July 7, 2009: Doctor Follow Up

Today, Cohen went for his follow up to the barium enema proceedure. His doctor fully agrees with the Radiologist and thinks that Cohen needs to be seen by a pediatric gastroenterologist and a surgeon to set out a game plan. We got more information about what the "kink" really is. It's medical name is volvulus. A volvulus is a bowel obstruction in which a loop of bowel (for Cohen its his colon) has abnormally twisted on itself. It causes severe pain and progressive injury to the intestinal wall, with accumulation of gas and fluid in the portion of the bowel obstructed. In infants, they can also present with irregular bowel movements with extreme force behind successful emptying. Sound familiar? The risks involved with this are pretty scary, and I don't want to freak anyone out so I'll refrain from mentioning them here, but if you're really interested I suppose you all have access to wikipedia. I will say this though, the Radiologist was fairly confident that the enema reduced the current volvulus, and thus reduced the current risk. However, in the analogy the Radiologist gave us he isn't certain he fixed the problem any more than temporarily. Imagine folding a piece of paper in half and creasing the fold. Now open the piece of paper, don't smooth it out, just open it. Over time, either a long period or a short period, it will probably go back to the folded position. This is what Cohen's colon is doing and is the reason it will need to be fixed surgically.

The surgery can be done laparoscopicly and they will simply remove the part of the colon that is twisted. They will take out his appendix while they are down there too... If this is the road we have to travel I will go into more detail about the surgery then.

For now, the game plan from here is to have the doctors in Spokane look at Cohen's films and they will call Cohen's doctor in Moscow in the next day or two with information and an opinion about where to go from here.