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View Full Version : Help! post surgery--possible SMA



trav86
07-13-2010, 05:26 PM
My son had a fusion on 6/30 with Dr. Michael Vitale. Spencer was discharged from the hospital on 7/4 and, aside from being quite crabby, seemed to be doing pretty well. But this past Sunday, 7/11, he started vomiting up everything he eats. We went for a 2nd post op visit today and one of Dr. Vitale's associates said it could be SMA. The small amount of research I've done has me scared. Does anyone have experience with this issue?

trav86
07-13-2010, 07:55 PM
SMA stands for superior mesenteric artery syndrome--a new, scary term for me.

Pooka1
07-13-2010, 08:21 PM
Okay I read up on that. It's amazing that they suggested that, it being so exquisitely rare. But it is good that they thought of it if indeed your son has that.

How many cases have they seen? I bet not many.

It sounds like there are fixes for it, both conservative and surgical.

It's good you got it early if that is indeed what he has.

Hang in there. Keep posting.

Best regards,
sharon

trav86
07-13-2010, 11:49 PM
I spoke w Dr Vitale tonight; he said if it was SMA it would have happened immediately after surgery, but the various things I read online said it typically happens 6-12 days post op. Kevinsmom posted her son's experience w SMA on this forum about 5 years ago and the symptoms correspond almost exactly to Spencer's. Dr. V says maybe a stomach bug, take him to pediatrician. Meanwhile, Spencer ate 2 tablespoons of white rice this evening and couldn't keep it down. He hasn't consumed and digested any food since Sunday. I'm trying not to freak out. Pediatrician tomorrow.

Confusedmom
07-14-2010, 03:46 AM
So sorry you/your son are going through this. Is he having normal bowel movements? Lots of people have posted about functional bowel obstruction post-surgery because of all the drugs. That can cause vomiting, too.

Keep us posted--sending good thoughts your way.

Evelyn

Pooka1
07-14-2010, 06:08 AM
I spoke w Dr Vitale tonight; he said if it was SMA it would have happened immediately after surgery, but the various things I read online said it typically happens 6-12 days post op. Kevinsmom posted her son's experience w SMA on this forum about 5 years ago and the symptoms correspond almost exactly to Spencer's. Dr. V says maybe a stomach bug, take him to pediatrician. Meanwhile, Spencer ate 2 tablespoons of white rice this evening and couldn't keep it down. He hasn't consumed and digested any food since Sunday. I'm trying not to freak out. Pediatrician tomorrow.

The pediatrician might be a place to start but you might consider elevating this immediately to a specialist which I guess would be a gastroenterologist or someone who has a chance of having seen some of these cases.

Good luck.

Pooka1
07-14-2010, 06:08 AM
So sorry you/your son are going through this. Is he having normal bowel movements? Lots of people have posted about functional bowel obstruction post-surgery because of all the drugs. That can cause vomiting, too.

Keep us posted--sending good thoughts your way.

Evelyn

We can only hope and assume they don't send kids home without bowel sounds.

twinsmom
07-14-2010, 07:09 AM
Wil all the surgeries we have been involved in, we have always had excellent care and observation of bowel sounds before discharge. Good luck and this wont last forever! Mary

Pooka1
07-14-2010, 07:18 AM
Wil all the surgeries we have been involved in, we have always had excellent care and observation of bowel sounds before discharge. Good luck and this wont last forever! Mary

Yes I don't think the situation with long-term narcotics usage causing bowel issues applies to kids as a rule as it might apply to adults as a rule. There seems to be a very wide gulf in recovery trajectories between kids and adults.

What kids do have to deal with are surgeons who do NOT restrict all food and drink prior to bowel sounds and they suffer needlessly and horribly because of it. The surgeons know better. I assume the OP's surgeon ruled out an ileus but you can never be sure what with the sheer number of patients and parents who come on here who clearly have been allowed (or just took it upon themselves to ignore advice) food and drink prior to bowel sounds.

Maybe there is hope this is an ileus and not SMA. That question needs asking.

Pooka1
07-14-2010, 07:18 AM
Does anyone know if Dr. Vitale restricts all food and drink prior to bowel sounds?

Maybe we can solve this right now though probably not.

trav86
07-14-2010, 08:13 AM
I don't know if bowel sounds were a criterion for Spencer being allowed to eat and drink post op. We were not told that food or drink were restricted, but he didn't eat or drink anything for about 24 hours because he didn't want to. At some point, they reduced the amount of fluid he was receiving IV because they wanted him to drink. About day 3, he was put on restricted liquids because his sodium was low. He was also given laxatives orally every day while in the hospital and had a bowel movement before he went home.
Do you know if his symptoms are consistent with an ileus? They sure don't seem consistent with a virus.

Pooka1
07-14-2010, 09:03 AM
I don't know if bowel sounds were a criterion for Spencer being allowed to eat and drink post op. We were not told that food or drink were restricted, but he didn't eat or drink anything for about 24 hours because he didn't want to.

