Mitochondrial disease appointment update 2018

Kerissa • Jul 26, 2018

Hey friends,

I’m sorry it’s taken me so long to write an update on how my neurometabolic appointment in San Diego went!

Been trying to pull all my thoughts together on what we learned at the appointment.

After updating my mito dr. on all that’s happened since I last saw him, he is thinking more and more that the POLG gene variant that was found in my whole exome sequencing is the likely culprit that’s causing my mitochondrial DNA depletion.

According to the NIH genetic reference site, POLG “is a DNA polymerase, which is a type of enzyme that “reads” sequences of DNA and uses them as templates to produce new DNA.”  It is also the “ only DNA polymerase that is active in mitochondria and that can replicate (make new) mtDNA.”

Again, he said I’m very special and that he’s never had a patient with mtDNA depletion syndrome AND Wilson’s Disease.🙁 So he wants me enrolled in the North American Mitochondrial Disease Consortium…currently, there are about 1200+ patients enrolled.  It’s hard to explain what NAMDC is, so you can read all about it here:  https://www.rarediseasesnetwork.org/cms/namdc/About-Us

Please read the link!  It’s very helpful to understand.🙂

POLG-related mitochondrial diseases can cause numerous issues, including problems like cardiomyopathy.  So he said I need to have an EKG every year and an echocardiogram every 2 years.  I also need to stay away from certain medications that can induce POLG-related liver failure.

There is a drug trial that is in phase 3 and going well, but this medication (called Elamipretide) is mainly for mitochondrial myopathy, so he said that wouldn’t be the best fit for me since I have more issues than just muscle weakness.  He did say the company that created Elamipretide is starting to work on many other promising drugs.

One of the main things we learned from this appointment is that things take TIME.  It takes time for companies to make new drugs….time for drug trials to “pass” through all the phases and get FDA-approved….time for research to discover new mitochondrial pathogenic (disease-causing) mutations and whether variants of uncertain significance (VUS) that are found through whole exome sequencing are pathogenic or not….and much more..🙁

My POLG gene variant is a VUS, and in order for it to be “confirmed” as pathogenic, there are 2 ways that can happen.  If you put this specific variant in animal models (like mice) and they develop the same symptoms as the patient, then that variant gets labeled as “pathogenic.”  But….this route takes a ton of money to do.🙁

The other way to confirm a VUS as pathogenic is to put a patients’ genetic data/reported phenotype in a database like NAMDC or MSeqDR (Mitochondrial Disease Sequence Data Resource Consortium), and if several patients with the same variant have similar symptoms, then that variant gets confirmed as pathogenic.

So it’s enouraging to hear all that’s being done in the mitochondrial disease world, but it’s also hard knowing that everything takes SO long to happen/do.🙁

I asked him what my future will look like medically, and he said no one can really say (since every patient with mito presents differently)….he said mito is very serious, but he also told me that I’m coping really well.  Of note, he did say my brainstem is not functioning well….  The “sleep center” is in the brainstem which is why my complex sleep apnea is so bad.

Regarding my myoclonus, the medication I’m on for that isn’t helping the best, so he told me about another medication I could try that doesn’t worsen apnea.  I have to see my neurologist here to talk about it.

I wasn’t able to make it to this year’s United Mitochondrial Disease Foundation (UMDF) national symposium because it was in Nashville.  My mito dr. said he was looking for me there.🙂 Next year’s is again going to be on the East coast, but my dr. told me that the UMDF symposium in 2020 will probably be in San Diego!🙂 Looking forward to that!  It’s so encouraging to see how dedicated/invested my dr. is in all things mito-related.  He really cares for his patients!

In other news, I saw my physical medicine dr. recently, and he wants to make sure my osteopenia (soft bones) doesn’t progress.  It’s not good to have at my age, so he referred me to OHSU’s endocrinology/bone metabolism clinic.  Another dr. to add to my long list of specialists..🙁 The clinic is booked out, so my appointment isn’t until September.

