Editor’s Note: James Plews-Ogan, MD, is a former pediatrician with UVA Children’s. Diagnosed with ALS in December, he works to improve the prognosis for others with the disease. Read his story.
As a mother, this is the moment I hate to remember. It takes place in a cramped, white room. Four burly orderlies, also all in white, surround the exam table. Under their large, muscular hands, my 8-month-old son writhes and screams in terror, as a nurse attempts to find some place on his body where she can insert an IV. He is so dehydrated that the options are limited. Eventually, they attach the needle to his head. He is still screaming.
Fast forward to the next day, and that same baby is in my arms, giggling and totally fine.
My story had a happy ending. But it almost veered the other way.
It was my kids’ pediatrician, James Plews-Ogan, MD, who made the difference.
The symptoms started abruptly.
We were in the car, my mom and I and my two young children, on a trip in Texas, in the middle of nowhere. Sam, the baby, started having bouts of wrenching screams every hour on the hour. Nothing could soothe him. He nursed, then spat everything up. Then he’d calm down, get tired, only to start up again, in pain. What could it be? My mother and I were mystified. Was it a new tooth? Food poisoning?
This went on for hours. And hours. And hours. Vomiting yellow liquid, screaming. And eventually, blood in his stool. “Emergency room,” Mom and I agreed.
I don’t blame the tiny county medical center for the misdiagnosis. It can happen. It was 2 a.m. They looked at the blood-filled diaper and concluded the cause was constipation. They sent us to an all-night pharmacy for Miralax. “He’ll get better,” they told us. We believed them.
Sam got worse. Nothing was staying down. Blood kept coming. No sleeping. Fever. And then the beginning of panic, blurry Google searches, desperate medications.
Finally, I called our pediatrician back home in Virginia. He’s an old-fashioned type of doctor: Kind and soft-spoken, he’s the only doctor in his private practice, he makes house calls, spends appointments letting the kids play, takes time to chat, really gets to know you. Paging him at 4 a.m., I knew I would reach him and no one else. I knew I could trust him. I just didn’t think there was much he could do being so far away. But I was desperate. There was still part of me that thought maybe I was overreacting.
Ogan called back and right away he identified the problem: Intussusception.
What? I’d never heard of it, nor could I really pronounce it.
“Get him to the nearest children’s hospital you can, as soon as you can,” he told me.
What is Intussusception?
As Ogan explained to me later, intussusception “is when the small bowel telescopes in on itself. A weak point or place shoves into the other part and when that happens, it gets swollen and nothing can move through. It’s an obstruction.”
I had never heard of this, and with good reason: While it’s the most common abdominal emergency for children under age two, and the most common reason for bowel obstruction in babies, it’s still, overall, not that common.
Some things to know about intussusception:
- It usually occurs in older babies, before the toddler stage
- Boys get it more than girls
- There’s no real “cause” for most cases; as Ogan told me, “it just something that happens randomly”—so, no way to predict or prevent
Sometimes, barium enemas are used—“they can be both diagnostic and therapeutic,” Ogan says. In other cases, a provider might use an ultrasound for diagnosis and, if damage has occurred, surgery could be required to repair the bowel.
- Severe abdominal pain that seems to come and go
- A red clotted or jellied stool
- The inability to hold milk or food down while vomiting up bile
- Swollen belly
- Pulling the legs to the stomach
If intussusception goes untreated, your baby may go into shock. Eventually, irreversible damage can happen and then infection or death.
A Simple Save
I don’t know why the little emergency room didn’t know what was happening with Sam. But I’m grateful Ogan did. If he hadn’t been available, if he hadn’t known his stuff, things could have ended disastrously.
But he was available, and we were raced to the nearest hospital, about two hours away. A sonogram confirmed the diagnosis. Sam was given an air enema that blew his bowel back into place. We had made it just in time—he was so dehydrated, his veins had flattened, leading to the IV incident. After the procedure, he wasn’t allowed to nurse; I just had to hold him and comfort him as best I could. We spent the night in the hospital. And he was just fine.
The thing about intussusception, as I learned first hand, is that it’s easy to fix, but only if you know what it is and catch it soon enough. It disturbed me that I had never heard of it—and pretty much most people I talk to have never heard of it, either.
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That moment, the one I don’t want to remember? We all have moments like this, ones we wish we could ditch but that stick out, all the same, reminding us of when an emergency took over our normal, everyday lives and gripped us in fear.
But I’m glad I remember. It not only reminds me how lucky I am that things worked out, but it also gives me a chance to share what I learned, so that maybe you, reading this, don’t have to suffer the same thing.