GJ Tube!

As mentioned, on 7/30 Eli could keep nothing down - not even pedialyte. So as soon as we got confirmation from our pediatrician, Eli and I headed to the ER. Our ER stay was longer than normal... lots of waiting. Took about an hour or more to get an IV in (after 3 attempts) because he was so dehydrated and his veins were very hard to stick (and he's normally a hard stick). We did some general x-rays of his lungs & gut in the ER to make sure there was no big obstructions - they showed nothing. And then after a lot of waiting, we were checked in to our room on the general Peds floor around 2:30am. Eli was so exhausted and dehydrated that he slept through everything but the IV sticks the whole night.

Tuesday morning Eli continued heaving even on an empty stomach, and actually began vomiting brown liquid - which we later learned was old blood. He continued to vomit blood through Wednesday... So we began to worry that with all the vomiting that he has now injured something inside his GI tract. The first thing we did Tuesday was an Upper GI x-ray with contrast - this is what we were supposed to do outpatient on Wednesday (8/1). The only finding of this study was that Eli has slow motility or gastric emptying issues... While this is technically a "new finding" because we've never done this study before, this is not actually new to us... This is something we've always known about him. He has a hard time digesting his food and he was actually on a medication to help him empty his stomach for a year that eventually stopped working for him. The rest of the day was talking to lots of his specialist doctors and we began discussing the GJtube surgery. All of our specialist were in agreement that this seemed to be the next best step for him because we were not finding anything "wrong" with Eli to cause all the vomiting... It's just seeming like his gastric emptying issue has gotten worse and we need to try to feed him in another way. His Gtube is a port that goes directly in to his stomach and we are keeping this port available to put his medications in. The Jtube is in the same port as his Gtube, but it is a continuation of Gtube down in to his small intestine. So his feeds now go in to his Jtube and we bypass the stomach so he is not vomiting his feeds. Most of the day Tuesday Eli slept... Exhausted boy and dehydrated. At night there was lots of whining/ whimpering, but still slept a lot.

Wednesday was a lot of waiting. No tests done today... On Tuesday the GI department decided we needed to do a full scope down Eli's throat and into his gut to see where bleeding was coming from and if there is anything else going on that x-rays can't show us. The scope requires anesthesia and some coordination with scheduling, so it wasn't until Thursday. Wednesday we had to do some pain management with Eli and more talking to doctors about the GJtube. By the end of the day we decided to not wait for the scope results and to just do the Jtube surgery. Since Eli was already going to be put to sleep for the scope, we wanted to just get the Jtube done and not have to put him to sleep again in a day or two. On Wednesday our nurse thought of a great idea to stop the vomiting- attaching a farrell bag to his Gtube to empty his stomach. We've used these bags before at home, but not hanging below him to empty his stomach. As soon as we attached it, the bag filled with brown liquid and Eli felt immediate relief. We are continuing to use the farrell bag today to help him manage his stomach output.

Thursday was a big day! Eli started the day with a stomach ultrasound - the GI doctors just trying to check everything off the list for a cause of the vomiting. Then in the afternoon he was put to sleep for a scope and to place his GJtube. The scope didn't show us anything new - just that the same gastric emptying issue. Everything went really well with the surgery and Eli slept until about 1am post surgery. When he woke up - he was happy! Not in pain it seemed.

Check out that G & J access!

Friday mid-morning we were able to begin trialing feeds in his Jtube. He hadn't had anything other than an IV since Monday evening! This kid needed to eat. We started with pedialyte at a slow rate and continued to increase his rate. A difference with his Jtube from what we are used to is that Eli will now be on continuous feeds - always hooked up to his feeding pump. Because our intestines don't have a basin to hold a feed, we have to go very slowly with putting nutrition in to it... So this will be something new for us to get used to. By Friday afternoon Eli was very fussy and uncomfortable. It was very hard to tell what was wrong. He ended up going to sleep for the night around 3:30pm.



