It was another crazy, busy day. Josh had a good first day of work and Lola enjoyed doggie daycare. What happened here at the hospital?

Since we had the pain and diarrhea last night, the GI team decided to let Ella’s food go in much slower today. Instead of a quick bolus feed by gravity in a syringe, they let the EleCare be delivered into her g-tube via a food pump. They chose a rate of 125ml per hour. This meant that she would get her full feed in a 2 hour timeframe.

The first feed at 9am seemed uneventful. Just before her next feed at 1pm, she had diarrhea with mucous. When we spoke to GI, they decided to try the same food schedule for the rest of the day to see if it improved. But they told me that if she had more diarrhea or mucous stool, we should go ahead and change her feeds to a continuous drip overnight to see if going the slowest possible amount would alleviate the diarrhea. We also discussed that if the food situation did not improve things, we would try steroids next.

Ella fell asleep for an afternoon snooze around 4:15pm. At 5:10pm, she woke up crying. From there, it was an hour and a half of pain for Ella. She was not real consolable. Fortunately, the attending came in to check on her and witnessed her episode. We talked through the likely diagnosis. He was concerned with the possibility of intussusception. Intussusception occurs when one portion of the bowel slides into the next, much like the pieces of a telescope. When this occurs, it creates an obstruction in the bowel, with the walls of the intestines pressing against one another. This, in turn, leads to swelling, inflammation, and decreased blood flow to the intestines involved.

He paged the GI team and they decided to get an abdominal xray to see if anything abnormal appeared. It does seem strange that she is having these episodes of pain more and more frequently. In this case, I’m just glad that the doctor witnessed it. Since the episode occurred, it was ordered for Ella to begin receiving steroid treatment via IV at 8pm tonight (methylpredisolone). Originally we were going to wait and discuss tomorrow with the GI team after we saw more stool pass with the change and delivery of food. But I guess these episodes led the pulmonology doctor that witnessed the episode to give the steroid to help with any inflammation that Ella has in her intestines. It won’t hurt Ella to give it early, but hopefully it doesn’t mess with any plans or strategies that the GI team had in mind.

It is around 9:30pm and the fellow on for the night shift confirmed that the abdominal xray does not show evidence of intussusception or any obstruction but rather lots of air pockets (gas). So, that is a positive sign. And so far, she has tolerated the EleCare throughout the day. We just need to see if her guts are going to absorb the food and eliminate the loose stools with mucous and blood. Her last stool was 1pm and we have not had any since that time. We’ve started another feed recently, so time will tell. I’m hoping that we can have a restful night.

Psalm 73:28 (NIV)
But as for me, it is good to be near God. I have made the Sovereign LORD my refuge; I will tell of all your deeds.