In the Shadows

rescue

They are in the shadows.

Babes are at risk.  (Jaundice can become toxic when not managed properly.)  Children live with no viable treatment options.  Research funds are needed.  Adults live in immense difficulty.  Families struggle to hold together fractured pieces of their lives.

…all because of jaundice.

There are those shaped by “the K word” and those who are threatened by it.

They live in the shadows.  Many babes are affected by jaundice, but not all escape it unscathed.  Here in the US, there is no reporting system for kernicterus.  Due to the negligent nature of the diagnosis and the ethical concerns that accompany it, it is not always diagnosed either.  How many are living with kernicterus and do not know it?  The effects of kernicterus take months and years to become apparent.  (Newborns don’t need wheelchairs.  They aren’t expected to walk or talk.  The movement disorders, sleep disorders, hearing loss, vision loss etc all become apparent as children miss milestones.  Without proper analysis, the k word is easily swept under the rug, misunderstood, mislabeled.

And what of those living with the milder effects?  Neurological hearing loss (that can only be discovered under sedation with a test that measures brain wave response to sound.)  How often is this misread as behavioral – smart children with unpredictable hearing and difficulty communicating?  Milder forms of kernicterus also seems to come with hyperactivity – how often is that mistaken for other disorders?

The truth is that the numbers of kernicterus are hidden in the shadows.

Our kids, those in picK are likely the tip of the iceberg, and our numbers grow weekly.  And the truth is – one case of kernicterus is one case too many.  The effects are just too catastrophic!

How do we rescue?  How do we make the change?  How do we illuminate?

How do we?

  1. On the front end, we turn the light on!  We spread the word – jaundice can do that, and it doesn’t have to!  TEST!  Prevention.
  2. For those living with the K word, we support the research that will lessen the load of that K.  Research for viable diagnostic tools and treatment options that can lessen the effects of the K…diminishing it’s effects.  Rescue.

Please partner with us in shining the light needed into these shadows to rescue those living with the K!

Beyond the Numbers: What untreated jaundice means for my family

Beyond the Numbers: What untreated jaundice means for my family

November 11, 2013 by Kasey Haas, Guest Blogger

Shortly past dawn my little sister, Lexi, awakens. She coos like a baby dove, calling my mom to her. Mom nestles her in a blanket and snuggles her on the couch, urging tiny bits of food and water into her mouth.

Lexi (center) and Kasey (the author, right)

Lexi (center) and Kasey (the author, right)

The scene is reminiscent of moments from around the world as parents care for their tiny, helpless newborns. Only my sister is not an infant. My parents have been repeating this scene each morning of Lexi’s eleven years and unless something dramatic happens on the medical front, I imagine that when my mom is 80 and my sister over 40, their mornings will still be shared in this manner, because Lexi has kernicterus (KI), a lifelong neurologic injury caused by her newborn jaundice.

KI causes severe motor impairments and a form of deafness called auditory neuropathy, but it spares the intellect, trapping children in bodies that don’t work but with minds that function perfectly. As the morning progresses at our house, Lexi will multiply fractions, conjugate verbs in French, and learn about European history—but all at home as our local schools can’t accommodate a child with such advanced intellect and poor physical function.

Lexi’s story is relatively rare, but not unique. Shortly after her birth, my parents noticed a yellowish hue to her skin. Our doctor assured us that there was nothing to worry about. “Feed her often and she will be fine.” And with that we were sent home with the newest member of our family. No tests. No further instructions.

Read more here…

Let’s Make Kernicterus a Never Event

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September 18, 2013 by Kasey Haas, Guest Blogger

In 2001, the National Quality Forum labeled kernicterus (KI)– a disability caused by untreated newborn jaundice and characterized by motor and hearing impairments – a “Never Event”. Alongside events such as leaving sponges and tools inside surgery patients, KI was classified as an event that is so easy to avert, that it should absolutelynever occur. Yet, even in the United States, we have failed to eradicate KI.

Why does it persist?  …Read more here

http://blog.d-rev.org/2013/09/18/lets-make-kernicterus-a-never-event/

DC. We came. We saw. We Conquered?

Posted on May 21, 2013 by 

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May 2nd 5 moms, 3 of which brought their kids with KI, (equipped with the wheelchairs that KI brought into their lives…and more than a few other pieces of medical equipment) to DC.

We were invited quests at the pediatric Academic Society’s annual meeting, particularly the bilirubin club, the global prevent kernicterus network, and the kernicterus symposium.

