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PARENTS’ OF RECENTLY DIAGNOSED ATAXIANS GUIDE


Greetings!

You have found this document probably because you are a parent or in a extended-parenting role (if you are a newly diagnosed ataxian go to http://www.internaf.org/ataxia.html), your ataxian has been recently diagnosed, and you are furiously searching for information while trying to keep your emotions under control. Many parents have been where you are and every one of them sympathizes with you right now for having to go through this.

 The information you seek is strewn across the web, nuggets of rich knowledge hidden often times in tremendous trivia, mis-information and requirements that you be a “good” web searcher. This guide is intended to give you a large kick-start in your search for information. We who have already searched offer this to you as a better starting point in your search.

 When I presented this material at the 2003 NAF Conference in Atlanta I used Emily Perl Kingsley’s “Welcome to Holland” story (http://www.nas.com/downsyn/holland.html) as an introduction, and I offer it now to you because keeping life in perspective is vitally important for us as parents; our children look to us moment to moment for balance and that perspective. The story will grow on you as you work through this initial transition as the parent of a newly diagnosed ataxian.

 My last thought to you is that this document is not free, and it is not finished. Many hours went into its creation and it now waits for you to add to it. As you use this guide to search and you find new information, or you see gaps in this guide’s coverage, you now have the responsibility to help the next new parent have a better starting point in their search. Email me, Paul Konanz at pkonanz@prodigy.net with your large or small nuggets of rich knowledge.

 Sincerely,
Paul Konanz
3/27/03


 

Table of Contents


FIRST YOU

HEALTH                                                                                                                                                                                 Personal Mental Health

Marital Health

Physical Health

Take care of yourself as Caregiver

 

GAINING KNOWLEDGE                                                                                                                                                                                                                                                                                        

Great websites

Great magazines

Prognosis, progression and symptoms

Medical Research

Supplements

Schooling

Modifying your home

 

PLANNING AHEAD                                                                                                                                                                                                                                                                                                             

Giving information to your ataxian, family and friends

Your ataxian’s social life

First time experiences

As walking becomes more difficult for your ataxian

Help give them independence

 

FINANCIAL/BENEFITS SUPPORT                                                                                                                                                                                                 

Federal

State

County

Local

 

What can I do?                                                                                                                                                                                                                                                                                                                       

Get a computer and get online.

Fund raise for your cure!

Help others

Advocate for your child

 

 

THEN YOUR ATAXIAN

Health                                                                                                                                                                                                                                                                                                                                     

Emotional Health

            Physical Health

 

“Normal”                                                         

                                                                                                                                                                                                                                                                                                                                

Medical after 18                                              

                                                                                                                                                                                              

Ataxia communication                                                                                                                                                                                                                          

Handling strangers

Confusion with drunk or drugs

 

Addenda

 

I          Coping with Loss (excerpt) - 5 Stages of Grieving                                                                                              

II          Working Through the Stages of Grief                                                   

III        Sure Steps to Caregiver Burnout                                                                      

IV        FA Specific Areas                                                                                                                                                                                                                                                                                         

V         Other “Recently Diagnosed” Guides                                                                 

VI        A Message for Newly Diagnosed Patients and their Families  
  


    

         FIRST YOU  

v     HEALTH - You are the MOST important person! Why? Because if you are not there for your child, they lose.

Ø      Personal Emotional Health

¨      The grieving process

·        Understand the grieving process (Addendum I)

·        “Anticipatory Grief” – See Addendum II

·         “Coping With the Loss Caused by Chronic Illness” http://www.option-counseling.com/copingwithchronic.htm

¨      Professional Counseling

·        You and the family; in individual and/or group settings

¨      Informal Counseling

·        Pastor/priest

·        Support groups (FAPG, NAF, INTERNAF, Start your own)

·        From FARA, “A message for newly diagnosed patients and their families”: See Addendum VI

·        Email/Chat groups (FAPG, NAF, INTERNAF)

·        Family/Friends

¨      Read some books or articles on “loss”

·         A bookstore or library has many

·        . http://www.option-counseling.com/articles.htm

·        www.fortnet.org/fapg/booksfor.htm                                                                 

·        http://www.fortnet.org/fapg/parents.htm

¨      Guilt – Get rid of it! Don’t waste your energy.

