Another Great Kentuckiana Health and Fitness Magazine Article by Jenny -

I hope y'all take the time to read this one. It is truly inspirational.

Slade Art Exhibition Spring 2008

Skyler wanted to share some of her pieces as well. I will also contribute a couple of Sibley's earlier pieces from my private collection.

Piece no. 1. Sisters by Sibley Slade, marker on paper, done when the artist was but three years old

Piece no. 2. Desert Landscape by Skyler Slade, wax on paper, a personal favorite of the artist's mother

Piece no. 3. Under the Sea by Skyler Slade, three dimensional wax and paper on paper. This piece is also laminated.

Piece no. 4. Bumblebees by Sibley Slade, wax on notebook paper. Note the intricate detail on this phenomenal piece.

Piece no. 5. A Portrait of the Artist with her beloved Kitty by Sibley Slade, wax on paper. Note how the artist's kitty is miraculously suspended in the air by only a small string. This drawing was done when the artist was age two years.

Piece no. 6. The Sibley Tree by Sibley Slade, marker on paper, done when the artist was but three years old. Note how the artist either signed or labeled this piece as well as the Sisters piece before she was literate. Just as Picasso has his "Blue Period," Sibley has her "Preliterate Period."

Prints of any of these pieces are available in e-mail format upon request (at a nominal fee.) The standing reserve for each of the original pieces is set at: priceless. Thank you.

Sibley's Art Gallery

We are very proud of our Sibley, who goes to primary all by herself on Sundays as of late. Today she brought home some delightful pictures to share with me, which I (in turn) deemed appropriate to share with y'all.

The wax medium on paper (Crayola) drawing on the left is entitled Me and Grandmama's Horse. Note the life-like waterfall and rainbow as well as the centaur-like quality of the horse.

The wax medium on paper (Crayola) drawing on the right is entitled Heavenly Father Watching Over Me.

Note the ghost-like quality of Heavenly Father, who watches omnisciently from the upper left corner of this masterpiece. This artist has obviously been influenced by the greats - Leonardo, Rubens, El Greco, Alaina Enslen. In fact, this artist was named for one of Michelangelo's works, the Sibyls of the Sistine Chapel Ceiling, which happened to be the artist's mother's favorite painting.

NO SURGERY!

Just got back from the uroligist and he says he doesn't want to do surgery. Instead, he is putting me on a new drug for six months. This should kill off the infection that I have been unable to get rid of for the past three months and make my inflammation die down, and thus my pain go away. He said that although my right kidney is draining slowly, it IS draining. So he doesn't want to go in and put a stint unless absolutely necessary. Once the inflammation goes down, it should drain easier and more quickly. Maybe after a few weeks of this new antibiotic I will feel better, get back in shape again, and start working on having another baby! I can take this new drug while I am pregnant too. Once I am done with the 6 month supply, I will still need to take it intermittently in order to prevent the infection from coming back. Thanks again for all of your sweet messages to me. I sure do love y'all! I am so relieved and grateful that today's appointment was (hopefully) my last appointment for a long time to come! I am glad for poor Bryant too. He has had to carry me from doctor to doctor and test to test all over God's green earth. What a sweetheart! Thanks again for all of your help and well wishes, especially you Gwen. Don't know what we would have done without you for the past little while!

just one more day!

I just have to hold off until my doctor's appointment tomorrow to find out what is going to happen to me. I am so sick of not being able to plan for the future and just in general not being in control of my life. I have been so fussy lately. I feel so bad for my family. They have been great. Bryant and Gwen have helped me out immensely. They will never know how much I appreciate all of their help. I will update as soon as I get any news on Thursday. (My appointment is at noon.) Once again, thank you for your kind words and well wishes. Not to be too cheesy, but they mean so much to me! Also, I have so enjoyed how everyone has been frequently updating their blogs lately!

On a different note, on Monday we worked on our flowerbeds in the front yard, or rather, Bryant worked on our flower beds in the front yard. Thanks Bryant! I will take some pictures and post them. Now all we have left to do for the outside is paint the house, cement the porch, buy some patio furniture, and a new garage door. Piece of cake!

Also, I don't have any pictures of this, but Skyler got to be on the news this morning. A local news channel did their weather forecasting from our elementary school. They landed their chopper there and everything! Sibley and I got to watch it land from our front yard. (She is home from school sick with a cold today.)

