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Frequently Asked Questions

Frequently Asked Questions. Photo by Season Atwater Photography

Included here are a few frequently asked questions and answers that people ask. If you would like to ask us a question just click on the box, send us your question, and we will answer it as soon as we can. We enjoy answering your questions!

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What is Miller Syndrome?

5-Sep-2017 by Debbie Jorde

Miller syndrome is a highly rare disease with only 30 individuals documented in the medical literature, worldwide. Until 2010, the cause of Miller syndrome was unknown.

Both of my children, Heather and Logan Madsen have Miller syndrome. There were only 3 cases listed in the worlds medical journals when Heather was born 40 years ago. The doctors told me it wouldn’t happen again. Three years later, on April Fool’s Day, I gave birth to Logan who also has Miller syndrome. We lived 33 years without knowing the cause of this rare disease.

Miller syndrome affects the development of the face and limbs and also includes many other physical anomalies. The severity of this disorder varies among affected people.

Although both of my children have Miller syndrome, their symptoms vary. We have met other people with Miller syndrome who are affected more severely than Heather and Logan.

Description of Miller Syndrome Symptoms

Children born with Miller syndrome have underdeveloped cheek bones and a very small lower jaw. They often have an opening in the roof of the mouth called a cleft palate, or a split in the upper lip (cleft lip). These abnormalities often cause feeding problems in infants with this disease. The small lower jaw usually restricts the airway, which can lead to life-threatening breathing problems.

People with Miller syndrome often have eyes that slant downward, eyelids that turn out, so the inner surface is exposed, and a notch in the lower eyelids called an eyelid coloboma. Many affected people have small cup-shaped-ears.

They also have mild to severe hearing loss caused by defects in the middle ear, also known as a conductive hearing loss. Miller syndrome does not affect a person’s intelligence, although hearing impairment can delay speech development.
Individuals with Miller syndrome have bone abnormalities in their arms and legs. The most common problem is absent fifth (pinky) fingers and toes.

Affected people may also have webbed or fused fingers or toes and abnormally formed bones in the forearms which include the radius and ulnar bones. Also, the lower legs are often affected.

Individuals with Miller syndrome sometimes have defects in other bones, such as the ribs or spine.

Occasional abnormalities include heart defects. Additionally, upper G.I. reflux and or kidney reflux can be present.
Males often have undescended testicles, while females may have uterine anomalies. People born with Miller syndrome also face easily dislocated hips. Furthermore, most affected children suffer from difficult vein access.

Cause of Miller syndrome and Re-occurrence Risk

Miller syndrome is a rare autosomal recessive disease which means that when mom and dad both carry the gene, there is a one in four chance with each pregnancy of having a child with the disease.

In 2010, our family became the first family in the world to have our entire genome sequenced. This groundbreaking research led to the discovery of the Miller syndrome disease-causing recessive gene.

In addition to this, scientists also discovered a completely separate recessive gene which caused the rare lung disease, Primary Ciliary Dyskinesia, PCD, in both of my children.

The risk of both of my children having both of these rare diseases is only 1 in 10 billion!

Source for the Information in this article:

NIH Genetic Home Reference

More information:

Dr. Lynn Jorde Describes Miller Syndrome to Medical Students: Video

Watch the KSL news story, How DNA Sequencing Changed the Lives of the First Family Ever Tested

Read the news story: Historical Genetic Discovery Brings Hope: Sequencing the First Family Ever Tested

What is the best treatment for Miller Syndrome?

What is an Autosomal Recessive Disease?

Filed Under: Miller Syndrome

What is the Best Treatment for People Having Miller Syndrome?

4-Sep-2017 by Debbie Jorde

Miller syndrome therapy requires a team of specialists, such as pediatricians,  oral surgeons, plastic surgeons, otolaryngologists; ear, nose, and throat (ENT) specialists.  In addition, ophthalmologists; specialists in diagnosing and treating eye disorders, otologists; who are specialists in diagnosing and treating ear disorders, audiologists; specialists in treating hearing loss, psychologists, and other healthcare professionals.

