Monthly Archives: August 2008

Alycia’s Hip Dysplasia

continuation from Hip Dysplasia.

Our Orthopaedic surgeon suggested that we try a non-invasive and non-medical method of treating Alycia first before deciding on a medical treatment plan for Alycia. Since Alycia was only 5 mths old then and her bones were still soft and not fully developed yet, there was still hope and high chances of ‘intervening’ the formation of the bones. Alycia had to be put on double diapers for 4 months and she was to be carried and put to sleep in certain positions in the hope of pushing the hips back to the socket. We spent lots of money on diapers for the next 4 months. Alycia was also very uncomfortable and hot in double layer of diapers 24 hours a day for 4 months.

4 months later, a scan and x-ray revealed that Alycia’s hips were symetrical and perfectly in place. When the dr said “I can now confirm that your daughter is ok and does not need to see me again”, I almost wanted to scream. That was another happiest day of my life. Thank God, my prayer had been answered again, it was trully a miracle.

So to all parents whose babies have some kind of imperfections or another, do not give up hope. Pray and miracles do happen.

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Battling PCOS And Infertility

I will never forget that particular morning in December 2000 at the office of my first gynae. After experiencing very irregular periods, spotting, unexplained weight gain, acne on my face and moodiness for a few months, I just knew there was something really wrong with me. That prompted me to drag my feet to the gynae’s office. After a scan of my ovaries, Dr Fan told me that I had Polycystic Ovarian Syndrome or PCOS in short. When I heard that diagnosis, I was really stunned and horrified. What the heck is that disease? Dr Fan then gave a brief explanation of this disorder and drew out a step by step treatment plan. Wah, wah, wah, wait a minute, what is this laser treatment to ‘drill’ holes in my ovaries and did you just say PCOS will cause infertility? You are saying I can’t conceive? I just couldn’t absorb so much info in a mere 20 mins or so in the clinic. So I went home in a daze and for the next few days, weeks, months and 2 years or so, there I was, surfing the net to study my ‘disease’ and how I can treat it. Dr Fan told me that there is no cure to the disorder but the symptoms can be treated. The symptoms are unexplained weight gain, obesity, acne, hirtuism (excessive hair) and also loss of hair, irregular periods, insulin resistant, infertility, among others. PCOS is actually a hormonal imbalance disorder.

Long sob story cut short and fast forward a bit ok…… in summary this is what I had gone through :

Consulted 6 gynaes in 3 years.

Took 3 cycles of Clomid only to suffer 1 miscarriage which was the saddest day in my life.

Went thru Hysterosalpingogram or HSG which was by far the most painful procedure in my life.

Went thru Ovarian Drilling keyhole surgery so that my ‘eggs can be released from my ovaries’ .

Went thru years of emotional roller coaster, tears, fears, worries and pain.

Had uncountable number of trips to my gynaes’ office.

Burnt a big hole in my pocket for treatments and sustaining both pregnancies.

Went thru 1 cycle of Intrauterine (IUI) fertility treatment.

Went thru an extremely difficult and high risk pregnancy when carrying Alycia. Was on semi bed-rest for 5 months when carrying Alycia as I had symptoms of pre-term labour. Had spotting and threatened miscarriage when carrying Alycia and Sherilyn.

Never had so many jabs in my entire life before. I had more than 50 jabs in a period of less than 3 years.

Whenever my gals made me feel like giving up being a SAHM, I would sit back and think what I had gone thru to have them. When my gynaes told me that it wasn’t only me with problems but DH also had very poor little swimmers, I had almost given up hope of ever having my own babies. It was really double whammy. Even on the day of my IUI, my gynae had put on a ‘no hope’ look on his face and told me that DH had very poor little swimmers, i.e. only 3% was good. But God really does answer prayers you know, not only 1 miracle happened to me, but 3 in a span of less than 5 years.

Everytime when I think back on how much I had wanted Alycia, how anxious and worried I was for 10 months, the sleepless nites I had before each consultation with my gynae, I would hug Alycia tightly and tell her that she’s mummy’s little ‘precious baby’, the term gynaes use to describe hard-to-get babies.

Each time Alycia made me mad and boiling with anger, I’d think back what I’d gone thru just to have her and my anger slowly dissipates, like I had just gotten an antidote shot in my arm. The day I gave birth to Alycia was the happiest day of my life which no word can describe.

So to all mommies out there, every baby is indeed a miracle and a gift from God. Ain’t we just so lucky to have our own kids? Love and appreciate them more coz there are many women out there who are desperate and would do anything, just anything just so to have a baby of their own. Go give your lil’ ones a big hug tonite and say “mommy loves you very much” and thank God for them.

