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Bedwetting Help – 16-Year-Old Can Now Focus on College

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It is now July 2018 and he is 16 years old and dry at night! Finally, bedwetting help for my teenager.

This summer was the first time ever he was at camp and was dry the entire time.  We also had a vacation with success and did not have to pack all the extras that were needed in the past to protect mattresses from my teenager wetting the bed.

Thanks to your complete understanding of the underlying cause of the bedwetting – deep, deep, sound sleep, and how to “fix it”,  our son now wakes up during thunderstorms and gets up during the night to use the bathroom.  He loves being dry at night and it has taken a big weight off of his mind when he travels and has overnights with friends.

College was also in the back of his mind and now he can look forward to that without the fear of wetting the bed and trying to manage all that goes with it in a dormitory setting.

The staff are very helpful in managing  his program through phone calls and emails.  It’s not necessary to be there in person to be successful. They were responsive to any questions we had and were supportive the entire process.

We can’t thank them enough for their program and are thrilled with the results!  Theresa was an excellent bedwetting counselor! It really helps to have one person working with you, her focus was on my son’s progress. We would recommend the program and wished we hadn’t waited so long to find this remarkable solution.

A thankful family in Texas   2018

adult bedwetting

Case Study of Adult Bedwetting Patient

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This is a case review of a 42-year-old Caucasian male, who we will refer to as William. He was suffering from bedwetting for his entire life.  Bedwetting is also known as nocturnal enuresis and primary nocturnal enuresis.   William reached out to our clinic after reading about our expertise in solving adult bedwetting.  He commented about his experience of relief while reading our website information, and that it made so much sense.  He then knew unequivocally that his heavy, deep sleep had to be the underlying issue, not only for his years of nighttime accidents, but also for his teenage son’s bedwetting.

Family History of Bedwetting:  

William’s father experienced bedwetting into his teen years.  William’s grandfather also wet the bed as a teenager.  His father’s father experienced teenage bedwetting as well.  Now William’s son continues to experience nighttime bedwetting as a teen.  He has always wet the bed – never been dry at night.

In recent years, William’s father was diagnosed with sleep apnea, and he currently wears a c-pap device, also know as a continuous positive airway pressure therapy, to help regulate breathing.  This is not an uncommon diagnosis stemming from the sleep disorder with which we work.   Also, not uncommon is the sleepwalking and night terrors experienced by his aunt.  These are symptoms that cannot be eliminated.  The only possibility is to manage these symptoms as best as somebody can.  Since bedwetting was “outgrown” by his dad and aunt, the detriment it poses is that these other untreatable conditions can surface and affect quality of life.

We know  a new pattern of sleep is needed which will not only eliminate bedwetting; it will also cut off the possibility that the untreatable conditions will arise.   

Dr. Roger Broughton, a neurologist and foremost sleep researcher from McGill University in Montreal, is an expert upon whose findings have led to our initial protocol.   He highlighted a condition called deep-sleep bedwetting.  The sleep study conducted by Dr. Roger Broughton is titled, “Sleep Disorders: Disorders of Arousal? Enuresis, Somnambulism, and Nightmares Occur in Confusional States of Arousal, not in “Dreaming Sleep.”

The result of this study shows the differences in normal sleep patterns and those of a bedwetter.  In normal sleep, people fall slowly from Stage 1 (lightest sleep) into Stage 4 (deepest sleep), and then back to lighter stages where it’s easy to awaken.  A full cycle takes approximately 90 minutes to achieve.  A person who wets the bed falls quickly into deep sleep and stays there for longer periods.  This is the problem.  The brain is not supposed to stay in Stage Four for very long.  Cycling doesn’t take place consistently throughout the night, and the bedwetting occurs as a result.

The study’s findings concluded that all bedwetters share a deep sleep pattern. Our center has decades of clinical and anecdotal experience, which proves that the only effective treatment and cure for bedwetting is to change the pattern of sleep. Chronic bedwetting is the symptom caused by the inherited sleep disorder. This same sleep disorder causes sleep apnea, excessive snoring, sleepwalking, night terrors, insomnia, and bruxism.

This type of deep, heavy sleep produces a poor-quality sleep rather than a high-quality sleep.  The infographic below illustrates the effects of sleep deprivation:

sleep deprivation

Initial Assessment:

A thorough assessment, required for preparing for one of our programs, revealed  that he also experiences difficulty awakening in the morning, had sleepwalking episodes as a child, and was prescribed Ritalin during his late teen years to help with focusing and hyperactivity.

