Secretions, IV lines and seizures

It’s a week since I last updated you and eight days since Abigail had surgery to correct her reflux and fit a gastrostomy feeding tube. In the days after her operation last week, her fitting certainly subsided and it was generally felt that Abby’s threshold for triggering seizures had been temporarily lowered by the trauma of surgery. She was moved back down to the surgical ward on Wednesday last week.

The days after the operation did see a new symptom develop. Abby occasionally experienced gagging and vomited up what I can only describe as ‘froth’. Initially it was thought this might be a seizure episode but it was later reckoned that this frothing effect was not due to a fit but something to do with the operation on her stomach. Abby’s surgeon felt that although he wasn’t sure of the specific reasons, the symptom would subside as time went on. Generally though, Abigail looked really good: her facial skin has cleared up tremendously and she’s been alert and responsive.

Thursday was not a good day, though. Doctors decided that Abby was not absorbing as much fluid as she needed through her gastrostomy and that she was in danger of dehydrating. To this end, Abby was taken back down to theatre and given her second general anaesthetic in a week so that doctors could put a more substantial intravenous line in. This would pump fluids directly into Abby’s bloodstream. It took two hours to fit a line and in the end doctors opted for the last resort of a long line into her neck which required a stitch to keep it in. Evidently, Abigail is so small that doctors had considerable trouble finding a vein thick enough to accept an IV line. The next morning Nix counted over thirty attempts to get a line in all over Abby’s body. They had even tried to put one into her head!

It was also Thursday that nurses began to offer Abby some milk feeds via continuous pump into her gastrostomy. These feeds were in addition to IV fluids. Gradually her milk feeds have been increased such that she is now on 30ml/hr – the same level she was on before surgery. At the weekend, Abby’s milk feeds had reached a level such that she didn’t require additional IV fluids and she was put onto continuous milk-only feeds. Despite this, her main IV line remained in place after all the difficulty doctors had in getting it in – they wanted to be sure that Abby was happy on milk before taking it out! Again, Abby has seemed very alert and well in herself throughout the last week or so and despite the trauma she’s been through.

This morning, though, there was bad news. Abigail had quite a severe epileptic fit that lasted around fifteen minutes. It was the first fit since the two days after her operation and like those episodes, she had the quick-release anti-convulsant drug Lorazapam administered. Abby was also given oxygen and doctors were bleeped to her bedside to assess the situation. There seems to be no apparent reason why she should have such a large fit again. As a result of the drugs, Abby slept very deeply for much of the rest of today.

This evening, Nix went in again to visit. Doctors were once again called to Abby as she seemed to be experiencing difficulty in breathing. This is not something she’s had a problem with before. All other vital observations appeared normal, but tonight Abigail is on oxygen and under close observation. She also vomited up some more froth this evening. One theory is that she may have accidentally inhaled a small amount of mucus which may go on to develop into a chest infection. Tomorrow, Abby is likely to have a chest x-ray.

Despite her large seizure this morning, surgical consultants are quite keen to discharge Abigail home! We are clearly not happy with her progress at the moment – she is fitting again, seems to have some sort of respiratory problem and it’s yet to be proved that she can adequately put on weight and feed correctly. Our health visitor has already begun to put the wheels in motion for her to be readmitted to the Queen Elizabeth Hospital in Woolwich (where she had been) for the remainder of her recuperation.