Jig-saw puzzles

Jig-saw puzzles: fascinating, absorbing, time-wasting, good for fine motor-skills, they follow a pattern or a picture which can often be seen on the box, but many people, including our own special lot, can solve a puzzle without looking at the picture.  But where to begin?  Pieces may be scattered all over the table, upside down, some in little piles according to their straight edges, colours, the hunt for the corners.  It looks so confusing!  I've watched some of our kids (of all ages) with PWS as they concentrate on the detail, looking intently at the cut of the piece, its colour and shape, and automatically find where it fits.  It's amazing how they do it, and if you watch carefully there is a kind of rhythm - they pick up a piece, examine it, absorb the information it portrays and either put it exactly where it belongs, or put it carefully down to be used at another time.

Recently, I watched a trail of emails that had come into IPWSO starting with Dr Kate Woodcock from Birmingham who had gone to Bejing as a Marie Curie Postdoctoral Research Fellow, wanting to research PWS in China.  We know the difficulty of establishing a PWS Association there (gatherings and groups of people are not encouraged), and we know that the practice of one-child families where children with disabilities are not welcomed.  So the jigsaw pieces are scattered, most are still upside-down, and there don't seem to be all the corner pieces.  Where to start?

One corner piece comes into view - a clinical geneticist, enthusiastic to try to do more to help the families of newborns.  Another corner piece and pieces that fit:  he is also a paediatrician so he gets to meet some of the children with PWS.

A stumbling block:  he doesn't communicate in English, so some more searching among the pieces of the jigsaw and up comes Taiwan, but there are no joining pieces until a piece with IPWSO turns up.  Kate makes the connection and Giorgio provides the next piece - the Taiwan PWS Association.  More pieces reveal names of professional delegates in Taiwan who provide the language connection, and so the jig-saw starts to be solved.  Piece by piece, name by name, country by country.

It's a massive jig-saw, and, thankfully, IPWSO has many of the pieces you might need!

The end of the year is nigh, and many of us will be celebrating our holidays and holy days.  May your time with families and those whom you love, be happy and joyous and may the pieces of your jigsaw always fit!

Diagnosis: Prader-Willi Syndrome

"Diagnosis: Prader-Willi Syndrome"  How many of us have heard those four words and felt the world come crashing down?  It doesn't matter how well-prepared we might be, it still comes as a shock. It's something we don't want to hear; we want our baby to be perfect, of that there is no doubt, and dealing with the hard reality that there is something fundamentally wrong, is quite possibly one of the most difficult things to accept.  I remember it well.

But, imagine what it is like for parents living in a country that is unable to find a diagnosis for their child?  They know there is something wrong, they've been advised by doctors that there is nothing they can do, and they leave the hospital feeling hopelessly lost, vulnerable, scared and alone.  They need our support and the first thing that we can do for them is make sure they have the right diagnosis - as hard as this is going to be, once they are equipped with the knowledge of how to care and manage their child's life, having a diagnosis is the best foundation to start preparing.

IPWSO has always been able to fund the cost of this diagnosis.

 This is how it's done.   IPWSO's head office is in amongst the offices of BIRD which is the Baschirotto Institute for Rare Diseases, in Vicenza, Italy (you can read more about this here.)  The laboratory there does the diagnostic tests for just the cost of the supplies - E150 (about USD150).  Parents of children in countries where diagnosis is difficult to obtain, just need to put a drop of their child's blood onto a piece of blotting paper and send it by mail to BIRD  (instructions are on our website).  It's as simple as that.

After the test is done, we contact the parents and the medics with advice, information and support.  We know how difficult it is for parents hearing the news for the first time, but without a diagnosis, life could be even more difficult and precarious.

Since 2003, IPWSO has been able to fund over 420 tests.  It is one of the principle factors to our work in the world and one that we wish to continue.  We have been through some difficult economic times and we know we are not the only agency feeling the pressure, but we believe what we do in the world makes a difference, so we need to continue to raise our own funds.

Maybe you can help?  Donating €150 (or $190 USD) covers a diagnostic test and possibly saves a life.  Donating $1,000 USD will cover diagnostic costs for six children and help provide training for testing in that country.  Donations can be made by an individual or a group, and can be in honour or memory of a loved one who will be recognized for a year on our web page.

We would be so grateful for your contribution - and so will the family you help.  For details, check here  We hope, that with your help, we can continue to help others understand the uniqueness of PWS that we all face.

