James...sigh...

I don't really know where to start. Life with James has always been an emotional ride, but it's been an absolute roller coaster lately. Let's recap...

When I was about 28 weeks pregnant with James when he was diagnosed with some type of Esophageal Atresia (missing part of his esophagus). We knew that his situation would be able to be corrected surgically. Before we could even meet the surgeons and have a consultation with them, James was born at 33 weeks and had his first surgery when he was 3 days old, weighing right about 4 pounds. The surgeons were fairly confident that he would be fixed and ready to go home as a "normal" baby within a matter of weeks. 10 weeks (and 4 more operations) later he did get to go home, but not fixed. James didn't have corrective surgery until April of this year (postponed from January). I suppose I thought, probably naively, that he would be all better in a few weeks and his crazy start to life would be all behind us... not so much. In the 2 months that followed James' corrective surgery, we made 5 trips to the ER for various things and dealt with constant reflux and spit-up. By the end of July, we were all home again and thought we fixed our problems with high dose reflux medicines. We had a fairly quiet August and James had tubes put in his ears in September. Then came October...

James came down with a couple of colds that turned nasty...pneumonia. He spent 9 days at Peyton Manning Children Hospital in Indy and then 2 more days once we got back to Pittsburgh in the hospital for dehydration. He finally got all better around the second week in November. Then the day before Thanksgiving (maybe 2 weeks later) James got sick again. We took him to the hospital that night, he got discharged the next day. Still sick and back to the hospital the Monday following Thanksgiving, discharged 2 days later. Still sick and back to the hospital on Friday. By this point he's pretty sick and admitted to the ICU, where they diagnose him with a bacterial pneumonia (the bacteria that normally causes ear infections moved into his lungs). At this point, we consult pulmonology and the surgical team that has been following him since birth because the doctors are finally convinced that something else is probably going on. Their first instinct was Cystic Fibrosis (because he's so sick from "minor" virus/bacteria and his mucus is really thick), but James had full genetic testing when he was a newborn and we know he doesn't have this. There are a lot of theories floating around, but they finally feel they know what's going on and have a plan.

Due to James' gastric pull-up to connect his esophagus to his stomach he has an unusual anatomy, his stomach is in the right side of his chest cavity and he doesn't have a valve in between his esophagus and his stomach. The doctors have noticed by looking back at all the tests James has had done over the past 6 weeks that his stomach is not emptying as fast as it should be. Apparently this is due to his unusual anatomy...the pyloric valve can't work properly and so his stomach is not emptying into his intestines fast enough. This has been causing his severe reflux. They can "fix" the problem by disabling the pyloric valve (it's called a pyloric-plasty). The hope is that this will eliminate his reflux. ...The surgery is scheduled for Monday.

The doctors think that for the past 6 months James has been refluxing so badly that sometimes he gets stomach acid and food into his lungs. They believe that this has been aggravating his airway and making his colds more severe. The pulmonologist will run a couple of tests and check the integrity of James' airways when he has surgery to make sure permanent damage hasn't been done and to eliminate other potential problems.

Once he has the surgery (his 9th), the main risk is called "dumping." This is when the stomach empties too fast into the intestines and nutrients aren't absorbed properly. The doctors feel that the risks of not doing the surgery (aspiration and permanent lung damage from stomach acid) are greater than the possibility of "dumping," which can be addressed with medication.

So again, I hope (possibly naively) that this surgery will fix all of James' problems and turn him into a "normal" kid. Time will tell...