Category Archives: inflammatory bowel disease

>Post Endoscopy & Colonoscopy…….

Posted on by
4

>

Yasmin got through the endoscopy and colonoscopy safely. Our thanks for all the well-wishes from many good friends, it gave us strength. Though she was admitted on a Thursday, the scope was scheduled on Friday. When it was time, I carried Yasmin down to the OR, dressed in her little surgical gown. The anesthetist placed the gas mask over her face, she struggled a little but quickly succumbed. Paul and I waited outside for a while and later the doctor invited us in to take a look at the monitor. It was hard to tear my eyes away from Yasmin lying unconscious on the table, meanwhile the doctor showed us several parts of her large intestine.

He did not use a pill-cam even though we requested for it. According to other pediatric GI specialists in the UK and USA, they commonly use pill-cams for young patients even 3 year olds. However, I guess things are different here in Malaysia. Due to the traditional cam scope, the doctor is not able to check the small intestines. However, he did a thorough check on the entrance into the small intestines. The endoscopy was then over, and it was time for the colonoscopy. We then waited outside again, and were invited back into the OR once the doctor had gone into the colon. He showed us her colon and as before, he kindly explained where and what we were seeing and findings he had.

Overall, the up close and personal look at Yasmin’s inside was a revelation. She was absolutely perfect! Everything was pink and healthy as it should be. There were no signs of inflammation, lesions, polyps or anything else out of the ordinary. Paul and I are immensely relieved that she did not have any of the GI diseases we initially suspected. It was good to know that she is not in the kind of awful pain that was reported in many children in GI literature.

Once the procedure was over, I carried Yasmin to the recovery room. Once her condition was deemed stable, we brought her up to her room. It took a long time for her to wake up from the general anesthesia, nearly 2 hours. Even then, we tried several methods to wake her up. We were warned that some patients when coming out of GA tend to act aggressively, cry or act weird. We were prepared for that, but Yasmin was totally fine apart from being groggy, sleepy and a bit uncoordinated, as was expected. The doctor discharged us soon after and Yasmin was happy to be home though tired. We were relieved to be home on Friday night, I was not looking forward to another night in hospital. Caring for a child in hospital is hard enough, even though it was only for 2 days. However, this was during Ramadhan, it was harder to go through it physically, mentally and emotionally while fasting. In the next few days, we expected to see signs of side effect from the anesthesia. However, again we were lucky there wasn’t any lingering side-effects or other concerns.  

The only thing abnormal was that she had constipation and night awakenings for 3 weeks after that. Initially we thought the constipation was due to the scope and it was taking some time for her bowels to get back to normal. However, take note that she had constipation and night awakenings 3 weeks prior to the scope anyway. We had done a stool test for yeast a few weeks before with our pediatrician, it turned out positive. However, we did not address it as we wanted to wait for the scope first in case it affected the outcome of the scope. Because she had recently undergone the procedure, we were advised to take it slow and give her body time to adjust. However, when she was constipated for 3 consecutive days, we gave her Lactulose, a stool softener/laxative. After that, we increased her fluid intake, fibre, vitamin C, magnesium and probiotics. However, it didn’t work. At times we had to use the laxative, to me constipation more than 3 days running needs to be addressed immediately.

I put her on therapeutic doses of S.Boulardii and ThreeLac as anti fungal treatment however there were no changes or improvements. On the advice of our biomed doctor, Yasmin is now on Nystatin and extra Bifido strains of probiotics on top of her usual supplements. Those with constipation may require additional Bifidos temporarily, this worked for both my girls sometimes. Within 2 days, her constipation is reduced, she has a bowel movement every 2 days. Previously she required laxatives. Hopefully, the further we get along with the anti fungal treatment, she will be back to her normal daily bowel movements. And best of all, she now sleeps through the night. Yasmin has slept through the night consistently for the past 1 year unless during times of illness or infections. No more broken sleep for the whole household.      