When we discussed the frequency that the bedwetting is occurring, William claimed he has wet the bed every week of his life.  In the past year he has seen an increase in the frequency of the bedwetting with a pattern of two to three times a week on average.  

Currently he has no medical issues other than seasonal allergies.

He has previously – during childhood and even as a teen – been examined by two pediatricians, three urologists, and a neurologist to determine a cause of the bedwetting, also know as primary nocturnal enuresis.  At no time was a physical symptom diagnosed.  Enuresis workups included:  Urinalysis, urethral obstruction scope, several ultrasounds, and an MRI.  

According to the American Pediatric Association, less than 1% of bedwetting is caused by a physical problem.

He stated that typically the physicians’ focus of bedwetting treatment was placed upon managing the bedwetting rather than a full resolution.  After a failed attempt using a bedwetting alarm, being told to wait and do nothing until puberty when he is likely to stop wetting was the direction his parents were given.   Clearly it turned out to be inaccurate (as it is with most of our patients)

He did not recall a physician providing any statistics regarding the length of time he would suffer from bedwetting, and of course he was not provided the statistics for primary enuresis: 1-30 for teenage bedwetting or 1 -100 adults who would continue wetting the bed as an adult.  

No medications were prescribed until he reached age 24.  Over time, he was placed on three different drugs, which included Ditropan and Tofranil to no avail.  His last desperate attempt was with Desmopressin.  William researched the side effects of Desmopressin when the dosage was increased to three pills each night, and when he started regularly feeling queasy and irritable, which he said was not typical.   William lives in a warm climate, is physically active, and knew how important hydration was to his well-being.   Desmopressin is meant to purposely cause dehydration in the body in an attempt to eliminate the bedwetting.  When his discovered the extensive list of side effects of Desmopressin, as well as the ineffectiveness, he stopped taking the drug immediately.

What makes drug intervention for bedwetting a completely ineffective approach is because it doesn’t remotely touch the causal factor of the core issue – sleep.   

Below is a list of some of the side effects of Desmopressin.  

Source  https://www.rxlist.com/ddavp-side-effects-drug-center.htm

Also known as DDAVP, it is an antidiuretic and anti-hemorrhagic drug used to treat bed-wetting, central cranial diabetes insipidus, and increased thirst and urination caused by head surgery or head trauma. DDAVP is also used to treat bleeding due to platelet dysfunction. DDAVP is available in generic form.

Common side effects of DDAVP include:

Headache, nausea, upset stomach or stomach pain, diarrhea, or flushing of the face (warmth, redness, tingly feeling). DDAVP can infrequently cause low levels of sodium in the blood, which can be serious and possibly life-threatening. Seek immediate medical attention if you have symptoms of low levels of sodium in the blood, including:  loss of appetite, nausea, vomiting, severe headache, muscle weakness/spasms/cramps, weight gain, unusual tiredness, dizziness, severe drowsiness, mental/mood changes (confusion, hallucinations, irritability), loss of consciousness, seizures, or slow/shallow breathing.

Physicians continued to tell him he was not trying hard enough, which he confided was scarring his self-esteem, and resigning him to the point of view that he would have to live out his life continuing to wet the bed. He expressed a deep resentment over the dismissal of this problem of wetting the bed, and was amazed and confused that it would even be intimated that he hasn’t done his part to end the stress of this condition.  

We can see more about how the problem with doctors saying bedwetting will be “outgrown” can cause psychological havoc to its victims, attacking self-esteem, increasing a sense of failure, and feeling “different”.   For many of our adult patients, they tend to live more solitary lives because they feel too uncomfortable disclosing the bedwetting to a potential mate.  Unfortunately, intimacy often becomes what they feel is an impossibility to them.   We understand it can be difficult to open up to somebody about this condition.  Many adults in our program have expressed anger or sadness or regret for having “missed out” on opportunities as a result of having to hide an extremely sensitive and often shameful part of their lives.

