Diagnosis and treatment

**WARNING**

This is a post about poo. If you don't want to read details about poo, or Kellen and his poo, then click the "X" at the top of the screen and come back tomorrow. I'll still love you, promise.



We had our consultation with our pedi about Kellen and his digestive issues today, and all-in-all, I think it went well. I went into the appointment armed with my notes, internet print-outs of what I thought the diagnosis was, pictures - albeit not great ones since our ink is going out in our printer - of his 'achievements' as he likes to sometimes call them, and our 2008 calendar adorned with stickers marking the poo occasions. Unfortunately, the stickers are few and far between in many of the months, hence one of the reasons for the visit. To give an example, November had three stickers. And I don't think I just missed or overlooked any poo poos that month. I can't say that with 100% certainty for all months, but we captured the vast majority with stickers, since the occasions are so rare that they're pretty hard to miss around here. October had six stickers, September had four, August three.

Poor guy.

Anyway...stats:
40 lbs
40.5 inches tall
bp 90/54

Yet another reminder that I MUST get out the car seat booklet and convert his car seat into a booster seat. Ug.

So the doctor, Kellen and I discussed the current status of poo in Kellen's life. We detailed the L-O-N-G history of this, prior dosage of Miralax, dosage since my being off work in December, that outcome, my concerns, a short term (next two weeks) treatment plan, then scenarios for if the treatment plan goes as we hope and then what our options are if it doesn't. We discussed dietary concerns - while acknowledging that virtually every diet has room for improvement, our diet seems fine by all accounts. The doctor discounted/discarded the notion that this was a predominantly diet-related issue, which had been a concern for Matt.

Conclusions:

• The doctor agreed to my diagnosis of encopresis.
• Daily medicinal regime will change for the next two weeks from Miralax to 1 oz Milk of Magnesia (I went after the appointment and got the Wild Cherry flavor and he LOVED it!) The doctor indicated that it generally took 4-6 hours for the medicine to work, so we'll try giving it to him as soon as we get home from school to see how that works. I think that would be better than him trying to go at school. If we realize it takes longer for the medicine to impact his body, then we might switch to the morning so he can have an after-school sit. We'll see.
• By the end of the two weeks, he should be going at least every other day with taking the Milk of Magnesia.
• If not, we'll need to go the barium enema route at the hospital (not what we really want to do, but might be a necessary route at this point in time if we've exhausted other possibilities)
• If milk of magnesia is working, then we'll go to phase two and use mineral oil (2-4 Tablespoons) daily for 4-6 weeks, gradually weaning him off of even that toward the end of that time frame to see if his body will self regulate.

More about the barium enema, in case you're wondering why we're considering that at all. The barium enema is a diagnostic tool for Hirschsprungs disease , but this would be our next treatment/diagnostic step in the process. The doctor also indicated frequently once a child having severe constipation problems underwent this procedure, the process of cleaning them out so well, which is what the procedure will do, served as a treatment itself due to its nature (paraphrasing how he said it, but that's the gist) by ensuring all hardened stools within the colon were expelled.

General dietary comments discussed included:

• Milk limited to under 20 oz daily (includes cheese/yogurt as well)
• Fruits/veggies - 3 servings daily [could stand to work on this area, particularly with the variety that we have in the house; more (servings/day) isn't necessarily better]
• Probiotics (already included in yogurt, adding additional packets is fine!)
• Drink lots of water (check!)
• Some juice for Kellen is ok (apple, prune) [nice try...but I've done my milk & water only job too well...the doctor just laughed at me on that one]
• Try actual prunes/dried prunes as a snack

Again, I feel pleased about our direction, and no longer feel like we're aimlessly wandering with no end point in sight. Let me clearly state that I don't want Kellen to have to undergo the barium enema. I WANT the new treatment to work, but at least now if it doesn't, I feel like we have some other option that is more than simply, 'give MORE of the XXX medicine that you were giving.'

Despite the continued reassurances that all is well and that Kellen taking this medicine for so long is ok, after over 4 years on medicine for what should be a normal bodily function, I am just wary...at some point in time bulimics get hooked on laxatives and their bodies can't function without them...what is this prolonged exposure doing to my 5 year old?

I just want him to be able to go to the bathroom without pharmaceutical assistance and not scream in pain and agony. Is that too much to ask?