Urologist update

Bleah... I was kinda blown over and beaten when I brought little Jere for his check up on the 25th March. The dear dr Y decided to throw me all the tests and what nots yet again! Standard procedure I suppose.

Our appointment was 1140am and we reached there on time. but waited till 1pm still not Jere's turn. I then asked the nurse if Jere needed any routine urine test. Staff R then said ok she will go ask the dr. The minutes were ticking by and I knew I had to chase them as Nat was waiting for me in school. Though I had forewarned him that I was going to be late, I did not want to be too too late. The nurse came out soon after and said yes but asked me to wait.
I said...can I do it myself?
She said no... no.
I said ok, please hurry then, my older boy is waiting for me to fetch him from school.
Soon after, I was asked to go into the treatment room and they got ready to catheter Jere's urine out for the test.

The staff and nurse manager talking among themselves: we send for 2 la ah?
Me: what test are u going to send for? the usual standard FEME?
Staff: Probaly FEME and culture
Me: FEME can liao la. FEME results come out, normal blood count want to do culture for what?
Staff: er... mummy, we gotta ask dr first

Dr came in....
Dr: wah... mummy you bully my nurse ah? you can do the Clean Intermittent Catheter (CIC) yourself right?

Me:(almost dumbfounded) Well, I offered. Your nurse want to do herself, what can I do?

I thought it was rather strange for the Dr to greet me that way. The hospital has signs to protect their staff saying that people cannot abuse them verbally. What about the other way round?

Dr: Ok, mummy, we gotta do all the tests again. It's been about 1 year since we did any tests.

Me: errrrrr.... what tests?

Dr: (flipping thru the thick file) Ultrasound, MCU, UDS, DMSA. I will order them all for you. You make a date with my nurses ok?

Me: Must we do all of them? Can we just do the basics? Like just the ultrasound?

Dr: No, mummy. These are all the basics.

and so.....

Lined up....

1.Ultrasound
A renal ultrasound is a safe and painless test that uses sound waves to make images of the kidneys, ureters, and bladder.

The kidneys are a pair of bean-shaped organs located toward the back of the abdominal cavity, just above the waist. They remove waste products from the blood and produce urine. The ureters are thin tubes that carry the urine to the bladder.

During the examination, an ultrasound machine sends sound waves into the kidney area and images are recorded on a computer. The black-and-white images show the internal structure of the kidneys and related organs.

Why It's Done
Doctors order renal ultrasounds when there's a concern about certain types of kidney or bladder problems. In Jerry's case, a neurogenic bladder.
Renal ultrasound tests can show:

•the size of the kidneys
•signs of injury to the kidneys
•abnormalities present since birth
•the presence of blockages or kidney stones
•complications of a urinary tract infection (UTI)
•cysts or tumors

2.MCU
[1] The MCU remains essential and a primary tool for the diagnosis and evaluation of infants and young children with many genitourinary disorders, and this procedure is used to obtain specific diag­nostic information not already provided by other imaging modalities. The MCU demons­trates anatomy of both the bladder and urethra and the presence or absence of vesicouretral reflux (VUR); it also provides information about the function and co-ordination of the bladder and urethral sphincter. [2] It remains the investigation of choice for delineating the anatomy and determining the function of the lower urogenital tract.

Simply said, Jere is having an MCU to find out if he has problems with his bladder or urethra or a condition called urinary reflux. An MCU is an x-ray test of the bladder as it fills and empties. We've done this a couple of times and everytime we do this, jerry comes out in tears and traumatised. This is what they do.
He is made to lie in the "space shuttle" and gently restrained by some velcro belts.
a nurse or doctor will clean the area around the opening of the urethra (the tube from which urine passes out of the bladder) with a mild antiseptic and then insert a catheter (a soft thin plastic tube) up through the urethra and into the bladder
the catheter connects to a bottle of contrast (dye)
the bladder is slowly filled with the dye
the dye allows the bladder to be seen on x-rays
the doctor, or x-ray technologist, will take x-ray pictures while Jerry is weeing
the doctor checks these; if they are okay the catheter is removed
the solution is washed off before a final x-ray

3.UDS
A urodynamics study is a series of tests that gives the doctor a detailed look at the function of the bladder and urethra. These tests can help the doctor evaluate any problems with storing urine or voiding (eliminating) urine from the body.
The lower part of the urinary tract includes the bladder (which stores urine until you’re ready to release it) and the urethra (the canal that carries urine from the bladder out of the body). Signals from the brain tell the sphincter (muscles around the opening of the bladder) when to relax and the bladder when to contract to let urine flow out of the body.

Jere is said to Need a Urodynamics Study to assess the neurogenic bladder as he's a spina bifida baby and these children are believed to not empty their bladder completely since their urine stream seems weak and intermittent. According to the drs at his birth, the spincter is not opening when it should to release the urine

4.DMSA
A DMSA renal scan is a diagnostic imaging procedure that is used to evaluate the anatomy and physiology of the kidneys. Some radiopharmaceutical called Technetium-99m DMSA will be injected into the child's veins. After the injection, the child will be free to leave the department and will be given a time to return for imaging, typically three to four hours after the injection. This delay allows the kidneys to absorb the radiopharmaceutical. When you return, you/your child will be asked to void and imaging will begin. Imaging will be approximately 30-60 minutes. It is important that the child remain as still as possible to allow for the best possible images. Thus in a case like Jere, he gotta be put to sleep! which i do not like at all... in other words, he will be put on GA if the medicine to knock him out does not work. And of course, the child may experience the discomfort associated with the insertion of the intravenous needle. I do remember the drs could not locate Jere's vein and ended up poking him at his feet and hands all. Once the radiopharmaceutical is injected, the needle is withdrawn and a gauze bandage with adhesive tape is placed over the site of the injection. The area where the injection was given may be a little sore or rather very sore for a little child.

Came home and talked to Tim. I did not like the DMSA at all. I remember doing it when Jerry was barely one and this procedure involved injecting a nuclear medicine in and putting him in the "space shuttle". Of course, the MCU also involves the darn space shuttle too. The ultrasound is the least invasive and I really don't feel like doing anything except for the basic basic ultrasound.
Yikes!

Lord, please guide me and tim to make the best decisions for Jeremiah. We know You got plans for Jeremiah Lord. Plans to prosper, not to destroy.

Please pray for us that we will listen to God's prompting and make God-led decisions.