The Weston Family Blog: MARCUS' STORY: January

Tuesday 9 January 2007

MARCUS' STORY: January - April 05

This is the most dramatic part of my story so far! We arrived at ward 7 in the RVI quite late in the evening of 13th Jan. A very nice student nurse booked us in. It was pretty scary for so many reasons but mainly because we'd left the quiet comfort of the Friarage Hospital where we knew all the doctors and nurses and entered a huge regional centre in the middle of Newcastle. I'd never been to a city before but I got to know Newcastle really well! Joely was staying with Nanna and Granddad and mummy and Daddy stayed with me in my side room for the first night.

The following morning we met Dr Thomas who was very serious and explained how seriously poorly I was. He told us I would have to have a special sort of feed that went in via a drip, into a big vein in my neck - the feed was called PN or parenteral nutrition. He told us I would need surgery to put the line into my neck and they also wanted to put a camera down my throat and take some biopsies. I didn't have much say in the matter but mummy and daddy agreed. He hoped the tests would show why I couldn't eat without being sick. So that was my first general anaesthetic. I came back with a tube attatched to my thin chest which tunnelled under my skin to my neck. Dr Thomas said my oesaphagus looked normal, as did the biopsies which was good but told the doctors nothing about my condition. The PN started and I grew a little but my liver was enlarged and fatty so the doctors had to be careful because PN could hurt my liver badly.

Soon after I arrived, we met Dr Bunn, my consultant, and Dr Hodges who is the other member of the team along with Dr Thomas. They took it in turns to look after me during my long stay and my subsequent visits to the RVI. Anyway, the consultants arranged a barrage of tests: blood tests, MRI scan, abdominal scan, x-rays, barium swallow etc. but with no success. I could feel everyone's frustration as every test came back normal. If I was normal, why was I so skinny and sick?? The doctors decided I had some reflux and some upper gut dysmotility. I continued to grow a little but at 4 months, I still looked like a newborn and had only just regained my birth weight! Then, the doctors decided to try putting my ng tube further down through my stomach, into the top of my bowel. This was a SUCCESS even though I kept pulling the tube out! The doctors had to take me to x-ray to put it back in as it was a bit tricky to get it in the correct place. However, I was sick far less and the doctors gradually increased my milk intake and decreased the PN.

Mummy and Daddy decided along with the doctors advice to go ahead with a "surgical jejunostomy" which is a kind of feeding tube that takes my food straight into the top of my bowel through a hole in my tummy. We knew we could all go home if this worked.

During all this time in hospital, Mummy, Daddy and Joely stayed in Crawford House with all the other families of poorly children. I was so glad they could all be so near. Joely was only 2 but she got used to being in hospital and there was an amazing nursey nurse called Tracy on the ward who helped Mummy a lot. I got to know all the nurses so well and I loved them all, especially Ann - Marie, Jackie, Nicky, Chris and Karen.

I had the surgery on 17th March 2005 and it all went horribly wrong. When I came round from the anaesthetic, I was in great pain but I couldn't tell anyone so I just twisted and screamed a lot. It got worse and worse and mummy and Daddy were so scared and worried. The doctors stayed with me all night because my breathing and blood pressure were bad. I had a couple of blood transfusions and the doctors really weren't sure what was going on. I just felt so bad and in so much pain.

The following morning, my nappy was full of blood so I was rushed to theatre again. The doctors did an emergency laparotomy, which means they cut my tummy open to have look to see what had gone wrong.

The next time I saw Mummy and Daddy was when i woke up in PICU. I tried to move but I couldn't because it hurt so much. My body was covered in tubes; I had a tube down my throat connected to a machine to breathe for me; my body was swollen to double its size due to all the fluids I'd had and my stomach really hurt when the morphine wore off. the doctors told Mummy and Daddy that my gut had twisted in two places after the surgery and I had a congenital condition called malrotation of the gut - THAT what was causing some of my gut problems - my gut was back to front! Mr Jaffray had to untangle my intestines and put them back where they should be before putting my jejunostomy on the other side. I also got an infection called sepsis and I had a really high temperature and I was tachycardic. Mummy, Daddy and Granddad spent the night watching me and willing the numbers on the monitor to go down...

