Rumination! GI findings

     Rumination!  What is that, you ask?  That was my question as well.  So, rumination is defined as having a deep or considered thought about something and it is also defined as the act of chewing.  Makes sense!  Chewing...smacking, that is what Kerstin has been doing.  Her gastroenterologist (GI doc) also said that rumination could be behavioral but, it would be difficult to determine if that is the case with Kerstin.  I am no medical expert but, I am a Kerstin expert, I do not know if it is actually behavioral.  This has been ongoing for a while, when it started she would do it as soon as I would be done with her bolus and close her mic-key button.  It would be ongoing for 20-30 minutes after. 

     This process becomes so bothersome to Kerstin especially when she does it to the point of gagging/ retching and sometimes actually vomiting.  Which would lead to aspiration as mentioned in "The Summer of New Things -- Things Anew!".  Kerstin has been placed on medicines for reflux, which is also a problem and with this medicine, we had hoped it would help with the chewing/smacking.  Originally, that was what the chewing was thought to be.  

     Well, after meeting with GI and he took some time to watch Kerstin receive her bolus, and immediately began to ruminate.  He informed us that a rumination specialist would be on board in December and he would like to add him to Kerstin's care team.  About a week after her appointment with GI, Kerstin has this lime green residual, which she has never had before.  It was especially surprising since she rarely ever has residual in the mornings. I call to inform her team about this, I was pleased that they were not alarmed by it and was told to keep an eye out for it.  She did not have any more that day or the next but did about four days later. 

     In the meantime, there had been some back and forth phone conversations with her doctor.  He personally called to let us know that he had been talking with her surgeon and they decided that a somewhat common procedure known as the fundoplication may not be ideal for Kerstin.  He went over three options with me: 1) changing her gtube to a gjtube 2) accept the rumination and watch for aspiration or 3) esophageal disconnect surgery.  Two of the three sound like another procedure, something I always want to avoid with my child.  Sometimes, some things are unavoidable or inevitable. 

     Her doctor was once again so patient with this mom.  He told me to talk things over with the family and let him know if we had any questions about any of the options.  Well, that was last Thursday, things were talked over with the family.  I was reminded how I fought against Kerstin even getting a feeding tube placed and quickly learned the ropes, she is thriving and otherwise healthy and doing well with her boluses.  Her getting a gjtube would not be too much different.  I even "phoned a friend" whose daughter has a gjtube to get a firsthand perspective.  Talking to another mom gave me comfort.  Everybody wanted to know when I would call the doctor back, I wanted to wait as long as I possibly could but, had a true gut instinct that he would call me soon and he did.  He called on Wednesday to see had we talked and if I had more questions.  I did and once again, he patiently answered each and everyone of them. 

     The plan now is to meet with GI, surgeon and nutritionist to get Kerstin's health plan, feeding plan and procedure in order.  Procedure...yes, another procedure!  This too will be for her good.  This means, I have more to learn in order to be and do the best I can for Kerstin! 

Smiling through it all! 

Resources: 
G to GJ -- Feeding Tube Awareness
G-J Tube Care --Cincinnati Children's 

More to come...