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Dr. Andrew Rynne
MD
Dr. Andrew Rynne

Family Physician

Exp 50 years

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Got Gastroperesis After Nissen Fundoplication. On Tube Feeding. Having Neurogenic Bladder. Advice?

I care for my sister (42 year old non verbal CP adult). She has undergone some extensive procedures over the last 14 months.. A very large peh repair w/ Nissan fundiplication.. 6 weeks later she developed severe gastroperesis and has been unable to eat by mouth since.. making her dependant on a GJ tube for feeding and venting. following that procedure she began suffering from neurogenic bladder and now has a SPC. Anyway, since dec. we have been struggling with a bacteria she picked up in hospital- pseudomonas... We were in the process of another round of IM gent when she developed hives and I had to D/C prior to 2nd injection .. (Yet another relatively new thing- she is becoming allergic to nearly EVERYTHING). Anyway, I changed her cath before taking a specimen for testing.. The culture has returned and pseudomonas is not present in lab report; however, streptococcus (group b) 10,000-25,000 colony forming units per ml... She has also had an increased amount of sediment in her cath while waiting for results.. Is it possible that this type of bacteria is reaking such havoc? does she need antibiotic treatment for this bacteria at the level indicated? Her pain (although increasing) can be managed fairly well with Tylenol and gas-x... The gas-x of course is used to help with the severe gas pangs that seem to appear every time an infection rears its ugly vengeance in her bladder.. Strange? I m not sure but it seems strange to me seeing as her diet NEVER changes. Her formula is a very elemental formula and as long as she is on or newly off of antibiotics , she does not have extremely active bowel sounds and gas pangs... Nor does she have cath sediment.
Mon, 17 Jun 2013
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  User's Response
Hi,

I am sorry for your sister's chronic problems. It must be really hard for both of to handle the situation.

I would like you to take into consideration the following: all problems (including infections) in people with CP are associated with some features of this condition:
- Decreased mobility
- Poor neural conduction throughout the whole body
- Mental changes

While not each and every potential problem can be predicted or prevented, but the above mentioned principles will at least give you an idea what to expect and how to handle these problems as a care-taker.

Although gastroparesis is a possibility as a complication of surgery, I believe that this is not the case in in your sister's case. I am prone to think that poor neural conduction is the cause for gastroparesis as well as for the neurogenic bladder.

My advise is to address the problems of your sister (paresis, infections etc.) very aggressively and get rid of them as fast as possible. The more the problems persist, the worse her condition is going to be. Try to put her back to "active" life as fast as possible. This is your best bet at this time.

Hope this helps.

Kind Regards,

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Got Gastroperesis After Nissen Fundoplication. On Tube Feeding. Having Neurogenic Bladder. Advice?

Hi, I am sorry for your sister s chronic problems. It must be really hard for both of to handle the situation. I would like you to take into consideration the following: all problems (including infections) in people with CP are associated with some features of this condition: - Decreased mobility - Poor neural conduction throughout the whole body - Mental changes While not each and every potential problem can be predicted or prevented, but the above mentioned principles will at least give you an idea what to expect and how to handle these problems as a care-taker. Although gastroparesis is a possibility as a complication of surgery, I believe that this is not the case in in your sister s case. I am prone to think that poor neural conduction is the cause for gastroparesis as well as for the neurogenic bladder. My advise is to address the problems of your sister (paresis, infections etc.) very aggressively and get rid of them as fast as possible. The more the problems persist, the worse her condition is going to be. Try to put her back to active life as fast as possible. This is your best bet at this time. Hope this helps. Kind Regards,