Friday, May 20, 2022

Addi and Cassi’s First Birthday Cake Mess

February 18, 2008 by  
Filed under Videos

Addi and Cassi’s First 16 Months

February 18, 2008 by  
Filed under Videos

“I” for Insane, “R” for Ridiculous, “B” for Broken – America’s Institutional Review Boards

December 19, 2007 by  
Filed under HealthCare

Stack-of-Paperwork

Regulations, Regulations, and more Regulations!

Some people have asked me why I am not blogging about different topics every day. I really wish I could be blogging more but besides having 1000 things on my to do list, I am actually scared to death to actually talk about some things that are happening to us right now out of fear we might not get the help and cooperation we need to try and save Addi and Cassi’s lives. There are many doctors, researchers and scientists who are being highly cooperative and it has been a truly remarkable experience. Thank you!

On the other hand, there are others who are not as cooperative. I have found that there are a lot of major egos in the medical and science community. A lot of science is about publishing papers about experiments in mice and petri dishes, not about finding near term treatments and therapies that can save the lives is kids like Addi and Cassi. The system is certainly not designed around sharing and collaboration – it’s really a collection of silos all competing against each other for funding or who will get the next Nobel Prize. Someday I will have the opportunity to explain more.

What I can and will talk about is IRBs – in my mind the term stands for "Insane, Ridiculous and Broken" ethics oversight committees. I had never even heard of the term “IRB” until a few months ago when a doctor said we have to, “get this idea through the IRB and this is going to take lots of time.”  An institutional review board (IRB), also known as an independent ethics committee (IEC) or ethical review board (ERB) is a committee that has been formally designated to approve, monitor, and review biomedical and behavioral research involving humans with the aim to protect the rights and welfare of the research subjects if they are involved in research studies.

One of the biggest problems we are facing at the moment with Addi and Cassi centers around the IRBs. These IRBs now standing in the way of Addi and Cassi getting critical tests done which will ultimately lead us to therapies more quickly. The bottom line is that IRBs are severely impeding progress of medical research in the United States today and something needs to be done about it at a national level.  I know my rights and I want testing done.

Let me give you an example of just how ineffective an IRB can be when you are facing a rare and fatal disease like NPC and you’re in a sprint, not a marathon, to save your kids lives. The National Institutes of Health (NIH) needs spinal, blood and urine samples from healthy children to compare against NPC children who they are currently studying. Both Addi and Cassi are in the study. If the NIH can compare normal kids samples directly against NPC kids samples, they might actually find something called a biomarker (a sign of illness in the bodies of NPC kids). Piece of cake to get samples, right? Wrong. The problem is it can take MONTHS to put together a “protocol” and get it approved through an IRB. Once you get a “protocol” designed, you need to get group of committed physicians (most likely ER doctors) who will be at the front lines to get consent from families to obtain these specimens.

I have been working with the NIH and my local hospital, Renown Regional Medical Center, to try and make this happen.They both have been very cooperative and are trying to move as quickly as possible under the rules but I’m now seven weeks into this process between getting the protocol, the consent form, and begging our local doctors to participate. I still have to get approval from the local IRB so cross your fingers. Why am I even having to do this? If I don’t do this, it will take months, if not years, to get these samples because there are not enough resources in the NPC community to accelerate the process more quickly.

I told this story to a friend who offered to send her child down to get the blood and urine sample done so we could send them to the NIH immediately. Problem is, you can’t do this, it’s against the "rules."  So while millions of samples are being flushed down the toilet or disposed of on a daily basis at hospitals around the country, kids are dying. These samples literally could provide clues into Niemann Pick Type C that could lead to treatments more quickly. 

This is an absolute nightmare of all nightmares. No parent should be faced with getting a diagonosis of Niemann Pick Type C and then enter into a totally dysfunctional medical and drug development system on top of it. While I realize that IRBs do serve a purpose, the regulations have simply gone too far and therefore are becoming ineffective. It seems like IRBs are far more worried about litigation when they should be focused on saving lives.

