40+5

Emma spent 40 weeks, 5 days "baking" inside of me and now she has officially been in this world for 40 weeks, 5 days. :) Thank you baby girl for all the joy you have brought to our lives!

vu reflux

When Emma was 3 weeks old she developed a very high fever. It was a Sunday so I had to rush her to the emergency room to be checked out. Because her only symptom was the fever they had to do every test they could to determine what was wrong with her. She had blood taken for a full panel, urine for a urinanalysis, spinal fluid to test for meningitis, and a chest x-ray to check her lungs. They started her on some broad spectrum antibiotics and antivirals and explained that we would be admitted to the hospital until they figured out the origin of the fever. Fast forward 3 (miserable) days in the hospital and we had an answer. Everything came back negative except her urinanalysis. She had a UTI. They did an ultrasound of her kidneys and ureters and it showed hydronephrosis (swelling of the kidney due to the back up of urine) so after we finished her oral course of the antibiotics at home we had to go back for additional testing to determine if the UTI was a fluke or if it was a problem that required more treatment. So we headed back to the hospital two weeks later to have a VCUG..

A VCUG, or a voiding cystourethrogram, is used to visualize a child's urinary tract and bladder. It can help diagnose VU reflux, determine why a child is having recurring UTIs, discover if antibiotic treatment or anti-reflux surgery was effective, and check if there are any abnormalities or blockages of the urethra.

..Emma was catheterized (a small tube was inserted into her urethra). Her bladder was emptied. The tube had to remain in place the entire time she was being tested. A radioactive liquid was then "injected" into her bladder through the tube. The contrast die illuminated her urinary tract on x-ray images. Using a special x-ray technique they obtained images of Emma's bladder filling and emptying. And it was not good...
<-- normal
<--what we saw

Before we left, the radiologist read the films to give us some kind of idea what was going on. The news: Emma had/has vesicoureteral reflux (VU reflux) affecting both her right and left kidneys and ureters.

All you ever wanted or needed to know about the urinary tract and VU reflux...


What is the normal urinary tract?
The urinary tract consists of the kidneys, ureters, bladder and urethra. The kidneys are the organs that are responsible for filtering waste products from the bloodstream and produce urine continuously. The urine drains down tubes called ureters from the kidneys to the bladder, which normally stores urine and empties intermittently by muscular contraction. The urine exits the bladder through the urethra.
When the ureter enters the bladder it travels through the wall for a distance creating a tunnel so that a flap valve is created. This valve prevents urine that is in the bladder from backing up and returning into the ureter. Thus, when the bladder fills and later when it squeezes down to empty, back-up (that is, reflux of urine) is prevented because the valve operates in the same way as when you pinch off a soda straw.
The valves' most important job is to prevent bacteria from getting into the kidneys.
Diagram of the way our ureters enter our bladder.

What is vesicoureteral reflux (VU reflux)?
With normal urination, the bladder contracts and urine leaves the body through the urethra. With vesicoureteral reflux, some urine goes back up into the ureters and possibly up to the kidneys. Reflux exposes the kidneys to infection. In children, particularly those in the first 6 years of life, urinary infection can cause kidney damage. The injury to the kidney may result in renal scarring and loss of future growth potential or widespread scarring and atrophy (muscle death). Even a small area of scarring in one kidney may be a cause of high blood pressure later in life. Untreated reflux on both sides can, in the most severe instances, result in kidney failure requiring dialysis or a kidney transplant.

Why does vesicoureteral reflux occur?
The valve system at the ureterovesical (ureter-bladder) junction may be abnormal:In some children the tunnel of the lower ureter through the muscular wall of the bladder may not be long enough. For these children, there is a good chance that growth may provide the necessary difference to allow the valve to work. In other children, the ureter may enter into the bladder abnormally (usually too much to the side), resulting in a short tunnel. This reflux is less likely to resolve with growth.