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Hip Dysplasia

When Alycia was around 6 months old, my 6 months of sheer joy of having Alycia, my beautiful first daughter came to an end when we were informed by our paed during one of the well-baby checks at the paed’s clinic that Alycia has ‘clicky hips’.  During a routine examination of Alycia’s legs and body, the paed told me that he heard some ‘clicking’ sounds on Alycia’s hips.  He then referred us to the orthopaedic surgeon for further evaluation.  I shall forever remember that day.  I really wanted to cry in the hospital.  This super imaginative lady here has super morbid thoughts and as usual, my mind fast-forwarded to the utmost worst case scenario.

Upon my return from the hospital, I immediately surfed the internet to find out more about hip dysplasia.

Here are some excerpts on Hip Dysplasia from Hip-Baby.org:

What Is Hip Dysplasia

Doctors should test every baby for hip dysplasia within moments of the baby’s birth, and also at many of the initial well baby doctor visits. These tests consist of the doctor moving both legs at the hips into various positions. The doctors are checking for symptoms such as “clicky hips”, or unexpected movement such as a loose or dislocated hip joint. If the doctor suspects hip dysplasia, she may perform an ultrasound (on a newborn) or have an x-ray taken. In our experience, the baby should be referred to a pediatric orthopedic doctor for a final diagnosis and treatment.

You, the parent, may suspect that something is not quite right with your child. Some common symptoms that you can detect include: the child may “crab walk” when cruising the furniture, her feet may be turned out so much that they begin to point backwards, or as shown in the picture, the folds of skin in her groin or on her legs are not the same (they are asymmetric).

The baby in this picture here is wearing a Pavlik Harness.

After reading the articles and information from Hip-Baby.org and other websites, I was devastated.  I imagined that Alycia would need to be in a Pavlik Harness, Braces, special shoes or worst, go under the knife.

to be continued….. 

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A Stressful Day Collecting Pee

I was to collect Baby C’s urine today to be sent to SJMC to be tested. Last night, I had planned carefully what to do today. I should wake up at 6am today, nurse Baby C, do some work on my computer, go for my morning jog, take my bath, prepare Aly and Sher for school, prepare Aly and Sher’s lunch box, nurse Baby C again, collect her pee and hubby to send pee to SJMC, placed in an ice-box at 10am BUT my plan went haywire when Baby C just wouldn’t cooperate with me.

Dr Indon of SJMC wants the pee collected without the use of a urine bag as chances of contamination is high with a urine bag. I am to carry Baby C in such a way that her legs are apart and let her wee wee directly into the sterile bottle. But when the actual collection of pee was done today, it was really STRESSFUL, FRUSTRATING and I really wanted to CRY and scream in frustration. This is my first time collecting baby’s pee without a urine bag and it wasn’t easy, as expected. Baby C was really traumatized and distraught.


My maid sat on the green stool whilst I sat on the white stool and we started off Round 1 at 9:30am. Baby C was struggling, arching her back, screaming, crying, kicking and she poo pooed! Her pee only dribbled out DROP BY DROP during the entire collection session. She also poo pooed and I had to clean her up very carefully so that the urine won’t be contaminated.


Very long story cut short, after 20 agonizing minutes for Baby C and me, this is the amount of urine collected. Pathetic isn’t it? What do I expect? It was collected drop by drop with great pains. Baby C didn’t give me wee wee fountains like she would EVERYDAY without fail. Why of all days she just wont give me a good shoot of pee today?

This bottle of pee is only sufficient to be poured into the bottle with boric acid for the urine culture (bottle on the right with white powder inside). I needed another bottle for the urine FEME test. But Baby C was wailing away and she was really very traumatized and distraught. I was distraught too. Why? Coz the bottle of urine for culture was already in the fridge. I was told by the medical assistant at Dr Indon’s clinic that the urine cannot stay more than 2 hours in the fridge and I was running out of time. The urine had to reach SJMC latest by 12:30pm. Our house to SJMC would take 20 minutes to reach at the quickest and hubby was very busy today. So I callled SJMC and the hospital near my house to arrange for the urine test to be done at the hospital nearer to my house. Then, hubby was to collect the urine report and bring it to SJMC to see Dr Indon for her to prescribe Baby C the new antibiotics.

