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Plan B

It seems that Anthony is unable to tolerate anything in his stomach without reflux causing stomach contents up to the back of his throat. Anthony has a very strong cough, which is good for clearing his lungs, however when he coughs, this also pushes his stomach contents up to his airway, which causes more coughing – it’s a vicious cycle. Even on an empty stomach, the stomach still has acids and any saliva that Anthony swallows, so his stomach is never really empty. We tried attaching a bag to the G-tube port (stomach port) to allow his stomach to empty. With this drainage bag, when he coughs, the acids go into the bag rather than up to his airway. We were feeding him via the J-tube and not seeing any formula in his stomach drainage. This approach was working great and we were up to 40cc/hour (with a goal of 50cc/hour).

Unfortunately, Anthony vomited about a week ago and the vomiting seems to have displaced the tube. We are now getting formula in his G-tube drainage. Basically, some of the formula is going in and then out again. This will not do. It seems the shorter GD-tube will not stay in place, plus considering the difficulty placing this type of tube, we have decided to go with a surgical J-tube.

So, Anthony will have two separate tubes, a G-tube to keep his stomach empty and a J-tube for feeding. The J-tube will be place beyond the site of his vulvulas surgery. Another advantage to this type of tube is that once Anthony is completely healed from this surgery, I’ll be able to change or replace both tubes myself, without having to go to the hospital. This is a big plus to me.

Anthony is scheduled to be admitted to the hospital on January 31st for pre-op testing and bowel prep. Surgery will be on Tuesday Feb. 1st and if all goes well he will be discharged on Wednesday or Thursday. He will continue on TPN via the PICC line until we are able to get enough calories into him via the new J-tube. We are optimistic that this procedure will work for Anthony and we can get him off the TPN and back to school.

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Anthony | cindy | | 1 Comment |   GD-tube gj-tube J-tube PICC reflux TPN vulvulas

Update on Anthony

Brief recap

On December 7th Anthony had emergency surgery for a jejunal volvulus and had 135cm of his small intestine removed. Details here

He spent 11 days in the hospital and came home with a g-tube and a PICC line. Because of the surgery, they had to discontinue his GJ-tube and place a G-tube. Prior to the volvulus, Anthony had to be fed via J-tube (Jejunal tube) because he is unable to tolerate G-tube (gastostomy tube) feedings due to severe gastric reflux.

We were unable to feed him sufficient calories via the new g-tube because of his reflux and we could not place a new GJ-tube because of the surgery. So, he came home with a PICC line for TPN (Total Parenteral Nutrition via an intravenous).

The Plan: to replace his GJ-tube once his small intestine heals. If they are unable to replace the GJ-tube, then they would do a surgical J-tube.

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On January 5, 2011, Anthony returned to the hospital for a GJ-tube. Anthony had had a G-tube for many years. However, after his spinal fusion about 4 years ago, his reflux kept getting worse until we finally decided to place a GJ-tube. A GJ-tube is basically a tube that is threaded through his present G-tube stoma and then guided via x-ray into his Jejunum (second part of the small intestine).

Because of Anthony’s past abdominal surgeries (Nissen fundoplication and the more recent bowel resection) threading the tube from stomach into the small intestine is a challenge. Plus, they have to be very careful with the placement of the tube to avoid the surgical site (where they sutured the small intestine together). They had to order a custom JG-tube, which is a short tube and could actually be called a GD-tube, because it goes into the duodenum, (first portion of the small intestine). If they were unable to place this tube, the back-up plan was to do a surgical J-tube.

It took them about 3 hours under general anesthesia to get proper placement of the tube. He was admitted overnight for observation. He was discharge the next day with the new tube at 20cc/per hour. We need to gradually increase this amount with a goal of 50cc/hr 24/7. This is enough calories to be able to discontinue the TPN and remove the PICC line.

We are really in no hurry to stop the TPN, because Anthony has lost a lot of weight and we would like him to gain some weight before removing the PICC line. We have a follow up appointment with the surgeon on Wednesday.

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Anthony | cindy | | 3 Comments |   g-tube gastostomy tube gj-tube J-tube jejunal volvulus PICC

Youtube: Longer Videos for Selected Users

Congratulations! Your account is now enabled for uploads longer than 15 minutes.

Aaron is one of youtube.com’s “selected users” and is now able to upload videos longer than 15 minutes. Why was he selected? From what I can find online, youtube selected people with a history of complying with the YouTube’s Guidelines and copyright rules. The fact that he spends virtually all of his free time on youtube probably helped too. When he is not making movies, he is watching them!

To celebrate his new found freedom, Aaron has uploaded one of his favorite films, which was previously too long for youtube (he doesn’t like uploading videos in parts). Here it is, “Deadly Seduction” Uncut, uninterrupted and commercial free!

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Aaron Technology Video | cindy | | Leave a comment |   "deadly seduction" "Your accout is now enabled for uploads longer than 15 minutes" aaron bissell Congratulations copyright Guidelines lightscameraaaron lightscameraaaron.com Longer Videos Selected Users youtube

He’s Home!

Anthony came home Friday afternoon after an 11 day hospitalization. We’ve been busy the past couple of days trying to catch up on life and get use to Anthony’s care. He came home with a g-tube and a PICC line. He is getting about 80% of his nourishment via TPN and about 20% via his g-tube. He is tolerating only around 20cc an hour via the g-tube.

The surgeon would like to try inserting a post-pyloric tube or GD-tube on January 5th. He will try placing the tube in the duodendum at a point before the anastomosis (where the two ends of his small intestine were sutured together). Anthony obviously can not tolerate gastric feedings, but hopefully if they can place the tube beyond the pyloric sphincter he will be able to tolerate tube feedings and we can ween him off the TPN. He will be in the hospital again for a couple of days after the new tube is placed to be sure he can tolerate the feedings via the new tube. We will also continue the TPN until he is able to take in enough calories via the tube. We are not in a hurry to get him off the TPN, because he has lost a lot of weight. We’d like to beef him up a bit while he has the PICC line.

Shortly after Anthony got home all the feeding supplies were delivered and a visiting nurse came to show us how to manage the PICC line, feedings and pump. She was very nice and helpful. She came back on Saturday to watch me hang the TPN. I felt like I was back in nursing school, but didn’t mind a bit, since it’s been a long time since I’ve done any kind of IV. I guess I passed, since I was on my own today. The nurse will come in once a week on Mondays to assess him and change his PICC line dressing.

We are running the TPN 16 hours a day from 6pm – 10am and the G-tube feedings during the day. Of course, keeping his bowels moving is another important part of his care.

That’s about it for now. We are so happy to have Anthony home for Christmas. We will deal with the next procedure after the holidays.

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Anthony | cindy | | 1 Comment