The ureter is shown tunneling through the bladder wall. 1-if the tunneling of the ureter ends here, reflux is likely. 2-if the tunneling of the ureter ends here, reflux is possible. 3-if the tunneling of the ureter ends here, reflux is unlikely.

Some children have reflux because of underlying problems such as lower urinary obstruction (such as urethral valves), abnormal bladder behavior (such as uninhibited bladder contractions or hyperreflexic bladders), infrequent voiding, or constipation.

They believe Emma has reflux because her ureters enter into her bladder abnormally. They also believe Emma's reflux will not "fix" itself through growth (20% chance) and so surgery is in her future.

How is reflux evaluated?
Children who are suspected of having reflux should have a renal ultrasound and a voiding cystourethrogram (VCUG). Based on these studies, reflux can be classified into five grades - grade 1 is the least and grade 5 is the worst. Mild degrees of reflux have a good chance of resolving spontaneously with age. Chances of resolution with high-grade reflux (grade 4-5, or reflux related to an anatomic problem such as a long-standing obstruction) are much lower.

Normal kidney, ureter, and bladder	Grade I Vesicoureteral Reflux: urine (shown in blue) refluxes part-way up the ureter	Grade II Vesicoureteral Reflux: urine refluxes all the way up the ureter
Grade III Vesicoureteral Reflux: urine refluxes all the way up the ureter with dilatation of the ureter and calyces (part of the kidney where urine collects)	Grade IV Vesicoureteral Reflux: urine refluxes all the way up the ureter with marked dilatation of the ureter and calyces	Grade V Vesicoureteral Reflux: massive reflux of urine up the ureter with marked tortuosity and dilatation of the ureter and calyces

Emma had an ultrasound in the hospital as I said earlier and then on a later date had a VCUG done. Her reflux was graded as a 4-5 on the right and 5 on the left.

How is reflux treated?
Since many children will outgrow their reflux, they can be followed carefully, with their reflux monitored at intervals by tests such as VCUG, renal ultrasound, or nuclear voiding cystogram. During this follow-up period they are kept on a prophylactic (low-dose) antibiotic to keep the urine free of infection. Any fever or urinary tract symptoms (such as burning, frequency, urgency, straining, foul odor, bloody urine, or unusual incontinence) must be evaluated with urine analysis and urine culture. Children who develop breakthrough urinary infections in spite of prophylaxis are at risk for kidney damage and need to be considered for surgical correction of reflux.

Emma is on a low-dose prophylactic antibiotic called Septra. She takes it once-a-day. She just went for her 6 month follow up in April. She had an ultrasound and a nuclear medicine study called a mag 3 scan done to check her kidney function. There was no good or bad news to be reported from that. They did not repeat the VCUG so we have no idea if her reflux is better or worse (I don't think it has changed for the better or worse) but we do know that there is only minimal (if any) damage to her left kidney from her infection when she was 3 weeks old. She has been infection free since her hospital stay in September '10 so that's good. She will go back in October to have another ultrasound and VCUG done.

How is reflux treated surgically? Correction of reflux (ureteral reimplantation or ureteroneocystostorny) is recommended for high grades of reflux, for reflux that fails to resolve, or for patients with breakthrough infections. The traditional surgical approach involves opening the bladder and creating a new longer tunnel for the ureter through the bladder wall.

I'm not sure of the time frame for when they plan on doing this. I know they will make a decision around her 2nd birthday to give her body a chance to grow and change. Unless of course she starts having several breakthrough infections.

What about long-term follow-up?
Children with a history of reflux should probably be monitored life-long with measurement of height and weight, blood pressure, and urine analysis. Occasional ultrasound tests will assure that kidney growth is on target for age and size. If kidney function from previous reflux should deteriorate, the pediatric nephrology team can begin appropriate medication and dietary restriction.

What about other family members?
If one child in a family has reflux, there is a 1 in 3 chance of having an affected sister or brother. Because we know that the chances of kidney damage are highest in the first 6 years of life, we think that brothers and sisters in that age range should be studied (with examination, ultrasound and voiding study) even though they may not have been known to have urinary infections.