Thank you for understanding...and if you can Donate a Diagnosis, there will be one family in this world, better off for your generosity!

An Ambassador for IPWSO!

Daniele ~ The Village Boy Becomes a Man

New parents of a baby with Prader-Willi syndrome (PWS) typically are devastated because they get on the internet and read about children with PWS - low IQ, lack of social skills and behavior problems.  They envision their beautiful baby someday becoming this person who grabs food from others, digs in garbage cans, and cannot be taken out in public.   The people who wrote those articles and did the studies obviously never met 36 year old Daniele, who lives in Italy.  He is the son of our IPWSO Executive Director, Giorgio Fornasier.   



Daniele - paying for dinner!

  To meet Daniele is to be charmed by him.  My latest example was a recent trip to Italy after driving with the Fornasier family to Germany to provide PWS education at the ESPE conference.  Daniele insisted (as he does with all of their international guests) to pay for one nice dinner for all of us. His dad drove him to the bank after his work day ended, but the bank had just closed.  Daniele knocked on the door and told the bank teller that he needed to get some of his money to pay for a special dinner that night.  His dad said he would lend Daniele the money, but Daniele said no, it must be his money.  Daniele asked to speak to the bank President.  The bank President came to the door and after Daniele explained the importance of his request, the President agreed to let him come in and make the withdrawal! 

Over the years, I have observed that in any restaurant in his area in Italy, Daniele is allowed to go back into the kitchen and greet the staff.  He also gets big hugs from restaurant owners, and everyone on the streets of his village knows and greets Daniele.  He always has a smile on his face and a swagger of confidence.  Daniele is the altar boy at mass every week, and also prepares the altar for service.  Daniele also has “adopted” two children in Brazil and pays for their care out of the money he earns.

As far as the male Italian charm, I will never forget the time we were driving and Daniele was sitting between Pam and me, with arms around us and giving us kisses on our cheeks.  His dad told him to cut it out.  After Daniele responded in Italian, I asked Giorgio what he said.  He told his dad, “You are just jealous because you are married and I am not!” 

Compared to anyone with or without PWS, Daniele is exceptional – but so are many of our children and adults who have PWS.  Their charm, their generosity, their capabilities are not what studies are made of – but are the qualities I wish we could share with all of the new parents before they sink into despair.  I wish they could meet Daniele in the hallways of the hospital right after they get the diagnosis.  With a big smile, he would shake their hand, give them a big hug, and tell them they have a beautiful child of God. 

Contributed by Janalee Heinemann, IPWSO Vice-President

PWSA USA Medical Adviser

Your Christmas Shopping is now Complete

I wonder how many of you have a daughter or even maybe a son with PWS who enjoys Christmas shopping so much that unless it is done by mid-August, the world as we know it, will cease to exist?

I don't know what it is - maybe it's genetic? - but it's been like this forever.  Well, ever since the concept of Santa Claus was rudely demolished by the older sisters.  This terrible news seemed to force the issue for youngest daughter (the one with PW) who took it upon her small shoulders to become utterly and completely responsible for the purchase, wrapping, and distribution of Christmas presents.  So anxious did she become that pretty soon the idea of shopping one week before Christmas became unmanageable, and it quickly became one month before, then two, then three, and now if shopping is not complete by mid-August, as I said before, the world as we know it will collapse and crumble.

Nothing has changed, as far as she is concerned, and her own shopping is, as you would expect, now complete.

So, having wrapped that lot up, she advanced on me with her brochure of Avon products, a pen, and a notebook so that I could make some detailed choices.  Nothing, it would seem, would prevent her from accomplishing the result she wanted - to sell me as many Avon products as possible, so that she could benefit from the kickback that being an Avon representative would give her.  Did I mention that she was a self-styled Avon rep?  Earlier this year, she answered an advertisement in the little local paper and signed herself up; along with her ever-patient caregiver who has been delegated a 'silent supervisor' who handles the money and oversees the distribution and collection of brochures.

Next, she advanced on her rather frail grandmother complete with Avon brochure, pen and list of people that Grandma would probably want to give presents to.  Thankfully, daughter was extremely patient and gentle and the feedback I had was that she was very thoughtful and had some excellent ideas.  For which I am eternally grateful!

