Sharing a house somehow made them more in tune at work, too. ‘Can I borrow you for a minute?’ Katrina asked one afternoon, leaning against the doorjamb to Rhys’s office.
‘Sure. What’s the problem?’
‘Little girl, four years old, history of UTIs. No history in her siblings, but I’m wondering if there’s an underlying problem.’
‘Are you thinking VUR?’ he asked.
VUR, or vesico-ureteric reflux, was when the valve between the bladder and the tubes that led from the kidneys to the bladder didn’t work properly, allowing urine to flow back towards the kidneys.
‘It’s only a suspicion. I haven’t done any tests yet.’
‘Start with an ultrasound,’ he said, ‘though it’s very easy to miss any signs of scarring, depending on what grade of VUR you’re looking at and whether your patient has a fever. You might have to do a cystogram.’
‘I hope not,’ she said. ‘It’s unpleasant for little ones, even if you do some play therapy with them first to prepare them for the procedure.’ The cystogram meant putting a catheter in the little girl’s urethra and filling her bladder with a liquid that showed up on X-ray, then doing a scan to see if all the liquid was going through the urethra or if any was going back towards the kidneys.
‘Want me to come and have a look?’ he asked.
‘Please.’
Katrina introduced him to her patient, Annabel, and her mother, and Rhys explained what they suspected.
‘We’re going to take a magic picture of your tummy,’ Katrina said to Annabel. ‘It won’t hurt, but it might tickle a bit because I have to put some special gel on your tummy to help me take the picture.’ She showed the scanning head to the little girl and let her hold it so she wasn’t scared, then swiftly did the scan.
Rhys looked at the screen. ‘There’s definitely some scarring there,’ he said.
‘So the good news is that we don’t have to do any further tests that Annabel might find uncomfortable,’ Katrina explained to Annabel’s mother.
‘And even better news is that although it’s vesico-ureteric reflux, I can’t see any distension. We grade the condition from one to five, with one being the mildest,’ he said, ‘and this looks like a grade two to me. So it should clear up on its own without surgery.’
‘What causes it?’ Annabel’s mother asked.
‘With small children, it’s usually caused by the tunnel through the bladder wall not being long enough,’ Rhys said.
‘As she grows, the tunnel will get longer and the condition will improve,’ Katrina added. ‘But we need to make sure Annabel doesn’t get any more urine infections, or it might cause some damage to her kidneys.’
‘And to make sure she doesn’t get an infection, we’ll give her long-term antibiotic therapy—a very low dose every day until she’s five,’ Rhys said.
‘But doesn’t using antibiotics lead to bugs becoming resistant?’ Annabel’s mother asked.
‘If you don’t complete the course properly, yes. But this is slightly different,’ Katrina said. ‘She’ll need to give regular urine samples to your GP, and we’ll call her in for an ultrasound every six months to check that her kidneys are growing properly. And if you get any signs of a urinary infection, you need to take her straight to your doctor.’
‘So that’s if she starts needing to have a wee more often than usual or has accidents that just aren’t like her,’ Rhys said. ‘Or if she’s not very well and you can’t put your finger on what’s wrong, she gets a temperature, or her urine smells unpleasant or has blood in it.’
‘Will giving her cranberry juice help?’ Annabel’s mother asked.
‘Should do, but look out for the other signs as well,’ Katrina advised.
‘So she’ll definitely grow out of it?’
‘I’m pretty sure she will,’ Rhys said. ‘If not, we’ll need to give her an operation to correct the valve problem—but try not to worry. In most cases the antibiotic treatment works really well and it’s more than likely she’ll outgrow the condition.’
‘We’ll need to scan her big brother and her little sister, just to check they’re not affected,’ Katrina added.
‘Because about a third of patients with VUR also have siblings with the condition,’ Rhys explained.
‘I can book them in for the scans now, if you like,’ Katrina said.
‘Thank you.’ Annabel’s mother smiled. ‘You’ve worked together for a long time, haven’t you?’
‘A little while,’ Rhys said.