C.Diff and Venting

A little about C. Diff: C. Diff is a bacterial infection, so this means it can be treated by an antibiotic, which is what they are doing with James. Antibiotics are usually very hard on James’ colitis, but they’ve told us that this antibiotic is usually good for colitis and may even be helpful … unfortunately not long term tho. Other then diarrhea, some of the symptoms of C. Diff are fevers, vomiting and abdominal pain. So … it’s possible that James’ fevers are from the C. Diff. At the same time, fevers also occur with the GM-CSF treatment. And when we talk about James … he’s been known to get unexplained fevers for the past year. So it’s hard to say if his fevers are related to the C. Diff … if they go away in the next few days then we’ll have our answer. We are pretty sure that James’ vomiting is related to his GM-CSF treatment since he is vomiting up phlegm most of the time and often a vomiting episode comes during or after a moaning/grunting episode (which are terms for describing a type of breathing where you are exhaling very loudly and in turn not inhaling very well). C. Diff is also common in people with colitis and they have advised us that a lot of times if a person has serious colitis they automatically put them on the antibiotics for C.Diff if they are hospitlized.

Where did James pick up the C. Diff? This is a harder question to answer. C. Diff is often caused by antibiotics. It is possible that this is still from James’ last dose of antibiotics since C. Diff has the ability to live in a body without symptoms for 8-10 weeks. But it has been over 10 weeks since a James was last on last on antibiotics. The same goes for picking it up in hospital. He has been out of hospital more then 10 weeks, and his symptoms appear the day before he came into hospital.

At this time we are unsure if this is the reason for the oweee he keeps complaining about and then grabbing his diaper. We’ll find out in the next couple days. They did send a urine test away, but initial results do not show anything.

C. Diff does also cause extra gas in a persons system. Last week we started a new “procedure” on James, called Venting. The advantage of having a g-tube is that we can take gas out of the system before it reaches the intestines. When venting we open up the tube, attach a large syringe with the plunger out of it and then press on James’ stomach to get the air out. James calls it “bubbles out” because as the air comes out it makes little bubbles in the bits of milk that also are in the syringe. The reason we started this was to see if it would help settle his moaning/grunting episodes during the day. If your stomach is full of air it presses up on the lungs (sort of like being pregnant) therefore limiting the lung function. We did notice that venting seemed to help during the day with the moaning/grunting episodes but it did not seem to help with the worst episodes at nap time or night time. For a bit we withdrew the air into a syringe so we could calculate how much he had and we were drawing back about 100ml of air several times a day, along with smaller amounts here and there.

It’s hard to say whether he has a lot of gas in his stomach because of the C. Diff or whether this has always been there since we have only been doing this for a weeks time and have nothing to gage by. James has come to realize what it feels like to have “bubbles” in his tummy and will tell us when he wants “bubbles out”. I’ve learned that even if I just did it 15 minutes earlier, if he says “bubbles out” there’s probably more there.

The C. Diff should not effect James’ procedure, unless he suddenly starts spiking some pretty bad fevers. And if he were to do that we would likely not be from the C. Diff because he’s on antibiotics now. Tuesday night we got them to pull out James IV as we seen no use for having it in. Well poor little guy only got one days break and yesterday they put one back in and hooked him up to IV fluids just to make sure he doesn’t get dehydrated. They insisted on doing this, even though I told them that he is having less bowel movements now then what is normal and he is still tolerating all his formula. They want it as a preventative. Today they lowered the amount that they are giving him.

And I spoke too soon about night times … should know better by now. James is more back to his normal night time moanings and deSATs … not his extreme bad version yet, but up often enough anyways. So much for getting rest.

We seen the GI resident this morning, who went over James’ history. They will be getting in touch with MAC to get the results of some of his previous tests and then do a review as a Team. We should hear back from them once they have gone over things. They are also helping to keep an eye on and be on top of the “oweee” James keeps complaining about.