Grandma Cathy’s Zero Oatmeal Raisen Cookies

December 7, 2007 by  
Filed under Recipe Submissions

Ingredients:

2 Sticks of Imperial Margerine
2 egg whites
2 1/2 teaspoons vanilla
4 tablespoons applesauce
1/4 cup oatbran (adds great fiber)
1/4 cut wheatgerm (adds folic acid, vitamin B12, and zinc vitamins)
Grated rind (zest) of 1 orang2
1 3/4 cup flour
3/4 teaspoon baking soda
3/4 teaspoon baking powder
1/2 teaspoon salt
1/2 teaspoon cinnamon
1/4 teaspoon nutmeg

Preparation:

In a mixing bowl, place 2 sticks of Imperial Margerine.  Stir until smooth.  Add the above ingredients in the order given.  Mix well.  Preheat oven to 350 degrees.  Place 1-2 tablespoons of dough on cookie sheet for each cookie.  Bake at 350 degrees for 15 minutes.  Nuts can be added and also dates.  Dough freezes well.  Makes 4 dozen cookies.

 

Common Questions About Niemann Pick Type C

December 1, 2007 by  
Filed under About Niemann Pick Type C

This video was made by our good friends, The Hadley’s, who also have two children with Niemann Pick Type C disease.  This video is easy to understand and gives an overview of Niemann Pick Type C disease and how we are working together to find treatments and a cure.

FREQUENTLY ASKED QUESTIONS

What is Niemann Pick Type C disease?
Niemann Pick Type C is a lysosomal storage disease (LSD) which is a genetic disorder caused by abnormalities in genes or chromosomes. There are group of over 50 lysosomal storage diseases that result from problems in lysosomal function. Every 30 minutes, a child is born with a LSD.

Addi and Cassi were born with two genetic defects on Chromosome 18 on the Niemann Pick Type C gene. Everyone in the world is born with the Niemann Pick Type C gene and could not survive without it. The gene regulates cholesterol metabolism in the human body and there are approximately 500 cases in the world.

In Addi and Cassi’s case, their double genetic defect causes harmful amounts of gangliosides, a very complex type of lipid, to collect in their cells (not blood) and clog them up. The cholesterol accumulation leads to cell death. As cells die, this causes neurological deterioration and also problems with the liver and spleen.

Impaired ganglioside metabolism may also be highly relevant to Alzheimer’s disease.  In fact, Niemann Pick Type C is often referred to as the “Childhood Alzheimer’s.”

What are the first symptoms of Niemann Pick Type C disease?
Symptoms vary from person to person. We hear common threads when we talk to parents: jaundice at birth, enlarged liver and/or enlarged spleen, ataxia, cataplexy, and seizures. Organ enlargement is often prolonged and unexplainable. If a child has trouble with balance and coordination in combination with these other symptoms, this could also be an early sign of Niemann Pick Type C. Wikipedia has a complete outline of NPC symptoms.

How did Addi and Cassi get Niemann Pick Type C disease?
Genes are found in 23 pairs within the human body. When a child is conceived each parent passes one gene from every pair of genes to their child. Addi and Cassi inherited two affected Niemann Pick Type C genes at conception. For a simple and informative overview of how we inherit our genes, visit Pathway or 23andme.com

How did Mom and Dad end up with faulty Niemann Pick Type C genes?
Just like Addi and Cassi, we inherited the affected genes from our parents on both sides of our family. Genes are passed down from one generation to the next. We both carry one good copy of the Niemann Pick Type C gene and one bad copy of the Niemann Pick Type C gene. Since we only have one affected gene we are simply considered “carriers,” and we do not exhibit the disease.  However, it is unclear if carriership of a faulty NPC gene could impact our health over the long term.

