Six-week Follow Up

Today LM and I went in for the six-week follow up to his original appointment.  He was scared.  He cried before we left the house, he fell asleep in the van on the way to the hospital.  He hid behind me when we saw the doctor, and when he saw the nurse who administered his first enema. 

They told him that this was a talking appointment and that there would be no touching or looking at of his bum.  He still chose to sit in the chair furthest away from the doctor, across the room from the nurse.  LOL

We were able to convince him to lay down on the table and the doctor felt his tummy.  She said it felt great!

The doctor asked about LM's bowel movements - she was impressed with his once every 1-2 day regularity, and the nurse liked the sound of the quality of those bowel movements.  They told me that they were really happy with this progress; they said that I am doing fantastically, and told LM that he is doing a great job. 

They told me that his recovery is happening so quickly - that normally it takes 6-12 months for this kind of improvement!!  Wow!

There were no x-rays taken, which I'm kind of bummed about; I'd like to see the difference, but I guess if they were necessary, the dr. would have ordered them.  She is going to write a letter to my dr. asking if she will take on LM as a patient and follow up with him on this issue.  I have recently decided to stop taking LM and his siblings to the dr. they've been seeing since LM was born because that dr. moved to a building downtown and cut his hours back to only one day per week.  He is older and reaching retirement age...maybe past that age, but I can't make my life fit into that timeslot.  So I'm trying to get my kids in with my doctor.  I can't do that, though, until they have an issue that requires me to take them in as a walk-in.  The problem with this is that my kids are generally healthy and I am not a "rush to the dr." sort of person.  So...they might not have another checkup for a long long time.  The perfectionist in me is very stressed by this.  One of my children has missed his yearly check up and that is so hard for me to deal with.  Gah.

Anyway, the doctor said to the nurse that it would be such a great idea to have a website all about constipation, with ideas to get more fibre into a child's diet, etc. and I said, "I did that!  I started a blog about this whole process and our path." 

I'm not sure they heard me.  LOL

The appointment was good, we won't see them again, I don't think.  It's too bad because they are wonderful and caring.  It's good though, because now we know how to fix this, in all of our children.  :)

Sweat Test

Today LM went in for a sweat test.  A sweat test is used to rule out diseases like Cystic Fibrosis, of which constipation is a common ailment.

My DH took LM to the lab at the hospital for the test.  The staff there were fantastic as usual and the test went smoothly and quickly.  It wasn't scary or invasive.  They had recommended that LM bring some toys/snacks/books to pass the time while he did the sweat test but he and DH barely had time to put together the puzzle they had brought before the machine had collected enough sweat for the test.  Perfect.  :)

Two Week Update

Things are going well!

LM is having regular DAILY bowel movements without pain or blood.  He is not running to me crying when he has to go anymore; instead he comes and tells me.  Soon he'll be going all on his own!

We have made 2:45pm our time to go and have him sit on the toilet if he hasn't had a BM yet by that point in the day.  I have him sit there for 10 minutes, and usually something will happen then.  I am so glad!

We have switched fully over to whole wheat pasta - the Great Value brand (Walmart) tastes great!  I've started putting whole wheat flour into our baking (biscuits last night) and fibre is always at the forefront of our thoughts about food.  I kept track of every gram of fibre that first week and it was very easy to slip into it becoming a habit and to just know when we'd gotten enough fibre into the day.

All snacks are now fibre filled, and that is where we get the bulk (haha) of our fibre as the kids don't really eat much at mealtimes.

I am now working on the kids to start drinking more again; LM loves cups with straws and our 2 year old drinks much better from sippy cups than open-topped cups, so we've had to go back to those kinds of cups.  This is kind of a big thing for me because I don't like sippy cups, and at age 1 we start giving our kids normal cups to drink from.  However, this is a medical situation that I don't want to struggle with anymore, so sippy cups it is, for as long as the kids want them.  At least the sippy manufacturers are making some cups to look more like travel mugs than sippies - I really really appreciate that.  Our kids each have one in their own colour - even our 8 year old and 7 year old each have one.  We bought them for a road trip last summer, and now they are being used on a daily basis by the younger kids.  And I am going to stop making a big deal about cups right NOW.  :D

Anyway, things are going well on our quest for more fibre.  LM is down to just the Lax-A-Day once per day, and we have not had to increase the dose at all, which is something that the nurse said might happen.