So, now that our suspicions of colitis has been ruled out, where does that leave us? First and foremost, this is good news indeed. Colitis or any kind of Inflammatory Bowel Disease is terrible in anyone, especially a 3 year old child. Having hard physical evidence that ruled this out is worth it. We are glad that we went through with it, even with all the trauma and possible side effects of the general anesthesia, it was worth the risk. Since the scope has ruled out colitis, IBD (Inflammatory Bowel Disease) and other bowel diseases, the GI specialist based on the symptoms diagnosed Yasmin with IBS (Irritable Bowel Syndrome) instead. IBS is diagnosed based on clinical observations and symptoms, there is no test for it. As usual, I take everything with a pinch of salt. I have read that many Irritable Bowel symptoms are similar to symptoms associated to Clostridium infection. I will look further into this as well as any viral infections, Yasmin regressed ever since the Rotavirus infection, so it makes sense to look into her immune system as well as viruses.

So, how do we treat Yasmin’s issues now? We are maintaining her usual supplements of vitamin C, B complex, minerals, probiotics and cod liver oil. I want to address her immune dysregulation as this is the core reason why she gets recurrent infections. Since we started 4Life Transfer Factor 1 month ago, neither girls have fallen ill. We also give her Klaire Labs Galactomune, a prebiotic formula containing betaglucan  to support TH1 immunity. We also supplement with Vitamin D3, also beneficial to the immune function.

Apart from immune modulating supplements, I also give her Culturelle daily for maintenance against clostridia. I also include Milk Thistle to maintain healthy liver and kidney function. I reintroduced L-Glutamine a couple of months back, this helps with leaky gut. Since we started her on L-Glutamine again, she is much happier, with good appetite and always cheerful. The biggest change of all, previously Yasmin has rarely been as close to her Daddy compared to Maya. She always has great fun with Paul whenever they are playing together but she rarely seeks him out for company. Since restarting L-Glutamine, Yasmin constantly seeks out Paul, always looking for him when he’s gone, she is very loving and attached to her Daddy compared to before. It is heartwarming to see how she dotes on him and vice versa. I al
so introduced 5-HTP to help her with sleep, melatonin did not help when her yeast issues are flaring up. We also never forget Epsom salt baths daily.

I look forward to our next appointment with our biomed doctor for more insights on what else we can do for Yasmin. But for now, we are pleased to have a cheerful, illness-free girl again.        

>Preparing for the Endoscopy

Posted on by
1

>After procrastinating and indecision for the past few months, we are finally getting the endoscopy and colonoscopy done for Yasmin. The procedure is for diagnostic purposes, rather than a treatment. Hopefully the scope and biopsy will shed more light on Yasmin’s medical problems. It will tell us of any inflammation, damage or lesions in the GI tract.

Yasmin is a mess of GI and Immune issues, every treatment and tests we have done keeps leading us back to her gastrointestinal system. Several doctors have recommended we do the endoscopy and after several consults, the Pediatric GI Surgeon is now convinced that there is due course for the investigation.   

Physical symptoms, behavioral regression, bouts of pain, recurrent bacterial infections, susceptibility to illness, chronic diarrhea for the past 10 months, poor appetite, no weight gain, disturbed sleep- her pain and suffering seems endless to us. So, no more chickening out, we are going through with it.

A part of us are scared that we make her go through the procedure and in the end, the doctor finds nothing is wrong. If so, then we’ve hit another dead end. Another part of us is scared that we WILL find something wrong.

Yasmin was admitted into hospital yesterday, however the procedure will only be done today. The preparation takes 24 hours prior to the scope. Yesterday, I had to get her to drink 1/2 litre of laxatives. It was an extremely hard task, getting her to drink it all.

After that, I had to make her take a sedative. When she finally fell asleep, the nurses did a rectal wash, similar to a colonic irrigation. However, it didn’t totally clear her bowels up as much as we had hoped. So this morning, we had to do the whole thing again. This time she had to drink 1 litre of the laxatives. She did a massive bowel movement (no big surprise there!) thankfully. Then we had to give her the sedative 3 times, after much struggling, spitting and gagging we managed to get enough into her that she finally fell asleep.

The nurses did another rectal wash, thankfully like yesterday she sleet through the whole thing. However, she woke up pretty soon after if was finished. Nothing keeps my Warrior Princess down for long.Throughout it all, Yasmin was happy and cheerful yesterday and today. She is still her loving, affectionate self. She is such a trouper!

