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Bubba’s Factor

Part 2 by Derek Markley

With Abbey happily moved over to a hotel, it was time for us to focus on getting Bubba to sleep. His little-kid incarceration was a concern. The main thing I remember was how incredibly horrible I felt seeing him in a hospital crib with metal bars raised on all sides. This had to be one of the saddest moments of my life. We knew he had to go to sleep, which he would not do quickly. He’d sit up and we’d have to reach through the bars to comfort him. It would’ve been easier to just push the bars down and play with him. Unfortunately, we knew he needed sleep. If we kept getting him out of bed, we’d be up all night.

I was treated to having the lounge to myself. The chair/bed wouldn’t turn out to be the strangest thing, nor the sleeping in the middle of a lounge area. There was a shower in the lounge. You can’t make showering that close to strangers feel normal. Nothing else about our day was normal or comfortable. My son was in a metal cage and my wife was sleeping in a recliner beside him. We were in the middle of St. Louis and our son had blood that didn’t clot. We were going to send our small child into surgery, and he was going to have a metal disk placed in his chest.

The next morning I went down the hall to see Bubba and Ashley. We were about to have a very long day. We’d begin by having Bubba factored up. The people at St. Louis Children’s Hospital were adamant that his factor level would be through the roof to assure no complications during surgery.

Surgery day always means that the patient will be given some type of medication. Bubba was given medication. He went immediately loopy and it was hilarious. I’ve often wondered if they give little kids their meds slightly early so the resulting goofiness is something the family can enjoy. You’re given a break from the handwringing and gut churning that has been gnawing at you.

The unfortunate truth was that he would be heading to a surgical suite and we’d be left outside trying to put forth a normal countenance that masked the fact we were both on the brink of sanity. There was no parenting class called, “How to Not Go Feverishly Insane Because Your One-Year-Old Child is Having Surgery.” My palms are sweating a little bit right now just thinking back to that time. This is one of the uncomfortable truths about raising a child with a serious medical condition. You will have to experience things that are not a part of the lives of most parents. These things will be stressful and unpleasant. These things will make you feel like you want to vomit. These things will be necessary to assure that you can help your child deal with whatever disorder, condition, or ailment has become a part of his or her life.

After roughly 32 hours (my estimation may be skewed), the physicians emerged to tell us that the procedure was complete and Bubba was headed to recovery. Everything had gone as planned and the port was in place. Later that day the nurses would have to access the port to complete his next infusion. Post-surgery infusions were crucial to assuring that the healing process began properly.

There are not many feelings in this world that allow you to decompress as fully and quickly as you do when you’re informed that your child’s surgery went exactly as planned. After what seems like forever, you are allowed to let your weapons-grade stress level return to somewhat normal human proportions.

We were taken back to a general recovery area. Ashley was holding Bubba and gently speaking to him. We just needed his eyes to open. Any small indication of being awake would’ve be great. This should’ve been one of those Disney moments when the little kid opens his eyes, sees his mother, and produces a massive smile. Then a small sparrow would land on Ashley’s shoulder, chirp happily, and a warm sunset would be visible on the western wall of the recovery room.

That was not our outcome.

Next week: Post operation success?

Derek Markley lives in Saltillo, Mississippi with his wife Ashley and their children Abbey and Bubba. He is the executive director of two University of Mississippi regional campuses and an assistant professor in the school of education. Ashley is a fourth grade teacher in the Tupelo Public School District. Derek is author of The Bubba Factor, which can be ordered on Amazon.com.

Bubba Gets a Port

by Derek Markley

Owen, who we call “Bubba”, has hemophilia B. He had two bleeds in two months before his first birthday. Our physician made a recommendation that would change our world.

“Bubba” Markley

Bubba was going to get a port. A small circular piece of metal would be placed in Bubba’s chest. There is a line running from the port that would be inserted in a vein. We’d use the port to infuse him with clotting factor. We’d be able to do the infusions at home after being trained by a home health nurse.