He was highly motivated to enter as well because his wife had recently filed for divorce.  One of the reasons involved her perspective on William’s bedwetting.  She eventually began to accuse him of deliberately wetting the sheets.   In fact, in a most unfortunate experience for William, his wife used this perspective and had her attorney introduce it publically in divorce court.   We have the utmost respect for William to ride that through, and then do whatever it would take to eliminate a problem that he thought he had no control over, and that has clearly impacted his life to the extent of being publically humiliated.  

Enuresis Treatment Center

Years of research and development dictates a two-week meeting schedule in order  to properly develop a  personalized plan.  We assign to our patients one of our staff counselors to work closely with them and facilitate their plan.  Our counseling staff includes a school psychologist, nurses, and teachers.  William was offered the opportunity to conduct his appointments via Skype.  He chose instead to have phone contact because, as he described, “the pain and embarrassment is too deep to face anyone”.

Our protocol dictates that our Director of Treatment reviews each case before a customized program is designed.  It was determined that a male bedwetting counselor would work with William throughout his program.  

Focus was placed upon ending the heavy and problematic sleep that had caused the continuation of the nocturnal enuresis.   Besides the enuresis, William presented with always feeling unrested, having difficulty focusing, being exhausted upon awakening rather than refreshed, and becoming more and more withdrawn over the years.  

We found out that William had symptoms of urgencies, a need to empty his bladder multiple times during the day, and we know this was attributed to the bedwetting itself.  It was determined that this is an actual a symptom of the bedwetting because the bladder tends to remain underdeveloped as a result of emptying regularly in the night.   We therefore developed and implemented a seriesces of targeted exercise, introduced at varies segments of his program ,develop to needed to fully support him and thus eliminate excessive needs to urinate during the day.   

In week six of our progressive and holistic approach, William began to see a change in his wetting pattern, and he was thrilled.  Of course, he would be!  For the first time in his life, he began to see progressive results leading to an end to the bedwetting.  He told his counselor that he was able to see progress and the finish line was in sight!

What is required for each appointment is pertinent data as it relates to the bladder development and the sleep intervention training.  Incremental changes are often difficult for the patient to detect, but the job of the bedwetting counselor is to identify and design the next step to maintain progress.

Enuresis Treatment Center’s sleep training protocol focuses on the relationship between the deep sleep and the disconnect with the bladder signals.  

As we know, the brain becomes less malleable as we age, and it was known that Williams program would possible take longer than it would take a child’s brain to respond.  

William’s counselor noted that he followed all directives in a timely fashion.  The Reinforcement Phase took longer, as was anticipate, but completed.  His counselor was satisfied, via current data, that his new sleep pattern had emerged.  The bladder and brain synchronized and the adult bedwetting ceased to be a problem.

William entered his teenage son into one of the Enuresis Treatment Center’s specialized teenage bedwetting programs four week after he finished his program.   
Source of graphic:
http://jonlieffmd.com/wp-content/uploads/2012/07/800px-Effects_of_sleep_deprivation2-300×220.png

Author Michael Stallsmith, M.A., Sp.A.

The Enuresis Treatment Center’s Director of Treatment is also a school psychologist.  Michael Stallsmith has, over the past 20 years, been involved in over 20,000 cases.  He is responsible for overseeing the counselors on our staff who work directly with the patients, and he is effective at implementing what’s needed for any challenging situations that may arise during treatment.

Michael continues his outreach with the medical community and school systems educating them about bedwetting and its relationship to the non-arousable sleep disorder.  Michael has been on staff at the Enuresis Treatment Center since 1982.

Scientists discuss deep sleep and treatment for bedwetting

Interview with two scientists discussing deep sleep, the bedwetting problem and bedwetting program and treatment for bedwetting.

Erica: First let me just say, the wetting has been part of our lives — he wet basically every single day of his life. It wasn’t just an occasional thing. So it was a real problem, and It became clear he wasn’t outgrowing it. We had tried some behavior therapy, we had tried an alarm, and it didn’t wake him up sufficiently. It was getting really frustrating.

We talked to our pediatrician who said the alarm is the best thing. One time when he went away to camp, he used some medication, which actually didn’t even work that well. We were never planning on that as a long term thing. It was just to try so he could go to camp.

Barbara: Excellent.

Erica: We really were frustrated, and I came across your website during some of my investigations. Quite frankly, my husband and I are both researchers. We’re scientists. I was struck by this information on the sleep cycle that you had in your description of the problem. That caught my eye for a couple reasons. One was this disruption of REM sleep that was discussed. Jerry never remembered having dreams, and I always thought that was really strange, and so that resonated as true with our experience.

