Specialist & Ultrasound

Like I mentioned last week, when I went for my follow-up ultrasound last Thursday, the doctor was concerned enough about Jacob's right kidney to suggest that I see a specialist.  Luckily, the specialist - Dr. T. (his "real" last name is really long and hard to pronounce!) - was able to fit me in for Friday afternoon.

When we first got called to the back at Dr. T's office on Friday, an ultrasound tech performed a regular ultrasound.  She was very friendly and talkative and even at one point said, "this doesn't look that bad.  If I were your doctor, I wouldn't have even sent you here".  Of course, she is a high-risk OB technician, so she is used to seeing a lot of really bad stuff.  To me, this comment was both reassuring and sort of dismissive on her part, but I tried to concentrate on the reassuring side of it.  

Once she was done, she said that Dr. T would be in to review the pictures that she had taken and also to look at the baby a little more.  Not much longer, he came in and he was very friendly.  He did look at what she had done and then proceeded to move the wand around my belly and look at Jacob a little more closely.  He pointed out both of Jacob's kidneys to us and took measurements, similar to what the technician had done.  He also looked at Jacob's heart, brain and stomach and explained that sometimes "issues" arise in these areas later in pregnancies and he wanted to look closely at them to be sure everything looked OK.  He assured us, though, that everything looked great!  He asked me to clean up (all that goopy stuff that they use for ultrasounds really makes a mess!) and then to come to his office so he could explain things to us.

Once we got to his office, he asked us what my OB doctor had told us about Jacob's kidneys. When we told him the little information that we knew, he proceeded to go into great length and specifics about what is going on.  He explained everything marvelously and even drew a picture so we could understand it better.  Basically, long story short, Jacob has a dilation of the area where his kidney meets the urethra (which is the tube that connects the kidney to the bladder). This dilation could be caused by four different things: 1. the urethra opening where it meets the kidney is not large enough, 2. the urethra opening where it meets the bladder is not large enough, 3. there is a "reflux" of urine that is splashing back into that area when his urine is passed through the urethra to the bladder, 3. his urethra is bifurcated (split) and he has two urethra instead of one.

The chances that it is #4 is very slim.  There is a better chance that it is #1, 2 or 3 and in all cases, it could correct itself over time.  He explained to us that Jacob's case is a very mild case as the "standard measured dilation" for cause for alarm has changed in recent years from 7 cm to 10 cm (and Jacob is measuring 9.5 cm). He said that he has seen a lot worse and he didn't seem overly concerned or think that this was going to be a huge problem in the future.

However, he does want to see me back for another ultrasound in three weeks so he can measure the dilation again to see if it is growing or if it is "fixing itself" (as many do over time). He would also like me to see a pediatric urologist named Dr. Peters after I have the next ultrasound.  He said it would be good for Dr. Peters to review the ultrasound pictures that he takes in three weeks so that he can give our regular pediatrician suggestions as to what needs to be done when Jacob is born. Dr. T said that the worst thing that can happen is that the baby would get a kidney infection which can cause severe damage to a newborn or infant.  He said that it doesn't take long for a kidney to fail in small children when they have kidney infections. So, our pediatrician will need to monitor Jacob carefully for the first year whenever he gets a fever or becomes ill.  Dr. T also explained that if surgery needed to be done to correct this dilation (if it doesn't correct itself over time), that this surgery wouldn't be done until Jacob was at least one year old.

So, all in all, even though this is still a scary and unknown thing, talking to Dr. T really put us more at ease.  I am glad that he is going to do another ultrasound to see how things are progressing.  Of course, the best news would be that the dilation is reducing on its own and then we have nothing to worry about.  But, if not, I do believe that between Dr. T and Dr. Peters, they will be able to tell us the best course of action and will make sure that Jacob is cared for properly once he is born.

Thank you for your continued thoughts and prayers.  We know that God is in control and that he is watching over us and our precious baby.