In With the New

What do I see in store for us in the next year? For the most part I don't know, we haven't planned any career changes, moves, or trips out of the country so it should be a pretty stable, calm year. Except for one not so minor detail.

In the beginning of June, we will be receiving the final (yes, we will be making sure it is final) expansion to our family. I found that making the decision to have our first child was so easy. Probably due to naivety and a love for children, Dustin and I jumped in with both feet and didn't really spend much time obsessing over the details. We thought it would be great to have a baby, so 9 months later we had one. With William, we spent a lot more time stalling, postponing, and getting cold feet about having another child. We knew we didn't want Theo to be an only child but it took a long time before we were ready to jump back into taking care of a young baby again. For this new baby, we spent nearly a year agonizing over whether we should or shouldn't have a third. 

Truthfully, I never really intended on having three children. A family of four is quite simple and neat. You can avoid the self-centered and lonely life of an only child (sorry if I have offended any only children out there) but still fit your family into a small-ish car. Also, you aren't outnumbered by children in your home. Regardless of this logic and all the reasons not to have a third, I felt deep down that we were meant to have one more child. I knew that I would never regret the decision to have a third child but that I might forever regret that we didn't. I know this sounds like over emotional, hormone driven logic and pretty uncharacteristic my normal outlook on the world, but I can't really explain it any other way. Also, the decision to have a third child has absolutely nothing to do with the fact that I have two sons. It absolutely makes no difference to me whether this baby is a boy or a girl. I am actually pretty touchy if anyone implies or assumes that we are only "trying for a girl". We were trying for a baby, not specifically a girl, so there! :) 

Our newest addition at 16 weeks

I will be having the baby here in Fukuyama. I would like to return to Canada for the birth but the complication of having to take the two children back with me, leaving Dustin for a few months, Dustin not being able to be at the birth or see his new child for a few weeks, and the cost involved makes this impossible. 

This week marks the halfway point of my pregnancy and hopefully the second half will be much better than the first. One of these days I will do a post on my experiences being pregnant here and the differences I have noticed between prenatal care in Canada vs. Japan.

Muscle and Blood and Skin and Bones

Last week, the kids and I went to Okayama for Theo's semi annual round of checkups. The appointments were pretty straightforward with no surprises or invasive tests. It always seems like a long trip to make for a few 10 minute chats with doctors to tell them that nothing has changed since they saw him last. I guess it is better to be safe than sorry though. The only glitch in the day was when I got on the wrong bus at the train station. The bus that goes to the hospital does not have a readily obvious bus number or show the name of the hospital anywhere on it. I usually ask the bus driver to confirm that it is the right one but I was feeling daring last week and just hopped on the one that pulled up at the appropriate time. About 15 minutes later I knew that I had made a mistake but luckily the bus went in the right direction and since the hospital is fairly large and looming I was able to see it a kilometer or two in the distance. I am never too annoyed about a bit of unexpected exercise. All in all, I was much relieved that it was nothing like our last visit.

Our last trip to the hospital was in February and a total disaster. The day started off on the wrong foot. Shortly after arriving at the hospital I realized that I hadn't to brought quite enough money on my person to pay for the hospital bill, meals, and transportation back home. I know this might sound neglectful, but I am still getting used to a society where cash is used for everything and virtually no one accepts anything else. Also, since I had left Hiroshima I couldn't use my bank book to get any more cash. As I waited for nearly three hours in the waiting room to see the doctor I tallied my resources and realized that I could, just barely, pay the hospital bill and the train fare as long as nothing unexpected cropped up and we didn't eat anything. Theo, who almost never has an appetite and only eats when absolutely necessary (i.e. when we force him to) didn't really seem to care that lunch time came and went. I, on the other hand, was got progressively crankier as the day wore on.

