Formula Change

As I decided it was time to write the dietitian to see if there are any more tricks in the bag to get Andi's weight up, her Dad said it was high time we figure out why she's puking so much, so we can stop it.  Many hands in the pot, but it has resulted in the decision to try a different formula.  The pediatrician covering for our usual Dr., called up a GI Dr. up at the hospital (Doernbecher's) and that Dr. suggested changing to Peptamen Junior.  It's fewer calories, but seemingly more tolerable to finicky stomachs like Andi Bean's.  The formula was delivered the same day, (one of the few times in life I feel V.I.P.! anymore!)  We started rocking that formula right away.  I also switched her to a five bolus schedule last night, since her nap ran so late, she was up late anyway... I only put in about 20 ml at night to flush her nighttime meds.  Yesterday also marked her largest daily amount of formula put in.  Her stomach looks bigger today to me, but it could just be bloated by the larger amount of food going in.  This new formula is 30k/cal, whereas her Neocrack cocktail was 36k/cal.  So, as is, it's less calories per day, but, it's less rich too - so maybe she'll tolerate it better?!  The sub. Dr. also increased her Prilosec dose from 2.5 ml to 4 ml, hoping that would help.
So far, I haven't seen much change.  The girl still pukes.  This morning, as I loaded her in the car to take a friend to the airport, I started her feed.  She was at maybe .4 ml and she started puking.  It had been easily more than six hours since she was fed last.  But, she apparently had a lot of air in her stomach, so she spit up what looked like saliva.  Once the air or pressure is released, she's fine.  She tolerated the full feed after that.  The next feed, she tolerated all of that too.  The third feed, she tolerated until almost the end, then she got fussy.  Fussy is usually a sign that she has pressure in her stomach, or she's simply bored sitting in her highchair and wants down.  I vented and got nothing.  I let her down, she was fine in Daddy's arm.  Then, he hands her to me and without warning, a surprise spit up.  No warning.  It wasn't a lot, but it still warranted a shirt change for Andi.  Then later, in bed - trying to get her down for her nap, she fussed, I was slow to get the vent, and then it came up.  All over the fresh sheets I just put on the bed.  Again, it wasn't a lot, but this one was thick and foamy.  It'd been in her stomach awhile.  I was able to vent some air out. 

My only guess is that she swallows a lot of air throughout the day.  It builds up and it either comes out one end or the other.  It's faster for it to come up. If the pressure builds, she's gonna blow.  I don't know how or if they can fix that.  My guess is that her digestive system is really immature.  She's never had to really digest full feeds, digest air, process anything much more than formula.  Now that the leak has been sealed, it's as if her system is trying to catch-up, but it's slow.

I don't know what the cause, really, but I sure hope it stops soon. I also hope that I'm not imagining that her stomach is getting bigger.  The sub. Dr. has us coming in Monday afternoon for a weigh-in and follow-up to the formula change.  We'll see.  So sick of saying that sometimes.  What's odd is that I'd just unpacked another three cases of Neocate, 12 cans at almost $40. a can.  If we do make the switch, I hope the enteral feeding place will take those back.  I don't think they will after a few days, so, maybe I can get me some Christmas spending money via eBay?!?  I'm TOTALLY kidding!!!!

Just for the record, I'd gladly take the puking over the old g-tube leak any day!  So, let's hope this formula change is the recipe for moving on and moving upward on the scale.  Change for the better would be very, very appreciated.