"My son was born with the congenital disorder Sturge-Weber, now we try to give him what the genetics denied him"

This is the story of Carolina and her son Alejandro, who was born with just 25 weeks and a rare anomaly that affects the blood vessels of the brain and causes seizures, glaucoma and other health problems. His own mother explains, in first person, what it is and what are the challenges they have had to face, now that he is turning 5 years old.

Carolina Ledezma
Por:
Carolina Ledezma.
"I have learned to be a doctor without a tittle, to whom the doctors listen to because no-one knows him so well as I do".
"I have learned to be a doctor without a tittle, to whom the doctors listen to because no-one knows him so well as I do".
Imagen Carolina Ledezma

A smile cheers up my days since that summer of 2013 when my life suddenly changed. But what do you do so that smile does not disappear? When you are the mother of a disabled child, everything plays against you to achieve it, but your son always brings you back to Earth with gestures that charge your energy, with a type of love that knows no physical and cognitive limitations.

PUBLICIDAD

I remember reading the chapter of the 25 weeks of pregnancy in "What to expect when you are expecting" a day before my son Alejandro was born unexpectedly. What author Heidi Murkoff described in her book I was able to confirm it when I finally saw my baby in his incubator. His skin was sticky and covered with hair like a peach. His body, fragile and connected to many tubes, almost fit in my husband's hand. His eyes were open but unable to see my tears. And a red mark on the middle of his face indicates a shadow that will become even greater in his future.

Soon after, a severe diagnosis confirmed an inevitable truth. His life was not only at risk for being so premature. Prematurity caused a brain injury that would affect his motor development and a chronic respiratory condition that clung him to a respirator. Also, that port-wine stain on his face, as the doctors told us, was one of the three indisputable signs of the Sturge-Weber syndrome, "a non-familial congenital disorder caused by the mutation of the GNAQ gene" that affects the blood vessels in his brain. It took only some weeks for the other two manifestations related to this congenital anomaly —glaucoma and epilepsy— to appear.

Almost five years later, it is still difficult to understand what went wrong, but the truth is that there has not been a single day of rest in our struggle to give him the opportunities that genetics denied him.

Beyond any label

For me, being a mother has always been like walking on a tightrope. After that unexpected day when I arrived by helicopter at a hospital in Neptune, NJ, I spent four and a half months living in pediatric child care units (NICU) and in homes where friends and family welcomed me without expecting anything in return. Only two months after we finally went back home in New York, our baby started to have seizures.

PUBLICIDAD

Since then, Alejandro and I spent ten months in an intensive care room at NYU Langone Medical Center and at NYU Rusk Institute for Rehabilitation Medicine, trying to be a united family with my husband and my other son despite living apart.

Imagen Carolina Ledezma

Among many complications, my little boy required a hemispherectomy on the left side of his brain to control non-stopping seizures. During the seven or more hours that operation lasted, my heart seemed to stop beating. When the effect of the anesthesia ceased, my child contradicted —as he has done many times in his short life— the medical prognosis: the right side of his body was not paralyzed. But one coma after another kept him connected to a respirator and several sedation medications submerged him in a deep sleep, from which he did not wake up even when we were celebrating a "due-day" birthday party for him at the NICU.

There were days of uncertainty and agony, when for moments I lost my faith and, at the same time, I believed more than ever in miracles. One of those days was when he woke up and smiled as always. The instinct of his neurologist Judith Bluvstein—who diagnosed him with early hypothyroidism, which it is common in many patients with Sturge-Weber— made me realize that medical specialization is just a label. Luckily, she is always looking beyond her specialty.

Three times doctors tried to remove his breathing tube. Only the third one, doctor Arun Chopra did it successfully. Everything was ready for Ale to get a tracheotomy next day, but once again Alejandro imposed his will. His respiratory problems will continue for life, but the successful treatment prescribed by your pulmonologist, doctor Mikhail Kazachkov, has saved us from many trips to the emergency room.

PUBLICIDAD

Twice a day my son receives chest physical therapy with a vibrating vest —which he believes is the most fun thing in the world—. He also withstands forced inhalations and exhalations when using a cough assist machine that helps to expand his lungs; and he inhales Albuterol vapors using a nebulizer to open his airways.

