Well it's been a pretty intense several months! Lots of good and bad things have happened, but they've all been pretty life changing I must say. Here's a visual:

Ran a 10k	Totalled the Neon
Bought an '07 Rav4	Drank too much wine
Sebastian's Eye Exam	Got to see the gummy bear
Turned Brian into a Mermaid (oh and he chopped off his hair for the first time in 10 years)

Sebastian's eye exam went well. The doctor didn't see any problems. They want us to re-check every year but it sounded like kind of a waste of time. The doc admitted that it's hard to see an optic glioma with just an eye exam. Sounds like just checking his vision on a regular basis would show just as much. So far we're not concerned at all. This child sees everything!

It was rough to go from running 6.5 miles to being injured and not being able to exercise for over a month. Then after a few weeks of slowly starting to get back in shape, the morning sickness (all day sickness really) kicked in and I spent the next two months hanging over the toilet or sitting on the couch. I even had to cut back my hours at work to part-time for awhile. Now that the sickness is gone, I'm trying to get back into shape again, but other pregnancy side affects make it slow going. So much for "every pregnancy is different." Liars. It's worth it though, I really am very excited.

Believe it or not, there was good that came out of the accident as well. It really put things in perspective for me. Since getting Sebastian's results, I had that nagging worry I couldn't quite get rid of. But the accident managed to push that completely out of my mind. You know why? Because we could've died! That's right, one second you're just driving down the road, minding the rules of the road, and the next, some stupid dingbat has decided to just turn left across traffic even though there's cars in the freaking intersection. The whole thing happened so fast. It just made me realize how quickly our lives could've ended.

It's just not worth spending your life stressing out. Apparently the accident, and maybe the vicodin and nightly large glasses of wine, relaxed me enough that I finally got pregnant after trying for quite awhile. It still surprised me though. You'd think the stress of all that would've kept it away, but there's no beating evolution- those on drugs and alcohol always get pregnant easier. Well it's true, look around! Idiocracy baby, it's happening every day.

The geneticist sent a follow-up letter about Sebastian's results with a little more information. I think it was intended to be a review of what we'd discussed in his appointment. But a piece of information jumped out at me and caught me off guard. It said that most people with NF1 develop neurofibromas, or tumors on the nerve sheath. I had been holding onto the statistic that only 15% of patients develop tumors so this didn't sound right. Did I totally misunderstand what they said? Was Sebastian going to get tumors? I called the genetic counselor to ask about it.

The geneticist did say a 15% statistic, but what I misunderstood was what tumors she was talking about. It applies to the optic glioma, or tumors on the optic nerve, which is what the eye exam will be looking for. During this phone call I remembered the discussion in the office, we were discussing brain tumors specifically, and she said these are usually the only kind that arise in NF1 patients and they are rare. So while this is good news still, the bad news is that most people with NF1 do indeed develop the neurofibromas. They usually start developing around puberty and can continue their whole adult life. They can end up with only a couple or they can have a bunch, there's no way to tell and no way to prevent them. They do not cause any pain or issues, they are not cancerous, and they do not usually need to be removed. It's just a cosmetic issue.

We sigh with relief when we hear something like "just a cosmetic issue". But when you think about what that means for your teenage years then there is no sigh of relief but instead a knot forms in your stomach. When my child's a teenager he might end up with tumors all over his body? Ok well maybe we can hide most of them with clothes. What about sports and gym class? Kids (and adults) can be mean, there's no argument there. I cringe to think about what could happen to him. What about when he's an adult? Even as adults, most of us are self conscious over minor things, fat, stretch marks, cellulite, freckles, moles, zits, imagined blemishes of nothing. Imagine having something like tumors to add to that list and it's hard to picture having a healthy adult relationship. Let alone, even if he finds a decent human being, he'll have to worry about the fact that there's a 50% change he'll pass it on to his kids.

How can I possibly raise him to have enough self-confidence to not let any of this bother him? I have no idea, but I'm sure going to try my hardest. Step 1 is to not think of the worst, because we truly do not know if it will be bad or not. Step 2 is for Brian and I to have as much self-confidence as possible so that he has good examples to watch, because let's face it, "do as I say, not as I do" never really works, no matter how much we wish it did. And Step 3 is of course to continue reminding myself that it could be a lot worse.

The letter also reminded us that they do not think Brian or I have this disorder, but there is still a 1% chance we could pass it on to our children. They say a batch of eggs or sperm could have the mutation, so even though we don't have it, we could still have more kids with it. Is 1% enough to even worry about? I think not.

If you are behind on the latest Sebastian news, I'd recommend reading my previous blogs about the subject, otherwise I imagine this will be confusing.
The First One
The Second One
The Third One

In my impatience to get the results, I called the geneticists office on Friday to see if they had them. I know how things pile up on people's desk, so I figured there was a chance they had it and just hadn't called us yet. And I was right. As we suspected, considering they said there was a 90% chance he had it based on his symptoms, his test showed a change in the NF1 gene, meaning he does indeed have neurofibromatosis.

The genetic counselor was who I talked with and she was of course very reassuring that everything was going to be fine. She pointed out that, had the test been negative, there were other, more serious disorders on the list that they would've needed to test for. So in reality this was a good thing. As much as I felt a twinge of anger at her optimism in that moment, I knew she was right. Things could be much, much worse.

