A Lil' Boy's Journey to Live….


Riley had the milk scan today.  He was a true Champ!  He drank his bottle, and then was "taped" down to a table for a hour.  He layed there and watched Baby Einstein for about 45 minutes, then he started to fuss a little.  By then he was almost done.
The scan showed that he was refluxing up to the top of his esophagus.  He was not aspirating into his lungs, though, which is good, and his stomach was emptying accordingly.
Dr. Szwast called me this afternoon and told me the results.  She is thinking that we should do the Nissan, and at the same time do the Ladds Procedure.  She wants to talk about this with here colleagues.  We want input from Dr. Rome, and Dr. Rycheck, and the GI surgeon.  Dr. Szwast is stressing that the Nissan is a pretty big procedure.  She also is not sure if they will do the two procedures together.  I asked if we HAD to do the G-Tube.  I feel that if we could just get Riley to stop vomiting he would start gaining more weight.  He takes a bottle.  He has issues keeping it in.  Again….this needs to be discussed.  The G-Tube usually comes along with the Nissan.  I just don’t want him to have to have the G-Tube if he can do without.  We will discuss all of this further on Nov. 5th.  We go back then for the sedated echo.  At that point she will have had a chance to speak to the other doctors.  So the 5th should be an informative day between the echo and these new discussions.
My sister, Terry, is having Jean’s Day tomorrow in her school district, Riverside.  Thanks for that!  She emailed me some info she was posting tomorrow, and I thought I would share it.  It is pretty informative.  Explains alittle bit about the procedures I’ve mentioned.
The general aim of GER surgery is fundoplication, which means a band of upper stomach muscle is wrapped totally, or partially, around the lower esophagus, in effect tightening the valve and lessening reflux. In the Nissan procedure, a total 360-degree wrap is performed, whereas in the Thal procedure a partial wrap is performed. Because with the total wrap a child can lose the protective ability to vomit, burp, and retch, the partial wrap is often the preferred choice. In a 1987 study of 7,467 infants and children operated on for GER, there was a 94 percent cure rate. GER surgery is considered particularly beneficial for infants who are neurologically impaired.

The bowel will be detorsed (unwound) and checked carefully (see pictures). The bowel that turns pink (showing returned circulation) after torsion is good bowel. If all bowel turns pink, a Ladd’s procedure will be performed to put the bowel in place to prevent another volvulus. An appendectomy is usually done since the appendix will not be located in the normal area in the abdomen. This could lead to confusion and delay in diagnosing appendicitis in the future.

If there is a question about the bowel’s viability, the abdomen will be left open and a second-look procedure will be planned within 24 to 48 hours.

If there is a section of necrotic (dead) bowel a colostomy may be needed temporarily. The ostomy nurse will consult with you on ostomy care.

The operation done to repair malrotation is called Ladd’s procedure. In Ladd’s procedure, the abdomen is opened (Diagram A).

The small intestines are seen first and appear to hide the colon. The entire intestinal mass is delivered out of the abdomen (Diagram B).

The intestinal mass is rotated to reduce the volvulus (Diagram C).

The intestines are re-positioned in the abdomen (Diagram D).

Diagram E shows the appearance of the intestines at the end of surgery

What is a Milk Scan?
A Milk Scan is a test that can determine if your child has gastro-esophageal reflux. It can also measure the rate at which the stomach empties.

This exam requires the use of a radiopharmaceutical mixed with milk, breast milk, or formula that your child will drink.

What should you expect during the exam?
The technologist will ask why the Milk Scan is being done, and explain the study to you and your child. We will then place a small amount of radioactive material into the milk/breast milk/formula that you bring from home. There are no side effects and the medicine will not change the taste of the milk/breast milk/formula. Your child will then drink their milk/breast milk/formula. Your child will need to drink two to eight ounces, depending on their ability, in ten minutes. We will work with you if your child has special needs.

The scan will begin while your child is swallowing and will continue for approximately one hour. Your child will lay on their back, on our table, with the camera underneath them.

If your child has a history of problems with swallowing, a special tube called an NG tube (nasogastric) will be inserted prior to the study by a Radiology Nurse. The tube is inserted through the nose and ends in the stomach. The liquid will be injected through the tube for the exam.

We do not sedate for this procedure.


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