The rash...

...and other side effects.

I think people assumed (me included, at least for a while) that the surgery would mean Baby J would be completely cured of his HD.  That he would magically be completely normal with normal bowel function, normal diet, etc.  But this is not the case.  Once an HD baby, always an HD baby.  See, even after the colostomy is closed and his bowels are reconnected to his bum he will still have issues with this.  He will likely never have completely "normal" bowel function and may not be able to eat a "normal" diet without restrictions.  Children (and even adults) with HD often struggle with issues of bowel incontinance-- be it constipation or diarrhea.  Their bowels are not "normal" so we shouldn't expect things to be.  Take away part (sometimes all) of a person's intestines and digestion just isn't going to work the same way.  There are lasting side effects

A minor side effect is his scars.  Baby J will live with several scars on his tummy.  A larger scar on his left side from where they closed his colostomy, and four smaller scars where the laproscopic camera went in.  These smaller scars may fade and become barely noticeable, but the larger scar from the colostomy will not.

Another side effect, that we were told to expect, is diaper rash.  Not your run-of-the-mill red baby bottom that can be easily fixed in a few days with some cream-- nasty, breaks the skin and makes it bleed diaper rash that just won't go away, no matter what you do.  It started a couple days after Baby J's first poo.  The nurses and I tried to stay on top of the messy diapers, but they were just happening so frequently (more on this in a minute) that it was impossible to do unless someone stood by him constantly, waiting to clean it up.  After he had been going for a day or so I got smart and asked for some diaper cream, I should have asked sooner.  Things were still pink, no skin breakdown had happened yet, so I thought we were in the clear.  The doctors told me that it wasn't necessary to wipe all the cream from his bum at every change since vigorous cleaning could also lead to skin breakdown and rash, so I tried my best to ignore my instincts and didn't wipe it all off.  But on day three after his first dirty diaper his bum started to turn red, despite my best efforts.  Now to explain...  (yes this may be a little gross)

The intestines' purpose in digestion is to suck moisture out of food and put this moisture and the nutrients it holds into the blood stream, then to move waste out of the body.  As moisture is removed from food it becomes less acidic and more solid in nature (remember this).  A normal bowel has a rectum that has a small pouch in it where waste is stored and compacted before it leaves the body.  Normal waste has a low moisture content and is fairly solid as it exits, even in babies, and is therefore non-acidic (or at least low in acid content).  Since persons with HD lose their rectum and this pouch for storing waste, along with part of their intestines that suck moisture from this waste their poo is more acidic, more runny, and happens more often than normal people and babies.  This means that, unless someone is there to change the diaper as soon as a bowel movement happens, and can essentially be there 24 hours a day to do so, skin breakdown and diaper rash are inevitable, even with this it is still likely what with constant wiping and cleaning of the area.

So I tried to prepare.  I looked up recipes for diaper rash creams and cures online along with homemade wipes recipes (many store-bought wipes have alcohol in them and this can cause pain and drying which just makes the rash worse).  I consulted with other HD parents.  I reflected on the nasty rashes Mr. E had as a baby.  I thought I had done good.  But after we came home I was smacked in the face with reality.  My baby cried every time I changed his diaper and screamed when I put the cream I had stocked up on on his bottom.  His poor little tush was getting redder and redder by the minute, and I was changing so many diapers it felt like I couldn't get anything else done all day.  So I mixed up some coconut oil, jojoba oil, and lavender essential oil (a recipe from the internet) to try as a rash cream.  It seemed to soothe the rash some and it soothed Baby J some too.  Unfortunately it didn't protect his skin from the waste as well as it should and things continued to get worse.  So then I tried layering.  I put the coconut oil stuff on then the diaper cream.  But this still made Baby J scream and the cream didn't stick well over the oil.  So I raided the rash cream aisle at the store and came home with several creams to try.  I started with a new cream immediately because I couldn't take the screams any more.  The first cream I tried didn't make him scream *hallelujah!*, but it also didn't stick well, with or without the coconut oil stuff on first.  So I tried something the doctor suggested and put stoma powder (a fine powder used to help clean around ostomies) on with and without the coconut oil.  This helped a little, but the second cream still didn't stick.  Baby J's little bottom kept getting redder.  When I ran out of cream #2 after 2 days I started with the next cream.  This one was thicker and stuck better, even over the coconut oil.  By this point I had also made my own wipes, which also seemed to help some.  So our diaper changes at this point went something like this...  Wipe, but not all the cream off his bum, just enough to clean; pat his bottom dry with a piece of tissue or gauze; coconut oil; stoma powder; cream; new diaper.  But we are still changing his diaper frequently, like every hour during the day, that's a lot of diapers and diaper cream.  I am pleased to say that I have found a quicker and highly effective routine after several different attempts.  That last cream has been miracle worker and it with the stoma powder is our best friend.  The biggest key to getting rid of diaper rash is ensuring that the diaper area is dry before applying any medicines or creams, that is where the stoma powder is so handy.  Something in that third cream helps neutralize acid and other rash causing elements, plus it is super thick so it sticks great and you don't have to use as much.  His bum still has some red spots, but it looks so much better than it did when we first came home and, so far, we have been able to avoid open and bleeding sores.  (In case you are wondering, I am not giving out brands and names of rash creams publicly since I haven't been paid to endorse them and I don't want to give others a bad name for not working for Baby J's rash.)

Longer lasting than the rash will be possible problems with constipation or diarrhea and diet issues and his risk for certain gut-related infections is higher.  Some people with HD never have food sensitivities and others have a lot.  Some overcome problems with incontinence and food sensitivities and others struggle with it their whole lives.  Some kids get these infections several times and others never get it.  Only time will tell how Baby J will handle all of this.  I also have learned that potty training can be an issue with HD kids, but Primary Children's has a bowel management program that we can participate in to help him learn how to train his muscles and deal with problems that may arise as he gets older.  I am grateful for such a great children's hospital so close and I never thought I would be grateful for poo!