Friday, February 7, 2014

Another Kidney Surgery

Our three-and-a-half-year-old son had Deflux surgery in October, which corrected the urine reflux from his bladder back up to his kidney. The urologist was hopeful that the procedure would help reduce the swelling in the lower pole of his left duplex kidney, but that was not the case. The swelling remained, and even increased. The urologist said that it might happen, mostly because the Deflux makes the ureter's opening into the bladder a little tight. But we were hoping anyway, even though it was not the case.

The urologist's hunch was that there was also a "ureteropelvic junction obstruction." In layman's terms, something was blocking the ureter so urine couldn't drain from the kidney. The "meat" of that kidney was shrinking, so the fear was that my son was losing kidney function. Fixing it, however, required more extensive surgery.

On Wednesday (February 5), my son went in for more surgery. The urologist is sooooo great. After my son was under general anesthesia, he did more tests to see what exactly was going on so he could know how to fix it. His hunch was correct--a weird blood vessel was located at the top of the ureter, blocking the urine from exiting that kidney.

If you're squeamish, you might not want to read the rest of this post: Just be warned, it'll get graphic...

It was a four hour surgery! Oh, the waiting was torture! Thankfully the O.R. team called often to tell me how things were progressing. But those four hours d--r--a--g--g--e--d by. But God was in that O.R. with my littlest guy, and He certainly guided the surgical team's hands!

The urologist detached my son's ureter, flipped it around so it wasn't in the way of that blood vessel, then reattached the ureter back together. He put in a stent that runs all the way from his kidney to his bladder to support everything while it heals.

I just can't say enough good things about my son's urologist. He came in to talk to us before the surgery, he even said to my older son, "I promise to take good care of your little brother." He came back to see us while my son was in the recovery room to explain how things went, what all he did to fix it (he even drew pictures to help us visualize the process he used), then he went back to my son in the recovery room to keep an eye on him. He was able to fix it all robotically, but part of using robotics is that air is pushed into my son's insides to keep everything in place while the work is being done. My son had an air bubble in his abdomen after the surgery that needed to be massaged around, and the urologist was careful to make sure it was done correctly.

After we were settled into the room where we'd stay overnight, the urologist came back to us AGAIN to check on us and make sure my son was stable.

A side effect the anesthesia is that it's hard work to breathe well. That, and the pain in the belly from all that surgery makes it generally painful to take more than a shallow breath. My son's oxygen levels went low, so a respiratory therapist came in to give supplemental oxygen for a while.

Everyone at this Children's Hospital is really great. The nurses were all very quick to give my son pain meds (alternating Toradol and morphine), they checked his incision sites often (he's got three incisions on his belly area), and just generally treated him like royalty. Even the housekeeping people would tell him how cute he is (no argument from this Mama!), and make sure we were taken care of and as comfortable as possible.

He stayed in the bed pretty much asleep the whole night. He'd wake up and fuss occasionally, and the nurses would give him meds to make him more comfortable. I was allowed to stay with him all night--I didn't sleep much, though. Every little moan and groan coming from my son would wake me up!

He didn't move much during the night, so his face was swollen in the morning. It just hurt too much for him to move, and the Foley catheter had him tethered down so he couldn't really move much anyway. Once the catheter was removed and he was a bit more alert, we had him get up into a vertical position and get that facial swelling down. He drank apple juice and water, but didn't want to eat anything.

At first we were told he would be released to go home once he used the toilet. But once the doctor found out he hadn't eaten anything, we had to stay. The staff needed to see that he was holding down food before we'd be able to go home. So we ended up staying about three more hours until he'd eaten a bit of lunch (half a piece of pizza and a cookie was all he could manage).

We had a two-hour drive back home. I got his pain medication (Lortab) from a nearby pharmacy so we could give some to him before we drove. He seemed comfortable enough, and even slept most of the way.

Recovery is going to be slow. He is not allowed to do much for the next three days. He's not supposed to straddle anything, so carrying him is kind of difficult. He's walking v.e.r.y. s.l.o.w.l.y. when he does walk, but mostly he's hanging out on the sofa, watching Mickey Mouse. He can't bathe for three days, and even then he's not allowed to soak in the tub. Graphic alert: we are to expect blood and tissue in his urine off and on for the next two to three weeks. And even though I am expecting it, seeing it actually makes me scared and nauseous. Yeah, let's just say that's not a pretty sight, and it pretty much scares the snot out of me when it happens. He's not allowed any "strenuous play" for two weeks. Yeah right...easier said than done, but we're going to do our best!

We go back to the urologist for a follow-up office visit and ultrasound in a month. Then we have to schedule ANOTHER surgery to have the stent removed. So he'll have had three general anesthesia surgeries in 6 months. My poor little baby!! But the urologist is hopeful that this will fix everything for good. The next risk is that scar tissue will develop, blocking the ureter again. So we'll still be making regular visits to have that monitored.

Here's a photo of my littlest guy sleeping off the anesthesia with his extra oxygen. He's holding Mickey Mouse, who goes with him e.v.e.r.y.w.h.e.r.e. (He has to wait in the van while we're at Wal-Mart, but he gets held the very minute we get back in the van!) Children's Hospital here is so great about letting the kids take their "loveys" even into the O.R. with them. Mickey's been into two surgeries with my guy, he's been a good friend.