My hip surgery is scheduled for August 10th.  Less than 2 1/2 weeks away!  The surgery scheduler is working on setting up my pre-op appointments as well.

I saw my GI dr. today, and he wants me to try another medication for my GI dysmotility.  It’s been bad lately.🙁 Will be starting at a low dose first.  Because my vitamin D level was low despite taking 5000 IU daily, I now have to take 50,000 IU (prescription strength) since low vitamin D is bad for osteopenia.  In addition, my GI dr. wants me to start taking a vitamin A beta carotene supplement (25,000 IU) because my carotene blood level was very low as well.  He’s also going to get in touch with my general surgeon to have my j-tube changed during my hip surgery.

I hope this update about my San Diego appointment was easy to understand.  Mito is so complex which makes everything hard to explain.. :/  If you ever have any questions, feel free to comment or send me a message!🙂

By Kerissa Lee 16 Apr, 2024
Read Part 1 if you missed it.  | Part 2 | Just 2 days after I was discharged from the hospital, I started experiencing severe nystagmus (shaking eyeballs) along with nausea, vomiting, and retching. I didn’t know what was happening and was again so scared. 😔 I was told to go to the ED since I wasn’t tolerating any of my oral medications. The doctors gave me IV fluids and lots of different IV anti-nausea and pain meds. They told me I needed to be admitted and talked with the neurology and internal medicine departments to see which one should admit me. But….to my dismay, both teams made a bad judgment call when they decided not to have me admitted (my mom has since talked with a patient advocate for guidance on what to do if “this” happens again). Even the ED observation unit didn’t want to take me because I was “too complex.” 🥺 I was sent home still vomiting and in so much distress (with mitochondrial disease, anything like untreated vomiting/diarrhea is a big “no-no” to put it simply because it’s a huge stress on the metabolic system). My body was really struggling, and I experienced very drooping eyelids and worsening weakness all over. The next day, I was seen by my PCP’s colleague, and after much discussion, he directly admitted me to the internal medicine floor. I’ll always be grateful to him for his quick action and the very thorough letter he wrote. There were sadly no beds available, so I waited at home. But, the following day, God was so kind to bless me with a private room that became available. Once I was inpatient, the doctors tried to get a handle on the nystagmus and vomiting. All the usual IV anti-nausea meds didn’t resolve things, so they gave me an “off-label” medication that can sometimes help nausea. That did the trick, but another issue soon arose—I started showing signs of mental confusion. I remember not being able to explain what was on my mind, and if I did talk, it didn’t make sense! For example, 2 nurses were in my room helping each other, and I made a comment about them being married. 🫠 Another instance, my family later shared that I asked them if they could see the ocean out the window. I can’t recall a lot of my time in the hospital because I was so confused.. My mom wondered if the confusion was from the off-label nausea medicine, so the team immediately discontinued it. By God’s grace, that did the trick…. Hospital life was definitely a roller coaster. You know that whack-a-mole arcade game? Once one problem ended, another popped up. After not receiving proper nutrition for many days, I started trying to eat orally again and resumed j-tube feeds, but for some reason, I wasn’t able to tolerate either like before. My stomach became so huge and distended….even with the feeding pump setting of just one teaspoon per hour. It didn’t make sense, especially since I tolerated a high rate of tube feeds two weeks earlier when I was admitted for the neurological weakness. I kept trying to increase the tube feed rate, but my GI tract didn’t tolerate it. The doctors brought up the possibility of TPN (IV nutrition). I was very discouraged and so homesick. With no progress increasing the formula rate, I did in fact have to be placed on TPN. Emotionally, it was a struggle dealing with this new problem on top of the mitochondrial crash.. 😢 Up next: Part 3…
By Kerissa Lee 13 Apr, 2024
