Multicystic Dysplastic Right Kidney.

So, as many of you probably already know, I am a perinatology sonographer during my daytime hours...(gee, sorry for all the shop talk tonight. Perinatology is high risk obstetrics, and sonography is ultrasound. Essentially, I do ultrasounds on babies or mother's with very high risk factors. I also refer to myself as a prenatal photographer, but that's not a very medically accepted term:) As you might guess by the context of my job, I see all kinds of various conditions that babies can be born with. I have learned that most things are not quite as scary as they'll sound, and though there are textbooks full of random things that can go wrong in fetal development, you'll be surprised to hear that they rarely do. And in the off chance that a child does have a flaw in their development, it's usually something very livable. My job, as a prenatal photographer, is to identify all the normal aspects of a baby fetus, to identify the abnormal elements of the fetus, and to help the parents understand and visualize what is developing abnormally when possible. (Okay, so it's a whole lot more complicated than that of course, but it's the gist...) The trick to my job is doing all of this in a way that is as reassuring as possible for the parents to be, while still being honest and not sugar coating a potentially upsetting condition. Lucky for me, I have a good idea of what it feels like to be the panicked person on the table, and so I am well suited for this job.

One of my favorite anomalies to talk with parents about is called Multicystic Renal Dysplasia (MRD). Interestingly, this condition has weaved its way in an out of my life more than once. I first ran across MRD when I was an ultrasound student. At that time, I was pregnant with Jake, and dealing with renal hydronephrosis. That meant my own kidney was really swollen as a result of a heavy uterus and baby squishing the tube that allows urine out of the kidney. Other than a lot of backaches and a few visits to a less than honest or polite urologist,my hydronephrosis pretty much caused little or no long term damage to my body or my pregnancy. It did, however, spark my interest in renal disorders. At the time I was learning about my own renal complication, I was assigned a research project for my clinical study. Aptly, I chose renal hydronephrosis as my topic of research. That lead me to researching a condition known as Multicystic Renal Dysplasia, because these two conditions can look really similar in the womb, but have much different implications at birth, so it was important to know and highlight the difference. And so, during that time of my life, I thought I had become an expert on MRD.

Little did I know, that was just a taste of what I was about to find out. Imagine my surprise when I was poised on an exam table, pondering why my good friend and fellow sonographer, Ms. Mandy suddenly became very quiet. For those of you who don't know, a quiet sonographer is usually a bad sign, and if you know Mandy, it is a VERY bad sign, because an exam with Mandy is like front row seats for a comedy stand up act. (Or sit down act, as she often jests.) When I looked up at the screen, I very clearly remember saying, "Holy hydro!" And, my initial impression would've been wrong, which brought everything I had studied during the research project flooding back to my memory. 

Upon closer examination, I realized that what I was starring at wasn't just a swollen kidney, but a multicystic dysplastic right kidney. My initial response to this anomaly living in my child was very similar to the response I'd have with any child. I studied it, looked at the cysts and tried to determine if they connected, if the fluid around Ben was adequate (indicating renal function), and looked for a normal kidney on the other side... These are all the steps I would take with any other fetus, and I followed each of them in my mind while Mandy worked my job. But, all at once, it occurred to me that this was not just any other fetus. This was my son. This was my son with this hideous looking kidney taking up more of his abdomen than I could fathom would be possible, and before I could push that idea away, my eyes stung hot with tears and Mandy became one of the few people to see me cry in my adult life.

Now, this reaction, with any other parent would seem completely appropriate to me. But from me, it was a completely silly set of emotions which were not well founded. I knew that MRD could only be fatal if it occurred in both kidneys, and yet, I could clearly see his left kidney was well formed. I also knew that if the left kidney was formed well but not working properly, there would be no fluid, and I could assess that the fluid was completely perfect with one glance. I knew that babies with this condition often were born and the ill formed kidney would atrophy away, leaving them with just one normal, functioning kidney, and a pretty normal life. So, what on Earth was I crying for? I knew this was not a fatal disorder, nor was it a disorder which would profoundly change the lifestyle that we had become accustomed to, nor would we have a child who couldn't function cognitively. In the grand scheme of things, most adults who find out that they have only one kidney probably had a multicystic dysplastic kidney and didn't even know it until it was discovered on accident years later.