YAY!  :D

Apple Fibre Cookies

Apple Fibre Cookies

Ingredients

• 2 egg whites
• 1/2 cup brown sugar
• 1/3 cup margarine
• 1 1/4 cup All-Bran cereal
• 1 1/4 cup apple juice
• 1 apple, cut up
• 1/2 cup raisins
• 1 cup all purpose flour
• 1 cup whole wheat flour
• 1 TBSP baking powder
• 1 TBSP cinnamon

Directions

Mix until wet. Drop on cookie sheet (about 16 cookies.)
Bake at 350 for 15 - 20 minutes.

~~~~~~~~~~

Thanks so much to Heather for emailing me this recipe - all SIX of us like it, and that in itself is AMAZING.  :D

These cookies are FANTASTIC - moist and delicious.  I made them exactly as written here, but next time I may try putting in some dried cranberries in place of the raisins, just to see how they taste.  

Also, I'll likely make them into smaller cookies; I made 19 and they were pretty big; a little too big for the kids to handle, I think. 

I've misplaced my paper that I used to calculate the fibre content, so I will update this post when I find it.  I believe that I made 19 cookies and each cookie contained 3 g of fibre.

Day 6

Breakfast (3g)...3.5g
Snack (3g)...2g
Lunch (3g)...1g
Snack (3g)...3g
Dinner (3g)...7g


Exercise (30 min)...Yes
Bowel Movement (1-2)...0  :(
Water (6 cups)...4?


Lax-A-Day (bedtime)...Yes

Day 5

Breakfast (3g)...3.5g
Snack (3g)...2g
Lunch (3g)...3g
Snack (3g)...??g
Dinner (3g)...5g


Exercise (30 min)...Yes
Bowel Movement (1-2)...1 (enema induced)
Water (6 cups)...6+


Lax-A-Day (bedtime)...Yes

Fruit Smoothies and Avocados

I have my first reader suggestion/tip!  :)

Tamara wrote:

Hi Amber,

I worry that my son doesn't eat enough fresh, raw food and get enough fiber too. Luckily, he hasn't had such a difficult time as your son. Your little guy is a trooper and I'm sure all will be all right.

I make smoothies for my kids with banana, strawberry, blueberry and almond breeze. We throw in a tablespoon of finely ground flaxseed for each kid. The flax seed is not noticeable at all and they love the smoothies.

Do your children like guacamole? Avocados are high in soluble fiber and can help keep things moving along as well.

All the best,

Tamara

Thanks Tamara!  This morning I made up a smoothie based on your suggestion, and all four kids enjoyed their cup of it!  Here's what we had:

Fibrey Fruit Smoothie

1 cup strawberries (3g fibre)
1/2 cup blueberries (5.6g fibre)
1 medium banana (3.9g fibre)
2 tbsp ground flax (4g fibre)
1 cup almond milk (1g fibre)
1 cup 2% milk
1/2 cup strawberry yogurt

Blend all together until smooth.

This made 5 cups, so we each started our day with 3.5g of fibre!  And it was SO easy.  And the kids still had more breakfast after their smoothie so I'm sure they had some good energy to get them through to lunch.  :)  I will definitely be making smoothies much more often now!

Did you know...?

Did you know that almond milk has 1g of fibre per cup?

It's not much, but every little bit counts!

Day 4

Breakfast (3g)...3g
Snack (3g)...1g (granola bar at preschool)
Lunch (3g)...4g
Snack (3g)...3g
Dinner (3g)...4g


Exercise (30 min)...Yes
Bowel Movement (1-2)...0  :(
Water (6 cups)...4


Lax-A-Day (bedtime)...Yes

~~~~~~~~~~

Today was a hard day to track and to get enough fibre in.  LM went to preschool and even though that is just two hours and one eating time, it is precious fibre time.  LM is not a big eater.  So if he eats a snack at preschool and is too full to come home and eat another snack containing extra fibre, then I'm kind of messed for the day.

