Saturday, August 27, 2011

Gastrostomy Tube



This is the story of Whitney getting her G-tube. I will try to make it basic and to the point. 

Wednesday morning we feed her Neocate Jr. Unflavored formula till 1 AM.  From 1 to 6 AM she got a slow drip of clear Pedialyte.  We gave her the normal Prevacid and Sildenafil at 6 AM as instructed by the cardiac anesthesiologist the night before.  We were all packed the night before with what ended up to be WAY to much stuff!  We got to Phoenix Children's Hospital around 7:30 AM to check in.  I signed a few papers, and the Dr.'s and nurses reviewed the day's plan.  The resident surgeon (still in school) said they would leave the NG tube in and use that to feed her at first.  Then her awesome surgeon said that they are going to take the NG tube out and just feed and give meds through the new G-tube.  So after we all made sure we were on the same page they took her back.  I was not able to go to the O.R. with her like I did when they did her cardiac catherization a few months ago at St. Joe's Hospital. 





Driving around in a car while we waited.




Whitney must have felt safer in the car because she did not cry. 




All smiles before they took her back.







Then my mom, my husband, and I waited in the crowded waiting room.  They took her back at around 9 AM (right on schedule).  The surgery it self would only take 30 minutes and getting her asleep and all set up another 30 minutes.  I assume both of those thing took longer then they expected because she was in there for two and a half hours.  Some of that time went to doing an echo.  I requested they do one then because she was "due" for one and it's so much easier asleep.  I actually got that idea from another mom's blog!  (Whitney has a tiny arterial septal defect (ASD) and a Patent ductus arteriosus  (PDA) and a small left pulmonary artery from her birth defect).  So around 10:30 AM the surgeon came out and said everything went great!  She did it laparoscopicly through her belly button (eww).  Put a camera in and found a really good spot.  She also saw that some of Whitney's intestines were stuck to each other but that that is nothing to worry about.  So the surgeon walked us up to the floor where Whitney will stay and we waited in that waiting room.  When they were all done with her and she was settled in her room waking up they called us to back there! 







First picture of her G-tube!  It's a Mic-key, 14 french (diameter) 1.5 (length)




They kept gauze around the whole time.  It did bleed and they would change the gauze, and it seemed like every nurse would put it on differently!  Whitney did pretty good,  she was druged up and cranky.  Around 4 PM they started her on a slow drip of Pedialyte till 9 PM.  Then we took her for a long ride around the floor in the wagon, she even walked a little but was really wobbly!  She really liked to ride in the wagon and get away from her crib.  We pretty much held her all day between the three of us.  At 10 PM they started her on a slow drip of Neocate Jr. till 6 AM.  They kept her on Morphine that day.  She did not throw up so that was really good! Everytime the nurse would clean it or start a meal or give a medicine, we watched her and then did it our selves.  You need to do this so you can learn quicker and get different opinions from the different nurses, when they feel your comfortable doing it your self they will let you go home sooner. My awesome friend came to visit us that evening after my mom went home.  She brought us a ton of good food!  My husband ended up staying the night with me. :)





She loved the wagon but still would not let go of her pacifier!





Trying to entertain/disract her with favorite toys and movies.  




The next day.  These aren't the best pictures of her g-tube but like I said, they had it covered with gauze.  They weened her off the morphine and now gave her hydrocodone (Vicoden) via g-tube.  It's good to get her weened of it soon that she doesn't need her IV so she can go home sooner!  She mostly just laid around that day (what else can you do!?). She sleept on her daddy for 3 or 4 hours and also on me for a while.  Then Gramma came and she slept with her till we were able to go home!  Basically, after much disscusion, they decided that they wanted to see 2 feeds/meals.  So they kept with our home schedule except gave her less volume... 60 mL's for 2 hours = 120mls = to 4 oz.  They did that twice (every 2 hours) and she didn't throw up!  I will slowly increase it at home. Whitney has had an NG Tube for 9 months you know, so for us the G-tube was easy to learn.  You just have to lock the extension on to the button and hook up the bag of formula.  Flush it at the end of each meal.  Everything was good with Whitney and they let us go home the next afternoon! We were already set up with the home nutrition company and with no new meds, discharge was pretty quick. 


I packed all of her feeding supplies like the pump, extra bags, bottles of water, and formula ( I needed them last time for her cardiac cath) but these nurses and Dr. used there own, and that was fine by me!  I packed Whitney's medications, lots of outfits, shoes, socks, and hair bow's for her and a whole bag of toys!  The hospital had most of that stuff and we kept her in the hospital gown till it was time to go home.  We knew that this trip/hospital stay would be covered by insurance because we meet our deductible a while ago.  That is why we used their medications and formula.  I brought entertainment for myself like books, sudoku, and music but didn't use them because I was Too preocupied and taking care of my daughter and learning and reading about the G-tube!  I had to bring my own pillow and blanket though (hospital's is thin and scratchy) if I were to get any sleep. 

