Friday, February 28, 2014

Causes: My Daughter has Vesicoureteral Reflux (VUR)

As part of my Causes series and in honor of Rare Disease Day, I am sharing Carlee's Vesicoureteral Reflux (VUR) story.  I found Carlee's mom, Morgan, on Instagram by searching #Neocate when we were considering switching Myra from breast milk to an amino acid based formula due to her own rare disease.  As a mom of a child with a rare health condition myself, I can completely relate to the lessons she has learned.  I loved reading their story and I am so glad Morgan was willing to share it.


Every parent says “We don’t care if it’s a boy or a girl as long as we have a healthy baby.” But what if you don’t have a healthy baby? What if from day one your precious little bundle of joy is sick? In and out of hospitals and doctors offices and you don’t have a clue what is going on? What then?
Our daughter, Carlee, was born full term and even though I ended up needing an emergency c section, she seemed to be happy and healthy. We were sent home 2 days later and everything seemed perfect. 

When she was 7 days old she became extremely lethargic, refused to eat, and had blood in her stool. Carlee spent the next 5 days of her life undergoing tests and being monitored very closely at our local Children’s Hospital. The doctors couldn’t seem to agree on what could be causing the lethargy and bloody stool. All of the tests came back fine and she seemed to be getting better. They switched her to a new formula, Nutramigen and diagnosed her with protein intolerance. We were sent home. We took her for weekly weight checks at her pediatrician’s office. She was still not gaining weight and still had blood in her stool. We were referred to a GI specialist who immediately prescribed her Neocate formula. The Neocate worked wonders and our little girl finally started gaining weight.

When she was 4 weeks old her doctor noticed that her kidneys felt a bit swollen and sent us for an ultrasound. She was diagnosed with Hydronephrosis (a backup of urine that causes the kidneys to swell) and referred to a pediatric urologist. At this point I was freaking out. I had no idea what Hydronephrosis was and what this meant for my baby. Of course I did what every nervous mom does and searched the internet for answers while we waited for her Urology appointment. I found very little and that only made me more anxious.
At 3 months old, Carlee’s Urologist sent her for a test called a VCUG (Voiding Cystourethrogram). A VGUG is an X-ray that helps determine the bladder capacity and emptying abilities. A catheter is inserted so dye can be injected. As the bladder is filling with this dye, X-rays are taken. The catheter is then removed and additional X-rays are taken while she urinated. Once the bladder is emptied, a final X-ray is taken. The entire test takes approximately one hour. – Now imagine all of that happening to your precious 3 month old who is scared out of her mind. It was awful and unfortunately it was the first of many.
The VCUG showed that Carlee had Vesicoureteral Reflux (VUR), also known as Kidney Reflux. VUR is the abnormal flow of urine from your bladder back up the tubes (ureters) that connect your kidneys to your bladder. Normally, urine flows only down from your kidneys to your bladder. She also had a duplicated ureter, which meant that she had an extra tube connecting her kidney and bladder that should not have been there.
VUR increases the risk of urinary tract infections which, if left untreated, can cause serious kidney damage. Other complications include hypertension and kidney failure. While some children outgrow this, some need surgery to cure it.  
When I heard this news I was at first relieved that we finally had an answer, a name to call it. Then, I was so upset that there was something wrong with my little girl that I couldn’t fix. I could cuddle her, love her, sing to her, feed her, change her, and none of that would fix this. I was completely dependent on what the doctors could do.
Carlee was prescribed an antibiotic to take daily to prevent possible infections. The plan was to pray that she would outgrow this as she got older. She would have tests every 3 months to monitor the condition of her kidneys and to see if the VUR got better or worse.
I am the type of mother who needed to know everything about this condition in order to get through it. I searched and searched for more information to better understand VUR and duplicated ureters. I only found medical mumbo jumbo articles that didn’t make any sense to me. I needed to know what was in store for my daughter and what we do if she doesn’t outgrow it. I finally found the support I needed in several Facebook groups for parents going through the same thing. I talked with several mothers who seemed to be experts on this and relief washed over me. My daughter was not the only one dealing with this. This was not something I would have to go through feeling we were alone in this journey. Over the next few months I learned so much about VUR from hearing other people’s stories.

Carlee was the happiest baby. Even through all of this she always had a smile on her face. She was beautiful, smart, goofy, and most of all strong.



