Tag Archives: education

Pyloric stenosis in its adult forms (1)

Back in the 1950s I once overheard my parents talking about my oldest (and long deceased) uncle Fred having a stomach ulcer and an operation to deal with this.  I well remember being transfixed and “all ears”, but having been stonewalled so often, I dared not ask my parents the question on my mind.  At this time I would have been about 10 years old, and I had worked out that my prominent and hated belly scar was from an operation I’d had as a baby as I’d developed a blocked stomach (pyloric stenosis, “PS”).  I was keen to know whether my uncle Fred would be sporting a scar just like his young namesake.

When I got to see my uncle in swim-mode some 20 years later I was disappointed: his scar was small and almost invisible, far less disfiguring than mine.  Compared with infant surgery in the 1940s, abdominal surgery on adults and 20 years later was quite tidy.

Gastric ulcer01What I’ve discovered only recently is that infant PS and adult gastric ulcers and PS are often related.  All three conditions and several others have been linked with a high output of gastric acid and this is often a family trait.  So my connection with my namesake uncle (and hero) likely went further than our family realised!

The previous post sets out some of the important similarities and differences between the infant and adult forms of PS.  This post will outline two medical articles on adult PS.

The first report was published in 2010 and deals with the case of a 71 year old male who was diagnosed with PS.  The interested reader is encouraged to use the link to read the full article which has been kindly made available to the public.

In brief, it notes that adult PS is found in two forms.  It is often caused by other conditions: a long history of a mild form of the early version, an earlier stomach problem such as a gastric ulcer, or cancer.  Sometimes, as in this case, no underlying disease was found.  This 71 year old was unaware of any such factors, yet tests and surgery proved this man did indeed have a PS.  His symptoms of “abdominal distension, nausea, and vomiting” had been noticed for (just) 3 months.

It is noted that both forms of PS occur far more often in males than in females, and that they often recur in certain families.

The aim of this report is to be applauded: to raise the awareness of both forms of PS within the medical community, and especially the various ways it can appear in adults.

For those like myself and (I expect) most of our readers, the article’s value is also in its acknowledgement that the infant and adult forms of PS are related, and that the infant form does not necessarily end with a simple surgery.  Far from it, as many of us have well come to know!

The second report can thankfully also be read in full by those interested in more detail.  It outlines the very large decline in the number of adult PS sufferers needing surgery.  I have already posted about this.

downward_graph_smallThis study was undertaken by a York (UK) body gathering data on peptic ulcer disease, and based on the statistics from the 3 kinds of stomach surgery done on 4,178 adults and how often adult PS was found during these procedures.  The study ran from 1929 to 1997 and included people born between 1889 and 1959.  It found that the age at surgery fell during these years, that PS was found in 17% of the earliest patients, and just 3% in the last group, and that gastric surgery rates fell markedly (although not uniformly) during the almost 70 years under the lens.

These results show very clearly the effectiveness of modern medical treatment for stomach conditions and introduced in 1977; this includes acid-suppressing medication which reduces the formation of gastric ulcers and resultant scarring of the stomach wall and pylorus.  However, the reduction of PS numbers was even greater than the falling numbers of stomach surgery, suggesting that a number of factors are at work, including diet, medication, and the management of upper bowel disease.

Once again, the great majority of readers will be less interested in the medical messages of the report than in what it might mean for interested lay people.  What do these figures mean for you and me whose history includes PS?

  • yay1People who have had infant PS are less likely to have serious long-term effects than they might have expected some 40 years ago or earlier, thanks to better diet options and medication.
    The fact that today we can read much more about the long-term problems experienced after infant PS is a reflection of our access to the media, not of rising numbers.
  • People who have had infant PS are ever less likely to need further surgery for ongoing problems including a renewed stomach blockage. We need to be aware that for some of us these problems are significant, testing, and often interminable.
    The report states what many have found (as I have read), that surgical responses to such problems are not only severe but also likely to be ineffective in the longer term.
  • Peptic ulcer disease continues today but it now very rarely results in PS.

So – generally good news for the PS-aware community!  My next post will review several other medical articles on adult PS.

