Answers

With James' potassium back on track and ruling out the teflitis yesterday, the GI team got involved again and they brought the surgical folks with them. They all came by to see James and ask me some questions about James' history. The information they gathered comfirmed their suspicions that James' problems are caused by enterocolitis, which is very common in children who have had Hirschsprung's disease.

Enterocolitis is essentially an inflammation of the lining of the bowel that causes the sphincter muscle to tighten up, retaining stool in the colon, destroying the lining and allowing infection to fester and attack the colon walls. If left untreated the results can be devastating--the colon can burst causing all this infectious fluid to spread throughout James' little body. If he survived that, clean up would surely be an incredible challenge. Somehow, no one is exactly sure how, a history of Hirschsprung's disease seems to predispose many children to enterocolitis. In other words, some of this is just in James' genes, although, it is likely brought about by the chemotherapy and it will be something we will have to work to protect him from during the course of treatment . For as long as this has been going on, it is likely another miracle that James has not yet had any more systemic infections.

Last night, James had a rectal tube placed to decompress his colon. So far he has drained about 750 ccs (about 25 ounces). Right after placement, he had an x-ray to be sure the tube is where it belongs. This morning, he had another which shows things have improved significantly. The hope is that over the next day, he will decompress enough that the tube can be removed. In other children (not on chemotherapy), they might also run a flush through the tube (either sterile water or saline, I can't remember which) to help clean things out. But there is some concern about doing that with James and the surgeons are hopeful that drainage will be sufficient.

Dr. Briones, the attending oncologist, was pretty nervous about the whole thing. He called last night to check on James and he is anxious to have the whole procedure completed. This morning he was wondering how long the whole process would take. He even said we really need to pray that James doesn't get an infection from this.

So, please keep praying with us that the infection James has (actually it's an inflammation of the lining of the colon) will clear completely and that he will be protected from further infection. We are thankful that this whole thing seems to have been contained so well--a miracle in itself.