Bile plug, the second

It's clearly extremely unfortunate that there is a sequel to this, but here it is.

The past day or two RJ has had some paler stools. True to our word we followed the hepatologist's advice and did not freak out. After all, it's nothing that would worry any parents who are less paranoidly attuned to the issue. We can expect output to vary, right?

RJ woke up at 3 am the night before last, and then repeated that last night.

I get up at 3 am, bleary eyed, from the bachelor bed in the guest room where I fell asleep while watching a movie last night. RJ ate like a ravenous beast, then defecated and IMMEDIATELY fell asleep in the delight of being relieved of his burden, as he is wont to do. (This is totally my very least favorite thing about breastfeeding, by the way. I can't waiiiit to start some constipating solids. Do you hear me RJ? I am just waiting for the OK from the doctor next week and then we will try some rice cereal and some broiled, pureed salmon!)

Sometimes I can pull off the diaper change while keeping him asleep, but that's not possible when the poo seeps out not only all over RJ's outfit but also mine, necessitating TWO outfit changes. So I ignore the pasty texture and paler yellow color of the poo, shove RJ out of his outfit and into a new one, then put him in his bed while I change my pants. Of course, he flails and kicks and is awake!

I dim the lights and convince RJ that it is sleepy time again.

While eating, he emits a loud noise from his nether region. I yank him off the boob, and check his diaper.

He does not in fact have a poo. Just gas. (RJ is a very flatulent baby.) He does, however, barf all over his onesie while I've opened his fleece sleeper to check, necessitating yet another outfit change. Note: get fleece sleepers for wintertime if you have a vomity baby, because you can totally wipe off the vomit without the baby underneath getting wet. Genius. If you keep the fleece sleeper closed, that is.

RJ, understandably, upon being stripped down in a cool room, think it's time to be awake again. I try to calm him down, and with a combination of rocking and shushing I get him latched back on and he does eat, while flailing his little limbs like he's in an aerobic class. What is going on? Why are you so agitated? It's 4 am! We should both be asleep right now!

A loud noise rends the air. Oh. That's why. Poo.

I check the diaper again. Yes, poo, of the pale pasty yellow variety. Okay.

But, what's that I spy? I open the diaper again and stare at it.

If you read the title, you will not be as surprised as I was to find it was a BILE PLUG. Just like the one he passed in the hospital. It's blackish and firm and about 2 mm in diameter. Poor kid.

I wake up Ephiny. She confirms this is just like the first one he passed in the hospital on her watch. We stare at the bile plug and poke at it, and glumly confirm that RJ's bile plug in the hospital was not the one-time thing like the heptatologist had been convincing us was likely.

Meanwhile, RJ is delighted to see BOTH of his parents gazing at him with concern. At 4 am! Yay, party!

In his excitement, he barfs a little on his sleeper. I wipe it off. He decides he's still hungry. He eats with much less agitation, now that he is fully empty. He goes to sleep. I crawl back into bed with Ephiny and try to do the same.

As of this morning, poo is now back to being properly bilious. (How stupid is it that we are reduced to doing poo updates? Even Jolly cheerily asks to see every diaper and announces "It's a BROWN one!" when applicable.)

But, seriously, crap. Just when we had so been enjoying the "freak one-time occurance" theory. I guess the good news is that once again, he's cleared this on his own. The other good news is that it's definitely not something about my diet that's causing his episodes, because I've been on an absurdly low-cholesterol, low-saturated-fat, ultra-healthy diet for the past two weeks that could bear less resemblence to the holiday feast that I'd been enjoying when he had his last episode.

RJ, you have used up your annual medical drama allotment a long time ago. You are not allowed any more hospital visits until you are a teenager and do something stupid but ultimately not worrisome that involves you breaking your arm or a leg and having to wear a cast that all your siblings get to sign. Do you hear me, bile ducts?

I so wish I could will this better by sheer determination.

Instead, I'm calling the hepatologist this afternoon and asking if we should up RJ's ursodiol dose with his mass, rather than weaning him off it as we had been (by keeping his dosage the same while he grows). I will also ask if we should go in sooner than a month from now for a blood draw to check his liver values and his AAT status.