Pyloric stenosis and training better doctors

Some of the things people do are utterly unbelievable, were it not for the fact that we humans all do so many things that range from dim-witted to diabolical.

Ostrich_head_in_sandAustralia is more affected by growing extremes of fire and flood, and yet we have a government that rejects the diagnosis and advice of 95% of the world’s scientists on climate change.

My experience of the long-term effects of a life-threatening stomach blockage which I suffered as a baby (pyloric stenosis or “PS”) has moved me to learn more about it and to publicise what I and countless others are discovering via this blog and on Facebook.

Now consider this: the medical world has finally recognised that someone with academic brilliance does not necessarily become the kind of doctor you and I would like to consult, so for more than 20 years now university medical schools have been adding a personal interview and assessment to their entrance requirements.

Imagine my utter disgust when I recently read that one of Australia’s premier universities decided to turn the clock back and scrap these character and skill assessments from the enrolment procedure!  Admittedly this university is in what is widely regarded as the country’s most uninformed and regressive State.

arrogant doc4The writer told me that “ . . . the University of Queensland had dumped its medical interview altogether, saying that it does not add value beyond academic results and was a poor predictor of academic performance.  Medical schools guard their decisions like state secrets so I am not privy to their data but the report did get me thinking about the kind of doctors we want to create and how we go about selecting them.”

One of the most common and upsetting experiences new parents can have with a “PS” baby relates to the doctors responsible for the initial assessment and care of their little one.  True, some parents go online to thank and praise their doctor and hospital staff, and it may well be that there is a silent majority of parents who don’t comment publicly on their experience.

What is it then about doctors and hospital Emergency Departments that causes so many parents to complain?  In brief, professional ignorance and personal incompetence.

Professional ignorance

Infant Pyloric Stenosis is the most common condition requiring infant surgery – at least in the prevailing awareness of the medical community in most developed countries.  It occurs between 2 and 5 times in every 1000 births.  In other words, not every family includes a PS survivor, but everyone of us knows several people who happen to have had PS!  I personally know more than half a dozen PSers (apart from the hundreds with whom I have networked online).

Professional ignorance 1Yet many parents find their doctor unaware of even the basics of PS which they have picked up from Dr Google or from their family health book.  Parents often complain that their doctor told them that their baby could not have PS if it is female, only a few days old, or not first-born.  Doctors routinely show disdain for parents’ reports of the simple signs of PS, like projectile vomits, significant weight loss, loss of soiled and wet diapers/nappies, abdominal muscles swelling and rippling after feeding and before vomiting, and a history of PS in the family.

Yes, it is true that “all babies sick up” and that serious vomiting can be caused by any of a number of serious as well as routine conditions.  It is also true that PS appears in a variety of ways: the majority of cases (but far from all) appear at between 3 weeks and 3 months old, sometimes PS becomes life threatening within days, and other times it develops for several weeks before it can be well diagnosed.  I was operated on when only 10 days old, and some PSers have reported on Facebook having surgery only days, others at 6 or 7 months after their birth.

However, what really upsets parents is that the above symptoms and facts are so often dismissed, that pleas for diagnostic tests are ignored and that often no attempt is made in the clinic to assess the obviously available symptoms – until the baby’s condition is critical and the parents are desperate.  So many parents are on record as being told (as if they were guilty of some misdeed) that “your baby nearly died before we were able to operate” or “this was the most advanced PS we have seen for a long time”.

Another area of professional ignorance that upsets many parents and survivors is the medical world’s apparently utter ignorance of or denial that PS and its surgery can have both short-term and lasting consequences.  I have posted many times about this and plan to continue to do this.

Personal incompetence

The linked article above relates more directly to the difficulties caused by doctors who lack personal sensitivity, the ability to empathise, show common decency, and have clear ethical values and conflict resolution skills – what we’d surely like to think are basics but are far from generally held.

frustrated01This post will not catalogue the complaints of parents and survivors in this regard, as I have written several posts sampling these; they also come in droves on several online forum sites and are sprinkled through the results of any targeted web search.