He also didn't have a BM which worries me a little.  I am thinking that if he gets into the habit of going every day then he will learn faster that it doesn't hurt and that it isn't scary.  He did have a second BM last night after bedtime; perhaps I can count that for today's?

I did get to the grocery store and found a few packaged snacks.  I hate to buy prepackaged stuff, but it just is so much easier to see that fibre written out for me already and to know I can give LM one or two of these items and the fibre is there.  I got a few different things for him to try...so far his favourite is the Nutrigrain bar.  We used to always have these in our home, but fell away from that for some reason.  The kids LOVE them.  I guess they'll be back on our list permanently.  Each bar has 2g of fibre.  It shouldn't be hard to get LM to eat two of those in one sitting.

Today he also gobbled up strawberries, baby carrots and grape tomatoes, choosing them over pancakes at lunch and over chicken at dinner.

I am afraid that in doing this our meal balance is going to be thrown out the window and we'll be lacking in other things.  I hope that when the focus on fibre becomes more natural, the other stuff will come back.

Day 3

Breakfast (3g)...9g
Snack (3g)...4g
Lunch (3g)...1g
Snack (3g)...3g
Dinner (3g)...many g (LOL  I stopped counting at the second snack, but for dinner we had popcorn and fruit)


Exercise (30 min)...Yes
Bowel Movement (1-2)...1 (enema #2 induced)
Water (6 cups)...6+


Lax-A-Day (bedtime)...Yes

~~~~~~~~~~

Today was Fleet enema number 2.  Not a fun time, but hubby was on board and was a wonderful helper.  LM still was not happy, but he was just crying this time instead of screaming.  It HAD to be better for him that the hug was from his dad, the torture was from his mom and there was no one else in the room.  We did it in our bedroom, with a show of LM's liking on the TV and some Smarties as a reward.  Just one more time.  We can do this!

The increase in fibre and fluids has already been affecting the rest of the family as well.  The gas in this house?  Whew!  And our two year old now has to visit the bathroom about 70 times per day.  Since she will not use the potty, just the toilet, this means that one of us has to go up there with her every time because she can't climb up onto the toilet herself without falling in (which we found out the hard way).  Bonus exercise for Mom and Dad!  :D

Oatmeal Chocolate Chip Muffins

Oatmeal Chocolate Chip Muffins

Ingredients

• 1 1/3 cups Rogers Porridge Oats*
• 1 1/3 cups milk
• 1 egg
• 1/2 cup vegetable oil
• 3/4 cup packed brown sugar
• 3/4 cup Chipits semisweet chocolate chips
• 1 1/4 cups all-purpose flour
• 4 teaspoons baking powder
• 1 teaspoon salt

Directions

1. Combine oats and milk and allow to stand for 15 minutes. Preheat oven to 400 degrees F (205 degrees C). Grease each cup of one 12-cup muffin tin.
2. Stir egg, oil, brown sugar and chocolate chips into the oat and milk mixture.
3. Combine flour, baking powder and salt. Add oat mixture to flour mixture, stirring until just moist. Fill each cup of one 12-cup muffin tin 2/3 full.
4. Bake at 400 degrees F (205 degrees C) for 20 to 25 minutes.

Makes 12-16 muffins depending on the size of your muffin tins.  Contains 34 grams of fibre; divide this by the number of muffins you make to get a per muffin amount.
__________
* Rogers Porridge Oats are a mix of oats, oat bran, wheat bran and flaxseed.  I purchase this to use in any baking that requires oats (I've also used it in meatloaf).  I found them at Walmart, but haven't seen them anywhere else.

You may also add nuts (such as pecans) to the mix or as a topping mixed with brown sugar for added fibre.  My kids don't like nuts, so I didn't add any.

If you try this, let me know what you think!

Applesauce with Craisins - 5g

This is a high fibre snack that all of my kids loved!

2/3 cups of applesauce (2g fibre)
1/3 cup of Craisins (3g fibre)

I put the applesauce into a bowl and sprinkled the Craisins on top.  5 grams of fibre, just like that.

One of my children doesn't like Craisins, so he had it with raisins instead, which contain 1 g of fibre for 1/4 cup.

Day 2

Breakfast (3g)...2g
Snack (3g)...5g
Lunch (3g)...2g
Snack (3g)...5g
Dinner (3g)...2.5g


Exercise (30 min)...Yes
Bowel Movement (1-2)...1
Water (6 cups)...4


Lax-A-Day (bedtime)...Yes