 




Whitney preferred to sit in the big comfy chair rather than her crib









All she was hooked up to was the G-tube and IV.  All the other wires are just monitors!









Kangaroo Joey pump and 500 mL bag 




Pulse Oximeter


















After all is said and done it really wasn't too bad!  It wasn't fun but I believe it will be worth it in the long run.  Just make sure you do a ton of research if your thinking about getting the G-tube. It really helped me to read other blogs about it. There are tons of "pages" on facebook with mom's or dad's that will answer any question about tubes and feedings. I was able to prepare for a couple of months.  This was my decision, I weighed the pros and cons.  Please let me know if you have any questions or concerns!  But of course every child and experience is different, I have learned!   


Tuesday, August 23, 2011

New Feeding Therapist and Dietician

The day started with the normal playing and breakfast and watching some of The Price is Right.  Then I went to get Whitney's pump and formula ready for mealtime.  I replaced the bag and primed the formula though the pump.  It clogged which is sometimes normal, so then I tried again and the pump just shut down!  Would not turn back on even when plugged in!  I was freaking out because she needed to eat right then, we were driving to Tucson in half an hour, and her surgery is tomorrow!  So I called up the feeding company, Option 1, and after a while they said a driver was in my area making delivers. He called me and said that he was a 10 mins away but headed north so I had to meet him at a McDonald's to exchange the pump (and I got my monthly supplies). It was 110 degree's outside!  I was an hour and a half late with Whitney's feed but somehow managed to get all 800 mL's in her throughout the day and night! 


My mom and I, with Whitney, drove to Tucson, AZ.  A two hour drive to see a therapist, Marsha Dunn-Klein and Dietician, Ellen Duperret, with mealtime connections and mealtime notions.  They were really good, nice, and knowledgeable.  We talked for two and a half hours.  Mostly giving them Whitney's history and feeding issues, lot's of information!  They also think a G-tube will help her better.  They will help with the Blenderized Diet if and when the Dr. says it's okay. They put her in the high chair and watched her eat some puffs and tried some puree baby food.  When we were getting ready to go, Whitney threw up in the waiting room, gross!


These are the last pictures you will see of her with the NG Tube! Tomorrow is the G-Tube surgery and Phoenix Children's Hospital.  Wish us luck, say a prayer, or send good vibes!!






























Sunday, August 21, 2011

Don't Jinx It!

But Whitney did not throw up today!! I'm almost in disbelief and I'm shocked! I don't know what we did or didn't do to accomplish this but I pray we will have these days more often!  Her feeding schedule today was:

 12- 6am   200ml total  33ml/hr goat milk formula with duocal
10-12pm   150 ml total 75ml/hr goat milk formula
2-4pm    150 ml total     75ml/hr Neocate Jr.
6-8pm    150 ml total    75ml/hr   Neocate Jr.
10-12am    150 ml total   75ml/hr Neocate Jr.

800ml total today! with no vomit!


I was very consistant with her feeds today. Not much high chair time. She took only one and a half naps.  She went shopping for a couple hours.  And overall she was very happy today!



Tuesday, August 16, 2011

Weight check and video

Not much new from today's speech/feeding therapy.  Still working on the same things like, well, getting Whitney to eat food.  She thinks she will progress better once she gets the G-tube.  Whitney's weight today is 16 lbs 14 oz.  Which is a one ounces gain.  I'm guessing she lost a couple oz when the tube was out but atleast she didn't lose too much.  This further leads me to believe that she is not ready to be weened off the tube. 
Here is a video of me and my mom putting the NG tube back in.  Warning this is sad she poor Whitney is screaming (obviously).  So only watch if you want to know how to do it yourself. 


Monday, August 15, 2011

Whitney eating Ramen tubeless


I feel bad not feeding Whitney but now I know that it is the NG tube making her gag and throw up.  This morning she ate scrambled eggs, slept for 3 hours then ate some Ramen noodle soup chicken flavor and Saltines.  My mom and I put the tube in shortly after lunch and had Whitney on a slow drip so that she wouldn't throw up with a bolus feed.  Maybe, if I can get enough formula in her she would tolerate a slow drip and not vomit.  Of course that's super annoying for me because I have to hold the pump all day!  But that's what we do for our tubies! 
Also, last week, her physical therapist said that Whit is doing great and that she needs more speech/feeding therapy.  So that's a really good thing that she doesn't need much more physical therapy.  I'm looking forward to more feeding therapy and think it will be more useful once Whitney gets her G tube.  I think Whitney will do great on a G tube and once she gains a lot of weight and is really healthy, then we can ween her off!  (with out starving her!).
Also, I'm super excited because we get to go to Tucson to have Marsha Dunn-Klein from mealtimenotions evaluate Whitney!  I've heard she is the best and she and her dietitian can help us with a blenderized diet!  And it's covered by my insurance! Of course it's a crappy 2 and a 1/2 hour drive there but it'll be worth it!







Sunday, August 14, 2011

NG tube came out

Whitney will 13 months old in exactly one week from today...

