An After-Thought About Juan Or's Condition of Being Underweight

During the most recent visit to the paediatrician for vaccination at 12 months old, the paediatrician found Juan Or to be underweight at 8.1 kg. As such, he recommended Juan Or to be on PediaSure (Abbott Laboratories) for 3 months.

Of course Mommy is baffled as to how Juan Or turns out to be underweight considering that the babysitter gives him 3 or 4 times of milk feeds (ranging from 7 to 9 oz. of milk per feed) per day, and Juan Or is also capable of finishing 2 bowlfuls of porridge (rice bowl size) in a day. And the porridge contains mashed up carrots, some butter or cheese (to fatten him up) and fish meat or ikan bilis stock. Then one day, a quick flash of thought occurred in Mommy that Juan Or's condition of being underweight may be caused by him taking his antibiotic (trimetoprim) on a daily basis. Juan Or has to take trimetoprim daily as a preventive measure of him getting urinary tract infection. Juan Or has this congenital condition called mild bilateral hydronephrosis (laymen's term: mildly dilated kidneys) which makes him susceptible to getting urinary tract infection. And the HUKM peadiatrician mentioned that any infection to his growing kidney is no good because it can cause kidney scarring and along the way will cause the kidney function to deteriorate. Mommy thinks perhaps the antibiotic, taken in long run, has killed many of the natural friendly microorganisms in Juan Or's gut system. And these microorganisms have been known to aid nutrien absorption. So perhaps Juan Or's nutrient absorption is not efficient, that's why he has poor weight gain.

(The antibiotic that Juan Or has to take every day, trimetoprim.)

So on the day the paediatrician recommended PediaSure on Juan Or, Mommy went to buy a 900g tin of PediaSure that is supplemented with FOS and probiotics. Mommy bought is for RM55.90 at Pasar Mini Wah Seng (Jalan Sepadu, off Old Klang Road). Mommy saw The Store selling it for RM60.++ Anyway, Juan Or finished the entire 900 g within 9 days! So Mommy had to go buy PediaSure again. Mommy went to the same shop and this time, the exact same type of PediaSure is sold for RM53.90! So Mommy bought 2 tins straightaway since Juan Or consumes it very fast.

(The PediaSure that the paediatrician recommends Juan Or to take, which Mommy bought for RM55.90, then later for RM53.90 at the same shop.)



After 9 days of consuming PediaSure, Juan Or already showed some results. His cheeks are puffier now and the diameter of his hand looks bigger. Haha....to put it in a light way, Juan Or's extra flesh or fat costs RM55.90!






(A photo of Juan Or a week or so before the visit to the paediatrician. )










(A very recent photo of Juan Or about 9 days after consuming PediaSure. Cheeks are puffier and the diameter of his hands are slightly bigger now. Photo taken at this angle may not reveal such big difference, but the difference is easily seen in real life.)

A Visit to the Hospital: Mild Bilateral Hydronephrosis

On 18th February 2009, Grandpa and Mommy took Juan Or to the hospital (Hospital Universiti Kebangsaan Malaysia) for follow-up check on his mildly dilated kidneys (mild bilateral hydronephrosis).

Some history on Juan Or's condition:

When Mommy was 5 months pregnant, the sonographer detected mild dilation on both of Juan Or's kidneys. Mommy was worried whether it was anything to do with Mommy's lifestyle of eating habits that cause this, but luckily the doctor assured Mommy that this condition has nothing to do with Mommy's part and that since the dilation is mild, hopefully the dilation will gradually disappear by itself as time goes by. By the time Mommy was in the 37th week of pregnancy, the ultrasound scan result indicated that the kidney dilation was still there, but still in mild stage.

Finally when Juan Or was born, particularly when he was 4 days old, the doctor did an ultrasound scan on his kidneys and found the condition to be still the same. So the doctor prescribed trimetophrime (which Mommy googled in the internet and found that it is a man-made antibiotic usually prescribed to urinary tract infection patients). Then the doctor recommended for follow-up check when he was 2 months old. And again, the result was the same. No improvement, and neither did it became worse. So the doctor recommended that Juan Or underwent MCUG test at 5 months old. In the MCUG test, some fluorescent dye was pumped into the urinary tract to see the source of blockage. So before the dye could be pumped in, the doctor had to insert a tiny tube into his penis. Boy! Juan Or cried and cried that day. And Mommy cried too! Mommy felt so pitiful for this little baby who had to endure such pain and discomfort at such a young age. However, the MCUG had to be aborted because the tube could only be inserted partially. Even a few paediatricians tried reinserting the tube, but failed. So in the end, Juan Or only had to do ultrasound scan and continue with his trimetophrime medication. The doctor explained that people with hydronephrosis has higher risk of getting urinary tract infection, so has to be on antibiotics as a preventive measure. Otherwise if there is infection, then the kidneys will be scarred and can interfere with the development of the growing kidneys. The doctor warned that the worst case scenario is that heavily scarred kidneys can lead to impaired kidney function. Oh...how scary!

Without fail, Mommy fed Juan Or with trimetophrime once every night. For the sake of Juan Or's health, Mommy is willing to do anything no matter how inconvenient it may be.

Things started showing a little improvement when Juan Or was 5 months old. The ultrasound scan result indicated that the dilation has reduced a little and the kidneys are growing normally. But Juan Or still had to continue with the medication.

So currently, at Juan Or's 9th month, the ultrasound scan result indicated that the dilation has reduced a little and the kidneys are growing normally. Mommy felt relieve.

On the lighter side, this time, Juan Or cried and cried when the sonographer placed the probe on his abdominal sides. In previous times, Juan Or acted cool when the same thing was done on him. Whatever happened to this baby? Has this baby become anti-social? Even when at the paediatrician's consultation room, Juan Or cried most of the time, except when the doctor gave him a toy to hold! The paediatrician also made physical examination of him including testing him on his behavioural development. The paediatrician hid a small purple colour teddy bear under a pillow, but Juan Or was uninterested and cried instead! Then the doctor dropped another toy onto the floor to see whether Juan Or's eyes followed to which he did. The doctor also commented that Juan Or's body weight is still in the normal range but seems to show a downward trend. So the doctor recommended that butter be added into the porridge or whatever food that Juan Or eats, and that Juan Or can eat more cheese. Later, when Mommy and Juan Or was out from the consultatation room, Juan Or was still crying. So Mommy placed Juan Or back into his stroller and let Grandpa do the pushing while Mommy went to get the next supply of trimetophrime. So along the way, Juan Or slept like a log....which brings to what conclusion? Juan Or was SLEEPY all along throughout the ultrasound scan right up to the paediatrician's consultation! That's why Juan Or was so fretful and in such bad mood! Even when Mommy transferred Juan Or from the stroller to Mommy's lab (when sitting in the car to go home), Juan Or was still fast asleep.

Mommy's baby.......zzzzzzzz.......Mommy will go buy butter and cheese to fatten you up, ya? Mommy loves The 'B'.