Paul was overseas and was only coming back to KL last night, but we didn’t want to postpone it for much longer as we needed to book the doctor, anesthetist and operating theatre beforehand.Though initially I was very apprehensive admitting her into hospital without Paul around yesterday, i kept telling myself not to let my own fears stop me from doing what’s best for my daughter.

Now, Yasmin is to fast until the procedure, she is hungry and cranky. It’s hard to deny her any food or drink, it was even harder getting her to swallow everything required. But if her bowels and upper digestive system are not cleared completely, then the scope may not be successful. The doctor may not be able to view anything, if there was too much stool left even worse the doctor may end up rupturing parts of her due if the view isn’t clear.

My biggest worry is the general anesthesia. I personally had a bad time coming out of the GA, it changed my behavior and demeanor. It took me several days before I was finally myself.

Yasmin is such an amazing girl, her capacity for love and forgiveness is enormous. Even after the times when I had to force feed her horrible meds, after the shouting, struggling and tears,  when all was done, she would turn to me, hug and kiss me. And when I said that I love her, she said “I love you too, Mummy”. If only we can all forgive and forget so easily, the world would be a better place.

I pray for a safe and successful procedure. I hope there are no long term side effects from the anesthesia. Most of all, I hope this will finally shed some light to Yasmin’s underlying medical issues.         

>The Rash Incident…..

Posted on by
Reply

>

The past couple of months have been very taxing for our younger daughter. She had several rounds of fevers, colds and coughs on top of her chronic diarrhea which has been going on for 9 months now. There were also 2 absolutely horrendous weeks of hive-like rashes called urticaria. It started from her legs and progressively spread all over her body, the itching intensifying every day. Initially, the rash and itching was isolated, but everyday there was a little bit more. In the first week, with the help of our local GI paediatrician, we managed to control the discomfort whilst investigating the cause. However by the 8th day, my little girl was in absolute agony. She would cry and scream trying to scratch herself and not finding any relief.

This is the first time this has every happened, I don’t recall this kind of rash happening to either girls before. Paul and I felt so helpless, watching our little girl covered from head to toe in huge red welts, her hands and arms were swollen. During that 2 week period, we went to see a doctor just about every single day, we ended up seeing 4 different doctors. It seemed that nothing seemed to help, the antihistamines, painkillers and other remedies or drugs did not reduce the swelling nor provide relief for the itching.

In the 2nd week, for days and nights Yasmin would cry nonstop and madly scratching herself. We used calamine lotion, 3 types of antihistamines each stronger than the previous and other treatments. For the first 3 days there was some vomitting and mild fever. But later, there was no more vomitting but with intermittent high fever that doesn’t recede with ibuprofen or panadol. Only voren suppositories could bring down the fever.We did a blood test for kidney and liver function and mycoplasma, they turned out to be negative, but the markers were slightly elevated in one of the liver function profile.

Everytime Yasmin was not in an air conditioned room, the itch intensified and her fever spiked. The 1st week of rashes also coincided with the day of the conference in Singapore, which Paul and I were looking forward to. We didn’t want to miss hearing Dr James Partington and Dr Kenneth Bock’s talk, it’s a rare opportunity to hear world-class Autisms expert talk for 3 hours each. But neither could I bear to leave my sick child at home even though my parents were willing to take care of her.

Paul and I decided to pack up the whole family and drove down to Singapore the day before the conference. We also managed to get a quick consult with the girls’ regular doctor there and get a 2nd opinion. We managed to keep Yasmin somewhat comfortable though we could see the rashes were still bad.Nontheless, the girls love going to Singapore and especially love staying in hotels. They were happy enough and we didn’t feel too bad about taking Yasmin away on a trip, even though we should never take a sick child travelling. Right or wrong, it was a choice that Paul and I made.

