Duke!

Our visit to Duke has been incredible! Today we met with:

• A perinatologist
• Dr. Kurtzberg (the physician who will do Claire's stem cell re-infusion)
• A pediatric neurosurgeon

Everyone we met with has been so caring and wonderful. They all took the time to review Claire's ultrasounds and MRIs with us, explained their respective roles in Claire's treatment, and patiently listened to our questions. I left every visit feeling like we would be in good hands.

While I love Claire's Atlanta doctors, I am thrilled with the team at Duke, which just reinforces our decision to deliver there. A few words about each visit:

• Perinatologist / Ultrasound. The ultrasound went well. Claire's ventricles have increased, but not by much (they are currently ~ 21 mm and 28 mm, up about 1 mm from 2 weeks ago), but her head circumference has increased significantly. It is now measuring 30 weeks, 1 day, or about 5 weeks ahead. This is HUGE. (No pun intended.) With hydrocephalus, a big head is actually a good thing - it suggests that the brain is actually expanding, so we are reassured by this development.

• Dr. Kurtzberg (Stem Cell Re-infusion Physician). I love, love, love Dr. Kurtzberg. It is clear she loves what she does and cares deeply for the children she treats. She remembered many of the families we have befriended. Thanks to our friend Michelle's website (http://www.fetalhydrocephalus.com/hydro/Infusions-1.aspx), we felt we understood the procedure before even meeting with Dr. Kurtzberg, so we mainly asked about the science behind the reinfusions (like, how do the stem cells know where to go??) and discussed what we could do to optimize the treatments. Dr. Kurtzberg recommended an initial reinfusion at birth, followed by a second treatment at 2 months and a third at 6 months. She also suggested other programs we might want to check out, like a Pediatric Brain Development program at UNC - Chapel Hill. We feel like she is committed to helping us do everything we can to help Claire!

• Pediatric Neurosurgeon. We met with the pediatric neurosurgeon who will perform Claire's shunt placement 1-2 days after she is born. We spent some time talking about the type of shunt Claire will receive (there are a few different options), and also discussed how we would coordinate between Atlanta and Duke. Shunts can malfunction or become infected, so I wanted to make sure I understood how we would address those issues if they arise. (Time is of the essence with shunt infections or malfunctions, so driving 6.5 hours to Durham might not be reasonable or feasible.) The doctor reassured us that it wouldn't be difficult to coordinate (and he knows our Atlanta pediatric neurosurgeon), so we feel so much better!

We also met with the Patient Care Coordinator, Hope. She was amazing! Every bit as kind and as caring as she seemed on our phone calls. I am so grateful to be working with her.

On the agenda for tomorrow are:

• OB Consult. We will meet with the head of OB-GYN and discuss the timing and logistics of delivering at Duke.
• Fetal Echocardiogram. We are having an echocardiogram to rule out any heart defects once and for all. So far, none have been detected, but Claire's size and position have made it difficult to detect small defects, like a hole in the heart.
• Maternity Ward & NICU Tour. Our last agenda item for the day is a tour of the facilities. It will be nice to have our bearings before we walk into the delivery room, so we are looking forward to this.

Then, after those visits, we will leave Durham, hopefully with big smiles on our faces! Please continue to pray for Claire - we hope tomorrow brings more good news!