Ashley has a tear in her anal canal and probably some very small varices in her colon. The worst part of her bleeding has stopped but she still has some bleeding. The doc still wants us to keep an eye on the color of her stools, if the bleeding gets worse we are to call the office ASAP, even if it is after-hours. Ashley's little tushy is sore and irritated so we are to use a hydracortizone cream and she is to take warm baths for few days to calm the irritation. She is still in pain when she stools but the bleeding appears to be slowing down.
During our visit, we also discussed Ashley's frequent headaches and possible cause. Ashley's liver doc believes the headaches are caused by the developing sinuses. Evidently, Ashley is at an age where her sinuses are developing. However, most children do not complain of pain while developing sinuses so Ashley will have an xray of her sinuses soon. Not sure what the doctors will be looking for in the xray other than something not normal. Oh and Ashley's tonsils are large but again the doc says as long as they aren't blocking her airway it's not a concern. He said lots of people have enlarged tonsils.
Dr. A also noticed that Ashley's spleen is slightly bigger than it was in August but he isn't terribly concerned because it seems to fluctuate in size. He did say the spleen was soft; I guess that's good. He said that her liver is palpable but had a hard time feeling it because of her surgery scar. He said her color looks good; not jaundice and she doesn't appear to be anemic. Because her blood counts look good, he isn't concerned that this bleeding episode is putting her at risk.
Of course, we didn't leave the liver clinic without adding a new medication to Ashley's arsenal. Apparently, Ashley's vitamin E level is low so she is now on liquid vitamin E. Let's see that means Ashley is taking 6 different medications daily both prescribed and over-the-counter. It seems we add one or two medications each time Ashley visits the liver clinic. Dr. A says the longer we manage Ashley's symptoms and complications with medications, the longer she will live with her original liver.
The plan is to watch Ashley for more bleeding episodes over the next few weeks, if all is well she will not go back to Shands until after Christmas. More than likely she will have a colonoscopy but she will not have an upper endoscopy since her last scope was perfectly normal. She will also have an ultrasound to look at her liver nodules/cysts. Of course, a full set of labs including vitamin levels will be drawn. If all is normal she will not go back to the doctor until June, at which time she will see a new GI doc locally in Orlando.
In summary, Ashley's bleeding does not appear to be related to her liver disease but of course that can't be entirely ruled out, so we will continue to watch Ashley closer. Although, Ashley's liver disease is stable, she is experiencing some complications but those complications are very treatable. Ashley has a good quality of life, as long as her complications are treatable and she is not spending time as a hospital in-patient, we are happy.
During our visit, we also discussed Ashley's frequent headaches and possible cause. Ashley's liver doc believes the headaches are caused by the developing sinuses. Evidently, Ashley is at an age where her sinuses are developing. However, most children do not complain of pain while developing sinuses so Ashley will have an xray of her sinuses soon. Not sure what the doctors will be looking for in the xray other than something not normal. Oh and Ashley's tonsils are large but again the doc says as long as they aren't blocking her airway it's not a concern. He said lots of people have enlarged tonsils.
Dr. A also noticed that Ashley's spleen is slightly bigger than it was in August but he isn't terribly concerned because it seems to fluctuate in size. He did say the spleen was soft; I guess that's good. He said that her liver is palpable but had a hard time feeling it because of her surgery scar. He said her color looks good; not jaundice and she doesn't appear to be anemic. Because her blood counts look good, he isn't concerned that this bleeding episode is putting her at risk.
Of course, we didn't leave the liver clinic without adding a new medication to Ashley's arsenal. Apparently, Ashley's vitamin E level is low so she is now on liquid vitamin E. Let's see that means Ashley is taking 6 different medications daily both prescribed and over-the-counter. It seems we add one or two medications each time Ashley visits the liver clinic. Dr. A says the longer we manage Ashley's symptoms and complications with medications, the longer she will live with her original liver.
The plan is to watch Ashley for more bleeding episodes over the next few weeks, if all is well she will not go back to Shands until after Christmas. More than likely she will have a colonoscopy but she will not have an upper endoscopy since her last scope was perfectly normal. She will also have an ultrasound to look at her liver nodules/cysts. Of course, a full set of labs including vitamin levels will be drawn. If all is normal she will not go back to the doctor until June, at which time she will see a new GI doc locally in Orlando.
In summary, Ashley's bleeding does not appear to be related to her liver disease but of course that can't be entirely ruled out, so we will continue to watch Ashley closer. Although, Ashley's liver disease is stable, she is experiencing some complications but those complications are very treatable. Ashley has a good quality of life, as long as her complications are treatable and she is not spending time as a hospital in-patient, we are happy.
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