At our weigh-in on Wednesday, Becca also had a quick check-in appointment with Dr. Rawls, our general pediatrician. Have I mentioned how much I love him lately? Or how much I love general pediatricians in general? So often the specialists get caught up in trying to solve the particular problems in their respective areas that they don't stop and look at Becca as a whole, real patient. And they aren't really concerned with solving the problems we, as a family, see as problems. Our peds, though - Dr. Collins in Gallatin and now Dr. Rawls - have been AWESOME about listening to us (mostly me!), looking at the big picture, and trying to figure out what is truly best for Becca - not just how to fix what they see as an isolated problem - or something that I think is a problem but isn't to them, medically speaking.
I'm talking, of course, about Becca's vomiting and lack of weight gain. Which is a problem (or two problems, depending on how you look at it). It's a problem for Becca physically, but I'm afraid that it's also becoming a problem for her in other ways. For example, Becca got a baby doll for Christmas. She LOVES Baby Rosie and wants her to do what Becca does. Baby Rosie eats a snack while Becca eats, she reads books while Becca reads, and she goes "night night" in her crib when Becca goes to bed in hers. Pretty typical (and adorable). But the other day, she tipped Baby Rosie over and made her throw up, then her lifted up to shoulder and patted her, saying, "It's okay, baby; it's okay."
Well. It seems throwing up is as much a part of Becca's routine as getting dressed. Or sucking on a paci (though mean old mommy and daddy are making this less and less a part of her routine). Or, oh, eating. Yeah, eating. And since, in Becca's world, what goes down must come up, the puking doesn't exactly encourage the eating...which then doesn't encourage the weight gain.
The GI doesn't seem to see this as a problem. Which is baffling to me. But they are, apparently, useless on this issue.
Dr. Rawls, though, agrees that this is not, um, optimal and helped me work up a plan. The biggest change is that we are going to hook her up to her feeding pump during naps, since these are usually puke-free. She's still a good napper at home, so that's a chance to get another 2-3 hours of feeds in her during the day. We're also going to be more aggressive and consistent with bolus feeds throughout the day. (And by "aggressive," I mean that I'm not supposed to be afraid that filling her up with formula will mess up her oral feedings (i.e. real meals). The girl needs calories, and getting good nutrition actually stimulates your appetite, since without it your body goes into starvation mode...and this is the frustrating cycle of the failure to thrive issue.) We're not going to get into taking the feeding pump to school, but I did teach her teachers how to do a bolus feed this week. (So much for being able to go to a regular preschool!) Unfortunately, Becca threw up during her bolus feed today. I'm really hoping this doesn't become a pattern because in one bolus we can get an extra 90 calories in her - a significant part of the 980 calories she needs every day.
On the upside, though, Becca is eating orally more and more. She's (obviously) still not a true oral feeder, but she's trying some new things and increasing her volume of things that she likes. She's particularly fond of meat these days, which is GREAT because she needs a high-protein diet. Generally speaking, she likes strong flavors because she can taste and find them better in her hyposensitive mouth. Her taste buds need a little waking up.
For example, last night we cashed in some Olive Garden gift cards and celebrated my birthday (thanks, Jen!). Becca is a really, really big fan of the Olive Garden, and it never ceases to amaze how much she will eat there. She even cried big tears when we were leaving because she wanted to stay and eat some more. (We left anyway because what she wanted at that point was to eat more Andes mints...which are neither optimal nutrition nor conducive to a smooth bedtime, which was next on her agenda.) She started off her meal with a lemon slice, chomping on the middle part and eventually taking bites out of the rind itself (not uncommon). She then moved on to gobs and gobs and gobs of grated Romano cheese. Seriously, every time a server walked by, she asked for more cheese. I'm guessing she ate a good 3 ounces of cheese. When the salad arrived, she had some onion, a few bites of pepper (banana peppers? I don't eat peppers, so I don't know what kind they are or how spicy they are.), and...her favorite...black olives. When our entrées arrived, she ate some of my chicken marsala and a bite of John's braised short ribs. And then she was back to the cheese. And the Andes mint. And she did NOT want to leave the "Ah-yiv Darden!" Big. Tears.
I take this as a good sign, both that she WILL eventually learn to eat enough orally AND that she actually is my daughter. I do so love a good Italian meal. Perhaps in the future, Becca will, too, sauce and all.