Right after her 1st birthday she started getting sick. Her pediatrician said it was a cold and sent us home. This was nearly 9 months after her diagnoses so I figured it probably was just a bad cold.  Tylenol and Motrin were not helping her fever. The next night her fever sky rocketed and she started shaking and staring off into space. She wouldn’t respond to us and we called an ambulance. We chose to go to our local ER because it was closer than the Children’s Hospital. The ER doctor…..how do I put this….well he was an idiot. He didn’t even know what VUR was. Told us that what definitely looked like a seizure to me was just “the chills” and sent us home. Her fever went back to normal so we went home and hoped she would rest and be better the next morning.
She wasn’t better the next morning and we took her to the Children’s Hospital. After we told them her history with VUR they immediately did a Urinalysis. Since she wasn’t potty trained being only 12 months, they had to insert a catheter to get a sample. My poor baby had to be held down because she would not be still. I felt awful because she was so scared but I knew that it needed to be done. The results came back a few hours later and she did in fact have a UTI (Urinary Tract Infection).
Now I’m freaking out (in my head of course so I don’t upset Carlee.) Does this mean that the antibiotics that she takes every single day are not working anymore? What do we do now? Why does she all of a sudden get a UTI after 9 months of having no problems? Nothing made sense.
She was put on another antibiotic for 10 days to fight the infection and sent home. She seemed to get better. Her fever was gone, she started to eat better and seemed more like herself. After she was finished with the 10 days of antibiotics we were told to put her back on what she had been taking daily to prevent infections.
One week later it all started over again. High fever, not eating or drinking, and Tylenol was not helping. We called her Urologist and were sent in to test her urine again. She had another UTI. That makes 2 in less than 20 days…
She was given yet another antibiotic and we were told to call if her fever did not go down soon. She wouldn’t eat or drink. She wouldn’t play with her toys. All she wanted to do was cuddle with mommy or daddy. She started throwing up every time we gave her the antibiotic. We called her Urologist and he said to come in right away. He wanted her admitted for IV fluids and antibiotics. She spent 2 days in the hospital confined to a crib/bed because of the IV. It was heartbreaking but I knew all I could do was be strong because that was the only option. Once she started eating and drinking again we were finally able to go home.
 
A month later she had another UTI. Her tests were moved up and a DMSA test was added to evaluate kidney function. The tests showed that her Hydronephrosis and VUR were both getting worse. Her left kidney had some scarring and her right kidney had decreased function. Now remember those support groups I was a part of? I knew the minute I heard this that she was going to need surgery. It still did not make hearing the doctor say it any easier though. We were given 3 options:

1.    Give her more time. Stay on antibiotics and keep praying that she would outgrow this on her own. (The doctor said this was very unlikely at this point but that he would give her a little more time if that’s what we truly wanted.)

2.    Deflux, a minimally invasive outpatient procedure, a gel material is injected around the ureter opening to stop urine from flowing back up. (50%-60% success rate for her grade of VUR and it was likely that she would need a second Deflux procedure)

3.    Ureteral Reimplant, open surgery where the ureters are re implanted into the bladder to correct reflux. (93%-98% success rate, 2 day hospital stay, 2-3 week recovery)

How does a parent choose? I trusted her doctor completely and knew that we couldn’t just wait and see if she outgrew this for any longer. We needed to choose between Deflux or reimplant surgery. We loved the idea of Deflux since it was an outpatient procedure but we didn’t want to have to put her through that twice. Even then the success rate was low. If it didn’t work she would need the reimplant surgery anyways.
We hated thinking about our baby girl having such a major surgery like the reimplant but it really seemed like the best choice for Carlee. It was going to be extremely hard but we knew it would be worth it in the end. She would be VUR Free and she wouldn’t be in and out of the hospital anymore. Nearly every VUR parent has to make this decision at some point and there is no right choice. Every child and situation is different.
When Carlee was 16 months old we walked through the hospital doors scared out of our minds. How were we supposed to hand our daughter over to these doctors and nurses and trust that they would bring her back to us? I know it sounds dramatic but when you are a parent in that moment that is what goes through your head. The hardest thing I’ve ever had to do is watch my little girl fall asleep under the anesthesia and then leave her.
The surgery was supposed to take 2-4 hours. It ended up taking close to 7 hours, 7 of the longest hours of my life.

