Poor B... more surgery on the horizon?

So, if we're not friends on Facebook, you may not know this but Brice was admitted to the hospital for 24 hours for post-op dehydration.

We landed back in the ER on Monday --- the kid endured another IV and was awarded an overnight stay in room 509. Thankfully, this was the turning point for him. He received  one dose of decadron on Monday night and another dose Tuesday morning. By the time we left the hospital, he was eating like normal and almost drinking like normal. He still refuses to take any and all medication by mouth... which is further complicating a new issue we've discovered...

While in the ER, after being told Brice was being admitted (but before being taken to a floor), our GI called. Drum roll please........................... Brice has an insane yeast overgrowth in his small intestine (found in the duodenal aspirate). The high end of normal is 10^5 and he is 4x10^7

 Today, he started a two week course of Diflucan. But the real kicker from his most recent EGD is that he has active reflux esophagitis. Technically, he should not have this because he takes 20mg of Nexium twice daily - that is a high dose for a child - and somehow, it's not enough. We don't really have the option of putting him on a higher dose. Our GI mentioned the very, very real possibility of a Nissen Fundoplication. He said we want to try to avoid this at all costs (which George and I feel the same about) but if he is still symptomatic after we treat the yeast, Brice will likely need a nissen.

I don't really know which direction I want to go on this. I really don't want him to have to endure another surgical procedure - and this one is more significant than a T&A. But at the same time, I don't want him to suffer from esophagitis. Not to mention, if that is left untreated, it raises his risk for a condition known as Barrett's Esophagus (essentially, the esophageal tissue changes to something similar to intestinal tissue). With Barrett's Esophagus, there is a risk of esophageal adenocarcinoma (yes, cancer).

If Brice were to have the Nissen, he would no longer have to take anti-reflux medications. No more Nexium eliminates the risk of bone density loss due to long-term PPI use - if he were to continue on Nexium, he would have a bone scan at 5.

We just want to feel confident in whatever decision we have to make. But with that said, I am not sure we will be able to. If we go one way, we run the risk of X and if we go the other way, we run the risk of Y. I really don't think this will be an easy decision to make. I can tell you this much, our decision will be very much driven by Brice's needs and not other people's opinions. At the end of the day, we want him happy, healthy and thriving - not in pain.

I also spoke to our GI, this morning about the vocal nodules and lymphoid hyperplasia (in the biopsied nasal tissue) --- he said both are likely due to GERD. I feel like reflux is out biggest enemy yet. I am ready to win the battle. We follow-up with GI on November 11 --- more to come then :)

Inside of...

... less than two weeks...

Mr. Brice has endured the following:

four IV's
two OR visits
two intubations/extubations for anesthesia

two ER visits

two bouts with dehydration
several bags of fluid

one colonoscopy

one upper endoscopy

one tonsillectomy

one adenoidectomy

one nasal endoscopy

one bronchoscopy

one laryngoscopy

lots of Zofran, Motrin and pain meds

and even more love, hugs, kisses and snuggles

On Thursday, October 13, Brice had the colonscopy & upper endoscopy (with a duodenal aspirate). His GI scheduled these procedures because of some belly/poop issues involving blood. Thankfully, upon visual (endoscopic) evaluation, everything looks as it should. We will have the biopsy and aspirate results back on Monday. Everything seemed okay. We took him to Chick Fil A for lunch and Target for a new toy. He played with Pierce and even went to his cousin's 7th birthday party. And then 8:30pm hit and HOLY PUKEFEST FOLKS... always a joy having lots of vomit, the consistency of pudding, on your shoulder, down your shirt, into your bra... lovely, just lovely (and yes, you can thank me later for that stomach-turning visual... and thank me even more for not giving you a far worse visual). And he continued to vomit until the poor kid was vomiting bile... 8 times inside of 2 hours. I took him into the ER. They ran bloodwork, started an IV, took an abdominal x-ray and administered Zofran (I swear, this drug is like a miracle worker - maybe I should write their manufacturer a letter - it's saved my life more times than I can think of... well maybe not my life, because that seems a tad extreme, but my sanity). His bloodwork showed dehydration and the x-ray was consistent with a person having a colonoscopy (not sure what that means). The doctors concurred (ER and GI on call) that the vomiting was likely due to the procedures.... or so we thought...

