Oh, The Places You'll Go

Glomerulonephritis

Earlier this week my wife commented that our family has been a lot healthier this winter, and that is probably due to the fact that our kids are having limited interaction with other coughing, snot-nosed kids who are terrible at sharing toys, but great at sharing germs.  Of course as soon as she uttered this statement our oldest started a hacking cough and a sniffling nose.  Fortunately it has been a much healthier winter for us, especially in comparison to last year when we found ourselves going almost weekly to the walk-in clinic for a variety of ailments from Thanksgiving to Easter.  I seriously considered inquiring about a frequent visitor punch card. 

One of the exciting things about having kids is that you will begin to find yourself in situations you never could have imagined you would ever be in prior to having kids.  During those moments, all you can really do is take a step back, rhetorically ask yourself, "is this really happening?, and revel in the absurdity. And then file it away because it will be great material for embarrassing your kids later on in life. I found myself in one such situation on a frigid February morning last year at our local pediatric clinic.   And.......action!

Getting out the door to do anything in winter takes ten times longer because children are relatively in adept at dressing themselves for below freezing conditions.  For Havi, who was 1 at the time, getting dressed was the equivalent of 12 hours of manual labor.  She would kick and scream, throwing herself down on the floor which would only intensify her screaming. By the time I had successfully dressed her in her winter attire, her boots would already be off because of course Uggs for a 1 year-old will only stay on with duct tape.  My general rule in winter is if a shoe, boot, glove or hat gets lost in transit between the car and school or a some other building, it’s a lost cause.  When it's winter, we move in one direction after we leave a heated vehicle - inside.  Isla, who was 3, would do nothing to help the situation as she had a attention span of, well a 3 year old. You have to trick kids into getting dress, and essentially doing anything else you want them to; bribe them with treats, use reverse psychology - I bet you can put your shoes on!, threaten to leave without them.  

So getting out the door to go the clinic on this particular cold winter morning was no different.  Both kids needing hats, gloves and over-sized jackets that probably weren't safe to be worn while sitting in a car seat.  A diaper bag overflowing with supplies - food, drinks, extra clothes just in case someone wets themselves, blankets (4 per child is pretty standard), and books. A rolling suitcase would work better if you didn't end up carrying both of them at some point. Of course don't forget an emergency energy bar for yourself, because the last thing you want while out and about with your kids is to pass out due to low blood sugar.  Health professionals always stress drinking plenty of water to stay hydrated.  I actually stopped drinking water when taking my kids out of the house on my own so I didn't have to worry about corralling them in a bathroom stall if I needed to take a piss. This also means I can pack one less extra set of clothes because I likely won't be wetting myself.

The worst thing about visiting the doctor is obviously the waiting.  Waiting for a doctor with children, time moves about 20 times slower than real time.  Even worse is that the nurse calls you back from the lobby where the kids were perfectly entertained by the television, the fish tank and a plethora of new toys and activities, to a non-descript room to take the kids' height and weight.  This procedure involves removing the layers of clothing and of course the shoes, which may or may not still be on at this point. It will usually keep the kids momentarily entertained, or piss off the 1 year old even more because he/she will probably have to lay down for a height & weight check, which is tantamount to water-boarding to any little kid with an ear infection. And if you are taking your 1 year-old to the walk-in clinic, the odds of them having an ear infection are roughly 100%.

Once that is completed, the nurse brings you to an even less descript room where you will wait for a pediatrician who is always running late.  The nurse will proceed to ask you the same questions you are asked every time you visit the clinic, which always includes verifying your address and phone number, even if it had been less than 24 hours since your last visit.  The nurse will also ask what the child needs to be seen for that day, and you’ll describe the issues the same way you did to the person who checked you in to the clinic and the same way you will when the pediatrician finally arrives to look at your child. I’ve been tempted to change the description of the symptoms throughout this question and answer series to see if anyone would actually notice.  Once this information is successfully entered into the computer, for the doctor not to look at, the nurse will inform you that the doctor will be in shortly, which is medical speak for six to eight weeks.  

