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Monthly Archives: September 1999

Periventricular Leukomalacia (PVL)

By Cynthia Bissell

Happy and healthy two-year-old Eric (a  former 26-weeker) with PVL and cerebral palsy loves to meet people.
Happy and healthy two-year-old Eric (a former 26-weeker) with PVL and cerebral palsy loves to meet people.

Periventricular leukomalacia . . . even in my nursing career, I had never heard of this diagnosis. I only knew it didn’t sound good. When I asked Eric’s neonatologist what this meant, he answered simply, “Cerebral palsy.”

Eric and his identical twin brother, Aaron, were born on July 28, 1993, at 26 weeks gestation. Both had many of the common complications of prematurity. Eric’s most serious complication was and is periventricular leukomalacia, or PVL.

When I first learned of Eric’s condition, I attempted to find out everything there was to know about the subject. I wanted an exact portrait of how this diagnosis would affect my son. I quickly learned a lesson that all families raising a child with a disability learn—there are no clearly defined borders in relation to outcome. We only knew that Eric was at high risk for cerebral palsy.

But what did that mean? Would he walk with a limp? Would he be severely disabled? My spirit grieved for Eric and my mind created negative caricatures of Eric’s future. Not knowing exactly what I was grieving for made it all the worse. Seeing a person in a wheelchair affirmed my worst fears. Seeing a typical child running and playing outside gave me a glimpse of what Eric had lost. As I looked upon this beautiful, tiny baby it seemed impossible that his brain was not perfect. I cried for what Eric had lost at such a young age. I also wept for the loss of Eric as I had imagined he would be. In many ways, the unknown was the hardest part of Eric’s diagnosis of PVL.

Children come into this world innocent, carefree, and full of life. At least that is how it’s supposed to be. What possibly could have gone so wrong that my child would never have the same advantages as typical children? Questions such as this constantly went through my mind. I struggled with feelings of guilt, sadness, anger, and jealousy. Guilt for maybe having done something that caused the twins to be born too soon. Sadness at the loss of the usual joys of pregnancy, childbirth, and twins. Anger because this happened to our family and jealousy toward people with “normal” children.

Now that Eric has actually been diagnosed with cerebral palsy, I am slowly gaining insights into his full potential. At least I can begin to cope. I try not to mourn what was lost, but accept and acknowledge what has been found. I realize that although things could have turned out better, they could also be much worse.

I am thankful for Eric and his brother. Eric has an infectious smile and a belly laugh that is contagious. He has brought tremendous joy into our lives and into the lives around him. He has taught me patience and to take nothing for granted. He has taught me what is truly important in life. When I first learned of his diagnosis, all I could think about was his disability. Now I see that he is “Eric,” a child similar in most ways to any other child. His disability is only a small part of who he is.

CINDY, MOTHER OF 26-WEEKER ERIC, TWIN TO AARON

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Your Premature Baby and Child," Helpful Answers and Advice for Parents, by Amy E. Tracy and Dianne I Maroney, R.N.
Your Premature Baby and Child,” Helpful Answers and Advice for Parents, by Amy E. Tracy and Dianne I Maroney, R.N.
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When Your Preemie Needs a Tracheostomy

by Richard and Cynthia Bissell

Fifteen-month-old Aaron (a former 26-weeker) doesn't let his trach get in the way of his exploring and learning
Fifteen-month-old Aaron (a former 26-weeker) doesn’t let his trach get in the way of his exploring and learning

We will never forget the day we went into the hospital and found Aaron in respiratory distress. His little eyes were open wide with fear. As he gasped for breath he seemed to plead with us for help. We felt so helpless as we watched him struggle to breathe. We could hear a tiny squeak coming from him with every breath he took. He was immediately intubated.

It was difficult to remain calm as we listened to the rhythmic sounds of the ventilator breathing for Aaron at the same time the neonatologist talked. Aaron had subglottic stenosis (a narrowing of his airway). The doctor recommended a tracheostomy. The implications of this were enormous. We could not believe they were going to cut our baby’s throat. He was so tiny—only four pounds—and so fragile. We felt like we had been punched in the stomach.

Making a decision like this would be difficult under normal circumstances, but we were making it after weeks of little sleep and constant worry. We were forced to depend on the competence and integrity of the medical team. We were putting the life of our tiny precious son in the hands of strangers.

