Welcome to middle child syndrome Rudy!

God answered our prayers that our new little guy would arrive early.  Funny how God was totally down with my plan.  I'm praying that he is cool with the rest of it......

I don't know where to start so I'll start with John Frederick Kalbach is here!  He arrived Sunday morning, August 11,  happy, sweet, healthy, beautiful and so itty bitty compared to the last baby who is all kinds of a giant to me now!  (Talking about Rudy)   Delivery was fast and furious, as was Jon's driving to the hospital.  After mild back pain all day and then some contractions that were getting painful we decided we should just head on to the hospital planning to do some walking when we got there but didn't want to chance the traffic considering the weather and tunnel being closed.  No sooner did we turn the corner heading off base and my contractions REALLY picked up.  I told Jon to put his 4-ways on and just get there.  We caught every red light and Jon "cautiously" ran all but one of them.  When I got in the car my contractions were about 5 min apart, when I got to the hospital they seemed about 2 min lasting about a min each.  It was as horrible as labor is.  I did get an epidural and that's a story for another day..... a resident or intern did it.  It was a bad experience. In the end it worked.  I got to the hospital around 9PM, JFK was born about four hours later the following morning at 12:51 AM.  The threat of forceps was mentioned after two contractions of pushing, so I panicked and pushed him out immediately.
He is beautiful.  He looks exactly like Ella and Rudy did.

So there's Freddie, new and helpless.  Ella and her major surgery tomorrow, and happy Rudy.  Oblivious to most of what's going on.  Feeling a little left out.  Sweet Rudy.

We were released from the hospital Monday afternoon but had to meet with Ella's doctor first and were able to leave Freddie in the nursery with my dear friend Jessica (who is a NICU nurse at NMCP) while we went to Ella's pre-op appointment.  I may have mentioned before that the Pediatric Urology Clinic at NMCP is so new that it is not yet set up.  The corpsman, and ambiance of the clinic are not child friendly.  We were told when we showed up for the appointment that everyone had mostly gone home early that day.   All the rooms were empty and the corpsman put us in this room (check out the poster on the wall) ...... Dr. Fox came in and turned about 10 shades of red.  Poor Ella had no idea what the picture was of.  Something in it resembled a squid..... Jon and I got a good laugh.  Poor sweet girl.

For pre-op Dr. Fox explained the surgery to us.  Essentially they are taking the "tumor", which is surrounded by calcium, out of the kidney.  In doing so, the margins are very close to the kidney's collection system and she is hoping to not cut into that.  Doing so will make everything a little more complex.  

The tumor which is 4 cm in size, grows both inside and outside of her kidney.  It seems in the imaging that it has not become involved in the adrenal gland at all.  However, I have learned it's all impossible to see or believe anything until they get in there.  Dr. Fox has referred to this surgery a few times as "very complex."  This makes me nervous.  I was about to request that no interns or residents be involved in the surgery (after my recent experience with the epidural and Freddie's circumcision) but Dr. Fox had already made that call because of the "complexity."  Ugh. 

 On Tuesday we went back to the hospital for more.  Ella had to get blood drawn, and a PPD.  That was fun!  (not)  

Then Freddie had an appointment.  Jon promised Ella  he would donate blood to use "just in case" and also so he could get stuck with a needle too so that took some time too.   Next we met up with Dr. Fox who escorted us upstairs to meet with the child life specialist.  He played air hockey with Ella while Jon and I got to sit down with 2 pediatric oncologists.  It took all I had not to cry.  They were nice.  I hope I never see them again. After them, we sat down with the child life guy and he spoke with Ella about the events of the surgery day.  What the rooms will be like, what she will see, and etc.  She told us that she felt better about it all after he explained so much to her. 

Next we went down to anesthesia to talk about when it would be that Ella would get her "sleep medicine".  We wanted to make sure it was before the IV went in.  She was reassured it would be AND she learned that there are flavors of anesthesia. 

By 3 PM we were exhausted.  Finally ate lunch and left.  All the time we spent in the clinic Freddie was with us and was good and easy as most 2 day old babies are.  I was the biggest mess of everyone, and continue to be.  

Sweet Ella is being so brave.  I can't even imagine what it will be like for her tomorrow.  I know how scared I would be if I were in her shoes.  

All that said, I mentioned hoping God would be totally down with the rest of my plan which I'll share and ask you to pray for with me.  