So, I cleared up my crying, thanked my lucky stars that my son had no other indications of a larger problem, and agreed that I would see a geneticist. The geneticist, (who interestingly now works within my building at times and has allowed me to assist him on procedures from time to time) agreed with what Ms. Mandy and I had diagnosed, and further sent me on to meet a pediatric urologist. Now, another stroke of luck, because it just so happened that the pediatric urologist we went to visit was MUCH better than the urologist I had as an adult. And, after a visit with the pediatric urologist, I found that I had even less to worry about than I had once thought.

I was concerned that my son would not be able to play sports. I have no idea why this is such a common misconception about children with one kidney, but Ben's urologist assured us that there is no statistical reason to believe that children actually injure kidneys in sports, even contact sports  Although, he would advise us not to let any of our children skateboard because that is a statistically dangerous activity for children under the age of ten. (Um, so of course I would later go on to play a contact sport on skates... go figure...) I was reassured that Benjamin would be able to take any medicines prescribed to him, that he would be able to get his immunizations as any other child would, that illness would affect him no differently than it would any other healthy child. I was assured, in fact, that Benjamin was a healthy child, because really, you only need one good working kidney to survive. 

Ben's doctor did suggest that we keep a very close monitor on Ben's blood pressure, as at any age, elevated blood pressure can be associated with only one kidney and can also be damaging to a kidney. He suggested a few tests to be done early in Ben's life to assure us that his good kidney would function properly, which it did. He suggested that we try to establish healthy eating habits and good exercise routines early in life, to ward off conditions such as diabetes which can be devastating to kidneys later in life. Finally, Ben's urologist suggested we follow the poorly developed kidney with ultrasound to be sure it atrophied as it was supposed to. The plan was to remove it surgically if it did not resolve on it's own, as there is a small but significant link to renal malignancies later in life when they do not resolve. We would watch every year until Ben was four, though we could not identify any cysts after the age of two. 

Ben's extraordinary pediatrician helped us implement these things and also added that the most common reason, statistically, to lose a kidney as a child is in a car accident. He suggested we simply be sure that Ben's good kidney always points towards the inside of the car. Ben's urologist was impressed by that tidbit and now bestow's it upon his patients as well.

So, flash forward to today. I have a very healthy nearly 5 year old boy who doesn't ever really stop moving. Though I plan to encourage him to be a golfer, or a tennis player, or any other low impact athlete, he seems to want to follow in his parents footsteps. He likes to climb. He likes to fall, and has already dislocated his elbow. He collects bruises and scrapes, just like most other boys. He likes to go fast. He can't wait to start playing soccer very soon. He has become my empathy for parents facing the anxiety of a fetal anomaly of their own. More importantly, he has become my reassuring story of success to share with parents who are faced with an anomaly of their own. 

I love you more...

I am a very sentimental person, and expressing love is very important to me. I distinctly remember my father talking about how he and his parents never really expressed how much they loved one another. He wanted that to be different with me. My father, to this day, will tell me he loves me several times within each visit. I can sense that my father, (not having experienced the sappy aspect of telling people how he feels), lessens the mawkish sensation by surrounding his "I love you" with other ridicule. Generally, he'd come up to me, wrap his arm around my shoulder and pull me close in a psuedo-hug, kiss my forehead, and profess, "I love you, brat. Now go get me some chocolate chip cookies."  Albeit, not as mushy as I am with my emotions, the point comes across loud and clear. I know that he loves me. I have always felt his love. Benjamin seems to particularly look forward to his Grandpa Wayne's comments. "I love you, too, Grandpa Wayne... But I am not a hotdog, silly!" 

The same goes for my mother. I'm really blessed that my mother is able to express her happy emotions really freely. I can recall several styles or phrases that my mother uses to say that she loves me. I know sometimes she simply tells me just that. Other times, she smiles and says something witty and silly just as my father does. Mostly, though, I think my mother is very good at demonstrating how she loves people. She has a knack for showing an interest in things that I love and sharing them with me. She has my back when she perceives that I feel threatened. She has a hobby of buying special "no-reason other than I love you" gifts, which I have inherited. She will cuddle if you'll let her close enough, she'll make you laugh if you'll listen to her jokes, and she'll cry with you if you need a shoulder. 