It both grieves and angers me that the medical profession is in some part still so unaware of or careless about the distress it can quite unnecessarily and avoidably add to the ordeal that new parents suffer when their newborn becomes seriously ill.

We live in times when many community work personnel and organisations, from social workers and teachers to banks, schools and churches, are being held to account for their laxity and negligence.

Unlike these bodies and professions, the medical world is still held in quite high regard by the general community.  Being the monitors and dispensers of physical life and death and having among the best minds and nest-eggs in the land certainly bring fear and power!  And let’s be fair, like people in every other part of society, many (and I trust most) doctors work hard, selflessly and competently.

However, much of the medical world is all-too-apparently addicted to power of various kinds.  This is why entrance interviews must be valued and maintained as much as entrance scores.

This surely is not a matter of “either … or” but “both … and”.

Pyloric stenosis: dealing with doctors who delay

Doctors working in a hospital or private practice should be aware of the symptoms and other characteristics of infant pyloric stenosis (“PS”).

M820/0092Sadly, many are not.  Just go online and read the horrible stories of hundreds of new parents.  Forum sites like Facebook and BabyCentre (in North America, BabyCenter) include a sorry litany of lamentations and “lip” about ignorant doctors, simplistic notions about the causes of a blocked stomach in a baby, and lack of knowledge of the basic signs of PS, not to mention the autocratic attitude of many of these doctors, all delaying a prompt and life-saving diagnosis and treatment process even further.

Yet PS is the most common reason for infant surgery that is “non-elective” – in other words, unavoidable to save a baby’s life.  And if PS is discovered soon enough and the baby is older than one month, non-surgical treatment is an option (although not often considered) that may save a mountain of trouble in later life.

Parents deserve much better than a medical professional roadblocking diagnosis and treatment: an uncontrollably sick newborn is stressful enough without being repeatedly fobbed off or put down by your doctor.

My holiday reading this month (in a balmy Aussie summer) turned up two telling internet articles that link with the above.

The first was from a British doctor who reflected on the challenges of working in a hospital emergency department (“ED”, or accident and emergency section).  He complains about the impossible hours these doctors work, to us “ordinary people” an unfathomable mystery that has been widely known for many years – and still seems to be beyond the combined skills of the most intelligent, educated and prestigious members of our community to address.

Scared_DoctorWhat this doctor also detailed was that so often ED doctors and staff have to work with the saddest and most damaged and dysfunctional people in our cities and towns: substance abusers, people without the ability or willingness to treat others with kindness and respect, and of course, the many people who have suffered the consequences of these ugly symptoms of a broken world.

Reading this doctor’s account brought home to me (yet again) that there is another side to the litany of parent complaints I mentioned above: many doctors are stressed out by Western society’s unwillingness to pay ever more for health care, by their profession’s inability to address the totally unreasonable workload of “juniors”, and by the continuing and deepening breakdown of society.

The parents of a sick baby are often the “collateral damage” of this.  Little do most of us know or care what may cause a doctor to be aloof, dismissive, or arrogant?  The parents themselves are usually too tense and preoccupied with their sick baby to consider “the big picture”.

What can the parents of a sick child do when they are faced with a doctor who upsets them even further?  Here are some suggestions:

