New GI doctor

As of Wednesday afternoon, St. Joe's still didn't have a bed available for Dad, so in the meantime Dad, Mom, and Dad's doctor raised enough Cain that Sinai brought in a doctor from another GI group. When they called him, Mom was told that the doctor had an office full of patients, but that he would try to stop by after office hours. Given the pace of anything that takes place at a hospital, and especially the wait that is usually involved for a doctor, I was very surprised when the new doctor, Dr. Okolo, stopped by the hospital after 7 p.m. (by then I had given up and thought we'd have to wait until today).

Dr. Okolo immediately impressed us with his manner and charm (and accent, I'll admit. Very British in voice and dress, down to the natty little bowtie) and impressed us even more with his take-charge attitude. He spent a half hour or more looking through Dad's chart before coming in the room, so he knew all of what he had been through in the past couple of months. We were thinking that the next step would be to take out the GI tube entirely, let the site heal, and give Dad a TPN line (Total Parenteral Nutrition; an IV line is surgically inserted into a large vein and all nutrition and meds are given through this line) until rehab can do their magic in getting Dad back on real food. But Dr. Okolo thought otherwise. He said the problem seems to be (in his words) mostly a north-south problem--the GI tube is too small for the stoma site, which isn't healing properly (he thinks largely because Dad isn't getting enough protein to allow healing to take place). He suggested going back to the GI assembly that Dad had before--a G tube into the stomach and a J tube into the intestine. He said a larger G tube (currently Dad has a type 20 French tube; Dr. Okolo suggested a 24 French tube. Whatever.) would take up some of the excess real estate (again, his words) so Dad wouldn't have the leaking like he does, and with food able to go directly into the intestine, none of that would leak out, so he'd be getting the nutrition he needs to help him heal. He said some leaking would be expected until the site heals entirely, but a larger tube and more protein should allow this to happen in a fairly short amount of time. He thinks a TPN line should be a last resort and that allowing as natural a process of receiving nutrition as possible is always best for a person. He said if we were agreeable to try this (we were), he would have to twist a few arms but should be able to do the procedure (with sedation but not general anesthesia) at noon tomorrow, which would be pretty much as I'm writing this if it is indeed happening.

Oh, Mom had talked to someone yesterday who said she had seen a case like Dad's once before on a person who had had a lot of abdominal surgery. All the surgeries weakened the membranes in the area so they pulled away from the stoma, causing all this leaking. We suspect something of the sort with Dad since he's had quite a bit of work in the area as well. The previous case *did* get a TPN line and just put up with a bit of malnutrition until he was able to eat again. When we suggested this as a cause of Dad's problem to Dr. Okolo, he was noncommittal.

With any luck, by now Dad has this new GI tube assembly in place and is doing fine. I haven't heard from Mom since early today and at that point she didn't know anything. I had hoped to post this last night or early this morning to ask for prayers for this procedure, but I know they are still needed now!