Monday, 27 June 2011

Pyloric Stenosis

Tom has been the little big brother since he was born, whilst both are considered 4 weeks prem in their red books I have always thought of Tom as being another two weeks behind Seb and put this down to his 4 weeks of static growth.

Tom always threw up some of his bottle since he was born. The health visitor explained this as ‘posseting’, Tom’s eagerness to put on weight- the fighter instinct- meant he was drinking more than his tummy could take and whilst the excess was thrown up. This was a good enough reason for me; both boys were putting on weight.

Tom continued to ‘posset’ and at six weeks he began projectile vomiting. We were taking as much action as possible- winding throughout the feed; leaving upright after feeds; tilting the mattress on his cot- nothing seemed to make a great amount of difference to our washing load, and Tom’s vomiting was not limited to immediately after a feed, they could happen anytime, even two minutes before his next feed.

I discussed this with the HV and as Tom was continuing to put on weight, did not seem in any distress, was weeing and pooing I was advised to move him to a comfort milk to see if a thicker consistency would improve the situation. It took me a week to make the move, I had researched comfort milk and it was for babies with colic or constipation, as I didn’t think Tom had either of these I couldn’t see the benefit of the move. But a week of projectile vomit later I decided it was better to have tried.
Tom continued to throw up, it was just thicker vomit!

At eight weeks Tom went for his check-up. Despite my perception that he was putting on weight the doctor was concerned he hadn’t put on enough. After prescribing staydown and gaviscon Tom did the best thing possible, threw up all over me. Fortunately this resulted in a referral for an ultrasound of his abdomen.

The appointment was scheduled for two weeks and we attempted ‘staydown’- in our case the clue wasn’t in the title and Tom continued to throw up. A week later not happy with the results I made an appointment at the doctors, the verdict- if you’ve got an ultrasound appointment there’s not much more to be done. The news that the results would take two weeks to be back at the doctors just served to concern me more.
The night before Tom’s appointment I woke to do his 2am feed to see he had thrown up blood at some point, even having read this was possible it still puts a fear which cannot be ratified. A phone call to NHS Direct later and a doctor was scheduled to visit. At 5am the doctor arrived, to once again say the ultrasound was the only route to the cause.

With so much pressure on this ultrasound I knew we had luck on our side when the drivers milling around the always busy hospital hadn’t noticed a vacant spot and we managed to park straightaway. Due to Tom’s age a doctor was scheduled to perform the ultrasound, he showed some concern at the results and said he would fax them immediately to the GP, he left me to get our things together. Two minutes later he came back and said he thought it better to get a second opinion. A paediatrician came down to let me know they suspected Tom had pyloric stenosis and we were to be admitted.

The pylorus is the section of your baby's digestive system between his or her stomach and small bowel. Pyloric stenosis occurs when the muscle in this area thickens, causing the pylorus to become narrower. As a result of this narrowing, milk can't get through to be digested.

Pyloric stenosis affects about one baby in every 400. The symptoms usually appear between three and six weeks after a baby is born.

Pyloric stenosis is about four times more common in boys than in girls, particularly in first-borns. It's less likely to develop in babies who are breastfed.

I felt relieved and panicked all once, we had the diagnosis and there was not only something that could be done but we were in the right place and they were willing to see us straight away, on the other hand I really didn’t understand what would be done.

We were admitted to the Childrens Ward and around noon Tom was put on nil-by-mouth. His blood and gas results showed that he was ‘unstable’ from the point of view he had thrown up for so long it had made him dehydrated and his blood levels reflected the impact. In addition his weight was considered to have reached a plateau. Calderdale Royal would not be able to do the procedure needed so a bed would be found at a nearby hospital. Whilst a bed could not be found this was not considered a bad thing, Tom could not be operated on until he was stable and we were near to home.