On Saturday, we took the boys to the pumpkin patch at Brice's school. Instead of carving their pumpkins, we decided they could paint them. So imagine this... we're en route to Target... to purchase said paint... Pierce starts coughing... I ask if my little buddy is okay... he looks confused... and then it happens... PROJECTILE VOMIT... undigested hotdog chunks and all (oh yes, people, you're getting another visual because I had the pleasure of cleaning it up... you're welcome). We went to a Halloween party at our neighbor's home... and Pierce puked again... the next morning, he puked again... all over the couch. Seriously, I don't know if I've ever experienced that much vomit in my life - and I've experienced a lot from other people (hey, it was our younger 20s - no kids, lots of time to experience all that NOLA has to offer). But I digress... obviously, a virus thought out home was a lovely place to visit.

And then Monday happened... that evening the virus decided to slam both George & I straight into the floor. I thought there was some unwritten rule somewhere that both parents could never, should never, ever be sick simultaneously... our ship was slowly sinking... it was a rough 24 hours. [total side note: George puked in the kitchen sink - no worries it's stainless and I scrubbed it - but the noise that it made scared the bejeezum out of Pierce - there I sat, on the couch, with one screaming kid, the other one crying, trying my hardest not to puke myself... oh the memories]

Fast forward a couple days... Wednesday, October 19, Brice had the T&A and other scopes. The doctor took a nasal biopsy to look at the cilia (for a few reasons - will discuss once we get results). His adenoids were VERY bumpy/rocky looking - consistent with being chronically infected/inflammed. He has bilateral nodules on his larynx and a broken blood vessel. The nodules are a tad confusing because those usually are a result of chronic vocal abuse. ENT told us to mention it to ST but even she was confused by it - especially since he doesn't have a raspy/hoarse voice (common with nodules).

Of course, in true Brice fashion, he wouldn't take his pain medicine by mouth. The (less than brilliant) recovery nurse suggested that he take a 30-45 minute nap and then maybe he would be willing... ummm no. I should have asked where I could send her a thank you note. Because of that and us having to wait 45ish minutes for an IV dose of morphine, the poor kid's pain was out of control. The morphine dose had NO effect on him. We had to hold him down and try to force his other pain med down orally. He slept on and off for hours... refused to eat or drink. At 3:30pm, our nurse said that if he didn't turn the corner within the hour, he would be moved to the floor because the short stay unit closed at 6pm. George and I took Brice on a walk and made a game out of drinking (you have to take a sip when we reach the window/door/hallway)... and it worked! He consumed 4oz of apple juice and 2 oz of ice cream - we were discharged exactly one hour later!! Brice did very well Wednesday evening - he tried to eat a mini powdered donut and a piece of pizza. Thursday was a decent day until 3pm. Friday morning, we thought we were going to have to head back to the hospital. My older sister saved the day with a smoothie - I was able to sneak his meds into the smoothie and life seemed okay. Saturday was MISERABLE - we reluctantly landed in the ER around 2:30pm.

When the nurse was doing his IV, she mentioned that with the way he presented and the fact that he was post-op, he was going to be admitted. The doctor was FABULOUS and it didn't hurt that she was the momma of a redhead - she could totally commiserate with the strong will they have! He was given a bolus, steroids, morphine and then they started a dextrose drip. He had a small bout with vomiting (well it came up and he forced it back down) so they give him some Zofran. Around 6pm, she and I discussed our options... 1) she could admit him or 2) we could stay another hour for a little more in fluids and another morphine dose. We decided to go with option 2 because it's always much nicer to sleep in your own bed on your own couch.

Today was another rough day... no medicine and nothing by mouth. We told him that we would go to Chuck E Cheese if he would drink something (you know we were desperate!). We bought him a special cup while there and he took a few sips. When we got home, he drank a small bit more - maybe a total of 2 ounces. Around 5pm, we were preparing to head back into the ER and this time, knowingly, to be admitted. But somehow, I was FINALLY able to convince him to drink something... and he took in 6 ounces!! He still isn't eating and as I type this, he no longer wants to drink, but hey, we're seeing minor progress. Hopefully it continues!