Sorry for such a long winded (maybe boring) post but I needed to get this written down so I have a record of it and also I wanted to share this with our families. It is so hard to explain it all correctly over and over. And sometimes I forget and leave some parts out. Happy reading.

I will leave you with a picture of our precious baby girl from a couple weeks ago when Granny was visiting. We went to a carnival just to get out of the house for the day and here is one of the pictures she took.
"Hello I look so much like my daddy!!"

goodnight moon

Usually at the Odom/Castle household we start bed time between 7-730. Emma has her final ba-ba, we call Nana to tell her goodnight, and then we head upstairs to get changed into our nighttime stuff. I (or James when he is home from work) read a story to her (Goodnight Moon=mommy; On the Night You were Born=daddy) then I lay her down in her crib and say a bedtime prayer before I walk out of the room. I used to rock Emma to sleep every night but about a month ago she put an end to that. Great thing for the long run but it still makes me so sad at times..

But last weekend we had several busy nights where Emma did not have her regular bed time routine and it caused her to be super upset when I did lay her down to go to sleep. So Monday I decided that maybe rocking her again before bed would help ease the stress she was experiencing from bed time; and to my surprise I got two days of cuddles before she decided that she didn't want cuddles anymore. But those two days I will cherish for a very long time. She let me hold her close to me and talk to her as she touched my face and smiled and giggled at me. She still refused to let me rock her to sleep but I did get a good 5-10 minutes of special mommy-Emma time :)

I see the love in her eyes..

bath time + baby mohawk

Bath time is one of Emma's favorite times. Unfortunately her skin gets so dried out from the water that she doesn't get to enjoy this time as much as she would like. But once she's in there, she splashes and plays with her duckies, blocks, and cup. So as you can imagine it's hard not getting a blurry picture... but still adorable as ever!

& LOOK at all the baby hair mommy gets to play with after bath time! :)

9 months

I finally realized why when I was pregnant time seemed to crawl.. why (almost) 41 weeks seemed like 41 years.. I was being taught to enjoy the little moments because once a baby is born time flies. Because I blinked and my baby is 9 months old.

I've loved every minute I've had with Emma, no matter how hard some minutes have been. She is the reason we get up in the morning. Even the nights we yearn to have a free minute to ourselves, we find ourselves missing her and wanting her to come home. We both marvel in the how much we love our little girl. We are so excited to see what the next minutes, hours, days, months, and years hold....

Emma's growth and development
weight= 21lbs 12oz (90th percentile)
height= 28.5in (79th percentile)

At this age you can expect your infant to sit alone, pull to a stand, stand holding on to things, jabber and imitate sounds, crawl, wave bye-bye, and begin to show separation and stranger anxiety. Over the next few months he will start to combine syllables, say mama/dada, walk w
with his hands held, and bang objects together.

Emma can sit alone, pull to a stand, stand holding on to things, jabber and imitate sounds, wave bye-bye and hello, and she has been in "stranger danger" mode since she was about 4 months old, haha. She refuses to crawl :( but hopefully soon she'll get over that or she'll start walking. Our backs are about to break, she's so heavy!!

Your infant will now begin to explore how things work, enjoy playing peekaboo and pat-a-cake and being read to. It is important to give lots of praise and many opportunities for exploration. If using a pacifier, it is a good time to start restricting its use to only when your baby is in his crib (or giving it up all together), so that his interest in it will decrease.

Emma takes an antibiotic by an oral syringe every night. After I've pushed the last of the liquid into her mouth she will take the syringe from me and play with it. About a month ago she started putting it to our mouths to imitate how we just gave her her meds. Such a smart little cookie :) Emma loves playing peek-a-boo and pat-a-cake. We read and play with books before naps and at bedtime. The child will not take a paci no matter how hard I try so no worries about that!

