Tuesday, February 9, 2016

B's Kidney Update (@ 1 month old)

Last Friday we went to Children's Healthcare of Atlanta for Bridget to have a renal ultrasound and a VCUG. Last night her pediatric urologist gave us the run down of what these tests revealed. So here's the skinny:

Good news first. Her ultrasound showed a healthy appearing RIGHT kidney. (Yay! Yay! Yay!)  Her doctor does suspect that the right kidney has a ureteral duplication (but uncomplicated), which means two ureters are draining from the RIGHT kidney to the bladder.  “Uncomplicated” means no reflux (no urine washing backwards up to the kidney as sometimes occurs) and no obstruction (blockage).  Uncomplicated also means there is no adverse consequence of having this anatomy. (Woohoo! At least one good kidney is what we've been praying for!)

The less than good news, but better than we were expecting news: As suspected from my prenatal ultrasounds, the LEFT kidney also has a ureteral duplication, but it's complicated. The ureter from the upper portion of the kidney (i.e. the “upper pole ureter”) ends in a ureterocele. Ureterocele means that the last part of the ureter as it enters the bladder is dilated, expanded, ballooned.  This is associated with obstruction of the upper pole portion of the kidney. (This was all what we expected from my prenatal ultrasounds.)

B's Left Kidney - all those dark spots are not present in a normal kidney

Because the upper pole ureter pushes on the lower pole ureter the lower pole ureter which does not end in a ureterocele and does not reflux is also partially, but only partially obstructed. While that sounds scary, it is not an emergency because apparently the lower pole of the left kidney can tolerate this situation for some time.  And, here's more good news, the upper pole is a small segment in its overall contribution to renal function- given its ultrasound features it may not offer any real significant kidney function. Bridget's urologist expects her overall kidney function now and in the future to be normal. (Great!!!)

So what is next? Apparently, the management of ureteroceles is very individualized and a key detail in decision making is the level of function in the upper pole and the impact of the left upper pole on the left lower pole function and drainage.  So B needs another test called a MAG3 renal scan. So looks like we're going nuclear.  Kind of scary, but some fellow kidney-moms I've met thanks to the magic of Facebook, have assured me it is tolerable.  The doctors prefer to obtain this study at 6 weeks of age due to the way that neonatal kidney handles the contrast.  B will be six weeks old next Thursday, so the test should be scheduled in the coming weeks. Once the doctor has the results from this scan he'll be able to decide what procedure she needs and when she'll need it. So while we don't have the game plan in place yet, we feel very optimistic and have been able to breathe a little easier today.  Of course I don't love that B will need surgery, but I'm thankful that her long term prognosis is looking good for now!

Thanks for the continued prayers and thoughts! We are loving our little lady and feel so lucky to have her in our family!

Wednesday, February 3, 2016

3rd Times a Charm

It's true, the more kids you have the easier it becomes. Or I have a really chill baby - jury's still out on why this newborn phase with Bridget has been rather blissful. Perhaps the large looming questions about her kidneys are causing me to truly embrace this time with her. Or it is the fact that I'm not nearly as crazy as I was with the boys.

For instance:
Lukas and Julian: I had an app on my phone that tracked which boob I fed them from, for how long and the time in between each feeding. I used this app obsessively.
Bridget: Girlfriend gets nursed any time she seems hungry/bored/fussy. I have no clue which side she has eaten off of last and am relying on the trusty "which boob feels heavier" method to pick a side. I don't care if I fed her 10 minutes ago, if she seems hungry, to the boob she goes.  If 3 hours have passed, I DO NOT wake the baby. Never wake the baby. I mean, come on.

L&J: Swaddled every single time for a nap or nightime and asleep on their back in the pack n play. This resulted in an exhausted momma as I was up with them seemingly all night for months.
B: We stared bedsharing at 4am her first night at home after she was up every hour in her crib. I haven't even attempted putting her back in her crib for nighttime and don't plan to. She takes naps in the Moses basket, in her vibrating chair, on my chest or wherever she will continue sleeping.  I've swaddled her about 5 times and apparently suck at it now as she Houdini's herself out each time.

Getting out of the house:
L: I specifically remember calling my mom when Lukas was about 4 weeks old in tears because I was going stir crazy. I had this tiny baby, in winter, and I was too scared to take him anywhere or do anything, but I was so alone and bored and a little loony.  She told me to put him in the car and drive the 35 minutes to her house. This "outing" saved my sanity!
B: We have had a few weeks staying inside the house but we get out much more than I did with the boys. Yesterday we drove the boys to school, went to the post office, grocery shopped and picked the boys up from school. Admittedly, it was a bit too much in one day with a 3.5 week old.

