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More often than not, we call them autistic as “may sariling mundo” (confined in their own world). But unknown to us, there is a lot that is going on inside their brain that makes them behave as such…

Carly(photo courtesy of http://www.allmyfaves.com/blog/video/carlys-cafe-amazing-story-of-one-girls-triumph-over-autism/)

I have come across this video about an autistic child who was able to breakthrough from her body and is now able to express intelligently what transpires within her body. Those we perceive as hurtful purposeless flinging of extremities, banging of the head to the floor or wall, apparently has an explanation…

“You dont know what it feels like to be me, when you can’t sit still because your legs feel like they are on fire or it feels like a hundred ants are crawling up your arms. People look at me and assume I am dumb, because I can’t talk. It’s hard to be autistic because no one understands me. What do I want? I want to be like every other kid. But I cant. Because I am Carly.

I am autistic, but that’s not who I am. Take time to know me, before you judge me. I am cute, funny and like to have fun. I think people get a lot of information from so-called experts, but if a horse is sick, you don’t ask a fish what is wrong with the horse. You go right to the horse’s mouth.”

When asked why she bangs her head to the floor, she said: Because if I don’t, I feel like my body is going to explode. It’s just like when you shake a can of coke. If I could stop it I would, but it is not like turning a switch off. I know what is right and wrong but it’s like I have a fight with my brain over it.”

“I want to be able to go to school like normal kids, but not have them getting upset, or scared if I hit a table or scream. I want something that will put off the fire.”

“I want people to know that no one is telling me what to say and I don’t have a hand at my butt like a puppet.”

Therapist asks her, Carly, why do autistic kids cover their ears, flap their hands, hum and rock?

Carly replied: “It’s a way for us to drown out all sensory input that over loads us all at once. We create output to block input.”

“Doctors would tell … that we have a hard time processing information. It’s not really true, our brains are wired differently. We take in many sounds and conversations all at once. I take over a thousand pictures of a person’s face when I look at them. That’s why we have a hard time looking at people.”

“Dear Dad, I love when you read to me. And I love that you believe in me. I know I am not the easiest kid in the world… Father, you are always there for me holding my hand and picking me up. I love you.”

“I think the only thing I can say is don’t give up. Your inner voice will find its way out. Mine did.

Carly, you truly are inspiring. Your voice was very significant in helping me change my perceptions of how autistics behave, what autistics are having in their brains. Now, I would say you’re not confined in your own world. You just have a lot of stimulation that makes you counteract it by those pervasive movements. Now I know why… Thank you Carly.

Carly: Autistic, Intelligent

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Posted by on April 23, 2013 in Uncategorized

 

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Aside

PHILIPPINE POLITICS DICK-SHUNARI

sotto (a) verb – copying one’s work and claim it as your own. (synonym: plagiarize); (b) noun, the act of crying on national television to claim a son died because of wife’s intake of contraceptive pills that came out to the public 3 years after the death of the son; (c) noun – a person who claims he was sent by God and whose mission in life is to oppose passage of reproductive health and responsible parenthood bill into law (synonym: bigot)

mitos magsawsaw (a) verb – the act of commenting on all administration-related issues; (b) noun – the state of denying once a close ally in order to advance own personal agenda (eg, “I am not close with GMA… we only see each other during house sessions”); (c) adjective – an attempt to sell yourself as feisty, fearless, ready to fight anyone. in other words, mongrel; (d) the act of claiming you follow the administration’s tuwid na daan but back lashes after being categorically denied of joining the administration bandwagon

enrile (a) noun, the act of claiming your ambush was staged to support passage of a martial law but in later life deny it in your memoir

lacson (a) noun – male with a macho first name but adapts a sissy nickname and categorically denies he is gay… and will never be gay; (b) adjective – a policeman who is cleared after being embroiled in rubout and deaths of people of influence

arroyo – (a) adjective, the butt of all misfortunes that beset’s a country; (b) noun – a petite woman who claims she will not run for election after unseating a popular president but still runs and wins through cheating; (c) noun – the original “amalayer”

dick (a) verb – to stand erect when stimulated…. by calamities, head a national organization, mobilize people and later on use this as a propaganda to woe votes during a national election; (b) noun – a tool used to penetrate an imperforate anus… just so your campaign slogan would rhyme

noynoy (a) noun – a balding head of the state; (b) verb – to delegate a task to your subordinates and take all the blame if they did not deliver; (c) adjective – someone who blames his fault to a predecessor, including the arrest and crucifixion of Jesus (via @hecklerforever)

