A Tough Day

Kelly checked into the hospital this morning and is resting comfortably. She is in no pain whatsoever, and we are assured that there is no risk to her greater than that of a normal pregnancy. She is also not on bed rest and is even able to wear her civilian clothes as opposed to the hospital issued gowns. She is free to move about the floor and the hospital as well; they just want to keep her close for observation since the amniotic fluid is gone. Low fluid can cause umbilical cord compression which can seen through a drop in the heart rate. The good thing he has going for him now is that is heart "looks great," as the doctors said.

We saw the high-risk OB - MFM (Maternal Fetal Medicine) doctor this morning, as well as one of the doctors from her primary practice. No hiding it, they are not optimistic like they were before. We had several discussions about end-stage renal failure, as well as dialysis. It was a shock to us, but not completely unexpected given the results of the last ultrasound. The doctor from her practice is typically light-hearted and tries to give hope when he can. I didn't see that side of him today. I saw a person who was obviously concerned for the baby as well as how we were dealing with it.

The plan for tomorrow is to have a discussion with the pediatric urologist that we saw before our first visit to Cincinnati, as well as a neo-natologist to discuss the matters of our greatest concern.

The first, and foremost, concern is lung development. We believe there was fluid up to, or at least very close to, 24 weeks which is of the up most importance. The period of gestational time prior to 24 weeks is a stage in development where lung development will simply never happen if there is no fluid. We may have cut it awfully close on that one, but we may have dodged that bullet. The fluid levels have been up and down since then but there has been fluid and she also received a sequence of steroid injections at 26 weeks. The purpose of those injections is to push the lungs along in the absence of fluid or the presence of low fluid. She also got another steroid shot today and will get one the next two days.

The second concern is the kidneys. Both kidneys are being force fed fluid by the bladder because the ureters are dilated from the pressure. If this were to happen to you or me, meningitis would be a typical result because of the infection. He is being protected by Kelly right now but, if this condition continues, his kidneys will certainly begin failing.

The third concern, which is what we had on our hands already is the bladder. It has been dilated for extended periods of time, causing the walls to thicken and become more muscular. That is not a good thing because intead of decompressing evenly like a ballon, it is decompressing like a crumpling piece of paper; unevenly in both size and pressure. It's possible that its new found strength was enough to force through the valves in the ureters, causing the fluid to go back to the kidneys. This is not that big of a deal compared to the lungs and the kidneys. As long as they can clear the obstruction after birth, the fluid will get out.

So, how do we get to there from here? We find out on Monday. We are going to have the mother of all ultrasounds that will be used to measure his chest cavity in relationship to the size of the heart (to check for lung development) as well as a detailed look at the kidneys. Once the doctors get the data from that, we are going to get everyone in a room and talk about delivery dates. Yes, the lungs have to be properly developed but they may not be able to do much for him if he comes out too early and the kidneys have failed. The options they can offer us to help the kidneys only come into play after he has reached a certain gestational age and weight. What that is, I do not know but I am sure I will find out soon.

I sent out an e-mail this morning with Kelly's contact information at the hospital. Obviously I can not share that here, but if you did not get it, shoot me an e-mail at john.carlson06@gmail.com and I can let you know how to get a hold of her.

Despite what we found out today, we are still hopeful and determined. We've been on this roller coaster for ten weeks now but we are not giving up. We will do what ever it takes to get the best shot at life, as long as we are still here to do it.

Unexpected Turn of Events

The situation with Kelly and "Little Dude" has unfortunately gotten worse. At the ultrasound today the doctors noticed that the shunt is out and that the ureters between the kidneys and bladder are dilated to the point where they are allowing the bladder to force fluid back toward the kidneys. So the fluid is backed up like before, but now it is now spread across the bladder and kidneys instead of just the bladder. They also noticed that the kidneys are brighter and dilated (echogenic is the medical term used), causing concern for their long term future.

They consulted with the doctors in Cincinnati who do not feel like another shunt will be effective due to the situation with the bladder and kidneys, so another trip south is not in the plans.

With that in mind, and the fact that there is no amniotic fluid left, the doctors here have advised that Kelly be admitted to the hospital for the duration of her pregnancy (another four to six weeks). She hit 30 weeks yesterday, but they are concerned that he would not fare well if he were born now. She will check into Meriter tomorrow morning.

So, the baby is going to get some super special care the next few weeks and we will be consulting with doctors across more specialties than I can keep straight in my head. Hopefully we can come up with a good solution; it's unfortunately come down to a race against time.

I will update people individually with her contact information at the hospital; if you want to get a hold of her there, please e-mail after tommorow morning and I will let you know how to get in contact with her.

I will also update the blog daily, if possible, to keep everyone up to speed. Stay tuned; it is definitely going to get more interesting.

Keep up the good work, Little Dude!

Today's amniotic fluid check was pretty close to the last one. The total volume is 1.9 cm, which is slightly higher but essentially the same as Friday (which was 1.7). The slight difference today is that they noticed one decent pocket and two small pockets of fluid, as opposed to just one on Friday. Hey, we will take whatever we can get!

We also talked to the doctor about delivery dates, and the plan is to try to get as close to 36 weeks as possible. If the fluid stays the same, or gets better, that is what we will shoot for. If it goes away completely, then we get into the pre-term delivery discussion. The goal is to get him as well-developed as possible to reduce the number of issues he has when he is born. We would all prefer to just deal with the bladder/kidney issues than other pre-natal problems that could arise if the baby was born too early. So the plan for now is to hold on and try to get as far along as possible. If you are curious, 36 weeks is Thursday, March 12th.

The next appointment is Friday, at Meriter Hospital, where we will "tour" the NICU (Neo-natal Intensive Care Unit) and visit with a neonatlogist. That same day we will also get another fluid check and the pediatric cardiologist will take a quick look at the heart as a follow up from the last visit.

So for now, we are grateful for another week and we wait to see what comes out of the visit on Friday.