So what's next? An eye exam to verify there are no tumors on the optic nerve. Seems like he'd probably have vision problems if this were the case, which he definitely does not, this child sees everything! But it's better to be sure since some people do not have symptoms. We decided to stick with OHSU (where the geneticist is) for the ophthalmologist since they are all pediatric specialists and even the receptionist knows what NF1 is, so at least we'll have doctors that know what they're looking for and how to look for it on a 3 year old. They said the appointment can take 2-3 hours, because they have to fully dilate his eyes and that can take up to an hour. I can't imagine how to get him to sit still long enough for them to be staring into his eyes for this, but that's why we're sticking with the specialists! But being the better doctors, they were booked until April so his appointment isn't until April 15th. If everything looks good, then we'll be done with doctors and tests for a whole year. Then it'll just be a yearly check-up with the geneticist and the eye exam, to make sure nothing's changed.

I keep reminding myself of the statistics. Only 15% of people with NF1 get tumors, and only a small percentage of them need operations. So there's an 85% chance he'll go through life without any problems from this disorder. It will just be a note in his medical file and the yearly check-ups. It really could be a lot worse.

Last week we got word that the insurance company approved the genetic testing for Sebastian. Of course I imagine at least some of it will end up going towards our deductible, so we'll probably have to pay. But at least they approved it which means if he needs further tests done relating to this after we've met the deductible, then they should be covered, so this was good news indeed! The geneticists office called right away and let us know it was approved and that we could bring Sebastian in anytime for the test.

Last time Sebastian got his blood drawn he was about a year old and daddy took him to do it since I was afraid I'd be a nervous wreck. It was for a large blood panel where they were testing him for a variety of things (thyroid, allergies, blood count, etc.) so they needed several vials of blood. Unfortunately it was at a regular LabCorp location where they did not have much experience on babies. It took them a couple of tries and poor Brian had to hold Sebastian down while he screamed and cried. I was very sad for him and thankful I wasn't there since I would not have handled that well.

This time, I offered to go with them but knew I would definitely be a nervous wreck after hearing those stories, and I'd hate for my fears to make Sebastian scared. So nice, calm Brian bravely offered to take him by himself again. But apparently I had nothing to fear. OHSU has phlembotomists with lots of experience with children so they have this down. Granted Sebastian is 2 years older than last time and they were drawing quite a bit less blood, but still it sounds like they knew what they were doing. They did the blood draw super fast, Sebastian flinched but didn't cry, and then they gave him 2 new books to take home. (Distraction is often a magic cure for small children.) Sebastian has talked about the experience several times with Brian and I without any sadness or fear. He says it hurt but referred to it this morning as "the doctor scratched my arm". I asked him if he cried and he says "nooo" with a giggle like that's a funny idea. What a tough little man we have on our hands. I'm so proud of him.

Results can take about a month. So now we wait...

Last Friday we took Sebastian to his first appointment with a geneticist at OHSU (Oregon Health & Science University). First I have to say that this place is pretty amazing. My first thought when I heard it was a university was oh great. At UNR if you went to the student health clinic, you had to wait all day to see a doctor who was still in training. They'd awkwardly examine you and then say "yeah I'm not sure what's wrong with you." After looking it up and talking to people in the area, I learned that OHSU is nothing close to that, but is actually a very popular research hospital with many of the areas best doctors. It turned out that our experience matched what we heard. It was a very good appointment and we were dazzled by the geneticist and how much she knew about this particular disorder (without reading off any paper like the neurologist had to). They also had a genetic counselor in the room who's main purpose seemed to be to help translate many of the terms the geneticist said that we did not know. They were both very nice ladies who were of course smitten with Sebastian.

The geneticist confirmed that Sebastian meets the criteria for having Neurofibromatosis. With his symptoms, there's a 90% chance he has it. Thankfully that was the worst of the news. The rest was lots of good news.

1. They agreed we need to do the DNA test to be sure. This test will not only test for NF-1 (Neurofibromatosis Type 1), but also SPRED-1 (also called Legius syndrome) which is a condition that has many of the same symptoms, minus the tumor growth. They are discovering more and more people with this one all the time, so here's hoping!
2. They are good at getting insurance companies to cover this test. They are submitting all of the necessary paperwork and we should hear back in about 2 weeks hopefully.
3. They have phlebotomists (people that draw your blood, a.k.a. vampires ;-)) at OHSU that are very good with children and know how to make the blood draw experience not traumatic.
4. Even if his test does come back positive for NF-1, the geneticist does NOT recommend or require regular MRIs unless he develops other symptoms. This is the opposite of the Neurologist who wanted to order his MRI right away. We were very pleased to hear this. First she will recommend an eye exam, where they will be able to see if he has any tumors on his optic nerve (one of the symptoms of the disorder). If they do see something, then he will need to get an MRI. But at least the eye exam will be a lot less invasive (and less expensive) than an MRI.
5. They agreed he is not showing any symptoms of learning disorders or tumors.
6. Of people with NF-1, only about 15% experience tumor growth, and of those people, only a small percentage actually require surgery. So it sounds very likely that he could go his whole life without ever actually having a problem from this disorder.

The only other piece of bad news was, once they do the DNA test, it takes an entire month to get results back. But still, at least we should know something for sure in the next couple of months. In the meantime, we will stay positive and off of google. :-)