My plan for Ella:  Tomorrow morning at 5:15 am we arrive for Ella's scheduled 7:30 surgery.  Ella goes in being brave.  Surgery lasts 4 hours or less.  The biopsy of the tumor/mass/abscess (whatever it is, they like calling it a tumor now- I do not) comes back with a definite diagnosis of something benign that once removed we can put behind us.  There will be no cutting into the filtration system of her kidney and when she leaves surgery she leaves with most of her kidney minus the tumor, and the adrenal gland is not involved at all.   The oncology team will not be needed.  Ella will be ready to come home from the hospital in less than 5 days.  Then this will be behind us.  Ella will recover as quickly as kids do.  Start back to school on Sept 3rd at her new school and love it.  Happy, peaceful, boring ending to a scary story.

There will be no iffy details, no cliff hanging events, summer over. 

PLEASE pray for all of us tomorrow.  Especially for Ella, the three surgeons involved and everyone in the OR, and the folks in the lab doing the biopsy.  Thanks again for all of your love, support and being present for us during this time in our lives.  We love all of you and could not feel more blessed to have the friends, family, church family, and navy family that we do.  

News, Surgery, Baby, Prayers......

This picture is from last summer at Lake Tahoe.  My girl is brave.

This morning was the meeting between all the specialists at CHKD who were going to look at Ella's case.  As I anticipated, I got a call from Dr. Fox shortly after she got to work which coincided with me just sitting down and explaining Ella's health issues to my OB.  I took the call while with my OB just long enough to get the major gist of the meeting which was:  All of the doctors there, including the one who specializes in kidney tumors etc. all concur that what is there is not a malignancy but rather a localized abscess.  Still I feel nervous about that, but this news kept me on a high for most of the day.

Then we called her back to talk about the next step.

Ugh...... So the next step just didn't seem like it could be THAT bad.  Infection/abscess seems like something you can just take antibiotics for or like something that a lay person like me would assume would not be a big deal.  But I guess like an abscess on your toe or mouth, it would need removed.

As it is still a better option than her having cancer (PRAISE GOD for that! )  It is going to require a major surgery.  Excuse me if none of what I say from here on makes sense, we have a TON of questions and it is all overwhelming:

She needs a partial nephrectomy. (removal of part of her right kidney)  Sometimes this can be done laparoscopically but because the abscess goes inside of the kidney,  Dr. Fox said that eliminates her as a candidate......?  So they will have to make an incision which would be about the size of Ella's hand, under her rib.  (My girl is itty bity and so are her hands, but relative to her little body her hand is quite large. ) The surgery is a big one.  There are risks.  Blood loss being one, long term urine leakage, blah blah what?!  I think it's the risks that are making me nauseous.
She could be in the hospital several days recovering.  She could have a stint for a month after.  She will probably have a spinal or epidural in order to keep her comfortable for a couple of days after the surgery.  (Unfortunately I've explained what an epidural is to her because I plan on having one when this baby comes....I suppose we will leave out that detail when it pertains to her)

Dr. Fox will be performing the surgery, and because it's a big surgery she won't do it alone, she will have at least one other urologist with her.

Jon and I are writing down our thousand questions.  We will talk with Dr. Fox again tomorrow to ask them.  Ella can have the surgery as soon as Aug 15th.  (One week from today)  That allows for two weeks before school starts.

Let's not forget the kicker.  Who here is due to have a baby in 9 days or less?  Part of the wonderfulness of this pregnancy and part of the reason we are having another child is because of Ella.  Her desire and begging for a baby brother or sister was one of the reasons that pushed us over the edge to decide to do so.  The other beautiful thing is her love for this baby. Her excitement and understanding of the miracle of life growing inside me is simply so wonderful.  She is SO excited for her brother to come, and so excited to be there when he does.  Of course she won't be in the room when he comes out, the plan was immediately afterward, but she needs to be there and she needs to have a chance to bond with him before she goes in for surgery.   I feel that also, after surgery, during hard times, babies simply make things better.  I know that for Ella who adores babies beyond anything in the world, this would be a benefit to her recovery...... Problem currently is that I'm not dilated.  Cervix is thinning, but that's about it.  My Dr. (Dr. Busche) is awesome.  She said if I come in next week and ask her to examine me she will strip my membranes and induce me.  She said I have a good reason.....criteria is that my cervix be "favorable".    Ideally, this baby comes tonight.  God's plan though.......

So that's what I know.  Likely makes very little sense and I'm sure I left a ton out.  We are so grateful for your prayers.  We are so lucky to have an amazing support network of friends, family, navy family, neighbors and church family.  We do ask for continued prayer for all of us.  Prayers for Ella and for her little brother to arrive sooner rather than later.  It's game time yo.  We want this behind us.