Then I went back to the actual scientific article that you cited there, and read some of the research. This paper in Science, which is one of the premier scientific journals—we know it has hard criteria to get in. So that was the original paper that was cited. I was actually really surprised that not many people had done anything with this.

I was really struck by your story about finding this information about the sleep cycle, and following it up to help your daughter. But I filed the information away for awhile, and still things weren’t going very well with Jerry. We finally decided —he was 9 and a half, almost 10, and we said we have to do something about this. I was a little concerned that it was, you know remote—we are in CA and you guys are in MI, but I decided to have a phone interview.

Gaile is who we spoke to for the first time, and she was great. It sounded really —I was impressed by what appeared to be the comprehensiveness of the program. It was working to address the sleeping problem, which is the core of bedwetting problems, I now understand.

Jerry: Which is somewhat counter­intuitive and not well-known, I should say. Most people don’t think of it as a sleep disorder or problem.

Barbara: Exactly. They know the child sleeps deeply, but they don’t connect it to being the cause of the bedwetting.

Erica: Right, but we knew something was up with Jerry. Number one, the dreaming thing I always thought was very odd. And then the alarm thing…we bought one of the more expensive alarms, but he didn’t wake up. The pediatrician suggested we get the kind that a hand comes up and slaps you in the face. (laughter).

This notion of being in a deep deep sleep never came up, but it kind of rang true for us. Deep sleep bedwetting is what our son was experiencing.  Seeing that this scientific study on the EEG pattern to corroborate that convinced me at least that there was a sound basis behind your approach. I was impressed with what Gaile told us about the various elements of your bedwetting program, and we set up our first appointment. We just decided we needed to try something.

The way the program worked with the private phone meetings every two weeks, the forms, and the help available whenever we needed it. Even though there were several stages involved, and as long as everybody’s committed to making it work, it’s a very comprehensive program, and it’s not that hard to follow. I think you guys make it easy to keep track.

Barbara: It’s a complicated bedwetting problem, but without our guidance and education, it would be enormously difficult.  You said you failed to stop bed wetting for your son.

Jerry: That’s what I’m impressed with, actually, is the kind of systematic way you approach this. From sleep, bladder, muscle control; from a brain perspective. You’re really hitting all parts of the body. By the way, one thing that Erica and I agree on—I’m sure you guys are doing this— but most of the pediatricians we’ve talked to have never heard of this, and they really need to know about your bedwetting program.

Erica: That’s where people go to with this…they talk to their pediatrician.

Jerry: Our pediatrician was telling us he should take the medicine.

Erica: No, she wasn’t. She mentioned a bedwetting alarm. She said he could take medicine, but that it will come back as soon as he stops it. So she wasn’t advocating drugs. But we gave her information about your enuresis program, and I have a friend who is a medical social worker who specializes in pediatrics. I was telling her about this and gave her the deep sleep bedwetting information about your program so she can tell her clients. This really needs to be disseminated to the people who are dealing with the care of children.

Barbara: You can certainly appreciate our uphill battle for 41 years. We’ve tried in every way to educate the professionals, particularly pediatricians. Of course we all go to our pediatrician first, but they just sort of dismiss it. They don’t really understand it. It doesn’t mean they aren’t good doctors, it just means they don’t understand bedwetting. So typically, they give the worst advice.

Erica: After I first encountered your program and the paper in Science that you originally cited, I then went to look to see who is doing research on enuresis and children. There is hardly anybody in the United States doing anything. In fact, there is a big group in the Netherlands doing stuff. They have some papers where they cited the original paper you cited as well. One issue might be just that this is not an area of research in this country, apparently.

Barbara: Again, because no one understands the real impact. They don’t understand the sleep disorder and how that effects the child physically, emotionally, and psychologically. Again, in every country we work with families—like Australia, France, Russia, Mexico—all doctors say the same thing. They give the worst advice: Don’t worry about the bedwetting problem..they’ll outgrow it. Then they say to restrict fluids, take them to the bathroom in the night, punitive measures; reward them.

And to reward for something or to scold for anything that is out of their control simply isn’t fair. Then they’ll offer to try an alarm. And then oh my goodness…we had a family in California with a 19 year old—you can appreciate— her son slept through two earthquakes. These children don’t hear bed wetting alarms. They don’t even hear smoke alarms, and that’s disconcerting.

