Since the inception of TRS in 2000, I have written about life "on the road". By plane, train, or automobile, I tell the story of trips; but the real story in each one is about the journey, not the destination. On March 15th, 2008, Daddy's Little Speed Bump was born. 21 months later, Speed Bump Number Two arrived. I thought it fitting to create a place, with a Road Scholars theme, to share this new journey.

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Thursday
Apr012010

Update on Alyssa

For those that aren't aware, Alyssa has spent the last three days in the hospital. She went to the doctor last Thursday after having three straight days of diarrhea. The doc recommended we change her formula and supplement her regular feedings with Pedialite to maintain hydration.

Alyssa is no stranger to new formulas. Since literally the moment she was born she has had a problem with spitting up. She visited the doctor in February for that issue. He sent her for an ultrasound to rule out any defects related to her esophageal valve and prescribed a low dose of Reglan to help her stomach empty out faster. The problem persisted, however, and Alyssa continued to eat, burp, relax, then suddenly--sometimes up to an hour later--spit up. The fact this was occurring "at rest" troubled her doctor. We cycled through half a dozen different types of formula. Enfamil AR, which is fortified with rice, seemed to help a little, so we settled on that and discontinued the Reglan, which seemed to make things worse.

We were prepared to accept that Alyssa is just a fussy baby and hoped she would eventually grow out of her reflux condition when, ten days ago, she developed diarrhea. After her first visit to the doc for the new symptom, nothing changed. Jen took her back to the doc Monday for a follow up. She had lost three ounces and was beginning to show signs of mild dehydration. Her doc ordered blood tests and a stool sample and sent her home. Tuesday morning, he called and said he would like to admit her overnight to run some tests. Jen packed a bag, dropped off Kaitlyn with the neighbor and took Alyssa to the hospital. They did another ultrasound and an upper GI to rule out any abnormalities or blockages. Both tests came back negative.

Wednesday was a waste, due to mis-communication and, in my opinion, poor practice of medicine. When I say "poor practice" I do not mean "malpractice", because I do believe that Alyssa has and continues to receive the best quality of care in the world. What happened Wednesday was the poor execution of an ultra-conservative strategy of medical practice that ultimately will increase the cost of this hospital visit. The on-call doctor, a young, tall, skinny man with an Eastern European accent, initially decided to bring in a GI specialist to consult on Alyssa's case. However, Wednesday morning, after a single dose of an acid reflux drug that typically takes three days to kick in, Alyssa was on a marathon stretch of hours without spitting up.

Dr. Ukraine canceled the consult.

By mid-afternoon when he revisited Alyssa and realized the lack of symptoms was most likely a coincidence, it was too late to get back on the GI doc's calendar. Doctor Ukraine was paged to another hospital and we didn't see him the rest of the day. That left us with the nursing staff. The day nurse said the GI doc was definitely going to come see us in the morning. The night nurse said the doctor was still on the fence and had not yet reordered the consult. Meanwhile, we're racking up reward points with the Baptist Health System. I hope this isn't the future of health care.

Thursday we got back on track. Dr. Ukraine was off and a new, more seasoned doctor was on duty. He witnessed Jen with Alyssa for five minutes and agreed the child clearly had acid reflux. He ordered a reflux test and suggested that it may also be necessary to do a pH test, requiring a probe inserted through Alyssa's nose down her throat and into her stomach for 24 hours. A few hours after the reflux test was completed, the GI specialist paid us a visit. The reflux test confirmed that Alyssa's stomach is slow to empty and she is experiencing reflux (duh). Thankfully, she is not a fan of the pH test for infants. Her belief is that none of the medications tried so far have been of the correct dose or been given sufficient time to work. She also believes the diarrhea may in fact be a symptom of the reflux and not a viral infection since Alyssa's blood tests came back normal. She laid out a detailed plan of treatment involving pharmaceuticals as well as changes to Alyssa's eating and sleeping habits. Hopefully this course of treatment will prove successful after a few days and no further action will be required.

In the meantime, Jen and Alyssa are spending their third night in the hospital. Alyssa's dehydration has already improved and she no longer has an IV. If she shows signs of weight stabilization tomorrow our hope is that she will be discharged home in time to color Easter eggs Friday night. We'll follow-up on an outpatient basis with the GI doc next week...who doesn't take our Cadillac insurance plan by the way, so phone lines are open and operators are standing by to accept your donations. I will be returning to "work" tomorrow, although I suspect most of my day will revolve around making sure this little pleasure cruise--which will undoubtedly run in the four or maybe even five digit range--is 100% covered sans a modest deductible.

For the latest updates on Alyssa's condition, follow me on Twitter (SLOengineer) or check my Facebook. Thank you to all who have sent your prayers, words of encouragement, and offers for help. It means a lot and we truly appreciate it. I am sorry that I haven't been able to accept all your phone calls or respond to every comment/email. I've been busy trying to get in touch with Dr. Gregory House. If you have his number, can you text it to me?

 

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