Sunday, April 19, 2009

What to do with one kidney

As a pediatrician I am a member of the American Academy of Pediatrics SOAPM - Section on Administration and Practice Management. We have a terrific listserve for SOAPM. Remember when you were a kid and it was exciting to get mail? There was a terrific New Yorker cartoon of a middle aged man in midflight off a diving board into his pool of jello - his face is turned to the few spectators in his yard and he says, "I promised myself when I was a kid!" Well, my SOAPM listserve is the equivalent of that for kids who really loved to get mail. I have a whole mailbox devoted just to SOAPM, and if I let it go a few days, there are a hundred unopened posts. How quickly we adjust to technology! It's now just part of life.

Anyway, a current question brought up by a pediarician and commented on by others is, what do you tell parents and kids if the kid has only one kidney? Special restrictions? There is a special survival value in paired organs - eyes, kidneys, cajones. Do you take special precautions if there is only one?

This brought to mind a signal event in our lives - when Peter, our youngest, had his accident. I weighed in to the discussion and thought some readers might find some interest:

I have been dealing with the question from the parent's point of view. In 2000 my son Peter, a junior in high school, was on a camping trip with the school and a 4,700 oak tree fell on him while they were sleeping. He lost a kidney, had many lateral processes of the lumbar spine severed, lost 18 inches of bowel, etc. That's certainly a 5 AM call you don't want to get.

Pete was taken on a very bumpy ride to the trauma center in Roseville, just east of Sacramento. The trauma surgeons put Pete on a "to follow" schedule as they operated on a classmate who was more severely hurt, let the elective cases go forward, and let the back up team sleep in. They also didn't transfer him to the nearby academic center where they could have tried to save the kidney. Then we found out that, despite the fact that this is the state mandated trauma center, the surgeons didn't have a contract with Blue Shield, so they were out of network - we got Blue Shielf to pay as an emergency case where we didn't have an option, but still. What a system we have....

Anyway, Pete is an athlete. Thankfully he recovered. We were 1 inch from paraplegia, and about 6 inches from death. So we are grateful and count ourselves lucky. But we were then faced with the one kidney dilemma. There are no real guidelines to go on. He is a roller hockey devotee, so we asked him to wear pads around his middle. He did, at least for a while. I don't know everything, of course. It's just hard to tell what to do. I was in the stands in the 90's when Eric Davis of the Cincinnati Reds fell on his flank in left field and was taken to our hospital - he lost his kidney, playing baseball. So we are left with, Peter, please be sensible! Thankfully he has now reached the age of 25 when the frontal lobes are supposed to fully kick in and give him judgment.

Budd Shenkin

No comments:

Post a Comment