NYD

"NYD". It's a common short form used by emergency physicians. It translates as "not yet diagnosed". That's a legally safe way of saying "don't know what the heck caused it".

Torran's hypertension is NYD. The nephrologist reiterated that they don't really know why premature babies get hypertension. Various pathophysiologies exist, it can be controlled with medication, and they "grow out" of it. Easy case, problem solved and move on.

We haven't changed Torran's medication dosing since he started on the amlodipine, so he has essentially been weaning over time as his body was getting bigger with the dose staying the same. Now, we experiment and wait. Tomorrow, for the first time in several months, Torran will not get his blood pressure medication. We follow up with repeated measurements at our paediatrician's office. By the end of the month, we should know if he's outgrown his hypertension or not.

Friday itself didn't go too poorly as far as starving the wee man whose stomach is on a timer. The worst part about the day actually came after the test, when the drugs were still floating around in his system and wreaked havoc on his sleeping patterns. Mine too (an unspoken side effect.. parental lack of sleep). Hopefully, we'll have him re-adjusted by tomorrow.

Now for the interesting part of the day...the report from the echocardiogram Torran's heart is the correct size and shape for his age. In other words, the high blood pressure was well enough controlled that it didn't cause the left lower part of his heart, the ventricle, to get bigger through harder work (ventricular hypertrophy). The ASD (atrial-septal defect) persists, but is small. I'd have to read the first report to compare sizes. What is bothering me is the information that he has a small PFO (patent foramen ovalis). I don't remember whether or not he had this before. At the time of his original echo, I was more concerned about the huge PDA (patent ductus arteriosus, 4mm) which was leading him towards heart surgery. The PDA and VSD (ventricular septal defect) remain closed, thankfully.

A PFO is present in about 15-25% of the population. During fetal development, the foramen ovalis between the atria (top chambers of the heart) allows fetal blood to circulate easily. A PFO is a flap-like hole which permits unoxygenated blood to move into the oxygenated blood under certain circumstances like sneezing and straining/crying. People who have a PFO may not be aware that they have it because it causes few symptoms. However, it is associated with migraines, cryptogenic stroke, laboured breathing, and recurrent respiratory infection. There are both surgical and non-surgical (but not non-invasive) methods of treatment.

Presumably, the open ASD and PFO will close with time. They are supposed to close at birth... well, a normal due date birth anyways. We don't have our cardiology follow up until next year. So it's off to medical records to get copies of the original report and the latest one to satisfy both my curiosity and my maternal concern.