Noise level:
L&J: I never tried to keep a quiet house with the boys, but I didn't love the dog barking or loud noises that might wake the baby.
B: With two rowdy boys, a dog, cat and two adults, there is no silencing the noise. But this time around, I encourage it and purposely have vacuumed around Bridget while she sleeps in her lamb chair on the floor. If the baby can sleep through the loudness of our house, she can sleep anywhere!

Although, there are a few things that I'm arguably more crazy about:
Head position:
L&J: I didn't worry at all about how much time they spent on their backs or in the car seat. L turned out fine, but if you'll recall, J had that lovely 4 month period in a helmet to correct his flat head.
B: Todd and I are both hyperaware of which side Bridget favors.  She likes looking to her right, so we are making sure she doesn't spend too much time on her back looking right. I've done a few of the physical therapy exercises we did for Julian's torticolis and she sleeps on her side often so hopefully we'll avoid the flat head syndrome this time around.

Wet diaper count:
L&J: My biggest concern with their peeing was try to prevent getting peed on!
B: I get more excited over wet diapers than one would think possible. Better yet, I'm like a cheerleader on crack when she pees while I'm changing her.  Pee means at least one of her kidneys is working, so we are cheering on the peeing.

L&J: With L I wasn't concerned with germs at all. I'm not a germaphobe and it didn't really occur to me to do be concerned even though he was born in winter. I mean, we washed our hands and had visitors use hand sanitizer but it wasn't on my radar.  Julian was born in summer so germs, the flu and RSV weren't a huge threat.
B: I think I've lost my mind. The boys come home from school and immediately strip off their school clothes, go straight to wash their hands and then put on clean clothes.  No one is allowed to touch Bridget's hands (because a baby's hands go directly IN their mouth) and I'm not a big fan of others holding her. The only positive side of her on the prophylactic antibiotic is that hopefully it will prevent her from getting any nasty winter germs!  Oh and it's making sure she doesn't get a kidney, bladder or urinary tract infection, so I suppose there are multiple positives.

I love being a mom of 3. I have had crazy thoughts of having a fourth but my sweet husband has assured me that I'll need to find a new husband to make that happen. And well, I like my hubby, so I guess we're done.  Unless we're not. I mean, we are. But one more would be so sweet. But insane. Definitely done. I think.

Wednesday, January 20, 2016

Kidney Tests

Sweet Bridget will be two weeks old tomorrow (in case you missed it and are curious, you can read her birth story here). We are all loving having her here and she is getting spoiled daily. The combination of our first girl, our last child (I think...) and her precarious health condition have lead me to truly enjoy the newborn phase with her. I'm not normally a fan of this stage, but I am relishing our days laying on the couch, co-sleeping at night and bonding while nursing. My recovery this time around has been my easiest of all three kids so that is probably contributing to my postpartum bliss.  Although the baby blues definitely come and go and I've had a few random bouts of tears which are making my husband think I'm going a little crazy.  I remind him that it's my hormones. Always blame the hormones!

So I haven't given an update on Bridget's kidneys because we unfortunately don't know anything more yet. She had an ultrasound the day she was born and our pediatrician said that it confirmed what we already knew. I didn't press him on this because he's not the specialist and I had given birth a mere 5 hours earlier and wasn't thinking too clearly.  Bridget's abdomen has looked distended to me since birth and one of the nurses even commented on this, but when I asked our pediatrician he didn't express concern. Bridget started taking a prophylactic antibiotic the day she was born because there is a risk of infection due to the urine that is backing up in her ureter(s) and left kidney. She will continue taking this until the urologist can determine it is not needed.

As for the next steps, we are scheduled to go up to Atlanta next Thursday for her first round of tests. I believe she will be having three tests, but I only know two of them. She'll have another ultrasound which should be able to more clearly show what is going on compared to the ultrasounds that were done on me while I was pregnant.  She will also have a VCUG which will show us how well her kidneys, ureter and bladder are working. All I know is that it will involve Bridget getting a catheter and getting x-rays. The whole thing makes me nervous so I haven't spent much time researching the procedure other than finding the link for this post.  And to be honest, I haven't read through the link. At this point, ignorance is bliss. I'm already nervous for Thursday and figure I don't need the extra anxiety of knowing exactly what will happen to B.  I also don't know if we'll meet with the urologist to go over the results that day or if we'll have to come back up for a follow-up appointment. But hopefully within a week or so we'll have an actual diagnosis and treatment plan. We know it is almost certain she needs surgery, we're just hopeful it is minimally invasive and can wait until she's at least six months old.

