Toby is a little bit happier today than yesterday, which was a little bit more than the day before, so the trend is in the right direction. He is still subdued and more somber than usual, but appears much more comfortable.

He continued to vomit yesterday and during the night. This morning, the doctors decided to change his ng tube for an nj tube. This means that instead of dripping into his stomach, his feedings would go directly into the intestine. It's another attempt to control the reflux by keeping his stomach empty- which is also the purpose of the reglan. They also decreased the volume of the feeds and restarted his iv for hydration. Tonight he will receive some intravenous nutrition to help him regain some strength. The plan calls for a few days of this with some more observation. Always, he is getting more tests to screen for other possible problems.

The surprise today came when we went down to x-ray for placement of the nj tube. After the initial x-ray, they told us he already has an nj and sent us back upstairs without doing anything. His nurse had put an new ng tube in Saturday. Evidently, it went in a little further than usual and is already in place where they wanted it. This may in fact help us progress a little faster through the observation period since it means we've already been observing the effects of that change for two days concurrent with the reglan.

Rx: more wait and watch.