I had so many questions. I furiously Googled terms to get a better idea of what was going on. The port images I found had an external line, a piece of plastic tubing outside the body. It didn’t look like it would be a great option for a little kid.

We were informed that the port would not have an external line. The only time Bubba would be accessed would be when we were infusing. The port is accessed any time a needlestick is done to push medicine into the port. Our physician also told us that we had the ability to use a low-profile port. This meant that the port was thinner than other models and would not stick out as far when implanted.

Even now, more than eight years after the surgery, I still have no way to accurately describe our feelings about what happened. I can describe the day in detail, but I can’t put my feelings into words. We had to be in St. Louis the night before the surgery at the St. Louis Children’s Hospital (SLCH). Bubba’s surgery would be early in the morning. He’d need to be in the hospital so they could give him enough factor to make surgery possible. We’d never spent the night in a hospital with a small child. But the decision was made. The Markleys—my wife Ashley, Bubba, daughter Abbey and I— were surgery bound!

Ashley’s mother had made the long trip from Washington D.C. to take care of Abbey throughout the process. She’d found a hotel room and Abbey would stay with her the night before the surgery. I would be spending the night in the room reserved for family of patients. The room had reddish-orange chairs. What appeared to be an ugly, uncomfortable chair was actually an ugly, uncomfortable bed. With the pull of a lever the front of the chair extended forward as the back simultaneously laid flat. Bam! It’s a bed—in the middle of a room where other strangers might choose to sleep, read, or otherwise hang out.

Ashley was going to sleep in the room with Bubba. The surprise came when we saw Bubba’s bed.

We were introduced to the Baby Hannibal Lecter line of beds. It was immediately noticeable that Bubba’s bed looked more industrial than the standard crib. It didn’t take long for a nurse to step in and show me exactly how this bed differed from most. Ashley and I were shown a demonstration of how the metal bars, which started on the bottom, slid upward and locked in place. It was a Bubba jail.

It looked like Trent Reznor designed it in the early 90s during his industrial phase. The experience was going to turn our kid into a little Goth in training. We’d need to get some black hair dye and a magnetic nose ring. He’d just mope around the house talking about things like the darkness in his stuffed duck’s eyes or the repressed aggression of the Backyardigans being the root of their imaginative adventures.

… and he looked absolutely pitiful when we put him in it the first time.

By pairing incarceration with surgery, I was certain that we’d taken two strong steps toward assuring that Bubba would never forgive us.

We would have a number of meetings that day. The people at SLCH were seasoned veterans and addressed many of our questions before we even had a chance to ask them. By far the most stressful time came when we sat down with the two physicians who would be performing the surgery.

I also had a moment in which I realized that I was not a child anymore. One of the physicians looked suspiciously young. Like most people I’d always visited doctors who were significantly older than me. It hit me like a ton of bricks. I was turning into the person that says, “I’m not letting that kid operate on my child.” I was a mere step from complaining about underage intruders on my lawn.

Once the doctors explained it to us, the process itself did not seem complicated, compared to other surgical procedures. My concerns were still firmly in place. You’re operating on my child who very recently celebrated his first birthday. The child going under the knife also has a small issue with blood not clotting. There is bleeding involved during surgery.

We were soon back in Bubba’s room ready to face the next challenge. How to entertain a toddler while sharing a hospital room with another family and their visitors? The answer is: Get out of the room. SLCH made a wise investment and bought plastic kiddie cars for use on our floor. They had a large handle on the back that extended upward so moms and dads could exert some control over their kid’s driving. It was the Hemophilia 500. Like many hospital floors, the hallways were laid out in a square with the large nurse’s station in the middle.

Bubba in the hospital

We went around.

We went around again.

… and again and again and again.

I began to curse the little red car.

But it kept Bubba happy and that was our goal.

Next week’s blog: Surgery!

