Saturday, August 20, 2011

MPS II Brothers From Mersing

Even before I joined in Malaysia Lysosomal Diseases Association (MLDA), I had a thought of writing down the story of different patients I met in the hospital. A lot of them were sad stories and some may need help physically or financially. But I didn't have the confident that I could write a beautiful story then. Still now my English command was still the same yet I realized if I could share with you what I saw, then you had a chance to learn about Lysosomal Storage Diseases (LSD) diseases and how it affect the patients and patients' families. To me, it's like having a budget free awareness program...:)

Khairul Nazmi Azizi (called Nazmi later) and Khairul Muiz Muhaimi (called Muiz later) were borned to be normal and healthy as any other kids. This storyline mainly covered Nazmi as Muiz is still very young at 2 year old, so we were yet to see more changes on him. They were borned into a family of 4 children (3 boys and 1 girl) with Nazmi being the eldest and Muiz being the youngest. Although only their father was working, everything looked fine and their mom Puan Sunarti had no problem handling the little resources.

Nazmi was borned in 1999, he was a chubby and happy baby, no one would ever suspect such a healthy baby would be down with MPS II one day. The disease started to progress very slowly, the changes were all very subtle initially. What Puan Sunarti noticed at the earlier stage around 2 year old that Nazmi has a different palm than the other kids. Both palms were very meaty and rounded. Other than that, everything seemed the same. The other thing she noticed was Nazmi's Mongolian marks at his back took a much longer time to disappear, it was until he was 5 to 6 year old that it finally went off. So, Puan Sunarti started asking different doctors about the rounded palms that Nazmi had. All the answers she got were quite standard that was Nazmi was chubby, thus it showed on the palms too. A logical answer.

Life went on until Nazmi was 6 year old in the year of 2005. That time, they were still staying in one of the small island outside of Mersing. Nazmi had a terrible flu during that year and happened to see a visiting doctor from Mersing Hospital. After the inspection, the doctor told Puan Sunarti that he suspected something wrong with Nazmi's heart as the beating was different from a normal child. Immediately Nazmi was referred to Mersing Hospital for futher check up. From Mersing, he was referred to Johor Baru Hospital in a short while. But the diagnosis did not come out immediatly after the first visit, it was until few rounds of visit that JB's cardiologist finally confirmed that Nazmi had cardiac failure and needed an urgent surgery, that was sometime in Aug 2006. He was referred to Institute Jantung Negara (IJN) right away. This time round too, Nazmi whole body started swelling and skin were peeling off all over. Besides, his height growth started to get stunted and his face became bigger with the forehead bone protuding out little by little. And his nose bone becoming flater and there were numerous bone growth around the skull bone. So, the skull became uneven if you touched the back of his head.
Nazmi less than 1 year old just started walking,
his palms were still normal then.
After heart surgery at 8 year old, noticed his curved palms or known as claw hands

It was until Feb 2007 that he had the slot for the surgery. After the surgery, Puan Sunarti met up with one posting doctor from JB in IJN during one of the post surgery check up. This time, finally a doctor had answered Puan Sunarti query about the funny looking of Nazmi's palms. According to the doctor, Nazmi might have underlying genetic/metabolic problem causing his heart to show some sign of failure again. He was finally refered to a geneticist some time in Feb 2008. In Sep 2008, 7 months later Nazmi was diagnosed with MPS II. Everything about Nazmi little little physical changes were answered as MPS II is a kind of disease that affect the developement of the bones. They typically had stunted growth and stiff joints.

But when the younger brother Muiz growing up more and more like Nazmi, Puan Sunarti sensed something was wrong. When the doctor found out about Muiz condition, he was asked to go to Hospital Kuala Lumpur (HKL) for further investigation. Before the doctor came back with the test result, Puan Sunarti knew Muiz had the same fate as her brother cause bones started swelling up on the skull and his hands started to becoming more and more curvy. True enough in May 2010, Muiz too was diagnosed with MPS II...A big blow to the Mersing family.

Luckily, after waiting for almost 3 years for treatment. Nazmi started his treatment life in Feb 2011. The family was overwhelmed but at the same time, they were hoping Muiz treatment can start at the same time too. But due to budget limitation, the money was only good for 1 MPS II patient. They had no choice but to wait for more allocations into ERT treatment fund. This is the sad part of the story that allocations were never enough, the less fortunate one would have to wait. Waiting and getting anxious seemed to be the only thing can be done at this moment. Getting anxious is inevitable as this disease may have brain involvement as it gets worse. As soon as brain is involved, all treatment will be stopped regardless how good the body may be responding to the drugs. So, imagine if you are the parents of a child of MPS II, what sort of life that you might be going through?

My hope to share with you the story is that more will be awared of these less fortunate one and supported us in the fight for the equal treatment right of every citizen in Malaysia regarless of the medical cost.



Story and Photos Shared by Puan Sunarti
Story compiled and written by KF on 20 Aug 11
Video by KF and Lee


 
Note on MPS II
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MPS II is a X-linked recessive whereby only male or boy get affected and female or girl will be the carrier. Therefore, X-linked recessive diseases are typically more common than the normal autosomal recessive. The problem with MPS II was the body can not break down mucopolysaccharidosis or known as glycosaminoglycans (GAG). In Hunter syndrome, GAG builds up in cells throughout the body due to a deficiency or absence of the enzyme iduronate-2-sulfatase (I2S). This buildup interferes with the way certain cells and organs in the body function and leads to a number of serious symptoms. As the buildup of GAG continues throughout the cells of the body, signs of Hunter syndrome become more visible. Physical manifestations for some people with Hunter syndrome include distinct facial features and large head. In some cases of Hunter syndrome, central nervous system involvement leads to developmental delays and nervous system problems. Not all people with Hunter syndrome are affected by the disease in exactly the same way, and the rate of symptom progression varies widely. However, Hunter syndrome is always severe, progressive, and life-limiting.

Info taken from Wikipedia