It seems if you forget to take the time to acknowledge how people show their love, you might not notice. Even though my father and I had specifically talked about how he tries to express his feelings, at that time in my life, I couldn't understand why we'd even have such a conversation. Of course he loved me. I knew that. Why wouldn't he? It wasn't until Jake was telling me that Grandma Linda was his favorite person in the whole world, and I asked him to explain why, that I understood why this was important. It struck me very profoundly to hear Jake explain that Grandma Linda loves him more than anyone body else. I reassured him that everyone in his life loved him, but she was exceptionally good at showing it. And it was really interesting to me, because I absolutely remember feeling the same way he described feeling when I was his age. My mother is just truly good at letting you know that you matter very much to her. I am still very happy to see that Jake perceives this message and feels as comforted in it as I always have.

So, becoming the combination of my parents techniques for showing love, I have become one of the world's sappiest people. I say "I love you" so often it nearly becomes cliche, though I mean it whole heartedly each time it leaves my lips. You might say I've been bitten by the "hug bug". (Direct result of my Grandma Rachel.) Sometimes I find myself weaving how much I love my children into songs... (another technique learned from my mother...) 

And I often consider the various ways my children show their love. This is a fun process that seems to be evolving as they grow. From birth, Jake has always showed his love by favoring me. (Both boys do this. I think it's a Mommy/son type thing, actually.) Both of my boys have always enjoyed cuddling. They will fight for a spot on my lap, but if they can't get on my lap, they are content if their foot is so much as touching my foot. (Ben is still very  much in this stage.) I remember a point when Jake was very little, when he started rubbing my back as I nursed him. It was sweet, and it was the same soothing type motion I would use to calm him while he was upset and being colicky. Eventually, both boys learned to give some sort of sloppy baby kisses and hugs. Those sloppy kisses at some point turned into loud "Smackers". (The type of kiss that is so loud that you feel it all through your cheek and hear it through your house.) As they learned to talk, they both randomly would blurt out, "I love you, Mama" when there was an awkward silence. 

Jake, being Jake, invented the "I love you more" game. It goes something like this:

Me: "Good night, Jake. I love you."

Jake: "I love you MORE"

Me: "I don't think so. Good night, dear."

Jake: "I love you more than I love video games."

Me: "I love you more than all the stars in the sky."

Jake: "Wow, Mom, that's a lot! I love you more than Ben loves Trains!"

Me: "That's quite a lot also, but I love you more than all the grains of sand at the beach!"

His game play gets more and more sophisticated as he gets older. He is now combining things to make MORE love...

Jake: "I love you more than Daddy loves disc golf plus more than you love derby!"

Or he resorts to cheating, so that he cannot be one upped while Ben is does his very best to keep up...

Jake: "I love you infinity. Plus one."

Me: "Well, boys, I love you more than all the hairs on my head and the blades of grass in our lawn."

Ben: "I love you 20 pounds, Mama!"

Though I realize that this game is usually a mere tactic to avoid "lights out" time, I do so appreciate being showered in adoration. I am very proud that my kids know that they are loved, and know how to show that they love one another. Whether it be a kiss, a game, a hug or a simple "I love you", it's good to know the lesson is being learned.

But boys... I love you more!

Sometimes just bumping heads is enough to show you love one another...

Matthew G. (Goodboy)

Let me give you a quick introduction to my oldest nephew, Matthew. First of all, his name is Matthew G. I believe the "G." was a tribute to Heather's grandfather, George, but Matthew will be quick to tell you that the "G." is short for Goodboy. And frankly, it's hard to debate that fact, because we all know he's right. Also, it's important to know that he is Matthew, not Matt, because a mat is something you wipe your feet on, and clearly, that's not how we feel about Mr. Goodboy. Ryan, relentless in his pursuit to rename all people (which is a fun family trait that I've noticed I have inherited recently), is still attempting to nickname Matthew, "Hugh", which gets far less rebuttal than does "Matt". Perhaps next year on Matthew's birthday I will have an update on how that project is going.

So I often allude to the idea that I write this blog in hopes to leave my boys with memories of their childhood, but  that is simply not the case with this particular blog. I know in my heart that my boys will not need reminders of their cousin, Matthew, because he has been their hero for as long as any of us can remember. So rather than rehashing how important Matthew has always been to the boys, I will instead explain how important he has been in my own life.

