The past couple of days have been quite a whirlwind. I mentioned previously that, for several weeks, we have been concerned about Iver's frequency and volume of vomiting. I know that all babies have reflux to some degree and do spit up (sometimes large-seeming volumes) after feeds, but I was finding myself and Iver covered in non-bilious stomach contents multiple times per day, requiring exhausting amounts of outfit changes, burp cloth-toting (we got to holding two at all times when holding Iver after feeds), and laundry. He otherwise seemed like a healthy, well-hydrated little boy who was still producing tears, wet diapers, and stools (and who did not have an appreciable palpable olive-shaped mass in the abdomen [yes, we both had palpated for this!]), and we were really trying not to be those over-anxious doctor-parents. However, the episodes had seemed to get progressively worse over the past few weeks and when the voluminous projectile vomit woke us up from sleep Saturday, a full three hours after Iver had eaten, and continued for several hours, leaving me sobbing at not knowing how to help my child, we knew we needed to get things checked out.
On Monday at the office, his weight was only 9 pounds (repeated at my request), which was only 12 ounces more than his weight about 19 days previously at his two-week check (most newborns gain about 1 oz per day), despite him being an extremely vigorous feeder and despite an ample breastmilk supply. We got some Zantac (antacid) and hoped it was just a bad case of GERD, but we took him to the hospital to have the abdominal ultrasound first thing in the morning on Tuesday, which confirmed that our little baby had pyloric stenosis.
Pyloric stenosis, as many of our medical friends know, is a very rare (1-2/1000) condition where the outlet of the stomach into the duodenum or first part of the small intestine is hypertrophied and which prevents stomach contents from passing through comfortably. Its etiology is multifactorial but it can run in families and presents at ages 2-6 weeks. It tends to affect firstborn males and is more common in Caucasian babies than in Asians or mixed-race couples which we obviously are. The symptoms fit our little boy perfectly, but the risk factors didn't really... which goes to show that, as we know in medicine, zebras (those less-common-than-horses diagnoses) can exist.
I was very emotional when learning that our little boy was "failing to thrive" (while surprising, it was also not that surprising given how much fluid we saw come out of him) and felt that my heart was breaking when the ultrasound tech (and our friend Natalia, the radiologist, who incredibly generously came in on her day off to review the pictures) told me flat-out and real-time that the pictures confirmed the diagnosis, as I knew that our little five-week-old baby would need urgent surgery. It's incredible how much one can love and want to protect your child, when once I doubted my "maternal" instincts.
However, I was also at peace knowing that this condition is easily fixed with surgery, and really has no long-lasting consequences or other medical associations. We are so thankful that everything happened so quickly, it definitely being a perk that K and I are both physicians in this area. We were initially under the impression that we may have to travel to the Bay Area or Sacramento for the surgery given our rural area without true pediatric specialists and anesthesia providers who feel comfortable putting young children to sleep; however, after a few phone calls, we learned that the semi-retired surgeon in Eureka who was on call was willing to and did recruit two anesthesiologists to be able to do Iver's surgery the same day.
We checked into St. Joseph's Hospital's NICU early afternoon, with surgery planned for early evening. The IV start was a bit rough on our little one, who was already fussy and starving, being kept NPO (nothing by mouth) in preparation for abdominal surgery, which (not being able to comfort/feed your hungry baby!) I think was the hardest part about this whole ordeal. However, Iver did get some solace from being cuddled, and also from his wubbanub (pacifier-attached-to-a-stuffed-monkey) on which he sucked with all his might (hoping milk would eventually emerge) and which he clutched (see all the pictures) until it was time to go to the pre-op area.
The surgery lasted about an hour including anesthesia induction and extubation, which took a bit longer than expected per (one of) the anesthesiologists(s) as they were cautious given Iver's young age. Nevertheless, everything went well and our little guy was alert (and still hungry) soon after. His little drowsy, hoarse cry was the most adorable yet heartbreaking thing ever. Back into his mouth went the pacifer, the closest thing we had to the prohibited breast or milk!
While the surgery (pyloromyotomy) can be done laparoscopically, it's apparently generally just as easy to do it with an open approach, and Iver has about a 4 cm sutured horizontal scar on his abdomen which should heal really well. He didn't even seem to be in much pain post-op, getting just one dose of rectal tylenol before leaving the O.R.!
He was able to start gentle (1 oz) of pedialyte orally about 6 hours post-op, and he tolerated expressed breast milk this morning and nursed mid-morning. Between the monitors beeping, the nurses taking vitals, my pumping, his whimpering, and my wanting to hold him constantly, he and I didn't get much sleep last night in the NICU, but sleep is not at all important in the context of everything that our little one went through. Amazingly, we were able to be discharged around midday today and headed home.
