Wednesday, November 19, 2008

Tough breaks

Having been diagnosed with an illness that affects just two in a million, 24-year-old Ben Murnane has been through more in his life than most of us will ever endure, writes Joy Orpen

Ben Murnane
By Joy Orpen
Sunday November 16 2008
Ben Murnane is only 24 years old, but already he has been to hell and back. Having been born with a very rare disease, he has visited death's door many times; he has endured terrifying psychosis and has known the joy of recovery.
"From the moment I was born, my parents felt I wasn't quite right," says Ben. "I was small and they had to dress me in doll's clothes. I just didn't thrive, and although I was medically examined, no one thought to do a blood test."
So, the family had no option but to soldier on. Then, in 1993, when he was nine, Ben's physical health began to markedly deteriorate.
"I had excruciating stomach pain and red spots under the skin. My mother heard a programme about leukaemia and she thought my symptoms sounded similar to those, so she took me for blood tests," Ben says.
The investigation revealed his platelet count and red and white blood cell counts were right down.
"This was pretty bad news," recalls Ben. He was immediately packed off to the children's hospital in Crumlin for some serious tests, which initally suggested aplastic anaemia. General anaemia occurs when there is a drop in the number of red blood cells; aplastic anaemia, however, happens when there is a reduction in all three types -- in other words, when the body's bone marrow is failing to do its job.
"The way to fix bone marrow is to have a transplant," says Ben. But as that has its own inherent dangers, it cannot be done lightly, and donors are hard to come by.
Although the doctors were desperately worried, Ben was sent home to spend Christmas with his family.
"There was a very real issue about whether I'd survive," he remembers.
After the festive season, Ben returned to hospital so the aplastic anaemia could be tackled. But on the day the treatment was to begin, the family learned that Ben actually had Fanconi anaemia.
"Aplastic anaemia was a very serious illness, but Fanconi anaemia is even worse," says Ben. "Two out of every million children are born with the disease." Fanconi anaemia is an autosomal recessive genetic disorder, which means that both parents must be carriers in order for a child to inherit the condition. Further tests revealed one of Ben's two sisters was also affected. The Murnanes were devastated, but there was no doubt about the diagnosis.
Ben displayed some of a cocktail of symptoms typical of Fanconi anaemia, including aplastic anaemia, skin discoloration, and small stature for his age. Other possible symptoms include intellectual disability and kidney problems. The Ashkenazi Jewish population carrier frequency of the recessive gene is much higher than in other ethnic groups, at about one in 90. Ninety per cent of Jewish children born with Fanconi anaemia have no thumbs at all. Ben, who is not Jewish, has double jointed thumbs. But the bad news didn't end there.
"Fanconi anaemia patients are hundreds of times more likely to develop cancer, while the average life expectancy is just 22," says Ben in his harrowing, but inspiring book, Two in a Million.
Over the years, treatment would prove difficult and frightening, but ultimately successful. Initially, Ben was put on an anabolic steroid called oxymethalone to boost his blood count.
"Once I was over the shock of being sick, I thought it was a bit of a thrill to have this thing that no one else had," he says. The oxymethalone wasn't working effectively, though. As time went on, Ben required ever-higher doses, and consequently he became bloated, his voice broke early, and he developed horrendous acne. Eventually, when he was 11, Ben was put on another steroid, which led to him becoming anorexic and prone to outbursts of temper.
"What that steroid did was make me go ballistic. My parents were terribly worried. I hit them more than once," Ben recalls. Despite this unruly behaviour, the doctors were unable to take Ben off the medication as his blood count was finally improving.
The theory was that this drug would kick-start the original drug into action. And that's exactly what happened.
But the situation again deteriorated when Ben was 13. His skin got so bad it was like having "dandruff" on his face; he was also terribly tired and developed worrying, but benign, growths.
Eventually, when he was 15, the doctors were finally forced to wean him off steroids -- they were no longer working. Ben was now really sick, and he desperately needed a bone-marrow transplant. The first matching, unrelated donor backed out at the last moment. By then, Ben had already cleared out his school locker and said farewell to his friends -- his chances of survival were only 50/50.
Then an American donor was identified and, in June 2001, Ben headed for Crumlin and began the process.
"The type of bone-marrow transplant I was about to undergo was new, and I was going to become the first person in Ireland to have it," says Ben. "It involved a revolutionary immunosuppressant drug called fludarabine."
Nonetheless, the risks were still very high. On June 20, Ben began radiation. On day six he was moved to the transplant room, a completely sterile environment: there, he was injected with his gift of healthy bone marrow.
"The actual transplant itself was about as undramatic as it gets," remembers Ben. "It was painless and lasted just 10 minutes."
The critical time was yet to come and Ben's patience would be sorely tested.
He had a bumpy ride, haemorrhaging weight, suffering chronic diarrhoea, blood in his urine, considerable pain and finally, a dramatic psychosis.
The physical battles had been going on for some time, and as they got worse, Ben descended into an almost comatose delusional world.
"Over the next few days my mind constructed a nightmare life for me. My parents had been killed in a car accident. The rest of my family had been killed in a plane crash. I'd been sent to a juvenile hospital and tied to a bed. I heard constant screaming. I saw the baby in the next bed being beaten and stabbed by nurses."
Following frantic tests, it was determined that Ben was having a bad reaction to a drug that was fighting a severe infection, which sometimes occurs after a bone-marrow transplant.
Once that was remedied, he finally turned the corner to true recovery. On September 11, 2001, the Twin Towers were attacked; that same day, Ben went home. Now aged 24, Ben has just completed an arts degree, and is busy promoting his riveting and beautifully written book while co-writing a travel guide about Dublin.
He's in great shape now, is Ben. May he stay like that for a long, long time.
For more information, see 'Two in a Million' by Ben Murnane is published by A&A Farmar, €11.99
- Joy Orpen

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