When she was very little (daughter, that is, not Grandma) she would also take it upon herself on Christmas Day to distribute all the gifts to everyone.  Not just hers, everyone's.  As you might imagine, this also included the exact time when this should be done.  Which meant that to avoid a fully impacted disaster, we had to learn patience and give in to this ritual.  It was not appreciated by Older Sisters.  However, as she grew older and slightly more wiser, she has allowed this ritual to be changed to her distribution of gifts into designated piles which people are allowed to open at their leisure.  Phew!  Disaster avoided.

However, the early Christmas shopping I doubt will ever be changed and as she comes from a family whose best skill is shopping-at-the-last-minute, she will always be the odd one out... unless she manages to convert everyone to the joys of brochure shopping with Avon!

In August, what happened was....

All around the world there are families needing our support.  Emails come in continuously - not always with cries for help, but quite often, so I'm going to outline some of the issues we helped with internationally in August.   For instance...

Qatar: A mother with an 11 year old son from Doha contacted us asking for support in maintaining her son’s dietary needs and physical activities.  While her son had been diagnosed at birth, he was unable to have GHT due to a sleep apnoea problem. This mother was asking for information about any centres run specifically for PWS where her son could get some help.  Our office in Italy sent all the relevant packets of information, both in Arabic and in English, including DVDs.  Of course, even though we are a big family of many countries (98 to date), there is not always immediate help at hand, so it was with some hope that we contacted Germany and asked our professionals there at the Witteskindhof centre  whether they might be able to help.

You may remember reading our blog  which told of a young woman with PWS from Macedonia who came to stay for a few weeks at Witteskindhof centre with her family.  While she was able to integrate socially and make new friends, at the same time both she and her family learned more about PWS and what kind of support is needed around this syndrome.

Not long after our Qatar request, we were rewarded with an answer outlining the conditions for acceptance.  We have passed this onto our contact in Doha and are hopeful that an excellent outcome will be reached.

Philippines: Not long after this, our CE, Giorgio Fornasier, had a visit from our parent delegate in the Philippines who has been a very active member in our large group.  Currently she is working for a Dutch company and travelling to the Netherlands every few months.  She was immediately put in contact with Dr Leopold Curfs there, and so another strong strand of information, support and help has been forged.

China: An enquiry from China – and, wonderfully, we have Chinese translated information that was able to be posted out immediately, and our parent contact in China alerted to this new family.

Mexico:  In Mexico, a very successful weekend workshop on PWS was held with topics covering paediatrics, growth hormone, behaviour and so on.  Our Scientific Consultant, Dr Moris Angulo from the USA, was one of their major speakers.  Mexico is making very good progress, especially with such expert help!

Peru:  It was sad to receive an email from Peru from a mother who had lost her 3 year old daughter who had PWS, and who was scared to become pregnant again, not knowing the risks involved of carrying a second child with PWS.  We have good Spanish-speaking medical contacts who were able to talk to this mother in her own language.

Chile: We welcomed a new Parent Delegate from Chile, Amarlia Barlart, who speaks excellent English as well, and who is eager to help families in her country.

New Zealand: We welcomed a new Caregiver Delegate from New Zealand, Julie-Anne Quinney and look forward to meeting her at the 8^th International PWS Conference next year.

Our Professional Providers Board:  Talking about our professional caregivers, they have e-office hours where you can contact them and talk through any issues or problems, or just talk about PWS with another country – it’s a great resource and we hope to build up quite a talk-fest.  You can find information on our website under the “Carers” tab.  During their last month's office hours, they spoke with caregivers from USA and Spain.  You don't even have to have a problem to talk!  They just love to know you're 'out there'!

Fundraising:  Finally – we are still struggling to revive our grant from Pfizer which allows us to do our daily work.  We know it is difficult to find funding for everyone all around the world, but we hope we will never be in a position to close our doors!  You can help, of course – our “Light a Candle” project is still alive and well, and we received a donation just the other day; our “e-gallery” project where you can buy wonderful and unusual art-work for a small donation, is still waiting for you!

Membership dues: And, if we receive all our membership dues, this will also help us in our work.  Outstanding dues still remain from:

Greece

Poland

Venezuela

Don’t forget, you need to be a fully subscribed member country in order to have a vote at the General Assembly next year where we look forward to another wonderful conference, full of more wonderful people!  (Well, we are, aren't we?)