Side note about Baby Boy, if you want to pray for him, his name John Frederick.  Freddie for short.  After his great-grandfather.

Tomorrow

Tomorrow is a big day.  7:30AM the team of specialists meet and during their meeting will review all of what they know so far about Ella.
I'm already starting to freak out.  I need to find peace to make it through today and until her Dr calls which I am anticipating her call sometime tomorrow.

At 10:40 I see my OB.  I feel pretty much like nothing is happening.  Actually, I still feel physically better than I have my entire prgnancy.  I'm  not sure if I should allow her to examine me, which in previous history has put me in labor, or let things happen on their own and make it to next week focusing and planning for the next step with my sweet girl.   Then again, labor could be a good distraction......?

If I haven't called you back or responded to texts or messages I'm sorry. I really just don't feel like talking.

Continued prayers for Ella, Jon and I are appreciated.

953-_ _ _ _

After Ella's day yesterday, we all came home tired so we rested, gathered our thoughts and came down from the anxiety high we had been on all day.  The kids wanted some "kid champaign" (aka sparkling grape juice) for wine time with grandma.  Jon and I wanted to go furniture shopping..... SO grandma stayed with the kids and had wine with them on the dock while Jon and I left on a date to go furniture shopping and dinner.

Before we even got off base the phone rang 953-2somthing....Dr. Fox.  after the initial "hi how are yous" It went something like this:

"Myself, Dr. Carter, Dr. (what's his name who is the adult urologist at Naval), and Dr. Restaino, all looked at Ella's MRI and it doesn't look like any malignancies any of us have ever seen.  I think that is a good thing.  I even sent it up to 4 of my colleagues in Pittsburgh that I studied under and they too have never seen anything like it.  This is good, but also doesn't tell us what it is, and doesn't mean it isn't malignant.  So my question for you is has Ella ever had any trauma to her kidney, falls, kicks, etc that you can think of?  (no) What about exposure to tuberculosis or other high fevers etc.....(not that I know of and can remember except 1 around age 3 which was 104.5 and I took her into the ER, didn't last long) Does she take naps?  (no)  So the next thing is as you know, on Thursday my team of colleagues in the area have agreed to look at Ella's images and we will gather their input.  We won't have a conclusion or timeline until next week when blood work comes back along with urine sample, both of which I'm expecting to be normal.  When we have all the input, we will determine our game plan.  By the looks of the MRI we may not have to go in as invasively as we thought and may be able to go in laproscopicly for the biopsy and if we have to change our plan during surgery we will be ready to do that.  It is still looking like the only way to know what it is, is to go in, and we have to do that in case it is something infectious, or malignant.  In the mean time, call me if she has any mysterious fevers or feels bad."

I'm so glad she called and let us know what they are thinking now rather than waiting until next week.  I'm still nervous.  But the initial "It's not any malignancy that any of us have ever seen" is glued to the hope I find in Ella not being sick or showing symptoms of anything being wrong.  She too has a 7 year old and completely understands we are anxious.

Thanks for the continued prayers!  We are getting closer to answers.

11 more days until my due date "operation get this baby out" is about to get serious.

Love,
Em

Monday Monday......

We got to the hospital "first thing" this morning, 7:45 and went strait to the urology clinic.  Apparently as Dr. Fox (the ped urologist)  is new to NMCP so is this pediatric specialty and the clinic is not yet set up except for the correct size BP cuff.  The corpsmen in the clinic were a litte "uncomfortable" with Ella.  It was almost comical.  That said everyone was beyond accommodating to us, understanding our anxiety and especially Ella's anxiety in regards to needles.

There was no official MRI in the schedule but they squeezed her in, gave her the OK to eat lunch and let her do it without sedation.   She went back around 12 and after the first set of pictures the pediatric radiologist, Dr. Carter, came to tell me she was holding as still as "stone" but they were going to go ahead and start the IV because they needed the contrast.  They fulfilled our plea/request for some EMLA cream prior to the IV and they made it happen.  Took her back in around 1 and she came out finished at 2.

