June 26-27: Gritman ER x 2

We spent a majority of the weekend in the ER with Cohen. I took him in Friday night because he was not swallowing anything, not even drool that he suddenly has, his breathing pattern was very strange, and he had suddenly turned a very very yellow pale color. When we got to the ER they hooked him up on the monitors and it showed his respiration rate and o2 sats were low. When the doctor poked around at his belly he started to cry and get fussy so she ordered an xray of his little body. From what the ER doc could see, the x ray showed an abnormal amount of gas in his belly, intestines and colon. All that gas was pushing his diaphragm up and making it hard for him to breathe. A baby enema was ordered and hopefully that would help him feel better. Alas, there were no pediatric enemas in the hospital at the time and (it being 12am) no store was open to get one. We were sent home with orders to give him an enema first thing in the morning. I left puzzled as to why this would be his problem because he had pooped maybe 30 minutes before we went to the ER…..

On Saturday morning we gave him the enema and were quickly shown results…from the enema, that is. He still wasn’t breathing correctly, nor was he eating very well. This time he was eating but then spitting it right back at me. His color was still very pale and he was abnormally sleepy. We wrestled with the thought of taking him to quick care. Then I received a call from the ER. The Radiologist had looked at Cohen’s films from the night before and had some concerns with what he saw. He was in the process of trying to contact Cohen’s doctor to discuss it with her. The nurse said she would call back with more information. By 3pm she had called back and said they couldn’t get a hold of Cohen’s doctor but to bring him in if he didn’t seem better. We did just that.

The ER visit on Saturday night was long and seemingly unproductive in the realm of presently helping Cohen. The new ER doctor that night thought the films from the night before were just fine, but he sent them up to Spokane to a Neonatologist to review them. The Radiologist came into the ER to have words with the ER doctor about their differing opinions. The Radiologist looks at xray films as a profession and is certain of what he saw in Cohen’s films, while the ER doc wasn’t so convinced. The Neonatologist chimed in that while the films are suspect, she is sure they would have caught this while he was in the NICU. With that, Cohen was sent for another round of x rays. Meanwhile, he was still uninterested in eating and just not being himself.

The follow up x rays showed the amount of gas in his belly was still a lot, but it had decreased from the first x ray. (Probably with the help of the enema). The first Radiologist saw the same issues he was concerned about, so they sent the two films to be looked at by Cohen’s doctor to decide where to go from there. (Oh, of whom no one at the ER could get a hold of ALL night long…) At 11pm, we were discharged home and told Cohen’s doctor would contact us on Monday.
So what did the Radiologist see? In addition to the abnormal gas patterns (which the ER doc from Friday saw), the Radiologist believes that Cohen has a transverse colon and probable case of Hirschsprung's Disease. This disease occurs when some of the nerve cells that are normally present in the wall of the intestine do not form properly during fetal development. The nerve cells are needed to help move food through the digestive system, and when the nerve cells are missing this movement cannot occur. The result is that stool can back up and cause either partial or complete bowl obstruction. The only treatment is surgery to remove the affected part of the intestine, and connect a healthy working part of the intestine to the colon.

This is the worst case scenario for Cohen’s symptoms, so we are hopefully that he does not have this disease. However, comparing his symptoms to the symptom list it looks as if there is a chance he does have it. The number one symptom is no bowel movement for the first 48 hours of life…and if you can remember, Cohen had a horrific time with pooping while he was in the NICU…ESPECIALLY during his first few days. Also, any one who has been around Cohen knows that when he poops he explodes. EVERY single poop that he has is a blowout. Seriously. Couple that with Cohen not pooping on a regular basis, all point to signs something is up…down there.

In addition to all of the lower GI issues, Cohen has the worst case of thrush ever. Thrust = yeast infection in mouth = GROSS. He had an ear infection two weeks ago and was on antibiotics, and apparently that can cause thrush in infants. According to the Neonatologist, neonates have the worst cases of thrush because of immature and inappropriate cell development (yadda, yadda, yadda which is what was going on in my head as the ER doc told me this…). He was on Nystatin the first day it appeared (thank you to the director of his day care who has an uncanny ability to diagnose the ailments of my children…first with Carter’s pink eye, now with this…), which was Tuesday and by Friday his mouth was completely white. I guess it takes double the time with Nystatin to help babies like Cohen, and if that doesn’t work after 2 weeks they have to get more aggressive. The ER doc looked in his mouth and discovered that not only is his entire mouth white, but so is the opening to his esophagus…which probably means it’s all the way down it. This can be really painful and irritating, so that plus the excess gas issue is making Cohen not feeling so great.

Luckily the thrush will go away with minimal treatment, so hopefully he will start to feel a little bit better. Right now our little man is at home resting. He has slept for the majority of today, which shows us how miserable he really is. It breaks my heart to know that Cohen’s belly has been this irritating to him for the last 4 months…..