Derek Markley lives in Saltillo, Mississippi with his wife Ashley and their children Abbey and Bubba. He is the executive director of two University of Mississippi regional campuses and an assistant professor in the school of education. Ashley is a fourth grade teacher in the Tupelo Public School District. Derek is author of The Bubba Factor, which can be ordered on Amazon.com.

Exploring New Worlds When You Have Hemophilia: John Oliver

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By Richard Atwood

Have you ever thought of traveling overseas?

A benefit of current treatment of hemophilia is the freedom to safely travel. This was not always possible before the use of factor concentrates. Now with just a few precautions, such as carrying a medical ID, a letter from your hematologist, and a travel case of factor concentrate with necessary supplies, along with your passport and a credit card, you can easily travel to many destinations in the world.

Suppose you wanted to travel across the Atlantic Ocean from England to America. Today you could take a five-hour flight from London to Boston. Now compare that to the voyage of John Oliver (1613-1641), the first recognized individual with hemophilia to travel across the ocean almost 400 years ago. Newly married in 1639, Oliver left England to settle in the Colonies.

John Oliver born in Bristol. The eldest child of James Oliver (1586-1629) and Frances Cary (1590-1635), Oliver had two sisters and two brothers who lived to be adults, and possibly three sisters who died as children. It’s unknown whether a family history of hemophilia existed. At 16, Oliver was apprenticed for eight years to his uncle, Walter Stephens of Bristol, a dealer in textile fabrics. Oliver belonged to a multigenerational extended family of seemingly prosperous merchants.

By 1639, Oliver finished his apprenticeship and received his inheritance after both parents died. His 22-year-old brother James died that year, allowing the speculation that he had hemophilia. Oliver received his brother’s inheritance of £50. After marrying Joanna Lowle (later spelled Lowell), Oliver, at age 26, packed their belongings. Then accompanied by his in-laws, the couple probably traveled by wagon to London, where everyone boarded the Jonathan.

The Jonathan was about 100 feet in length with a capacity of 200 to 300 tons. There were two or three small cabins for important passengers plus a hold for 100 passengers (with maybe room for cattle on the deck). There were over 50 individuals who were aboard. A regular fare was £5 (around $4 in today’s market) and a cabin cost £17, plus £8 for one group’s luggage, and even more for food.

Sailing under Master John Whetstone, the Jonathan departed London on April 12, stopped briefly in Southampton, and arrived in Boston Harbor on June 23. A voyage across the ocean at that time was expected to take six weeks. This trip lasted over nine weeks, indicating bad weather or other problems. Some of the passengers died on board from childbirth complications, infant illnesses, and possibly infectious diseases. Sanitary conditions were most likely impossible to maintain, and food supplies were limited.

John Oliver traveled in a party of 17 led by his father-in-law Percival Lowle (1571-1665), an importer and merchant in Bristol. Lowle was accompanied by his wife, his two married sons and their families, his two married daughters and their families, plus business associates and apprentices. This was the beginning of the prominent Lowell pedigree in New England. (The city of Lowell is named after them, and is home to University of Massachusetts Lowell.)

Soon after arriving in Massachusetts Bay Colony, Oliver and his wife settled in Newbury, about 35 miles north of Boston. The couple bought house lots and arable lands, meadows, marsh, orchard, fences, privileges, and commons from Mr. Stephen Bachelor and Christopher Hussey for six score pounds. Oliver was a merchant of imported goods from England, probably working from his home. In 1640, he was admitted as a Freeman and his daughter, Mary, was born. The next year he was chosen to serve on the General Court appointed commissioners for small causes in Newbury.

Oliver must have died in January 1642, probably due to complications of his hemophilia, leaving an estate worth £420 in lands and goods. In 1645, his widow married Captain William Gerrish, another merchant who traveled in the Lowle party. Later in 1656, 16-year-old Mary Oliver, a hemophilia carrier, married Major Samuel Appleton Jr. from that prominent New England pedigree in Ipswich. Their marriage started the extensive Appleton-Swain pedigree of hemophilia A in Massachusetts—the first known family with hemophilia in the Americas.

