Kabuki Syndrome Awareness Day!

Today is Kabuki Syndrome Awareness Day worldwide! Since we are all sick in my house, I wanted to put out an informational piece regarding Kabuki to help raise awareness via the internet. The fact that we are stuck inside today is a prime example of how Kabuki affects our family and others.

Kabuki Syndrome is a rare genetic disorder, affecting just 1 in every 32,000 live births. It's so rare that there are only a few families in Ohio that live with it. It is usually clinically diagnosed by certain facial features common to Japanese Kabuki Theater

makeup, including high arched eyebrows, large wide-set eyes, ear abnormalities (large, low set, small or missing) and a wide nasal bridge. It can also come with a cleft lip or palate, hearing loss, vision impairment, feeding difficulties, and intellectual disability. All Kabuki symptoms range from mild to severe, and is considered akin to Autism for the sensory, behavior and mental disability problems. Kabuki patients also can have hypotonia (low muscle tone), persistent fetal finger tip pads, short pinky fingers/toes and large hands and feet. It can cause late-onset dwarfism, short stature and developmental delay. It can also cause dental issues like not having certain teeth, teeth coming in in the wrong order, gum disease and gingivitis due to poor oral hygiene because of sensory problems.

Besides the physically visible abnormalities, there are a slew of medical complications that may or may not come with a Kabuki diagnosis. Medical problems can affect nearly every part of the body: Lungs and airway, stomach, heart, kidneys, reproductive organs, skin, muscles and immune system. Some Kabuki patients have issues that other Kabuki patients do not have. Some patients have lots of physical and medical problems but not as much on the mental side, while others have severe mental impairment and relatively little medical problems. Some have it mild all the way around and some have it severe all the way around. Some patients walk normally, some are late walkers, some cannot walk without an assistive device and some cannot walk at all.

Every single Kabuki patient is different, which is what makes it so hard to treat. To this point, doctors are tailoring treatment to each patient's need, but there is no set standard that all patients receive. Most doctors recommend early and aggressive treatment for ear infections due to the chronic nature in which Kabuki patients tend to get them. Ear infections, if not treated properly, can cause hearing loss, which is already a problem with most of these patients anyway. It is also recommended to have all vaccinations at the time they are due, including the pneumonia vaccine. Because of their susceptibility to infection due to a low-functioning immune system, any respiratory illness can progress rapidly.

Heart and kidney problems are very common in Kabuki patients as well. Congenital heart disease contains a vast array of problems, including septal defects, valve problems, physiological abnormalities and more. The kidneys can also have a vast array of problems, from having one U-shaped kidney to having two different sized kidneys, to improperly functioning kidneys and more. There are too many possibilities that I cannot think of them all, let alone list them.

With regard to Jaxson, he is affected by Kabuki in all aspects and then some. He has KP on his skin and occasional eczema outbreaks. He has hypotonia that led to him being a delayed walker and gives him gait problems still. He also tires easily when walking a lot and has muscle aches. He was born with a cleft palate, but not his lip, and suffers from hearing loss and vision impairment. He eats by feeding tube due to swallowing problems (likely caused by hypotonia) and oral aversion (sensory). He has wide-set eyes and ptosis (upper lid comes down farther than it should), fetal finger-tip pads (typically disappear in infancy) and will need lots of dental work in the future. He has kidney stones, reactive airway disease and horrible reflux. His heart has a bicuspid aortic valve and his mitral valve had a membrane blocking it at birth, plus other abnormalities with the mitral valve. Because of his heart problems, he also has pulmonary hypertension and is even more susceptible to illness. He has developmental delays in speech, fine and gross motor, and feeding, but cognitively is on par with his peers.

Jax also has issues that are not necessarily proven to be part of Kabuki. He had a tethered cord at birth, had bones fused in his skull at birth, lives with hydrocephalus and Chiari I malformation. All of those things also contribute to his gait and balance problems, can affect his bowels and cause pain, numbness or tingling in his extremities. His 10 surgeries are not typical of a Kabuki kid either, especially since half of them cover the things not related to his syndrome.

Kabuki Syndrome by itself does not alter life expectancy for people diagnosed, but the problems it causes can contribute to premature death. The severity of the problems is what would cause that, and it is not unheard of for children with Kabuki to pass before they should. So while it's a little ray of hope that Kabuki patients can live a normal life span, there's still a little buzzing in the back of the head with "what if's".

Now that I've talked about the problems Kabuki can cause, I also want to talk about the positives. These kids, they are definitely special! Most Kabuki patients are extremely friendly and social, they love other people and constantly want to have attention. They LOVE music! Jax is definitely an example of that. They are generally happy kids, sometimes to the point where you might think they don't know what is going on. But most of them do, they are smarter than you think they are. Kabuki patients are sensitive too, they care if you are happy or sad and want to make sure the people they care about are okay. Jaxson, even with all he's been through, is the happiest kid I've ever seen. He's strong, like all of his Kabuki family, and doesn't seem to feel pain unless it's massive. He gets frustrated when he can't communicate, hates to ask for help and adores his big brother. He is the sweetest thing, asking for hugs and cuddles, wanting his bear (lovey) to have hugs and kisses and pretending his bear is sick when he is. He hates his feeding tube but refuses to eat so he tolerates it. He never wants pain medication, even if he tells me he hurts! He hates clothes, preferring to run around in his diaper. He loves to get under his brother's skin too, which is hysterical to us because he's totally paying Jeffrey back for the last three years of being in his face!

The one thing I want people to take away from this blog is this: Kabuki Syndrome is a diagnosis, but it does not define who our children are. Our Kabuki Kids are beautiful, happy, loving individuals. They have their own personalities and generally have a smile on their faces. Our KKs are nothing short of amazing! They literally have to fight every single day just to survive, and they not only do it, but are mostly happy in doing so. We can learn a lot from our Kabuki family, like how to live life to the fullest with a smile on your face because you never know what's around the corner. In that, it applies to all aspects of life, but the Kabuki patients exemplify what it means every single day.