Thursday, September 8, 2011

Gavin's 7 Year Check Up

Gavin's stats came in at 50 inches and 59 lbs. I'm skeptical of the weight as he is usually 55 lbs at home. And if our scale at home is 4 lbs off, in the wrong direction, I'm not a happy camper!

At any rate, he grew 2 1/2 inches in the last year, and added 7 pounds. Last year he was 77% for height and 79% for weight. Now he is 81% for both! At this point he's estimated to grow another 2 ft, so he'll be almost as tall as his dad.

We had one measurement that was concerning - his blood pressure. I don't remember the bottom number as it wasn't concerning, but the top number measured 124 and then 120 the next two times they took it. For his age/height the top of the range is about 114. And being at the top of the range in and of itself is concerning, exceeding it is not so good. We are hoping it is just "white coat hypertension". The school nurse will be checking it weekly for us to get his trendline, and we're hoping it is down when she checks it today.

It's likely just nervousness at being at the Dr. He asked me on our way there if they were going to burn his hands. This kid remembers everything. When he was 2-3 yrs old, he had warts on his hands, and our ped dry iced them. To no avail. After several visits we weren't putting him through that again. I don't remember how we ended up at a dermatologist, but he ended up getting immunotherapy done there. It worked WONDERS and the only side effect was some itchy spots where they put the treatment to trigger the immune response.

sidebar: if you/your kids suffer from warts do not put them through the painful and scary process of having them burned off! See a dermatologist for immunotherapy.

At any rate, the blood pressure is probably nothing, but I always like to know what the worst possible scenario is. In kids like Gavin who do not have primary, or "lifestyle" risk factors - stress, smoking, overweight, bad nutrition, etc - it's more likely a kidney or heart issue.

As soon as I hear kidney, I am taken back to the medical interventions in the NICU. While all absolutely necessary to save his life, it's a harsh reminder that one simply can't be born 3 months early, go through months of medical intervention and come out unscathed. Everything has a side effect, has a flip side. So even if his blood pressure turns out to be unconcerning, this experience is just a sad reminder for me. Just when I so boldy declared we were over prematurity right?

Most early-ish preemies are born with a PDA, which is basically a valve that is open due to the way the blood is oxygenated in the womb, and normally closes within 72 hours of birth. Being born more than 8 weeks early increases the risk that it will not close on it's own, leading to major issues. They attempt to close it will a medicine called indomethacin, or "Indocin" which helps in the valve closing. Oddly enough, I was also on this drug from 17 weeks to 26 weeks pregnant to reduce amniotic fluid. A side effect of the drug is that it can decrease bloodflow to the brain, gut, and kidneys. So they were watching Gavin's urine output closely while he was on the drug. At our hospital, they routinely administer 3 doses of Indocin to try to close the valve, if that does not work, then surgery is the next option.

Gavin's urine output slowed significantly after 2 doses of the medication - indicating harm to the kidneys, they did not give the final dose. We were fortunate that his valve closed with just two doses. But today, I get to wonder what the price was. Don't get me wrong, I would never elect surgery on a sub-2 lb baby (which he'd dropped down to at that point)over medication. I just wonder if not only did his treatment have an impact, but was there any impact in utero while I was on the medication?

Again, all required interventions to keep him alive and get him home. I wouldn't change it. I just hate that it keeps rearing it's head.


Sarah said...

Well, since we had a nice 'chat' last night, I won't go into what things to try :) but certainly I would try a natural approach first. And I would stress too much, easy as it is to say rather than to do.

There are also a lot of factors that play into BP, for instance, was his blood pressure taken in a chair with his back and feet supported? If not, then the reading likely wasn't appropriate. Also, always use a manual cuff as opposed to an automatic, with someone who is very apt at pediatric blood pressure. People were diagnosed as hypertensive for years simply because their feet were dangling over a bed.

And, sometimes this crap just rears it's ugly head. Just when you like to put it behind you :)

Trish said...

Harkening back to the NICU made me sigh that exhausted sigh again. Prematury's reach is long and bitter.
It sounds like he's growing fantastically, though, which is great to hear.