5year old kid has surgery for an aortic stenosis. As often happens in this situation , he is hypertensive post operatively. His left ventricle is accustomed to generating huge pressures to get blood out through the defective valve, and even post op, continues to be hyperfunctional.
In this case, however, we can't keep pressure down to a safe level, no matter what....nipride drip, lots of pain meds and sedation are only minimally effective.
Within a day or so it becomes clear that part of the problem is that the child is both constipated and in distress, which is increasing his blood pressure.
We give him the standard remedies: glycerin suppositories, some stool softeners.
His blood pressure gets higher.
We then give him some stronger guns...magnesium sulfate, then Miralax, then in desperation, golytlely, which is designed to clear out bowels before major imaging. He still doesn't produce any stool, although xray tells us his bowels are full and ready to evacuate. His blood pressure is still sky-high and he spends most of his time clenching his buttocks, his quadriceps, and moaning, clutching at his belly.
In desperation, I ask his grandmother (who is his legal guardian), "what is "boy's usual pattern? Does he often have constipation? Is there something you do for it?"
Her answer:
"We couldn't stress him with potty training because of his heart defect. He usually just goes behind the couch in the living room. "
