Stenosis

Did someone mention atropine? . . . extract of belladonna? . . . erm, as in deadly nightshade? We have some direct experience of that.

We had two families: a boy when we were young and foolish and two girls 20 years later when we knew something about how the world ticks. After six days in the maternity ward first time round in 1975, we were thrown on our own devices to do the best we could with the tiny but voracious monster that had come into our lives. All those diapers and too little sleep and The Beloved's mother a long way away down the country. Well, the boy ate and burped and ate more and barfed and had a bit more and then fell asleep - for a short while, anyway. Then the suck burp barf suck zzzz cycle would repeat. Eventually we got concerned enough at the puking to go to visit the nearest GP [back then in the 70s, a generous government handed out medical cards to students, so we didn't have to pay]. The doctor looked at us, looked the child over, asked about the vomitting . . . and diagnosed a case of pyloric stenosis!?!

The pyloric sphincter is a little ring of smooth muscle that separates the stomach from the small intestine. I don't know what its base-state is but when you have a meal it contracts to seal off the stomach so it can do its digestive chemistry and churning. When that part of the cycle is over [think front-loading washing machine], the sphincter relaxes and the chyme [technical term] moves into the duodenum for further processing. That's the normal case.  With pyloric stenosis, the sphincter is a reluctant to open up . . . the autonomic nervous system senses that something is wrong in the front-loader department and reacts by advising the stomach to jettison its contents. It's called projectile vomiting and it can be dramatic. You know it is projectile vomiting if the bolus hits the wall on the other side of the room. It is, nobody know why, about 5x more common in boys.

On foot of his diagnosis, the doctor prescribed oral atropine drops, and told us to see how that went. So for the next tuthree days, the atropine worked systemically through the tiny body. The Boy stared at us through huge black pools, which was disconcerting, and there was no obvious change in his feeding pattern. So we joined the regiments of people who fail to complete the course of medication. Just as well the doctor didn't start with the alternative treatment for the condition which is to go in with the knife and nick the smooth muscle so it doesn't close completely; the stomach is a little leaky thereafter and digestion isn't as efficient but nobody dies . . . or gets hit in the back of the head by a splatter of baby-barf.

But WTF was the doctor thinking of when he so casually made his diagnosis? and suggested that a potentially deadly poison was introduced into the bathroom cabinet of two clearly naive and unworldly 'parents'?

There's a lot of it about.  Two weekends ago I was told to medicate the cat . . . and clean up its vomit, if any. Medicating dogs is easy, our late lamented Rashers would scarf up anything that appeared in her bowl whether it contained, offal, left-oevrs, white pills or pink garnish. Cat's are the very divil because they are picky and have sharp claws. You may wrap the cat up in a towel and try to administer medication orally but I won't. Anyway. The cat was sick, as in peeing blood sick, so it had been taken to the vet who prescribed Metacam suspension 0.5ml/day. There is a possibility that the vomiting was induced by me administering Metacam á la tuna. On foot of that I read the small print (and it is really small and very extensive) which says that Metacam is not recommended if there is any kidney damage! Peeing blood? Could that suggest problems with the old kidneys? Further research in the web says METACAM Oral Suspension is only approved for use in dogs and the main thrust is that this drug is a pain-killer suitable for managing osteoarthritis. But WTF was the vet thinking of . . . etc. etc.