Confussed about tests

[Anonymous]

I’m really confussed. Can someone explain how an emptying study is done. Noah is scheduled for this test next week and we were told to bring something to mix the barium in. The nurse said I could bring yogart, pudding, a bottle, or whatever he would take. I thought this scan was done with nuclear medicine put in 4 oz of formula. How can we get an accurate rate of emptying if I give him barium mixed with yogart? Doesnt certain foods digest slower than others, depending on the caloric content and fat content? This just doesnt make sense to me.

Also, we are going to get an MRI done and a stomach ultrasound to look at his kidneys. Any idea what the MRI would be looking for? Noah has a delayed swallow and very minimal gross motor delay. Could that have something to do with it? And what about the kidney ultrasound? What does that have to do with lack of appetite?

The nurse at my Peds office called to give me the info on these tests, and when I asked her these questions, I dont think she really knew the answers. These tests are all being done because of the 2nd opinion I got the other day from that GI in Cincinnati who wants to do a g-tube. Now that they are scheduled, I’m getting leary of putting him through this. I wanted the emptying scan done so badly, but now I’m having second thoughts. He has already had radiation from the swallow study and the Upper GI, and I dont want to expose him to any more radiation than necessary. I guess I’m just frustrated and confussed and I’m not sure what I want to do. Does anyone have any info on these tests to help me to understand exactly how its done or what it would show?

lisaann2006-2-17 17:9:52

[hellbennt]

I would call the hospital and ask to talk to the actual technician who does the tests…especially the one doing the emptying study…as for kidneys, I’ve heard of ‘kidney reflux…’

I know you’ve been to a feeding specialist, but have you been to Early Intervention, the 0-3 program that each state has? you don’t need an insurance referral I don’t think…maybe they can also help you?

[Anonymous]

Lisa, I don’t know about the emptying scan… I was with you, I thought that they had to drink a fixed amount of formula mixed with barium and that they would watche the emptying of the stomach at varying intervals. I wouldn’t worry too much about the radiation, I really don’t believe that it’s very much, and if it will give you useful information then it’s probably worth it.

About the MRI of the kidneys, that will show if the kidneys are working properly. I’m not sure why your doc would do this test. Usually it’s done as part of a complete workup. We might have one in follow up to her urine test results. He might have ordered it if you mentioned your concern over Noah’s diapers not being wet enough.

I just wanted to mention regarding the motor delay that I recently called our early intervention program to get Hailey assessed as she is 8.5 months old, and nowhere even CLOSE to looking like she’s ever going to crawl, and makes no effort to move around, and also because she does this strange thing still where she likes to throw her weight back in sitting… not sure if it’s becuase our doc told us to put a pillow back there when it started at 5.5 months and now she expects a cushiony fall. But anyhow, they told me that for sitting the range of normal is 6-9 months, and for crawling 7-12. They said that she’s not considered as having a delay.

Hopefully someone will post more answers for you regarding the tests. Good luck in your decision.

[Anonymous]

Lisa: I do not know much about GES, Brian never had one before, but I know kellyw (she is on this board and another one which you also post) whose daught had GES before, maybe you can e-mail her for more information.

You mention MRI, do you mean brain MRI? Brian had ultrasound done on his kidney, because he had urine infection when he was 4 1/2 month, ped ordered the ultrasound to find out if his kidney is enlarge, it came out normal, then he had VCUG done, it turned out that he has urinary reflux. If you are not sure that what the MRI and untrasound are for, you can call the md who order it and ask about it.

[Anonymous]

one of my twins had a gastric emtying scan in december—i sure this is totally different because she is 14. she had to be fasting, when she got there they gave her a scrambled egg sandwich—the nuclear medicine was in the eggs. they also gave her toast and something to drink—-they did not rush her in eating. they took pictures of her stomach about every 15 minutes for a couple of hours. this was before we figured out that celiac disease was the cause of her problems.