Because it seems proper to start from the beginning of a story, I should say that before there was Jacob, there was Matthew. As everybody knows by now, when Ryan and I found out we were expecting a baby, I was less than confident with the idea of becoming a mother. Let's face it, I'm not a natural born domestic type girl... I can't even keep a plant alive, for heaven's sake! How on Earth would I be able to keep a baby growing and healthy????? As Ryan and I debated our how to handle our new arrival, we secretly debated all the options available to a newly pregnant person... I was leaning pretty heavily towards the idea of adoption, but Ryan was pretty sure that if he had a son, he'd like to be the one taking care of him. At that point, I was beside myself, because I really did not feel confident that I could actually raise a child. Not that I didn't want one, because I have always wanted to enjoy a little person of my very own, but I was quite literally afraid that I just wouldn't be able to do it, and I'd let him down. That all changed the day I met Matthew. Matthew was the first gleam of hope that there might be a maternal instinct hidden somewhere inside of me.

After meeting Matthew and watching him play with Ryan, I knew Ryan was born to be a father. It was obvious that when Matthew was in the room, the television, the conversation and any other distraction no longer mattered. Ryan would become consumed with wrestling and teasing and car washes... (That was one of Ryan's favorite things to do with Matthew, to take him through the drive through car washes...) At that point, I had confidence that at the very least, Ryan could probably keep a baby growing, so maybe things were not so bad after all.

But after getting to know Matthew, I found myself day dreaming that maybe our baby could look like him. Matthew has amazing eyes, and he's always been very handsome. More so, he's always been very respectful and obedient, and I would watch these little amazing traits that he held and wonder if Ryan and I could be capable of creating a baby with such amazing traits. This, along with getting to know my someday sister in law, (Matthew's mother, Heather) I started to find the terror washing away, and I was shocked to find hope taking the place of fear. Before too long, I was eagerly awaiting the arrival of my own little Matthew.

Oddly enough, as the story goes, I did get my very own Matthew, but only as a nephew. (In fact, he stood in my wedding, and became part of my family right at the alter with us.) Of course, my own baby had a wonderful temperament and disposition of his own and was his own person, just as all of us are... but that didn't mean the story of Matthew in our lives ended there. Not surprisingly, thinking back, my boys, especially Jacob, became just as impressed and in awe of Matthew as I had. Whereas Matthew had inspired hope and confidence in my soul, he instilled strength and safety within my boys. From the moment he met my boys, he has been loving and gentle with them. He has served as a perfect example of how to behave, how to play and how to get along and share. And yet, at the same time, he has captured their attention with his strength, his knowledge and his creativity. Matthew has inspired my boys to play together well, to draw, to build amazing machines with legos and to be better boys than they might have been otherwise.

Matthew is very much the cool older brother everyone wishes they had. He's always been a pretty amazing person, and I hope that as we celebrate his birthday with him, he knows just how special he has always been to our family.

Thank you, Matthew! Happy Birthday.

FOUR!

So... My apologies for the long time between blogs. I will try get doing them on a more regular basis again, because I do so enjoy sharing...

For the past few months, Jake has been asking relentlessly to go miniature golfing. Apparently, in his 1st grade gym class, the kids were driving golf balls, and he thought it was really fun. Also, he had seen some putt putt golf places which looked really exciting, and he couldn't wait to try out this mini golf idea. So, when Ryan and I had a weekend free of derby and disc golf, and the weather cooperated, we had decided to surprise the boys and take them to Badger Sports Park for a quick round of mini golf.

To be honest, I am not a huge fan of putt putt.  As it turns out, I am also not a fan of mini golf... though until that day, I had no idea that there was even a difference. For those of you like myself who were not well informed, a "putt putt" course is filled with crazy obstacles, whereas a "miniature" golf course is filled with more realistic obstacles which mimic actual golf courses. (Um yeah... I know. The difference is not distinct, to say the least.) Suffice it to say, after conferring with my husband, it turns out that the particular course that we were playing was in fact a mini course, with more life like obstacles than silly stuff. (Though the course does offer silliness.)

