Thursday, May 22, 2008
The Feeding Solution
The feeding plan didn't work out very well. Elaina was still having episodes of severe vomiting. The Resident Doctor that came up with the feeding plan didn't think it was that big of a deal. It was, after all, her brilliant plan. I don't think that she truly appreciated what this vomiting meant to Elaina. It wasn't just spitting up. Elaina would choke on whatever came up and it would block her airway not only in her throat but her nose. She would turn purple. She actually burst blood vessels on her nose and under her eyes. If someone wasn't right there next to her, she would stop breathing. This isn't something to be treated lightly. She's already had two very unpleasant trips with LifeFlight. We don't need to have a 3rd. When Elaina was on the continuous feed Wednesday night, she had 3 times where she threw up. The nurse was right with her and was able to turn her over to help her get it out and then suction her nose and mouth so that she could breathe. Today, the Resident Doctor (who was SO pleased with her plan) decided that it was okay that this had happened, no big deal. Babies "spit up". Elaina could go home with the continuous feed at night and if she had a problem, Mom could be right there. Besides, she has a monitor at home that will sound alarms if her heart rate goes down. OK - whatever!! Needless to say, I didn't like that idea. So I refused to take her home. I insisted on talking to the Attending Physician. Now, this doctor was MUCH better at grasping the situation. He talked to me about other options, and told me that he felt Elaina would probably do best on a continuous feeding schedule through an NJ tube. This is the tube that goes into her small intestine. This way there is nothing in her stomach to throw up! We talked about the pros and cons of the NJ as well as the pros and cons of sending her home as is on the NG, and decided that the NJ was the best solution at this point. Right now, Elaina's job is to grow big enough to have the strength to get through her upcoming surgery. She gets so tired when she eats that she's making herself weak. She breathes harder and her heart rate goes up. That combined with the loss of calories and fluid from vomiting (which can lead to dehydration) makes the NJ the most logical choice. The tube has to be inserted by a Radiologist under an X-Ray. She had it done this evening, and came back to the room slightly traumatized, but no worse than when we've had to change her NG to the other side of her nose. Once the feeds were started she went right to sleep. Her breathing rate went down, her heart rate went down, and she stopped her squirming. She'll still get her reflux medicines, this will keep her stomach acids under control. Since she's no longer eating by mouth, she will have to re-learn how to swallow once she has her next surgery. Like I said, I had to weigh the pros and cons. If everything goes well tonight, Elaina should be home by Friday afternoon. It's one more thing to have her tied to, but not having to worry about her choking to death is worth it!