Erica: My social worker friend knows mothers with young children. There will be three or four people whom she knows who have kids with bedwetting problems, and she has referred them to me, and then I refer them to you. The other thing that is really important for anybody who is considering the program is listening to what we’re talking about right now is that because we come from a scientific background, we tend to be quite skeptical. We don’t buy the ads. I was very skeptical when we saw the 97% success rate, like how can that possibly be.

Greg: And the money­-back guarantee.

Erica: But here we are. We were worried that Jerry would have a lifelong problem. But as soon as we started going with your bedwetting program and seeing what it did and pulling out all the stops and making all the connections between the bladder and the brain—working with the sleep disturbance, working with the bladder capacity, working on the sphincter—all these things to try to take every angle on the problem, we were very, very impressed. It wasn’t a matter of belief, sounds cool”—it was working. Before you even get to the endpoint, you can see how it was working.

Barbara: Many people do have a lifelong problem with bedwetting.

Erica: Yes, I know you treat adults, too.

Barbara: Yes, and currently, our oldest patient is 44. And the older one gets, the more challenges they encounter, which can include social isolation and leading very solitary lives because they would rather be alone than have to share or speak about this to anyone. All around the world, bedwetting and its challenges has such a high impact on everyone. It is a shame that the professionals don’t understand.

Let’s speak a little bit about Jerry and how this has changed his life.

Greg: Fortunately, we never made a big deal about it. We were very careful not to be putative all along, so he’s never developed a real problem about it. But it was quite clear that he felt ashamed or guilty or whatever…pretty typical stuff. He clearly didn’t want his friends knowing about it. I used to have a bedwetting problem for awhile—and I still have issues with sleep—and I remember that feeling. But then all of a sudden, he would sleep over at someone’s house and not pee, and that was great when he completed your treatment and he was was able to stay dry and not have to worry about it.

Erica: What we used to do, he would do sleepovers, and then he even went to camp once before we were in your bedwetting program, and he would take a Pull­Up and would be discreet; put it away in a plastic bag. He was actually pretty well ­adjusted around it. He didn’t seem to feel stigmatized. But it was this thing that he always had to take care of. We were always crossing our fingers saying, he doesn’t leak”. He would be mortified if they found out. It’s just been so liberating for him—I can tell—not to have to think about it. Like being over at a friend’s house and to be asked last minute, have to worry about going home and getting stuff and having the bag—just that he doesn’t have to worry about it.

Barbara: Just not to have to think about it, even! It’s an “Do you want to sleep over” over­night that he can jump into.

Erica: It’s sooo nice. For me as a parent—he’s a really bright kid, he’s a well-­liked kid, well­-accomplished….I always used to think: Here’s this great kid, and there’s this one thing. It got to the point when I first called you guys that I was feeling like— we’ve got to help him. We’ve tried a number of other things trying to prevent bed wetting, but we thought we’ve got to get him out of this. And it worked.

Barbara: You all handled this enuresis problem very well, too. You understood that his worst fear would be that somebody will find out.

Some people don’t handle it as well as you did in that they scold and blame the child for being lazy, that sort of thing. That’s wonderful for him that you understood. And, of course, Greg, you understood having experienced bedwetting first­hand

Greg: Right. It’s it’s definitely changed ­ not the least of which is that we don’t have to do the wash every day.

Erica: Oh yes, we have a drought here in California. So it suddenly occurred to me—I guess it was by the middle of the spring— i realized “I’m not doing wash every day, Greg!” That was great, too!

Barbara: I remember a story years ago, at the end of treatment, a child was complaining saying, Miss Barbara, my mom and dad only change my sheets once a week now. That’s no fair”. And then you realize that his whole life they had washed sheets every day. He thought that was normal. He hadn’t realized that he’s not in a hotel! (laughter). You realize that that was common for him. And then there was a child that I spoke to who said he had a dream for the first time. It was the first time that he had ever experienced a dream. It was phenomenal for him! He was describing “Oh, I saw this and that, and it was in color”. You realize something so simple like a dream never happens.

Erica: It used to make me feel — this is something I paid attention to with the treatment. I did notice him having dreams more.