Aside from her round belly, Bridget looks completely normal and perfect. Our pediatrician referred to her as perfect at her first checkup. She is peeing regularly so we know at least one of her kidneys is working properly. But the fact remains that she has a birth defect. And until we know the extent of the issue, my mind can't help but worry every day. When she cries uncontrollably I worry she's in pain. When I look at her belly I am reminded that while she looks perfect, her insides tell a different story.

I am praying for the best possible outcome next week. I don't even know what that means, other than Bridget getting to live a full, long life.  She is such a sweet baby and I am so blessed to be her mom.  Thank you all for the continued prayers and inquires about how she's doing.  As soon as we know more, I'll update everyone. Until then, please continue praying for her health and our strength as we navigate this next phase.

Ok, time to snuggle with my sweet girl.

Saturday, January 16, 2016

Welcome Bridget Starr

I am thrilled beyond words to announce the arrival of our daughter, Bridget Starr! She was born a week and two days ago and we are so utterly in love with our sweet girl.  It feels as though she has always been a part of our family. The boys adore her and she's already acquired the nickname "Bridgey" from her brother Julian. Our family is now truly complete. 

Here is her birth story:

Date of Birth: January 7, 2016 @ 11:29am
Original Due Date: January 14, 2016
Weeks Pregnant: 39
Baby's Weight: 8 lbs 4 oz
Baby's Length: 20 in

We learned back at my 37 week appointment that my MFM recommended that I deliver Bridget at 39 weeks. He had told us he didn't want me to go past my due date, but the notes he sent to my OB recommended that I be induced at 39 weeks if she wasn't here by then. While this was disappointing to me since I wanted to have a natural birth with no interventions, I also realized that I was lucky to have made it this far with my pregnancy given Bridget's kidney defect. So I tried to make peace with the likelihood of induction, but still hoped I would spontaneously go into labor on my own.

Over Christmas I thought things were starting.  I lost my mucus plug on Christmas Eve and was worried she'd arrive that night and I'd miss Christmas morning. Thankfully she stayed put. I then got the stomach bug the weekend after Christmas and prayed she would sit tight until I was over that awfulness. Again, thankfully she stayed put. Then on New Year's Eve at my 38 week appointment my OB checked my cervix and without warning swept my membranes trying to move things along.  She knew I wanted to avoid pitocin, so I think she figured a membrane sweep was the least invasive intervention that might get things started. I would've liked being consulted before this happened, but it is what it is. This is when the fun false/prodromal labor started. For the next week I had contractions daily, sometimes for hours on end.  And Sunday afternoon, January 3rd I was convinced the real deal had started. 

Sunday, the 3rd, I walked 2 miles in my neighborhood in the morning. Then we took the boys to the Museum of Arts and Sciences here in Macon. As we sat in the planetarium watching a show about the life of a star I noticed I was having consistent contractions. I didn't start timing them for a few hours, convinced it was just more false labor. But as the evening went on, it was clear they were there to stay. Todd and I went for another mile walk and while we were walking the contractions were coming about 2 minutes apart and were quite intense. We got back to the house and I called my doula asking her advise. She suggested we eat dinner, give it an hour and see if they stuck around.  So we ate, put the boys to bed and eventually headed off to L&D around 7:30pm.  Contractions were still coming about 3-4 minutes apart and lasting 60-90 seconds long. Yet they weren't painful. We got assessed at the hospital and I was 3cm and 60% effaced, with contractions registering every 8 minutes.  Of course, on the ride to the hospital I noticed the contractions slowing down, but we went in anyway. The nurse said they wanted to monitor me for an hour and then decide what to do. I made it clear that I did not want to be admitted if I was not in active labor and that sitting in a hospital bed for an hour was not something that I intended to do. So we were allowed to walk the floor for 45 minutes and come back to see if things had progressed. An hour later, nothing had changed. So my midwife agreed that I could go home.  I was embarrassed that we'd even gone in to the hospital, but glad we were not being kept unnecessarily. So off we went home and I was able to go to sleep for the night.

