Coordination of care in baby's surgery leads to ‘great patient experience’ for McCall family

Amanda and Steve Keaveny of McCall were in that “magical post-partum phase” after the birth of their third son Eddy. The family was settling in, and Eddy was eating, sleeping and healthy.

All of the Keaveny boys were delivered at St. Luke’s McCall. Eddy was the first to be delivered in one of the birthing rooms at the new hospital, which opened in July.

“It was a peaceful experience,” Amanda said. “The nurses knew all the techniques and strategies of supporting a natural birth. They knew what I wanted before I knew.”

After returning home, everything was going as the Keaveny family expected. Until around when Eddy was five weeks old, he began to spit up more than usual. Amanda thought it could be acid reflux or maybe she was overfeeding him.

But things changed quickly from being normal to “not being right,” she said.

Eddy transitioned from spitting up to projectile vomiting. Another warning was Eddy’s light diapers.

Amanda’s mom — Eddy’s grandmother — was visiting the family at the time. She shared that Eddy’s symptoms sounded familiar to a condition Amanda’s father had when he was an infant.

The condition, hypertrophic pyloric stenosis, is a narrowing of the pylorus, a muscular valve at the bottom of the stomach — often called the “olive” due to its size when normal. When it becomes too thick, or hypertrophied, breastmilk or formula can’t get through to the small intestines. This can lead to excessive vomiting, according to the American Academy of Pediatrics.

While HPS is considered rare, it is more common in male infants and sometimes runs in families.

It was a Friday in early October, and Eddy’s symptoms continued to worsen.

After a trip to the St. Luke’s McCall Emergency Department, an ultrasound was recommended to help diagnose HPS, as it provides a picture of the pylorus, which would present thicker and longer than normal if HPS is the issue.

The earliest the exam could be done was the following Monday, as St. Luke’s McCall is unable to offer 24/7 ultrasound services. Nurse Liz Watson connected with St. Luke’s physician Dr. Paddy Kinney, who, after examining Eddy, said there was no reason to wait until Monday to get an ultrasound in McCall and referred them to Boise.

“Dr. Kinney was confident and decisive on what we needed to do,” Amanda said.

Kinney contacted the team in Boise at St. Luke’s Children’s to let them know the Keavenys were on their way.

“When we arrived, the Boise team were expecting us, and we were in an exam room within 10 minutes,” Amanda said.

They first saw the pediatric emergency physician, followed by a consult with the pediatric surgeon.

“We were concerned and anxious about Eddy’s condition and having to have an ultrasound,” Amanda said. “The radiology tech was awesome, and the ultrasound room setting was calming.”

The exam confirmed the diagnosis of HPS. Eddy’s pylorus was two times the normal size, similar to the size of a date.

After the ultrasound was completed, the pediatric surgeon was available to see Eddy within 20 minutes and he was admitted to the Children’s Hospital. Eddy had the necessary surgery on Monday morning.

The surgery, called pyloromyotomy, was done laparoscopically and includes making a few tiny cuts or incision to open the thickened pylorus muscle.

“They told us they call it the ‘goldilocks surgery,’ not too short, not too long, the incisions need to be just right,” Amanda said.

Eddy spent a week in the hospital to recover from the successful surgery. He was cared for by a team of nurses, nurse practitioners, physician assistants, doctors, a lactation consultant and speech therapist.

“They were all engaged in his care and worked together. They were all constantly working to improve Eddy’s comfort and ours,” Amanda said.

“We really appreciated the down-to-earth bedside manner and communication from the entire care team. We had lots of questions. Everyone was patient, reasonable and responded and explained in a forthright manner. They reassured us that Eddy was safe and was going to be O.K.”

Even though the Keavenys were receiving care in Boise, Amanda’s primary care physician, Dr. Maureen “Mo” Ferguson of McCall, was constantly checking in with them to see how they were doing.

“She even came by and visited us while we were in the hospital,” Amanda said. “She stayed with Eddy so I could take a break and go for a walk. Who does that?”

After being discharged from the hospital, Eddy was able to have his follow-up visits with Ferguson in McCall. He kept improving and is thriving today.

“St. Luke’s coordination of our care led to a great patient experience for us,” Amanda said. “We were fortunate to catch this early and we are so grateful to everyone who cared for Eddy and our entire family. I don’t know how to thank everyone. They were all exceptional.

“From the care we received when Eddy was born, to the St. Luke’s McCall emergency department doctors and team, and the entire team at St. Luke’s Children's.”