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.