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 :)