miriam (a) noun – a person who asks God for a second life to be able to investigate erring public officials, including God; (b) noun – a person accused of using public funds to buy grocery, pay salary of maids and pay rent to own building

chiz (a) noun – an arrogant, alcoholic man who sprawls on his girlfriend’s house’s sofa; (b) adjective – an ambitious man who asks for a campaign fund but denies he needs a haciendero to be able to pursue a presidential campaign; (c) noun – a person who uses neuroleptic, hypnotic technique when talking in front of the press to captivate an audience; (d) adverb – talking in verbally-rich sentences that only translate to two to three English words after each sentences

llasos (a) adjective – a person who is gay but deprives himself of sexual gratification because of vow of purity and celibacy… ahhhhhh shet! adu la amin!

rh bill (a) noun – the reason for all the calamities in a Catholic country. (antonym – wrath of God)

nancy (a) noun – any person who served as an executive assistant of a parent that becomes instantly qualified for a senatorial seat

jamby (a) noun – a person who offers a contest with luxurious prizes (eg, ipad) to woe votes; (b) noun – someone who claims to be pro-poor but doesn’t know the prize of the food poor people eats

sonny (a) adjective – gwapo. ’nuff said. (hahaha bias… e definition ko to no, may angal?)

eric (a) verb – to dance as a campaign for any health related programs

DAKAY: IDOL!

Fr. Dakay of Cebu criticized the new pope for taking a bus,. He said the new pope (as a cardinal in Argentina) would cook his own food or take public transport. “just because he knows how to cook doesn’t mean he has to cook his food. And I don’t think Buenos Aires will allow him to take a bus. He has a car. Moreover he added that “sobra ra sab na kaayo nga pasakyon na lang mi tanan og Ceres (bus) — (It is too much to have us ride a bus. That is no longer right.) (From philstar the freeman editorial, March 18, 2013 12:00 am.)

Nang dahil sa yo Fr Dakay, mas lalo dadami pa ang magiging Katoliko. Nice job!

Have a solemn reflections on this Holy Week. In other words, enjoy your vacation.

Follow me on Twitter: @simply_clinton

DICK-shunari, DAKAY

 
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Posted by on March 27, 2013 in Personal, Politics

 

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— Politics: Devil’s Game

Lucy Torres: “This strengthens my resolve to continue to fight, ganito talaga ang pulitika. Laro ng demonyo,”

Taning: hiyang hiya naman ako sa yo oy! Nananahimik ako dito, bakit na naman ako nadamay, porke nadethrone ka lang. E di ba champion ka?

— Collateral Damage

Magulang ni Heart Evangelista, pinakiusapan si Chiz, live on TV, na makipag cool-off sa anak.

Chiz Escudero: “Hindi ako showbiz indi ko pinagsasama at di ko pinaghahalo ang trabaho ko sa personal kong buhay at lalong hindi ko po pinapayagan na manghimasok ang personal kong buhay sa aking trabaho.”

Chiz Escudero, pinakiusapan ng mga Ongpauco na lubayan na si Heart Evangelista. Hiyang hiya naman kami sa standards nyo.

Halla! 28 na yang anak nyo, di pa ba nagme-mens at pinanghihimasukan ang love life? Pang-ilang relasyon na niya ang pinakialaman nyo? Mamaya, mag-faint ulit siya dahil sa makapal na usok. Charot!

— Award Winning

Eddie Garcia, hinirang na “People’s Choice Favorite Actor” (sa pelikulang Bwakaw) nitong nakaraang 7th Asian Film Awards sa Hongkong.

Samantala, si Nora Aunor naman ang nag-uwi ng Best Actress trophy para sa movie na Thy Womb.

Bravo!

— Ambush

Reliable source: Convoy of Jack Enrile in Nabunturan, Compostela Valley were fired at in Mawab, Davao Oriental | via @marizumali

Karamihan sa nagrereact, sinasabing peke ang ambush; like father, like son. (Me: Kawawa ka naman, di ka na pinaniniwalaan ng tao, kahit pa siguro totoo.)

Kris Files TPO vs James Yap

Kris Aquino, nagfile ng TPO laban kay James Yap dahil umano sa isidenteng nangyari sa bahay ni Kris noong Disyembre. Ayon sa reklamo ni Kris, umano ay gustong makatikim ng “human rights” aka “marital obligation” ni James kaso nabigo siya, dahilan na siya’y makapagbitaw ng mga salitang hindi katanggap-tanggap. Nakita raw ng kanilang anak ang pangyayaring ito at at pilit pinapaalis ang ama.