Test Results

Bryant and I just got home from the hospital, where I had another test done today. This one was sort of like a cat scan where they injected me with nuclear dye and watched it go through my kidneys and into my bladder for about an hour so that they could pinpoint the blockage and gauge the severity of it. It was really interesting because Bryant and I got to watch the whole thing on a computer screen. It looks almost like I have two kidneys on my right side, one on top of the other. The top one drains just fine, just like the left kidney, but the bottom right one doesn't drain well at all. In fact, it never did drain totally until he injected my arm with a diuretic. I asked the radioligy tech if he had ever seen another patient with two ureters and he said no, that it wasn't common, and that I was a freak. We laughed pretty good at that. Anyway, I am sure the doctor can fix it. If nothing else, he could go in and put a stint in so that it would drain. I have my appointment with him next Friday, so I will let y'all know how it goes. Thanks again for all of your prayers and well wishes. I am always so encouraged by your comments. I printed some of them out and put them on my microwave. I look at them when I am having a bad day and they make me feel better. I love y'all and hope everyone is well. Happy Birthday Jacob!

THE CAT IN THE HAT!

The girls have so much fun with our cats. Luckily for them, Umba likes to ride around in their babydoll stroller at high rates of speed. I mean, do you know any other cats that would do that? I sure don't.

A new day...A new doctor...A new outlook on life!

I had an appointment with a new doctor today, one that came highly recommended. Boy was it a different experience than the last doctor's visit! (One differnce was that he didn't have me give a urine sample in a dixie cup. Another was that this doctor wasn't answering his own phones.) Anyway, my new doctor says I definitely have blockage on my right side and he ordered another test for me. The test is scheduled for next Tuesday. Then I have a follow up appointment on the 21st of this month, where they will do one more test. If the blockage is bad enough, then this guy will go in and fix it. If it isn't, then he has prescribed me an antibiotic to stay on permanently, so that infections don't keep coming back. And the one he prescribed is okay for me to take when pregnant. I am so upbeat. I feel like I am finally going to get this whole kidney thing resolved and be able to have a baby soon! So I guess y'all's fasting and praying is paying off for me. Thank you! Thank you! Thank you! I love y'all so much!

A package in the mail

My mother sent a package of gifts from Cambodia and we received it yesterday. It was full of some really cool stuff. I took a picture of Sibley wearing one of the Cambodian silk shirts. She aslo sent me a real kimono, which I am really pumped about. We got a beautiful statue of a mother and baby elephant, which Bryant took to his office and said would bring him luck. We got lots of beautiful jewelry, a scarf, and some pretty purses. What can I say? She even spoils us when she is on the other side of the world! Thanks mama! Thank you too Daddy! I forgot to tell you when we skyped this morning how much Bryant liked his hat too. I will post more pictures later.

what the doctor said

For me to say I am disappointed and frustrated would be the understatement of the year. I went to the new uroligist and he says there is nothing he can do for me. He doesn' t think there is anything wrong. Even though the radioligist read my ultrasound and cat scan reports and noted that I have "ureteral junction obstruction" and "hydronephrosis, " the uroligist said that those things were just a result of me being born with two ureters on my right side. I don't know what else to do. I feel like I know what is wrong with me and what is causing the pain, blood, and infections and no one will help me. I asked the uroligist if it was just a coincidence then that I have had blood in my urine and frequent u.t.i.s for the past 5 years and he said it was. I just can not and will not accept that. I guess I will go and get a 3rd opinion. Thank you for your thoughts and prayers and well wishes. I can't tell you how much it means to me to know that people love me right now. I love y'all.

This is what I have - ureteropelvic junction obstruction and hydronephrosis

This is what the cat scan showed. I figured out that I have had some obstruction ever since I was pregnant with Sibley. They told me during my ultrasound way back then that she was blocking my right kidney. That explains why I have had frequent UTIs and intermittent blood in my urine ever since then. I think I must have gotten a kidney stone pretty soon before Christmas, which aggravated my situation and things have gone downhill ever since then. See there - mystery solved!