Our last appointment for the day was an MRI to check Theo's spine. Because he can't stay still enough in the machine to get good photos, they needed to sedate him. In Canada, this meant that they put in an IV, gave him some kind of milky looking substance which knocked him out almost immediately, but when the IV was removed afterward he woke up within a few minutes groggy but functional. At our appointment in December, I was informed that they never used IV sedatives on children in Japan because they were much too strong. They instead gave him some orange flavoured syrup that was supposed to knock him out in 30 minutes to an hour. An hour came and went and instead of Theo getting sleepier, he just got extremely stoned. It was hard not to get irritated at him as he loudly demanded irrational things, tried to remove all of his clothing because he felt too hot, and insisted on walking around even though he kept on tripping and falling all over the place. At one point I thought he might settle down if I brought him outside into a courtyard with pretty mini-lights strung all over the trees. Instead he stared at it in wide eyed amazement while his head wobbled around and said: "wow, mommy look at all the pretty, pretty lights!". By the two hour mark the doctor was amazed that he was still on his feet and conscious. He told me that I would have to brig Theo back in a month so they could try again with a larger dose of sedatives.

Dejectedly, a completely high Theo and I made our way down to the reception to pay our bills and hopefully have enough left over to pay for a train ticket home. As I was standing in line to hand in my paperwork, Theo made his clumsy way to one of the chairs and promptly fell into a deep sleep. I ran back over to the doctor's office and he was able to rebook the MRI appointment he had just canceled. Theo was whisked in for pictures and out 10 minutes later. Unfortunately, this meant that I had to haul a completely unconscious, 20 kg sack of potatoes onto the bus and then on to the train back to Fukuyama. The good news was that I eventually did manage to haul his limp body safely back home and even had a little money left over once we arrived!

More of the Same

This month has been full of doctor's appointments. Between both children, we have been to the doctor's office eight times this month. Thankfully, most of the appointments were scheduled. At the beginning of the month, Theo had an appointment with a pediatric urologist here in Fukuyama. They took a blood test at that time and noticed that his white blood cell count was higher than normal.  He didn't have a fever, was acting pretty normal (or as normal as he ever acts), and his urine test came back clean, so I didn't really think much about it.

Powder packets of medicine

That night Theo woke up with a fever and complaining that his ear hurt. The mystery was solved, but now I was faced with the problem of finding a pediatrician and trying to communicate with my limited language skills. I located the closest pediatrician from a list of doctors that we had received from city hall and walked over with the kids. The appointment was actually fine, and between my few words of Japanese, the doctor's few words of English, and quite a bit of pantomiming, we established that Theo had a middle ear infection. I thought he would prescribe antibiotics and we would head home, but that would have been far too easy. Instead, he felt the need to refer us to an otolaryngologist even though he had already established that Theo had an obvious and uncomplicated ear infection. The children and I found our way to the next doctor who preformed all of the same checks that the pediatrician had and agreed that Theo had a middle ear infection. This time, at least, we were given a prescription of penicillin, acetaminophen, and antihistamine before leaving. When I had picked up the medicine from the pharmacy, I was surprised to find that it was all in powder form in little wax paper pouches. I have never given children medicine like this, since in Canada it is always mixed into a syrup by the pharmacist. After making call to a Japanese friend of mine, I found out that the powder is supposed to be poured into his mouth and washed down with water. The powdered medicine is mixed with sugar, so Theo had no problem taking it whatsoever.

Happily waiting for a CT scan

The next week, we went twice to the hospital that we had been referred to, Okayama National Hospital. One day we had an appointment with a pediatric urologist and the next with a pediatric neurosurgeon, who both spoke excellent English. One of the biggest concerns that I had before coming to Japan was that I wouldn't be able to communicate with Theo's doctors. I really didn't want to become uninvolved and uninformed about his medical condition purely because of the language barrier. I have been really fortunate in finding specialists that are all very easy to understand and communicate with in English. At those appointments, Theo had another ultrasound and a CT scan, both of which he found very exciting. He loves what he calls "doctor machines" and thinks it is pretty cool when he gets a chance to see them in action. Lucky for him, that happens often enough.

I managed to snap this shot before they kicked me out. He
is not drugged, just blinking!

It  took us about an hour and a half one way to reach the hospital from Fukuyama and this made for really long days hauling both kids back and forth. I was pretty proud that I managed to take the right trains and buses, and make all our appointments on time without losing anyone along the way or suffering through too many temper tantrums.