James Yap, pinabulaanan ang akusasyon ni Kris. Gusto lang daw niyang halikan siya ng bata bago umalis pero pag hindi niya ginawa, si Kris ang hahalikan niya. Noong umayaw si Bimby, saka niya nilapitan at tinangkang halikan si Bimby.

Chopsuey 2: Politics, Showbiz

 
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Posted by on March 19, 2013 in Personal, Politics, Showbiz

 
Aside

I got an interesting referral from one hospital. It is not really that difficult of a case but it is quite puzzling for the untrained ones, nevertheless interesting.

The mothers’s history is generally unremarkable. She only had some flu-like symptoms during the last trimester of the pregnancy. There was no history of hypertension nor diabetes. Mother’s prenatal visits were timely and regular as this is very much wanted pregnancy. Generally, she never had symptoms. She came to the hospital in labor. She had an ultrasound which stated that the baby is in fine condition, there was adequate fluid. About 12 hours into delivery the bag of waters ruptured. The mom recalled that she noted the fluid to be yellow-stained (normally it should be clear). There was no foul odor.

She gave birth by normal vaginal delivery. The baby was not that big, weighing only 2.6 kgs. There was no difficulty during baby’s delivery. There was no cord loop around the neck (that may have strangulated the baby). The fluid was viscid, thickly saturated with meconium (baby’s first stool). Few minutes thereafter, the baby began to have respiratory distress requiring oxygen support.

Baby had an xray of the chest revealing pneumonia. He was then started on empiric broad spectrum antibiotics. Baby was nursing well from the mother while on oxygen supplementation. There was no progression of the respiratory distress. Despite requirement for oxygen, baby remained comfortable. On the 5th day of life, baby still cant be weaned off from oxygen, breathing was still fast although comfortable. Repeat xray of the chest revealed significant clearing of the pulmonary infiltrates initially seen on the previous xray. An arterial blood gas analysis was done but it was unremarkable. So why then is the baby requiring oxygen despite the comfortable breathing, normal blood gas analysis and clearing of xray picture?

The baby was then referred to me at this time. At first I went with the line of unresolved infection so I suggested shifting of antibiotics as well as determination of c-reactive protein (an indicator of inflammation – often due to infection, that may as well be used to monitor response to treatment).

The CRP was reactive, meaning it indicated presence of an ongoing inflammation/infection, but the value was not congruent with the distress of the baby. So I tried to play along with some of the facts that the baby presented. First, baby was born throught thickly meconium stained amniotic fluid. Second, the baby’s initial xray findings highly suggested pneumonia. Third, the baby remained oxygen dependent despite ample time for antibiotics to have worked, granting this was supposed to be an isolated pneumonia. Fourth, despite improvement of x-ray picture, the baby remained, clinically, unimproved; was still dependent on oxygen support.

With these, I came to rationalize that baby might be having meconium aspiration pneumonia (MAP). (While meconium is supposed to be sterile , meaning it is free of bacteria, antibiotics was a rational modality of treatment as CRP was reactive). But on top of the MAP, I considered that baby might be experiencing as well a complication.

I then requested to obtain blood gas analysis from the right and the left arms, with emphasis on the pulmonary oxygen between the two sites.

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The aorta, the main vessel that arises from the left ventricle (red vessel creating a loop on the above illustration) gives rise to three large vessels that supply the upper part of the human body. The first branch immediately divides into two, one serving as right subclavian artery (that which supplies our right arm) and right carotid artery (that branch supplying to the blood). The second main branch becomes the left carotid artery which also supply our head on the left side whereas the third main branch is the left subclavian artery which supplies our left arm.

There usually is a ductus arteriosus that exists in the fetus and closes permanently about 10 days after the baby is born. It usually arises after the right subclavian and carotid arteries, and before the left subclavian artery. Thus, by origin, the right subclavian artery is usually termed preductal while the left subclavian artery may be, most often, post-ductal. Since preductal vessels include those vessels that send blood supply to the brain, it is also then safe to assume that preductal blood picture also reflects the same blood picture that goes to the brain.

In cases of pathology when the pressure in the right side of the heart is higher than that of the left, and the ductus artery is still patent/open, the unoxygenated blood in the right side may dilute the already oxygenated blood in the left through the ductus arteriosus. In cases therefore involving increased right-sided pressure, the baby tends to be cyanotic from this explanation.