Men & Grief

While we've been on the topic of grief recently, I was reminded of an article about men and grief that  I once asked for to go into our newsletter many years ago now.  I wanted to know why some fathers grieved differently from mothers and why men grieved differently from women.  Bear in mind this was a while ago, and I'm quite sure that, generationally, things have shifted significantly.  But if they haven't, for you, then maybe this might help.  You will also notice that in this story diagnosis had been late, as it still can be in many countries and there was no help with feeding.  This family really struggled.

"I had been looking forward to the birth of our first child. For months I had been fascinated by her movements insider her mother; at the beginning little flutterings and then as the months passed, stronger, more vigorous movements. It was exactly what one would expect of a strong, healthy baby.

I was present at my daughter's birth, an experience that defied words All stories and all films that had the birth of a child in them made much of the initial birth cry. I was absolutely unprepared for our experience: she arrived without a sound. I have a clear picture of the doctor holding her up, her little mouth shaped like a cry — but there was no sound. I am unable to describe what came over me at that moment — words like shock, disbelief, do not even hint at what I felt.

My overriding reaction was what I can only call resignation; whatever would be would be and I had no power whatever to change any of it. I was devoid of feeling. That stayed with me for moths. The only thing that broke through my lack of emotion in those early days was a kind of subdued elation when our little girl would actually swallow milk from an eye-dropper which was the only way we could feed her. Eventually our efforts weren't enough and she had to be tube fed at hospital.

At work I was an automaton. I have little recall as to whether I was happy or sad, warm or cold; I had no appetite. I used to enjoy a drink. I never tasted the stuff from this time for months afterwards!

As the hospital testing continued to determine what the condition might be, I became aware how differently my partner was responding. She saw all tests as a challenge. I was indifferent to the various tests and as each eliminated this or that possibility she saw all these as major victories. The diagnosis at this stage was benign hypotonia.

I was conscious that I was unsupportive. My partner's hopes were constantly undermined by my scepticism, actively negative and yet, I could not break out of the "what will be, will be" mindset. While my wife wanted to talk about progress and development and testing, I just wanted to be left to myself. I had closed off — little outside myself held any interest. I "escaped" into Wilber Smith.

A friend was a good listener, but I could only share at a superficial level. Talking was not helping as the overriding feature of "all this talk will not change anything" undermined any chance of healing.

The second stage was marked by my waking one day and noticing the sun was shining. I felt warm for the first time in months. This time pin-pointed another stage: anger. Wild mood swings, optimism (that our little girl would be "normal," that she would outgrow this strange condition) followed by depression caused by the uncertainty of what the condition would mean long term. I cried more now — most nights. Sleep was full of curious dreams and I would wake up exhausted. But there was less of "what will be, will be." By now our little girl was drawing me more and more into her life. I felt I was able to share more of my partner's hopes. The future seemed much less fixed.

Eventually our daughter's strange condition was diagnosed as PWS. It took me a long time to accept this. I read all I could about this syndrome — the information coming from my partner's research; a book here, a paper there, an article somewhere else. After a time I noticed a shift in what I was feeling. The crippling resignation had given way to a hope that what was now, did not have to be in the future. My wife was already planning counter measures for our daughter to run against the classic symptoms — extra help for learning, exercises to firm up the little muscles, games to keep her stimulated.

Sometimes it seems a long time ago; more often it feels like yesterday. A kind of emotional evenness came when she was five and a wholeness at seven. The anniversary is still hard, but my partner eases me through it each year.
Yes, we men do cope with grief differently. Education should enable us to cope better."

After the cat had died...

After my daughter had to make a heart-wrenching decision to have her cat of 10 years put to sleep, she showed some interesting behaviours and some that I'd not seen from her before.  It was difficult enough to handle the behaviours before the event (and I am eternally grateful to her residential staff who supported her, at times, courageously, and also very lovingly, through the entire procedure).  Her anxiety levels had risen considerably once she knew the cat was terminally ill.  Predictably (for her), she became angry, tearful, and violent (bashing a hole in a door, while crying uncontrollably).  All of us tried to talk her through the whole affair, saying that she was doing the cat a kindness, was brave in making the right decision, the cat will never recover, and so on.  Of course, all of you reading this will know that this was rather like water off a duck's back, because all that mattered was the actual moment she was in at the time.  There's no reasoning with someone (with PWS) when they are in such an emotional state.