 

Ø      Marital Health – Now is the time to Love One Another!

¨      Re-read Men are from Mars, Women are from Venus. Re-remember men and women deal with stress differently

¨      Pay more attention to each other. Talk! Pull closer, not away.

¨      Be nice to one another; both are hurting

¨      Respite for parents: http://www.licckids.org/respite2.html

¨      See “Caregiver” below

 

Ø      Physical Health – If you get sick or hurt because you didn’t take care of yourself the child loses!

¨      Eat properly, sleep and exercise

¨      Learn how to correctly help move someone

¨      See “Caregiver” below

Ø      Take care of yourself as Caregiver – Avoid burnout

¨      Remember “Sure Steps to Caregiver Burnout”, Addendum III. Several good FAPG references: http://www.fortnet.org/fapg/parents.htm

¨      Very good reference: http://www.lougehrigsdisease.net/als_caregiver.htm

¨      Links: click on “Caregiver” http://www.lougehrigsdisease.net/als_useful_als_links.htm

¨      http://www.caregiving.com/

¨      Web search “Caregiver burnout” http://search.yahoo.com/search?p=caregiver+burnout

¨       Web search “Caregiver training” http://search.yahoo.com/search?p=caregiver+training

¨      State/county/local caregiver training

 

v     GAINING KNOWLEDGE Ignorance is not bliss!

Ø      Great websites

¨      FAPG (FA Parents Group): http://www.fortnet.org/fapg/ (Join their Email support group)

¨      NAF (National Ataxia Foundation): http://www.ataxia.org/; including the Generations’ archive. (Join their E-NAF Chat room)

¨      FARA (FA Research Alliance):  http://www.faresearchalliance.org

¨      MDA (Muscular Dystrophy Assoc.): http://www.mdausa.org/; including the Quest’ archive.

¨      INTERNAF (International Network of Ataxia Friends): http://internaf.org/ (Join their Email support group)

¨      ILC’s (Independent Living Centers) http://www.ilusa.com/links/ilcenters.htm. Call and talk to these people!

¨      Ask your NAF support groups for websites. http://www.ataxia.org/groupmap.html

¨      NAF bulletin board: http://www.ataxia.org/cgi-bin/ubb/ultimatebb.cgi

 

Ø      Great magazines

¨      MDA’s Quest: http://www.mdausa.org/publications/Quest/

¨      NAF’s Generations: http://www.ataxia.org/generations/

Ø      Prognosis, progression and symptoms (For FA see Addendum IV)

¨      Get to the right doctor, one that has treated ataxia

·        Ask NAF or the NAF support group in your area

·        Ask on FAPG Email

·        Go to a MDA clinic

¨      Network! Ask questions.

¨      Get on the web (be careful of old, outdated information in the last four below)

·        For FA:

¨      FARA: http://www.ninds.nih.gov/health_and_medical/pubs/friedreich_ataxia.htm

¨      FAPG: http://www.fortnet.org/fapg/faq.htm

·        http://internaf.org/ataxia.html

·        National Organization of Rare Disorders (NORD)

·        http://medworld.stanford.edu/medbot/

·        http://www.ncbi.nlm.nih.gov/PubMed/

·        University of WA - www.geneclinics.org

 

Ø      Medical Research

¨      For FA, see FARA, MDA, FAPG, and Addendum IV

¨      For other ataxias, INTERNAF: http://internaf.org/ataxia.html

¨      NAF support groups, http://www.ataxia.org/groupmap.html

 

Ø      Supplements

¨      For FA see Addendum IV, http://www.fortnet.org/fapg/vitamins.htm, and discuss on FAPG Emails.

