We seen the new GI doctor on the 12th. The appointment went well and they spent some time in the room with us. I explained everything he has been through in the past 2 years.
Jacob has seen this doctor before...but we switched to Tampa after the 1st appointment. I learned that that the last time we seen this doctor was February 16,2010...talk about picking yourself up off the floor and continuing to live after tragedy...this was 17 days after Jacob's identical twin brother died at 6 1/2 months old. This doctor is in the same practice that took care of his brother at the hospital he died at...I'm sure this was part of the reason we switched...2 years later and we are back.
I explained to him Jacob's GI history the best I could remember it.
* coming home from the NICU arching and screaming all the time...the reason for initial GI referral.
*May/June 2010 switched to different GI (still in denial about sons severe disability) he was still eating by mouth at this point, but was getting sick a lot.
*June 2010 had peg tube placed. was also placed on meds for reflux at this point...we thought the tube would be temporary until he outgrew being sick all the time before we realized he was aspirating.
*somewhere around this time we had a swallow study showing aspiration so his food was thickened and we had to start positioning his head to the side to eat.
*Jacob went from arching and screaming all the time to projectile vomiting no matter if he ate by mouth or by tube. We were against a nissen because I was dead set against my son not being able to eat by mouth and I thought it might affect his ability to eat...when he was not sick he was a really good eater. He ate better than his brother. He ate baby food 1st off a spoon and took it well, he ate more bottles than his brother etc and weighed more.
*November 2010: At this point I had struggled more and more with his feeding. He had developed an oral aversion and I would have to gag him to get him to suck and swallow. He was getting more tube feeds than by mouth feeds at this point. He had a swallow study that showed he was aspirating every time he gagged and I was advised to stop feeding him my mouth. I was crushed and lost hope of him every being able to do anything "normal". I kinda gave up for a little while. He had already started feeding therapy at this point he started when he had the 1st swallow study, but his therapist was out on medical leave and I had no where to turn.
*May 2011 GI doctor finally replaced peg tube with a Mic-key button.
*For the past year 1/2 we have been at a stand still. He can't eat liquids in a bottle by mouth. He gags, chocks, aspirates and vomits. His oral aversion has improved. He loves pacifiers, but can't tolerate liquids. He lost the ability to suck, swallow, and breath. He can take 7-8 bites of stage 2 baby food consistency food when he feels like it, but I think he still aspirates some so he don't eat that often. We have been on at least 4 different formulas and a blenderized diet. He still vomits A LOT! He initially gained weight once going to the blenderized diet, but has been sick and has lost weight since we started giving him commercial formula when he is sick for fear he will aspirate the blenderized diet. So, we have been between 25-29lbs for the past year. The old GI only offer to us was a G-J tube which I refuse to do. Since he will have to be on feeds almost 24-7. I feel like it is only a band aid to the problem and no quality of life for him or us. The G-J tube is 1 tube that goes into the stomach and another tube that goes into the intestine to bypass the stomach. You can not bolus feed into the intestine and he would be on a pump with a feeding bag all the time.
This is where the new GI comes in...our old GI refused to refer him for a nissen stating that it does not always work with spastic CP kids...which is true, but at this point I am desperate. So the GI wants to repeat some test we have done, but over a year ago. He wants an endoscopy, PH probe study, and a gastric emptying study. He has them scheduled for the 24th, but we are trying to coordinate the procedure he has with the physical medicine doctor so he only has to go under anesthesia one time. So, I am unsure of a date and time for sure.
Endoscopy means looking inside and typically refers to looking inside the body for medical reasons using an endoscope, an instrument used to examine the interior of a hollow organ or cavity of the body. Unlike most other medical imaging devices, endoscopes are inserted directly into the organ (they go through the mouth to look down the throat into the stomach.)
What is esophageal pH monitoring?
Esophageal pH (pH is a measure of the acidity or alkalinity of a solution) monitoring is a procedure for measuring the reflux (regurgitation or backwash) of acid from the stomach into the esophagus that occurs in gastroesophageal reflux disease (GERD).(this is a prob that looks like an NG tube that goes down the nose into the stomach to measure the acid content and the amount of reflux he has. It has to stay in his body for 24 hours and requires him to stay over night in the hospital.)
What is a gastric emptying study?
A gastric emptying study is a procedure that is done by nuclear medicine physicians using radioactive chemicals that measures the speed with which food empties from the stomach and enters the small intestine. Gastric emptying studies are used for testing patients who are having symptoms that may be due to slow and, less commonly, rapid emptying of the stomach. The symptoms of slow emptying are primarily nausea, vomiting, and abdominal fullness after eating. The symptoms of rapid emptying are diarrhea, weakness or light-headedness after eating after eating.
DEPENDING ON WHAT THESE STUDIES SHOW WILL DETERMINE THE NEXT STEP. EITHER A NISSEN FUNDOPLICATION OR A PYLOROPLASTY.Not sure if they would do both.
Nissen fundoplication is a surgical procedure to treat gastroesophageal reflux disease (GERD). In GERD it is usually performed when medical therapy has failed. In a Nissen fundoplication, also called a complete fundoplication, the fundus is wrapped all the way 360 degrees around the esophagus.