Friday, March 12, 2010

Jacob Sees the Pediatric GI Specialist

As many of you know, Jacob has had an issue with perpetual constipation since he was about six months of age. We've progressively had to get more aggressive with our treatment of the problem and have moved beyond diet, natural treatment, etc. Our pediatrician has been treating Jacob throughout the problem, but as things got worse, Chris and I became concerned we were potentially masking a larger problem with all the laxatives we are using with him. The pediatrician understood our concern and referred us to a pediatric GI specialist at the University of Kentucky. We've had to wait almost six months for the appointment, but we finally had it today.

The appointment was a total adventure. The appointment was for 9AM, but we were told to get there 30 minutes early to allow for parking, registration, and locating the office. Sheesh! So we left the house at 8, and managed to get there, park, and register all by 8:45. We were put in a room right around 9...after doing battle with a two year old who had zero interest in being weighed or measured. Then we sat. And we sat. And we sat some more. Then the nice nurse came in and said the doctor had just finished with his patient and was coming to us next. So we sat. And we sat some more. And we sat to the point that both Mommy and Daddy felt like this was a serious test of their patience and it was a small wonder that Jacob was so content playing put in and take out with the contents of his backpack. Finally....sometime after 10 (!!!!!!!) the doctor came in. We've seen a specialist once before about the way Jacob's head was shaping and the appointment literally lasted less than 30 seconds. Chris and I were very concerned that this appointment would go the same way and were really edgy about waiting as long as we had. Fortunately, this appointment did not go that way! The doctor spent a long time with us, collected a very thorough history, and asked a lot of questions. He is a bit of an odd old man....well, let's be honest, he's really odd and totally freaked Jacob out, but he seems to know his stuff and he explained it all in a way that we could understand.

Here is what he told us (in a nutshell). Jacob's problem is normal and our approach to it so far has been completely appropriate. The majority of his issue stems back to infancy and the failure for him to develop adequate muscle tone and strength for having a bowel movement. He lacks coordination in this area and needs time to build that up. Until then, he will remain on a constant regimen of Miralax. He will stay on the Miralax for five days a week for likely another 6 months. We will then start to discontinue and wean off. If it doesn't work, we up it again and recognize his coordination still has not developed. The doctor warned us that it is not at all uncommon for a child to struggle with this issue until the age of three and a half, so it may be pretty much an ongoing battle for us, especially when we enter the potty training stage of things. He explained what the Miralax does and how it works and put our minds at ease that we are not at all harming him or altering the way his body functions (which had concerned me...the label on Miralax clearly states not to take it for more than 14 days unless advised by a physician). We are currently scheduled to go back for a follow up in May, but likely won't have to keep that appointment as long as the current regimen continues to work for Jacob. The doctor won't even begin to discuss weaning Jacob off the Miralax for at least another 6 months. We'll have another follow up then and talk about the process of weaning him off and I'd imagine we'll just go from there.

I apologize that this is a bit of an unpleasant conversation to have, but many have asked how Jacob's appointment went and rather than type this all out a dozen times, I decided it would be easier to post it here.

We had planned to take Jacob to Monkey Joe's after his appointment, but since we were there forever and since Jacob's behavior during the appointment was not stellar (likely due to being trapped in the room for an hour waiting and then being creeped out by the odd old man doctor), we decided Monkey Joes will have to wait for another Friday afternoon outing. We'll get it in one of these days.......

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