Most infants at this age take two naps during the day (length of naps are usually very variable between different children, but naps are usually 1 - 2 hours each) and are able to sleep for the majority of the night. If not, check to make sure that he has a good bedtime routine and has developed the proper sleep associations. He may start waking again at times of stress, illness or after learning a new task (such as walking).

Emma takes two (1.5-2 hour) naps a day but she can make it through the day on just one (3-3.5 hour) nap. She has slept through the night (99% of the nights) since she was 2-3 months. When she's teething she wakes up in the middle of the night to jabber to herself but puts herself back to sleep most of the time.

sophia's first dance recital

We went to Sophia's dance recital today. She did a great job in her cupcake dance! It was so precious, I wish I had pictures/video of the actual performance but my camera failed.
Emma also deserves praise for today.. she was an absolutely wonderful baby all day, running on only a 2 hour morning nap. After the recital we had dinner at StoneCreek (one of our favorites). Here are some pictures from our dinner...



Emma studying the menu...


Sophia's celebratory cupcake shaped cake.. it was deeee-lish!


Sophia loved the cake


Miles was happy to celebrate too..


Emma with one of her fav things, a straw, in her cute dress from Great Great Aunt Loretta

happy birthday uncle b!

Uncle B's birthday was on Mother's Day but we celebrated last night. Posted below are videos from the party.

Miles and Sophia were chasing each other around and Emma wanted to join in so Grandpa helped her out...


Emma was pulling herself up to the coffee table and stood there by herself. Yay Em!

GG- the outfit Emma is wearing was one she got at her "baby shower" when you guys were in Indiana in February. I love it :)


One more video posted below.. when we were at Nana's on Friday night Emma started doing something funny. She is one smart cookie and realizes that when we move her highchair close to the kitchen island (where they eat dinner most nights) that means some food is going to be put into her mouth. So she has started holding her mouth wide open while rolling to the table. It's so funny.. ENJOY!

day to day

We have a busy weekend ahead of us but here are a few pictures from the end of our week...



Emma tried some pineapple for the first time and was less than impressed





Cool girl Emma :)

peek-a-ZOO

We took Emma for her first zoo visit today. She was so uninterested, haha, but we really enjoyed our day together as a family :) She did love looking at the fish and dolphins swim around and also the baboons but other than that she was more interested in little kid (people) watching than anything else.
I really hoped we could get some good pictures today; however, Little Miss had a different agenda. She would not look at me when the camera was in my hands and every time we tried to snap a picture of her she would turn away. I did trick her into the one below.


Her teeth are bothering her so much-- she is constantly gnawing on anything she can get her mouth on. Poor baby girl :(

After this photo was taken, I gave Emma her paci to play with. We walked to the cheetah exhibit and one minute I was talking to her and the next minute we find her like this....

... sound asleep-- and with the paci?!

She was out like a light. But no girl is ever too tired to shop...

Her new giraffe that she loves. We have yet to name it, so we're open to suggestions :)

It was a very, VERY hot day in Indiana (86+) but we finished our zoo visit before it got too hot. The rest of the day Emma and I just spent plenty of quality time with Daddy.. it was a great day!!

the laugh that our world revolves around

This laugh brightens my days. I hope it brightens yours too :)

almost crawling

Emma is so close to crawling and I see our life flashing before us with every inch she gets closer. I know once she figures it out there will be no stopping her. But this is a milestone we cannot wait for. Not only because she's so heavy she's breaking our arms but because it is a major milestone in Emma's life. It's something to celebrate!! So until then enjoy the video of her ALMOST getting it. Sorry for all the background noise, she was really interested in me playing with Dolce. This is the longest I've kept her on her belly since she learned to roll over almost 6 months ago now.

quick/short update

Emma has four..count 'em four.. teeth coming in at once

teething--it's hard work for Emma and Mommy. Her top teeth are FINALLY popping through after a couple weeks of torture for the both of us. Picture to come soon but for now she won't let me mess with her mouth.

on another note, HAPPY MOTHER'S DAY :)

it's a great day to have a baby

I remember the day like it was yesterday; waking up disappointed because I wasn’t in the puddle of my broken water, disappointed I wasn’t feeling any different. I was after all 5 days past my due date—almost 41 weeks pregnant and feeling like if I went one more day being pregnant I would bust. Only a woman who has been pregnant before can understand how thin your patience runs when you get towards the end (and pass the end in my case). In the last weeks, I think I cried at least once a day, every day that I just wanted to not be pregnant anymore.