Our pediatrician informed us that around the 1 year mark, kids start to understand what actually happens at the doctor; i.e, they typically get shots.  Your job, once the nurse leaves, is to stand in front of the door to block their ambitious attempts at escape.  This usually ends when the doctor quietly knocks before opening the door to enter the room, subsequently drilling you in the back of the head.  At this point, the children have stopped crying because pediatricians are non-human life forms whose presence immediately calms any situation. Our pediatrician is so amazing, we're seriously considering adding her as a beneficiary in our will.  

We have made trips to the doctor for a whole host of ailments.  From run of the mill ear infection and pink eye to more exciting stuff like hand, foot and mouth and strep.  I'm always amazed at how quickly pediatricians can make a diagnosis once you describe your kid's symptoms.  I've started to become suspicious that they might just be making these illnesses up, especially since about 90% of the time they will tell you it's a virus and just has to run its course.  When you happen to be so lucky to get something that can be treated, it's almost always an antibiotic.  Even better when they are suffering from multiple maladies and the antibiotic will treat them both.  It's like a two for one!  "Good thing about her having pink eye and an ear infection is we give her an oral antibiotic and you don't have to fight her with the eye drops!"  Thanks, doc, best thing I've heard all day.

After a certain number of unscheduled visits to the clinic, and an excessive amount of time on WebMD, you tend to get a little cocky before even seeing the doctor, certain you already know what is wrong with your kid. Despite this, you still trudge to the clinic and pay $50 to likely have the provider prescribe your child "fluids and plenty of rest." This is done more so to confirm that your own diagnosis was correct and you could probably be a doctor too. Odds are you'll be completely wrong, because again, there is a good chance they are just making something up. Luckily my wife is in the healthcare field, so we (she) usually has a good handle on what might be up when our kids are under the weather.

For this specific visit, I anticipated what to expect. Havi had a wheeze and a cough, so we were thinking RSV, one of those many ailments that has to "run its course".  Isla had a two-day cough that turned into a two-day fever, and then started complaining about her ear hurting. Boom, ear infection! Sign me up for med school. Jess was also concerned Isla might have a UTI (urinary tract infection) since she hadn't been going to the bathroom that often and her urine had been kind of dark. It would be a new one for us, but since I was going in anyway, might as well inquire about it and more effectively use our co-pay.  

Of course we were wrong about Havi - she actually had an ear infection. Isla did too, so at least we got one correct. As far as the UTI, the doctor wanted to get a urine sample from Isla to see what was going on. Here is where it starts to get really interesting (thanks for sticking with this post, I know there has been a lot of build-up). February of 2014, Isla was 3 years and 3 months old and had been potty-trained for about 6 months. Our directive was to head to the lab so she could pee in a cup, a task I sometimes struggle with when at the doctor. But they gave us a contraption called a hat to put in the toilet so I didn't have to actually hold the cup underneath her and end up with a pee covered hand. In the end that would have been the least of my worries. I manage to get both Isla & Havi into the bathroom by the lab, which is no easy task because "The Magic School Bus" is currently playing on the TV in the Lab Lobby. I contemplated letting Havi stay in the lobby, but figured it would be bad form to leave a 1 year old unattended in a public place in front of a TV. I also contemplated leaving the bathroom door open so I could keep an eye on Havi, but I was concerned Isla may have trouble performing under pressure. I was right.  