  1. blog-writing1Make notes of your baby’s story: keep a full and detailed record of its weight, feeding intake and times, its output (both top and bottom), its general wellness and appearance, and anything else you notice.  This will enable you to give the doctor or ED staff clear facts.  It’s much harder to brush these aside.
  2. Do your homework and learn what you can from books and/or the web about your baby’s symptoms.  Stomach or feeding problems can be caused by quite a list of different medical problem conditions, and each comes with different symptoms and needs different tests to help guide diagnosis.  Many doctors will not spend precious time or order costly tests to search for or nail down a diagnosis unless there are already clear signs pointing to it, or (and this is sad but understandable) unless it becomes clear that the baby’s life is in danger (e. g. as shown by steady weight loss or dehydration).
    Sadly, if this happens, the baby may already have suffered effects on its brain development.  Parents should do what they can to make it easy for their doctor to steer a diagnosis in the right direction.
  3. writer-thumbA doctor is trained and likes to work as a scientist: they have to gather the evidence and work methodically towards a conclusion.  This means eliminating possible causes.  Allow the doctor to be the scientist and stay in the driver’s seat.  Hold yourself back from telling the doctor what you think or have already decided what the problem is, but be informed and alert enough not to let the doctor fob you off or delay a decision if the symptoms you have listed clearly point to a particular problem.
    The need for all this advice is abundantly clear.  there are countless reports of doctors ruling out PS “because your baby is a girl” or “because your baby is not your first-born”.  Other common reports are of doctors refusing to even consider testing for PS even though there are clear symptoms and one (or even both) parents had it and the condition is common among the baby’s relatives!
  4. Patient & doctor03Be firm and insistent about what you expect but stay calm, respectful and reasonable – hard as this may sometimes be.  Most of us do not handle hostility, abuse, and unreasonableness well!  Doctors are no exception.  Mind you, it seems that not a few doctors invite anger and harsh language by their lack of medical competence and/or people skills.
    If you know you risk “losing it” in some way or other over a sick infant, it would be wise to take a close, supportive and mature family member or friend along.  Some people I have advised online have (I believe) not helped their baby’s cause by their own behaviour.

My next post will look at the second article – about the selection and training of doctors.

Networking about infant pyloric stenosis (1): links

For those who have had surgery for infant pyloric stenosis (“PS”) the online social media and discussion forums have been a Godsend.

Being a 1945 PS baby, for most of my life I was able to compare notes with only a very few others who share my PS-related joys and sorrows.  But worldwide networking has arrived and flourished since the advent of the internet in the 1990s.

Parents now compare notes on their baby’s PS, the surgery, and what followed.  Many regard it as the most traumatic experience they’ve ever had, too often made worse by the lack of awareness, sloppy diagnostic work, and even arrogance of their doctor.  Many tell their tale or join a Facebook Group hoping to increase the general awareness of PS, the most common condition of infancy which is usually dealt with surgically.

blog-writing1Survivors are typically keen to break out of their sense of aloneness.  We can now compare our feelings over the surgery and scar: we had no say and have no memory of our first crisis, but we can now meet others with the gnarly or deeply sunken scar which most of us hated, especially in our earlier years.

Many PS survivors also want to learn about a list of ongoing problems which some have and which seem to be related to their stomach operation, although doctors don’t agree or want to know about this.  After all, the paediatrician and the surgeon assured our parents that the operation was easy, quick, almost always immediately successful, and that there are no long-term problems after PS and the surgery.  “If only!”

Facebook is the most accessible and popular address and has at least six large and small PS Groups and they are actively used by both parents and PSers.  Unlike web forum sites, Facebook Groups can only be accessed by registered users; they just need to type “pyloric stenosis” into the Search box to get a list of Groups.

Forum sites like Experience Project, MedHelp, Patient UK, and Topix each have one or more discussion groups for PSers.  These four links are to each site’s most popular discussion on PS matters, and a search there will usually give you links to other discussions on that site.

Expectant and recent mothers share their experiences, concerns and questions on specialist sites including BabyCenter (in the USA), BabyCentre (in the UK), and also in other countries.

Readers interested in any of the PS-related issues are to be encouraged to “visit” some of these online locations.  Consider sharing your story and help increase the public and medical world’s rather too common ignorance of PS!

In the next few posts I want to pass on some samples of the important information that is shared on the pages of some of Facebook’s PS Groups.

Pyloric stenosis and reflux (GERD)

Parents of a pyloric stenosis (“PS”) baby often face one or both of two questions –

1                    Does this sick baby have PS or reflux ?

2                    My baby’s had surgery for PS but is still sicking up – is this still PS or is it reflux ?

This blogsite’s main post on telling the difference between PS and reflux (or GERD or GORD) was written 30 months ago and is one of the most often visited.  That’s two good reasons to look at the main facts again.

First, some necessary information about GERD.

GERD stands for gastro-esophageal reflux disease (the American spelling), and GORD is the English equivalent.  What is it ?