(7am) The morning I went into labor I was standing outside when I noticed my belly was tightening. OH and three minutes later it happened again. However, I was not going to be fooled by these practice contractions again. Because you see 6 weeks earlier I had been having contractions and went to OB triage only to be told that I was having indeed having true contractions and I was dilated 1cm. They decided to admit me and observe me overnight to see whether I would go into full on labor or if they could stop it with some simple morphine. Well let’s just say the morphine not only helped stop the contractions but it also helped me to sleep for almost 24 hours. When they were discharging me that next morning they said “we’ll see you next weekend I’m sure”. Yeah right, that didn’t happen. From that point on, all anyone would say to me is, “any day now”. Any day now 6 weeks later…

I wasn’t thinking “today is the day” when I was having these not-so-painful-but-consistent contractions that morning. But I did keep track of them and within the 40 minute drive to my appointment my contractions had been coming every 1-2 minutes.

(9am) When I got to the OB office, I informed the lady that checked me in that I was having contractions. She brought me right back and they hooked me up to the NST machine. Emma was not very perky so they gave me some OJ to drink and she perked up but the monitor was not showing that my contractions were very intense. The midwife said she would check me since I said I was having contractions. She immediately said “OH, you’re 5-6cms dilated! We need to get you admitted.” So after all the necessary paperwork was taken care of and phone calls were made I was wheeled over to the OB floor of the hospital. I was shaking the entire time—today was actually going to be the day I met my baby girl. This is the day I had been waiting for since we found out I was pregnant in last December.

(10am) They got me all checked into my room, they made me change into the hospital gown, and they put an IV in my arm. During this whole time, I was still not feeling the contractions very much. Of course, I felt the tightening and releasing but it was just pressure, there was no pain. So when my nurse came in to ask me about whether or not I would want an epidural I jokingly said, “If labor feels like this, then I don’t even need one.” Well she took me serious. Worst thing I ever said in the moment, best thing I ever said in the end.

During this time the midwife came in to check me and I was progressing nicely. She felt around on my belly to check Emma’s position and she asked me how much the tech “guessed” she would weigh when she was born. I told her the tech said a little over 9lbs and she says “HMM, that’s no 9lb baby”.

(11am) As the minutes flew by, the contractions became more and more intense and I became more and more uncomfortable. It got to the point where I was begging for an epidural or some kind of pain meds. The midwife, of course, had to check me before the nurse would put in the call to the anesthesiologist and when she did finally check me I was 8.5cm dilated. The midwife said she was going to break my water because that would progress me further and I would be ready to go. At this point, I got hysterical. I was in so much pain but the pain did not wipe away all of the medical stuff I knew and I knew that if she broke my water the contractions would hurt even worse. I NEEDED that epidural before that. The midwife got the little tool and held it up for me to see that it wasn’t going to hurt. I freaked out some more and of course my body took care of what needed to happen before the midwife could. My water broke as the midwife was trying to convince me to let her use the tool. At this point I remember thinking “the ultrasound tech warned me that if my water did break to watch out because I had a lot of fluid and it would be everywhere but it really wasn’t that much so did I just pee myself?” (The midwife assured me that it was amniotic fluid, not pee.) When they looked at my amniotic fluid a little closer they became worried that there may be meconium in it and so they put in a call to the NICU so they could come down.