~~~~~
I was OVER THE MOON today when LM pooped with no blood and no pain!  It is working already.  I cannot wait for the day that he goes to the bathroom all by himself without tears of fear that it will hurt.  To see such quick results is a blessing, because I've been telling him that the doctor wants to help him,  not hurt him and that the fibre and water will fix things if he keeps up with it.  Immediate results are exactly what a four-year-old needs and that is what he's gotten.

It will be exciting to look at that x-ray in six weeks and see a nice clean picture.  :)

Day 1

Friday, October 22

I've decided that to get LM his 14 grams of fibre, I will serve him snacks at a set time and aim for 3 grams of fibre in each meal/snack.

Breakfast (3g)...??
Snack (3g)...none
Lunch (3g)...2g
Snack (3g)...none
Dinner (3g)...refused dinner

Exercise (30 min)...none
Bowel Movement (1-2)...1
Water (6 cups)...4

Lax-A-Day (bedtime)...Yes

The Plan

This is the plan that the nurse laid out for us:

Friday (at hospital):  deep Fleet Enema (nurse did this with tubing to get it up higher)
Sunday (at home):  Fleet Enema #2
Tuesday (at home):  Fleet Enema #3
Wednesday:  Pico-Salax drink; 1/4 pouch at 8 am, 1/4 pouch at 2 pm

Daily starting immediately: 
- 10g of Lax-A-Day
- 14 grams of fibre from diet
- six cups of water

Make appointment to return for sweat test at lab.
Make appointment to return for follow up in six weeks.
Try to get LM in as a patient of my doctor since his is on the way out.

I'll also be aware of LM's exercise...I want to make sure that he gets in at least 30 minutes of running/biking/hard playing per day.  Keep moving to keep things moving.  ;)

And off we go!

The Appointment

We had to wait two months, but we finally got in to see a doctor that would do something for LM's fissure.  The appointment was at the surgery clinic at the local children's hospital, and I have to admit, the thought of surgery made me a little bit anxious.  LM would NOT take the idea of surgery well; I knew it, and I hoped there would be a quick answer; diet changes, not a big deal, yadda, yadda, yadda.

Well, that is not quite how it went.  We arrived for our appointment at 10:15 in the morning.  They had asked me if I preferred a morning or afternoon appointment and since my sweet hubby was working evenings this week, I figured a 10:15 appointment would give me plenty of time to talk to the doctor, stop at the drug store and get home to feed all the kids lunch.

We sat in the exam room and I explained to LM that he would have to show the doctor his bum.  He asked if the door would be closed.  Yes.  He asked how many people would be in the room.  I told him it would be us and the doctor and maybe one nurse.  He said he was okay and that he didn't have any more questions.

LM is a shy boy and when he didn't talk to the resident that came in first, I answered her questions for him.  After a few minutes, he warmed up to her.  Then she said he'd have to pull down his pants, just a little, for her to take a peek.

Yeah, there was no way he was going to do that.  He started to cry.  The resident said she'd go to get the doctor right now so that he only had to drop trou once.  She left the room and I wrestled his pants off him while he screamed like I was removing a limb and not just some fabric.

The doctor and resident came back and took a peek at his anus.  The doctor said that the fissure is healed right now (sounds like he heals fast like his daddy!).  She put on a glove and stuck in a finger {insert blood-curdling scream here}and commented that there were balls of hard stool just inside.

And I thought that would be it.  Alter diet, be on our way, right?

Wrong.

Just after 11:00 we were headed to the x-ray department for an abdominal picture.  We got in there quickly, much to LM's dismay.  They had a very fun video game there that he wanted to get back to after he was done his x-ray.  We had to pass it by though.

We returned to the surgery clinic to see the doctors again.  They put us back into an exam room where we sat, listening to their excited conversation in the hall outside.  In just a moment, they called me out.  They wanted me to see the x-ray.

"I don't know if you see x-rays very often," the doctor started, looking at me.