I put Baby C for a quick nap whilst I quickly ate my breakfast at 11am. I only have 1 more hour to collect another bottle of pee and I just knew that I would not be able to meet the deadline. After breakfast, I woke Baby C up and of course that made her bawl. The moment I removed her diaper, she peed big time and the pee was everywhere on her body! Sh*t!! I had to nurse her again and wait for another half an hour for the pee to come out. I really wanted to cry. Baby C could sense my frustration and agitation and this made her bawl and struggle more when my maid carried her, whilst I held on to the bottle.

It was really a big hoo-ha. My maid was carrying Baby C who was arching her back, kicking her legs, bawling away till she almost puke, my mil was trying to distract baby with a rattle and I was sitting on the floor, holding the bottle, making “shee shee” sounds and staring at her phet phet, waiting for the pee to come out but only drops of pee trickled down. I just knew that the urine will be contaminated as Baby C had pooed twice and the urine that trickled down touched her anus too. Though I had cleaned the area with water and cotton, there could still be traces of bacteria there.

When Baby C was really distressed, I nursed her… with her diaper removed and my maid held on to the bottle, trying to collect the pee. Baby C was crying away as she latched on…. and kicking her legs. I was really stressed out and so was Baby C. I was dry…. no milk flowed out due to the stress and Baby C was dry too…. no pee flowed out. I really wanted to cry and scream!!

Long story cut short, my hubby was already outside the house at 12:30pm. I just passed whatever urine I had collected to him and prayed that the urine in the second bottle would be enough for the test. Thank God it was enough though it was very little.

Results turned out that there were still 10-20 WBC (white blood cells) in the urine, which means that there is still an infection in the urine. Last week’s results were 20-25 WBC.

Very long story cut short, I am required to bring Baby C to SJMC on Friday for another urine test. This time, Dr Indon will insert a catheter into Baby C’s ureter to collect a ‘clean urine’ sample. It’s going to hurt but it’s the best way to get an accurate reading of the urine test. Poor Baby C, she will have to endure another painful time. Sigh…. I just hope we will get out of this nightmare very soon!

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Kidney Reflux

During a routine ultrasound scan when I was about 13 or 14 months pregnant with Cassandra, my third daughter, my Ob&G detected something and said this to me… these words will forever be etched in my memory :

“There is an issue here that I need to address.  You see, this is your baby’s bladder, this is the stomach and these are the kidneys.  The right kidney is a little dilated.  You will have to see a fetal specialist for a detailed ultrasound scan”.

When my Ob&G told me this, his usual cheerful face turned grim and serious and that made me feel worse. I immediately had this hollow feeling inside me, the feeling that I was just going to lose my baby.

My Ob&G then explained that one of the symptoms of a Down Syndrome baby is a dilated kidney. 

When I heard those word, my head fastforwarded to the worst case scenario – abnormal baby, Down’s Syndrome, miscarriage, termination of pregnancy, D&C, etc.

I shall continue the story of my third pregnancy  later. 

Here’s an article on Kidney Reflux, treatment management and prognosis taken from www.urologychannel.com :

Treatment for grades I – III VUR includes daily low-dose antibiotics (e.g., trimethoprim-sulphamethoxazole, amoxicillin) until the reflux resolves or until the child is at least 5 years old. These cases require regular monitoring by a pediatric urologist to diagnose UTI and prevent the condition from worsening.

Secondary reflux that does not resolve with antibiotic treatment, or that results in UTI despite antibiotic therapy (called breakthrough infections), and primary reflux that is severe (grades IV and V) require surgery to prevent permanent kidney damage.

Nonoperative Management
When reflux is related to an underlying problem such as constipation, infrequent voiding, abnormal bladder activity, or blockages such as strictures or valves, the predisposing factor should be corrected first and the reflux then re-evaluated.

Mild-to-moderate degrees of reflux (grades I to III) have a good chance of spontaneous resolution with age in over 80% of children. This typically occurs over the span of few years. Unfortunately, there is no magic crystal ball that will tell us exactly when the reflux will go away for a particular child. The chance of spontaneous resolution of high grade reflux (IV to V) is much lower.

The key to the nonoperative management of reflux is to buy the children the time to outgrow the reflux without getting into infection problems. Certainly with a high likelihood of spontaneous resolution, most children with mild-to-moderate reflux should be given a chance to outgrow their reflux. While we wait for this to happen, they are protected from urinary infection using low doses of preventive antibiotics.

After an 1- to 2-year interval of treatment with antibiotics, reflux is reevaluated with VCUG. At the same time, doctors check the kidneys with ultrasonography to be certain they are growing properly and no interval damage has occurred.

