Our Quiverfull - Not tolerating feedings well

Aug. 31, 2007

Not tolerating feedings well

Last night Noah started getting fed through his tube again. His previous rate of feeding was 35 mls/hr, but our goal has been to either increase that rate or increase his calories because he was no longer gaining weight. This has been a huge issue because he seems to be at his maximum tolerance both in calories and in rate. Last night his feedings ran at 20 mls/hr with the goal of increasing through the day. At 25/hr he was getting uncomfortable and at 30 was very nauseated and utterly miserable to the point of requiring IV benadryl to be able to even calm down. His rate was backed up to 25/hr and he seemed to feel better for a while.

During this time a surgeon (not his regular one, but a very experienced on who is on call this weekend) came to see him. He was concerned about the feedings and said that he feels that Noah, for some reason, may not be able to take sufficient nutrition through his digestive system no matter where the tube is. Failure to handle 30/hr is not a good thing. He wanted to try upping the feedings again but if Noah wasn't up to a full calorie load tomorrow we would need to find another way of getting calories into him. In all likelihood this would be surgery tomorrow for a broviac (chest central line) so he could recieve TPN. Unlike his PICC line, a broviac is a surgical procedure done under full general anesthesia, but it is more durable and more stable than a PICC.

Not long after the doctors left, Noah started throwing up while still at 25/hr. It seems like he may have aspirated some vomit as he now has a wet and painful cough. His feedings have been stopped completely and the surgical resident will be up shortly to see him. He may need a chest x-ray tonight if he keeps coughing. It is very likely at this point that he will just need to move ahead with the broviac and won't start the feeds back up tonight, but we will need to see.

I am not opposed at all to more TPN. Noah has lost a lot of weight - more than a pound just since Tuesday night. He needs nutrition, so the idea of TPN per se isn't a problem, but there was more news that just sort of took my breath away. The reason they want a surgically placed and long-lasting broviac is that the doctors are looking at *weeks* of inpatient TPN. He is getting more and more unstable due to weight loss and will probably need to be inpatient until he is up to a decent weight AND they can figure out why he can't tolerate feeding AND until they can fix what needs fixing AND he can prove that he can tolerate the feeding. Whew.

I don't know how many of you read World Magazine, but in the words of Andrea Su's recent editorial, "It isn't time to worry yet." At least for now, this is firmly in the realm of "maybe" even though it is becoming increasingly likely. God's grace is sufficient for my needs right now and will be sufficient for my needs tonight and tomorrow and beyond, so I am not about to borrow trouble and start worrying.

Noah did perk up today, probably from the few calories he got. He still has a lot of pain, but when the pain was under control he started to take a little interest in his surroundings and is even sitting up looking at books in his crib right now. Until this afternoon, he wouldn't take his head off my shoulder during his awake times. I even got a kiss tonight!!!! This confirms our feelings that Noah stands to benefit from aggressively going for nutrition instead of playing around anymore. (hmmm . . . . haven't I been saying this sweetie needs nutrition??)

I was blessed with the most lovely visit this evening. The Rausch family (who sent in the Perfect Plastic Containers I blogged about) all came by to see me. They have 6 beautiful and charming children and their visit really was a breath of fresh air. I had a sweet time of fellowship and prayer with them and came away so refreshed. I miss my children and it was a joy to spend some time with their children.

I also had a visit yesterday from Lynette, who also reads Noah's blog. She came by with a basket packed with all sorts of snack goodies and a wonderful gigantic salad from Fatz Cafe. She also brought me a big fluffy pillow, saying that God had impressed on her that I needed it. Well, this was about like the Perfect Plastic Containers - I have my pillow from home, but it is losing its loft and I had been planning to replace it. The pillows here are incredibly thin, and just the other night as I tried to find room to get comfy in bed with Noah I was thinking "This spot here needs a thick fluffy pillow so I can roll over without banging my back on the rails." I am so humbled by God's small, daily, perfect provision and by the obedience of His children as they are sensitive to His calling and are open to being used by Him. Lynetter and her precious children also brought a present for Baby Girl Estes - teeny tiny ruffled socks and a little rosebud elastic headband and two little pink binkies! I think every nurse on the floor has been in to admire them.

A funny thing happened this morning. The young resident who has been so difficult about pain control (the one who comes in early each morning and points out that Noah, who is SLEEPING, doesn't seem to be in pain) came in this morning after Noah was awake. Not only was Noah awake, but he was hurting and crying pretty hard. The resident ran to his bedside and looked at me like I was nuts and declared that, "This baby is hurting! He needs morphine right away!" It was amazing how things changed when the resident saw my suffering baby first hand instead of hearing me insist that he really was hurting! I hope he learned something . . . .

Well, the little critter in question has tossed aside his books and is putting on his "owie face" so I need to go. Please pray for clear and obvious direction for us and that if Noah needs the broviac that he will get an OR slot during the window of time that Jeff will be here. I don't want to be alone if Noah needs surgery. (Of course, I WON'T be alone, but you know what I mean!)

Love,
Kate

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Comments

Aug. 31, 2007 - Today's post....

Posted by Anonymous

I am SOOOO sorry that Noah is having such a hard time. I will keep him in my prayers tonight. Take Care and God Bless !! Jessica from Fl.