Today we are often critical of air travel. High cost, lack of leg and elbow room, inadequate bin size, rude passengers, extra charges, security checks, long delays. Consider what John Oliver had to endure during those nine weeks he was aboard a ship to appreciate how we travel today in airplanes! Yet like Oliver, we also have to pay extra for luggage and food, so some complaints about traveling seem to persist forever. But don’t let that hinder your travels abroad!

Bombardier Blood in Utah!

When our team was dividing up who will represent Save One Life at various showings of “Bombardier Blood,” the incredible movie about Chris Bombardier’s Seven Summits Quest, I jumped at going to Utah. Utah is one of my favorite places: drenched in southwest colors of red and yellow, with soaring mesas and fins, and deep, rich canyons, it’s an adventurer’s dream. It seemed to fit the message of the movie, too: go out. See the world. Climb, hike, walk, smell fresh air, dream, do.

After spending a week exploring Antelope Island, Moab and Zion, I headed north on I-15 and reached Salt Lake City. The Utah Hemophilia Foundation’s executive director Scott Muir was there to greet me. And not only greet me, but to give me the gift of his paintings, bound as photos in a hardcover book! All the paintings are of Zion National Park, which he well knows I adore. Scott is a talented photographer and artist.

And apparently, executive director! We had a huge turnout for the event. About 150 or more families arrived to socialize, have dinner, enter raffles and engage with the various pharma and specialty pharmacy vendors. I was so happy to meet up with long time friends, colleagues and Facebook friends (some of whom I have not yet met in person). There were so many children, and while you might think their presence might disrupt a movie, the children were as good as gold.

I gave a few words before the movie started, and let the audience know this amazing stat: out of the 108 billion people who have ever walked this earth, less than 500 have ever accomplished all Seven Summits. I’m not sure you can easily even measure that! The audience was hushed as the movie began, and for 90 minutes, were riveted to the screens.

Laurie Kelley and Scott Muir

After the movie, one 14-year-old asked me a very leading question: how did Chris keep his factor warm on the mountain? “Why don’t you ask him yourself?” I replied. His eyes lit up! Chris must seem like a hero to so many, and thus, out of reach. But he is very approachable. The young teen was thrilled to get Chris’s email address, and I had to ask him: was he interested one day in doing mountain climbs? He nodded his head vigorously and smiled! Come join us, I invited him!

And coincidentally, Save One Life will be hosting a three-day hike to the bottom of the Grand Canyon in 2020!

Bombardier Blood is about making dreams come true, and if you can see it at your local chapter, please do! You may believe anything is possible.

Thanks to Utah Hemophilia Foundation for hosting this movie, and to all who sponsored the event. Special call out to Octapharma, which sponsored Chris’s last two and most expensive climbs, and for daring to take a risk on a young man with a big dream. Sometimes the riskiest adventures yield the greatest joys and successes!

Bombardier Blood was created by Believe Ltd, and is now produced by Alex Borstein. It showcases not only Chris’s climbs but also the disparity of treatment in bleeding disorder between developed and developing countries, being addressed through the work of Save One Life.

A Star is Born

Continued from last week; a profile in leadership. Andrea Trinidad, woman with VWD, who is changing lives for all with bleeding disorders in the Philippines. Reprinted with permission from Jojo Silvestre, the Daily Tribune. https://tribune.net.ph/index.php/2019/04/30/ambassador-for-bleeding-disorders/

Star was born with bruises all over her body. At three weeks old, she had a nosebleed that prompted her parents to take her to the emergency room.

Andrea told the doctors that her family has a history of bleeding on both sides. A nephew from her father’s side just got diagnosed with severe hemophilia.