Our surgeon was extremely strict about this. Neiher kid had food or water until Day 3 when bowel sounds were heard. This was heartbreaking because they were very thirsty starting on the day of surgery for most of that time though they were not very hungry at all at any point while in the hospital. But it was the lesser evil... the surgeon is strict about this for a very good reason and you can read all about that reason in the various testimonials on this site which sound horrifying.


At some point, they reduced the amount of fluid he was receiving IV because they wanted him to drink. About day 3, he was put on restricted liquids because his sodium was low. He was also given laxatives orally every day while in the hospital and had a bowel movement before he went home.
Do you know if his symptoms are consistent with an ileus? They sure don't seem consistent with a virus.

I am no expert but if he had a bowel movement then I think that rules out an ileus but by the same token, why doesn't that rule out SMA also? What I don't know is if an ileus or SMA can develop later after the bowel is clearly working. Perhaps this may be due to an adhesion or something? Anybody know?

The low sodium might be a clue. See if you can link that to SMA or ileus or something.

You will solve this. Press ahead and press the surgeons to discuss details of differential diagnoses.

CamsMomKelly
07-14-2010, 09:24 AM
Trav86, I hope this is just a minor setback and he gets over it quickly.
Pooka what do you mean restrict food/water until bowel sounds heard? My son has had 3 previous surgeries(notfor Scolio) and they have always started on the drinking right away, food maybe day later, then of course miralax or something to get it going... Is this not how some do it?? Im not trying to argue with you or anything just curious...

trav86
07-14-2010, 10:09 AM
From what I've read online, it seems that being able to move one's bowels does not rule out either ileus or SMA. Spencer had some ginger ale this morning and thus far has kept it down. We're trying jello now. I read a study that said lying on the left side can help alleviate SMA, so I'm having him do that. I'm thinking I'll buy something like ensure, but will consult with pediatrician before feeding it to him. We have an appointment at 1:30.

Gryffindor
07-14-2010, 10:14 AM
Since my daughter hasn't had her surgery yet, I can't really offer an informed opinion other than to suggest the possibility that your son might be having a reaction to his pain meds?

My husband had a terrible work accident where he lost his thumb. He was prescribed pain meds and they weren't working. So, to supplement the pain meds he also started taking Tylenol. He immediately started vomiting and couldn't keep anything down. After speaking a pharmacist, he should have been taking Motrin instead of Tylenol as Tylenol was already present in the pain med he had been prescribed. In other words, he was overdosing by accident.

I don't know if this could be what's happening in your case. Just throwing it out there as a possibility.

Pooka1
07-14-2010, 10:25 AM
From what I've read online, it seems that being able to move one's bowels does not rule out either ileus or SMA.

Okay. Great job chasing that down.


Spencer had some ginger ale this morning and thus far has kept it down. We're trying jello now. I read a study that said lying on the left side can help alleviate SMA, so I'm having him do that. I'm thinking I'll buy something like ensure, but will consult with pediatrician before feeding it to him. We have an appointment at 1:30.

Are you in science or medicine? It seems so.

If it is relieved by lying on the left side and in no other position, you might ask a speicalist if that is definitive for SMA. It may or may not be.

Excellent work on your part.

Good luck at the appointment. Ask anything and everything you can think of. Don't leave without answers or a referral to a specialist.

Pooka1
07-14-2010, 10:36 AM
Pooka what do you mean restrict food/water until bowel sounds heard? My son has had 3 previous surgeries(notfor Scolio) and they have always started on the drinking right away, food maybe day later, then of course miralax or something to get it going... Is this not how some do it??

Our surgeon did not allow any food or drink until gut sounds were heard. This occurred on Day three for both my kids. It is my understadning that the bloating that occurs if you eat/drink prior to this point is associated with worse pain that the scolisois surgery. Or so a few testimonials have stated.


Im not trying to argue with you or anything just curious...

There is no arguing on this site. Only stating facts (when known) in the face of some not interested in facts. That's not an argument; that's just cold, hard reality.

Corrections by folks who know what the heck they are talking about are (or should be) always welcome. That said, lay people with no relevant training need to carefully couch their comments to avoid appearing like they know what the heck they are talking about. The research section is a misasma in this regard for example.

trav86
07-14-2010, 10:42 AM
Thanks to everyone for your good ideas and your support.

My first thought was that it was the pain meds. I told Spencer the pills might be upsetting his stomach, so he stopped taking them. He had a 5mg oxycodone Sunday at bedtime (that was the day the vomiting started), another one yesterday at 5 am and nothing else since--no advil, no tylenol, nothing. At this point, he's so unhappy with his stomach condition that he's willing to live with whatever discomfort his back is causing.

Before that, he was taking advil and oxycodone every 4-5 hours. Maybe he damaged his stomach with the meds and this is the aftermath. I hope that's the case and that it's just a matter of time until he's feeling better.