¨      For other ataxias, INTERNAF: http://internaf.org/ataxia.html

¨      NAF support groups, http://www.ataxia.org/groupmap.html

Ø      Schooling – IDEA/IEP’s, ADA, Advocacy, Cooperation

¨      IDEA (Individuals with Disabilities Education Act): http://www.ed.gov/offices/OSERS/Policy/IDEA/

¨      IDEA: web search, 500,000 hits: http://search.yahoo.com/bin/search?p=
Individuals%20with%20Disabilities%20Education%20Act

¨      IEP (Individualized Education Program): web search, 31,000 hits; http://search.yahoo.com/search?p=%22Individualized+Education+Program%22

¨      FARA: http://www.faresearchalliance.org/education/newly_diagnosed.asp#school

¨      FAPG: http://www.fortnet.org/fapg/school.htm and http://www.fortnet.org/fapg/students.htm

¨      MDA: http://www.mdausa.org/ , click Search, put in “school”, 10 pages of articles!

¨      IEP advocate:

·        http://www.altonweb.com/cs/downsyndrome/index.htm?page=spainadvocate.html

·        http://www.nfb.org/fr/fr1/fr98cv07.htm

·        http://www.parrotpublishing.com/Inclusion_Chapter_1.htm

·        College: http://www.fortnet.org/fapg/college_helps.htm

 

Ø      Modifying your home

¨      ADA Accessibility Guidelines for Buildings and Facilities (ADAAG): http://architecture.about.com/gi/dynamic/offsite.htm?site=http%3A%2F%2F
www.access-board.gov%2Fadaag%2Fhtml%2Fadaag.htm

¨      Kitchen plans: http://www.pva.org/NEWPVASITE/publications/pdf/AcsKitch.pdf

¨      66-page paperback published by the Paralyzed Veterans of America called:  The Accessible Home Design - Architectural Solutions for the Wheelchair Users; Thomas D. Davies, Jr., AIA; Kim A. Beasley, AIA; Copyright 1999; ISBN 0-929819-10-1

¨      Web search, 1M hits, http://search.yahoo.com/bin/search?p=Accessible%20home%20plans

¨      http://www.fortnet.org/fapg/daily.htm

v     PLANNING AHEAD – Don’t back into the future!

Ø      Giving information to your ataxian, family and friends

¨      http://www.faresearchalliance.org

 

Ø      Your ataxian’s social life

¨      Involve them in as many groups as possible to maximize the chance for making stick-around friends. Choose groups that have active adult supervision, and talk with the adult about inclusion.

¨      Church, scouts, YMCA parent-child programs, school groups, make your house the place to be, special interest groups, etc

 

Ø      First time experiences

¨      Until the Treatment arrives your child’s ataxia will progress. Identify every physical experience you think they deserve to have and then set about to make sure they do it, as soon as reasonable. If they can do it at least once they’ll never have to say they couldn’t do it!

 

Ø      As walking becomes more difficult for your ataxian

¨      Become knowledgeable of the pro/con’s of canes, walkers, 

¨      Improve accessibility

·        Horizontal handrails in your home’s hallways?

·        Remove loose throw rugs

·        Bathroom grab bars

·        Insure the school is accessible and safe; access/seating in rooms. See Schooling above

 

Ø      Help give them independence

¨      Commensurate with their age and behavior, as you do with your non-ataxic children

¨      Take the same reasonable risks with them that you would with your non-ataxic children

¨      If they need your help ask for permission, give them more control over their environment. “May I”, instead of “Let me” or “I’ll do it”

¨      Train them to be always mentally independent and self advocators

¨      Advocate for them

v     FINANCIAL/BENEFITS SUPPORT You must go find it! And advocate for it!

Ø      Federal

¨      SSI

·        www.ssa.org

·        http://www.fortnet.org/fapg/ssi.htm

·        Social Security: http://www.lougehrigsdisease.net/als_legal_financial.htm

 

Ø      State

¨      National listing of state resources. Wow! What a website! http://www.disabilityresources.org/DRMreg.html

¨      California GHPP (Genetically Handicapped Persons’ Program): http://www.dhs.cahwnet.gov/pcfh/cms/ghpp/

¨      Board of Rehabilitation

¨      ILC’s (independent living centers) for information and consultation: http://www.ilusa.com/links/ilcenters.htm

 

Ø      County

¨      County Child Services

¨      In-Home Support Services

¨      United Way agencies

 

Ø      Local

¨      Fraternal organizations

 

v     What can I do?? - Learn and participate!