One way of determining whether there is a significant shunting from the right side to the left side via the patent ductus arteriosus is performing a 2-D echocardiography, which exactly measures the pressures between the two sides of the heart. Just compare your obtained pressure from the right side of the heart with the normal values for age and you can immediately say there is elevation of pressure, or simply put pulmonary hypertension. Another way of determination is to obtain blood gas from preductal (right arm) and post ductal (left arm, right foot, left foot) extremities. Then, compare the partial oxygen tension/pressure (pO2). A gradient between right and left of more than 20 mmHg is highly suggestive of right sided pressure, in this case, persistent pulmonary hypertension, of the newborn (also known as persistent fetal circulation).

The baby’s right arm blood pO2 was 81.7mmHg, whereas the left arm pO2 was 42.16mmHg. There was a gradient between right and left arm of 39.1mmHg, way higher than 20mmHg cut off, clearly suggesting that the baby has a pulmonary hypertension. Pulmonary hypertension usually arises when the small supposedly thin capillaries in the lungs that carry blood for oxygenation thickens. With thick pulmonary vessels, the transit of oxygen from lung alveoli to the blood vessels is rendered more difficult and hence the slow or lack of oxygenation of the blood that returns to the heart, making the baby a little bluish. And if the pulmonary hypertension is severe, this “resists” the incoming blood from the heart and is shunted directly into the aorta via the ductus arteriosus, unoxygenated, already diluting the blood that may have successfully went into the lungs for oxygenation (but not sufficiently). This can turn into vicious cycle until the baby’s demise.

In cases however of pulmonary hypertension, where the wall between the right and left atrium has a large communication known as patent foramen ovale, since at the level of atrium there is already mixing of blood between right (unoxygenated) and left (oxgenated) sides of the heart, there may not be an appreciable gradient of pO2 between preductal and postductal blood gas analyses.

Respiratory Distress?

 

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Aside

CARLY RAE JEPSEN SUPPORTS GAY RIGHTS

Carly Rae Japsen pulls out of concert for the Boy Scouts because the latter do not support gay rights. According to Perez Hilton’s blog, “Carly Rae Jepsen was set to perform at the Boy Scouts of America National Scout Jamboree concert in Mount Hope, West Virginia this summer, but considering that they’re very closed minded when it comes to gay rights — she decided to cancel her appearance.”

CRJ tweeted the following:

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“The group Train was also going to perform at the summer concert, but after Carly dropped out of the lineup, they said the hell with the Boy Scouts… unless they change their anti-gay policy.” (source: http://perezhilton.com/perezitos/2013-03-05-carly-rae-jepsen-cancels-boy-scouts-concert-because-they-dont-support-gay-rights#.UTYmFKW9alJ)

Carly Rae Jepsen Advocates Gay Rights

 
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Posted by on March 5, 2013 in LGBT Rights, Personal

 

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(Image courtesy of http://www.sciencedirect.com/science/article/pii/S0022346803008698)

During my training, I was lucky to witness a case of hydrops fetalis undergo a rare form of management done in our institution.

During the prenatal course, the obstetrician noted the baby to have hydrops fetalis. Serial ultrasound established the diagnosis and at the time the baby was nearing birth, the condition persisted.

As in my previous articles, hydrops means the generalized swelling of a fetus. The skin becomes edematous and very taut, disabling a good expansion of the chest when breathing. The pleural space, where the lungs float is also filled with fluids, compressing the lungs. So once the lungs becomes occupied by air after birth, there will be difficulty of the lungs to expand. The pericardial cavity, which the heart occupies, may also be fluid filled. Abdominal cavity may also contain fluid, termed ascites. At least 2 of these 3rd spaces must be involved before diagnosis could be entertained in an individual.

On the baby’s latest ultrasound, it was noted that the right lung has pleural effusion, the left lung was spared. In order to manage the baby optimally at birth, a pre-natal conference among all parties involved in the delivery of the baby was called – the perinatologist, neonatologist, and pediatric surgeon, to discuss how the delivery process will take place. At that time that this was done, the unang yakap was still in conception so it was not employed in this particular delivery.

The perinatologist wanted to employ EXITextrauterine intrapartum treatment. This means that the treatment will happen when the baby is out of the uterus but is still within the confines of the delivery procedure (umbilical cord remains uncut).