But somehow we needed to keep pushing forward the idea that what she was doing, was the very best thing.  I apprised the vet beforehand, and told him that as far as my daughter was concerned, he was the "cat specialist" and she would trust and believe him.  I had good knowledge that this vet was not only an excellent diagnostician, but also incredibly kind and gentle.  He asked how much my daughter would understand and comprehend (everything) and conducted the whole procedure in a humane, thoughtful, and utterly gentle manner.  My daughter conducted herself with poise and grace throughout the whole time (and I think that her favourite TV channels, TV vets and Animal Rescue, probably played a part here too).

And now we come to afterwards.

She phoned me immediately from her caregiver's phone (she lives some way from me and I was unable to drive, having had a recent hip operation, otherwise I would have been there), and told me what had happened.  Both of us were very tearful.  And then she said she thought she would like an ice-cream.

She was allowed that (and, stupidly, I didn't stipulate what kind.  So she had one that probably had the calorific value of two meals combined).  Later that evening, she asked her caregiver if she could go to McDonalds for a coffee and muffin.  The caregiver said that she wasn't able to do this.  So there was a medium-sized melt-down.  The caregiver left the room until my daughter calmed down a little.  What she did next was to gather up 10 of her tiny incense cones, go outside onto the drive-way, sit down and put them in a ring around her and lit them.  Each cone represented an animal in her (and our) lives that had died.  She spoke to each of them individually, and collectively, telling them stories, reminiscing, and introducing them to each other.  This lasted an hour.  The caregiver, not wanting to interrupt her, could only finally entice her inside with the temptation of a plate of jelly.

The day after (she'd arisen at 2am to play music), she was calm, collected, and spoke easily about her cat and... how she's going to get a new one very soon.  After she's finished grieving...in about a week, or so, she thought...

***

This blog is a bit longer than usual and the general story finishes here, but if you want to read further, I was so interested in this behaviour that I wanted to find out more.  So what I did was to google behaviours in the intellectually disabled group.  There have been lots of papers written, but I didn't find much anecdotal evidence which is always much more interesting to parents.  I also wondered whether, because our sons and daughters with PWS are living longer, and well past their previous life expectancy, this was an area that we may need to look at for future reference.

Professionally, there was a lot of stuff like:" Individuals with intellectual disabilities as such may have limited understanding of causality.   There also may be cognitive reactions.  In the initial phases of grief, people may be in shock – disbelieving or denying, unable to process information.  Throughout the grieving process, individuals may find their concentration or span of attention is impaired.  They may process information less effectively.  It is not unusual for health professionals or others to be asked the same question or to provide certain information repeatedly."  (Of course, we must understand here, that the subject of the grief  in this instance is not just a cat, but someone close to that person.)

This kind of information, to me, seemed pretty  normal for anyone in a state of grief.  This article went on to say that it wouldn't be unusual for "people with intellectual disabilities to experience sleep disorders", or engage in "risky behaviours such as substance abuse.  They may be angry, lashing out, or seem withdrawn."  They may experience "impaired judgement" and theses changes may be profound.

Some other articles described stages of process for dealing with grief, like, preparing the person, instructing caregivers, modelling emotional support etc.  All of which is necessary, and it's good to know that such work has been done on this kind of preparation already.  Wanting to know more, I asked Professor Tony Holland (Professor of Psychiatry, Cambridge University, and President of the UK PWSA) what he knew.  He led me to Professor Sheila Hollins' work. A Professor of Psychiatry and Disability, she has a son with an intellectual disability; Professor Hollins is also a Peer of the British Realm and as such, one would think has some influence.  Professor Hollins has written some excellent books about loss and grief, mainly in pictures, for people with disability which you can see here "Books Beyond Words" 

To his knowledge, Professor Holland did not know of "anything specifically written about grief in people with PWS, but I could imagine that loss could have other implications that lead to high anxiety - eg, it's a change in routine", and he also advised that it is best to try to explore the mental experiences so as to understand what "might have started as grief, has now moved onto something more."

I still wanted to know more so I turned to my e-group of older parents with older kids with PWS  (PWS_Older@yahoogroups.com  if you're interested).  We've had this group since our kids were in their early teens and shared a lot of 'stuff'.  I was wanting to know about responses to grief in anecdotal terms.  And this is what I was told:

"My Dad passed a couple of years ago and a friend was killed in a house fire 7 yrs ago. My son handled all that amazingly well. But let one of his chickens die or be killed by a predator and he goes off the deep end. He screams and hollers for hours…..then he has to bury it in the back yard. We have our own little pet cemetery….."

