Saturday night Caroline refused her 7 pm bottle, like she has been doing for months and months now. At this point we hardly even try to get her to eat it...it's a lost cause. So we usually have to put her to sleep and then wake her up a few hours later, around 10 pm, to make her eat the bottle. We put her to bed and she didn't fuss or object too much. When I went in to get her at 10 pm I noticed that there was a large wet spot on her sheet, so she must have vomited but I didn't know when. I never heard any commotion on the baby monitor while she was sleeping.
I gave her the bottle and she drank about 2 ounces and then forcibly vomited it all back up...all over herself, me, the couch. I woke Bill up to clean the couch and then she and I hopped in the tub to rinse off the puke. I had to rock her for about an hour before she fell back asleep.
She woke up fussing around 2 am, which is also the new norm these days. We're guessing she's either waking up out of pain or hunger every night, and given that she had not eaten a single thing in 12 hours, we guessed maybe she was hungry. Bill gave her a bottle...same results. Puke all over her, Bill, the couch. We went through the routine all over again, and I rocked her back to sleep for an hour.
By Sunday morning I was pretty worried and started consulting baby health books and my favorite resource, the interwebz. We determined that she needed some Pedialtye in small quantities to keep her from getting dehydrated. We gave her 1 tsp of Pedialyte and it was promptly vomited back up. With that we called the on-call nurse at her pediatrician's office to find out what to do next. She didn't have a fever, and her mood was pretty much normal, so I was absolutely convinced this was just another symptom of her ongoing unresolved digestive problem. Bill was sure it was just a stomach virus, but I was absolutely convinced it was connected to her other problems. Bill talked to the on-call nurse and she advised us to head to the emergency room since Caroline couldn't keep anything down and there was concern about dehydration. I was blatantly relieved that we were hopefully finally going to get to the bottom of this problem. Perhaps the situation was finally dire enough that the doctors would listen to me and see that there is a 'bigger picture' issue at work here!!
We went to the emergency room at Texas Children's Hospital. We got there around 9 am and filled out some forms and were promptly seen by the triage doctor. Waited for about 20 minutes and then they had a room ready for her. We talked to her assigned nurse and doctor and I explained that the immediate concern was dehydration due to vomiting, but I was also concerned that this vomiting was connected to a larger unresolved issue that has been plaguing us for months, with not eating and not sleeping and suspected pain. I mentioned things I had been obsessively googling, like impacted colon and stomach ulcers and small bowel obstructions. The doctor agreed that an xray would be helpful, and later confirmed that poor little Caroline's system was completely backed up with poop. She was not impacted per se, and there was no evidence of looped intestines or other physical problems, but she was severely constipated which was causing the vomiting.
I asked the doctor if this constipation was the possible source for all her problems the last few months, and she said yes. I asked why did this happen, and how do we avoid it? She said the compounded prevacid can cause constipation as a side effect, but it didn't make sense to me...if she's been on the prevacid since April, why would the constipation only be showing up now? She recommended taking Miralax for a few weeks to help clear out her system, and giving her apple juice or prune juice in conjunction with solids to help her keep pooping.
In the meantime, they wanted to perform an enema to clean out her pipes and then offer her juice and make sure she was able to keep something down before she was sent home. They performed the enema while Bill and I tried to distract poor Caroline...she was such a trooper. Not happy about it, but not screaming her guts out or anything. 10 minutes after the enema she had the most foul-smelling bowel movement that has ever wafted through my nostrils. Bill and I were gasping for air in her hospital room, and begged for face masks. There were a lot of poop jokes exchanged. What else can you do?
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| Preparing for the poop-a-thon. We sang songs to keep her entertained, including a rousing rendition of "Tutti Frutti Baby Got a Stinky Booty." |
She got a does of Lactalose and a dose of Miralax when we got home, but despite those 2 medicines AND an enema, she didn't have another poop. I was worried and had this nagging feeling that this wasn't over yet. She took about 5 ounces of formula at 7 pm and kept it down, so I tried to be optimistic.
This morning she got up around 7:15 and I gave her a bottle at 8. She took about 4 ounces and then promptly projectile vomited it all back up. Every single ounce. In between trying to console the crying baby and stripping off vomit-covered clothes and scrubbing the couch, I called Bill to tell him we needed to go back to the ER.
We got to the ER at 9:15 am and it was a lot crazier than yesterday. We waited 45 minutes just to see the triage nurse, and then waited another hour and a half just to get a room. We waited 30 minutes and saw a nurse. Then waited 30 minutes and saw the attending physician. Then waited 30 minutes and saw the attending's supervisor. The whole day seemed like nothing but waiting and waiting and more waiting. The attending physician finally called our GI and conferred with him and agreed to do a lower GI contrast study, where they insert barium into her lower intestines and watch it move around to check for obstructions. The test itself was not actually painful per se, but I know it was not comfortable for the poor baby to have a tube and fluids stuck up her butt and then held down unable to move. She screamed and cried for the entire procedure. It was not fun for either of us, and I just prayed that we would finally get some definitive answers.
We waited another hour until the attending physician came in and said the test results were normal, everything looked fine, so they were sending us home. My heart just sank. Not that I WANT my daughter to be sick or have some physical abnormality, but I was hoping that if this test didn't give any answers that they would keep probing. When we entered the ER this morning, I was determined to get some answers. But I left with nothing more than another prescription to treat constipation, and not a single clue as to what was causing her to be so severely constipated to begin with.
As I told some of my friends on Facebook, My frustration is that between the GI and her pediatrician, they have just been treating each symptom in isolation without looking at the bigger picture and digging deeper for answers. The bottom line is, somewhere between the time the food enters her mouth and exits her butt, something is not working right! I don't know what it's going to take for the doctors to get to the bottom of this. But at various points throughout her 9 months of life, she's had: gagging, choking, vomiting, spitting up, pain, fussing and crying, hard/bloated abdomen, refusing bottles, refusing solid foods, constipation, and diarrhea. Her growth up until now had been on-track, but within the last month or so it has flatlined. If this keeps up she will start to plummet off the growth chart. Maybe then the doctors will be satisfied that she's 'sick' enough to warrant concern and aggressive testing and treatment.
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