For those of you that aren’t familiar with us, PICK is a small grass-roots non-profit that has reorganized and reemerged from several dormant years.  We have 2 missions that fuel one another:

Prevent

 Cure

 In a nutshell, it’s this:

  1. Jaundice can be harmful to newborns
  2. Proactive care, testing, evaluation, screening, and treatment are NEEDED
  3. These steps can PREVENT KI for happening
  4. We advocate education and compliance to standards that will stop KI before it starts.
  5. For those who already live with the devastating consequences, be they severe (appearing much like spastic quadriplegia, coupled with hearing loss, inability to eat, digest food properly, speak, and sleep) or milder (appearing more like behavioral issues, hyperactivity and frustration) there is a great need for research leading to EFFECTIVE treatments…treatments that will pave the way toward a cure.

So, back to DC, our mission there, although barely articulated behind the flurry of arrangements for childcare, spouses, nursing care, lodging, fundraising (we each paid our way almost entirely…but don’t feel too sorry for us, WE BELIEVE in this and are willing to invest in it).  So our mission:

  1. Let the medical community, particularly those who are invested in bilirubin research, phototherapy, testing, neonatology, neurology and pediatrics, remember what they are about
  2. Get the word out that our membership CONTINUES to grow (this is NOT a good thing, and yet it can be used for good in that it can help us pursue better treatments and get the word out)
  3. Network with others invested in seeing KI stopped.
  4. Get the word out to connect other KI families across the globe (for more effective research and treatment)
  5. Let our kids work on something bigger than themselves…making lemonade of the lemons in their life…not suffering silently, but using their collective voice to impact change

At times, between diaper changes, tube feedings, charging medical devices, concerns about brewing troubles in their complex bodies, taking time to let the kids stretch outside of their wheelchairs etc…it felt like we just didn’t have enough to give.  Indeed our actions had to be arranged around our kids needs.  They were the stars of the show,after-all, and their needs had to be met.

luggage for 1 kid with ki and his mom

this was all of the equipment that we brought for my son

And they were AMAZING.  What highly intelligent kids sitting in bodies that would not cooperate at 7,9, and 11 years old would sit through hours of lecture on high level science behind phototherapy?  These kids!

At one point I had to wipe my boys tears from his eyes as he saw a slide of a severely jaundiced and critical baby.  He can barely utter a word, and yet, he spoke volumes, and the whole room saw it.  He knows what happened to him, and he carries a tremendous amount of compassion for other children at risk.  He’s on the team!

There was more than 1 teary eyed physician that offered thanks for our organization and for our kids and the inspiration they offered.  They shined.  Their intelligence and humor shined.  They made us laugh constantly, and many docs offered thanks to us forreminding them what they are about in the fight to stop  KI.

Our hearts broke to hear more about the extent of the global burden of jaundice, and the cataclysmic damage left in it’s wake.   But we didn’t just talk about the problem, we heard from the field, what people are DOING about it…products being developed to make testing in the field affordable and portable with minimal battery power, safer means of heliotherapy for babes that don’t require the NICU, and phototherapy options for between $200-600 that last 8 years and are built to withstand power surges and shortages.  WE WERE INSPIRED.  There is a problem, and there are people out there with their hearts and minds invested in the battle to see it stopped to stopKI!!!

We won’t lie.  Speaking about KI for 16 hours a day for 5 days, while caring for our kids – NOT EASY.  We each fought back tears of our own at different times.  Living in the reality and discussing a tragedy beyond human comprehension – it takes it’s toll.

Doing something –

Acting –

Being the one that cries out, that exposes the need for action –

Seeing the powerful voice that our children have…the voice that is so much stonger than words uttered –

…it’s medicine for the soul!

Networking.

  1. We made dozens of contacts and are in the process of developing an educational program for professionals, that will be viewed at several university hospitals.
  2. Some of our growing group in Brazil will be able to meet this week with a non-profit that is working to give Brazil access to more affordable and effective phototherapy.
  3. Our kids got to meet many heros that have fought to prevent their condition.  They inspired one another, and the docs that work hard to stop KI.
  4. We received over $7,000 in donations as a direct result of our work there.  (These expenses will be used to support research and reimburse some of the board’s travel expenses.)
  5. We were able to distribute over 500 of our brochures.
  6. Numerous board meetings and brainstorming took place (something that is often a challenge given our spread over 3 time zones and busy schedules.)