"My son is very spiritual, as am I.  He attends church and loves being an acolyte, a server and in the choir.  He loves the ritual and pageantry.  We have had many discussions about God, and such.  Sometimes he's so very deep.  He grieved for our pets and his granddad in a strong, but deep way.  He also seeks solace in food, but then again, don't many of us?"

"A friend who was also a home help, had given our daughter a kitten for Christmas.  Some years later, this friend died.  She had an open coffin and viewing before the serviced.  We explained to our daughter as best we could, and gave her a choice to go and view.  The cat had to go as well.  So off we went, four of us, my husband, daughter, me, and the cat.  No one questioned the cat being there, and in a way she was an ice-breaker for everyone.  They loved seeing the cat there, and how much she had grown since kitten-hood. "  My daughter looked at our friend in her coffin, talked to her, and then we said a prayer.

She has coped with death in the family really well,  and the death of animals as well, since we live on a farm.  But pet dogs, or cats, or lambs - she just has to replace them straight away and is constantly looking for one til it is replaced."

"Yes, my daughter felt grief, but handled the reality very, very quickly.  She was very strong in that area.  She could face life 'square on' but felt very deeply for her animals.  Replacing them seemed to be the answer for her as she then enjoyed them young again and it took her mind into a new experience.  It could be that she was able to cut off after a certain point in her grief pattern."

"I knew of someone who was 'engaged' for a long time to a lady (with PWS).  They hoped to marry.  They lived in close proximity, possibly in the same house, I don't know.  However, she died.  I asked the provider how it had affected him and how he was doing.  She said that it didn't affect him at all and that he was just living as if nothing had happened.

"Another lady died recently, she'd lived with three other ladies for at least 12 years.  She died on a Friday.  The other ladies were concerned about whether the group would be going garage-saleing the next day as previously planned.

"With my daughter, there's no emotion, but only questions about the person's/animal's whereabouts... for years!"

"When his paternal grandmother passed away a few years ago he handled it really quite well. His main upset was that Dad no longer had a mother or father. A few months later when it was Mothers' Day he didn't want to see me at all - he just wanted to take Dad out for lunch because he didn't have his mother."

While we're on the subject of death - how about the after-life?  My daughter had an experience in her new home whereby some chimes began tinkling for no reason, and a small pot of handcream leapt off her table across the room.  To cut a long story short, the caregivers had a priest come in to bless the house, but my daughter asked that the priest allow her friend (who had died a few years ago, and who my daughter thought it was) to continue to visit.  And, apparently he does - the chimes ring, and my daughter holds a conversation with her friend.  In answer to this, one of my e-friends said this:

"My son has frequently been visited by family members who have passed. He mentioned my Mom a few times and his other Grandmother from his Dad's side. But mainly it's a young cousin of ours, she has visited many times and my son would tell me about what she was doing, what they talk about and about heaven. Sometimes I hear him laughing in his room and later when I ask what was funny he'll tell me that he was talking to his young cousin. Recently a mom on facebook who just lost a child (non pws) mentioned that her child with PWS is the only one in the family who is visited by the one who passed. I believe our kids know and see things we are unable to."

This is only a small sample from six mothers, and you can see that grief in PWS may run the whole gamut of expression, just as it does in the normal world, but perhaps there is a link to understanding grief that our guys have that can help us understand them even better.  I just wanted to write about this in case there were other parents wondering the same thing.  I'd be happy to hear any comments.  Quite possibly, it's the behaviour before the event that is more challenging than afterwards, but we need to be aware of both sides of the coin.

Linda


References: http://www.ddhospicepalliativecare.org/forum/ciwid.pdf
http://bma.org.uk/about-the-bma/who-we-are/biography-sheila-hollins

Mum, I've baked you a cake!

I recently had an operation that has required some time recuperating.  My daughter's response was to bake me a cake.  She lives some hours away from us in a house which is fully staffed 1:1. She's the only one in "her" house and she absolutely loves her new life.   Many people think she is very lucky, but luck had nothing at all to do with it.  Sadly she was not able to curb her behaviours to allow harmonious living with others and she had to go through some very tough times because of it.