The boys playing in the hospital waiting room

Lastly, William had three appointments this month getting his vaccinations started. As I mentioned in an earlier post, we decided to wait until we arrived in Japan before beginning any vaccinations. After waiting for our health cards to arrive and just plain dilly dallying, I finally decided William's time was at hand. I brought him to the same pediatrician who initially saw Theo about his earache and he referred us to a vaccination clinic. I would really like to know what pediatricians do here other than refer you to doctors that they feel are better qualified to deal with your children's health. Last week, William received his first DPT shot, and on Wednesday he had the first of his Hib and pneumococcal vaccines. Needless to say, we have had a pretty sore and cranky baby for the past few days.

This month has felt very hectic so far and I am hoping that we are done with appointments for at least a few weeks. A little bit of peace on earth would be very welcome in our household over Christmas and New Years!

First Encounters

By the time we left Canada, I was quite comfortable with the medical system. After having checkups, one trip to the emergency room, two pregnancies and births, and one child with special medical needs, there was rarely anything that surprised me. I never had too many complaints about the care I received, but it was really all I had ever known.

Since arriving in Japan, I have been really fortunate in finding doctors and getting Theo's medical records translated. Through our neighbour, we were able to meet a pharmacist that would like to be an English/Japanese medical translator. She has been overwhelmingly helpful in getting the reference letters from Theo's Canadian doctors and a medical history translated into Japanese. She was also able to help us find a hospital in Fukuyama with a pediatric urologist and nephrologist and set up an appointment.

Theo looking into the middle distance

Theo's visit to the hospital was on Monday. We were able to visit the doctor, who spoke impeccable English, have an ultrasound of his kidneys, blood tests, and a urinalysis. The tests showed that there has been no change in his kidney function since Canada, but the doctor informed me that he would like to refer Theo to a larger hospital with a more specialized pediatric urology and neurosurgery department. He was concerned that since Theo has a very rare kidney and spinal malformation, that they would not be able to provide the most comprehensive care for him here in Fukuyama. We are being sent to Okayama National Hospital which is in the prefecture directly east of us. It is actually extremely close to us, only 18 minutes by shinkansen. I was afraid that he would refer us to some place much farther away, like Osaka or Tokyo, so Okayama sounded great to me. Hopefully they feel confident taking Theo's case and don't just refer us somewhere farther away. Our appointment  is on December 13th, and our pharmacist friend is being nice enough to join us there.

I have been to at least 20 appointments in Canada just like the one we had on Monday, and here are the major differences I observed:

1. It takes months before you can get an appointment in Canada. Unless it is an emergency, it is extremely common to get an appointment to see your doctor anywhere from 2 - 6 months in the future. You get very used to booking appointments months in advance. Here, I was given the option of seeing a doctor within a week of calling.

For lack of a relevant picture, here is a cute one of William

2. In Canada, it takes at least four months before you get an ultrasound. Your ultrasound is taken by a technician, interpreted by some doctor, and the results and images are then sent to your actual doctor. It takes about 2 weeks before you get your results. They will only speed up this process if it is an extreme emergency. In Japan, Theo was given an ultrasound, by the doctor, at his appointment, and I was told the results right away. Needless to say, I was impressed.

3. Health care is free in Canada, but prescriptions are not. For Theo's appointment on Monday, I paid 500 yen ($6.50 Canadian) because he is covered by National Health Insurance and Infant Medical Expense Assistance. Prescription medicine here is free though.

4. The doctor I saw on Monday was incredulous that the doctors in Canada had never done an MRI of his kidneys and that the only CT scan he has ever had was when he was 2 months old. It seems that doctors here are much more willing to preform every test available to better monitor your health.

All in all, I was very pleased with my first encounter with the medical system here. Even though Theo's doctors in Canada were very competent and caring, I think in the long run he will receive better care in Japan. Lets just hope that our experience in Okayama confirms this!

Bill and Ted's Bogus Journey Part 2

 The first two days that Theo spent in the hospital were extremely busy for us. We were throwing a going away party that week, and though we were tempted to cancel it, we realized that might be more work than just going through with our original plans. All of the food had been bought and not many people knew that Theo was in the hospital, so it would have been a whole day of nearly identical phone conversations to call the whole thing off. The party ended up being extremely successful and fun: the decorations were fantastic thanks to my mother-in-laws magic, the food was good, and I think everyone had a great time.

