It Comes Out, We Go In

On Friday morning we woke up at six to get ready to go to the hospital to have Joaquin's supra pubic (that's the correct spelling I finally figured out) taken out. The scheduled surgery time was 8:30am, but it end up starting until around 9:30am - busy doctors, I guess. The removal went off with a hitch and he stayed in the recovery room for around an hour - enough time to wake up from the anestesia and show the nurses that he was urinating enough. We were then scheduled for an ultrasound at 3:30 to get good view of the kidney and see how it was doing. After that we were to wait for Dr. Sarwal to call us back and us the word on whether or not we could go home.

After waiting for quite a while, Dr Sarwal asked to speak to me on the phone after she had looked at the ultrasound images and consulted with the other doctors. I could tell by the tone of her voice that it wasn't good news. I wasn't worried that anything was wrong necessarily because Joaquin seemed like he was feeling good - while we were waiting he was crawling around on the floor and pulling himself to standing on some little people chairs in the ultrasound room. Dr Sarwal said that he had a bit of hydronephrosis, which is dilation of the branches and pelvic cavity of the kidney, caused by an accumulation of urine resulting from obstruction of normal outflow. Or in simpler terms: his kidney was a bit swollen and had a little more fluid in it then they woud like to see. Now, this is not too much cause for concern because the kidney had a bit of hydronephrosis before it even came out of me. See, when a woman is pregnant, her uterus tends to tip to the right and sometimes that right kidney is a little damaged because the uterus will lean on the ureter (the tube connecting the kidney to the bladder) and kidney and compromise the flow of urine and blood in the vessels. We had told Dr Concepcion ahead of time that we woul like to have more children down the road and so they take the right kidney because I would need the left kidney because that one is not compromised by a growing, heavy uterus. And they also didn't want to leave the donor with a kidney that was compromised in any way - they would never want to put a donor at risk.

What they also saw on the ultrasound was a little blockage in the ureter where the ureter attaches to the kidney. It wasn't there before, so they were thinking that it came to be there when they pulled the catheter out - some debris that was hanging around near the end of the catheter. The normal enzymes in urine generally breaks these kinds of things up. They were a little worried that at some point during the night he might stop peeing, so to be on the safe side, they decided to admit Joaquin to the hospital on Friday night. I was a little upset, more at the prospect of having to be in the hospital, because I understood why they wanted to hospitalize him. I wasn't too worried because he had been peeing well all day.

So we get comfy in the hospital on Friday and Joaquin went to sleep pretty early. He wasn't even really hooked up to any machines. They just wanted to simulate Joaquin's home care so the nurse only came in once every two hours to change his diaper and make sure he was peeing.

Saturday morning comes and Dr Wong comes in and says that his creatinine is still where they want to see it and he is still peeing so it means that there might be a little blockage, but it didn't seem to be doing any harm. She wanted to consult with Dr Concepcion and then they would get back to me. I asked her if it meant that we would be staying another night, but she said that we were past the point of the blockage causing any harm - it would have done it already if it was going to.

A little while later Dr Concepcion came literally dancing through the door. He was very pleased that his creatinine was low, had actually gone down a little more since the previous day, and he was peeing like a champ. He tried to give Joaquin a high-five, but Joaquin just stared at him. He said that he hadn't slept well the night before because he was so worried that the blockage meant they would have to go back in and put a stent, or a little tube, in the ureter to make sure it stayed open. He said that he was thinking about Joaquin all during his 5 am surgery as well. You know things are good when your giant, lead surgeon comes dancing through the door.

And so we were discharged around 1 o'clock in the afternoon.

Now they will just continue on with the daily blood draws and will have a clinic appointment tomorrow and a follow up ultrasound next week some time. Joaquin is doing so well, though. I wasn't ever really worried about him because he acted just like his normal self and he was peeing plenty, but still... We've got expect that these little things will happen and because of the LPCH's track record with kidney transplants (100% success rates in the first year) that they're going to err on the side of caution. As a parent, no matter if it was in my control or not, I always feel like a bit of a failure whenever we get hospitalized. I was so proud of not getting hospitalized during his whole year of dialysis - but now we're in new territories in regards to his kidney. They've always told me that this first year had the likelihood of being a little rocky. I just hope that since we did so well on dialysis that we can continue to do as well with his new kidney.