OVERVIEW
The ureter is a long thin tubular structure 10-12 inches long which carries urine produced in the kidney to the bladder. The urine is transported by a process called peristalsis. The ureter actively propels urine from the kidney down into the bladder.
Ureteropelvic junction obstruction is a condition where blockage occurs at the junction where the ureter attaches to the kidney. This results in decreased flow of urine down the ureter and an increase of fluid pressure inside the kidney. Increased pressure inside the kidney can over time cause deterioration of kidney function. The obstruction can be either congenital (the patient is born with it) or develop over time secondary to trauma or change in body shape with age. The blockage can be due to scar tissue, kinking, a blood vessel or rarely tumor.
SIGNS AND SYMPTOMS
Ureteral obstruction can cause flank pain on the effected side. The pain may be intermittent and some patients notice increased pain when drinking alcohol, coffee or increased fluids. The pain can sometimes be in the front of the abdomen and can radiate down to the groin. In some instances, the condition is detected accidently on x-rays or ultrasound during evaluation for unrelated problems. When infection occurs in association with obstruction, patients can become quite ill and have high fevers. This condition may require hospitalization, emergency drainage of the urine and treatment with intravenous antibiotics.
TREATMENTS
The traditional treatment for ureteropelvic junction obstruction has been open surgery to cut out the area of scarring and re-connect the ureter to the kidney. Over the past several years, newer less invasive treatment options have been developed.
Endopyelotomy is a procedure through which a telescope or balloon with an electric wire on it is passed to the level of the kidney. The scar tissue is then cut open from the inside. These procedures can be done in a short period of time as an outpatient with minimal anesthetic and with a much shorter recuperation than with open surgery. Patients will have to keep a temporary internal tube (stent) for four to six weeks. The radiographic success rate with these procedures are 15%-20% lower than what is obtained with open surgery. Moreover, 40% of patients may have significant persistent pain following procedure.
Laparoscopic Pyeloplasty was developed in order to give the same high success rate obtained with open pyeloplasty while decreasing the morbidity. The internal procedure is performed in the same manner as the open surgery without the need for a large incision. Postoperative pain is less, recuperation is significantly quicker and scarring is minimal when compared with open surgery. The procedure requires a general anesthetic and hospitalization (usually 2 nights). An internal stent is also needed for four weeks. Success with this procedure is the same as open surgery (>95%). Click here for more details...




© Copyright 2008 All Rights Reserved Disclaimer Email:mailto:webmaster@urology.jhu.edu600 North Wolfe Street, Baltimore, Maryland 21287


Hydronephrosis is distention (dilation) of the kidney with urine, caused by backward pressure on the kidney when the flow of urine is obstructed.
Kidney stones are common causes of urinary tract obstruction.
When hydronephrosis occurs quickly, people may have excruciating pain, most often in the flank (the area between the ribs and the hips).
When hydronephrosis occurs more gradually, people may have no symptoms or experience attacks of dull, aching discomfort in the flank.
Doctors initially use bladder catheterization (or ultrasonography) to detect hydronephrosis, and they may use ultrasonography or another imaging test to determine the site of the blockage.
Treatment depends on the cause of the obstruction.
Hydronephrosis: A Distended Kidney
In hydronephrosis, the kidney is distended because the flow of urine is obstructed and urine backs up in the kidney's small tubes and central collecting area (renal pelvis).
Normally, urine flows out of the kidneys at extremely low pressure. If the flow of urine is obstructed, urine backs up behind the point of blockage, eventually reaching the small tubes of the kidney and its collecting area (renal pelvis), distending the kidney and increasing the pressure on its internal structures. The elevated pressure from obstruction may ultimately damage the kidney and can result in loss of its function. When the flow of urine is obstructed, urinary tract infections are fairly common and stones are more likely to form. If both kidneys are obstructed, kidney failure may result.
Long-standing distention of the renal pelvis and ureter can also inhibit the rhythmic muscular contractions that normally move urine down the ureter from the kidney to the bladder (peristalsis). Scar tissue may then replace the normal muscular tissue in the walls of the ureter, resulting in permanent damage.
Causes
Hydronephrosis commonly results from an obstruction located at the junction of the ureter and renal pelvis (ureteropelvic junction). Causes of this type of obstruction include the following:
Structural abnormalities—for example, a birth defect in which the insertion of the ureter into the renal pelvis is too high or there is inadequate development of the ureteral muscles (congenital ureteropelvic junction obstruction)
Kinking at the ureteropelvic junction resulting from a kidney shifting downward (ptosis of the kidney)
Stones (calculi) or a blood clot in the renal pelvis
Compression of the ureter by bands of fibrous tissue, an abnormally located artery or vein, or a tumor

Hydronephrosis can also result from an obstruction below the ureteropelvic junction or from backflow (reflux) of urine from the bladder. Causes of this type of obstruction include the following:
Stones in the ureter
Blood clot in the ureter
Tumors in or near the ureter
Narrowing of the ureter resulting from a birth defect, an injury, an infection, radiation therapy, or surgery
Disorders of the muscles or nerves in the ureter or bladder
Formation of fibrous tissue in or around the ureter resulting from surgery, radiation therapy, or drugs (especially methysergideSome Trade Names SANSERT)
Bulging of the lower end of the ureter into the bladder (ureterocele)
Cancers of the bladder, cervix, uterus, prostate, or other pelvic organs
Obstruction that prevents urine flow from the bladder to the urethra, resulting from prostate enlargement (most often caused by a condition called benign prostatic hyperplasia—see Prostate Disorders: Benign Prostatic Hyperplasia (BPH)), or rectal impaction with feces
Abnormal contractions of the bladder resulting from a birth defect or a spinal cord or nerve injury