1.The baby was delivered via emergency section. He was brought out of the uterus, the umbilical cord still connected to the placenta.

2. The pediatric surgeon inserted a needled through the right pleural space, drained fluid as much. (The purpose of doing this is to allow maximum expansion of the lungs when it gets aerated; the fluid, if not evacuated, will limit the expansion of the lungs leading to poor tidal volume, lesser oxygenation of the blood, which will aggravate the already compromised baby).

3. Umbilical cord was then cut and baby was handed to the neonatology team.

4. Neonatologist then intubated the baby.

5. Chest x-ray was done to document the level of the tip of the endotracheal tube, check how much of the fluid was drained, and check how expanded the lung after the procedure.

In short, the procedure was successful. We were able to ventilate the baby afterwards. Baby however had other pressing problems, and as expected he when through persistent pulmonary hypertension, or persistent fetal circulation. PPHN or PFC usually results from a thickening of the walls of the arterioles/capillaries that surround the lung alveoli. Because of this thickness, oxygen travels slowly from the alveolar space into the bloodstream, thus leading to lesser oxygenation of the blood. PPHN can be primary (no identifiable cause) or secondary (a result or effect of another primary disorder). In this case, if the baby, who has hydrops fetalis, also has PPHN, it would only mean than the hydrops was a chronic disorder that it has affected the development of the lung tissue and vessels. If the PPHN was primary, then the arterioles and capillaries are thick to begin with, and there’s no way to reverse this anymore. If it is secondary, it means that the arterioles or capillaries have thinned out for postnatal life but then became thicker as a response to/result of an insult/injury. Despite proper ventilation and support given to the baby, he succumbed to PPHN after several days.

EXIT…?

 

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Aside

I was again given the opportunity to deal with a very interesting, intriguing, puzzling case in my career as a neonatologist.

I was called for the delivery of a baby presenting with hydrops as seen during prenatal ultrasound. (Hydrops refer to the generalized swelling of the baby, and is defined as the presence of fluid accumulation in third spaces including pleural, peritoneal, pericardial spaces, edema of the skin, as well as swelling/thickening of the placenta). Accordingly, the ultrasound detected fluid in the abdominal cavity and testicular sacs, but none wheresoever. The consideration of hydrops is dubious but still it was highly considered. I called on the different personnel who will be involved in the baby’s care later on. Meanwhile, the obstetrician has already spoken to the mother (the husband is overseas) and explained the possible outcome of the baby’s birth. (Hydrops usually is dreadful, some expire within an hour). They were preparing that the baby might indeed expire immediately after birth.

Upon baby’s birth, we noted that the abdomen was distended, scrotum was bulging, as big as an apple. The skin was not edematous however. It seems that baby did not satisfy the criteria for hydrops. Baby had a weak breath, thus I had to intubate him. In less than an hour, I took an x-ray to confirm presence of fluid in other body cavities. Liver was palpable on examination (though it may be normally appreciated about 2 finger-breadth below the right subcostal margin, baby’s liver was about 4 finger-breadth palpable); there was also a soft mass I palpated at the right side, seemingly an enlarged spleen. Pleural space (where lungs are) is free of fluid. This at least ensures that baby’s breathing would not be difficult, unlike when there’s pleural effusion (fluid in the pleural space), the fluid will prevent full expansion of the lungs with every breath, letting to less oxgenation of the blood, which will make the heart work double time. There was a single bubble (signifying air entry into the stomach), but none for the rest. This is understandable as the x-ray was obtained just minutes after birth. It will takes hours before the air swallowed will pass into intestines, then about 24 hours until the air passes out of the anus.

I requested for ultrasound to see what in the abdomen is causing this disorder in him. But to my and the sonologist’s surprise, we saw nothing but a large liver. There was no tumor, the intestines were being pushed down though, ebbing and bobbing into the scrotal sac. The mass I palpated indeed was the spleen. But these don’t seem explain why there is fluid in the abdomen, and the scrotal sac enlarged, as seen in the prenatal ultrasound. With a liver enlarged, I tried to work up the baby along that line. I tested for blood samples reflecting liver functions, decided to repeat the x-ray of the chest and abdomen 6 hours after birth, this will give ample time for air to pass through to the rest of the intestines distal to the stomach.

Repeat chest and abdominal x-ray showed passage of gas into the distal intestine. This can eliminate pyloric stenosis (part of the stomach before duodenum) as a possible entity. Albumin was low, so I corrected.

