04.09.2008 - Pre-Operation

From Julian's COTA Journal.

It's 9:30 p.m. here in Palo Alto, the end of a long day. Julian's been admitted to the hospital in anticipation of his bladder surgery tomorrow afternoon. Originally, we were to admit tomorrow morning, but the Urology N.P. doesn't want him to dehydrate before the operation. As such, they're going to put him on an I.V. drip tonight in order to stabilize his electrolytes and fluids for the surgery.

Today's V.C.U.G. went well: I'm not entirely sure what V.C.U.G. stands for, but basically they plugged his vasecostomy and filled his bladder with a dye that could be seen by a fluoroscope; then they pumped the bladder full of the dye to see what the bladder looks like and see how it behaves under pressure. The Urologist who will be performing tomorrow's surgery also performed the V.C.U.G. today, and was pleased with the current condition of Julian's bladder. Until now, we had no real idea whether or not Julian's bladder could ever function normally; now it looks like Julian could actually have normal bladder function after all.

So tomorrow they'll do a cystoscopy, where (cross your legs guys) the Docs will go in through the penis, all the way through to the bladder, working on the valves along the way. In particular, they'll ablate (i.e. cut with a laser) the posterior urethral valve at the exit of the bladder, which was the initial cause of most of Julian's problems starting while he was in utero.

Stacy and I were reflecting over dinner tonight how Julian's kidney issues have kind of overshadowed his bladder issues up until now. It dawned on us that by tomorrow night, Julian will no longer have a vasecostomy and should be urinating through his penis. We're nervous, but excited at the same time, as we are at long last on the road to some semblance of normalcy with regard to Julian's day-to-day quality of life. In other words, we may actually be able to start potty training soon!

If all goes well tomorrow, and assuming no subsequent bladder surgeries are required, Julian could be set for his kidney transplant as soon as three weeks from now. Of course that depends on the availability of a viable organ as well - see Stacy's post from April 4th for more info on that front. In any event, we're praying that the transplant will happen sooner (i.e. 3-6 weeks) rather than later (i.e. 3-6 months).

Another item to pray for: it's very likely that one of the outcomes of this surgery is that Julian's kidneys may start to decline more rapidly, which would necessitate dialysis, even if only to get us through to the transplant. We're stating a preference for hemo-dialysis, rather than peritoneal dialysis, which is the kind we tried last December. We're going for the hemo-option because a) it didn't work last December, and b) hemo would take place a couple times per week in the hospital - a much more manageable situation for Stacy, who will be his primary care-giver through all of this (I'll be commuting between Colorado and California as long as Stacy and Julian are here). So, while they're working on his bladder tomorrow, it's likely that they'll also install a hemo-dialysis port at the same time, just in case.

Okay, now it's nearly 11:30. Since I started this post, the nurses have come in and a) installed the i.v. and b) taken a urine sample. Julian is finally asleep; I'm about to follow suit. Stacy is at the Ronald MacDonald House, getting a solid night in preparation for tomorrow's surgery.

I'll post more tomorrow - stay tuned and keep in touch.