Hemangiomas

I really didn’t know much about hemangiomas until Emelia developed them, maybe on day three of her life. They were more common in preemies, peaked around 4-6 months, and were usually gone by age two. That was the extent of what was explained to me. Emelia had two of them, one on her back and one on the back of her head, which turned into four as two appeared on her face around the time of her discharge from the NICU.

At her two month appointment, her pediatrician was concerned about the quantity of them—by this time there were about 15 that had sprung up. There were concerns that there may be some growing on her organs, so she referred her to the cancer and blood disorders clinic at Children’s for an abdominal ultrasound.

On Tuesday, I drove into Minneapolis for the appointment. The ultrasound was first, and Emelia did well for it, though she didn’t like being woken up and spent the entire time stretching and grunting. I didn’t ask any questions because it’s been my experience that the techs don’t really want to say anything and want to wait for the doctor. I noticed she was taking some measurements on some small areas so my heart sank a little.

Afterward, I found my way to the hematology clinic. I nursed Emelia while we waited to be called back.

Once in the room, the M.A. had me undress her (Emelia, not the M.A.) and change her diaper. Then we waited another ten minutes for her to come back and it was all I could do to keep Emelia from fussing. The M.A. finally came back and took us to get her weighed (13 pounds 10 oz) and measured (22 inches). Then we headed back to the room and waited for the doctor.

She was wonderful. Emelia seemed to like her as evidenced by obliged smiles every now and then. She explained to us that they aren’t sure why these hemangiomas develop, but fertility treatments (yet another reason why infertility can go fuck herself) and preeclampsia could have played a role. The original two on Emelia’s head and back are now a deep red/purple and that indicates they probably have stopped growing and will start to, you know, retreat back, or whatever it is hemangiomas do when they complete the end of their life span.

The one on her forehead seems to also be nearing the end of its growth, but the one over her eyebrow has a satellite growth right above it, so she isn’t sure if that one will grow bigger.

Since hemangiomas peak at about 4-6 months, the rest on her body shouldn’t get much bigger than they are now.

We went over treatment options, but she said it wouldn’t be medically indicated since there were none growing over areas of concern such as the spine or eyelid. We ruled out doing propranolol, the oral med of choice because the risks of side effects would outweigh the benefits at this point.

Timolol, the topical cream for this, is an option if we want to slow the growth of the two on her face, again for cosmetic reasons. It would have to be applied two to three times a day and once treatment begins, we can’t stop it, so it would last until Emelia was 9-12 months.

Otherwise, we can do nothing and wait for them to go away on their own. Since her doctor was pretty confident that these may not get much bigger, this is definitely something we can do. Laser treatment is an option down the road for Emelia if she chooses.

“When they’re four and they’re saying it’s a problem, that it’s bothering them or they feel embarrassed, that’s when I recommend the laser therapy,” she told me.

All of this was riding on the ultrasound results which were taking forever to get back. Finally, around 4:00 when I was getting antsy to get going since I’d already be in rush hour traffic, she went to call down to request the results. Emelia was having a great time kicking at the crinkly paper on the exam table.

The doctor returned and asked me if the tech had mentioned anything about her kidneys. I shook my head. The good news, she said was there were no areas on her liver. It would have meant she’d be at risk for thyroid dysfunction and would automatically need the oral propranolol and a thyroid med for several months. It was a relief to know the only concern with these was cosmetic.

However, she said, the tech noticed there appeared to be something off with her kidneys. Since they weren’t actually looking at the kidneys, she didn’t get a good picture, and it might have been the angle of the ultrasound, but it looked like they were fused together, something called a horseshoe kidney. I haven’t Googled it, because I don’t want to go down that rabbit hole until I needed to. But if that was the case, Emelia would need to be referred to nephrology. This wasn’t in any way related to the hemangiomas, but this was good in the sense, that if there was a problem, we’d know when we wouldn’t have known otherwise.

She wanted to do the ultrasound that night, but it wouldn’t have been until 5:30, well over an hour from then, and there was no way I could wait that long.

We ended up having our appointment this afternoon.

I won’t leave you in suspense. There were no abnormalities found. About two minutes into the ultrasound I couldn’t stand it anymore and blurted out, asking if she saw anything bad. Nope, things were looking good. The doctor called and left a message on my drive home, confirming that we were in the clear.

Whew.

So hemangiomas. Hopefully, they won’t stick around long. We’re trying to decide what to do as far as treatment or not, but I’m inclined to forgo it and let these run their course.