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Gastroenterology (Expert Forum)
Need guidance in J-tube feedings
Answered by
Kevin Pho, MD - Internal Medicine
Kevin Pho, MD
Boston - MA
This forum is for questions regarding Gastroenterology issues such as Acid Reflux (GERD), Barretts Esophagus, Colitis, Colon/Bowel Disorders, Crohn's Disease, Diverticulitis/ Diverticulosis, Digestive Disorders, IBS, Stomach Pain.
Need guidance in J-tube feedings
by lonnisue, Apr 12, 2005 12:00AM
I have a severly disabled 22 year old son who is undiagnosed nueromuscular disease with seizure disorder. He has always required total care does not speak or ambulate. He has been in bed for two years since having hip-displacemnt surgery. (both hips) He has had a g-tube since age three. Since about October we have come to find out that his stomach is not working . One of the factors was a severe aspiration puenumonia at which point it was realized that his stomach was just not working.
At this point we had a g-j tube inserted through the same stoma the g-tube was in-with a port in his stomach (for emptying gastric fluids to prevent aspiration) and one in his Jejuenum. This tube was repositioned four times as the j section kept coiling back up into the stomach. All his meds were going into the g-port and feeds into the j-port.
He became ill again with psuodamonas puenumonia-His g-tube was clogged by the nurses, the j-tube was back up into the stomach and a huge ulcer was discovered at the front of his stomach. He became very depleted having no feedings only d-5. He lost 15 pounds total between both illness's.
We finally got a surgeon to place a j-tube from the outside-
Ideally we should be getting 3 cans of nutren-2.0 in there daily (one can formula-one can water-via pump).
We have been going good for a few days then the pump conection backs out and won't resume for a few hours up to a day or so.
He has gained 2.5 pounds since we have been home (about 2weeks).
I am told that he developes "air pockets" whcih are probably the culprit.
He does not have a bm without a suppositiory or enema due to lack of muscle tone. We have had the new tube checked for postion three times already-it always seems to work just fine- only after many hours of nothing through the tube.
Since he is so depleted and only at about 58 pounds (61 before all this started) I take him to the er for some iv fluids and to check his potassium and tube placement-this screws up his schedule even more (viscious circle).
I am having very very much trouble getting him the medical care he requires since he turned 21-They stopped us form going to the university hospital he has gone to since birth and some fo the local docs I have tried to get to see him have flat out said "no". I really need some answers!
Is there a regimen?? schedule?? any advice or suggestions??
We can't take reglan causes severe seizures-have also tried cisapride with the same results.
HELP US PLEASE
lonnisue
At this point we had a g-j tube inserted through the same stoma the g-tube was in-with a port in his stomach (for emptying gastric fluids to prevent aspiration) and one in his Jejuenum. This tube was repositioned four times as the j section kept coiling back up into the stomach. All his meds were going into the g-port and feeds into the j-port.
He became ill again with psuodamonas puenumonia-His g-tube was clogged by the nurses, the j-tube was back up into the stomach and a huge ulcer was discovered at the front of his stomach. He became very depleted having no feedings only d-5. He lost 15 pounds total between both illness's.
We finally got a surgeon to place a j-tube from the outside-
Ideally we should be getting 3 cans of nutren-2.0 in there daily (one can formula-one can water-via pump).
We have been going good for a few days then the pump conection backs out and won't resume for a few hours up to a day or so.
He has gained 2.5 pounds since we have been home (about 2weeks).
I am told that he developes "air pockets" whcih are probably the culprit.
He does not have a bm without a suppositiory or enema due to lack of muscle tone. We have had the new tube checked for postion three times already-it always seems to work just fine- only after many hours of nothing through the tube.
Since he is so depleted and only at about 58 pounds (61 before all this started) I take him to the er for some iv fluids and to check his potassium and tube placement-this screws up his schedule even more (viscious circle).
I am having very very much trouble getting him the medical care he requires since he turned 21-They stopped us form going to the university hospital he has gone to since birth and some fo the local docs I have tried to get to see him have flat out said "no". I really need some answers!
Is there a regimen?? schedule?? any advice or suggestions??
We can't take reglan causes severe seizures-have also tried cisapride with the same results.
HELP US PLEASE
lonnisue
Doctor's Answer
by Kevin Pho, MD, Apr 13, 2005 12:00AM
, Apr 13, 2005 12:00AM
I am sorry to hear about this unfortunate situation.
I really don't have any new or insightful suggestions to help with this case. If there is continued difficulty in enteral nutrition, you can consider going with a parenteral route (i.e. either partial or total IV route of nutrition). This should be considered long term, but until your surgeon or GI doc can figure out what can be done to help with the J- or G-tube this can be considered as temporizing measure.
I would also suggest another option - possibly at a second major academic medical facility.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
I really don't have any new or insightful suggestions to help with this case. If there is continued difficulty in enteral nutrition, you can consider going with a parenteral route (i.e. either partial or total IV route of nutrition). This should be considered long term, but until your surgeon or GI doc can figure out what can be done to help with the J- or G-tube this can be considered as temporizing measure.
I would also suggest another option - possibly at a second major academic medical facility.
Followup with your personal physician is essential.
This answer is not intended as and does not substitute for medical advice - the information presented is for patient education only. Please see your personal physician for further evaluation of your individual case.
Kevin, M.D.
Medical Weblog:
kevinmd_b
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March 5th, 2005 he woke me at an early 3 am. He was not feeling so well and was moaning. I had shut his tube feedings off. He did ok until 6 am but when awakening he started vomitting, first claer then green then brown. I called the gastro doctor the first time and he said lets watch him. The second call 1 hour later he states it seems like his ileus is back. The third time I said I heard air coming from his stomach (j-Tube site) and when rolling him over his stoamch was like a hard basketball. He was picked up by ambulance 5 minutes later. They did tests, Xrays etc.... They ended up doing emergency surgery. They needed to remove 14 inches of his intestine and when reconnecting the good part it discinagrated. We had to wait 24 hrs, to see if indeed the tissue took. It didnt and his small, large intestine to his rectum was black due to NO blood supply. We then needed to take him off life support. He passed away 32 minutes after discontinuing the life support. He fought like a trooper til the end and had to make that discission in the matter of minutes. It was the hardest thing I ever had to do. He is no longer suffering but is saddly m issed everyday.
He ended up with a perferated bowel due to malrotation and sepsis syndrome. He was the best thing that ever happened to me and I personally would have as many tests done as possible, make sure he does not have an obstruction or ilues or anything that he can not tell you about. Doctors sometimes it is a guess to them also.
I wished there was more everyone could have done, of course. Maybe it was my sons time, part of me believe that they could have done something for him from Oct-March and they did not.
I wish you well and empithize and sympathize with you.
Good LUCK in all you do for your child. God Bless you all!