So...the cake was duly delivered and later that night as I lay in bed thinking, it occurred to me how much she has grown and developed over the past couple of years.  She's now 28 and her move into this new home has been a revelation - to her, and to us.  For the first time in quite a while, she is happy.  She is losing weight, has a couple of small part-time jobs (supported) and the new care-provider agency seems to 'get' what PW is all about.  Why else, I asked myself, would they have let her bake a cake?


Whenever she wanted to bake when she lived at home, I would inwardly cringe.  My thought was that if I 'gave her an inch, she would take a mile' and I didn't have the energy to cope with that, so baking was something she longed to do while I longed for any excuse for it not to happen.  I knew I was denying her the one thing in the world she wanted to really do - cook! 


Once, for a 'significant' birthday she saved up her money to buy me a cake which she had got decorated in bold letters "Happy Birthday Mum" in lurid blue icing.  She didn't ask for a piece of that cake, and neither did she ask for a piece of her latest cake.  Her great joy was in choosing what she wanted to bake, cooking it, and giving it away, although on any given day of the week otherwise, she is one of the most opportunistic "acquirers" of food I have ever known.  And the most ingenious.  But when she's cooking from the heart (an expression bandied around on every cooking show these days) she has this spirit of generosity and nurturing that you seldom see elsewhere.  Except, I think, in PWS.


So many of our guys with PW have this wonderful spirit of generosity.  It's odd, when you think that the chief characteristic of PWS is always said to be this unrelenting desire to eat - yet, sharing food is something they genuinely love to do.  Francie has done it since she was very little.  It's one of the most disarming traits of the syndrome.


And yes, this latest cake was very nice with a layer of yummy dates at the bottom.  She made it from a packet, but included the dates as she thought I might like it better.  And, I did.

New weight-loss drug: Qsymia

The latest weight-loss drug to be approved by the FDA is called Qsymia (pronounced kew-sum-EE-ah).  It has been prescribed for overweight people, so naturally the world of PWS will take an interest in this. To keep you updated with this from a PW perspective, our Vice-President, Janalee Heinemann, has written this review (below).  You can also find information here: http://www.bu.edu/today/2012/will-qsymia-make-you-thin.  It should be noted that if people are planning to try a drug, it's most useful to do so as part of a controlled trial.

Weight Loss Drug Approved by FDA

By:  Janalee Heinemann, MSW

PWSA (USA) Director of Research & Medical Affairs

IPWSO Vice-President

As many of you are probably aware, there is a new weight loss drug, Qsymia, just approved by the FDA.  The weight loss was more with this drug than with two others recently reviewed by the FDA and one approved (Lorcaserin/Belviq) that was not nearly as remarkable regarding weight loss.  Qsymia is a combination of two older drugs that have long been known to help with weight loss:  phentermine (the safer half of the old fen-phen drug that was banned) and topirimate – a drug that was studied back in April 2000 under a PWSA (USA) grant, “Open-Label Pilot Study of Topirimate in Adults with Prader-Willi Syndrome.” Topirimate is an anticonvulsant drug that makes people feel more satiated after eating, which is why we sponsored the study by Nathan A. Shapira, M.D., Ph.D.  The study showed that Topirimate did not significantly change the calories consumed, Body Mass Index, or decreased self-reported appetite in PWS. In addition, there were no significant changes in compulsions. Surprisingly though, Topirimate treatment resulted in a clinically significant improvement in the self-injury (i.e., skin-picking) that is characteristic of PWS.
The researchers of Qsymia state that it targets multiple brain signals that drive people to overeat.  We cannot say at this time if it will be effective with PWS.  Please know that we will keep you informed of any new outcomes on this and other obesity drugs that might be helpful with PWS.  Currently, I have been working informally with two pharmaceutical companies who are working on potential products that might impact on PWS, but as with all pharmaceutical companies, there are always strict agreements of confidentiality.  We are also working with FPWR on financially supporting the Best Idea Grants post the hyperphagia conference with 2012 One Small Step funds.  We never forget that the #1 deadly enemy of PWS is the appetite.

For those outside "Prader-Willi Land"

After posting last week about our new project, FamCare, I read a post in one of the PWS listservs which I want to share with you.  It describes a parent's feeling of utter joy in finding a place for their adult son.  I know - we all do - that not everyone has this opportunity, and this is why IPWSO has developed its FamCare support; to help families along this rocky road, hopefully to a productive and happy ending.