Op-ed: Working together to support healthy habits
Matthew Lin

At the Health and Human Services Office of Minority Health (OMH) we put people and communities at the center of our work. We collaborate with national and local partners to encourage people to take charge of their health by adopting healthy habits and lifestyles. We are especially excited to support Univision’s Healthy Habits campaign, which aims to raise awareness among Latinos to achieve a healthier lifestyle by taking small steps that will have big benefits in their future.

Speak up about your mental health: 60% of the people do not get proper treatment
Reena Pande

The stigma that surrounds depression or anxiety forces many to deal with those issues by themselves without seeking help. But there is nothing to be ashamed, explains the doctor Reena Pande.

There have been countless episodes in which I have had my child's life in my hands, but I have been able to hold it tight without doubt, following every advice given to me by doctors, nurses, respiratory technicians and therapists. These have been our allies who I admire and respect, although sometimes they have failed.

Alejandro's diagnosis includes cerebral palsy. His brain, already affected by the injury with which he was born and the Sturge-Weber syndrome, does not connect with his muscles properly. The high muscle tone makes you believe sometimes that you can break one of his legs trying to change the diaper. Looking at people pass in front of him is a superhuman effort for Ale, due to the severe hypotonia that affects his head and trunk.

Alejandro's small body has endured about 15 surgeries and there will be more in the future.

A doctor with a diploma

These past five years I have learned to be an untitled doctor. My child's doctors listen to me —as they say— "because nobody else knows him so well and knows what to do". Working with their doctors and therapists as a team has been the key to gain their respect, but also to learn how to navigate the complicated health and education system for people with disabilities.

PUBLICIDAD

Almost since he was born, Alejandro has received physical, occupational, language and vision therapies (cortical visual impairment and glaucoma are also some of his disabilities). Thanks to the advice and unconditional support of his pediatrician Amy Demattia —his "Guardian Angel"—, he received therapy and other services paid by the New York Early Intervention Program, until he was 3 years old.

Imagen Carolina Ledezma


After a long hospitalization, Medicaid has covered those medical expenses that my husband's private insurance does not pay. Only the bill for his NICU admission that lasted three and a half months exceeded five million dollars. You really need to have nerves of steel for not to give up trying to make the system work for you.

My son will turn five at the end of July and we will celebrate it on the same beach where he almost decided to be born, shortly after my husband took the only picture of me, pregnant with incipient belly, that I have. Today Ale goes to a school —Roosevelt Children Center— that it is like his second home, where his teacher, therapists, paraprofessional educators and everyone follow his progress that it is limited by his fragile medical condition, but it is unstoppable by his strong soul and incessant joy.

At his school, Alejandro is learning to overcome his limitations to communicate using an Ipad, provided by the NYC Department of Education. His creative teacher designed a switch that his weak arms can move to activate the computer. With that device that my son wears on his wrist like a bracelet, he reads e-books on a giant screen, participates in board games with his friends, says "yes" or "no", selects colors and recognizes faces and objects. These are small steps for almost everybody, but for us they are the key to a future with a certain autonomy.

El que Alejandro pueda conducir este auto de juguete dirigido por un ipad especial representa el primer paso para que en un futuro pueda desplazarse en una silla de ruedas motorizada con independencia, algo que sus condiciones médicas le impiden actualmente.
Video Este auto es mucho más que un simple juguete para este niño con parálisis cerebral

The most recent project of his teacher has been a customized, motorized toy car (a Hot Wheels by Mattel adapted by Access Redefined). Ale is learning to move the car by himself using his motion switch.

PUBLICIDAD

For another child, that car is another toy; for Alejandro, it is not only an instrument to reinforce what he has learned in school to communicate and do what he wants, but also it means that maybe in the future he may be able to use a motorized wheelchair independently.

Legal crusade for a good education

But Alejandro may not be as lucky as he is now that he must enter kindergarten. The Department of Education guarantees him a placement at a public school. However, we have not found where he can received the high quality of education and care he requires.

After having a meeting to define your individualized education plan (IEP), it was determined that you should go to a private school. Now we are waiting ... and about to start a legal crusade for the DOE to guarantee an appropriate education in a restricted environment for him.