Few things about today:
- Ella stayed really really still.  She did amazing.
- Before the contrast images, the radiologist did tell me he saw what they needed to see.  It's not as concerning to him as it is Dr. Fox (the urologist) but it is something that shouldn't be there.  What they looked at in other imaging suggested "it" was inside the kidney, these images and the CTs are helping them understand if in fact that is true or if it's outside the kidney and more involving adrenal tissue rather than kidney.   His words "not as concerning" to him as it is to Dr. Fox got my hopes up.  So I'm nervous about that.  However, Ella is symptom free other than her BP being mildly high is perfectly healthy.
-The team of urologists and nephrologists in the area have agreed to look at Ella's case on Thursday with all the imaging done thus far.  The only thing missing is blood work that won't be back until next week in which they are looking for mentanephrines.
- Ella was in there with Jon so I don't know first hand how long it all took with the MRI machine working, but seriously, once again can't be more thankful for our healthcare.  All these tests have to be outrageous.
-Rudy stayed home with my mother-in-law and I came home to a much cleaner house than I left.  We are so lucky to have her.  She's the absolute best.

That's all I know.  Now we wait some more.  They told us we will get a call next week to get an appointment for next week, I'm expecting a call sooner just because that's how it's been rolling out.

I'm seeing my OB on Thursday, hoping this baby show is getting on the road.  I think this baby boy has dropped, BUT physically I feel better now than I have my entire pregnancy.

Again, thanks for all your thoughts and prayers.  I woke up in the middle of the night with a great sense of peace after falling asleep full of anxiety.

Heavy hearts.

Tonight we found ourselves with heavy hearts and feeling nauseous. I'm imagining the night before surgery is going to be horrible.  Its just the night before an MRI.  Ella knows she is getting an IV tomorrow in order to sleep through the MRI and she is not handling it well.   She is sleeping in our bed.

For me it's not her anxiety and tears over the IV, but knowing that tomorrow we will have more pictures of what's there and still we won't have a solid answer and the plot could still thicken, and we have to wait longer.

Seperation from the kids gives us both anxiety right now. I don't do well alone with my thoughts.......then I google.  Bad. Bad. Idea.  I told the doctor the other day I had not called to speak with the oncologist because I didn't want to go there yet in my head.  He told me he understood that an agreed it really wouldnt help right now anyway.  It makes sense to me that it's not cancer.

Sometimes I even find myself forgetting I'm having a baby in 12 days or less.  If I weren't pregnant I am pretty sure I'd be asking the doc for some calming drugs.  I hate this uneasy feeling that never ceases. Things are so normal, everyone is so healthy, talking back, fighting, running, playing, laughing...... But there's this thing....... When I remember its there I feel like someone punched me in the stomach.

In Sunday school today they taught the story of David and Goliath to the kids . Rudy told us the story in the car after we left (wish I had I on video, it was precious!) and it totally opened up dialog about bravery and how God will be with her tomorrow when she gets the IV.

The sermon for the grown-ups was about not focusing on the greatness of the problem and the human resources to fix it but instead focusing in th greatness of our God and His resources.  It's the waiting and downtime when everything happens, when our leaning on God's greatness occurs, and rather than being concerned with our own overwhelming thoughts we look to Him and He will provide.

6:30 on a Friday night..... don't Doctors go home for the weekend?

I thought it was over for the weekend.  Calls from doctors that is.  I'm not used to seeing the phone ring from NMCP and it not be 953-0000.  A new 953 number showed up at 6:30PM after Jon and his mom left to take care of some last minute things at the Portsmouth house and the kids ran out the door to the playground.  Dr. Fox the urologist who we were supposed to meet with on the 12th called to get Ella in for an MRI first thing Monday morning.  (first thing is apparently 8am by the way. really?  8am is first thing in the military? )  She needs blood work, and probably an IV.  Ugh.  We never should have told her she wasn't going to get those again unless / when she had surgery.

Anyway, in "reconstructing" some images on the last CT the new images are making them wonder if what they are seeing is more the adrenal gland.  Tumor was mentioned again and also that there are many kinds of tumors, not all of which are terrible.  Not that that is what they saw, but a possibility and of course she mentioned that "when we see calcifications people automaticly think "tumor" but that isn't always the case."  She did ask how Ella was feeling, if she had headaches, or nausea, or any other symptoms and the fact that she doesn't is very good.

I'm overwhelmed.

I don't mean this blog entry to sound like I'm whining.  I'm SO grateful for the care we are getting and that this Dr. called me at 6:30 on a Friday night.  Surely she wants to call parents with kids who have scary things growing in them and talk to them first thing before she starts her weekend.   I just don't want anything worse and I don't know if this could be worse than what they were thinking before and I don't want to google it because we all know what happens when you google medical issues, you ONLY get worst case scenarios.  Maybe I can have the baby Saturday or Sunday night and we can just all be at the hospital on Monday morning at what I consider "first thing" anyway.