yet not being able to help.

We were referred to Dr L, a senior pediatric GI specialist in another hospital, as that is where the equipment and facilities for children’s endoscopy are available. Again I had to go through the entire history with yet another doctor. Yasmin’s main issues include behavioral and physical regression after her bout with Rotavirus more than a year ago. Chronic diarrhea presenting soft, unformed, yellow, smelly stools for past 6 months, alternating with slightly better formed stools with dual colour (green/brown), mucous and slimy, with undigested food. She had abdominal pain, bloated tummy, loss of appetite, picky eater, itchy bottom, recurrent bacterial infection, frequent colds, flus and fevers. Dr N as well as 2 of our biomed doctors have recommended an endoscopy as all the interventions that we have done has not shown great improvement. And any improvement we gained was temporary and very short-lived.

Dr L was willing to do an endoscopy and obtain some samples for biopsy. Yet even after being presented with all the history, symptoms, physical exam and recommendations, he stressed several times to me that he will probably find nothing from the endoscopy. He gave me the impression that he’ll do it, but it’s a waste of time because to him, these are all symptoms that will “probably go away by itself as she grows out of it”. Instantly my Mummy Radar went up, I knew well enough that a doctor who was not committed to the patient nor the procedure is not going to be the best person for the job. And unlike the first pediatric specialist, Dr L was not even aware of the gut-brain correlation, nor the well-known GI disorders in Autistic patients! Shame on you!!

Anyone who has read materials on GI diseases in Autism or by Dr Arthur Krigsman in particular, understands the intricacies of doing an endoscopy for a child presenting GI symptoms associated with ASD. You need to know WHERE to look, WHAT to look for and trained to RECOGNIZE it. Paul and I made the decision that this is definitely not the person we want to do an endoscopy for Yasmin.

We also had our first consultation with Dr Kyle Van Dyke. Over the 2 hour consult, Paul and I were impressed at how quickly he grasped Yasmin’s issues. Of the 6 DAN doctors we have consulted, I just realized that only 1 of them has a child with Autism. Not only is Dr Kyle a biomed doctor, he mentored with Dr Elizabeth Mumper for several years, he is a frequent speaker at DAN and other Autism conferences. But most importantly, he also personally experienced the heartbreak of having a child with Autism. He also treats the siblings of children with Autism and has treated his other child too. Hearing his son’s story at the DAN conference, there were many issues that were reminiscent of Maya and Yasmin’s.

He too recommended an endoscopy for Yasmin, however when we explained the situation, he suggested doing an abdominal X-Ray to check for impacted stool. So, this is next on my ever increasing to-do list. He also put Yasmin on Enhansa and several other recommendations. It’s only been 10 days on his protocol and too soon to tell whether it’s a coincidence, but Yasmin’s temper tantrums and irritability has lessened and no longer complains of itchy bottom. Her tummy is no longer bloated and her appetite has improved. How long this will last, we don’t know.

However, we are grateful for any improvement big or small. Giving up is not an option. Letting my baby suffer in pain day in and day out……. do NOT tell me to give up. Do NOT tell me that there is nothing we can do about it. That sort of attitude or so-called advice is not welcomed. You know when someone thinks that they are being helpful and they say to you “Don’t worry, she’s still young”. What the heck does that mean??

So she’s young, is that any excuse not to treat her medical illness? You really think that someday she’ll grow out of it? Most people don’t realize that chronic symptoms if left untreated can be a precursor to bigger and worse diseases when the child is older. Now, don’t you think as a parent that it is our responsibility to ensure our child’s health? The earlier you treat it, the better their chances at recovery. Why in the world should I wait until it’s too late? I mean, seriously!

Etiquette lesson #23 – if a friend or a family member has a sick child, do not say “Don’t worry, it’ll be fine.” A parent can’t help but worry and we don’t know if it will be fine. Instead say “I’m so sorry to hear that. Is there anything I can do to help?”

For those who know me well, I will never keep fighting for my girls. The words “No need to do anything, she will grow out of it” is not in my vocabulary. Yasmin deserves to know that Mummy will always do what’s right for her. I WILL make her feel better, by hook or by crook. If I can recover 1 child from Autism, I can certainly help ease Yasmin’s pain. I will I will I will………