They did and by the next morning I had improved but mummy was still sad as she couldn't give me a hug. Mummy went back to Crawford House for a sleep but while she was gone my ventilator got blocked with some mucous and all the alarms went off and I went blue. Daddy was terrified and got pushed out of the room while the doctors and nurses rescucitated me. He phoned Mummy and she raced back over to the ward. I was fine but everyone was so scared. I didn't really know what was going on because I was still on a lot of drugs including morphine at that point. One by one, the drips and wires came off and after 4 days i was well enough to leave PICU. I now have a huge but neat scar which runs above my belly button, from one side of my tummy to the other. It took a while to heal but now the scar is part of me, part of my story.

I remained in hospital for a further month, we had to wait for my gut to begin functioning 'normally' again after the surgery and Mummy and Daddy had to learn how to look after me at home. They had to learn how to prepare my special milk, administer my medicines, use my pump and look after my new J-tube. I suffered a couple of hiccoughs during my recovery but finally, when I was six months old, I was allowed home!!

I should add, at six months old, I still only weighed around 10lb. My body was very skinny and weak. I couldn't even hold my head up yet. However, I was delighted to be home and was wasn't really sick all that much. When I was, it was stomach acid and/bile that came up. It made me scream when I was sick because it hurt quite a lot but generally, I was much better now. i even started smiling and playing with my toys!

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Marcus' Story

Isn’t it funny, the most complicated of puzzles always seems so obvious…once you’ve discovered the solution? This was definitely the case with Marcus.
On the 17th October 2004, my friends and their children had come round to our house to play. I had finished work just three days before and was already feeling quite strong twinges but I still had almost four weeks to go before the baby was due. I was huge! That afternoon, my friends joked that I seemed preoccupied; and I was … I was wondering whether the baby was coming! My bump was so big, there was no way it would stay in there for another 4 weeks; there wasn’t any room left!

Three days later, I was in bed cuddling my husband and my newborn baby boy. We were ecstatic. He was huge: 7lb 15oz and three weeks early. The midwife commented that he appeared more mature and we noticed his face was pretty puffy and bruised. He also looked as though he hadn’t quite grown into his skin. We put this down to the fact he was early and was stuck in my pelvis for three days. That first night, I noticed he didn’t feed well, but thought little of it. The next day, Marcus was checked over by the Paediatrician who noted his droopy eyelid before allowing us to take our new bundle home.

After just three days at home, we had to take Marcus back to the hospital. He had quite a nasty eye infection and his droopy eyelid was really swollen. We were pretty concerned about his eyes; they looked really sore, very swollen and a bit wonky. Over the following two weeks, his eyes improved but his feeding was becoming problematic. I was breast feeding but knew he was not feeding for long enough or often enough. He was also vomiting pretty regularly. However, I wasn’t overly concerned until he was 2 weeks old and had still not regained his birth-weight.

At three weeks old, Marcus contracted RSV virus and refused to feed altogether and lost another 8oz - he was now four weeks old and only 6lb 15 oz, a whole pound lighter than when he was born and he looked terrible. We were desperately worried about Marcus, he’d been prescribed reflux medicine to control the vomiting. It didn’t make any difference and I began bottle feeding so I could be sure about how much milk he was receiving. Life was becoming increasingly difficult by this stage. We had to take towels with us if we went out because he was vomiting so much. I was also spending almost all day feeding Marcus, drip by drip. He would arch his back and scream every time the milk touched his tongue. It was as if he knew it would cause him pain later down the line. He started to scream when you brought the bottle near him. Despite spending every waking minute trying to feed him, he still wasn’t taking enough to grow. Marcus also slept through at night, I’d have set the alarm clock to wake me up so I could force feed Marcus - it was such a dreadful time. I’d sit in bed sobbing, why won’t my baby eat?