Hydronephrosis of both kidneys can occur during pregnancy as the enlarging uterus compresses the ureters. Hormonal changes during pregnancy may aggravate the problem by reducing the muscular contractions that normally move urine down the ureters. This condition, commonly called hydronephrosis of pregnancy, usually ends when the pregnancy ends, although the renal pelvis and ureters may remain somewhat distended afterward.
Symptoms
Symptoms depend on the cause, location, and duration of the obstruction. When the obstruction begins quickly (acute hydronephrosis), it usually produces renal colic—an excruciating, intermittent pain in the flank (the area between the ribs and hip) on the affected side. Obstruction on one side does not reduce urine flow. Obstruction can stop or reduce urine flow if blockage affects the ureters from both kidneys or if it affects the urethra. Obstruction of the urethra or bladder outlet may produce pain, pressure, and distention of the bladder.
People who have slowly progressive (chronic) hydronephrosis may have no symptoms, or they may have attacks of dull, aching discomfort in the flank on the affected side. Sometimes a kidney stone temporarily blocks the ureter and produces painful hydronephrosis that occurs intermittently.
Hydronephrosis may cause vague intestinal symptoms, such as nausea, vomiting, and abdominal pain. These symptoms sometimes occur in children when hydronephrosis results from a birth defect in which the junction of the ureter and renal pelvis is too narrow (ureteropelvic junction obstruction).
People who have urinary tract infections may have pus in the urine, fever, and discomfort in the area of the bladder or kidneys.
Diagnosis
Early diagnosis is important, because most cases of obstruction can be corrected and because a delay in treatment can lead to irreversible kidney damage. Doctors may suspect hydronephrosis because of a person's symptoms and sometimes because of findings discovered during a physical examination. A distended kidney can occasionally be felt in the flank, particularly if the kidney is greatly enlarged in an infant or a child or a thin adult. A distended bladder can sometimes be felt in the lower part of the abdomen just above the pubic bone.
Doctors depend on testing to make the diagnosis. Bladder catheterization (insertion of a hollow, flexible tube through the urethra) is often the first diagnostic test done in people with renal colic, pelvic pressure, or distention. If the catheter drains a large amount of urine from the bladder, then either the bladder outlet or the urethra is obstructed. Many doctors do ultrasonography to determine whether the bladder is filled with a large amount of urine before doing bladder catheterization.
If the presence or site of obstruction is in doubt, various imaging tests can be done to identify evidence of obstruction such as hydronephrosis or a site of blockage. For example, ultrasonography is a very useful test in most people (particularly children and pregnant women) because it is fairly accurate and does not expose the person to any radiation. Computed tomography (CT) scanning is an alternative. It is rapid and highly accurate, particularly at identifying stones. Other imaging tests, such as intravenous urography, may be performed to identify the site of obstruction, if it is not visible with ultrasonography or CT.
An endoscope (a rigid or flexible telescope) is sometimes used to look at possible sites of obstruction as closely as possible. An endoscope can be used to examine the urinary tract.
Blood and urine tests are done. Blood test results are usually normal, but tests may reveal high levels of urea nitrogen (sometimes called BUN), creatinine, or both, if obstruction affects both kidneys. Results from an analysis of urine (urinalysis) are usually normal but white blood cells and red blood cells may be present when a stone or a cancer is the cause of obstruction, or when the obstruction is complicated by an infection.
Prognosis
Permanent kidney damage is unlikely to result unless both kidneys are obstructed for at least a few weeks. The prognosis is less certain for chronic hydronephrosis.
Treatment
Treatment usually aims to relieve the cause of obstruction. For example, if the urethra is obstructed because of an enlarged or cancerous prostate, treatment can include drugs, such as hormone therapy for prostate cancer (see Prostate Disorders: Cancer), surgery, or enlargement of the urethra with dilators. Other treatments, such as lithotripsy or endoscopic surgery, may be needed for stones that block the flow of urine. If the cause of obstruction cannot be rapidly corrected, particularly if there is infection, kidney failure, or severe pain, the urinary tract is drained. In acute hydronephrosis, urine that has accumulated above the obstruction can be drained with a soft tube inserted through the skin into the kidney (nephrostomy tube) or by insertion of a soft plastic tube that connects the bladder with the kidney (ureteral stent). Complications of nephrostomy tubes or ureteral stents can include displacement of the tube, infection, and discomfort.
Urgent relief of chronic hydronephrosis is usually not required. Complications of hydronephrosis, such as urinary tract infections and kidney failure, if present, are treated promptly.
Last full review/revision August 2007 by Glenn M. Preminger, MD
Back to Top

Previous: Introduction
Next: Stones in the Urinary Tract

The results of church basketball

This is why Bryant, who has terribly weak ankles, should not play church basketball. Things were bad enough when just Mama was out of commission. Now Mama and Daddy both are out of commission! Hopefully he will be better after he rests it all weekend. I am giving him ibuprofin and loaning him some of my tylenol with codeine.