I think I can finally say that we are seeing some steady improvement in our girl! Yesterday was the first full day with NO backtracking, just beautiful forward progress! Hooray! No vomiting, no pain, plenty of urine, trialed some ice chips by mouth successfully, worked up to a 3/4 Elecare, 1/4 Powerade mixture, and dropped her Zofran! It was a good day.
For my own records, I want to make a note of what did NOT work and what finally did. In the hospital, they started with clears at 30ml/hr and worked up to 64ml/hr (her goal rate) by increasing 5ml each hour…this worked. Then for formula, they tried to do the same thing…did NOT work. We had to backtrack countless times with lots of pain and vomiting along the way. They slowed the transition down by backtracking to a lower rate and increasing by 5ml every 2 hours and then slowed it again to every 4 hours, but it was still painful, nauseating, and not what I would consider a successful transition. We hit her goal rate, but not without K paying a pretty big price for it.
We came home at her goal rate, but she was still needing to drain through her G continuously, still vomiting, and still not urinating well. We went back to Powerade because she was not urinating, and she felt much better and we finally got some decent output, but when we tried to go back to Elecare, everything went downhill. My friend, Melody (being the experienced genius that she is), suggested going to 1/4 Elecare, 3/4 Powerade for a while and then slowly shifting the ratios and transitioning up to full formula. That was really the turning point for K and things have been moving forward since. We’ve done it before with G feeds, but it just didn’t occur to me to try it in this situation because everything was so new and unstable at the time. So here is a note to Future Kyla:
TRY THIS FIRST next time!
The truth is, I don’t know if it would have made a difference from the beginning. It could have been a matter of her system finally coming back on line and being ready to accept feeds, but either way it made for a gentler transition and if we ever go through this again, it will be the route we try first. I strongly suspect she would have benefited from a longer period of total gut rest in the hospital (supported by IV fluids) and perhaps all of this would have been easier from the start, but we’ll never really know that either! Hopefully this isn’t something we are going to have to deal with frequently, but if it ever happens again we will definitely be taking a different approach. For now, though, I’m just glad she is starting to feel like her old self again!
Last night I asked her how her tummy was feeling and she said, “Good. It’s telling itself, ‘Girl! Don’t you be afraid!.'” Amen to that, little tummy! ♥