Ø      Get a computer and get online. Can’t afford a computer? Try these:

¨      http://www.freebyte.com/free_computers/

¨      http://hometown.aol.com/aiadisable/

¨      http://www.freepcs.org/

 

Ø      Fund raise for your cure! We are all close; now it just takes money!

¨      Web search “fundraising ideas” got 317,000 hits.

¨      www.frda.org/advocacy/fundraising.shtml

 

Ø      Help others

¨      Support groups

¨      Network

¨      As you gain knowledge, share it!

Ø      Advocate for your child

¨      In a positive firm way demand ADA compliance.

¨      Model good ways to handle people’s “attention”

¨      http://www.pva.org/NEWPVASITE/publications/onlinepubs.htm

¨      http://207.78.21.41/advocacy/default.asp

¨      http://www.alsa-or.org/advocacy/LegalAdvocacy

¨      http://www.masspac.org/resources/videos.htm

¨      http://www.kansas.net/~cbaslock/ada.html

¨      Web search “ADA advocacy”

   


  THEN YOUR ATAXIAN

 

v     Health

Ø      Emotional Health

¨      Grief process

·        Denial for a time is not bad. It is part of the grieving process. And since ataxians lose a little function at a time they will go through the grieving process in small cycles many times, including periods of denial.

·        Give them a balance of slack and expectation in their acting out. Again, they will be looping through the grief process more than anyone else, even if it doesn’t look like it

¨      Support for them

·        MDA Camps! Wonderful respite for them to be “normal” (what is “normal”!?). Don’t let them miss out on this great yearly experience. http://www.mdausa.org/clinics/camp.html

·        Two good FAPG references: http://www.fortnet.org/fapg/children.htm and for books http://www.fortnet.org/fapg/booksfor.htm

·        Encourage them to network with other same-age ataxians

·        Ataxia Chat 2002: http://login.passport.net/uilogin.srf?id=24002

·        INTERNAF Email: http://internaf.org/ataxia.html (An adult ataxian forum)

·        NAF bulletin board: http://www.ataxia.org/cgi-bin/ubb/ultimatebb.cgi

 

Ø      Physical Health

¨      Exercise – If you don’t use it you will lose it

·        Moderate body toning and flexibility exercises emphasizing repetition to re-teach movement coordination

·        Adaptive manual or motorized leg exerciser

¨      Diet

·        Avoid extra iron in supplement form.

·        Eat a good balanced diet

 

v     “Normal” life

Ø      “Normal” is a physical and psychological myth. Ataxians make life as “normal” or abnormal as anyone else

Ø      Go for it!

¨      Sports

·        http://www.fortnet.org/fapg/BrianneAdv.htm

·        http://www.dsusa.org/

·        http://www.nscd.org/

·        “Disabled Sports” search; 700,000 hits. http://search.yahoo.com/bin/search?p=disabled%20sports

¨      Travel

·        Google: http://directory.google.com/Top/Society/Disabled/Travel/

·        “Disabled Travel” search; 1M hits!

 

v     Medical after 18

Ø      The ataxian can directly apply for SSI; MediCal or equivalent also. See above on SSI.           

Ø      Parental access to medical records is the same as any other 18 year old. Forms exist for your 18+ ataxian to give you permission to see his medical information. In California it is called an “Advance Health Care Directive”.

 

v     Ataxia communication

Ø      Handling strangers

¨      Some strangers in public places can unintentionally be pretty offensive and intrusive. Prepare your ataxian with a standard response or two to inquiries of why are they walking differently.