At this stage, Marcus was admitted to hospital where they discovered his heart problems - which are quite mild fortunately. The doctors also changed his milk, added some more reflux drugs and started naso-gastric feeding. We went home for another couple of weeks but Marcus still didn’t gain weight. The vomiting worsened as he couldn’t cope with the increased volumes we were forcing on him with the NG feeds. Going out was impossible with the vomiting and every time someone asked about his NG tube, I cried. I didn’t know why he had it, why he wasn’t growing or what was wrong with my baby.

Around this time, our GP commented that Marcus’ ears were rather low-set. I was furious, what did his ears have to do with anything? I was more concerned about his feeding, that’s why I went to see him. He said, “You can’t make a baby eat if they’re not hungry.” Great! Really helpful….NOT! I got straight on-line and Googled “Low-set ears.” I was gob-smacked by what came up on screen. Noonan Syndrome. This was the first time I’d really considered that there may be something serious and long-term wrong with Marcus. I read the symptoms: low set ears, wide-spaced eyes, loose skin, pigeon chest, heart-defects, and developmental delay. Marcus was lying across my knee. I looked at him and then at the screen…and back to him. I knew in my stomach, this was it, The GP was right.

Eventually, Marcus was readmitted and remained in hospital for another 7 weeks while the doctors tried bolus feeds, continuous feeds, experimented with milk and reflux drugs. He had all sorts of scans and x-rays to try and determine his problems but to no avail. I asked the doctors there about Noonan Syndrome - they didn’t think so, his feeding problems were too severe, they didn’t fit.
At 15 weeks old, we said goodbye to the brilliant staff at Northallerton and Marcus was admitted to the Royal Victoria Infirmary in Newcastle, 50 miles away from home. He had just regained his birth weight and the doctors there decided to perform biopsies of his gut and insert a central line so they could get some nutrition into him. His gut biopsies were normal, as was the barium study, MRI scan, chromosome studies and abdominal scans. Marcus was fed via parenteral nutrition and NG tube for the following few weeks.

Meanwhile, Joely was almost 2 and her life had been turned upside down with Marcus’ arrival. We were all missing each other but there was no easy way to manage the situation. When Marcus was transferred to Newcastle, family life became easier in some ways as we were all able to stay in Crawford House, accommodation provided for the families of poorly children by The Sick Children’s Trust. We ended up living there for 3 months.

At first, Marcus seemed to make little progress and the doctors were no nearer to determining why he couldn’t feed. We were visited by the genetics team who felt there might be a genetic reason for his problems. Again, I asked about Noonan syndrome, and they said they didn’t think his problems fitted that pattern.
After 4 weeks at the RVI, Dr Bunn struck gold. She thought it might be worth feeding Marcus into the top of the bowel, into his jejunum. It worked, Marcus gained weight, the vomiting improved and he slowly came off the parenteral nutrition. We decided it would be best for Marcus if he had a surgical jejunostomy inserted so we could take him home and feed him that way. We were so excited, we had a solution.

Our excitement was very short lived. At 5 months old, he went to have the surgery to insert the feeding tube. It all appeared to go well but later that evening; it became clear that Marcus was very unwell. His heart was racing, blood pressure was high and his breathing was much more rapid than usual. He was writhing in pain. The surgeon sat with us all night, then Marcus’ nappy filled with blood; rich, dark and red. He had a couple of blood transfusions before being taken back to theatre in the morning.

