Sunday, November 21, 2010

Feeding Intolerance or Bacterial Overgrowth in the Small Bowel ???

So for the past week we have been entertaining the idea that Kaitlyn may have a bacterial overgrowth of the small intestine. It might explain the bloating that we have had, the gas and intolerance in feeds! However, I don't think it explains the gastroparesis and duodenal paralysis, the low to no bowel sounds and the fact that she still has barium throughout her intestine two weeks after surgery!! Our surgeon thinks the bacterial overgrowth may be what's causing the feeding intolerance. He has consulted GI and they have decided that they will treat Kaitlyn for bacterial overgrowth, as there is no way to really accurately test for bacterial overgrowth. The best way to tell if bacteria is causing her feeding intolerance is to treat for bacterial overgrowth and then try to feed her again. GI has recommended an antibiotic to be given through Kaitlyn's J-tube (treat the infection directly!) and has placed her back on Cisapride (motility med.)!

We were also having issues with low grade fevers and off and on fevers! We cultured EVERYTHING!! All cultures came back negative....except low growth yeast from her throat! (Guess that might explain the THICK white quarter sized plugs we have been pulling out on the end of our 12Fr catheters!!! YUCK!! Kaitlyn had a few days before we started treating for bacterial overgrowth that she was feeling miserable. She was not sleeping, she had the fevers, she was whining almost continuously, and sometimes was even crying!! We couldn't find anything wrong. In the meantime we kept watching her haemoglobin levels get worse and worse! She was really anemic!! We decided to do a transfusion of packed red cells! About half way through the transfusion Kaitlyn stopped whining and went to bed really well (she actually went to SLEEP)!! Then the next thing we notice is her fever is gone...and doesn't return!! The next day she was acting like normal Kaitlyn again (just a little tired from missing so much sleep the past few days)!

Because of the fevers and the no sleeping and crying Infectious Disease ordered a CT scan to rule out any inflammation/infection in the small bowel or other organs that we have been unable to see with other diagnostic imaging. The CT scan was clear, but did show us that both hips are dislocated. This is quite common with SMA, particularly the weaker children/adults. No intervetion is typically needed as there is just no muscle there to support the joint! We did have proper x-rays done of her hips to document the bones as they are right now!

Here's the journal of our past week:

November 16

What a rough couple of days! Kaitlyn has been unable to rest...and I mean NO restful sleep for almost three days! She has been crying a LOT, fussy and just NOT herself. Her hemoglobin finally dropped to 68 and our pediatrician called it....she's not making enough new blood! We had to give her a transfusion of red blood last night. What a difference it made in her sleep. She went to bed around 10pm and is still sleeping now at 8am!! I got my Kaitlyn back :) She is now exhibiting some discomfort when we touch her belly and x-rays are clear, ultrasounds are clear, all cultures sent are clear and her tummy is still soft!!! Today we are having a CT scan to rule out anything minute we might be missing!!! I almost hope they find something (something fixable!!!!!!). This "not knowing" what's going on, not understanding why she is not tolerating any feeds is driving me NUTS!! We are also working towards getting the paperwork started for home TPN!! This process apparently is supposed to take several months!!! Owen's Birthday was on Sunday! My big guy is 6 years old now :) He is the bestest of all big brothers and we are so proud of him!!!

November 18

Kaitlyn is a different kid since her blood transfusion two nights ago!! The fussies have stopped, the fevers have stopped, the really high blood pressures have stopped and blood pressure is stabilizing!! Her HR has gone down 30 bpm and she is sleeping peacefully through the night again :) CT scan was clear...no abnormalities. Heamoglobin is up to 117 from 68! Kaitlyn is chronically anemic, we almost never see normal haemoglobin values :)

GI has decided to put Kaitlyn back on Cisapride and begin treating with antifungals/antibiotics for a possible bacterial overgrowth in her small bowel! This is our last effort to get her gut working. In the meantime we have started the process to get home TPN!! Apparently the longest part of the process to get home is the training involved to teach the families how to run the TPN at home!!! Can you see me rolling my eyes folks!!!!! If Kaitlyn's issue is bacterial overgrowth it might not look so good for enteral feeds...but we will be giving it our best shot!

November 19

Kaitlyn was in such a good mood today :) Laughing and playing her funny little games! She had her nurse in stitches..hehehe. Update: Hypertension diagnosis is official! Renin levels came back twice the normal values!! We have doubled her dose of Blood Pressure med and her BP seems to have stabilized over the past couple of days. She will remain on BP meds for the rest of her life. CT scan showed dislocated hips :( We knew the left was out. They do not seem to be causing her any discomfort on a regular basis at this time!

We have started an antibiotic through her J tube to fight the possible bacterial overgrowth! We have also restarted the Cisapride (motility med.) for what GI calls the "what can it hurt....and if it helps even 10%"!! We are giving this stomach one last chance and we are putting everything we've got into it!! She is on half vivonex/half pedialyte mix and is running at 10cc per hour. So far she is looking pretty good! We are definitely getting more by way of residuals, but they are clear (for the most part) and only slightly tinted yellow/green!! Do I dare to say that the belly might actually look a wee bit less distended tonight?? SHHHHH...don't tell her I said that!!!

TPN....UGH....TPN! What a HUGE hassle!!! There is a special TPN board in which a handful of people sit in specialized positions?? One of the main decision makers for the home TPN process is away on sabbatical until January! The nurse specialist (also highly important for the home TPN process) is away on vacation!!! She won't be available for a meeting to even discuss the option of Home TPN until Decemeber 8!!! So if the belly doesn't work, then we are stuck here until after the 8th of December! We are doing everything else we can in the meantime! We will be trained on how to run TPN at home. We will be practising accessing Kaitlyn's port and disconnecting and connecting lines! We have done everything already that we need to know except for the changing of the actual needle in her port!!

3 comments:

Devon said...

Goodness, what a roller coaster ride you and poor K have been on!!! I hope it all gets figured out soon!

Kisses from Dakin!!

Sky said...

oh Im so happy to hear she can rest, she needs some good sleep to help fight! keeping you all in my prayers!!!!

oleyfriends said...

Hi,

I wondered if you had heard of the Oley Foundation. We offer free information and peer support to families like yours with a member on home tube or IV feeding.

Check out our web site at www.oley.org. For a good overview, click on the "New to Oley" button.

Feel free to call/email me if you have any questions or would like to meet another family in a similar situation.

Warm regards,
Roslyn Dahl
Oley Foundation Staff Member
dahlr@mail.amc.edu
(800) 776-OLEY