Did you know you were carriers of a defective Niemann Pick Type C genes before you conceived?
No. We had no idea we were both carriers of a faulty NPC gene. Their was no genetic or prenatal testing to detect it. A few new genetic testing companies are now testing parents for rare genetic defects such as Counsyl, 23andme.com and Pathway Genomics.

Are there medications available to treat Addi and Cassi?
There is one drug called Zavesca (Migulstat) that is in the second phase of a clinical trial.  Zavesca is the only drug currently recognized to “possibly” provide benefits to Niemann Pick Type C patients. The drug has been approved in the European Union but not yet the United States. Zavesca is used to treat Gaucher’s disease and was approved by our insurance company “off label” to treat Addi and Cassi. Off-label use is the practice of prescribing drugs for a purpose outside the scope of the drug’s originally approved label. It costs approximately $160,000 a year to have Addi and Cassi on Zavesca.

In April 2009, the U.S. Food and Drug Administration (FDA) granted special permission under its “compassionate use” program for Addi and Cassi to receive intravenous infusions of 2-hydroxypropyl-β-cyclodextrin, a non toxic sugar compound. Addi and Cassi are the first children in the United States to receive experimental treatment with this compound and are currently undergoing treatment at Renown Regional Medical Center in Reno, Nevada.

How do you get the drug Zavesca?
Blue Cross approved Addi and Cassi for off label use of Zavesca. Insurance companies make the decisions to provide this drug on a case by case basis. We receive Zavesca each month through the mail from Curascript, the only provider of the drug in United States.

How do you get Cyclodextrin?
Cyclodextrin is not a controlled substance and it can be obtained. We have created and submitted a special treatment protocol to the FDA in order to give Addi and Cassi cyclodextrin treatments in a hospital setting. A company called CTD, Inc. in Florida is a supplier of various cyclodextrins in the United States.

How is Addi and Cassi current health?
The girls are “hanging in there” as we like to say. They currently have enlarged spleens and mildly enlarged livers which are not causing many issues at the moment. They exhibit a number neurological symptoms and are having difficulty with gross and fine motor skills. Their ability to speak has been lost but they are still walking and recognize us. They are very loving and affectionate little girls and we are incredibly blessed to have them in our lives.

Do Addi and Cassi know they have Niemann Pick Type C?
No. Addi and Cassi do not understand they are sick and we are working on keeping our lives as normal as possible for as long as possible.

What is the progression of the disease?  Does NPC move slowly in some and more rapidly in others?
Niemann Pick Type C disease acts differently in all people and doctors are unable at this time to give us any indication of how fast the disease will progress in Addi and Cassi. People who have the disease have different symptoms and rates of progression, even kids in the same family with the same genetic mutations. Addi and Cassi have early onset childhood symptoms — there are also a few cases of adult onset.  NPC is most commonly a childhood illness.

Will Addi and Cassi die from NPC?
Niemann Pick Type C disease is fatal. We are doing everything in our power as parents to not let this happen to our beautiful twins. We are extremely aggressive in treating our children and have designed a strategic plan to try and stop this cholesterol disease from causing more damage.  We are looking into additional experimental therapy options beyond Zavesca and Cyclodextrin.

Will diet help control Niemann Pick Type C disease?
Doctors say that diet is not considered impactful in the management of the condition but we are trying an extremely low cholesterol diet. We believe that diet does play some role in this condition. Our bodies naturally make cholesterol. The fact is people don’t need to ingest cholesterol because we all make enough cholesterol naturally to survive.

Addi and Cassi’s condition is thought to be  influenced by the kind of cholesterol their bodies make naturally. For some reason the natural cholesterol they produce stays trapped inside their cells. Cholesterol accumulates and slows down cells leading to cell death.  The best way to think of this is to imagine a cellular traffic jam. As this traffic jam of cholesterol occurs inside the body, it starts to cause a variety of debilitating neurological and physical problems.