And then there are the things that don’t fall into bullet points as easily:

For the first time that I know of, in over 8 years, 3 kids with KI got a chance to spend five days together.  It gave us a unique time to reflect, as mothers, on the similarities and differences our children share.  This information might prove very useful in steering research.   And speaking of research – the leading researchers of KI and hyperbilirubinemia were THERE and they were taking it all in too! In fact, the fabulous neurologist and world-renown researcher Dr. Steven Shapiro spent a large amount of time with our kids.  There was some fabulous conversation about science, some great connections on research to benefit our kids, and educationalventures to help encourage better handling of newborn jaundice, and some fun too!

We very much look forward to the day when our organization will grow to a size that can accommodate a FAMILY CONFERENCE.  Bringing the researchers and families TOGETHER – there will be more benefits there than I can articulate.

And humor!!!  Lexi, not only has an IQ of 160, but she also has a wicked sense of humor.  Lexi does not have the hearing loss that the boys have, and is able to speak several words rather reliably.   The boys understood every bit of what Lexi was getting at.  The ability to speak does not negate the ability to understand.  We were able to ask questions and give options and get huge smiles and laughter in response…and the laughter of Lexi and Blue and Zach is a tangible piece of pure joy!!!

So, between laughter and tears and long days, and new connections, YES, we conquered!

PICK @ PAS 2013

Posted on May 3, 2013 by Miriam

PICK at PAS in DC 2013

As I post pictures tonight, I think of how deceiving pictures can be. They are the split seconds. I tried to convey some of the reality of our day. In truth, it brought the challenges of formula pumps leaking all over the restaurant floor, a footrest falling from a wheelchair, some serious reflux, concerns about abdominal swelling around a surgery site, worries about a yucky cough, a wheelchair tray that seemed to fall off every 10 steps or so, diapers leaking etc. So, no, it’s not easy…and yes, we try to breathe deep and let our children’s smiles sink into our souls.
In truth, one of the agencies that we have worked hard over the past few months to see while here, has still not responded, and that’s hard. We want to be able to help others understand the catastrophic cost of KI and do what they can to put the better protocols in place and follow them. But even with that disappointment, it is with happy hearts that we join PAS tomorrow and thank the doctors that ARE invested in the battle to #stopKI!

Miriam

Preventable Tornado

Jaundice. It’s a word most parents are familiar with, but to my group…it sends chills down our spine.

We don’t joke about cute yellow babies, or pumpkins that are orange.

For us, jaundice was the strange weather that heralded a MASSIVE TORNADO in an innocent child’s newborn body, just days after coming home from the hospital.

Go ahead. Call me dramatic, but with a deeper understanding, you might agree. (AP Photo)

There has been wreckage.

My boy had multiple risk factors for more serious jaundice (hyperbilirubiemia).

Over 12 times, I asked doctors and nurses about his bruising, his early birth, his color and EVERY single time – they dismissed my concerns…this was on the phone, and face to face, and even in the ER when he lay dying in my arms at 9 days old.

The kid with the cut finger was rushed back while we waited hours.

The finger healed.

My son has an irreversible, virtually untreatable condition that has impaired his ability on a profound level to talk, walk, sit, stand, eat, use a toilet, hear, see, form enamel on his baby teeth, control his own movements, digest food, etc.

What jaundice did to my boy – it’s no small thing.  IT WAS A TORNADO.

Kernicterus

I had no idea.

None.

It was treated like a common cold.

They say it’s rare, and to some degree it is.  I don’t see 50 kids a day with it.  But to what degree is it rare?

NO ONE KNOWS.

NO ONE IS TRACKING KI.  There is no mandatory reporting of KI or higher bilirubin levels.

I’ve lived through this – I’ve seen the tremendous amount of negative pressure – pressure to smother the word – kernicterus.

Here’s why: IT’S PREVENTABLE.

You follow these steps, you use the technology and KI is avoidable.  But some people think it’s a fairy tale – that if it doesn’t happen to every baby that it can’t happen to any baby.

It CAN.

It does.

PICK, continues to receive new members on a weekly basis, around the globe, and right here in the US.

We believe that our members are the tip of the iceberg.  Why?

