28 November 2012

Barium Enema Success

Bennett's barium enema procedure went well today.  The pediatric surgeon required Bennett to undergo a barium enema to make sure she knows how much "loose" bowel there is.  She believes one reason Bennett is having reoccurring issues with rectal prolapse, at this point, is due to growth of the bowel.  I am sure I will learn more about what the doctor wanted from the procedure in the morning.  Bennett's surgery will begin some time after 9AM.
Unfortunately, since our surgery was scheduled urgently and the barium enema was a must, we didn't get a good choice of Day Surgery times.  The only time they had left for this procedure was 1PM today.  That meant that Bennett couldn't have anything to eat after 7AM.  Try telling that to a 3 year old who loves to snack throughout the day and certainly wants to eat lunch.  My best option was to send to him school but ask the school to take him out of the classroom during snack time.  Then, I picked him up right before lunch and took him to the procedure.

Although I had pre-arranged this plan with Bennett's teacher at school, I felt a bit of panic as I started to send him out of the door.  If someone at school accidentally gave him even a small amount of drink or food after the wrong time, our entire procedure would have to be cancelled.  So, I grabbed a marker, a piece of paper and some packing tape and created him a "sticker" he wore at school all day.  Thank goodness he is three and had no idea what he looked like wearing this handmade sticker.  But it worked and Bennett successfully made it throughout the day without food or drink.

As soon as we got through the initial paperwork the hospital makes us do, we went to take care of anesthesia.  Bennett was leery of all the medical stuff but finally warmed up and started being his silly self.  (Note: both Bennett and Pumpkin got medical bracelets.)

This is EMLA cream on Bennett's arm.  It's a numbing medication used on kids when they have to get an IV.  Initially, the team decided we would try to do the barium enema procedure under oral Versed, a pain medication known to make one drowsy but not put one to sleep.  But, having been through the barium enema more than once with Bennett and knowing that, for Bennett, "drowsy" doesn't equal relaxed (it still took 3 people to hold Bennett down when he got stitches, even though he had been given Versed), I requested we go forward with our back up plan: to use propofol, a pain medication that would put him completely asleep.

The nurses were resistant.  I had expected they would be.  Nurses and doctors typically prefer less intervention than more intervention.  But I was adamant.  I explained, "he will be going through more procedures tomorrow.  I need him to feel safe and calm today.  This is a child with a chronic illness, a child who is going to be poked and prodded most of his life.  I want him comfortable for his procedure."

The nurse said, "yes, but do you understand he is going to have to get an IV now??"  I said, "yes, but do you realize that, if he doesn't, he is going to be awake while several adults hold him down to do this uncomfortable fear-inducing procedure?"  I went on to explain, "look, it's in your best interest, as well.  There is no point wasting your time to have a child, who is able to push out his own bowel, push out your catheter.  Let's do what is best for him and for you."

The nurse finally relented and explained we would have to wait for approval from the doctor.  I stayed very patient.  My goal for this procedure was to see my child traumatized as least as possible.  I felt strong about my decision and happy with our choice (Brian and I discussed it beforehand).

While we waited on the doctor, Bennett got very loopy on the Versed.  Within a few minutes he seemed pretty drunk.

We killed time, waiting for the doctor to OK the orders for propofol, by watching TV.  Hospital TVs always have remote controls that plug in the wall and put the speaker in the remote.  Bennett used it like a telephone.

 Chatting with me in his slurred speech...

Getting sleepy.

The doctor ended up agreeing that he could have the propofol.  I always try to demonstrate my competence as a mother right away after meeting a doctor.  I want the doctor to realize that I am a capable, caring and educated mother.  I want the doctor to be able to quickly identify me as someone who is concerned for her child's well-being but who isn't someone to be bullied..  I find that when I do this, doctors will usually respect my wishes or at least won't push me too hard.

My decision to have Bennett be asleep during the entire procedure turned out to be a great one.  He slept through the whole thing, giving the radiologists a perfect test and giving me the confidence he wasn't scared throughout the procedure.  The procedure took about 20 minutes and it took another 20 to wake him up.

I don't have pictures from the first 15 minutes after he woke up.  That's because I was holding him while he screamed his head my ear.  I've learned Bennett is a "mean" drunk.  He doesn't like the feeling of coming out of anesthesia so he gets angry.  But, after some time, he began to wake up more and calm down.

He didn't like that I was holding him so I finally let him down.  He didn't want to sit because he felt the need to poop (understandable after an enema).  And he didn't want me to touch him, either.  So, I let him stand next to his bed while he began to eat and drink (a requirement before we could go home).  I found that if I pulled a chair up next to him and put my legs on either side of him, I could protect him from falling and hitting his head on the cold tile floor.  He was so loopy for a long time.

Still feeling sleepy.

Beginning to wake up...

Right before we left, Bennett had a bowel movement.  I went to change him and then realized that his "bowel movement" was really just a lot of poop and fluid from his procedure...something the diaper they put on him after the procedure was clearly unable to hold.  Poop went everywhere.  I went to change him and found that all of his clothes were soiled.  It was like the kind of newborn poop that goes up a baby's back.  We were in trouble.  I hadn't even considered bringing an extra set of clothes... we were given and went home in our very own Scott and White's Children's Hospital's finest fashion: a children's hospital gown and a new old Scott and White hospital bed blanket.  As you can see, Bennett was thrilled.

But I was happy we had clothes to wear on our way back home.  Bennett began to wake up even more in the car and enjoyed some Teddy Grahams.  By the end of the night, he was jumping off our living room furniture and wrestling with his Daddy.

The nurses warned us he might nap later in the day or even go to sleep early.  Ha! Are kidding?  Not this super kid.  Nope, not getting to eat all day, a dose of Versed, a pump of propofol, a barium enema and a super diaper blowout don't bother him.  He is completely back to normal and ready to do it all again...first thing, tomorrow.

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