Thursday, July 21, 2011

An update on the ol' ticker

We took James yesterday for his one year check up with the pediatric cardiologist, Dr. Brenner.  It was actually a pretty anti climatic kind of visit - we go back in a year.  But I'll back up a little bit.
I drove us down to the Outpatient Center at Johns Hopkins.  They have garage parking, but valet costs the same amount, so we did that.  I know, we're lazy, but its a lot easier to just pull up, get James and his stroller out and walk into the building than it is to walk from the garage.  I make it a point to do whatever is going to cause me the least amount of stress when going to hospitals.  So we went up to the 7th floor and checked in.
In the waiting room James and Adam played with the toys there and we noticed a little boy about James' age.  Actually, as soon as we walked in Adam said to me, "Look at that cute little baby."  So the other kid's mom asked how old James was and I told her.  She said her son was a little younger and then told me that she's getting rid of his bottle soon (he was drinking it when we walked in).  I didn't ask about him having a bottle, but I think she was having a little bit of mommy guilt.  When she put her son down (he was wearing a just a diaper, waiting to go back for an ECHO) I noticed that he had recently had surgery.  His scar was about 8 inches running all the way from his collar bones to the middle of his tummy.  It honestly took my breath away, I really had to check myself to make sure I didn't get emotional.  Because really, I'm sure the last thing this woman needed was for a stranger to get choked up at the sight of her little boy's recent incision.  She told us that he'd had surgery on the 30th and I was amazed.  This kid was up and running around, completely unfazed.  I told her he looked like a tough little guy and she agreed, saying he was far tougher than she was.
We got called then, so we took James back.  He was weighed, measured, had his blood pressure taken, and an EKG done.  Something that really caught my attention, that they didn't do last year because he was a tiny baby, was put a blood pressure cuff on Adam (who was holding him) before they put James' on.  They really wanted to make sure that James wasn't scared and saw that his dad had the same thing on his arm.  Then they did the EKG, which requires putting 10 lead on various areas of your chest and upper body.  Again, they put the stickers on Adam to show James what was going on.  I know a little of that was probably lost on James, since he's still a pretty little boy, but as his mom I really appreciated it.  James was pretty pissed about the EKG and having to hold still, but it was done pretty quickly and the stickers came off.
We went into an exam room and waited for Dr. Brenner, who didn't take long.  He asked us some general questions about James' health and then told me he was going to listen to James' heart.  James was on my lap at this point and he got to stay there.  Adam was in the chair next to me and the doctor looked at him and said,  "I'm going to pretend to listen to you first, don't cry."  That definitely lightened my mood and I had a good laugh.  James didn't like the stethoscope, but he cooperated and Dr. Brenner "listened" to me and Adam's arms and wrists and finally James' chest.  The doctor said he could still hear the murmur, which wasn't a surprise, since all of James' doctors have said as much.  He said that we didn't need to do an ECHO, but since we were there, we might as well.
There was no wait for the ECHO and Renee, the technician, took us right back.  James had to lay on a bed, with me and Renee on either side, with the lights out.  When the lights were turned off, he gave me this funny face, like "What the hell, mom?"  But the Elmo's World DVD kept him distracted for the most part.  There were some tears and fussing when Renee would move the wand, but for the most part, James did well.  Adam helped comfort him and the time went quickly.
After the ECHO, we talked to Dr. Brenner again, to get the full scoop.  James' defect has not gotten larger, but it has also not closed or gotten smaller.  The deformation of the right cusp of his aortic valve does not seem to be worsening, but over the course of a year there wouldn't be much noticeable change anyhow.  Due to the location of the defect, James will be monitored again in a year.  If the hole was in any other location on the ventricular wall, we would be going back in 3 years.  The long term implications of aortic valve leakage due to further deformation are an enlarged left side of the heart.  This could lead to problems of heart functionality, but Dr. Brenner assured us that this is something that would happen over the course of 10 to 20 years, if it happens at all.  There is no immediate need for any corrective action and nothing to look out for in the next year.
So like I said, pretty anti climatic, but very reassuring for us!
One of the nice things about Dr. Brenner is that he has a notepad full of blank drawings of the heart.  I'm a visual learner, so this is great for me!  It also reminds me of my dad and how he can draw a picture to explain anything.  (Sidebar: He can even tell you what picture to draw over the phone to explain things, like when I was in college and he explained the Coriolis effect to me so that I could pass my Physical Geography final...  but I digress).  So here is a copy of our picture from the doctor.

The black dot in the middle is where James' hole is


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