a letter for maddy from Dr. H

[Guest guest]

To all:

I spoke with Dr. Nance. He was very polite, interested in Madison and

anxious to learn. He was in general agreement with the plan. It was also

clear

that he could see how fragile Madison is and how potentially complicated her

pre and post operative management could be.

He had two reservations:

1. Gut dysmotility is a weakness of their GI department, which we both

agreed is not at all rare. I told him that you, Kathy, had learned about this

group of patients at Cornell and had been working with Madison again for the

past 2 months. He mentioned 2 GI people whom he frequently works with.

2. He dislikes J-tubes in general because of the potential for obstruction

of the small gut lumen by the tube. I told him what you had said about this

problem Nitsana and mentioned the T-tube, an idea that he seemed to like. I

asked him to speak with you about this, the general configuration of these

children's stomach's prior to Sx [i.e. funnel antrum and saggy body], what

procedure you had done on her before, our experience with the need for

repositioning the G-tubes and the patience necessary to reestablish feeding for

these

children.

All in all I was very pleased with him and think that this is the way we

should go. I will be in touch with Stanley at CHOP about the BS

issues.

Kathy, you need to plan how you will reduce the dextrose concentration in

preparation for surgery and how you can have a bag of TPN that they will be

able to use until theirs is mixed once she is an inpatient.

MDH