The most difficult part was kissing Aaron good-bye before sending him into the operating room. Part of us wanted to stop the whole thing and just hold him and tell him everything would be all right. Our more rational side handed him to the surgeon and watched tearfully as he was escorted down the hall.

Seeing Aaron for the first time after his surgery brought both relief and trepidation. He looked so much more comfortable: He was not struggling to breathe and he was peaceful. Yet, he had this foreign tube sticking from his throat and many tubes attached to his small body. We wondered, What would be the final outcome? Would he be able to talk? What would our lives be like as we cared for this child? Many of these questions could not be readily answered.

The day before Aaron came home from the hospital, the medical supply company delivered all the equipment we would need to care for him at home. Before we knew it, our living room was full of medical stuff—a suction machine, monitors, oxygen tanks, tubes, and wires. It was all a bit overwhelming.

Once Aaron was home, one of the scariest jobs was our first trach tube change without the backup of the hospital personnel. We were also afraid that his trach tube would become blocked or that a curious child (even Aaron himself) would pull out the tube.

Over time, trach care has become so routine that we often don’t think twice about it. To Aaron, the tracheostomy is just another part of him, like his eyes, ears, nose, and belly button. We try to treat Aaron as a typical kid, but with a few added precautions.

RICHARD AND CYNTHIA, MOTHER OF 26-WEEKER ERIC, TWIN TO ERIC

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Your Premature Baby and Child," Helpful Answers and Advice for Parents, by Amy E. Tracy and Dianne I Maroney, R.N.
Your Premature Baby and Child,” Helpful Answers and Advice for Parents, by Amy E. Tracy and Dianne I Maroney, R.N.
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Families Organizing for Change

grafton

Diane Enochs, Area Director, Central Region DMR, Congressman Jim McGovern, Rich Bissell, Regional coordinator, Families Organizing for Change.
Diane Enochs, Area Director, Central Region DMR, Congressman Jim McGovern, Rich Bissell, Regional coordinator, Families Organizing for Change.

“Congressman McGovern has been a long time advocate of individuals with disabilities and their families, this forum is just another way for him to get out and meet the people he is representing.” This is how Rich Bissell, Regional Coordinator for Families Organizing for Change sums up the recent community forum that McGovern attended in Shrewsbury. After visiting with two Central Mass families in their homes, McGovern met with over 100 individuals with disabilities and their families.

Representatives from the Department of Mental Retardation, Matson Community Services, and the Seven Hills Foundation were also in attendance. McGovern spoke on issues of health care, education and social security before taking a series of questions from those in attendance. The local advocacy group “Central Massachusetts Families Organizing for Change” of which Bissell, a Grafton resident heads, coordinated the event. According to Bissell Families Organizing for Change is “a group of families and self advocates that have come together for mutual family support and advocacy in order to make life better for all individuals with disabilities.” Supported mainly by The Department of Mental Retardation, Families Organizing for Change provides advocacy training for families who care for a person with a disability. “Diane Enochs, (the DMR Area Director for the Central Region), has been tremendously supportive of FOC,” Bissell says, “ Without her support we would face a real uphill battle.” McGovern spoke about how “Government and Community must work together to ensure that individuals with disabilities are given opportunity and a chance to succeed.” He also spoke about “utilizing existing resources in creative and more effective ways.” “DMR seems to be taking a front seat when it comes to reaching out to the community. Supporting organizations such as FOC and Self Advocates Standing Strong (a Statewide group of individuals with disabilities) puts decision making power in the hands of the consumer, where it really belongs.” Stated Cindy Bissell, Mother of twin boys with disabilities and wife of Richard.

Issues raised at the forum included transportation problems for people who cannot drive, lack of resources at the public school, and financial difficulties faced by families who have children with disabilities. “The message that I wanted the Congressman to hear is that Families want choices. Bissell said, we are like all parents, we want to be able to keep our children safe, at home with us, and we want to be able to give them the tools that they will need to succeed in life. My sons need extra support now and they might even require a certain level of support their entire lives. They deserve the same opportunities as every other child. Eric is in a wheelchair and will need that wheelchair for his entire life. But that wheelchair is only a small part of who he is and does not totally define him. If he is given adequate support now, when he is young, there is a good chance that he will need much less support later in life, and more than that, there is a good chance that he will have a lot more opportunities for success.”

Congressman James McGovern
Congressman James McGovern
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