Medical Update - 8/25/09 (Part 1)

EYES

For some reason, children with SB tend to have trouble with their eyesight and so the docs typically want them checked out as soon as possible. I don't know if it is because of the neurological nature of SB, or because there is a connection to the hydrocephalus or if it is because they are typically put on ventilators right after birth (improper dosages of oxygen the first few weeks can even lead to blindness).

Annie had her eyes checked a few months ago for the first time. How they check an infant's vision, I have no idea. The wife flew solo on that appointment so you would have to ask her. The upshot was that she had a considerable astigmatism and was in need of glasses (great - one more thing, right?)

Well we had our follow-up appointment with a more experienced physician last week and he basically gave her the all clear. Actually, he first gawggled at how cute she is - then he explained that she probably has better distance vision right now than near vision but that in time she would follow her mother and have better near vision than far. No need for glasses so far. So that's good.

URODYNAMIC STUDY

**Warning! Pee-Pee-Poo-Poo Stuff straight ahead!**

The remainder of this post will use the words: Urethra, Rectum, Catheter, Electrodes, and possibly Anus if I am feeling up to it. You have been warned.

The urodynamic study is something that has been lingering like a black cloud of anxiety my mental horizon. First of all it's DOWN THERE STUFF and no one wants to talk about DOWN THERE STUFF. Second of all, it could result in a catheterization regime. YOU WANT ME TO STICK A TUBE UP WHERE??!!

Of course, it wasn't as bad as I had imagined it to be. First, the wee one was stripped down to her birthday suit and laid down on an exam bed. After some preparation, the doc inserted a tube into her urethra (the hole where the pee comes out) until the tube reached her bladder and urine flowed through the tube. Out came 30 ml. Check.

As it turns out, the tube (catheter) actually had two tubes inside it - one to pump water in and one to drain it out - we will get to that later.

Next the doc inserted a tube into the rectum and attached two electrodes - one to each side of the anus (THERE! I SAID IT!). By electrode, I mean the sticky patches with wires that they attach to your chest to monitor heart rate (only these were much smaller).

All the tubes and wires attached to a machine with a laptop computer. The nurse clicked the mouse and water started flowing from the machine, and up the tube into Annie's bladder. The computer monitored how much water was going in, and the pressure inside the bladder (blue line on the computer screen). The tube in the rectum monitored the pressure in the abdomen outside the bladder (red line on the screen). You subtract the red line from the blue line to get the actual pressure in the bladder (green line on the screen).

The electrodes monitored the muscle contractions (the ability to "hold it" when you want to).

The trick was keeping Annie still and quiet. If she laughed, giggled, screeched or sneezed, her abdomen would jostle and all the lines on the computer would go squiggly. When this would happen, the doc would click the mouse and mark the graph: Sneeze, Fussing, Talking and so on.

As would be expected, at some point so much water had gone in that it started to leak out - that's when the test was over.

Since Annie had lain so still and quiet (mostly) the doc had the time to do a second round so that she could take an average of the two. The doc attached a syringe to the outgoing tube in Annie's bladder and pulled the same amount of water out that had gone in. Then she fired up the laptop and the water started flowing in again.

Afterwards, we talked about the results. The doc recommended we start catheterizing but said we could wait on it if we wanted to. The doc also wanted to send down the initial 30ml of urine to the lab to have it checked for any signs of infection.

Details of the results to follow . . . I need a break from all this DOWN THERE STUFF for a while . . .