A craniofacial center has a team of experienced specialists who can coordinate care.  The specific symptoms of each individual affected with Miller syndrome are treated.

Miller Syndrome Therapy

Specific treatment often consists of surgeries.

Together, Heather and Logan have had over 55 surgeries to date.

Surgeries are required to correct abnormalities of the jaws, limbs, ears, and eyes. Surgery and/or speech therapy are necessary due to having a cleft palate (opening in the roof of the mouth.)  Congenital heart defects and other complications with various organs often require surgical intervention.

Speech Therapy and Hearing Aides

Speech therapy may be of benefit for individuals with speech development delays due to hearing loss and may require the use of a hearing aid.

Heather and Logan both have moderate to severe hearing loss and wear hearing aids full time in one and sometimes both ears.  During kindergarten through high school, they each worked closely with a teacher who is a hearing specialist.

Genetic Counseling

Genetic counseling can benefit affected individuals and their families as part of Miller syndrome therapy.

Doctors had only reported three individual cases in medical literature when Heather was born.  With so few cases reported, a geneticist informed us there was a zero risk for having a re-occurrence with another pregnancy.  The correct answer would have been, “We don’t know.”

Logan was born three years later also having Miller syndrome.  As a result, we became the first family ever to have a re-occurrence

Genetic Research

In 2010, we became the first family ever to have our entire genome sequenced.  Scientists found an autosomal recessive gene that causes Miller syndrome which results in having a 25% chance of a re-occurrence with each pregnancy.

Knowing the cause of Miller syndrome doesn’t change the treatment, however, Heather, Logan and I now have peace of mind knowing the cause of their challenges.

For more information about Miller syndrome visit the sites below.

NORD National Organization for Rare Diseases

NIH: Genetics Home Reference

FACES: The National Craniofacial Association

Filed Under: Miller Syndrome

Is Miller Syndrome Life-Threatening?

3-Sep-2017 by Debbie Jorde

Families and friends of people affected with Miller syndrome ask if the rare genetic disease Miller syndrome is life-threatening. Because there are only 30 cases documented in medical literature, there’s still a lot about Miller syndrome that isn’t known.

Symptoms of Miller Syndrome Can Be Life-Threatening

Children with Miller syndrome are born with underdeveloped cheek bones and a very small lower jaw. They often have an opening in the roof of the mouth called a cleft palate, and/or a split in the upper lip called a cleft lip.

Heather and Logan had three of these characteristics. They didn’t have a cleft lip. Having a small jaw restricts the airway, which can lead to life-threatening breathing problems.

In regards to both of my children who have Miller syndrome, Heather and Logan’s lives were threatened at birth and during infancy because their small jaw created a small airway making breathing difficult. Also, their cleft palate made getting enough nutrition a challenge.

Along with these problems, at that time we didn’t know my children also have a lung disease that is separate from Miller syndrome and is life-threatening.

As a result, it’s not conclusive as to which disease was life-threatening for them. Certainly having both diseases was life-threatening then and continues to threaten their health now.

The small lower jaw and airway, along with the cleft palate abnormalities frequently cause feeding problems in infants with Miller syndrome.

Both of my children struggled at feeding time. I fed Heather with a specialty feeder called a Breck feeder which consisted of a glass syringe, 1-1/2 inches in diameter.

The syringe had a rubber ball on one end and a long black lambs nipple on the other end. The long nipple went far back into her mouth towards her throat to bypass her cleft palate so that all the formula wouldn’t come out of her nose.

I tube fed Logan for six months because he kept inhaling the formula and getting pneumonia, which can be life-threatening. However, with modern medicine, doctors were able to treat Heather and Logan in time to stay ahead of serious infections.