Susie*Bee
07-14-2010, 11:26 AM
CamsMomKelly: in answer to your question about the ileus, my understanding is it has to do with the length of the surgery (how long you're under) so maybe your son's other surgeries were not as long. With really long surgeries, sometimes your stomach and intestines do not "wake up" when they should, so if you eat or drink something, the normal peristalsis, or involuntary moving the food along that happens, doesn't occur, and you get very grave problems. That is why they should wait to hear gurgles or blurps or some sign that your gut is awake. I had an ileus and couldn't eat or drink for 5 days. Ti Ed has me beat, but I don't remember the length of time for him-- 8 days maybe? Of course, we weren't withering away because we were hooked up to IVs. But we were still thirsty and feeling hungry... (missing food, you know!) Does that answer your question? For some reason, there are many surgeons who don't monitor this at all.

CamsMomKelly
07-14-2010, 11:50 AM
Yes that does help.
My daughter had wisdom teeth removed and was taking painkillers for days about 4 days in i would say she started heavily vomiting too, the doctor prescribed something to calm her stomach and to move her off the vicodin ( I think it was) that cleared up the vomiting about a day later so maybe it is the meds?
My sons other surgeries were actually longer then this spinal one is supposed to be , so yes maybe they arent monitoring it or I didnt see them monitoring it but yes after all he has had problems and caused pain in his stomach. I will keep this in mind after this surgery to not make him eat/drink unless they check the stomach noises or question the nurses about it . :)

trav86
07-15-2010, 08:22 AM
We ended up back in the hospital. When the pediatrician saw Spencer, she saw immediately how bad he looked; he's lost 17 pounds (from 154 to 137?in 2 weeks, and he was acting like a zombie! She called the surgeon and they determined that he should go to the ER and possibly be admitted. He was given IV fluids and anti nausea medication, and he started to feel lots better. We came home in about 3 hours. The pediatrician thought we should have stayed but he would have had to be in the ER overnight, and it was an absolute zoo! Screaming babies, alarms--the parents next to us almost came to blows about whose fault it was that their daughter was sick and security was brought in.

He seems to be on the mend. The pediatrician said that the meds might have messed up his stomach causing him to vomit initially and to become dehydrated. The continued vomiting could have been caused by the dehydration--a kind of vicious circle.

Fingers crossed that this is behind us.

Gryffindor
07-15-2010, 09:40 AM
trav86: Sorry to hear that you had to go to the ER. Those kind of visits are never good.

I'm glad that they think it's the meds and not something more serious. Did you discuss the possibility of your son taking some other form of medication than what he's currently taking?

I only ask because several people in my family get violently ill if we take anything with Codeine (including me). My father almost died after taking one pill that his doctor prescribed him to slow down the progression of his recently diagnosed Alzheimers!

sarah105
07-15-2010, 08:23 PM
I had some problems throwing up everytime I took my pain meds while I was in the hospital. I would literally throw up within two minutes of taking my meds every time! Finally one nurse had the idea to try liquid versions of the pain meds and, for me, it solved the problem. I don't know if it would help you, but maybe you could ask your doctor to prescribe meds in liquid form. I only had to be on the liquid meds for a day or two and things got a lot better and I was able to take them in pill form again.

trav86
07-17-2010, 03:17 PM
Spencer continues to get better. Thanks for the tip about the pain meds, but it's a moot point since he refuses to take any. (I think he vomited one too many times.) Everyone here has been so helpful and supportive--I don't know what I'd do without all of you!

Pooka1
07-17-2010, 03:19 PM
Spencer continues to get better. Thanks for the tip about the pain meds, but it's a moot point since he refuses to take any. (I think he vomited one too many times.) Everyone here has been so helpful and supportive--I don't know what I'd do without all of you!

Another parent recently posted whose child had SMA. I asked her to post on your thread or PM you. But it sounds like this may not be an issue.

Very glad he is getting better!

Fingers Crossed
07-29-2010, 09:35 AM
Just checking in and wondering how Spencer is doing? Such an ordeal on top of just the "normal" post-surgery drama.

My daughter had her six-week post-op visit yesterday. Her doc said she could run, so this morning she ran two miles with the cross country team (on a training run). She is mad that she has gotten so "out of shape" but her back didn't bother her. I was amazed!

momw/scoli
08-02-2010, 01:32 AM
I wish I had seen this sooner, but I don't get on as much as I used to because my girls are doing so good. I hope Spencer is better! My daughter had SMA last summer after her scoli surgery. They said it happens to thin people. The third day after surgery, she began to projectile vomit. Her dr. suspected SMA and gave her an upper GI. Sure enough, when they straightened her spine, the artery that leads to her stomach became longer and thinner, so it made food harder to digest. The cure is to gain weight and lay on your left side after eating. Trying to gain weight after surgery is hard. I bought her a blizzard everyday! Emily was also allergic to her pain meds. She broke out in a rash and they made her throw up. It was horrible. We didn't know if it was SMA making her sick or the medicine. It took her a really long time for her stomach to feel better. It's a really long story, but she is doing great now. She was a lifeguard this summer, she ran and won a mile race on July 4, she made color guard, and she's going to be a football trainer. Things are going to get better!
Becky