Reflux or GERD in babied ((c) Mayo Clinic)

Reflux (GERD) in babies – (c) Mayo Foundation

If the muscle ring at the lower end of the esophagus (the tube that takes our nourishment down from the throat to the stomach) is unusually relaxed, weakened, does not close when it should, or becomes herniated, the gastric (or stomach) contents are forced back up the esophagus.  But this fluid material will now have become acidified, and so it will burn and damage  the lining (the mucosa) of the esophagus.  What we feel as a result is usually described as heartburn, chest pain, regurgitation, and nausea.

Reflux can be minor or very, very unpleasant but in itself it doesn’t kill.

It is believed that in the “Western” world between 10 and 20% of people will suffer with GERD at some time or chronically.  Serious and continued GERD can cause other problems, ranging from coughs and esophagitis to ulcers, scarring and even cancer.

Almost everyone will sometimes experience passing reflux.  Depending on its seriousness, GERD can be managed with diet, antacids and other medications.  Some of GERD’s causes may require surgery.

Babies have an immature system, including their gastric tract, and for this reason most babies will “sick up” – some occasionally and some very much.  Anything that upsets a baby’s stomach is likely to affect its working, whether it’s mother’s lovely spicy dinner flavouring her breast milk, or abdominal surgery during which some strange tools and gloved fingers fiddled with its insides.

So it’s not hard to realize that almost all babies will continue to vomit and have reflux after abdominal surgery such as a pyloromyotomy.  This may happen just a few times, or during the days of post-operative recovery, or for some weeks or even months and years, or baby may (now) have a chronic problem.  Unless the baby’s immediate family are all troubled by GERD or have never known a sign of it, it may be hard to get a sense that a PS baby’s post-op GERD is either a family trait or was probably triggered by the surgery.

My reading and listening have shown me several things –

            1. Little substantial medical research has been done and published about this common problem.
            2. The very few small samples that have been reported have all found (1) that PS people have a higher rate of gastro-intestinal “conditions” – but (2) hasten to add that the number is not significant.  My logic and reading make me disagree!
            3. Pediatricians and peds ward workers will usually warn parents to expect some post-op vomiting and GERD.
            4. When GERD continues, most doctors dismiss it as resulting from the surgery.
            5. Those affected by PS, surgery and GERD should be aware of the fact that (like every part of our broken society) the medical world engages in what might be termed “power play”.  Doctors like their many kinds of authority, hate it being questioned, protect each other, work and talk together, etc.  They also dislike spending time that will affect their day and the patients they must see: issues (and thus people) will not always be adequately dealt with.

Now about pyloric stenosis…

First some major differences between GERD and PS.

          1. GERD in itself is not deadly but untreated PS usually is – and quite quickly so.
          2. Linked with this, GERD will slow down weight gain and growth but PS will usually reverse it.
          3. Although both result in vomiting, GERD is caused by the stomach’s entrance muscle ring and PS by the exit muscle.
          4. In GERD the muscle ring is not 100% effective but will usually develop; in PS the muscle ring is stimulated to over-develop, a process that can usually be stopped only by medication or surgery.
Pyloric stenosis in babies

Pyloric stenosis in babies

Many of our medical advisors (GPs and paediatricians) will not diagnose a baby with PS (or even consider this) until all other possibilities have been eliminated.  This is correct: we don’t rush to infant surgery unless it is necessary.  But this sound principle sometimes masks diagnostic ignorance or incompetence.  Countless hundreds of outraged parents have written up their traumatised stories on the internet to warn others that their baby could have died before their doctor might have diagnosed PS.  They usually tell us they went to another doctor, or (quite often, it seems) created a scene at the local hospital’s Emergency Dept.

Soon I want to revisit the different degrees of infant vomiting caused by the pylorus.

As stated above, true PS will usually kill.

The baby loses first weight and then condition.  Bowel motions and then urination will slow and stop.  The stomach and esophagus will be damaged by the acid and violence of its vomit – which may show traces of fresh or old blood.  The baby will not only be ravenously hungry and starve, but it will also visibly dehydrate, and (unseen to the eye) its blood chemistry (make-up) will become so messed up that it will move into sleepiness – this being the sleep of death.