But this wasn’t of a significant help. It won’t still explain why there was herniation of intestines into the scrotal sac, nor the large liver. It may explain the fluid accumulation, but that’s just it. I was at a loss. I was at a loss what next step to take. There were no other organ systems showing abnormalities, which might suggest a syndrome. It was a clear cut gastrointestinal system derangement. I didn’t shame to call on a gastroenterologist to help me solve this puzzle. I didn’t want to miss a thing for the sake of the baby, who I am being asked to do everything possible to make him survive. (A herculean request).

The gastroenterolist also seemed puzzled by the baby’s case. A toss between malignancy and… it was hard to come up with differential diagnoses… On baby’s second day of life, his abdominal girth dramatically increased, but remained soft. There was feces meconium coming out of the baby’s anus, though the color was like that of a caramel; there was no vomiting. This tells you that there seems no obstruction of the intestinal tract. But we wanted to sieve and scan through and don’t want to miss anything. Even if it was initially mentioned that CT scan might not be of help, we still did it. Surprisingly, the CT scan of the abdomen revealed only a large pneumoperitoneum (air inside abdominal cavity, but outside the intestines – which should never happen in a normal individual), fluid accumulation, but nothing more. This then puzzled me all the more; air can only escape into the abdominal cavity if there is a perforation along the intestinal tract. I then referred the baby to a pediatric surgeon, who scheduled baby for an emergency explore laparotomy.

At the operating room, the stomach, duodenum and jejunum were intact. At the middle of ileum however, there was a perforation, and an atresia (obstruction due to non-recanalization of the intestinal cavity during the development). The atretic portion, together with the perforated segment was then excised, washing and evacuation of the spilled fluid and meconium into the abdominal cavity and creation of ileostomy were done. We marveled at the actual operative findings in this baby because we never expected it to be so. Gladly, it wasn’t a cancer or a tumor. So, in retrospect, the perforation occured even before the baby was born. The reason and when it happened, we dont know. This lead to leakage of fluid and meconium into the abdominal cavity that incited reaction from nearby organs, including the liver which became enlarged. There were adhesions also of the intestines due to inflammatory reaction to the meconium that was spilled. The liver then produced low albumin as well that lead to the edema formation.

Baby did well during the operation. No untoward complications took place. We will have to play close attention to the function of the intestines as we have yet to commence feeding.

———-

One week after the discharge, he came back for his return visit to the office. I was surprised upon seeing him. He was so malnourished, his skin was wrinkled and he looked severely dehydrated. In the medical parlance, that is a condition we refer to as “failure to thrive.” Painful as it may be, I had to admit baby again, to “rehabilitate” him from his dreadful status. It seemed that while on ileostomy, most of the milk he has been taking was not absorbed. Instead, he was dumping them and thus the resultant situation. (This is a condition known as short bowel syndrome).

I referred him back to the surgeon for further management. Finally, we agreed to have baby operated on again, to reunite the intestinal segments that were disconnected before to create an ileostomy. After preparing baby for the said procedure, the operation was finally carried out. It took about 72 hours when we noted that baby has patent intestinal segments, he was having regular passage of stools, hence we started feeding baby, initially minimally, then gradually increasing. After he was able to achieve his full enteral feeds, the venous line was discontinued. We even documented this by doing a fluoroscopy, to really check if the intestines are patent. And yes, the dye passed through without impediment through the intestines, no retention whatsoever. This made us then confident that baby’s problem has been resolved. So, for the remaining days of baby in the hospital, he was being fed, he was moving his bowels regularly, his weight noted to be increasing daily. And we were happy to send him home.

He was asked again for follow-up return after a week. And again, baby surprised me. His abdomen was now bloated like a balloon. Again, this puzzled us once more. He seemed to be having Hirschsprung’s disease and this just contradicts how he behaved during the last hospital stay. Well, we had to abide by the baby’s presentation. The surgeon again created an ileostomy, repeated fluoroscopy and obtained biopsy specimen. Then baby was back to his problem of short bowel syndrome. It was not a challenge how to resolve this but with the help of gastroenterologist, we were able to minimize him dumping watery stool. Baby was discharged once more with confidence that his problem has been resolved. Our aim then is to nutritionally build baby and then when bigger enough, will do the corrective surgery.

For now, baby is stable, with a slow weight gain… I really hope it works this time so baby will recover fully before his next surgery.

A Puzzling Abdomen

 
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Posted by on September 7, 2012 in Congenital Anomalies, neonates

 

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