May 2010

     As mentioned in the April post, May was a very strenuous month. After we found out that there was a problem from our regular OB we were referred to a high risk OB in Lexington the following day. This doctor indeed confirmed that there was likely an obstruction in Owen's urethra. He then referred us to another High Risk OB in Cincinnati for the following day.

    Our first trip to Cincinnati was very long and draining. We had a high level ultrasound performed in the morning, as well as a very long MRI scan to completely check Owen's anatomy for any other malformations. At the end of the day we met with Dr.C (pediatric surgeon), Dr. P (high risk OB and surgeon) and a few other doctors. During this meeting it was confirmed that Owen has PUV. At the time we were given several options.
1. Do Nothing (which would cause Owen to eventually pass in utero or soon after birth do to underdeveloped lungs)
2. Open Fetal Surgery (VERY risky, in which Owen would have been taken out of my uterus, and replaced after surgery)
3. Shunt Placements (doctors would use a needle to go through my uterus into Owens bladder to place a small tube to allow draining)
4. Laser Ablation (a laser device would be used to go into Owen's urethra to open the valve blockage)
5. Abort

Well obviously option 1 and 5 were totally out of the question for us. We were determined to do anything possible to give Owen the best chance of survival. The doctors then explained to us that the Laser Ablation would not be in the best interest of Owen because of his size. The male anatomy is easy to direct a path through his urethra past 20 weeks. (We were a little over 20 wks at the time.)
    They also explained to us the dangers of the Open Fetal Surgery. This is still considered experimental, and although some do not survive the surgery, it can also be a saving grace for other babies. During the surgery, doctors would actually take Owen out of me, and then open his bladder to the outside of his body (called a vesicostomy). This can be performed once the baby is born as well. This would allow any urine produced in his kidneys to drain down his ureters and when it reached his bladder it would drain outward, thus enhancing his lung development and reliving pressure build up in his urinary system. However, we were told this was also not right for us at the time. As Owen had an adequate amount of amniotic fluid (12cm).
   The Shunt Placement surgery has less of a risk than the Open Fetal Surgery, however it also comes with it's own complications and dangers. Any time the uterus is tampered with leads to an increased risk of premature delivery. The shunt placement is also not a guarantee to help the kidneys. It is primarily done to allow the outflow of urine to aid in lung development.

   After learning all of our options we were shocked to find out that the doctors had made the decision to wait before doing anything. This was a very hard pill to swallow. Why wait until things get worse? Why not prevent them? The doctors ultimately decided that since Owen had enough fluid, they wanted to leave things alone for the time being, instead of performing a risky surgery. In all, the risks did not outweigh the benefits.
    So after our trip to Cincinnati we were scheduled with weekly meeting with Dr. M, our High Risk OB in Lexington. Unfortunately, upon our next visit with him it was discovered that the amniotic fluid level was dropping. Dr. M performed 3 different bladder taps (like an amniocentesis, except the fluid is taken directly from Owen)to actually pull the the fluid out. This was done using a very long needle and sticking it through my uterus into Owen's bladder and pulling the urine into a syringe. This was done to actually test the electrolytes in his urine to see how his kidneys were holding up. After the 3 tests, it came back with mixed results. We were still determined to do everything possible to help save Owen.

   This led us back to Cincinnati to prepare for Fetal Shunt Surgery. Dr. P performed the surgery with no complications. A shunt was placed into Owen's bladder and left kidney to allow them to drain and bypass the blockage in his urethra, thus replenishing the amniotic fluid. Recovery went well, with only about 4 hours of mild contractions, and then the uterus was fine! We returned home to weekly visits to Dr. M (Lexington HR OB) to check the fluid status. I (Tyler) was able to finish out the last 2 weeks of school on a mild bed rest. This was very nice, as we had gone through a lot of resting and doctors appointments so a sense of "normalcy" was greatly appreciated.
   We were sailing along through the end of May, which we thought was very promising. June, however brought on it's own list of complications...