Monday, Tuesday and Wednesday brought more contractions, but nothing consistent. On Wednesday I made one last ditch effort go get things going on their own. I walked miles around my neighborhood, drank red raspberry tea and applied clary sage EOs to my belly, hips and ankles (something that supposedly can get labor going). But by late Wednesday night I accepted the fact that we were heading for induction the next day. My doula called that night to talk things out. She said the hospital would likely have me arrive at 11pm Thursday night to start the cervadil and then depending on where things stood Friday morning they'd go from there. So I went to bed assuming we'd have all day Thursday to try to get labor going on its own. 

I was jolted awake at 5:30am Thursday morning by a phone call from the hospital telling me to arrive at 7am!  This was surprising since I thought I wasn't going to go in until that evening!  I quickly took a shower, ate some eggs and finished packing our hospital bag. Julian woke up so I was able to get some snuggles in with him and then we woke up Lukas to tell him we were leaving.  The boys were groggy and I was a little sad to leave knowing they wouldn't be getting my full attention once their sister arrived. 

So Thursday morning we arrived at the hospital and checked in. I was sad that I wasn't going to have the birth experience I was hoping for and a little on edge. The nurse checked me and I was 3-4cm and 60%. So not much change since our trip to L&D that Sunday, which was discouraging - I had hoped the prodromal labor contractions were doing something! And thankfully the monitors were picking up contractions, so things were happening. My midwife knew I wanted a natural birth, so rather than starting with pitocin, she agreed to break my water and give me 3 hours to see if things would start on their own. 

My water was broken at 9:15 and things moved FAST! My awesome nurse, Karla, suggested I try nipple stimulation to get things moving as it sends natural pitocin (aka oxytocin) signals to your body. So I got up and walked laps around the room whilst rubbing my nipples. It was surely a sight.  But it worked! Almost immediately contractions started coming regularly and within thirty minutes I went from chatting with Todd to having to concentrate and breathe through each one. 

My doula, Mandy, arrived around 10am. I was still jovial when she arrived and excited that things were progressing. But that didn't last long. I wasn't able to continue standing once the contractions really kicked in. So I sat on the hospital bed with my back straight and my legs criss-crossed and knees pointed down at the suggestion of Mandy. Contractions were intense and quickly were one on top of each other. Mandy and Todd helped me breathe through them, each sitting on either side of me holding my hand. As a contraction would hit I closed my eyes and zoned out for each contraction. The hypnobirthing classes I took during my 1st pregnancy 5 years ago for Lukas definitely helped keep me relaxed. Todd, Mandy and Karla talked about Todd and my love story which kept me entertained in between contractions. Or at least distracted! 

By 11am I had the urge to throw up and felt a lot of pressure around my bum. Apparently these are sure indicators that things are moving along, but it was also the time I absolutely lost it and was convinced I couldn't continue but I was in transition at that point and there was no turning back! Mandy looked at me and said "You can do this. You ARE doing this!" And she said that within 3 hours I'd be holding my baby. She meant this to be encouraging but I looked back and said there was NO way I could do this for 3 more hours!  Thankfully we didn't have to wait that long. 

My whole body began shaking uncontrollably and I was feeling the need to push.  Karla checked my cervix and there was a lip that wasn't moving, so she told me to push once and she helped move part of my cervix back that wasn't moving because of the baby's head. This helped get me to 10cm and suddenly it was time to push. The midwife wasn't there yet, and Karla had another nurse come in the room to be a second set of hands in case she needed to deliver Bridget! Let's just say I was a vocal momma bear during pushing and I feel sorry for anyone that could hear me. Lots of F-bombs and a few "get her OUT!!!!!" yells may have happened. Along with some other choice words. But in only three contractions she was out! Somehow I didn't experience the ring of fire and had no tearing!!! And the sense of relief once Bridget was out was immediate! But holy hell it was intense. 

Bridget was born at 11:29am - under 2 hours from the start of real contractions to finish with no pain meds! It felt great to not be drugged afterwards and I was shocked that I actually did it. And this recovery has been much easier than the first two. We only stayed in the hospital 24 hours and are all happy to be home.  (And as a fun sidenote, my mom was here helping us with the boys when Bridget was born. She was blow drying her hair and suddenly all the power in the house blinked off.  She had to reset the clock in the kitchen and looked at her phone to find out the power outage happened at exactly 11:29am! How cool is that?!)

I'm thrilled our baby girl is here. She is a sweetheart and we are completely wrapped around her finger already. She is peeing great so we don't have to do anything immediately with her kidney. We are scheduled to go to Atlanta for her first round of tests on January 28th, so we'll know more then.  But for now we're just loving on our newest addition!