“‘No, she can’t have hemophilia. She is a girl,’ the doctors told me,” recounts Andrea.
Star grew up having at least one nosebleed episode every week. On bad days, she would nosebleed daily. Finally, in 2006, Andrea brought Star to Hong Kong. It was there that she and Star were finally diagnosed with a bleeding disorder called Von Willebrand Disease (VWD).

More common than hemophilia

Hemophilia, VWD and other inherited bleeding disorders have similar symptoms — bruising, nosebleeds, gum bleeds, excessive periods, to name a few. While hemophilia is the most known bleeding disorder, VWD is actually the most common. According to the WFH, VWD affects roughly 1 to 2 percent of the population.

“That was also when I realized that there are very limited resources here for people with bleeding disorders,” Andrea shares. “Managing bleeding disorders is expensive. But the scarcity of medicines — the factors — is something that truly surprised me. That even if you have the capacity to purchase these medicines, there are times you can’t find enough supply.”

Andrea soon started a blog to share the family’s experiences and in some ways, reach out to people around the world who have the same bleeding disorder. She was surprised by the amount of attention her blog received and the number of people who linked up with her. She then saw an opportunity to learn more about rare bleeding disorders and share with others whatever knowledge she could gather. It opened a whole new world for her.

Founding Hemophilia Advocates

In 2008, Andrea met Laurie Kelley, founder of two humanitarian programs — Save One Life and Project SHARE. Laurie came to the Philippines to do a fact-finding mission to gather data on the situation of persons with hemophilia in the Philippines. She invited Andrea to come along. It was an eye-opener to the very sad situation of Filipinos with bleeding disorders. She vowed to help the community and became a local volunteer for Project SHARE and Save One Life.

In 2011, she was invited to become an ambassador for My Girls Blood, a US-based non profit specifically aimed at raising awareness that women can also be affected with bleeding disorders.

In 2016, Andrea along with four others, founded Hemophilia Advocates-Philippines (HAP). The group’s main goal is to push for government-funded treatment for people affected by bleeding disorders.

“Hemophilia and bleeding disorders are lifelong but manageable. If we have access to treatment, we can lead normal lives,” she says.

But that is not so for most affected Filipinos. Treatment for a simple, non-life-threatening bleed, such as internal bleed in the joints, could cost around P100,000 for a single infusion for an adult.

Through the network Andrea helped to build among donors and beneficiaries, HAP has been able to bridge that gap. International organizations, such as Project SHARE, send medicines to HAP, which in turn, distribute to those who badly need them.

Global ambassador

Andrea’s personal advocacy has brought her to different parts of the globe, at her own expense, to link up with other organizations, so she could learn more about it and also seek help for the less privileged Filipinos who also have the bleeding disorder but don’t have the means to get treatment.

“Being an advocate has helped me more,” Andrea says. “Our journey with von Willebrand Disease is no longer as lonely as it used to be. We now belong to a real community of people who ‘speak the same language.’”

When Facebook introduced the Facebook Group, Andrea started a support group, which then became the HAP, which celebrated its second anniversary recently. Aside from providing factors, the organization also helps empower patients through scholarships and business opportunities.

Legislative advocate

Since she started the blog, Andrea worked nonstop with her advocacy. Today, she is busy lobbying for the passage of Senate Bill 1335 or the “Bleeding Disorders Standard of Care Bill,” which seeks to give free treatment for persons with bleeding disorders such as hemophilia, VWD and other inherited bleeding disorders. The bill also seeks the establishment of Hemophilia Treatment Centers across the country.

She also hopes that through the proposed bill, medicines, especially donated factors from overseas, will reach its recipients the soonest possible time.

Andrea and her daughter still occasionally need blood transfusions but she no longer feels helpless unlike before. She is able to live with the disorder while seeking help for others at the same time.

“If I wanted to, I can just focus all my energy on me and my daughter,” she says. “But I believe that I inherited this disorder for a reason. For as long as I can, and for as long as the hemo community needs me, I will continue with my advocacy of helping them.”

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