The scene is the three of us in the bathroom. Isla is on the toilet with no desire to go. Initially, she was not interested in utilizing the hat to catch her sample, so things started with me holding a measuring cup underneath her bottom. After a few minutes of me crouched in an awkward position bracing to be peed on, I was able to convince her that using the hat would be easier and she allowed me to put it in place. That allowed me to divert my attention to another pressing matter, dealing with her sister. We had been at the clinic for about two hours by then, putting us around the 10am mark - exactly the time when Havi should be going down for a morning nap. At this point though she is more interested in helping Isla and thinks the best way to assist is to get both of her hands inside the toilet. As I quickly, but gently, move her away from the germ-covered commode, the tears and screams of an over-tired, ear-infected one year-old fill the bathroom.  
I'm sure the lab techs on the other side of the paper-thin wall are thoroughly enjoying the commentary. I'm pleading with Isla to deposit some pee in the cup. "Please, just a couple of drops." We're running the water. We're singing songs. I'm making promises that I have no ability to keep - "You can eat ice cream for breakfast for the rest of your life!". I'm still trying to keep Havi away from the toilet. She's crying because she's overtired and sick. Isla's crying because she "just can't go!" I should be crying, but instead I'm sweating because I'm dressed for a Minnesota winter. This is the time when I have to take that step back and recognize the absolute hilarity of this situation. Never, ever before this moment could I have imagined I would find myself here - in a 5x5 bathroom, doing everything in my power (short of a manual catheter) to get a 3 year old to pee while also keeping a 1 year old out of the toilet.

After about an hour and a half, which seems like 40 days, and multiple false alarms, we finally give up. I inform the lab techs it's just not happening, and they seem about as relieved as I am. We run into doctor and she confides that the antibiotic Isla will get for her ear infection will also treat a UTI, so while she'd prefer to get a sample, she says to just keep an eye on it. As we left the clinic I made the executive decision that we all needed a sick day. Ear infections might not be contagious, but we didn't want to take any chances. 

We kept an eye on Isla and thought it was getting better until it wasn't. So a week later, since we hadn't been to the clinic that week yet, I took her back and this time she was successful in giving a sample. I had never been so happy to hear the sound of someone urinating. The sample informed us that of course we were wrong and it wasn't a UTI. It was something the doctor called glomerulonephritis. Yep, my response too. 100% made up.

Apparently, this hard to pronounce condition causes an inflammation of the tiny filters in the kidneys, causing the kidneys to not properly filter the the things they are supposed to filter from the bloodstream. This can be either an acute (short-term) thing that will resolve in a few months or a chronic (long-term) thing that could have some serious implications, like eventual kidney failure. All signs pointed to a an acute condition, likely brought on following a bacterial infection like strep. Still, this did little to comfort Jess, who is the worrier in the family and has easy access to lots of medical information.

The preliminary diagnosis of post-strep glomerulonephritis started a string of five daily visits to the clinic to provide a urine sample, blood work and a blood pressure check. Isla was actually prescribed a blood pressure medication, because apparently her's was through the roof. The urine samples were always an adventure, but usually a lot easier when her sister wasn't trying to help out. We did have a day when we waited in the lab lobby for about 3 hours, trying to push fluids to get her to go. It was that day that I realized that the "Magic School Bus" videos that play in the lobby are on a loop that eventually starts over. Hey, we've seen this one before. Today, actually.

Eventually everything cleared up - Isla got her BP under control, the puffiness in her face subsided, and the protein in her urine cleared. A, probably unnecessary, trip to a specialist provided some additional confirmation that we weren't going to have to worry about dialysis for our 3 year old anytime soon. It was an experience to say the least, but we were very, very fortunate that everything turned out fine, and Isla was a trooper throughout the entire process. You never want to see your child experience physical pain and discomfort, and feel it's your duty as a parent to do whatever you can to help them get better. Often times though, there is little you can do, outside of pray, wait, and hope for positive outcomes. A lot of families aren't nearly as fortunate, and I can't imagine what that experience must be like for them.  

The other thing you can do is laugh. We're often told that laughter is the best medicine. Illnesses can be fragile reminders that nothing living is indestructible, and finding the humor, whenever possible, in the ailments that find us, or we sometimes bring upon ourselves (foreshadowing here) can be a powerful, natural remedy. It doesn't even require a doctor's prescription, although you're welcome to go to the clinic anyway, which will probably give you more stuff to eventually laugh about.

Isla showing off her battle wounds.
Sorry, no pictures from the bathroom - they frown on that kind of behavior.