With so few cases of Miller syndrome, the average life expectancy is still unknown. I’ve never known how long they would live. Heather was born in 1980, and Logan 1983. I am grateful they are still alive. In spite of their challenges, they enjoy making a positive difference in the world.

Resources:

NIH: Miller Syndrome

Video: What is Miller syndrome? With Dr. Lynn Jorde

What is Miller syndrome?

Filed Under: Miller Syndrome

Is Autism a Symptom of Miller Syndrome?

2-Sep-2017 by Debbie Jorde

People often ask me if my children have autism, now known as autism spectrum disorder, ASD, due to them also having a rare genetic disease called Miller syndrome. This is a relevant question.

Behaviors Like Autism

The best autism professional in the state of Utah diagnosed Heather and Logan with autism in their late 20’s.

It’s not surprising that everyone missed diagnosing autism in my children until young adulthood because of their other problems. For example, hearing loss is a symptom of their disease.

As a result, they didn’t always respond to social situations in typical ways. None of us questioned their responses as being those of someone who has an autism spectrum disorder.

Their rare condition also affects bone and muscle formation that causes short arms and missing fingers, along with other visible characteristics. Strangers don’t behave naturally around my kids, at first, because they look different from the average person.

The abnormal sociable interactions affected my children’s social development in a similar way to that occurs when autism is present. Doctors didn’t consider their behaviors as being autistic, because years ago, the specialists didn’t understand autism as well, and it wasn’t visible in the media.

In conclusion, the answer is no, autism is not a symptom of Miller syndrome. Although both of my kids have ASD, the current medical literature doesn’t list autism as a symptom of the disease.

Learn more

Learning About Autism

Filed Under: Miller Syndrome

What is Pimary Ciliary Dyskinesia, PCD?

2-Sep-2017 by Debbie Jorde

Primary ciliary dyskinesia, (PCD) causes life-threatening lung infections in both of my children, Heather and Logan. Along with chronic respiratory tract infections, PCD also causes abnormally positioned internal organs, and the inability to have children in some people.

Signs and Symptoms of Primary Ciliary Dyskinesia, PCD

Abnormal cilia cause the signs and symptoms PCD. Cilia are microscopic, finger-like projections that stick out from the surface of cells. They are found in many areas of the body: in the linings of the airway, towards the upper airway in the throat, the reproductive system, and other organs and tissues. PCD also causes abnormal tail-like structures, similar to cilia, that propel sperm cells forward.

In the respiratory tract, cilia move back and forth in a coordinated way to move mucus towards the throat, away from the lungs. Without proper movement of the cilia, elimination of fluid, bacteria, and particles from the lungs isn’t possible. People with primary ciliary dyskinesia also have year-round nasal congestion and a chronic cough.

Bronchiectasis

Chronic respiratory tract infections can result in a condition called bronchiectasis, which damages the passages, called bronchi, leading from the windpipe to the lungs and can cause life-threatening breathing problems.

Before scientists did genetic research using our family’s genes, doctors diagnosed Heather and Logan with bronchiectasis, however, they didn’t know how it was caused. Sometimes reflux causes bronchiectasis so both of my children had invasive surgery to correct their reflux.

Heather and Logan’s Early Symptoms

Both of my children experienced breathing problems at birth, and throughout their early childhood. They were both on antibiotics for ten years to avoid life-threatening infections. Although their chronic infections suggested problems, a correct diagnosis didn’t occur until their mid 30’s.

In March of 2010, we became the first family worldwide to have our family’s entire genomes sequenced. This research resulted in finding out Heather and Logan have bronchiectasis because they inherited the lung disease, PCD.

To inherit PCD, both parents must carry the disease-causing recessive gene, which results in each pregnancy having a 25% chance of producing a child with PCD. This is due to the child receiving two affected genes; one from mom and one from dad.

For answers to a list of FAQ you may go to the PCD Foundation website link below:

https://www.pcdfoundation.org/about-pcd/faqs

Filed Under: Primary Ciliary Dyskinesia, PCD

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