"Nope," I replied.  I hadn't seen an x-ray in quite awhile, thank goodness.

And they started explaining it to me.  First of all, all my interest in medical books did not teach me that the bowels went up and across and back down.  I thought that was something else, like a large intestine.  But I guess that doesn't make sense for the large intestine to come after the small intestine...

He was full.  PACKED full.  All the way from his rectum, up and across and back down.  Full of poop.  The doctors marveled at this.  They commented that this was one of the fullest kids they'd seen.  I started thinking that LM could be the poster child for full-of-poop.  And then I started wondering how the heck he is still so skinny with all that crap (literally) lodged in his abdomen.  THEN I started worrying about how skinny he'll be when it all comes out...

The doctor snapped me away from my thoughts by mentioning that they would have to do something about this today.  He was just too full.  I didn't really grasp what she meant until a nurse came along with a box in her hand.  It read Fleet Pediatric Enema.

Oh crap.  LM is NOT going to like this.  And I'm going to have to get his pants off again, seriously? 

They called the nurse that specializes in bowels.  She took LM and I into the treatment room and went over about nine pages of instructions, meds, diets and fibre - twice.  Another nurse came in and they suited up.  I lifted (wrestled?) LM up onto the bed...and he screamed while the nurse held him and I tried to get his pants and underwear off.

And he screamed while the nurse cradled him on his side on the bed, patting his head and offering reassurance to him while the other nurse inserted the tube.  They wanted to do a deep enema just because he was so full.  I tried to hug him and show him love while paying attention to how the enema was administered; I'd have to do it twice more at home and this was something that I did NOT want to mess up.

He screamed while they held him on the bed, waiting for the enema to take effect and begin the contractions that would push out the stool.

He screamed as I carried him to the bathroom and set him on the toilet.  He screamed that he wanted to go home.  I hugged him until he told me to stop because he didn't want me to hug him while he was on the toilet.  The nurses shut the door and left us alone in the bathroom, saying we could take as long as we wanted - as long as LM wanted - then we were free to go.

He pooped.  And there was blood.  And mucous.

It was quite alarming to me, and I'd been seeing this stuff for a couple months now.  One of the nurses came back to check on us and I got her to peek into the toilet.  "All normal," she said.

LM recovered his emotions and I helped him get dressed.  We walked out to the treatment room and were handed a bag with all of the paperwork that the nurse had gone over with me.  And a lab requisition.

My stomach dropped.

LM asked if we could please just go home now.  I told him that we had to make one more stop, and his groan almost broke my heart.

I opened the lollipop that the nurses had given him before the treatment had begun and gave it to him.  And we walked to the lab.

"What are we doing here, Mommy?" LM asked.

"Well," I started, trying to find the least scary words (I didn't find any).  "They need to take some of your blood."

This started the howling up again.  LM cried and cried.  I held him and rocked him and kissed his forehead.  This was agonizing and my child wasn't even really sick.  My heart went out to all the parents that were actually in the hospital because their children were patients there.

When LM's sobs subsided I told him I was going to call his daddy and he could come with me or stay on the couch where he sat.  I went to the phone on the wall that would allow me to dial out (no cell phones allowed) and phoned my husband to let him know where we were and that we'd be awhile.  And I almost lost it.  My eyes filled with tears and I recounted the morning that we'd had and all the stress that LM had been faced with.  But I didn't let them fall...this was not the time nor place.

After about 45 excruciating minutes of waiting in the crowded lab, LM was called back to the room to have his blood drawn.  More screaming.  More crying.  The nurse felt for him and told him to take as many stickers as he'd like.  He didn't take any.  I picked out a bandaid for him and another nurse came in to hold down his arm.  As he cried, they took his blood and I could not get him to look away from the needle.  The nurses thanked him for turning his arm the right way in his struggle to get away (I guess lots of kids turn their arm the wrong way and the nurses have to re-insert the needle).  They told me that there'd be a bruise there later because he was so tense.  I nodded but barely heard them.  I was busy telling LM that it was time to go HOME!

"Can we still get ice cream?" he asked.

"Of course," I said, throwing out the window the deal we had about him being brave and us getting ice cream for that.