"After four very difficult years, with many, many ups and downs, our son is finally part of a community where he is just like everyone else, and where the staff "gets" the strengths and needs of folks with PWS.   He has joined some great young gentlemen  and he is over the moon with joy. The young men have graciously welcomed him, and are helping him settle in. Finally, I am feeling the relief that my son will be able to live a healthy, happy and productive life. I feel like we won the lottery!


I wanted to share this with you all, as you are the only folks who will truly understand our joy after so much struggle. No one understands the day to day life of living with PWS like us families. While we love our children and they bring us great joy, they present so many unusual issues and cause incredible stress, that those outside of "Prader-Willi Land" will never understand. For the first time in a long time, I am at peace and can rest."

IPWSO's new FamCare (Family Care) project

IPWSO is exited to tell you about a new venture it is undertaking.  Called "FamCare", it is designed to find ways of supporting families around the world who are caring for their adult child with PWS at home.  We know that there are many of you doing this and looking for answers to questions, or just for someone else to say, "we know what you're going through".

Georgina Loughnan, from Sydney, Australia, who is an IPWSO Board member, is heading up this new project.  She has worked over the past 21 years as a clinician with adults and adolescents with PWS.  She has seen families continually work hard to provide and access the best care possible for their adult children with PWS, and recognises the difficulty that this can pose.  She says:

"As children develop into adolescents and adults, families continue to struggle to find the most appropriate setting for them.  It is these areas that need to be addressed as soon as possible for the adult child with PWS, to ensure that every environment they spent time in is as appropriate to the needs of someone with PWS as possible.

"Finding a school that will step up to the challenges demanded by someone with PWS is a difficult task.  The school years can be most rewarding and above all, secure for a child with PWS if the service providers fully understand the syndrome and the specific needs it brings.  On leaving school, the adult child with PWS faces a whole new lifestyle, one that inevitably offers many opportunities for great independence and high hopes.  However, people with PWS can never survive well with independence, especially in travel or situations that provide even the hint of access to food.

"All environments into which adults with PWS venture need to be appropriately managed to prevent the development of overweight and difficult behaviour.  Where an adult child with PWS remains living at home with the family, it will always be up to the family members and any other people supporting the adult with PWS to make provisions for the best possible environment."

FamCare's aim is to support families who need help, inspiration, new ideas, and just plain common-sense answers to the every-day problems that arise in caring for and managing the situations that arise when living with an adult with PWS at home. 

Watch this space... there will be more!

Reflecting on unfairness...

After writing last week about the importance of forward-planning for our sons or daughters with PWS -  something that will stand them in good stead as they enter their older years - I was rudely reminded how fragile this whole thing can be.  A newspaper article written about Spain's financial difficulties included the story of two families, each with a young boy with PWS whose lives were being well-managed thanks to the availability of Growth Hormone Treatment.  However, because of the fiscal difficulties in their country, access to this treatment had been completely restricted and no longer available to them.  It is a reminder how carefully built networks can so easily be blown away in a puff of wind.

It is so disheartening to read things like this knowing what a struggle it has been - and still is - around the world to convince medical authorities of the importance that Growth Hormone plays in the well-being of those with PWS.  I know what a struggle it was in my country, New Zealand, to convince the powers-that-be to make GHT available to children with PWS, and we had to fight for our rights up to the highest parliamentary level.    It is not only disheartening for parents, but also for the medical professionals who have researched and proven the benefits of this treatment for their patients, only to have it snatched away.

Some might say, at least the boys had the treatment for a few years and this should stand them in good stead, but experience has proved that when GH is stopped, there is a reversal in the muscle tone and, for some, in other areas of development, and this can be quite a major turnaround.  For these Spanish boys, there is a huge injustice in this decision.  There is, in fact, a huge injustice in most countries where GH is not freely available, and where medical treatment, support, and even understanding of the syndrome is not to be found.

IPWSO is planning to develop a series of forums on its website, for the medical professionals, one for the caregivers, and one for parents.  The parents forum - which will have a translation button - is a place where all parents can meet and share experiences.  Most of all, this can be a place where parents can ask questions  which can be directed to professionals who may be able to shed light on a problem.  Sometimes there are no answers, but other parents may have had similar experiences that they can share which may help.

It is important to know we are not alone in the world.