Torsten's official diagnosis - Pallister Killian Syndrome

We were all in Illinois last week to say a final goodbye and to bury our granddad George. I think that by the time the call came in, we were already running low on tears. On Thursday morning, February 19, 2015, the geneticist called us herself while she was on a break from jury duty. Once you've worked with a number of doctors, you know that receiving a call from them directly is ordinarily not good news. 

Torsten's skin biopsy came back positive for Pallister Killian Syndrome. Although this condition is extremely rare, we were expecting these results and were not terribly surprised. We were scheduled to meet with genetics today to work out the next steps and get all of our questions answered, but unfortunately, the Dallas ice storm has closed down most of the city and our appointment was cancelled. We'll be meeting with her asap, but as Ryan and I discussed last night, PKS is so rare, that it's not likely that she'll be able to tell us much that we don't already know.

To help everyone understand a little about this syndrome, I've listed a few questions and answers below. If you have any other questions, please send them over. If we don't know the answer, then they are probably great questions for us to take to our next appointment.

Q: What is Pallister Killian Syndrome (PKS)? 

A: Also known as Tetrasomy 12p mosaicism, PKS is an extremely rare genetic disorder. Pallister-Killian Syndrome occurs due to the presence of the anomalous extra isochromosome 12p, the short arm of the twelfth chromosome 12p. The name Tetrasomy 12p means four copies of the short arm of chromosome 12 and the name Isochromosome 12p tells you that the additional chromosome (12p) is made up of two mirror copies of itself. Mosaic tells you that cells with the extra chromosome exist side by side with cells with a different number of arrangement of chromosomes. We're still researching and trying to learn all of this ourselves. Hopefully we'll be able to share more detailed information soon.

Q: What causes PKS? 

A: No idea. According to the geneticist, this condition is completely random. There is nothing we have done to cause it and there is nothing anyone can do to prevent it. 

Q: Will we have Dane tested for PKS? If we have other children, are they at risk for having PKS?
A: No, we will not have Dane tested for PKS. Dane does not have any symptoms of PKS. He is exactly where he should be for size and development. We have no worries about Dane. Regarding other children, it is extremely unlikely that we would have another child with this condition. We recently read that our chances of having a second PKS child are less than 1/400,000,000. Since this condition is random, we have the same chance as anyone else of having a PKS child.

Q: How many people have PKS? 

A: The total number is unclear, since undiagnosed cases exist. It is thought that there are less than 200 diagnosed cases in the world. However, one US hospital estimates that there could be significantly more than this number in the US alone. 

Q: What are the features of PKS?

A: It is very unlikely that all of the following features would be present. Some features can include: hypotonia in babies (floppiness), developmental delay, learning difficulties, delay or absence of speech, distinctive facial appearance (high round forehead, broad nasal bridge, widely spaced eyes, large mouth with thin upper lip), sparse hair growth around forehead, thin or sparse eyebrows, streaks or patches of darker or lighter skin, high arched or cleft palate, short arms and legs (not proportionate to body), diaphragmatic hernia (hole in muscular wall separating the heart and lungs from contents of abdomen), seizures, permanent hearing loss, heart defects, extra nipples, feeding difficulties and reflux, large big toes and extra fingers, epicanthal folds (skin folds across the inner corner of the eye) and a large tongue that develops after babyhood.

Q: Are there things that Torsten will definitely not be able to do?

A: We are not ruling out anything. We are just now getting back into speech, physical and occupational therapy. We have every reason to believe that Torsten will walk independently (and very soon), will speak and will have as much of a normal life as possible. As soon as we meet with his doctors, we'll begin looking at schools and programs that fit his needs. 

As we have been with every other issue that we've dealt with before, we are grateful that Torsten is ours. We will continue to work with him constantly and make sure that he remains the most happy, easy going and kind child we've ever met. It's an honor to be his mama, and Ryan and I will continue to make sure that we get the best care available for him. Thank you to all of our friends and family for your continued support through this recent diagnosis. 

