A Very Happy Birthday!

Tyler decided to give me the ultimate birthday present...another clear xray. The pleural effusion is completely gone. Praise God for the healing of Tyler's thoracic duct. I couldn't believe that it was totally gone, so they showed me the xray. I should have taken a photo because it is clear and there is absolutely no fluid in the space. This is better than when we went home the first time because there was a small amount of fluid under the lungs then.

It is unlikely that the pleural effusion will show up again while we are still on the special low-fat diet. At some point we will need to get him back on a regular diet, but until then, things are manageable. He does not tolerate the only formula available for infants with chylothrax, so this is a challenge.(In the past, he has had the lactobezoar chunks.) We are mixing it with skimmed breast milk to try to make it easier on his stomach. He is getting 1/3 skimmed milk to 2/3 enfaport. Since he has been throwing up some of his feedings, we decided to stay overnight one more day to be sure that he can keep down feedings before heading home. We will need to feed him with a special feeding pump using the NG tube. The pump is nice because it can make sure that feeds go in over a 45 minute period.

This morning we came in expecting to be going home after rounds. Tyler decided to give us a lactobezoar enchore. I guess it would be too easy to finally just go home without anything crazy happening. He had some more lactobezoars at the noon feeding but they were smaller. We have decided to back down the enfaport to skim milk ratio to 1/2 and 1/2 since he has tolerated it this way before. We have to give him this formula since there is nothing else available with low enough fats for the chylothorax.

Since the doctors aren't going to do anything else for the lactobezoars; we decided that if he keeps down his next feed we will go home today. We hope that he can handle it for at least a couple months so that we can be sure he can take fats again. With the current ratio of milk to enfaport, he will not be getting the full amount of calories that he needs, but it is better than throwing up every feed. We hope his thoracic duct will be able to tolerate milk again in a few weeks and we can stop the enfaport.