Collin started retching again a few days ago and, though we assumed it had to do with the med transition, it had not improved as the days went by. Today, we found some yellowish liquid in his mouth after a retch, making us think that all of his heaving is stressing his Nissen wrap and causing it to start to 'slip' (the term for when the loop they made with the stomach muscle around the bottom of the esophagus starts to come loose). Luckily, Collin knows how to protect his airway now, so it's no longer a safety issue, but we would still rather the Nissen loosen from a natural progression of his growth rather than from the stress of trying to throw up, so we got serious about trying to figure out what was upsetting his stomach so much.
We had already been experimenting with the flow rate of his feeds for several days and venting his tummy before and after eating (we hook an extension with an empty syringe to his g-tube button to let air or excess fluid out), but nothing seemed to make a difference. He was retching up to an hour after eating and nothing really came into the syringe, so it wasn't because of being over full or gassy. Kyle mentioned that maybe it was the Sabril, but I had a feeling that that wasn't the case because he seemed to have done so well with it overall and when Topamax upset his tummy, it was different than this in some way that I can't explain other than to say that my Momma-Spidey-Sense can make the distinction. I just felt like the recent retching had something to do with his digestion. We thought through everything he has eaten (which isn't much, since we still haven't really had a chance to put him back on solids since his fever last week), his supplements, and nothing made sense.
It had been in the back of my mind that coming off of the Zantac so fast could have caused some trouble for him. After blocking stomach acid for so long, it seems like that could be tough on a little tummy. And when I spoke to the pharmacist about taking Zantac for my hives last week, he mentioned that the only thing I would have to worry about was a possible upset stomach. We always ask the doctors about how to 'go on' and 'come off' a drug, and most of the time they wave off our question with an assurance that it would make no difference. But we've had too many experiences with meds, vitamins, and even tiny amounts of formula causing a shock to Collin's system. I still think it was a dose of Poly-Vi-Sol that sent us to the hospital the second time. So, I talked to Kyle and did some reading today and, sure enough, I found some evidence that coming off Zantac too fast after a long course of it can cause rebound symptoms. We put together a weaning schedule right away, gave him a dose with some Pedialyte to give him extra fluids to dilute his stomach acids, and he hasn't retched since.
My mom always contends that there should be some kind of honorary medical title for parents with situations like ours, and I have to say that when I realized we had figured it out today, I felt like Doctors Kratzsch and Kratzsch, world renown experts in Collinology.
Collin wasn't quite as excited as we were and slept all the way through our celebratory walk and viewing of It's the Great Pumpkin Charlie Brown. Either he was enjoying his lack of killer heartburn or is launching into a colossal growth spurt after two months of not growing on prednisone. Maybe next week he will look less like the great pumpkin himself.