Excessive vomiting and trachs

Ann · #1 11-05-2003, 02:45 PM

Hi Val - Jack does not have a fundo, nor was one ever suggested and he vomited ALL THE TIME!! Â*I don't think the trach per se causes the vomiting, but the way secretions are handled with the trach is not the "natural" way the body deals with them. Â*I think the trach affects swallowing and also traps secretions and, therefore, causes a lot of gagging and puking. Â*Jack's weight was never an issue, nor did I seek any advice from the doctors regarding the vomiting (I try and stay away from doctors as much as possible), therefore, we always just dealt with it. Â*I have to say, that as Jack has gotten older, his vomiting has all but disappeared, but, also the amount of his secretions has dimished significantly (for reasons unknown). I believe there is a direct relationship between the amount of secretions and the amount of vomiting. Â*Does Matthew have a lot of secretions? Â*Can you give him anything to cut down on the secretions? Â*

Jack is also probably one of the few kids that is completely "drug free". He gets no meds for anything. Â*I feel like that is my biggest accomplishment with him!

Hope you get some answers and I don't blame you for not wanting a fundo done. Â*I'd try to avoid it if you could. Â*It is not a given that every kid with a g-button must also have a fundo.

Jacob's Mom · #2 11-05-2003, 03:29 PM

Unfortunately we didn't research this enough before giving the go-ahead for Jacob's fundo and, of course, hind-sight is 20/20. Â*Jacob has had a huge problem with gagging and wretching, although it is getting better. Â*Once I began researching that issue I discovered the fundo may be contributing to the gagging and wretching. Â*I also find that when he is fed too quickly or when air accumulates in his belly, he tends to gag more. Â*If I had the choice again, I would not allow the fundo to be done. Â*

As for Matthew, along with any meds for secretions, maybe you could suggest they give him something for reflux - Pepcid, Zantac, etc. Â*I don't know how often or how quickly he is fed, but maybe one or both could be adjusted so there is not so much in his stomach at once. Â*I would definitely try all other routes before the fundo. Â*

At any rate, I wish you and Matthew luck. Â*Please keep us posted!

Stefan & Jennifer · #3 11-05-2003, 09:08 PM

Nissen fundoplication does not guarantee no vomiting, as we found out much to our chagrin. There's a post fairly recently entitled "vomiting after fundoplication."

If vomiting is your only issue, there's ways to handle it without the fundoplication surgery, possibly. Fundoplication is meant only to fix reflux, not necessarily vomiting.

It's a tough surgery and if you can avoid it, do. Our sons secretions and swallowing of his own saliva improved after his reflux was cured, but the air in his stomach causes him a lot of discomfort and we have to be careful to "burp" his tube a lot and let him relieve pressure when he starts to gag, otherwise he may vomit.

#4 11-05-2003, 10:12 PM

The trach shouldn't cause vomitting. But as previously mentionned, excessive secretions and the swallowing of secretions may.
Robinol is a prescription med that is available to "dry" secretions. But then you have to worry about possible excessive dryness, which you do not want.
Reglan is another medicine that is typically giving for reflux, along with zantac or cimetidine to decrease stomach acid.
You also may want to vent Matthew's g-button about 30 minutes prior to each feed to let any residual and gas out of the stomach.
Try to give Matthew's feed while he is in an upright position, at least at an angle of 30 degrees.

I would try to avoid fundo, unless Matthew starts to aspirate and develops respiratory problems.

Good luck

cariaad · #5 11-06-2003, 03:28 PM

Something I just remembered we tried was thinning Alli's secretions. It was an over the counter medicine...guifiacine or some such. It's purpose is to thin bronchial secretions. It did help during a particularly rough time. If they are thinner they may come up easier and not xcause gagging which leads to vomiting. Deb

Stefan & Jennifer · #6 11-06-2003, 07:17 PM

Val,

That sounds exactly like Jake's problem--coughs and gags part way through his feeding and then starts working his way up to trying to vomit. We "unplug" his g-tube and let him vent air and formula into a syringe, he feels immediately more comfortable and we just let it drain back in (the doctors said not to throw out his stomach acid when he does this, it causes a PH imbalance in the stomach)...he's usually fine after that.

Good luck on finding a resolution to your problem. If your son doesn't have reflux, there's other options than the nissen. Our son gets Prilosec and Reglan even though he's had the nissen done.

Stefan

Laurie · #7 11-09-2003, 09:52 AM

Evan started having vomitting problems only AFTER his feeding tube was placed. We have had to do a lot of adjustments to his feedings to control it. He tended to throw up upon waking up in the morning, and lowering his night feedings from 60 to 50 ccs per hour helped. Play with the feeding volumes, times, etc. Matthew may just be a little overfull. Evan often vomitted after coughing, so it looked secretion related, but adjusting his feedings made a big difference. We had solved the problem, but the doctor ordered one of the new GJ mickey buttons (we can feed either his stomach or his jejunum) and we tried doing continuous feedings to the J tube, but now Evan is back to once per day vomitting again, so I think we will try to take the J button out. Good luck!