Just me and my pylorus

Well, we never expected that we would be celebrating Ada's three week birthday at Children's Hospital. In order to share the details of this week's events, both David and I have written our thoughts below.

A: At the beginning her third week, Ada started to projectile vomit. At first it was once a day and we figured it was just an exaggerated bought of spitting up, but then it became twice a day, and by the weekend she was projectile vomiting after most meals. Concerned for her health (and my ability to launder as quickly as needed to replenish clothing soaked in milk), we called the doctor who set up an appointment first thing on Monday morning. When we arrived, he confirmed his phone diagnosis that Ada either had a spectacularly bad case of reflux or she had something called pyloric stenosis, a condition of the valve leading from the stomach to the intestines, which would necesitate surgery. I already felt frazzled by my inability to feed my daughter. I felt helpless to make her better, to nurish her, to get her through her boughts of violent vomiting which would often choke her. As you can imagine, the mention of potential surgery was enough to unglue me. So while I cried, David went online and found out as much as he could about both conditions and the doctor scheduled us for an ultrasound the next day (Tuesday). While we waited, we weighed the possibility of her having each condition, and since she had symptoms of both, it was difficult to convince ourselves that it was one thing or another. For me, it was also hard to decide which condition I hoped that she would have. While surgery was a frightening prospect, the thought of coping with reflux that caused projectile vomiting for an undertermined amount of time was also unpleasant. I chose to not hope for either diagnosis but rather to hope that Ada's condtion would simply soon improve.
D: I'm no physician, but I didn't expect a diagnosis of pyloric stenosis. See: http://en.wikipedia.org/wiki/Pyloric_stenosis
From what I can tell a typical pyloric baby has the following profile:

• male
• first born (at a 4:1 ratio compared to siblings)
• Jewish ancestry
• relative who has also had pyloric stenosis

Ada had none of these risk factors. Oh, and about 1/300 infants are diagnosed with pyloric stenosis compared to 1/3 for acid reflux. Suffice it say I wouldn't have bet the house on Ada having this abnormality.

A: On Tuesday morning we took Ada to Children's Hospital for an ultrasound. Within 3 minutes of the tech taking Ada's ultrasound results to the radiologist, we had a diagnosis: pyloric stenosis (for more info see http://www.eapsa.org/parents/resources/pyloric.cfm). Ada was immediately admitted to the hospital and scheduled for surgery that day. Once we were admitted, we were taken to her room, and she was given an IV to begin hydrating her and to replace lost electrolytes. It took until late in the afternoon before she was hydrated enough for surgery. We expected it would be 8 or 9 before they would take her into surgery, so around 4:30 David headed home to collect some things that we would need for our stay. About a half hour after David headed out into the rainy rush hour traffic (if you have ever driven in Columbus, you know that rain somehow mysteriously incapacitates drivers from having any semblance of an ability to drive, so there were many accidents to navigate around) the nurse came in and told me they would soon be taking Ada to surgery. I called David to let him know that the time frame had changed, but I was not able to reach him. I figured it was better that way, as he would just be worried and agitated knowing that he was missing her going to surgery, and at that point, there was nothing that either of us could do about it. I had very much wanted to have David there because to prepare her for surgery they had to insert a tube in her nose and run it into her stomach. The tube is then attached to a syringe so they can remove the contents of her stomach. I did not initially want to watch this, but realizing that David wouldn't be there with her, I decided to stay because I did not want to leave her alone. A few minutes later, they came to take us to surgery. I got to carry her down and wait with her until it was time for her operation. I also got to meet the anesthesiologist and the surgeon. Ada, at this point, was starving (she had not been allowed to eat since 5 that morning and it was now 7 pm...and if you know how this child likes to nurse, you can imagine how upsetting this was to her), pissed off about that damned tube in her nose, and fed up with everyone poking a prodding her. She screamed the entire time, loud enough and long enough to nearly tear out my heart. The surgical nurses had an unearthly calm about them considering this screaming baby. But I suppose that's par for the course at Children's. In hindsight I see how much I was relying on their calm to keep me composed for Ada.
D: One of the main reasons I headed home was to grab our cell phone chargers. This is Murpy's Law applied to cell phones - your battery will fail when you 3 week old daughter goes into surgery ahead of schedule. Many thanks to Alladin's restaurant in Clintonville for letting me change my phone and babble about the situation while I waited for our food.

A: After they took Ada to surgery, I was escorted to a waiting room to, well, wait. Ada was given a patient number that was posted on a screen not unlike a departure/arrival screen at an airport. Depending on the color that her number was highlighted you could use a color key to determine where she was: Pre-op, in the OR, in recovery, returned to her room. It seemed like such a logical, practical way to communicate about such an emotionally charged and frightening situation. Yet again, as I reflect upon the situation, I see that Children's knew what they were doing by employing such a simple, efficient system at an otherwise chaotic time.

A: David soon joined me and we waited together for the surgeon to talk to us. Less than an hour after arriving in the waiting room, Dr. Kenney arrived and informed us that Ada was fine. She would be returning to our room in an hour. I was so relieved there were no complications, no accidents, no issues. The hunger that my anxiety had been supressing returned and we headed back to Ada's room to eat before she was returned to us.
D: Never has an anesthesiologist's salary seemed so justified - or a surgeon's for that matter. But somehow I wasn't all that worried about the surgery per se (which is a 15 minute long procedure) but the idea of an infant under general anesthesia provided me with plenty to try to avoid thinking about. Note by the way, that a 15 minute procedure doesn't account for the hour of prep and hour of post-op observation. That was a hell of a wait.

A: And then she arrived, our perfect little daughter. I didn't want to let her go.
D: I think the photo says it all.
A: We were told not to bounce or rock her for several days in order to allow her abdomen to heal. Though the surgery was done laproscopically, she would still be sore. We both took turns holding her as she slept. We had three hours before we could begin feeding her, first with Pedialyte (like Gatorade for babies) and then working our way to short bursts of nursing, gradually increasing the time until we got back to normal. Here she accepts a pacifier from Daddy, which she would not do before our trip to the hospital and she has not done since returning home.
D: Note: the pacifier was dipped in a sucrose solution. That makes difference. Oh, and if it looks like I'm sleeping here - I probably was. This was a long, long night.

A: Ada snoozes while displaying her IV line.

A: You wouldn't think that this picture was taken in the hospital. She looked very healthy the next day.

A: Ada in her hospital bed.

A: Ada's surgery was done through her belly button and through two small incisions in her abdomen. One of them can be seen just below my fingers in this picture, looking like a supernumary nipple. It's really two stitches covered with surgical glue. No bruising, no swelling. If you aren't squeamish, you can see a video of the procedure here: http://www.eapsa.org/parents/resources/pyloric.cfm.

A: Now we're home and very thankful to be so. There is very little sleep to be had at the hospital with nurses interrupting on the hour. We have slept well for the past two nights. Ada's first day home was a bit rough with two episodes of vomiting. The doctor said that this could happen as her stomach is still sensitive. But today, her second day, went much better. She spent the first part of her day sleepy and the second half of her day starving, all good signs that her body is doing what it needs to heal. She nursed on and off from 5:30 until 10:00 this evening, leaving me sore and without milk. Fortunately I was able to pump a lot of milk at the hospital, so David was able to finally get her to sleep with a bottle. And that's where we are right now: tired, full of good food, and happy to be home.