It started with a broken arm, and ended with a trip to the emergency room for a manual disimpaction. And in between? Well there’s the tale.
A year-and-a-half after Ben got out of the hospital from the pancreatitis scare, on the very first day of Christmas break, he was in a particularly good mood. With his GI problems finally diagnosed and treated properly he was finally beginning to gain some weight and fill out. Where the year before he was all skin and bones and pale as a ghost, now he had a healthy glow about him and some actual meat on his bones. He was also much more energetic, which was not surprising since he was finally actually absorbing the proper nutrients from his food. He had of late taken up skating, and really enjoyed when I would walk with him as he skated around the block in our quiet little neighborhood.
As a skater myself, I knew the importance of safety. I absolutely never let him get out on his skates without also strapping on his helmet. Unfortunately, I did not also insist upon wrist guards and knee pads even though I never personally skated without them. In retrospect that was a glaring oversight on my part, and I feel awful for what happened. We were less than 20 yards from our driveway when suddenly and unexpectedly Ben’s skates came out from under him. He instinctively put out his hands to catch himself, faster than I could react, and then a heartbeat later he was on the ground screaming in pain.
I gave him a quick once-over and did not see any blood or visible damage, but I could tell by the way he was crying and holding his arm that this was more than just a bruise. I immediately got on my cell phone and called for an aid car, afraid to unnecessarily move him too much if he really was injured. Within a matter of minutes the paramedics arrived. They quickly examined him and then informed me that it was very likely that he had fractured his arm, that it was not severe enough to require a ride in the ambulance, but that I should get him to an emergency room for an x-ray as soon as possible.
Within the hour Ben was in front of an emergency doctor, and the x-rays confirmed that he had in fact fractured his arm and would require a cast. They placed him in a temporary splint, gave him some painkillers, and sent us on our way.
The following Monday we saw the orthopedic surgeon. Ben was put into a proper cast, and he seemed visibly relieved once his arm had been properly set and stabilized inside the cast. He would actually only need to wear the cast for a few weeks, the fracture being a comparatively minor one. What we never, ever would have expected was that the cast would lead to pica issues.
Pica, if you are not familiar with it, is a persistent compulsion to eat non-nutritive substances like dirt, rocks, hair, or paper. In Ben’s case it started with the soft padding on the inside of his cast. We didn’t notice it at first, but he had begun picking at the padding exposed at the end of his cast and then eating it. By the time the cast came off, this unwelcome new behavior had become a significant problem.
After the cast was gone he moved on to eating paper. He had a particular fondness for toilet tissue, sneaking into the bathroom at every opportunity to grab reams of paper off the roll. No amount of deterrence or redirection seemed to help. We eventually ended up removing all of the toilet paper from the public bathrooms, and instead kept it all in our master bath that we kept locked. Anytime he used the toilet we would have to go and retrieve a roll just for that use, and place it back under lock and key as soon as he was done. This, by the way, led to a few very awkward moments when we had an occasional guest in the house. As you might imagine, it is a bit embarrassing to have to run and get a fresh roll from a locked cabinet when a visitor asks to use your restroom.
Ben’s next favorite source of paper was the wrappers on crayons, which he would surreptitiously tear off and eat whenever he had the opportunity. He did this both at school and at home, and even though everyone around him was very aware of the problem Ben still managed to eat a significant amount of paper that year.
It was sometime in the following spring that we noticed that Ben seemed to be constipated. He was bloated, seemed very uncomfortable, and he did not seem to be producing anything in the bathroom. We went to see the GI specialist, explaining our concerns, and the doctor prescribed large doses of Miralax in order to draw more water to Ben’s colon and help get things moving. A week passed with no progress, with Ben’s appetite and stamina shrinking every single day. Another consult with the doctor, and we started giving Ben a second laxative that was actually a stimulant.
When that kicked in it was one of the most horrifying afternoons we had ever experienced. The cramps started, and Ben was lying on the Bed screaming in pain. It came in waves, and got worse with each iteration. It was not unlike witnessing a woman in heavy labor. I stood in my ex-wife’s home watching her cradle our son in her arms while he screamed in agony, while I was on the telephone to the doctor’s office trying to convey just how much pain Ben was in. The nurse I was speaking to could hear Ben’s wails of agony, and after briefly placing me on hold to consult with the doctor she instructed us to head straight to the emergency room where the doctor would meet us in order to perform a manual disimpaction on Ben.
The drive to the ER was pure chaos, the car filled with the cacophony of Ben’s ululating cries and Sara’s sobs of sympathetic pain. I had to physically carry Ben into the hospital because he was completely unable to stand or walk by that point. In a matter of minutes Ben was whisked into the operating room. Sara and I spent more than an hour nervously pacing about the waiting room, fearing the worst. Finally, we were informed that the procedure had been completed successfully, Ben was fine and resting in the recovery room, and the doctor would be out momentarily to talk to us.
Dr. Bornstein had a bemused look on his face when he finally strode into the waiting room. Sara just looked him straight in the eye and said, “It was paper, wasn’t it?”
“Yeah,” he replied. “I gotta tell ya, I have done thousands of these procedures in my career. In all that time, this is the first time I have ever done a manual disimpaction where it didn’t stink to high heaven. It was all paper, and I couldn’t even get all of it…”
He had cleared out as much as he could safely reach, and then done another x-ray to confirm that what little blockage remained should not be an issue. He instructed us to increase the dose of the Miralax and to give Ben plenty of juice and water to drink, and that within a few days the dam would break.
As for Ben, once he woke up in the recovery room he had a look of blissful release on his face. He was still uncomfortable, but it was readily apparent that he was much more comfortable than he had been at the start of the day. He even went into school the next day.
We warned the teachers about what was going on, and suggested they should keep a particularly close watch on him in the bathroom and to let us know if anything happened. It was not until the third day that we finally got a phone call from school. Ben had quite literally exploded while in the restroom, with the last of the paper plug finally cleared away.
That has been several years ago now, and thankfully the pica issues are finally a thing of the past. Unfortunately the damage done with that experience still persists to this day, with Ben having chronic GI issues ever since. We seem to have it under control now, but it has been a constant battle.
I guess I am telling you all of this in order to tell you two things: 1) If you or your children ever go skating, neither helmets nor wrist guards are optional — ever. You may never need them, but that one instant that you actually do need them you will be eternally grateful you had them. 2) If you see any pica issues in your kids, address it hard and fast. It is a tricky thing to solve, but the potential damage that can be done is very long-lasting and miserable. There are effective treatments (some nutritional, some behavioral), and there are medical professionals who know how to deal with it. Pay attention and take to heart what they have to say. The horrors I have had to experience in the bathroom with my son, I would not wish on anyone…