Friday, May 5, 2017

Gemma - The Flu, a UTI, and two imaging appointments

The day after Gemma's four month appointment she had a fever of 101.  I called about it during the day and the advice nurse said it was from the vaccinations. But that night (11 p.m.) the fever got really high - 105.3 degrees. We called again and the advice nurse said to not bring her to the hospital until it hit 106. We gave her tylenol and it went down to about 103.

Our pediatrician called us in the morning and had us take her to get blood drawn to check for the flu. (Everyone in our family had the flu vaccine but babies don't get a flu until six months.) T took the day off (Friday) to help out at home. It was much easier to take Gemma alone instead of bringing all three girls! Getting Gemma's blood drawn was traumatic - they drew it like she was an adult and the person couldn't get a vein and was wiggling the needle around and Gemma was screaming and I was crying. A different person tried on the other arm and got it with less needle wiggling. The pediatrician had us start Gemma on Tamiflu that day (twice a day for five days). The pediatrician was pretty sure it was the flu (Gemma had also been spitting up a lot more than usual (baby throw up), had a tired soft cry (unusual for her), and had less energy).

The pediatrician also wanted us to come in to the office to get a urine bag put on Gemma to check for a UTI (urinary tract infection). So I took Gemma in and the medical assistant put it on and gave me instructions how to get it off and take the urine to the lab. Gemma fell asleep in the carseat on the way home so I let her sleep. She eventually woke up during a poop explosion which caused the bag to come off and the urine to leak mostly out, plus be contaminated. I had T take the sample to the lab anyway (around 4 p.m.) where they told him the sample likely was not enough. That night T and I were supposed to go to the swanky work holiday party but Gemma still had a fever of 102 so we cancelled the babysitter.

The next day (Saturday) I took Gemma back to the pediatrician's office (they have secret Saturday hours!) and got another urine bag placed on her. By the time we got home the bag had come unattached and the urine leaked out. I called and they had me come back and this time I told them I would wait in the office with Gemma until the urine bag was full. I didn't even put a diaper on her so I could keep a close eye on things and so the diaper wouldn't pull the bag out of place.

I kept Gemma naked and we hung out. I mostly had her standing up on the doctor bench. Eventually I nursed her while she was lying down and I leaned over the top of her. I didn't want to do anything that would disrupt the urine bag at all. Finally, Gemma started to pee and the bag started filling but the bag wasn't on all the way so some of the urine started to leak out. I shouted out the door that the bag was leaking and a medical assistant came to help me. She held the bag in place and ta-da there was finally enough of a clean sample to send to the lab! If it was that hard to get a clean sample in the dr's office I really think we never had a chance trying to take Gemma home and get a sample.

The sample came back positive for a UTI so we started her on antibiotics (twice a day for 10 days). Since Gemma was so young the doctor wanted us to have an ultrasound done to make sure her kidneys weren't harmed by the UTI. Luckily, ultrasounds involve no discomfort for baby. So on December 27 I took Gemma for an ultrasound. The timing worked out just right that I had just fed her and she just had a nap so she was happy for all of the ultrasound which showed no damage to her kidneys.

In conjunction with ultrasound the pediatrician also wanted Gemma to have a VCUG. Which is basically a real time x-ray to watch how urine exits the bladder, ureters, and urethra. The doctor wanted to see if Gemma had vesicoureteral reflux which is when urine flows backwards back up into the ureters and sometimes all the way back to the bladder. The only symptom of this is frequent UTIs.  Vesicoureteral reflux is rated from grade 1 to 5 with 5 being the most severe. Most of the time vesicoureteral reflux resolves on it's own before age 4, but some grade 4 and 5s require surgery.

On January 12 I took Gemma in for the VCUG (T stayed home with the big girls). She had to get a catheter so they could get a pee sample (to check for a UTI) and also to put the dye up her. She cried the whole time but it wasn't screaming so it wasn't totally terrible. It was only 10-15 minutes until the procedure was finished. The VCUG showed a grade 1 reflux but no UTI and we made an appointment with a pediatric nephrologist (kidney doctor). I wasn't sure why they wanted us to see a nephrologist instead of a urologist, but I made the appointment anyway.

I did some research about vesicoureteral reflux in preparation for the appointment. Sometimes it's nice that I have this background in anatomy and physiology so I can read actual medical papers / journals and understand them instead of reading random internet articles and hoping they are true. Anyway, for lower grades of reflux typically nothing is done, as the child grows the ureters straighten and lengthen and the reflux stops on it's own. The American Urological Association used to recommend daily antibiotics to prevent UTIs for all grades of reflux but stopped recommending that when several studies showed the same number of UTIs in patients taking daily antibiotics as those not taking antibiotics. The studies also showed that those taking daily antibiotics were three times as likely to become antibiotic resistant. BUT daily antibiotics were still recommended for children under age one because the risk of complications from UTIs is higher. I didn't want to go the daily antibiotic route because Gemma had only had one UTI, and I didn't want her to become antibiotic resistant, and giving her medicine is so hard (nine months of daily trying to get Gemma to open her mouth and squirt in the medicine a little at a time and letting her suck my finger between squirts sounded terrible - giving her the tamiflu for five days had been hard enough!) I had actually already started looking for another doctor for a second opinion in case the first doctor wanted us to do daily antibiotics.

Gemma's nephrology appointment was February 9. Aunt B was visiting us (to help because I had shingles! more on that later) so she stayed with Pippa and Roxy. The appointment was such a non-thing of only five minutes. The doctor was nice and said that usually a urologist sees vesicoureteral reflux patients. She also said that she wouldn't recommend doing anything unless Gemma had one or two more UTIs.

So a happy ending of us doing nothing and Gemma hasn't had a UTI since then. Hopefully she's already outgrown it. :)

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