 
The surgery went great and we went home 3 days later. Carlee was such a trooper. The day we got home she went right back to playing and running around. She still needed pain meds for a good 2 weeks but she bounced back faster than any of us thought she would. Kids surprise you.
On February 28th 2013 (one year ago today) she had more testing to see how well the surgery helped. Carlee was VUR FREE!!
Right before Carlee’s 2nd birthday she had one more ultrasound scheduled. We were not expecting to hear that while her VUR was gone, one of her kidneys had healed too tightly and was not draining completely. She needed another surgery. The doctor needed to place a stent so that her kidney would drain completely. It was a very short 10-15 minute surgery and the stent would be removed 6 weeks later. She had the surgery a week later.
We got home that afternoon and Carlee was in horrible pain. She was having bladder spasms and would not urinate because it hurt so much. We called the doctor and he prescribed something for the spasms. It did not help. Her body was completely rejecting the stent. Two days after it was placed the stent was removed. We spent another 2 days in the hospital because my sweet girl was so traumatized by the painful urinating that she refused to go. She held it for so long that the nurses had to drain her bladder with a catheter several times. The Urologist and I had a serious talk and he explained that if she kept holding it for so long it was going to continue to hurt when she released it because her bladder was being stretched. If this continued I would have to learn to use a catheter to drain her bladder at home.  We decided to take her home where she would be more comfortable and relaxed. We hoped that this would help her get back going more often. She did better after about a week.
Last month, we had more testing to see if the stent helped even though it was only in for a few days. We got the greatest news ever. Her kidneys are draining and her bad kidney has increased in function! We don’t have to take her back for more testing for an entire year. How amazing it was to hear that! After 2 years of this hell it is finally over. My little girl can finally just be a happy and healthy little girl and not go through tests all the time.

She still associates going pee with pain sometimes. We are still working with her on that. Otherwise she is a normal 2 ½ year old. She is my crazy, bossy, sweet, funny, smart, strong, loveable little girl. And I would do it all over again for her if I had to.

I have learned so much in the last 2 years.

I have learned nearly everything about a kidney condition that I didn’t even know existed before. I’ve learned that no matter how bad you think you have it, there is always someone else out there that is dealing with more than you are. So be thankful for what you have even if it’s not very much. I’ve learned that being a mother changes you completely, and being a mother to a child with health issues changes you even more.  I’ve learned how lucky we are to have so many friends and family there for us along this journey. I don’t know what I would do without them.

Thank you for reading our story and for the opportunity to share it. If your child is dealing with a kidney condition or any health problems, remember that you are not alone.
      
          “Sometimes heroes reside in the hearts of small children fighting big battles."


(Carlee with her little sister, Sophia.)

You can find Morgan on Instagram at mommyoftwo72049

 

7 comments:

  1. Wow! My sweet 3 month old boy was diagnosed yesterday with VUR. level 5. My heart is broken. Your blog helps shed some light on what we may be up against for the next few years. I'm so so scared.

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    1. Hang in there! Any diagnosis can be a challenge--I'm glad you've found some information that might be helpful. This was a guest post done by a friend and I let her know about your comment as well. Hugs!

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  2. So thankful she is doing better. My 10 month old spent the first 4 months of her life crying all the time. First treatment for UTI was at 2 months of age, antibiotics cause her to have watery stools and got dehydrated. Went to emergency room where she had her 2nd catheter done in just a weeks time and given a iv for dehydration and antibiotic through iv. Went home she was feeling great for about 2 weeks. Again started getting fussy and wanting to do nothing but cry, still no fever nothing. Dr thought to change her milk so we did. Then one night i went to check on her before going to bed and touched her head and she was burning up, woke up my husband cause my baby girl was just spaced out, wouldn't respond to anything. Rushed to the emergency room but made it 10 minutes down the road and she was getting worse. Pulled into the fire station and they called an ambulance to come get her. Another catheter, and iv she had another infection. Did the test with the x-ray and catheter and the dye stuff. Found out she had grade 3 in right kidney only. She has been on daily dose of antibiotics since and has been the happiest baby ever. I just pray after reading your story your little one stays healthy and the antibiotics don't stop working for my little one. I cried the whole time reading this story cause I know the feeling of having your baby look up at you and beg with those eyes and tears to make the Dr's stop.

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  3. Hi
    My son is also having grade 4 reflux. did a scan but shows no scarring. he will be moving on to foods soon. what kinda diet did you maintain for your child. please advise. million thanks.

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    1. No special diet is needed due to kidney reflux. Water water and more water never hurts though! There is a possible connection between VUR and constipation so if your son starts having that problem just increase fiber in his diet. Otherwise enjoy his first foods!

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    2. Hi Morgan..thank you for your reply..do you have instagram? my baby only has 1 kidney..still no advice from the surgical team..do i have to avoid potatoes or high potassium foods...every week i bring baby for blood tests to check his creatinine level...

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    3. So sorry, I just saw this! She does have Instagram @teachingmytwo - that's how I found her.

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