If in any doubt, see your doctor or the hospital, and if still in doubt about the outcome, insist on doing a test feed, and having blood tests and imaging tests done (xray, ultrasound).

If your baby is not showing these terrible symptoms, before or after PS surgery, its problem is unlikely to be PS.

gerd-or-ihps-table1I recently came across the story of a 10 month old boy whose distressed mother suspected that an incomplete pyloromyotomy was responsible for his continued projectile vomiting and his being only half the weight normal for his age.  Was this a case of continuing PS and doctors denying an obviously incomplete pyloromyotomy?  Or was it severe GERD that was responsible?  A truly independent doctor was very much needed to decide.

Parents and patients will sometimes find such people-of-integrity and compassion hard to find.

Pyloric stenosis and adhesions

One of the most frequent long-term causes of grief after surgery for infant pyloric stenosis (“PS”) is adhesions.  This subject has been 3rd on the list of the most frequent of the 50,000+ visits to this blog, which is some indication that adhesions are not an insignificant matter.  So much for the assurance to parents when they submit their baby for an operation to remedy PS:  “This surgery never (or hardly ever) has any long-term effects”.

There are many informative websites devoted to the pain and other distress caused by adhesions, such as the one on the Better Health Channel of the Victorian Government in Australia.  I have often posted on this subject, as the “Categories” and “Search” boxes on the upper right of this page will show.

What are adhesions?

AdhesionWhen the body tries to repair the damage inevitably caused by surgery, scar tissue develops not only in the incision but also around it or from the cut tissue.  After PS surgery this means: around and spreading from the incision and the pylorus.  Adhesions can also grow between the inside of the abdominal wall and abdominal organs near the surgery’s work area (the bowels, liver, spleen, etc.).  This tissue can be as fine as plastic wrap or hard and fibrous like a web of string, in which case it is also inelastic and firm (like the skin surface of the scar).

Adhesions develop in more than an estimated 90% of people who have an invasive abdominal event such as surgery, injury, infection, radiation therapy, or a condition like endometriosis.  However, only a percentage of those with adhesions will be affected by pain or discomfort.  Most of us with them can be thankful that our adhesions are “just there”.

But this is far from true for everybody with a PS past.

Why won’t my doctor do anything about my adhesions problem?

What you read above really explains why doctors are reluctant to advise those of us who suffer with adhesions to get them removed: every time the body is opened it is likely that more adhesions will form from ever greater damaged areas.  There are ways of reducing the likelihood of adhesions forming, but prevention is better than a rather chancey remedy!

What can I do about adhesions?

Father compassion01eParents of a baby with PS should do their best to be good advocates for their baby, considering his or her long-term welfare and need for information about issues that they won’t be aware of.

Parents should also try to avoid surgery as the sexy “quick fix” for PS that most surgeons love, unfortunately without much care for the possible longer-term consequences.  There are less hazardous and less traumatic alternatives to the knife available – which only some doctors seem willing (or able, due to the rigidity of the usual training regime) to discuss and consider.

Mild cases of PS (where there is no weight loss) can be “toughed out” with or without the help of medication like Ranitidine which I have discussed elsewhere.

PS infants older than 3-4 weeks can also be treated medically – as they are in several non-English speaking but developed countries.  In these countries it is recognized that most babies recover without surgery, and those 10-25% that do not respond well enough to the medical therapy are sent to surgery; the mortality rate after PS is no different in these countries than in the Anglo-world!

Adults with a PS surgery past will probably begin to come across the word “adhesions” soon after they start having problems including –
– ongoing or intermittent abdominal discomfort, cramping or pain,
– what seems like gall bladder disease,
– bowel obstruction or blockages,  and sometimes even
– dyspareunia (painful intercourse) and infertility.