Meanwhile, at the Children's Hospital, Theo was still not recuperating. His temperature was spiking every 4 hours and he was not eating, drinking, and had very little energy. On Friday morning he had an ultrasound of his kidney which revealed that it was actually infected. The antibiotics didn't seem to be doing a thing, since his fevers kept coming back. Finally the doctors decided wait until Sunday evening to see if the antibiotics would begin to work, and if not they would put a tube in through his back, into his kidney which would have to remain there for months to allow the buildup of fluid and pus to drain. After a few months they would remove the tube and there was also some talk of removing the upper portion of his kidney at that time. Obviously, we were really hoping that the antibiotics would kick in soon.

Finally feeling good enough to enjoy the toys

The weekend wore on and Sunday evening drew closer with Theo not doing any better. Finally, when I had resigned myself for the worst, his fever didn't return. The antibiotics finally started doing their job and Theo started perking up more and more. Over the past few days he has started eating more and actually wanting to run and play.

The last we heard, he can come home this evening! After almost two weeks in the hospital, and Dustin's departure date looming closer, we are really relieved that we will be able to go home soon. It has been hard balancing work, Theo, and all of the extra stress of packing and moving but I am sure that Theo will be the happiest one of all when it's over.

Thanks everyone for your thoughts and prayers while he has been in the hospital. In the end, everything worked out so much better than we expected!

Playing with William

Bill and Ted's Bogus Journey Part 1

We have had a few long days and sleepless nights since my last post. Theo had been sick all last weekend when we were moving (as we all were) but didn't seem to be getting better. I attributed his intermittent fever, irritability, and fatigue to the really bad cold that he had caught last Friday, but by Tuesday I was beginning to get concerned when he got a fever again and was sleeping 16 hours a day.

I brought him into the Children's Hospital Emergency in Winnipeg on Tuesday evening because I was beginning to suspect that something more important, like a urinary tract infection, was lurking under the congestion and cough that he had. In retrospect, I should have suspected something a couple of days earlier and brought him in, but being super sick myself and also trying to pack and move the whole house, I suppose I was not being as intuitive about his sickness as I could have been. I thought that the worst case scenario would be a UTI, but since he hadn't once complained about pain while peeing, wasn't going to the bathroom any more than usual, or any other obvious symptoms, I really thought it was not the case. Once at the hospital, they took a urine sample and confirmed that he did in fact have a UTI.

Theo enjoying his brother's company at the hospital

As I wrote about in a previous post Theo's kidney is an object of interest for many a doctor. He only has one remaining kidney and only half of it functions properly. As soon as it was discovered that he had a UTI, the doctors went into a tizzy because they didn't know whether the infection had spread from his bladder to the kidney, and if it had, would the remaining functioning part of his kidney be completely damaged. They promptly hooked him up to an IV of some pretty potent antibiotics, which sounds much easier than the 1 1/2 hours of multiple nurses, numerous collapsed veins, and screaming which was actually involved before they managed to get the IV in properly.

Every doctor, resident, and student on the floor then decided to show up at intervals poking and prodding Theo and each one asking me to tell a detailed story of his life. I started getting a bit annoyed since it was midnight at this point and they were asking pointless things like "what did you crave during your pregnancy with him?". He eventually fell asleep on the bed in the ER in spite of people poking him every 5 minutes and we were finally admitted to a room in the Children's Hospital by 1 am. Dustin "slept" in his room the first night since I had to return to William who was being watched by my mother-in-law.

So bored

That long drive out of town to my in-laws in the dark was strange since it was the first time I have seriously pondered the fact that I am the proprietor of the only kidney available for transplant in our family. Theo and I share a rare-ish blood type and unfortunately are the only ones in our family with it. The test to show if his kidney was actually infected would take another 48 hours, and if it was, it would take another day or two to assess how much of his kidney was seriously damaged by it. I could feel the phantom scalpel tickling under the ribs on my back while I tried to prepare myself mentally for the possibility of having an organ removed on short notice.

To be continued...