[Anonymous]

Lisa,

Sorry i really don’t know much about this. I just wanted to ask who your 2nd opinion ped gi is in cincinnati. We see dr Rudolph.

[Anonymous]

Sarah,

We saw Dr. Bucavalous (sp?). What is dr. Rudolph like? Do you like him and find him to be attentive and helpful? Where do you live in Ohio?

[Anonymous]

We live near Cincinnati. I LOVE dr rudolph. He is so fantastic and very caring. He took us seriously even though Isaac was still gaining weight. He waited until Isaac was 6 months old to do the endoscopy b/c he said most cases it would correct itself. When it didn’t he was quick to schedule it and he is very liberal in his medicine dosage. He has a 2 year old and likes to talk about her all of the time too so i felt like he understood how we felt. He prescribed a medicine that is not your normal infant reflux med but it has changed everything for us. He suggested not changing formulas to neocate b/c he felt that it was not the problem and he was completely correct! My only complaint is that his nurse is just not so great but now dr rudolph will call if you request to speak to him instead of her.

What area are you from?

[Anonymous]

You are essentially getting a ugi with a small bowel follow through. Totally different than the nuclear medicine emptying scan. What you will do is have them drink the barium (they suggested the food just so you can get it in his system). Then they take xrays at different intervals to see how long it takes to empty the stomach, then go through the small bowel. given what they are looking for, they may stop after the stomach is cleared. They aren’t looking at the actual food but the barium that went down with it (they can’t see the food, it is radiolucent meaning xrays easily penetrate it.). I am a regular xray tech, I don’t do nuclear medicine so I am only vaguely familiar with their test. In a nuc med study you ingest radio active materials. With reg xray, nothing is radio active. You are “shot” with radiation which takes an image. Make sure they shield your baby’s privates. They may not be able to on every single pic if they are following it down the small bowel, but for the first few they can. Radiation is cumulative so you are right to be concerned;keep an eye on it. Most rad techs are very sensitive to this (we have timers when doing fluoro and track amount used). Every exam is different in the way of how much we use. This would be less than say a CT scan but more than a chest xray. As long as they aren’t using constant fluoro (which I can almost guarntee they won’t), your dose is low.

With the mri, I am assuming brain. didn’t you say he was looking for neuro causes as well? This why the MRI (ask about sedation, they have to be still for the study). The ultrasound, You need to ask more about that as far as why. What type of urinary issues did he mention? If you are sick, that could affect appetite. so if your child has kidney reflux and it gets bladder or kidney infections, that would hurt the appetite.

[Anonymous]

you can check out http://www.ausrad.com for descriptions of different radiology exams.

[Anonymous]

When Andrew had the emptying scan, he had to drink a specific amount of formula (maybe two ounces? he was only 3 months at the time) plus “something” while lying on a machine that tracked the time it took for the food to leave his stomach. I believe it was reported in percentages, and they expect a certain percentage to be gone after 30 minutes, then after an hour, etc. Andrew’s was diagnosed as mild to moderate delay. I’m sorry I can’t be more specific, but it was 9 years ago and it is all a little hazy. I do know I was with him the whole time.

He also had kidney ultrasounds and a brain MRI. The kidney ultrasound is easy – non-invasive, doesn’t take too long, and at our hospital it was done with the radiologist so we had the results immediately (Andrew had an enlarged ureter and kidney, which resolved on its own by the time he was 2 or so.) We were told that kidney issues can cause or make reflux and appetite issues worse. gain, I was there the whole time.

The MRI can be tricky – as someone pointed out they have to be completely still. I’d imagine they will have to sedate him – I’d get clarification on that ahead of time. Andrew also had low tone, gross motor delays, and swallowing issues, and the MRI is to help rule out a neurological component. (Andrew’s was normal.)

I hope this helped somewhat – I know it is scary to contemplate these tests and what they might mean. Try to take it one step at a time. Feel free to ask if you have any more questions! Oh – Andrew is now a healthy (88 lb) 9 year old!