Then we waited…and waited… After about four hours, the surgeon came and explained that Marcus had malrotation and because he’d inserted the J-tube using key hole methods, the gut had knotted in two places and caused a volvulus. He felt the surgery had gone well; he’d re-situated the j-tube on the other side of the abdomen and performed a Ladds procedure to correct the Malrotation. He said we’d be able to see him soon…

4 hours later, they still wouldn’t let us see him and no-one could tell us anything. Gary and I were going out of our minds. Eventually, it all got too much and I threatened to go and find Marcus myself. The Sister took us to PICU and sat with us in an office, the surgeon, who told us the surgery had gone well, entered. I knew it was bad. I was terrified. Why had he brought us into his office? Had Marcus died? I waited for him to speak; I didn’t trust my own voice. His words are a blur to me now but he explained that Marcus had taken a turn for the worse while in recovery. He had sepsis and he was on a ventilator. “Can we see him?” I heard myself ask. I held Gary’s hand very tightly as he led me into a cubicle. There was a baby on the bed, intubated, sedated, swollen and very bruised. He didn’t look at all like he did this morning. I had to look closely at his face just to make sure they hadn’t made a mistake. “Is he going to die?” I asked suddenly.

The doctor replied in a soft Scottish accent, “I suppose the honest answer is yes, he could … but I don’t think he will.” That was enough for me; I focused on the surgeon’s faith or belief in Marcus. I didn’t think he would die either.

My Dad drove up to Newcastle that night and the three of us sat in vigil around Marcus’ bed all night. We stared at the monitors; praying, willing the numbers to reverse - willing his temperature and heart rate down. Marcus little body lay still on the bed for most of the evening, only moving when the sedation wore off. We sat watching the rise and fall of his little chest, inflated with every compression of the concertina within the ventilator chamber. His tiny body was covered in wires, tubes, canulas, blood and adhesive plaster. By morning, the worst was over, his temperature was down, his heart rate had stabilised. Our prayers had been answered.

After a week, Marcus made his way back to ward 7 and we were able to start using the jejunostomy to feed him. We did have a few teething problems but by the time Marcus was six months old, we were all back at home in Richmond.
This marked a new phase in our lives. It was very frightening at first, having a small baby fed permanently, twenty hours a day via a pump. He was attached to a drip stand at home and we had a little ruck-sack to put the pump in when we went out. Gradually we got used to it and all the people coming to our house to attend to Marcus’ needs - we now fondly refer to them all as ‘his entourage’. They’ve become friends, the faces change sometimes but their presence is ever felt. They come in the shape of the community nurse, health visitor, dietician, physiotherapist, speech therapist …

Marcus still didn’t grow too well, and the next year was a struggle. We tried many different types of milks and regimes. Eventually, we found that Paediasure worked and his weight improved dramatically but his vomiting gradually got worse again. Sometimes he’d vomit green bile up to 10 times a day, writhing and screaming in agony. We went back and forth to see the doctors but they couldn’t find a reason why he was so sick.

Meanwhile, we were trying desperately to get him to feed orally. I managed to get him to drink water and eventually, after one particularly sicky weekend, I stopped his feeds and waited. I offered him water which he took readily and then I tried offering some milk - he took it!

He has been taking his milk orally for a year now. At first he lost a lot of weight but he seems to have found his own line at the bottom of the centile chart now. I believe Marcus cannot cope with huge volumes of feed, he like little and often. He vomits very rarely now, only when he’s drank too much or is poorly. He doesn’t eat solids yet but we’re working very hard on that at the moment.
Marcus was diagnosed with CFC last November, just after his 2nd birthday. It came as a shock at first but within a few days we realised how lucky we were to know for definite, what was wrong. Knowing is far, far better than not knowing. And all the pieces of the puzzle fit together and seem so obvious now. Marcus has always itched and sweated. He has sparse curly hair, low muscle tone, ptosis, sensory processing difficulties, hearing loss, short sighted, feeding difficulties, heart defects ... The list goes on an on ...

Today, Marcus is doing really well. He will be 11 in October and his speech is improving, he can read, he's eating solid food, and he's brilliant with technology. He’s a complete joy to us and we appreciate each and every milestone all the more because we know how much effort and determination it’s taken him to reach it.

Thanks to the doctors who figured out the puzzle, we now know why and how Marcus struggled so much at the beginning and why he has so many complex problems, and it all seems so obvious now!

Tuesday 9 January 2007

MARCUS' STORY: January - April 05

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Marcus' Story