Thursday, July 24, 2014

GI Update: Colon Transit Study or Sitzmarker Study

After not hearing back on Monday, I had to hound the GI office to get a treatment plan.  Apparently Ellie's GI doc is on vacation and as such, her case is now being handled by the on-call doc.  The Dr. S, the on-call gastroenterologist, was the nice young man who performed Ellie's anorectal manometry.  We were called in for an emergency GI office visit on Tuesday.

Ellie after her GI visit on Tuesday.

By Tuesday, Ellie had not had a bowel movement in 9 days.  She had 4-8 x increase in her daily Miralax, Exlax x 2, Milk of Magnesia x 1, a glycerin suppository, 1 enema and 1 enema that I couldn't get into her.  This is along with her probiotics, juice, and a ridiculous berry consumption.

Ellie's X-ray showed normal bowel gas patterns which means gas was able to move through her intestinal tract.  Translation: no bowel obstruction!  There was moderate impaction from her ascending colon to the rectal-sigmoid colon.  Translation: moderate constipation throughout most of large intestine excluding the rectal vault.  Dr. S asked me if she went and didn't tell me since he expected to see much more stool on the Xray.  I incredulously looked at him and said "um, she is in a diaper so I am the one changing her and school gives me a daily report over the phone".  I was very thankful that she wasn't more backed than she was given how long it had been.

Bear is still up to her usual antics

There is a thought that Ellie's colon is moving very slowly.  This is called delayed transit.  Basically the stool does not move through the gut like the majority of the population's does.  As such, more and more water is reabsorbed into the intestine making the stool hard.  Hard stool = constipation and as such makes it much more difficult for Ellie to go.  The confusing part is why her rectum is consistently empty.  The doc has no explanation and is confounded.  I am finally being listened to!  Three different GIs have told me that she is stool withholding.  This is impossible.  The urge to go is felt in the rectum and if her rectum is empty. . . well you get the point.

To determine Ellie's gut motility, we are conducting a Sitzmarker Test aka Colon Transit Study.  This morning I force-fed 2 spoonfuls of yogurt containing 24 tiny radio-opaque rings that will show up on an X-ray.  On Monday, Ellie will have another abdominal X-ray.  They will count the number of rings in her colon and also look at the location of the rings.  Retaining 13 rings is considered within normal limits.  A repeat X-ray on Wednesday may also be necessary.

Right Colon 
Left Colon
4th Day

7th Day

Transit Time
12 hours
14 hours 
16 hours
42 hours 

Normal Value
11.3 hours 
11.3 hours 
12.4 hours

35 hours
This is for an adult--they take 3 capsules, not 1 like Ellie.

On Tuesday evening, Ellie had a bit of diarrhea.  I guess the laxatives are finally working.  She had 3 more bouts through last night [Wednesday].  I am concerned that this will throw off the results of the transit study as diarrhea = increased motility.

Finally, Ellie is in the process of starving herself.  Last Monday 7/14, Ellie weighed in at 30.4 lb.  On Tuesday, she was down to 29.2 lb.  I am afraid to weigh her today.  On Tuesday, Ellie stopped drinking but was eating small amounts of food.  On Wednesday, she stopped eating but did drink.  After 40 hours of not eating, today she had a mini lunch at Quizno's.  She is also drinking.  She is not sleeping very well and as such is a little more wild and cranky.  I feel horrible for Ellie.  She must be positively uncomfortable.  I am really looking forward to getting some answers in the next week.

Desperate times call for desperate measures: Quizno's
Blowing y'all a kiss!!!  


1 comment:

  1. It must be very difficult and frustrating for you all to have to go through this. We struggled to get our daughter's coeliac disease diagnosed many years ago and lived through constipation, vomiting, and finally classic symptoms of malnutrition - swollen belly, thinning hair, anaemia etc. And don't get me started on doctors who won't believe mothers know what they are talking about....! Yes my child is ill, no she is not eating because she is ill, she is not ill because she is not eating!
    I sincerely hope the next round of tests provide you with an answer, and a resolution to what is ailing little Miss Carmen Miranda!


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