[Anonymous]

My dd had an emptying scan when she was 4 weeks old. She was already in the hospital as she had choked on her reflux & quit breathing. Because she was so young, they tried to start hers 1st in the morning. She did have to fast for 3 hours. So I fed her at 5 am as her scan was at 9 am. They gave her about 1-2 oz of formula with barium. I can’t remember the intervals they rescanned her to see where the barium was. She had pretty bad delayed gastric emptying. After 3 hours of scanning, the barium was just starting to trickle out of the stomach. They wanted to keep scanning her but the ped GI on call at that time basically told them off & said “It is obvious she has DGE, the baby is crying as she hasn’t eaten in 7 hours other than the oz. of formula with barium. She was on meds until she was 9 months old.

[Anonymous]

Lisa, does he mean an MRI of his head? I’m kind of surprised that he would suggest this without first referring to a pediatric neurologist. That’s how they usually do things here. I had one done, and they do require sedation when they’re so young b/c the machine is loud and they have to lie very still. Are you going to go forward with all the tests? I do have to say that I often marvel at your health care system… the speed with which you can get tests ordered and done amazes me. Here the wait list for an MRI is over 4 months even for people with suspected head lesions. It’s crazy. Really makes me consider moving to the US- especially with all we’ve been going through with Hailey these days. Please keep us posted. Good luck.

[Anonymous]

Thanks everyone for all of your help!!!

Sarah – We live in Columbus. We’ve been going to a GI at the Columbus Childrens hosp., but he hasnt been much help at all. He did our esoph scope and ordered an upper gi. After that, he brushed us off and told us we didnt need to see him anymore. He dismissed us to the Feeding Team (Ped, OT and SLP) and said they would handle everything from then on. Thats when I got really ticked off and self referred to Cincinnati. I didnt think it would do any good to see another GI here since all the docs belong to the same Gastro Group. I was really happy with Dr. Bucavalous at Cincinnati. He seemed really knowledgable and didnt blow us off. He really understands that Noah has a feeding issue, but first wants to rule out ALL physical causes.

Donna– Thanks so much for the info. The reason I was so confussed about the stomach emptying scan was because the Ped’s nurse told me he would be drinking barium, but the test would be done by the nuclear med dept. I wander if maybe she is confussed about which test it will be, a nuclear med scan or a barium w/ follow through. I’m going to call the hospital tomorrow and find out exactly which test he will be having. How much radiation is used for the swallow study and Upper GI? The radiologist who preformed the upper gi did a really good job of only taking intermittant shots. When the swallow study was done, they had the camera on for much longer periods of time. That really concerened me.

Tricia – Great info…thank you! It sounds like our doc is doing the exact same tests that Andrew had done. Thanks so much for explaining about the kidney ultra sound. I had no idea that kidney issues can cause reflux/appetite problems.

Lori– Yes, its a head MRI. I’m not sure why he didnt first refer to a neurologist. I guess he didnt think that there would be much liklihood of there being a problem. He vaguely mentioned checking the area of the brain that controls appetite. He also said something briefly about Noah’s swallow delay and very mild gross motor delay (didnt sit up well until 9 months and not pulling up yet at 10 months). Noah is crawling now however. – I think the healthcare system here is pretty quick in most cases. A few years back I was having MS type symptoms, and got an MRI within 3 weeks of seeing the Neurologist. Noah’s appt for his MRI is a 2 month wait, but his emptying scan and kidney ultra sound are scheduled on the 22nd and 28th of this month. I am leary of doing the stomach emptying test. I’ve wanted this test done for many months now, but now I’m afraid of what the results will be, plus I’m really paranoid about all this radiation he’s been exposed to.

[Anonymous]

I didn’t realize that the radiation/radioactivity was even an issue until reading your concern and Donna’s post! When Hailey had her UGI she had the camera viewing a picture the whole time. We were covered up, but they never coverd her- not even her groin! I never thought twice about it until now. Could this be dangerous to future fertility?

[Author]

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