The tuition fee in a special school that promises the care and specialized education that he needs is expensive: $135,000 per year. It is not an easy challenge for us to get the financial assistance from the State to pay for it, but we trust that Alejandro' smile once again will prevail.

My husband and I have worked since we were teenagers. We always believed that at this time of our lives, we would be financially solvent and we would have everything covered. After having Alejandro, everything has changed. The numbers do not match despite all the services that the State and our health insurance satisfy. We are frightened to think what would happen if the Government advances in its idea of cutting funds to public health programs.

PUBLICIDAD

To celebrate Alejandro's five years we decided to start a fundraising campaign to fulfill three wishes that would improve our son's quality of life. If you want to donate, click on this link.

To know more

Born too early. More than half a million babies are born prematurely and with birth defects in the United States. Learn how you can improve this reality.

A gene that opens doors. The Kennedy Krieger Institute in Baltimore is the authority on Sturge-Weber syndrome research and its researchers discovered the genetic malformation that causes it. To learn more about this disease, go to this link. Also the Sturge-Weber Foundation is trying to create awareness about the Sturge-Weber syndrome.

Pain for life. 50% of people with cerebral palsy live with pain. Find out more about this illness.

<b>Alejandro was a 25 weeks premie. </b>He only weighed one pound 13 ounces and measured 17 inches. Since the first days, he showed the signs of Sturge-Weber, a vascular syndrome that affects the brain. For four months he lived in the NICUs of Jersey Shore Medical Center, Neptune, NJ, and the Children's Hospital of Philadelphia (CHOP). On July 31st, Ale will turn five years old. We decided to create a 
<a href="https://www.gofundme.com/ale-s5thbirthdaywish  ">fundraising campaign</a> to give him "three birthday gifts" that will allow him to have a better quality of life.
<br>
<b>Five years later.</b> In addition to his diagnosis with a rare vascular syndrome that causes seizures, glaucoma and a Port-wine stain of his face, other complications also affect Alejandro's motor and cognitive development: cerebral palsy, 
<a href="https://www.aaaai.org/">asthma</a> and chronic respiratory problems, hypothyroidism, among others. Despite his problems, Ale is a happy child who loves being with his family and who always smiles in the morning when he goes to school.
<br>
<br> 
<br>
<b>At the school</b>. Ale gets up every morning at 6:00 am or 7:00 am to go to school on a school bus. Nothing is more fun for him than feeling the vibration every time the unit pass a bumpy road. At his preschool, he stays from 9 am until 2:30 pm. Ale has an intense program of physical, occupational and speech therapies. His teacher, Yuseke Namiki, is always innovating with new technologies and developing Alejandro' skills in a very fun way.
<br>
<br> 
<br>
<b>Bike therapy</b>. One
<b> </b>of the activities that Ale enjoys most at school is riding an adaptive bicycle. His nurse Anna Jezz makes him doing it for about 20 minutes or more every day. Thanks to her dedication, Ale is able to move the bike by himself over short distances today. The bicycle is part of the physical therapy program to fortify his legs and improve coordination.
<b>Learning to communicate.</b> Ale uses an Ipad to play and communicate at home and at the school. His language center has been affected by surgery and brain injuries, so he cannot speak. His teacher created a motion switch with which activates his computer by moving his arm. It is still too early for him to be able to use this combination of technologies fully, but every day he improves little by little. With the help of his speech therapist Paulina Smietanka, his occupational therapist Asya Rabinovich and his vision therapists Lauren Schneider, he has learned to touch the screen with his hands to play and activate functions. And every day he "talks and sings" with his grandmother through Facetime.
<br>
<br> 
<br>
<b>Go Ale Go! </b>One of the toys that his teacher and Bob Paradiso, of 
<a href="https://accessredefined.squarespace.com/">Access Redefined</a>, customized for Ale is a Mattel Hot Wheels Wild Thing (
<a href="https://youtu.be/gmfKAPnQ5f8 ">see the video</a>). Using his arm to activate the motion sensor he uses as a bracelet, Ale moves the car slowly by himself. "Alejandro can greatly benefit from the use of a custom adapted motorized car. Not only will it give him that independence to move about in a safe way, but it can hopefully help Alejandro to build upon skills such as motor control, consistent switch activation, faster reaction time, understanding stop and go, and understanding directions such as left versus right," according to physical therapist Diana Kudelko.
<br>