While babies with pyloric stenosis can still have some spit-up and vomiting episodes post-surgery, they should decrease in the next week. We are are so excited to be able to feed on demand without fearing all of it may come right back up without holding him upright for hours, and without fearing he will drown in his own vomit. Less laundry will be a perk, too, but we are just happy for a healthy baby boy who, with hope, will now gain weight well, smile more, enjoy tummy time, and otherwise thrive! We are so thankful for the care of our doctors and nurses, and for all the prayers and messages of support we have gotten from friends and family! We are very blessed.
And, in case you haven't seen enough pictures of our handsome boy, here are a few more:
Man, how I love this little guy.
On Monday at the office, his weight was only 9 pounds (repeated at my request), which was only 12 ounces more than his weight about 19 days previously at his two-week check (most newborns gain about 1 oz per day), despite him being an extremely vigorous feeder and despite an ample breastmilk supply. We got some Zantac (antacid) and hoped it was just a bad case of GERD, but we took him to the hospital to have the abdominal ultrasound first thing in the morning on Tuesday, which confirmed that our little baby had pyloric stenosis.
Pyloric stenosis, as many of our medical friends know, is a very rare (1-2/1000) condition where the outlet of the stomach into the duodenum or first part of the small intestine is hypertrophied and which prevents stomach contents from passing through comfortably. Its etiology is multifactorial but it can run in families and presents at ages 2-6 weeks. It tends to affect firstborn males and is more common in Caucasian babies than in Asians or mixed-race couples which we obviously are. The symptoms fit our little boy perfectly, but the risk factors didn't really... which goes to show that, as we know in medicine, zebras (those less-common-than-horses diagnoses) can exist.
I was very emotional when learning that our little boy was "failing to thrive" (while surprising, it was also not that surprising given how much fluid we saw come out of him) and felt that my heart was breaking when the ultrasound tech (and our friend Natalia, the radiologist, who incredibly generously came in on her day off to review the pictures) told me flat-out and real-time that the pictures confirmed the diagnosis, as I knew that our little five-week-old baby would need urgent surgery. It's incredible how much one can love and want to protect your child, when once I doubted my "maternal" instincts.
However, I was also at peace knowing that this condition is easily fixed with surgery, and really has no long-lasting consequences or other medical associations. We are so thankful that everything happened so quickly, it definitely being a perk that K and I are both physicians in this area. We were initially under the impression that we may have to travel to the Bay Area or Sacramento for the surgery given our rural area without true pediatric specialists and anesthesia providers who feel comfortable putting young children to sleep; however, after a few phone calls, we learned that the semi-retired surgeon in Eureka who was on call was willing to and did recruit two anesthesiologists to be able to do Iver's surgery the same day.
We checked into St. Joseph's Hospital's NICU early afternoon, with surgery planned for early evening. The IV start was a bit rough on our little one, who was already fussy and starving, being kept NPO (nothing by mouth) in preparation for abdominal surgery, which (not being able to comfort/feed your hungry baby!) I think was the hardest part about this whole ordeal. However, Iver did get some solace from being cuddled, and also from his wubbanub (pacifier-attached-to-a-stuffed-monkey) on which he sucked with all his might (hoping milk would eventually emerge) and which he clutched (see all the pictures) until it was time to go to the pre-op area.
Waiting to meet with the doctors...
not scrapping the bib yet
with his little IV in
In Daddy's arms in pre-op
The surgery lasted about an hour including anesthesia induction and extubation, which took a bit longer than expected per (one of) the anesthesiologists(s) as they were cautious given Iver's young age. Nevertheless, everything went well and our little guy was alert (and still hungry) soon after. His little drowsy, hoarse cry was the most adorable yet heartbreaking thing ever. Back into his mouth went the pacifer, the closest thing we had to the prohibited breast or milk!
While the surgery (pyloromyotomy) can be done laparoscopically, it's apparently generally just as easy to do it with an open approach, and Iver has about a 4 cm sutured horizontal scar on his abdomen which should heal really well. He didn't even seem to be in much pain post-op, getting just one dose of rectal tylenol before leaving the O.R.!
He was able to start gentle (1 oz) of pedialyte orally about 6 hours post-op, and he tolerated expressed breast milk this morning and nursed mid-morning. Between the monitors beeping, the nurses taking vitals, my pumping, his whimpering, and my wanting to hold him constantly, he and I didn't get much sleep last night in the NICU, but sleep is not at all important in the context of everything that our little one went through. Amazingly, we were able to be discharged around midday today and headed home.
Ready to head home (sans bib!)
And, in case you haven't seen enough pictures of our handsome boy, here are a few more:
Man, how I love this little guy.