Adhesions can sometimes range far and wide from the pyloric (upper abdominal) region, especially if the surgery was rough and/or if the location of our internals is not textbook (as happens).  In my years of researching this subject area I have come across quite a number of people who had a healthy gall-bladder removed and were only then told their problem was caused by adhesions from their PS operation.

constipationIf you have any of these or a similar problem, insist that your doctor or specialist consider checking you for adhesions before you sign for anything major!  More surgery will usually make the discomfort and pain worse – although usually only after some more years have rolled by.  A few of my correspondents and friends have had adhesion surgery several times over a lifetime: this may well be the best course for some.

Several therapies other than surgery to break up or help live with adhesions have been mentioned on this blog, such as here, and here – and there are more on the web.  Most of these helps have been praised by some and found a waste of time and money by others.  One of my Facebook Friends wrote to me:
I used to belong to another group where they discussed in depth [a] physio clinic in the US and a lot of people felt they had been made worse with it.  It involves a lot of hours of intense therapy and the manipulations left them [with] worse pain and no relief from their adhesions.

Hmmm… “Taste and see”, if you have the need.

2013’s most visited infant surgery (SIS) posts

This last post for 2013 on the “Surviving Infant Surgery” (SIS) site was written away from home and after a very busy but delightful, Christian, and family Christmas.  I thought if might be of interest to list the most visited posts of this blogsite during the past year.

It is with continual surprise and gratitude that after three years I continue to see the interest in the SIS blog rise each year, so that the total “hits” now number almost 50,000.  Even more gratifying is the feedback from many readers, online and by email.  The message of your comments is, “Thank you, you’re helping people like me (or us) so much with your honesty, careful writing, shared experiences, and by helping me / us to realize that my / our experience is far from a lone or odd one.  Do keep up the good work.”

The post that drew the most interest by quite a margin was about the possible long-term effects of infant pyloric stenosis (“PS”) and the surgery that often follows it, Ramstedt’s pyloromyotomy.

ponderAdhesions after a pyloromyotomy were a frequent and often troublesome concern among those who used this blog during 2013.  Two of the top 10 discussed this, the posts # 2 and # 6.  The 2nd most visited post dealt with the effect of the surgical scar and internal adhesions on a pregnancy, and the subject of #6 was the adhesions that can be expected after any abdominal surgery – with special reference to the trouble adhesions have been found to cause to people after an infant pyloromyotomy.  Sadly, this is one of the subjects raised by PS and its surgical “remedy” that most doctors brush off with a vengeance: there is no prescription, no surgery, and no other easy way of dealing with abdominal adhesions.

The subject that had the next (3rd) most readers’ interest was related to this also: Does an abdominal scar cause trouble during pregnancy?  The short answer is that it can – but usually if any, it is a relatively minor discomfort.

The post with the 4th highest number of “hits” discussed a deep fear and occasional reality: Can PS raise its horrible head again after a pyloromyotomy?   Continued vomiting, although of a less violent form, is quite common, even to be expected, after a pyloromyotomy, although usually only for a short time.  It is very understandable that parents who have just been through the harrowing experience (indeed, traumatic for many) of infant PS will be more than anxious about this possibility.  While most doctors and hospital staff are reported to be very supportive in this situation, many parents are unsettled (to say the least) by the earlier bland and simplistic assurances that “surgery fixes PS immediately, permanently, and without any after-effects”.

Self-exam1The post that came 5th in popularity in 2013 reflects another area of anxiety and emotional pain that has come with the surgery for PS: while some care nothing about their scar, others can tell tall stories about it, and some hardly think about it, there are many “py babies” who grow up to hate their scar with deeply felt hatred and embarrassment and would dearly love to be rid of it.  So one of my posts on scar reduction plastic surgery rated #5 in interest.

Symptoms of post-traumatic stress sometimes result from the anxiety, surgery, and maternal separation that PS can bring, especially from the way the condition and its surgery were handled up to the late 20th century.  This subject was also discussed in many posts, but the one that rated # 8 in 2013 made the top 10.

By using the “Categories” search box (top right of the page) or searching for keywords or “tags”, readers will usually be able to find a number of posts on each of these and other subjects.

The “My Story” page (with its tab at the head of every page) has also rated very well.  Thank you for your interest, encouragement and support!

At the end of another productive year of SIS, I want to thank all my readers and especially those who have given feedback online or by email.