Sh!$ Happens

I have taken a bit of a blogging hiatus and although I have composed numerous posts, none have made it past the draft phase, fragments of some have appeared on facebook and countless others have never actually made it past my frontal lobe.  My brief break is not due to a lack of blog worthy material but rather and issue of time management... or rather lack of time to sit at my computer without having to address the urgent 911 call for chocolate milk or kiss the exponentially growing lump on someone's forehead caused by direct contact with a wii remote or .... what is that smell????  Poop trumps everything.  And you guessed it boys and girls... poop is the topic of this post.  So for those of you with more sensitive constitutions or olfactory senses... this is your spoiler alert... you have the option to bail now... Shit happens and I am gonna tell you all about it!!! 

23-19... 23-19

Taken from the movie Monster's Inc. as code for human contamination in the monster world... Patrick and I use the distress call  23-19 to alert each other that the diaper has failed and its contents are no longer contained.  With 2 still in diapers this code serves as a silent (if not deadly) alarm, a call into action so to speak... a "hurry the hell up, I need help NOW" message that when broadcast it requires immediate action.  

For example... 

When we are at the pool... 23-19 means "quietly and quickly gather the kids... we are leaving NOW!".  

When in a store... "don't ask questions... leave the cart... find a pair of pants that will fit... and meet me in the parking lot"

When at school... "Who's pants are these?  23-19... please wash and send loaner pair back for next time."

When at the park... "OK... is he your kid or my kid this time?"

When at home... "Honey... I think Daddy is calling you!"  (snicker, snicker)

But in all seriousness... We all know that someday our children will be potty trained and we will one day look back on these days and laugh.  We all will do (or have done) the "happy ... no more diapers dance" and although we are a wee bit sad to see our babies grow up we are thrilled to not have to be dealing with diapers any more.

Well... not all of us are so certain.  

Sam, among other things, has a condition called Hirschsprung's Disease,  long segment Hirschsprung's disease to be exact.  To put this simply... Hirschsprung's disease, or HD,  is a condition where the ganglion cells or nerve cells don't grow all the way to the end of the bowel.  Without any nerve cells there is no way for the body to detect that waste is present and to then push it out.  HD may effect a very small segment of intestine/bowel (an inch or two), or may effect much more or even all of it.  Most of the time this condition is recognized shortly after birth.  After a diagnosis is made, the process to correct this condition consists of a 2-part surgery and often times there are other interventions needed.  The first step is a biopsy to determine how much of the bowel has been affected.  Then a colostomy is placed to allow for the removal of waste... then the pull-thru procedure (a surgery that removes the effected intestine/bowel and reconnects the working parts to the rectum).  It is a long process but in the end... most kids do very well with few problems.

HD is more common in boys and even more common in children with Down syndrome (2 strikes for Sam).  Sam got his colostomy when he was 13 days old, weighing less than 2 pounds, on Christmas Eve 2002.  Due to the risk of contamination, he underwent the pull-thru procedure at 6 months of age, 6 weeks before his open-heart surgery (there would have only been a few inches separating where he pooped from where they opened his chest to fix his heart).  During the pull-thru surgery,  the surgeon discovered that not only was Sam's HD much more extensive than previously thought but that he also had Malrotation.  Basically, his intestines didn't coil correctly and were all flipped around backwards.  Typically your appendix is in your lower right abdomen... Sam's appendix was in his upper left side.  In the end the appendix and everything down from there was removed, leaving Sam with less than 1/5th of his large intestine.  

Sooooo .... What do you get when you combine no large intestine and low tone???  You get poop!  Lots of poop!  Lots of watery, loose, frequent poop!  Poop, poop, poop, stinky, smelly poop!  We were told, oh so many moons ago, that even if Sam had no other medical issues that, considering the amount of large intestine that was removed that he may be close to 12 before he could have enough control to be potty trained.  12... seriously??? I was crushed at the reality of this.   It is pretty common for kids with Down syndrome to potty train a bit later than their typically developing peers but I was crushed to think that my child would be in diapers until he was 12... Well Sam is now 8 and right now 12 is looking pretty good.  I have resolved myself to the fact that he may always need a diaper, but that doesn't make me any less hopeful.  "Everything is possible... the impossible just takes a little longer!"  Sam has surprised us enough already that I cannot even begin to put limits on his capabilities.  I prepare myself for the worst but hope for the best.  And honestly if I had only known then what I know now I would not have shed any tears... shit happens.  

First things first.  We are not even thinking about potty training Sam right now... he is no where near ready.  Sean on the other hand is sooooo very ready but he is playing the game... and I am trying to be patient (Oh Lord, Grant me patience to deal with my blessings).  He actually played the "Sam wears diapers so I can wear diapers" card the other day... really kid?  Sam on the other hand needs to have more solid stools first.  Right now his poop, on a good day, is about the consistency of applesauce or maybe toothpaste.  And *news flash* boys and girls... pull ups don't hold poop!!!  Sam wears a diaper that we have to special order ( Molicare Air Actives ), but it has the holding power required to reduce the frantic 23-19 calls.  To complicate things even more... Sam is still 100% g-tube fed... and I am thinking that an all-liquid diet does not help our plight.   We are working towards oral feeding also but after his his heroic battle with Infantile Spasms/West Syndrome (a severe form of epilepsy) Sam has been unable to coordinate the suck, swallow, and breath responses needed to eat safely via his mouth.  That too will come with time but I diverge... today we are talking about POOP!

Recently we started adding pectin (yes the same stuff you use to make jelly) and loperamide (immodium AD) to his daily regimen with the intent of thickening his poop and slowing down the rate at which waste moves through his remaining bit of large intestine in hopes of creating a more solid "product".  Slowly, oh so very slowly we have seen his poop get thick  and thicker.  We are now looking at a consistency somewhere closer to oatmeal or peanut butter.  You see the goal here is to achieve solid poop!  You can't successfully potty train until you have solid poop.  Solid poop is an indication that your child can "hold it" and that there was conscious effort to void the waste... it didn't just "slip" out.  It is a sign that the body has been able to absorb some of the excess fluid (typically a job done by the large intestine... remember that Sam has less than 1/5th of what the rest of us have).  

So although we are moving in the right direction... Sam is also scared to death of sitting on the toilet.  I have never seen fear in that child's eyes like I have when he has been place upon the toilet.  He has endured numerous surgeries, several invasive and painful procedures and yet he is afraid to sit on the toilet.  Alas... no one said it would be easy and once again I fall back on my mantra... "slow and steady wins the race"

Sam has been home sick all week which only punctuates the negative thoughts that slip into my mind from time to time when I allow myself to think about the years and years of diapers changes that inevitably are an intrinsic part of my future.  And although potty training Sam is a lofty goal, there are other things that I want so much more for him.  For instance, better communication skills and just the basic ability to tell me that he wants his diaper changed... seriously, that would be more precious to me than gold (gold nuggets that is...LOL).  So with 2 still in diapers, my salvation these days comes in the form of a little Scentsy warmer and lots and lots of wonderfully scented bricks.  My house smells of spiced grapefruit and cucumber lime... instead of... well... you know.

Please excuse the fact that there are no pictures with this post... considering the subject matter I am sure you understand  :)