No WONDER!

No WONDER he couldn't keep anything down, he didn't have the proper equipment!

Max had an Upper GI yesterday. The had him drink Barium, and did X-rays to watch the contrast and see where the fluid went. They easily realized that Max has gastroesophageal reflux disease (GERD). Not your run of the mill reflux...Max doesn't do anything halfheartedly. Show off.

Gastroesophageal reflux (GER) occurs when stomach contents reflux, or back up, into the esophagus during or after a meal. The esophagus is the tube that connects the mouth to the stomach. A ring of muscle at the bottom of the esophagus opens and closes to allow food to enter the stomach. This ring of muscle is called the lower esophageal sphincter (LES). The LES normally opens to release gas after meals. With infants, when the LES opens, stomach contents often reflux into the esophagus and out the mouth, resulting in regurgitation, or spitting up, and vomiting. GER can also occur when babies cough, cry, or strain. (http://digestive.niddk.nih.gov/ddiseases/pubs/gerdinfant/)

In Max's case, his LES is totally loose, so anytime he lays or reclines back the stomach contents run back into his esophagus. This explains everything! The big lumps of mucous in the back of his throat every time we'd pick him up, and the panting when he'd try to burp. Also, the huge amounts of air he gathered in the stomach.

This actually came as such a relief knowing there's a solution. We sort of felt like we were just flapping in the wind, not knowing how long it would take Max to "figure it out" with eating, and I could just TELL there was something more than your average reflux happening. This isn't an out of the ordinary thing, many CDH babies have this issue, because the intestines and other organs didn't have the placement and space to develop properly above the diaphragm.

To repair Max, Dr. Kays will do a Nissen fundoplication.

In a fundoplication, the gastric fundus (upper part) of the stomach is wrapped, or plicated, around the lower end of the esophagus and stitched in place, reinforcing the closing function of the lower esophageal sphincter: Whenever the stomach contracts, it also closes off the esophagus instead of squeezing stomach acids into it. This prevents the reflux of gastric acid (in GERD). The esophageal hiatus is also narrowed down by sutures to prevent or treat concurrent hiatal hernia, in which the fundus slides up through the enlarged esophageal hiatus of the diaphragm.

In a Nissen fundoplication, also called a complete fundoplication, the fundus is wrapped all the way 360 degrees around the esophagus.
So, whenever his stomach contracts, it will act as the LES or sphincter and tighten around the esophagus.

ANSWERS. whew.
Jordan and I honest to goodness were weirdly excited about the news. I guess it just felt like poor Max will be so much better off! It's been emotional watching him struggle so badly to swallow a few mL's of milk! He can't eat more than a few capfuls before he vomits!

Because of all this, Max will also get a feeding tube during the surgery, because he will still have some major training to do with his eating. It sounds okay to me, not too hard to live with or manage. He could have that feeding tube for a month or a year, but I wont let him get lazy with the bottle feeding! :)

One of the cool parts of all this- and TOTALLY not the important part- is that we can come home once he recovers from that surgery. So, we now are fairly solid on the fact that we will be coming home within two weeks. THANK. YOU. GOD. (really, thanks God.) Max just needs to recover from surgery, and show Dr. Kays and Dr. Dickie that he can take his full 60mL feeding through the tube at least (if not with a bottle combo). We were just over the moon on that part. I know we have a ways to go, but Jor and I would sure love to go that extra mile at HOME.

The surgery is tomorrow, and they are not doing it laparoscopic because they want to explore his stomach a bit to just check for anything else as a precaution. They will use his scar from his hernia repair. Surgery number three, here we gooooo!

What a tough little boy, huh? :) We will let ya'll know how it all goes.
Claire