  1. Our group has an unusually high # of educated middle to upper class families.
  • KI DOESN’T DISCRIMINATE.
  • THESE FAMILIES HAPPEN TO FIND US BECAUSE THEY HAVE THE RESOURCES OR THE KIND DOC IN THEIR PATH TO FIND US.
  • NOT EVERYONE HAS THESE RESOURCES.
  1. The negative pressure in the medical community – the pressure to not “throw someone under the bus” by saying the word kernicterus is strong – and it prevents many children from getting the proper diagnosis.
  2. The milder kids are missing.  KI is a spectrum.  There are the more severe and those less affected.
  • IN CASES LIKE MY SON’S IT’S HARD TO KEEP A LID ON THE FACT THAT A BILIRUBIN OF 45.6 IS SURE TO CAUSE A BRAIN INJURY.
  • BUT WHAT OF THE OTHER CASES, WHERE JAUNDICE DIDN’T GET TO 45.6 BUT IT WAS HIGH AND/OR IT WENT ON FOR WEEKS?
  • WHAT IF YOU TAKE MY SON’S CONDITIONS AND THINK OF THE MILDER FORMS: THE HEARING LOSS THAT REQUIRES A SPECIALIZED MEASUREMENT OF BRAIN WAVES TO DETECT – THAT CAN OFTEN APPEAR LIKE A LEARNING DISABILITY, THE MOVEMENT DISORDER THAT IN MILDER FORMS CAN LOOK LIKE A LACK OF COORDINATION?
  • WHERE ARE THESE KIDS?  THEY ARE OUT THERE, BUT THEY RARELY MAKE IT TO OUR GROUP, BECAUSE IT’S MORE DIFFICULT FOR THE FAMILIES TO PUT THE PIECES TOGETHER.
  1. And then there is the sad reality: that there is no tracking of kernicterus because there are no real numbers on kernicterus.
  • WE’VE SPENT TIME PLEADING WITH AGENCIES TO GET OUT OF THIS UGLY CYCLE, AND THEY’VE RAISED TIED HANDS.  THESE HAVE BEEN HARD BLOWS.

So while estimates (derived from looking at Canada’s KI reports) come in at a minimum of 100 NEW cases of KI per year, keep in mind – these are kids that are actually at a level where they would receive the KI diagnosis.  How many more of the milder cases are happening? How many of them are being displaced under other diagnoses? ADHD? Autism? Developmental Delay?  We need the research to know

When a tornado comes, how do you put a price tag on the damage, on

Lives lost?

Homes lost?

Futures robbed?

Livelihoods destroyed?

Siblings scared?

The grief that carries from one day to the next?

A community altered?

What is the price on that?

How much more is the emotional price tag when the likelihood was foreseen?

tornado3.1

(Photo: Associated Press/Mike Gullett)

THE DAMAGE IS 100% AVOIDABLE.

WHAT IF THE AUTHORITIES DECIDED THEY DIDN’T WANT TO SOUND A SIREN?

Many fear the effects of fear, but when you can stop the object of your fear: What is to fear?

And here is the kicker. The cost of the test is minuscule.

You can never measure the catastrophic effects it has upon the families and the ripple effects upon the communities.  They are egregious!  But what you can measure – the healthcare cost? My son’s life care plan is

60 MILLION DOLLARS.

…All because someone did not perform the appropriate test (estimated to cost ONE dollar).

…because they thought their eyes could see the severity of his jaundice.

KI is a tornado…and it’s being allowed to go on with no siren.  No warning came for us.  If we had been told of the possible catastrophe, we would have sought shelter – it wasn’t a rain storm to watch on the porch.  It came in the night and forever took my son’s abilities.

AND THE MATH.

Let’s say that 100 kids a year in US develop KI.  Let’s say each of these cases has an economic impact of 30 million per child (1/2 the estimated cost to my son).

30 million dollars x 100 = a cost to the health care system of 3 BILLION DOLLARS or unnecessary cost, and of course this cost would be over the child’s lifetime, but you also need to realize that it happens EVERY year.

I’m not saying I know the cost of KI in terms of being able to hand you a number. Like I said, there is not positive pressure, or even a system to report it, but on the ground I can tell you – it falls under the tornado category. Although it doesn’t happen to every jaundiced baby, when it does, the cost is catastrophic beyond words.

What of these children’s futures?

What of the crippling effect it has on their entire family and network of friends who help shoulder their burdens,

What of the parents who struggle with depression and decreased ability to work through multiple hospitalizations of their child and the agony of their daily lives?
From the wreckage, I cry out to you: sound the siren!  It is only when the victims make the disaster known that change can come, and I tell you:

Please help us!

Please treat jaundice seriously.
Please spread the word that Jaundice CAN do THAT…
and IT DOESN’T HAVE TO.

Let’s turn the tide around.

Let’s minimize exposure.

Let’s prevent KI by bringing much needed awareness.

Let’s research KI to find the means of treating it.

Let’s pave the way to a cure.

LET’S BRING THE DAY THAT WILL #STOPKI!