No antibiotic is risk-free, and likewise no antibiotic will destroy all types of bacteria. Nevertheless, amoxicillin, cephalosporin, trimethoprim-sulfamethoxazole, and nitrofurantoin have proven the most useful and effective preventive antibiotic agents with minimal side effects.

During the course of nonoperative management, any fever, unexplained illness, or urinary tract symptoms (burning, frequency, urgency, foul odor, bloody urine, or unusual urinary accidents) must be aggressively evaluated with urine analysis and urine culture to make certain that it is not a urinary infection.

A breakthrough urinary infection, in spite of preventive antibiotics, is a dangerous situation indicating that there is not enough time for spontaneous resolution and that the next step should be surgical correction of reflux.

Surgical Correction
Correction of reflux (called ureteral reimplantation or ureteroneocystostomy) is recommended for high grades of reflux (because they are unlikely to resolve by themselves), for reflux that fails to resolve on its own despite monitoring over several years, and for patients with breakthrough infections.

The traditional surgical approaches have high degrees of success and usually involve opening the bladder and creating a new, longer tunnel for the ureter to pass through the bladder wall. If the ureter is very wide due to high grade reflux, it may need to be narrowed to make a successful flap valve with at least a 4:1 ratio of tunnel length to ureter width.

Potential complications include bleeding, infection, urinary leakage, and bladder spasms shortly after the surgery (usually resolve in 2 to 3 weeks), and ureteral obstruction or persistent reflux later. The latter two complications are managed differently if they occur.

Sometimes complications improve on their own with time and other times, additional surgery is necessary. The child is left on preventive antibiotics for several months until postoperative VCUG proves that the reflux has been corrected.

Other surgical methods that may be performed include laparoscopic correction and using an endoscope to inject a bulking agent (e.g., Deflux®) at the ureteral opening.

Overall experience with these treatment methods is limited compared to traditional surgical approaches and, in general, they are considered less effective in correcting VUR.

Bulking agents are used to create a bulge in the tissue, making it more difficult for urine to flow back up the ureter. This outpatient procedure usually is performed under general anesthesia and takes about 15 minutes. If VUR does not resolve, this treatment can be repeated. Side effects include urinary tract infections and widening of the ureter.

Prevention
The kidneys filter the blood and extract waste products from the blood to make urine. Urine passes from the kidneys, down the ureters, and into the bladder for storage prior to urination.

The ureter normally enters the bladder wall at an angle so that a flap valve is created. This valve prevents the bladder urine from backing up toward the ureter and kidney. Thus, when the bladder fills and when it squeezes down to empty, backup (also called reflux) is prevented because the valve operates in the same way as you might “step on a straw.”

This valve-like action creates an important barrier that helps keep the kidneys free of bacteria. Once urine has passed from the upper urinary tract into the bladder, the normal valve not only makes certain that urine does not reenter the upper tracts, but it also ensures that the high pressures created at the moment of urination are not transmitted to the kidneys. Another important feature of a properly working valve at the ureter-bladder (ureterovesical) junction is that it permits you to remove all of the stored urine from the body with a single act of urination–that is, the bladder urine has nowhere to go other than out the urethra.

Follow-Up
All patients with a history of reflux should be monitored for life. Even if the reflux resolves (either spontaneously or by surgery), the risk of kidney malfunction, hypertension, and pregnancy-related problems still exists. This usually involves periodic visits to the pediatrician’s office with measurement of height and weight, blood pressure, and urine analysis. Kidney function can be crudely evaluated by blood tests (creatinine and BUN) or more precisely checked by creatinine clearance or glomerular filtration rate. Occasional ultrasound tests will ensure that kidney growth is on target for age. Female patients should be carefully monitored during their pregnancy.

By the time surgical correction has been performed, some children have already had significant kidney damage. In other patients , the kidney damage from reflux early in life may result in kidneys that don’t grow appropriately in size or function and thereby seem to deteriorate with age. When kidney deterioration has been demonstrated, the pediatric nephrologists must begin careful surveillance with appropriate medication and dietary restriction.

Does Reflux Run in the Family?
If a child with reflux has a brother or sister, there is a 1 in 3 chance that the sibling will also have reflux, even in the absence of any urinary infections. Because we know that the chances of kidney damage are highest in the first 6 years of life, we think that brothers and sisters in that age range should be aggressively studied with ultrasonography and VCUG, even though they may not have had any urinary infection. Older siblings, in the absence of symptoms, may be more simply screened with urine analysis and ultrasonography. There is also evidence that offspring of the patients with reflux are more likely to develop reflux.

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