I haven’t asked him lately as much. That always was weird to me that he didn’t because he has such a great memory. It suggested to me that he wasn’t having them. It always kind of broke my heart a little bit that he wasn’t experiencing dreaming.

Barbara: Because you know how important that is to brain health and how one functions during the day. Dream sleep is such an important part of getting quality sleep.

Erica: Yes, so I did notice a difference in that. It’s interesting. I haven’t asked about it lately, but I will now.

Barbara: Particularly with your backgrounds, you know how lack of dreaming and how it can cause frustration during the day, or anxiety or moodiness. Sometimes because of the poor quality sleep and lack of dreaming, they are misdiagnosed as having ADD and ADHD.  Almost daily we talk with parents who are dealing with bedwetting and ADHD.

Erica: Fortunately, that was one of the things that he’s never had trouble with. This is also another reason that we would have never thought about a sleep problem with Jerry because he is pretty high energy, and compared to a lot of kids, he doesn’t seem to need a long night’s sleep. He never was drowsy during the day or not focusing or whatever. The main way it came out was with the bedwetting and the lack of dreaming.

Barbara: I’m so happy that we had the opportunity to help him. Those last two months at the end of treatment being totally dry must have been very refreshing for all of you. Erica/

Greg: Oh yes!  How to stop wetting the bed was a topic of conversation routinely.

Barbara: Until you get all of the components — you can try little bits and pieces and get part of the puzzle—but unless you get all of the components, one is not going to be successful with ending bedwetting and changing the pattern of sleep.

Erica: I also think that being a part of the program has a motivational kick to it. Especially with Jerry who didn’t really want to wet the bed, but also seemed to be ok with it, on some superficial level at least. Having the structure—all these things that we were doing— kind of got him fully on board with the process. Don’t you agree, Greg?

Greg: Yes.

Erica: Even though we tried other enuresis approaches, there was no getting away from this one, and I think that helped.

Barbara: With every failure experience, it makes it more and more difficult for a child. I’m glad we were able to help him while he was 10 years old instead of 18 years old and graduating from high school and can’t go away to college.

Greg: That would be a nightmare, yeah.

Barbara: People just sort of give up after awhile and resign themselves to thinking “I may be wetting the bed the rest of my life”.

Erica: Do you do follow­up with people, like a year later or anything like that?

Barbara: Yes, we have an automatic follow­up checking with families to make sure there are no difficulties. And we tell everyone— as I’m sure you were told—that if you ever have any situation in the future where you need our help, you only need to call. No matter if it’s five years or 10 years.

Erica: Lori did tell us that. She was wonderful.

Barbara: She’s a wonderful Treatment Advisor and very caring. Being a nurse, she has the medical background if we need some knowledge, although we’re not doing anything medical. But it’s nice to have all the professional background for the Treatment Advisors like we have to develop individualized bedwetting programs.

Well, thank you very, very much. Our very best to all of you. We appreciate the opportunity to help make a difference and change his life. And of course, it changes the family’s life.

Erica: It does, and we are very, very grateful to you folks, and to you for developing this program. I cannot image adolescent bedwetting.

Barbara: I’ve had my long struggle, also. But it’s nice to be able now to help others. Just as when you spoke with Gaile, she is kind of giving back what was given to her. Her heart and soul is in it, so that makes a difference.

Erica: I really enjoyed talking with her a lot.

Barbara: Good, I appreciate that. Everyone here tries to be as helpful as possible. That’s why we’re here six days a week. If someone needs help, they only need to call.

Erica: Just one last thing about Gaile. I was very impressed with her because I was very skeptical, so I was challenging her with understanding more about your bedwetting program with a bunch of different questions, and this and that, and she was just so non-defensive. It actually really spoke to her confidence in the program. She answered everything clearly. She understood my skepticism. She acknowledged legitimate questions. She offered guidance and pointed me in directions whenever possible. She said she’d get back to me on things, and I was very impressed by that. It played a big role in moving further with it, I think.

Barbara: I thank you very much. By the way, Erica. I was a very challenging mom, also. It think that’s what you have to be, because we are the only advocate for our children. We appreciate what it takes.

Erica: Yes. I’m really glad I pushed forward with this one, I’ll tell you.

Barbara: Thank you again, Greg and Erica! We are so happy for your family!

GaileGaile Nixon,
International Director and First Patient of ETC