Dear friends, It’s been almost 3 months since I last blogged.. So much happened, and it’s very hard to believe how quickly things changed. I know many already know the whole story. But for those who haven’t heard it, I will try to recap here. It’s quite the tale, but I wanted to share it on my blog to look back on because God truly carried me through the unimaginable. ❤️ When I requested urgent prayer for the sudden onset numbness and weakness in my whole left leg back in January, I had a routine follow-up already scheduled with my primary care dr. on January 25th. I was so thankful I could see him right away for this new issue. I showed him my worsening weakness, and he sent me straight to the ED to make sure I didn’t have a condition called Guillian-Barre Syndrome (GBS). While waiting for a bed to open up on the neurology floor, the muscle weakness spread to my right foot and up my right leg to the point that I could barely lift both legs up. Words can’t express how truly scared I felt that I was going paralyzed. 🥺💔 It was the hardest time of my life, and I continually wept, not just because of the physical pain (which was the worst leg pain I’ve ever experienced) but also because of the emotional distress.. The “foot drop” in both feet was so severe that my soles were almost parallel to the hospital bed when laying down. It was devastating. Due to the weakness, I couldn’t even walk to the bathroom and had to use a bed pan. The team was concerned about possible heart/lung issues, so I had to be placed on a continuous cardiac telemetry monitor (which is different than the standard one). Twice, they asked me if I’d be okay with life-saving measures like getting intubated (placed on a ventilator) if the weakness kept spreading like it was.. I underwent countless neurological exams by nurses, medical students, residents, and attending neurologists. To rule out GBS, a spinal tap had to be done as well as extensive brain and spinal MRIs (cervical, thoracic, lumbar, and sacral). Not feeling well, it was incredibly difficult to lay in the very narrow MRI tube for more than 2 1/2 hours without a break. When GBS was ruled out, we still didn’t know what was causing the weakness. To be honest, in a way, I WANTED to have GBS because they explained GBS has a good treatment. So, not knowing the outcome and prognosis was very hard. 😢 Looking back, I remember how I shared a verse from Isaiah when I wrote my “2023 reflections” blog post at the beginning of this year: “Let him who walks in darkness and has no light trust in the name of the Lord and rely on his God” (Isaiah 50:10). When I posted that on January 1st, I never could have imagined how dark life would get. I knew God had a plan, but I was still so terrified. And there was nothing I could do but trust him (even though my faith felt so weak while in the thick of it). I cried so much and struggled with great fear. But in the midst of that dark time, I thought of a well-known passage from 2 Corinthians: “So we do not lose heart. Though our outer self is wasting away, our inner self is being renewed day by day. For this light momentary affliction is preparing for us an eternal weight of glory beyond all comparison…” (2 Corinthians 4:16-17). A phrase stood out to me: “light momentary affliction.” This trial weighed heavily on my shoulders….it definitely didn’t feel “light” OR “momentary.” I had so many questions. Could I surrender all and trust that God has my best interests at heart? I prayed that he would grant me the eyes to see everything from an eternal perspective and use this hard time for his glory and good purposes. After spending 9 days on the neuro floor, I was sent home.. The neuro team attributed this whole event to a “very unusual mitochondrial crash.” And only time would tell how I would recover. Up next: Part 2…
By Kerissa Lee 23 Jan, 2024
Hi, friends, I had a whole other post ready to go with some good news, but instead, I have an urgent prayer request. I started experiencing sudden onset numbness, tingling, and weakness in my whole left leg, and it’s been so scary. 🥺 It just came on out of the blue. I was doing so well with physical therapy each week (able to walk fast on the treadmill and leg press 40 lbs), and now, I have to limp because my left leg is soo weak. I really want to avoid the ED as much as possible, so I saw one of my doctors today. She’s concerned I’m having a big motor nerve issue. 😭 The plan is to see a physical medicine specialist, have a nerve conduction study, get an urgent MRI done, as well as see my PCP and pain doctor on the 25th and 29th for further evaluation/testing. I know I already said this, but it really has been so scary to lose function so quickly. Can you pray that I will trust the Lord and not worry? It’s been very hard, so I’d really appreciate your prayers and support in the coming weeks. Thank you so much. ❤️
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