The Year Ahead

At the end of this last year in November we were fortunate enough to have an appointment with a biochemical disease doctor, Dr Galina Nesterova, who just so happens to have a lot of experience treating people with cystinosis. It was so amazing to finally be able to talk with an expert in the field and feel like my concerns were being properly addressed. Don’t get me wrong, I think that our nephrologist and all the support people we see at the renal clinic are great but sometimes I’ll bring up an issue which is fairly common among the cystinosis population and I’m met with resistance. I feel like my concerns get dismissed because they might think I don’t know what I’m talking about.

Here’s the thing though, I have far more time available to research cystinosis and the sorts of things I should be looking out for than they do. And I understand there’s a thin line between being cautious and overly paranoid when it comes to rare diseases but when I bring up a concern, I want to feel like I’m actually being listened to. For example I’ve been concerned about Elsie’s legs going a bit knock kneed and have been told several times from the renal clinic that it’s fairly common in children and they usually grow out of it by age 5, so until that age they don’t think action is necessary. However after bringing this up with Dr Nesterova she explained that for children with cystinosis the problem may not correct itself and could get worse as they age and gain weight. Then she referred Elsie for some physiotherapy and wants them to assess whether orthotics are needed to help keep her ankles from turning in. Finally, progress!

For the past few years Dr Nesterova has been assisting Dr William Gahl at the National Institutes of Health (NIH) in Maryland, USA in his Natural History Study of the Use of Cysteamine in the Treatment of Cystinosis and I’ve been wanting to take Elsie there since I first heard of it. Many people throughout America visit the NIH every couple years to take part in this study, which includes extensive testing and review from one of the top doctors in the field of cystinosis. But, living in Canada, I didn’t think it would be something we could participate in. However when I mentioned it to Dr Nesterova she said it would be no problem for us to participate and that we would just have to cover our travel costs! I was given the contact for the study coordinator and I’m hoping to bring Elsie there sometime in the Spring or Summer this year.

With the prospect of having experts in the field to ask questions from and get a real sense of just how healthy Elsie might be I’ve found myself looking to the year ahead with a lot of hope. Every year since Elsie’s diagnosis I’ve felt like we’ve gained more and more control of cystinosis. Instead of it running our lives it now feels like just a part of a our lives, and a manageable one at that. Sometimes I worry that this is just the eye of the storm and in a few years we’ll be thrown back into the chaos with something like her kidneys starting to fail, or maybe her thyroid will start having problems but for now I’m choosing to put all that fear aside and just live in this peaceful moment of health.

Her first check up at the renal clinic this year went fairly well but we have had to add some new medications to the mix. Her red blood cell count has started to drop so they’ve added a multivitamin called Renavite to try bring the count back up. They’ve also added an iron supplement called Euro-Fer and a half tab of Tums to add some calcium that she’s probably missing from her diet. At 15.53 kg she is sticking to her growth curve at the 26th percentile for weight and at 103 cm tall she’s in the 44th percentile for height which I think is awesome! All in all I feel like we’re in a good space at the start of 2017.

With the new additions to her medications I thought it’d be nice to post her medication schedule again:

1:30am – Cystagon 300mg

7:30am – Cystagon 300mg 

With Breakfast

• Sodium Phosphate – 1.5ml
• Potassium Citrate – 7.5ml
• Spironolactone – 2ml
• Carnitor – 2.5ml
• Vitamin D Drop – 1

With Lunch

• Potassium Citrate – 7.5 ml
• Carintor – 2.5ml
• Tums – ½ a tablet

1:30pm – Cystagon 300mg

5pm

• Potassium Citrate – 7.5ml
• Renavite – ½ a tablet
• Euro-Fer – 2ml

With Dinner

• Sodium Phosphate – 1.5ml
• Potassium Citrate – 7.5ml
• Spironolactone – 2ml
• Carnitor – 2.5ml
• Enalapril – 2ml
• Vitamin D Drop – 1

7:30pm – Cystagon 300mg

At Bedtime – Growth Horomone

Eye drops – 6x/day: every two hours

Elsie has started to express an interest in learning how to swallow pills so hopefully soon we will finally get our act together and start teaching her how. It would if she could swallow pills when she starts Kindergarten in September. That way we won’t need to worry about medications needing to be refrigerated and things like that. When we do start the process I found this article from The Pursuit of Research with tips on how to teach your child to swallow pills which I think will be invaluable. And while I can’t believe my little girl will be starting school so soon, that I think is another post entirely!

All in all I’m looking forward to the rest of 2017. We hope to attend one of the cystinosis conferences this year as a family as I would love to meet and talk with some of the wonderful families we’ve met online and I think Elsie would love meeting and making friends with their beautiful children. So here’s hoping that 2017 meets up with my expectations.