Tom did not take well to the situation at first (who can blame him), he managed to dislodge his cannula's and by morning he couldn’t be placated having not had a bottle since eleven the previous day, in addition he still wasn’t considered stable. Fortunately by noon a bed was sourced at Sheffield Childrens Hospital and we were transferred mid-afternoon.
Johnson Babies
Travelling by ambulance the safe way
I have only been in hospital for a torn ligament when I was about 13 and my two labours, I am not used to the hospital environment.
  
After being examined by the SHO a registrar came to see us. At this point, the diagnosis of pyloric stenosis was considered very tentative- Tom had reached the grand age of ten weeks and was considered too old, whilst his bloods and eating habits were consistent, his lack of weight loss was inconsistent with the diagnosis. However, the registrar looked at Tom, turned to the SHO and said “Classic Py”- proving to me that it’s possible to want to kiss a man other than your husband. Unlike previous examinations the registrar immediately found the textbook ‘olive’, because Tom was so dehydrated and his stomach emptied the ‘olive’ was higher up than usual. Tom was now stable, the operation was scheduled and all we could do was wait as whilst Tom was considered a medical emergency it was not a surgical emergency as we were receiving appropriate medical attention.
Pyloric Stenosis
My poorly baby
48 hours later Tom went to surgery. And I do not know how parents do it. I know we have been so fortunate with our babies, and many babies undergo far more intense operations, but I only have this as my benchmark- and I went to pieces. I think by this point I had been given a label by the (lovely) medical staff ‘ever so slightly unbalanced’ would probably have covered it! When Tom came out of his surgery I was asked to go down with his pacifier as he was screaming the place down (that’s my boy!) and when we were reunited all he really want was a cwtch from mummy.
We were kept in for a further 48 hours until Tom could demonstrate that he could take the required amount of milk and ‘retain’ it. Of course he couldn’t, but luckily it was agreed that as he had thrown up for ten weeks it was probably second nature- and it wasn’t projectile and it was (this time) literally posseting, I also think Mr J, Squeaks, Cheeky and my mum turning up made them want to evict us!
Pyloric Stenosis
The reunion
Whilst my tears and concern for my son may at times seemed hysterical, I would just like to credit anyone who works for the NHS- everyone we came across at Calderdale Royal, Sheffield Children's Hospital and the Ambulance Service was simply amazing. And to parents who are in these situations, I know we all have the ability to find the strength to be strong for our little ones and I am in awe!
To understand pyloric stenosis, the best medical stuff I’ve seen can be found at http://www.bupa.co.uk/individuals/health-information/directory/p/pyloric-stenosis 

1 comment:

  1. dont read much about this, does not seem to be overly common. My daughter had the same operation but she had it at five weeks old.
    She was vomiting slightly before we got her home, (you stayed in for 5 days way back then) but they did not seem to concerned. But the she started vomiting more often so the HV suggested changing her formula, had tried breast but she would not take to it, which we did. Still she vomited. So they suggested boiling her bottles not sterilising them in case she allergic to sterilising solution, but still she vomited.
    I got to the stage of propping her up in my baby bath to limit the impact area and the washing she would cause ( I had no machine and an 18 month old toddler)
    By now she was losing weight and crying a lot, and I had her at the Dr's every day, but the baby was fine the mother was paranoid!!
    By now she was just over 4 weeks old and crying for hrs and hrs on end. So this saturday night I phoned my GP and told him to take her away because I was going to suffocate her with a cushion, I just could not take any more. Did not care if he took her home to the wife or gave her to social services I just needed to get some sleep.
    So he admitted her to hospital, just to shut the mother up dont think there is much wrong with the baby he said.
    We took her in and they checked her over and found she was dehydrated and the hospital said she would have died within 6 hrs. She weighed 7lb when born nearly 4 weeks prem, and by now weighed 3 1/2.
    They stabilised her best they could and operated on her on the monday evening having done a barium xray to prove what it was.
    My GP admitted because it only happens in 1st born children (not true) and never girls ( also not true) he did not look for it. But again a GP will probably only see this once in his career.
    Very traumatic.

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