Love, 

Ryan, Tasha and the boys

Torsten on his balancing bike - Feb. 2015

For more information on PKS, see the following sites:

http://www.pkskids.net/

http://www.rarechromo.org/information/Chromosome%2012/Pallister-Killian%20syndrome%20FTNP.pdf

Torsten, no label

Tuesday, January 27, 2015

I've spent every day of 2015 worrying about my son (and now sons), even more than usual. We've "started over" after taking a break from therapy, doctors, specialists and appointments overall. We're starting over with therapy and are getting fresh evaluations at Baylor over the next few weeks. We started over with a new geneticist and the genetics team at Children's in Dallas. And we started over with the tests. Although I feel somewhat guilty about it, I got to put on the blinders over the past 6 months, let my son be a kid and pretend that everything is fine. It's been a half year of sweet oblivion and I'm already missing it.

We made our first trip to the genetics department at Children's in the first few days of the new year. We spent several hours with counselors and doctors, all of them asking every question imaginable and going over every inch of our son with a fine toothed comb. At the end of the appointment, they came in with a few pages of information and told us they believed our son may have Sotos Syndrome. Of course we'd never heard of it and knew nothing about it. She gave us a few details, then told us that there is a blood test to confirm, but that it's terribly expensive and it was unsure if our insurance would cover it. One look between us and we knew we would be having that test regardless of the cost. We asked that they continue working with insurance, but we wanted the test, and now. An hour later, we were in the lab with our sweet boy, where we'd start over with needles and tests and pain. It's easy to forget how tough your kid is in all the ways you wished you didn't know. He watched the needle go in his arm, gave a little moan and looked at me for help, then just watched her draw blood without another sound. He's our little warrior.

After researching it on our own, we really felt that Sotos wasn't a fit for Torsten. There were so many things that just didn't fit - off the charts large head, extremely tall and high on weight charts, high birth weight and specific facial anomalies to name a few. His head has always been big, but never off the charts. And he's always been low on the charts for height and weight. He was an average sized baby at birth and the facial anomalies that identify SS kids weren't present with Torsten. However, I didn't want to be the parent in "denial", so I kept an open mind while waiting for the test results.

They said the results would take 4-6 weeks, but we got them in 2.5. They were negative. I called our parents, did a little happy dance and we celebrated with a bottle of wine. The counselor who called gave me the name of what they now believed Torsten had, so I made a note of it, told her I'd look into it that night and that I'd call her the next day if we decided we wanted to move forward with the next round of testing. For a few hours, we enjoyed the great news and celebrated that we got a negative test result.

Once we finished dinner and got the kids to bed, we began researching the next possibility, Pallister-Killian Syndrome (PKS). I sat on the couch with my computer while Ryan sat in the chair next to me on his. Barely a word was said for several hours while we both soaked up as much information about this chromosomal abnormality. Not long into our research, it was becoming apparent to us both that this diagnosis fit our son. It really fit our son. Several hours, plenty of tears and tissues later, we called it a night and decided that we would move forward with the next round of testing immediately.

Unfortunately, the test for PKS is not a simple blood test. A skin biopsy will be performed by the doctor herself this Thursday at Children's. They have to cut a small bit out of the back of his arm, send it off for tests and hopefully have results in 2 weeks. Until then, and hopefully after the results as well, our son is just Torsten. There are no other names or labels that apply at the moment and I've decided to enjoy that for as long as I can. The best news we could receive would be that he is just behind. He's had multiple surgeries and has always had a hard time catching up. Even if it's just me being in denial, there's a chance that I'll only able to deny it for a little while longer. Until further notice, I'd prefer to keep the blinders on and pretend that everything is fine. I hope the next time I'm writing, it's to say that everything IS fine and that Torsten is starting therapy and preschool soon. Until then, I won't quit hoping.