Meconium is what they call a newborn’s first bowl movement (BM). Sometimes when a baby is overdue or just by chance at the end of your pregnancy the baby passes that meconium within the placenta. The baby then is at high risk of meconium aspiration (breathing the meconium into their lungs) which is very bad. So anytime the amniotic fluid is any color other than “straw” the NICU is called into the birth to assist and assure that the baby’s airway is cleared immediately.

At the moment this happened it was all kind of a blur to me. I was in so much pain that all I wanted was the epidural. The midwife said it was ok for me to have one so the anesthesiologist was called down. But of course by the time he got there I was feeling the urge to push. The midwife was called in to check me again and I was 9.5cm. I begged and begged and begged for that epidural but they assured me that if I did sit up to get the epidural they would never be able to complete it because the pressure of Emma would dilate me fully and I would feel an insane urge to push.

(1pm) Time to push. AHH the worst part. I don’t remember a lot of this other than the unreal pain and pressure I was feeling and how I just wanted to stop. I wanted Emma to stay inside. But my body would not allow it and I had to push along with it.

As I was pushing I remember things getting very intense. I had no idea in the moment what was going on but it turns out that Emma’s cord was wrapped tightly around her neck, shoulders, and thigh. The midwife couldn’t even get her finger underneath the cord to pull it off from around her neck so getting Emma out became very urgent. I remember the nurse hitting the button on the wall to call additional help into the room and then I remember them telling me to push as long and hard as I could. On top of everything else the poor child got her shoulders caught in my pelvis. The nurse had to get on top of me and literally push Emma out with me.

(1:30pm) FINALLY, Emma Blakemore arrived. Along with all of the amniotic fluid that the tech had mentioned (Sorry about that Elizabeth!!)

The midwife laid Emma on my belly while she cut the cord. I remember Emma and me just staring at each other; taking every inch of each other in. And oh my gosh when they talk about love at first sight, these are the moments they are talking about. But within seconds they whisked her away to have her checked out. And I realized I hadn’t heard her cry. WHY was she not crying? What was WRONG? And then that cry. Oh to hear her sweet cry. At that moment every inch of pain went away and I knew everything was going to be ok. While they were getting Emma warmed they announced she weighed in at 8lbs 14oz (2 oz from 9lbs) and the midwife took this opportunity to let me know that she told me so.

The rest of the day was filled with plenty of visitors and lots of OHs and AHs at this beautiful baby girl that was brought into this world. But the best part of it for me was being able to hold her close to me. To be able to touch her and watch her breathe. To be able to listen to her all her funny sounds. To be able to breathe her in and hold her close.

After a whirlwind of a hospital stay- she got very jaundiced and was a glow worm for the first 5 days of her life and she also had to be put under the lights in the nursery for a day- I finally got to take her home. It was a bittersweet moment for me and I will never forget.


Emma Blakemore - August 19,2010 - 8lbs 14oz - 21.25in

little miss piggy

Emma LOVES to eat. Case and point below.

She's been feeding herself her ba-ba since she was about 4 months old...



Her favorite food by far is yogurt. It's her "love on a spoon"! She likes it so much she insists on licking the bowl after she's done...



Over the weekend Granny Odom came for a visit. During lunch on Sunday afternoon I gave her a pickle to try. Needless to say she is her mommy's daughter and loves pickles :) Sorry daddy...



tonight while I was fixing dinner for myself and her, I gave her a banana...

gummy bear

I started this blog the day after I saw the first little speck of Emma on the ultrasound screen. At that point, we had no idea Emma was a girl-- she didn't even look like a "baby"--we only knew that the speck looked just like a gummy bear! (see picture beside text. click on it to make it larger.) So lucky Emma became our little gummy bear.

That day was such a special day. We not only got the confirmation that there was indeed a baby growing inside of me but we also got to hear her little heartbeat, at 8 weeks 5 days! That's amazing in and of itself. Our little Emma was such a blessing from the beginning.

I hope to keep this blog up better than I did in the beginning for the simple fact that it is a great way to keep everyone updated on recent photos and happenings in Emma's life.

Speaking of, Emma is awake now and momma's free time is up. I will post more later