We did get ice cream - for everyone in the family.  And I got him a kids meal for lunch too (since we didn't get out of there until almost 2:00 pm) because we never let our kids get kids meals.

As I write this, my emotions are still right below the surface.  They are made even stronger by the memory of a nine year old girl who struggled through a blood test herself.  Her mom had to sit on her.  It was the same hospital, different location, almost 23 years ago.  That mother had promised the girl a special cassette tape for her Cricket doll, if she was brave for her blood test.  That little girl wasn't brave.  Her mom had to hold her down.  She got her reward anyway too.  The girl was me.

The blood was collected to test LM's CBC, electrolytes, glucose (I wonder how that will come up with two lollipops and no water in his system!), calcium, phosphate, urea, TSH, and Free Thyroxine.  They will also test for Celiac disease.  I need to make an appointment to return for a sweat test which will rule out Cystic Fibrosis.  The doctor wants to make sure that they cover everything that could cause constipation before just jumping to a conclusion that LM's problem is his diet.

We'll return for a follow-up appointment in six weeks.  I'm hoping to hear "case closed" then.

And now I start working to make that happen!

The way this all began

This problem kind of snuck up on us.  Back around the beginning of June, LM started having hard stools.  He would go to the bathroom and would come out crying in pain.  Eventually he became afraid to go to the bathroom and it became an issue.  My four year old son all of a sudden needed me to not only accompany him to the toilet, but also to know that he had to go there in the first place.  He wouldn't tell me that he had to go, but instead would come to me sobbing.

To be honest, it was quite frustrating.

By the end of June, there was blood in the toilet, every time.  Now I had a sobbing mess of a child and a toilet filled with blood.  Upon some investigation, I found that his poop was splitting him open, no matter how soft or hard it was.  I tried to coach him through it, telling him that as much as it hurt, he could NOT hold it in for days on end.  I loosely began to research fibre.  We started adding more into our diets, but nothing serious.

We went on our summer vacation and came home, no change.  I made sure LM was drinking enough.  He was always a good water drinker; that couldn't be the problem.  I searched the internet for answers.  I tried lactulose, colace, mineral oil, benefibre...no improvement, no improvement, no improvement, no improvement.  I started to worry about long term effects of me just giving LM "stuff to help" on the recommendations of friends and family.  I read about anal fissures and felt HORRIBLE for not taking LM's cries of pain more seriously.  I stopped it all and took him to the walk in clinic at the beginning of September.

Well, walk-in doctor would not even look at LM's bum.  He ordered a referral to the children's hospital surgery clinic and sent us away with a prescription for ratio-Hemcort-HC, a topical ointment that I could put on the fissure.  He told me to give him more of the Colace.

I left the office thinking that the doctor could have at least looked at it and saved me time.  It turns out he made the right decision.

I'm on a Mission - Introduction to this blog

I'm on a mission to help my son with his problems.  His poopy problems.  And maybe I can help your son too, in some hands-off way, by writing this.  Or maybe your daughter.

Yesterday my boy had an appointment at our local children's hospital.  It was to start at 10:15am and be an in and out consultation sort of thing.  This is not how it was.  It turned into a big thing.  And it was shocking to me.

I'll call my boy LM, to protect his identity, because I'm sure he'd rather that I didn't share this with the world, but I think it is something that people should know about (he chose LM himself).  I have had 2 other children with constipation problems at some points in their lives, and I have had problems myself.  None of us have seen a doctor about it until now, but I did bring it up at one of my children's check ups and the doctor's advice was, "drink more water."  SO NOT HELPFUL.  That is so not helpful when your child doesn't like water, or when they are already drinking six cups a day.  And any information online is so vague, it is hard to know what you can do, and it is hard to know the seriousness of something that you can't physically see.

Also, I need to map his progress for myself, so I can look back and know that my efforts are paying off.  Because I know I will need that reassurance eventually.

My plans for this blog are to record the journey; to share what has worked for us and what hasn't; and to have a place to keep ideas for high fibre recipes, modifications to existing favourite recipes, and ideas for snacks that will keep things moving along.  If you have struggled (or breezed!) down this path too and would like to contribute some tried and true tips or recipes, please email me at fibreful@gmail.com and I will share it in a future post.

Welcome to a fibreful life!