At any rate... I find the game of putt putt, and real golf, for that matter, rather dry and boring. I've never been much for individual sports, and this seems to be no exception. [I can kind of dig disc golf, because I love walking through the forest, I get to throw things at other things (letting out aggression) and because discs come in so many varieties. Disc selection is as close as I get to accessorizing and outfit.] Though ultimately, after a hole or two, I tend to get rather bored when golfing. Ryan, on the other hand, is a fantastic golfer, and a natural disc golfer. I have a theory that these abilities, or lack there of, may live in our genetics somewhere, judging on our children's reaction to our day.

Initially, both boys were super excited to see that we were at Badger Sports Park. This place is about as much excitement as any one person can handle. Before you even enter the building, you can see Go-Karts, a mini golf course, batting cages and soccer fields. When you get inside the building, you'll see tons of arcade type games, mini bowling, laser tag, large inflatables and several vending machine type things all for play. Once I could settle the boys down enough that I could wrangle them up to the counter, Ryan paid for a round for each of us, and the actual excitement began. The boys got to pick their very own color golf ball!! HOW COOL! I chose pink. Ryan selected green. Ben took his favorite color ever (light blue, not dark blue, apparently). Jake took an orange colored ball, because it was his favorite color next to black, and they didn't actually have a black golf ball. With colored golf balls and putters in hand, we took to the course.

As soon as we stepped up, Ryan and Jake instinctively put their golf balls down on the putting surface and practiced putting around. Meanwhile, Ben took off to look at everything going on every where, and I had to pull him back. I let his curiosity distract me from the sweltering heat, until it was our turn to step up to the first tee. As in disc golf, we decided that the youngest person on the card should take the first turn. Ben had that honor. Ben sat his light blue ball down on the putting green, and swung with all his might. Then, he quickly darted to where the ball was about to stop, and hit it again and again and again until he had it near the hole. Then, he picked up his ball and literally threw it into the hole. Watching Ben play miniature golf was actually more like watching that person who sweeps the ice while curling. This technique pretty much suited him until he encountered a more interesting obstacle (like flowing water, which carried his ball away and allowed him to play to retrieve it), or until he lost interest in playing a game of his own. At that point, he began spending his time curling my golf ball into the hole, balancing on the decorative landscaping and singing random songs to anyone who would listen. Though normally I would've liked to have encouraged Ben to stick with it, I was bored too, so I decided to let his antics become my own amusement.

Next up to the tee was Jacob. Jake carefully and thoughtfully put his orange golf ball down on the putting green, assumed a very impressive stance, took a few practice swings, and then hit his ball nicely down the fairway. He carefully walked up to the hole, took out the flag (like a pro) and began putting his ball into the hole. Initially his putts were somewhat too powerful and jumped over the hole, but Jake quickly realized his strength and started to finesse the ball gently rather than smacking it. At each hole, Jake considered obstacles, debated paths to hit the balls along and carefully put his strategy into play. When his ball did not go the way that he intended, he was upset, but only slightly. When things went as planned, he rejoiced and reminded me of Tiger Woods in the way that he waived victory fists into the air. He was somewhat annoyed with Ben, extremely interested in staying competitive with Ryan and overall really impressive at such a mental game for someone so young. Also, he was equally as good whether he was putting left or right handed, and I don't know if he realized he was interchanging the two...

I'll save you the run down on Ryan's and my own golf game. Let's just say that the highlight of my game was certainly watching Ben "rescue" my golf ball and guide it to it's home... and listening to Jake's words of encouragement. Such a little gentleman, Jake would say things like, "wow, Mom, that was a great shot!" or, "Don't worry, Ben. You're getting better at this!" I was just as impressed with Jake's sportsmanship as I was with his ambidextrous golf swing. It seems that Jake, like his father, maybe a natural born golfer. His mental attitude, amazing attention span and willingness to keep learning helped him end the round very impressively.

After we finished our game, Ryan decided to treat us also to a round of Go-Karts. Jake was a little bummed that he wasn't big enough to drive his own car, but he was soon over that. It turned out that the car that he shared with Ryan was MUCH faster than the car that Ben and I drove, so it wasn't much of a race at all. Luckily, Ben was just content as could be to be in a car with me, and we and watched other cars zoom by. Just as I had been, Benjamin was much more enamored with the idea of fast pace moving and being playful, while Jake and Ryan were more interested in winning (or more precisely, they were much more interested in playing the game well.)

All in all, this day at Badger Sports Park was really fun. It was yet another interesting look into the difference between my boys... both so sweet but as different as the sun and the moon.