We 'heart' Dr.BH!

I'm thrilled to report that we love Dr.BH, Cooper's new pediatric GI specialist. We met with her yesterday and she took a thorough history, truly listened to our concerns, and validated the conclusions we drew about the likely cause of Cooper's aspiration pneumonia and subsequent choking incident (that damn Enfamil AR formula). And she was too professional to bash Dr.E but we got the clear impression from the words she chose and comments she made that she disagreed with him on all the key points regarding Cooper's reflux treatment.

Dr.BH dislikes Enf.AR formula and never recommends it, certainly not without determining a baby's tolerance for its thickness by doing a swallow study. She would have ordered the swallow study/upper GI test while Cooper was in the hospital to get it out of the way (Dr.E should have done that but he was a no-show as mentioned previously), but she does NOT want to order the test now since Cooper is stable and doing better on the Enfamil Lipil and has been through enough trauma already (exactly what we wanted to hear). She said if he shows signs of repeated aspiration, choking or other reflux related complications she will order the test.

Dr.BH says Cooper should be kept on the Prevacid at least until 6 months which is when most reflux babies experience significant strengthening of the muscles involved and begin to show signs of outgrowing the condition (though some babies take up to 2 years to outgrow it). We'll see how he's doing at 6 months and decide whether to keep him on it or to try reducing the dose to see how he does on a lowered dose (Dr.E wanted us to taper him off it starting now - can you imagine!? Obviously not an option since his reflux caused aspiration pneumonia).

Babies generally can be started on solids between 4-6 months but Cooper won't get them until we reach 6 months and see how he's doing because solid foods can be risky for refluxers. I'm relieved about this because there are only so many changes and challenges Cooper (and I) can take at once and we all know we've had more than our fair share of craziness these past 4 months. She said that if he's showing signs of the reflux still being strong at that point she might consider prescribing Reglan which helps move food out of the stomach more quickly to help prevent it from being refluxed back up the esophagus so that he can proceed with starting solids with lowered risk (but we are hoping that won't be necessary b/c it's not the nicest of medications).

Dr.BH reiterated the importance of keeping Cooper upright for 45-60 minutes after feedings (previously the recommendation was 30 min but since he has aspirated we need to be extra cautious) and we need to keep him inclined when he sleeps and during diaper changes (since most diaper changes occur around feeding times). So....I've ordered an AR Pillow for Cooper's daycare crib (this type is ideal for naps but not for lengthy sleep periods and this one fits the portable cribs used at daycare but not standard cribs). For Cooper's crib at home (which he hasn't slept in yet (only has played in it) we're getting a Tucker crib sling so that we can elevate Cooper's crib mattress and prevent him from sliding off the inclined portion. Once we have the sling and a wedge to elevate his crib mattress we'll attempt to transition him to his crib. Meantime, he still sleeps in his bassinet (with an elevated sleep positioner to keep him inclined). I had already created a make-shift incline on his changing table downstairs but it's not inclined enough and we didn't incline the upstairs one so I need to work on that this weekend.

While in her office, we had to feed Cooper which turned out perfectly because it stimulated him to create a poopy diaper from which Dr.BH took stool samples to send to the lab to test for milk protein allergies. If Cooper has an allergy, it could be the root cause of his reflux and we'd put him back on Alimentum or even another more broken down formula. Cooper was tested for blood in his stool (which is a sign of such an allergy) at around 8 weeks of age but it was negative although apparently a false negative is not uncommon. Since Cooper has been off the hypoallergenic formula which helps babies with milk protein allergies (Alimentum) since 10/4, the test should pick up indications if an allergy exists. We'll know in about a week or so. I'm torn about what to wish for. On one hand, if it's an allergy causing the reflux that's a somewhat easy fix with dramatic short-term results while he's still on formula (more complicated later on as solids are introduced), but if it's not an allergy we'll know the reflux is more likely to be outgrown sometime within the year or so. We can handle it either way so I'm not going to stress about that (right now I'll just stress about preparing Cooper and myself for my return to work which is 2 weeks from today - ah!!! ;0).

Dr.BH gave us a new prescription for Cooper's Prevacid. Suggested we keep giving him the probiotics for another 2 weeks and then taper him off of it (to treat the side effects of the strong antibiotics he was on in the hospital and for a week afterward), and told us we could call anytime and that she'd be happy to discuss Cooper's situation and ideas by phone since she knows it is quite a trek to make with the baby from our place to her office. What a wonderful change from cranky, lying Dr.E! Dr.E wouldn't even DISCUSS Cooper's situation unless we were seated in his office (a 45 minute drive).

In a nutshell, we 'heart' Dr.BH! :)