<b>A throne for the king</b>. At home and school, Ale requires using many special equipment such as a Rifton activity chair, a wheelchair, a hygiene system, a stander and a gait trainer, but he does not like to use them for long time. With the help of the team of Adaptive Design Association, a foundation that fabricates equipment with recyclable materials for people with disabilities, three students from the Columbia University Program in Physical Therapy and professor Lisa Yoon designed a chair for Ale to play on the floor. The seat, made of corrugated cardboard, has a back with a certain inclination and a tray so that Ale keeps his head up and uses his hands to play, as well as a leg support so that he does not move forward.
<br>
<b>Standing up.</b> Ale's motor limitations, as a consequence of his cerebral palsy and of a combination of hypertonia and hypotonia that affects his body, make it very difficult for him to stand, walk and sit. One of the key equipment to help strengthen his muscles is the stander. He must stay for at least two hours a day on this device everyday. Alejandro receives physical, occupational and language therapies three times a week at his school, but also at home.
<br>
<b>Home therapy.</b> Each day, Ale works with special itinerant teacher Michelle Then to reinforce skills learned at preschool. Twice a week, he receives one hour of vision therapy, which has helped to broaden his visual field and focus better, even though his vision is very poor and his brain does not process the images clearly. One of the biggest advantages of Ale is that he is always happy and loves his therapists.
<br>
<b>Fun exercises.</b> Physical therapist Lisa Yoon has worked with Ale since he was almost two years old. There is not a day when Ale does not want to work with her. He learns how to sit down, standing up and crawling (something normal for other children, but very difficult for him). Also, every Wednesday he works with speech and feeding therapist Darcy Abrams. Because of his low muscle tone, Ale cannot eat food by mouth. With intensive therapy disguised with music and caresses, he is learning to chew and swallow without risk.
<br>
<b>A swing at home.</b> A swing helps children develop motor skills such as balance and coordination. Having one at home has been one of the best ideas to entertain and train Ale every day, especially winter or rainy days. Ale loves to move very fast and in circles in the swing, as well as to stand still or trying to move his legs while grandma sings. There are not many toys that he can use and they are usually very expensive.
<br>
<b>Fish in the water</b>. In the warm water, Alejandro seems to be free of all limitations. He moves his legs and arms like never before. With the help of a special life jacket or a floating device that keeps his head above water, he is as happy as a fish. Aqua-therapy and swimming improve muscle tone, coordination and endurance. Twice a week, during spring and summer, Alejandro participates in an intensive aquatic therapy program that combines physical and occupational therapy at NYU's Rusk Institute of Rehabilitation Medicine in New York.
<br>
<b>Therapy with horses. </b>Every Sunday, Ale goes to the Forrest Hills Riding Center, of the non-profit Gallop NYC, to receive 30 minutes of hippotherapy or assisted equine therapy. "The rhythmical and 3 dimensional movement of horse to the patient resembles the movement of the pelvis during walking. The walking pattern of the horse imitates the walk of a person and through the repetitive pattern the brain and body develop this pattern," explains the pediatric physical therapist Dianne Garcia. In addition to the immediate response of his body when galloping and the progress on following instructions, Ale has developed a very special bond with Bush, the pony he rides frequently.
<br>
<b>Graduation day.</b> Ale graduated from preschool at the beginning of June. In September, Alejandro will
<a href="https://www.gofundme.com/ale-s5thbirthdaywish"> start classes in a new school</a>. Social workers, neuropsychologists, therapists and special teachers confirmed that he needs highly specialized instruction in a classroom with fewer than six children. There is no public school in New York that offers the right conditions for him and there are not many private schools either. We trust that wherever he goes, people will know that his smile is the indelible sign of his resilience
<br>
1 / 14
Alejandro was a 25 weeks premie. He only weighed one pound 13 ounces and measured 17 inches. Since the first days, he showed the signs of Sturge-Weber, a vascular syndrome that affects the brain. For four months he lived in the NICUs of Jersey Shore Medical Center, Neptune, NJ, and the Children's Hospital of Philadelphia (CHOP). On July 31st, Ale will turn five years old. We decided to create a fundraising campaign to give him "three birthday gifts" that will allow him to have a better quality of life.
Imagen Carolina Ledezma