I'm posting a couple videos of my daughter eating some Mac & Cheese.  Whitney threw up and was choking on her NG tube so we pulled it out. It was last replaced about 2 weeks ago anyway.  This is the first time she ate solids with out the tube.  I was amazed at how well she did!  Because normally she won't even try to eat it for one and if she does try, she gags on it and would throw up.   Now I know it's because of the feeding tube, having something in the back of my throat would make me gag too!  Whitney ended up about 10 pieces of Mac & Cheese!  I was so happy!  Later she actually ate about four Gerber Puffs sweet potato flavor and three graduates lil' crunchies veggie dip flavor! Also amazing! Normally she'll barely eat one and gag on those too.   After she fell asleep I fed her a bottle of Goat Milk Formula, thicken with powdered rice cereal in a Dr. Brown bottle and she drank 90 mL's or 3 oz!  Pretty good!  Instead of giving her the Revatio, we put the oxygen on her at 1/4 Liter Flow.  And are monitoring her sat's.  So far so good!  I will try another bottle in a few hours, around 2AM If she doesn't take that then I will put the Ng tube in a start a slow drip.  Then pull it out in the morning and see how she does eating with out it!  10 days till G tube surgery...
These videos are for educational purposes.
















Tuesday, August 9, 2011

Speech Therapy & Weight Check

Whitney went to her speech/feeding therapy today. The therapist K. also does Craniosacral therapy to help Whitney relax her neck and shoulders and ribs. She put Whitney in the high chair and had her dip spoons and a toothbrush in water and then in flavored water. Whitney did really well with that and actually drank it from a spoon! Then the therapist K. put some puffs on the tray and tried to get Whitney to eat them. She took a few which is better than what she does at home. I'm surprised that Whitney didn't gag on that and throw up! It was a pretty good session!
Usually Whitney loves to eat shredded cheese and some noodles or rice, but the past couple of weeks she just throws everything on the floor. K. said to teach by playing a game with her to show her put things in a bowl or cup or my hands so that she doesn't just throw her food and spoons. One time Whitney let me put little pieces of ham in her mouth and she seemed to like it and didn't even gag!
I'm wondering if that with this strict feeding schedule, that Whitney just isn't hungry at all and to try to eat more just makes her want to vomit. So my delema is do I skip a feed to try to get her to eat solids or just keep pumping formula in her so that she gains better weight? Right now she gets 800 mL's - 840 mL's a day of 30 kcal formula which is Goat Milk formula at night (200ml) and Neocate Jr. Unflavored during the day (600-640mls).  She vomits one-two times a day about 4 oz.  GI Dr. M (or his nurse) says that's okay as long as she's gaining weight....would she gain more weight if I fed her less and she didn't vomit so much?  Or is she just vomitting because of the tube in her throat?  When we first started the Neocate Jr. Whitney went a full week with out throw up!  Well I have two more weeks to figure this out before she gets her G-tube.  I'm thinking I just want her to gain more weight and be strong for the surgery, then try the blenderized diet and when she's healthy and strong try to ween her off the tube. 

Today Whitney is 12 months and 3 weeks old and weighs 16 lbs 13 oz. 

Here is a video of Whitney trying to eat a MumMum's cookie carmel flavored








Monday, August 8, 2011

Photo Summary: Whitney's 1st Year

Newborn: diagnosis right-sided Congenital Diaphragmatic Hernia.  Missing 75% of the right side diaphram.  Liver and intestines in chest restricting lung growth and pushing on heart.  1 in every 2500 births. 50% survial rate.  Whitney = 20% chance survial. 

6 pounds 10 ounces







Immediately intubated.  On ECMO (Extracorporeal membrane oxygenation) Day 1 of life till Day 6.  CDH repair surgery on day of life 7.   Recovered and healed.  Received formula via NG tube. Learned to drink from a bottle.



















Stayed in NICU (nursery intensive care unit) for 56 days. Came home at 2 months old oxygen dependant.



Three months old

Start at home physical therapy and feeding therapy













Four months old

Diagnosis: Failure to Thrive, severe reflux, aspriation











Five months old

admitted to hospital for NG tube
on prevacid (acid reflux), bethanechol (control esophagus), and Alimentum formula (hypoallergenic)
 











Six months old

did not tolerate Alimentum
discovered a goat milk formula
start solids












Seven months old

Whitney vomits one to two times a day. 

12 pounds 13 ounces








Eight months old

Only drinks from a bottle while asleep and takes 2-4 oz at a time.  90% tube feed.

14 pounds 2 ounces











Nine months old

15 lbs 2 oz













 Ten months old

off of the oxygen and still won't eat solids
on Goat milk formula and no medications.

15 lbs 7 oz













 Eleven months old

Switched back to Alimentum, vomits every feed for 6 days. 
Prescribed Neocate Jr. unflavored and tolerates it with once a day throw ups.
15 lbs 13 oz












Twelve months old

On NG tube for 9 months.  I think it makes her gag and vomit more, and makes oral aversions worse.  Will be getting a G-Tube soon...