Saturday and Sunday he continued to seem in pain. We continued to trial with his feeds and he got up to 50% pedialyte and 50% formula at his goal rate. But he was just a cranky guy all weekend - Eric and the nurses were trying everything they could think of to make him comfortable, and pain medication really wasn't working. We weren't worried about the Jtube at this point because he wasn't outputing from his stomach anything formula colored, but they did an x-ray to check the placement of his Jtube just to be sure. X-ray looked good for his Jtube, but it did show a lot of gas and BMs that needed to pass. Most likely this was the issue... And they were right. After Eric got a large burp & fart out of Eli on Sunday- he was happier :)

Monday morning Eli was back to his normal, crazy self! He was smiling... kicking... talking. Then around 11am we increased his formula to 75% and pedialyte to only 25% to continue to try to get him to full feeds. At about 12pm he started getting really fussy and I needed to leave to go to a care team meeting. The goal was to get all of our specialists together and on the same page, but unfortunately our pulmonologist and GI doctors could not be there... And they are the 2 that often have differing opinions about his reflux and care. Nonetheless, it was wonderful to have the pediatrician, our palliative care doctor, and Dr. Coates (neurologist) on the phone to discuss Eli and his worsening GI condition. We were hopeful we could continue what we were doing and talk discharge soon. We did a routine EEG on Monday to just follow up from a year ago... Everything looked OK and similar to how they have been. The increase in formula seemed that it was not going as well as planned. Eli began to put more stomach acid out in to his farrell bag and he was cranky and beginning to get exhausted again. Monday-Wednesday Eli was just kind of out of it.


By Wednesday we were worried about dehydration again - he had little wet diapers since Monday and no BMs. So we needed to make some drastic changes. First thing we did was add 10ml of water per hour... which doesn't sound like much, but that's an extra 240ml of fluid in a day- big change for Eli. We also hung Eli's farrell bag above his head - how it is typically used. The point of the farrell bag is to relieve pressure from the stomach of gas or contents and then put the contents back in to the stomach. We had been just emptying Eli's stomach (just stomach acid - the blood stopped on Thursday) for the past week and not putting it back in... He had been outputting 200-300ml of fluid, but Monday - Wednesday he was outputting 300-400mls. (This is a sign that he is not tolerating the increase in the formula.) So we went back down to 50/50 formula pedialyte, added extra water, and hung his farrell bag above his head to get that liquid back in him. Everyone felt like this was a really good plan and we were talking discharge for Thursday (8/9) as long as all of this went well... Well it didn't :( Adding 240ml water and 300-400ml of stomach acid back in to Eli was too big of a change. He vomited in the afternoon a couple times, in the evening a couple times, at night a few times, and then every hour of the night. By the 4am hour the nurse and I just put the farrell bag back on the floor below Eli to drain his stomach again. This help and we both got a couple hours of sleep.


Thursday the team all agreed we tried to much and we went back to keeping the bag on the floor and just adding some water to his routine... Eli did great with this Thursday (8/9) and Friday (8/10). No vomits either day. Friday Eli was back to his normal self all day! It was wonderful to see and the best I had seen him in a month. He was active, alert, and smiling. The only thing keeping us in the hospital now is making sure Eli is hydrated before we go home. The doctors all agree that we can work on increasing his calories and work on phasing out the farrell bag at home. So Saturday morning (8/11) we did a blood draw to check his electrolytes and hydration, and it looked good!!! WE ARE OUTTA HERE! It will be a long battle at home to get back to his new normal, but at least we will be home... We know that Eli will recover faster there.

New things from this hospital stay:

His Jtube and doing continuous feeds. Oxygen... Eli had some dips in his oxygen while sleeping some nights and some during one day when he was stuffy. We will now have an O2 monitor at home and an oxygen tank for when he needs a little boost. Atrovent - another breathing treatment (works and looks like albuterol) when needed to help open airways.

Praises:

• Getting our happy boy back!
• Our village... we have AMAZING family & friends who helped take care of us in the hospital and Ava at home. Ava was very spoiled with lots of fun 1-on-1 time.
• Rhodes School being so supportive of Eli and allowing me to miss my first day back to work!
• Awesome pediatricians and rounds teams at the hospital who listened to us every step of the way.
• Amazing nurses - we love our nurses! Never enough love for them.

Prayers:

• Getting used to life on a Jtube and continuous feeds, getting to full strength feeds, staying hydrated, and back to gaining weight
• Eli learning how to digest his stomach acid again so we can slowly get off the farrell bag
• Eli's breathing - only to need minimal use of his home oxygen if at all
• Our family time... it's been very difficult to be apart for almost 2 weeks and now Britta rushes in to the start of the school year
• New nanny starting - transition from old nanny to new one goes well

“Come to me, all who labor and are heavy laden, and I will give you rest. Take my yoke upon you, and learn from me, for I am gentle and lowly in heart, and you will find rest for your souls. For my yoke is easy, and my burden is light."”

‭‭Matthew‬ ‭11:28-30‬ ‭ESV‬‬