How did Addi and Cassi receive their NPC diagnosis?
As we have come to find out, Niemann Pick Type C is often overlooked by doctors and children with the disease can often go undiagnosed for years. It took us close to two years to receive a diagnosis of NPC.

When Addi and Cassi turned two, they contracted a severe case of infectious mononucleosis. During an abdominal exam by our local pediatrician, she noticed that Addi and Cassi had enlarged spleens. Spleen enlargement is a common side effect of mononucleosis and at the time there was very little cause for concern. Over the next year and a half, we took Addi and Cassi to Stanford multiple times.  Stanford ran a series of tests ranging from genetic testing (including Niemann Pick A and B), hematology tests and immune system deficiency tests. Nothing unusual showed up in Addi and Cassi’s blood or urine and their spleens were functioning well despite the enlargement.

When Addi and Cassi’s spleens remained enlarged for a prolonged period of time, we started getting extremely worried. We decided to seek a second opinion. More tests were conducted by Children’s Hospital Oakland. A volumetric CT scan was conducted which showed slight liver enlargement in addition to spleen enlargement in both girls. A whole series of serious lysosomal storage disorders were then tested for and ruled out.

We started noticing that Addi and Cassi were having problems with their balance and issues of “spaciness” after ingesting foods. We insisted on more genetic testing.  At that time, we were told by Stanford that Addi and Cassi could possibly have Niemann Pick Type C disease.

We recommend that if your child has an enlarged spleen, they should be tested for storage disorders, including Niemann Pick Type C.

How do they test for NPC?
Testing for Niemann Pick Type C is extremely complicated. In some cases, it can take up to 3 months for an answer from DNA and molecular testing. We embarked on a different path for an answer.

Based on a recommendation by Dr. Patterson at Mayo Clinic, we were able to receive a preliminary diagnosis in10 days based on a specific kind of test conducted by electron microscopy. Since Niemann Pick Type C can’t be detected in the blood, Addi and Cassi had small skin biopsies taken from the back of their arms. We had two samples taken from each and they received a small “kitty whisker,” or stitch on their arms.

One biopsy was placed in a glutaraldehyde solution for the examination by electron microscopy which was done by Stanford’s neuropathology department. This particular test looks for intracellular inclusions (or polymorphous cytoplasmic bodies) and this test came back positive which gave us the early indication of NPC.

Th second skin biospy was sent in sterile water for a cultured fibroblast study. This is cholesterol trafficking test (measuring cholesterol esterification) and free cholesterol accumulation (by filipin staining). Researchers watch the skin sample grow in a dish and see what happens with cholesterol. It can take many weeks for a cultured fibroblast result.  Sometimes the skin samples do not grow requiring the testing to be redone. Another way to test for NPC is through a bone marrow aspirate to evaluate for inclusions, storage cells and sky blue histiocytes (we never had to do this).

Final determination of NPC must be made by molecular analysis (DNA testing).  Because two distinct genes can cause the disease, and more than 250 mutations have been described, molecular analysis can be time consuming and can take many months as well.

What types of special therapy will Addi and Cassi need?
We will be placing Addi and Cassi in speech, physical, occupational and vision therapy (if we can find this service locally).  We are currently working to add in these types of services to our daily routine in addition to their special needs school program.

Are Addi and Cassi in regular school?
Yes.  Addi and Cassi attend Brown Elementary, a local elementary school and that has special needs programs. We have no idea what to expect with school or how certain medications will react in their systems. We will need to make decisions on their schooling over time. Our ultimate goal is to make life as normal as possible for Addi and Cassi.

What should I say when I see you?  Do you want to talk about this?
Don’t be afraid to approach us to talk about the girls. We are not in crying mode, we are in action mode.  We have made great strides over the past two years and hope is increasing everyday.

How are you coping?
As well as can be expected.  We remain optimistic that we can find therapies for Niemann Pick Type C and 100% of our focus is on this goal.


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