 

Ø      Confusion with drunk or drugs

¨      Some ataxians carry a card reading: “ATAXIA is a neurological disorder. It may affect the ability to walk, use the hands, or speak clearly, but does not affect intelligence or mental processes. Or, design your own!

¨      Prepare your ataxian to handle school officials or police that have questions: http://www.fortnet.org/fapg/drunk.htm

  


Please remember to Email pkonanz@prodigy.net with any suggestions for information additions or to report gaps in topics.


Addendum I

 COPING WITH LOSS (excerpt) - 5 STAGES OF GRIEVING

Funded by FEMA through the Minnesota Department of Human Services--Mental Health Division, in cooperation with CLIMB Theatre and the University of Minnesota Extension Service.

    (Excellent article: http://www.extension.umn.edu/specializations/familydevelopment/DE6450.html)

…. The stages of grief are:

§         Denial

§         Anger

§         Bargaining

§         Depression

§         Acceptance

After a disaster you will definitely go through the stages of grief, but you might not go through each stage only once, and you might not go through them in the order specified. For instance, you might move from anger to bargaining, then back again, before you move on to depression, and finally acceptance. It is important to remember that not all people move through the stages with the same intensity of emotions, or at the same rate. These differences in how and when individuals experience each stage can add stress to relationships. For example, a husband who is in the anger stage may be very impatient with a wife who is still in denial: "I can't understand why she's still got her head in the sand." She, on the other hand, may be wondering: "Why is he so angry when there's nothing to be angry about?" ….

Denial: "No, not me, it can't be true."

Anger: "Why me?"

Bargaining: "Yes, me, but...." It allows you to "frame" the crisis so you can manage it. Bargaining may help you cope with feelings of sadness without experiencing deep depression.

Depression: "There is no hope." A crisis entails loss, which is followed by sadness.

Acceptance: "It's all right now." Once the preceding stages have been completely worked through, you will finally be able to accept what has happened, and you may even be stronger than you were before the disaster occurred.



Addendum II

 Working Through the Stages of Grief

(2002 NAF Conference, care of Sue Kittel)


When one of our children receives a diagnosis of Friedreich's Ataxia, the
whole family can experience grief. The following list includes the stages of a unique grief, called Anticipatory Grief. As most of us know, as we cope with a progressive condition like FA, we continue to grieve through each stage of change and progression.

We may feel some or all of these emotions during Anticipatory Grief.
1. Intense Sadness
2. Frustration
3. Guilt
4. Anger
5. Loneliness
6. Fear
7. Hope

What could hinder you?
1. Denial
2. Poor Communication
3. Other Complicating Factors (i.e.: other illness in the family, or financial      problems, etc.)
4. Lack of Support

How Can I Help Myself?
1. Keep communication open between you and your children, spouse and one or two close friends.
2. Express your emotions (happy, sad, anger, etc.)
3. Take time to care for yourself.
4. Reach out for help
   


Addendum III

Sure Steps to Caregiver Burnout

(Words of wisdom from Carmen Leal-Pock's presentation at the HDSA national convention in Rochester, NY, June 1997)

From the Winter 1999 issue of Hopes & Dreams, newsletter of the Illinois Chapter, Huntington's Disease Society of America.  

1. "Do it alone."

You really don't need help from friends, family, and other caregivers.

2. Don't pursue your own activities.

Your whole life should revolve around concentrating in the illness. And never do anything silly, just for yourself -- you might forget, for just a moment, the horrible situation the illness placed you and your loved ones in.

3. Forget about planning time for yourself alone or with others.

If you leave your "patient" alone or in someone else's care for a few hours, who knows what might happen?

4. Don't set limits on care giving activities.

This is a 24-hour, 7 day a week job. In order to do it right, you need to respond to every request, right away!

5. Spend holidays alone with the person with HD.

Better yet, arrange a stressful holiday gathering with as many activities as possible, to prove that the person with HD is "the same as he or she ever was."

6. Engrave your plans in stone.

It's much better to "forget the whole thing" than to remain flexible and risk having an alternative good time. If the person with HD can't fully participate, he or she should just sit the whole thing