The next morning, it was hard to concentrate on the presentation. I was incredibly tired from repeated sleepless nights caring for Yasmin plus I had bronchitis. God, please forgive me for spreading my germs to the other parents who attended the conference. Though I had heard both Dr Partington and Dr Bock just a couple of weeks before that in Hong Kong, it was still incredibly beneficial. You just can’t learn enough I feel. It was also good to meet new friends and catch up with old ones, though in the back of my mind I was incredibly worried about Yasmin. She was never far from my thoughts even though I was chatting to people or concentrating on the biochemistry lesson courtesy of Dr Bock. Paul was kind enough to stay with the kids and our nanny while I went to the conference first for Dr Partington’s lecture. He made sure Yasmin was stable enough and that he could safely leave them for a few hours with our nanny. Paul managed to join in for Dr Bock’s portion. Our hotel was only a few minutes drive away so we knew that in case of an emergency phone call from the nanny, we could rush back to our girls quickly.

The day after the conference, before we drove back to KL, we also saw a pediatric immunologist in Singapore. We also wanted to make sure that Yasmin would be ok for the 4 hour drive home, to have some temporary solution so that Yasmin won’t be too uncomfortable during the car ride. The doctor was very concerned about her immune system and recommended that we see an immunologist in KL for further investigation. She suspects the fever and rash was a viral infection rather than an allergic reaction. She gave us some medication to control the fever and itchiness. The drive back to KL wasn’t too horrific, thank goodness.

Back in KL, we saw our regular pediatrician again and we also managed to get an appointment with the only pediatric immunogist in Malaysia. They are working together to investigate Yasmin’s condition, namely inflammatory bowel disease and her impaired immune system. Our consults and testing with the immunologist unfortunately could not bring us any closer to a resolution. But by then, he had identified enough that her immune system is compromised and everything led back to issues with her GI disorder. After all, 70% of our immune system lies in the GI tract. Again, the topic of endoscopy had come up.

Yasmin’s rashes and fevers went away after a course of antibiotic, our paediatrician prescribed it because the rashes were so bad that it caused swelling and infection of the fat layers of her skin. The Rash Incidence has been so traumatizing for us that it took me a long time to even be able to talk about it or write about it till now, 2 months later. Since then, based on the recommendations from our doctors, we have taken steps towards getting closer to healing Yasmin. We did an xray which confirmed fecal impaction, thus we put her on laxatives and enemas. This gave her much relief, her tummy was no longer bloated, her mood and behavior improved and her appetite was much better. However, after some time, the symptoms would return. We have also been battling constant colds, flus, fever and coughs. Till now, I dread the rash would return. The Rash Incident was more traumatizing for us compared to her previous hospitalizations, can you believe it?

I also finally had the time to read Dr Andrew Wakefield’s book Callous Disregard. This turned out to be very timely for me, as Dr Wakefield included many case studies of children he’s worked with. There were many references to bowel disease, immune dysfunction, chronic diarrhoea, behavioural issues  due to GI disease, endoscopies, gastrointestinal symptoms – everything that I was going through with right now. It is a huge loss to the medical world indeed and Autistic children worldwide that a gifted paediatric gastroenterologist was struck off the medical register due to biased misrepresentation, government blunders and the profit margins of vaccine manufacturers. Meeting him again in Hong Kong and listening to his lecture also gave me the resolve to go ahead with the endoscopy. Paul and I had many misgivings about doing the procedure for Yasmin, but now our fears have been allayed. I also read again Dr Elizabeth Lipsky’s book Digestive Wellness and anything else that related to IBD and GI diseases.

I am working closely with my pediatric GI doctor as well as the peadiatric GI surgeon who will do the actual procedure. We are in the midst of preparing for the endoscopy and possible colonoscopy, which will also include more consultation, scheduling and booking the operating theatre and anaesthesiologist, blood work and biopsy. All her symptoms and conclusions from the many doctors we consulted points t
owards IBD, Inflammatory Bowel Disease. So now we are STILL in the initial stages, which is getting a proper diagnosis of which type of IBD or another type of GI disease. However, I am hopeful that we are on the right path. Once the endoscopy and findings confirm it, we can then proceed with treatment. What the treatment will be depends on the diagnosis. And if everything comes up negative, I will deal with it when the time comes. Right now, diagnosis first……..