Well, this post was pre-empted by yesterday’s exciting events! But, if I don’t write it now I’ll forget. Mommy brain. Yesterday, Braxton had an appointment with his GI doctor to discuss results of his Gastric Emptying Scan and follow-up on feeding difficulties.
The test was originally done to check for gastroparesis – delayed emptying of the stomach, which the doctor thought could have been brought on due to the pneumonia Braxton had in August. The scan actually revealed the exact opposite! GI has determined that Braxton has Gastric Dumping Syndrome. I’m not going to explain this nearly as well a our doctor did, but here goes… the short answer is Dumping Syndrome is where the stomach empties too quickly. Doesn’t seem like a big deal, but it really is – when the stomach empties too fast the formula gets to the small intestine too soon which signals the pancreas to increase the amount of insulin the body is producing. [Didn’t think you were going to get a science lesson today, did ya?] His body then absorbs the sugar of the meal way too quickly while his body is also producing insulin. As the level of insulin increases the sugar level peaks and then crashes which can cause vomiting/diarrhea/sweating/lethargy [all problems Brax has had during/after feeds] This would explain the vomiting Braxton has had when feeding. There is “early” dumping where symptoms can start immediately with feeding and “late” dumping where symptoms don’t happen for 1-3 hours after feeding. Braxton has had both; there are times when he’ll vomit IMMEDIATELY upon starting a feed and times where it’s about an hour later.
So, how do we fix it?
Thankfully, it’s a pretty easy fix. The vomiting is caused by the rapid increase then rapid decrease of sugar levels in the body, so the doctor wants us to add corn starch to each feed. I know what you’re thinking – corn starch?? Well, corn starch is a complex sugar that takes the body much longer to digest and absorb. It also thickens the feed so it moves more slowly through the digestive system. Since the body won’t be able to absorb the sugar so quickly, this *should* stop the vomiting and we *should* be able to increase rate of feeding and get Brax back to where he was before this big mess. The doctor said “I’m confident this WILL work….I hope” gee thanks doc! =/ He really wants us to work up to feeding Brax 8 oz [he’s currently at 6oz] per feed and get him off the pump again.
Last night I did try the corn starch and gave him his usual 8oz for the evening feed, but instead of doing it slowly, I ran it at slightly higher than his day feeds annnnnd he kept it down! wooooo!! No coughing, no gagging, no vomiting. So, maybe..juust maybe we’ve finally got this thing figured out! Today, I sent him to daycare with just 7 ounces each feed, just in case it didn’t work as well. I’m going to very slowly jump the speed of the pump everyday until we can try to get him off of it.
Also, with regard to actually feeding by mouth. GI would like us to try Braxton on Periactin. Periactin is a medicine that helps to increase appetite and also helps to expand the stomach. GI’s goal with this is to MAKE Braxton hungry so he’ll WANT to eat by mouth again. He said the effects of it wear off after a few weeks so we’ll have to do cycles. Give the medicine for 3 weeks, give him a week break, then start him on it again. As an added bonus, Periactin is an antihistamine so hopefully it will also help Braxton with all the added congestion he has going on. We see the Ear, Nose and Throat doctor tomorrow and I’m going to bring up the persistent sinus congestion and see what he thinks about going in and cleaning the sinuses out or maybe just seeing what the Periactin does.
Let’s hope this plan works!