Let me start back to where it all started for us, as our Evan was impacted at birth. Before I do though, let me begin with who Evan is. Evan is not stroke. Not seizures, even though his life has been impacted greatly by them. Evan is a vibrant and wonderfully opinionated little toddler, who has taught his mum mum and daddy so much.
He has taught us already, to give your best and not let anything in life hold you back. Evan is a lover of people, being so affectionate with his family and with animals. Evan loves the outdoors
and will try anything, even when it is incredibly difficult for him. He loves music, art, as well as “playing hockey” with his papa.
The majority of pediatric strokes actually occur in the perinatal period. To many people’s surprise, the most focused period of risk for ischemic stroke in your lifetime is the week you are born, and for our Evan, as in most perinatal strokes, a cause cannot be found for sure.
For the most part, besides nasty morning sickness, my pregnancy was healthy and doctors were seeing no issues with Evan growing even in ultrasounds and other testing before he was born. My water broke at 36 weeks and 5 days. He was ultimately born later at 36-6, once day later. This meant that he came one day pre-mature.
So much of Evan’s birth was a blur, in that I was pushing with Evan, and that I knew at some point, the doctor said that Evan was losing oxygen, which ultimately we found out that he also had a knotted umbilical cord that may or may not have impacted this loss of oxygen in the blood. After multiple attempts at traditional birth and Evan already being in the birth canal, the doctors ultimately rushed us into emergency C-section.
I cannot even recount how scary this time for us was. Both my husband and I had no idea what was happening, if our baby was going to be okay or even why oxygen was dropping. We were trying to make sure my mom in wait-room knew what was happening, and trying to get my father back from a mission trip from Cuba (which he did make it back). Hearing Evan’s heart beat on the monitors in the C section room and my personal faith was what kept me going in that room. I will never forget how Evan’s warm cheek felt on my cheek after he was out, as I was shivering from the shock of the traumatic birth. My baby warmed me on my cheek and then he was taken for observation.
My husband and I did not get to hold our Evan until the following day after his birth, as Evan was taken to the NICU at Evergreen health for monitoring right away after c-section. A doctor in the c-section room from the NICU had been monitoring (their protocol for C-sections) and wanted to continue to watch Evan. For this, we will be forever grateful for this doctor’s attentiveness and we let him know after Evan was ultimately out of the NICU.
I begged to go up to the NICU the next day (both me healing from vaginal and C-section) by wheelchair. Holding Evan for the first time, he had seizures, neither my husband and I even knowing it. It was awful. The kind of seizures that Evan has presented with to this point, are where his body does not visually move around, rather, getting his attention is not possible after many attempts of different kinds. Lots of professionals quickly flooded his NICU room. After they stabilized him, they rushed Evan down to get his first set of MRI of his brain. We waited for an hour or two to get the results and then my husband and I had to ask if our son was going to live (as we were not told clearly the impact that this would have on Evan’s life). We were told that he was being transported to the NICU at Swedish First Hill Seattle, where we were told that Evergreen had a contract with for neurology. They even had us hug and love on our child before letting him go with a special team by ambulance. We knew what this meant. Some babies didn’t even make it to the next hospital. We prayed and prayed. We had more people in our faith community pray.
31 days our newborn child was in the NICU, due to strokes at birth, manifest as seizures. Seizures are a common symptom of perinatal stroke. They usually start 12 to 48 hours after birth and repeat. Our doctors say that we will never know for sure, but the strokes happened sometime in the 48 hrs before his birth. Some babies have no clear symptoms for weeks or months after their stroke. Often parents, caregivers and doctors do not notice any signs of perinatal stroke until age 4 to 6 months, when the baby starts to seem weaker or partly paralyzed on one side of the body (hemiplegia or hemiparesis).
For us the positive was knowing what was in front of us once they told us what was happening, but it was still terrifying and left so many questions.
It is an understatement to say that we valued every hold and connection with our boy, traveling daily back and forth from Monroe to Seattle. We prayed with him, sang to him, held him, read to him. We were told by teams of neurologists (regular doctors were clearly scared to tell us too much that might be inaccurate) who would make their way through our area of the hospital, that children surviving stroke, about 60% will have permanent neurological deficits, most commonly hemiparesis or hemiplegia. Hemiplegia/hemiparesis (total or partial paralysis on one side of the body) is the most common form of cerebral palsy in children born at term, and stroke is its leading cause. We know now that Evan has right-sided hemiplegia, paralysis of his right side, his right side being weaker than his left.
We will never forget the first time a neurologist showed us the MRI images of “damage” to Evan’s left hemisphere of the brain. Evan also had around a handful. Of EEG’s, brain electrodes tracking his brain activity, to monitor the frequency and severity of seizure activity in his developing brain. This was also after having him be put on a heavy dose of anti-seizure meds to stabilize him. The neurologist could only estimate potential issues that Evan could have as he got older. Only guesses. Can you imagine the fear and anxiety as a new parent? Every parent wants their child to be successful and have every chance possible to make a great different in this world of ours.
We knew that long-term disabilities caused by a stroke in childhood could include cognitive and sensory impairments, epilepsy, speech or communication disorder, visual disturbances, poor attention, behavioral problems, and poor quality of life. We were told, do everything that you can early-early intervention.
I knew this-early intervention-as I am a Social Worker by trade. Having your own kiddo impacted by something like this, is a whole other story. I knew very little about strokes, seizures, and quite frankly, the variety of disabilities, before our family was impacted.
When Evan got home, we got him involved in both private and community-based birth-3 services. He started PT first at 4 months of age, then adding additional therapies.
This was all during the time that we were beginning to wean him off the anti-seizure medication, which while it stabilized his brain function, it also made our baby very lethargic and impacted feeding. We needed to see if he could be without the meds and not have seizures. What a scary season. Amazingly, he did not have any seizure activity that we knew of until a couple of months ago. Neurologist is currently monitoring for any others, but so far so good. If he continued to have them, we would be looking at medication.
Today, what we know the brain damage has impacted: to this point: He has a diagnosis of Hemiplegic Cerebral Palsy (weakness of the right side with balance and mobility), visual (thankfully not hearing), possible sensory issues, speech issues, poor attention. We know as Evan grows, additional areas could come up and at any point seizures could come back or not.
He currently sees therapists weekly for physical therapy, occupational therapy, and speech therapy, working both with private and the birth-3 community-based agency in our area.
Evan’s brain injury impacts him in a real tangible way, in that for him to be able to walk, he requires the use of an AFO, ankle foot orthotic to keep from falling/losing balance.
Evan has participated in constraint therapy an intensive series of lessons over a 2-3 weeks period, wearing casting on the dominant hand/arm, to motivated the child to use the affected size. Research continues to show that this dorm of therapy can increase awareness and quality of movement required for two-handed activities. Evan will continue to participate in this type of therapy throughout his therapy life with time in between and as recommended.
Though Evan will likely always be left-handed, he is using the right side of his more. This will help prepare him better for school in writing, playing, doing activities that other kiddos enjoy.
We cannot say enough about the heroes who work with our Evan and us weekly, as we practice these exercises daily, to give Evan the best possible outcomes. Anything that Evan wants to try, we let him. Nothing will hold him back. At one point, providers were not sure that Evan would be able to crawl even, getting up on his hands (which ultimately can help kids use tendons in his hand to be able to write later), but Evan proved otherwise. Evan is a fighter. He shows us all how to fight!