I have recently seen a 1 year 11 month old female patient presenting with multiple complications. She was born premature at 32 weeks with tracheal-esophageal fistula, esophageal atresia, dextrocardia (no complications currently per cardiology). She had surgery to repair the fistula one year ago but is still having bleeding at the site causing hematochezia and hematemesis. During the surgery she also underwent a total thymectomy (Rationale not given). She is anemic with a hemoglobin of 7.6. She has reflux and is on an H2 and PPI prescribed from GI, but is having tooth decay related to these medications (per GI). Current weight for the patient is 15.7 pounds (nearly 2 years old). Patient has constipation and hard stool. GI and surgeon have discussed G-tube placement, but are still hopeful she can gain weight without G-tube and associated risks. She currently does not have any observed mental developmental delays. She is currently in occupational therapy for feeding. Her pediatrician has deferred most of the care to GI and general pediatric surgery. Labs show anemia, low iron, protein/globulin. Otherwise normal.
I would like to use BPC/KPV for the GI bleeding, but have not used this in a small child so dosing is unknown for me.
Current care plan:
Increased caloric foods (discussed in depth)
Digestive Enzyme prior meal (OTC, not pharma grade): lead to 1 pound weight gain in one week (pancreatic elastace is pending). I will initiate Creon if indicated with two positive elastace tests.
TA1: 5 units
TB4: 5 units
Glia Plasmalogen
Cyproheptadine: weight based 5 of 7 days per week.
Lactulose 1.5mL 1-2x daily
Further input or suggestions/critique would be appreciated,
Clyde Boswell
.