Wednesday

Cranky, acidy at times. Hard time napping but I got her to take two. 1130 to 130 and 3 to 515. Spoke to D. Mizell and got Prevacid suspension dose upped to 6mg twice daily.

830 to 130 (5hr)
215 to 415 (2hr)
(I think this is an acid dump issue.)
515 to 730 (2hr15m)
TOTAL 9hr15m

Thursday

Decent naps, but hard to obtain. Slept about 1030 to 12 and 3 to 5, with a quiet time at around 1 when we took Jen to school.
No longer taking suspension well (tastes bad). I want to try otc lansoprazole and see if the doc will prescribe the capsules.

Tried to get down at 9, acid too bad. Slept maybe 30min. Needed Rolaids to get back.
1030-130 (3hr)
215 to 530 (3hr 15m)
No real sleep after that. :(
TOTAL 6hr15m

Friday

Started dosing with the beads in the lansoprazole capsules. Half the beads in the morning and half at night. I want to add in a dose in the middle of the day but her naps today didn't allow me to do so.

Doctor appointment at 10. Had 1 oral vaccine and 3 shots. Slept from 11 to 12, then 130 to 530 (probably because of the shots). Got a dose of Tylenol at around 7. Fell asleep again at 730.

730 to 12 (4hr 30m)
1215 to 3 (2hr 45m)
4 to 6 (2hr)
Fitful sleep until 730.
TOTAL about 9hr15m

Saturday

Small nap from 10 to 1045

Nap from 12 to 1245, another from 3 to 5

Gave lansoprazole at 730, 1, and 7. Big acid flare-up at 815, needed Rolaids liquid to settle down enough to sleep.

Nighttime
845 to 1145 (3hr)
1220 to 420 (4hr)
5 to 730? (cant remember) (2hr 30 m)
TOTAL 9hr30m

Sunday

no good naps, very restless, cranky in the evening. gave lansoprazole at 730, 1, and 7.

Nighttime
930-12 (2 hr 30 m)
1-4 (3 hr)
445-645 (2hr) popped pacifier in, reswaddled
645-8 (1hr15m)
TOTAL 8hr45m

More from Dr. Phillips on acid dump (nocturnal acid):

You have a period of acid dump from 2 am till about 7am.    That is the period of maximal acid dump at night. So, if the drug is in the bloodstream for a maximum of ~2hrs (remember the absorption occurs after ~1.5hrs so, from the 1.5hr mark forward for ~2 hrs you have coverage for any acid being made.   So let's say you time it perfectly and give the dose at 1/2 hr after midnight so that the drug would be in the blood stream at 2 am (it takes 1.5 hrs to get absorbed) Then at 2 am you would have drug present for 2 hrs - till 4am.  Then no drug - but body still making loads of acid (nocturnal acid).  From 4 am on there would be no protection from acid

The acid pumps (called proton pumps) are in the acid making cells (called parietal cells).  They make acid when signaled to do so.  They are signaled to make acid after you begin eating (mainly by food or milk which raises the pH in the stomach).  After your evening meal they go dormant till approx 2am, then they come on and make a large amt of acid.  This is because long ago we did not cook things well (no stoves existed, hardly any fire existed) and the large meal of the day was at night then you went to sleep.  During the night your body would make a lot of acid to kill the bacteria you ingested (that is how you lived through the night-in essence).  So we still have that 2 am to 7 am acid dump. 

The other thing you have to know is a little PPI pharmacology - PPIs can only turn off acid pumps that are already on.  So if the pumps are not on (in the resting phase) and you take a PPI (that does not have a buffer) then the PPI will get absorbed and when the PPI gets to the parietal cell it will find no acid pumps that are on and it will not be able to shut off any pumps and the PPI will be removed from the body (just as all drugs are removed from the body) through metabolism and elimination.  If you take the PPI in an immediate release form with a buffer, then the buffer will turn on a large quantity of acid pumps and they will all get shut off by the PPI. Then later in the early morning hours when the body tries to make the nighttime acid dump (there will be no acid pumps remaining) - so no acid dump. 

See how amazing the body is

from midnight to 3 am for the beginning of nighttime acid dump.

The studies were performed (not by me) but over hundred's of studies who look at the baseline pH (before treatment) and then after treatment.  So all this baseline data exists and in the observation of these baseline data.  And it was observed (quite obvious) that there was all this nighttime acid.

Monday:

small nap out of arms from 1015 to 1045am. fussed much of the day, but no long stretches of screaming. good nap from about 1:30 to 4:30. fussed at store tonight. ate well. fell asleep at 730pm, with pacifier. spit out pacifier at 10pm.

Slept 10pm-12am (2hr)
1230am to 4am (3hr30m)
5am ro 7am (2hr)

Tuesday:

upper GI study at 930. preliminary results say no abnormalities. slept in car, also 11 to 1 and 2 to 4. not a terrible day. only really cried when tired or hungry.

Slept 9pm to 1245am (3hr45m)
115 to 415 (3hr)
445 to 645 (2hr)
sporadic/crummy sleep until 8am

Sunday: no real naps, especially out of arms. Heavy reliance on pacifier.

Sunday night: slept 8 to 11 (pacifier spit out at 830). Sleep somewhat fitful. Very tired.
1230 to 5
630 to 815

Diapers starting to smell acidy again.

Saturday night: woke every hour or less. Tired but couldn't stay asleep. Lots of squirming. Worst night yet.

Copied from a reflux group I'm on, I posted this Friday when we got home.

We saw the nurse practitioner (the GI was booked all yesterday and wasn't in, today, I figured the nurse was better than nothing, and I wanted to get in ASAP). My husband went in while I stayed in the waiting room with the older two kids, but she then came out to speak with me, anyway, since we were the only ones there at the time. Suggested an elemental formula even though we weren't dealing with classic MSPI symptoms. She first suggested Similac for Discomfort, but I thought that was one step more complex than what she was already on (why add in casein when that is notoriously harder to digest??), and I said my first daughter never did too great on Alimentum, so elemental was the only other real food suggestion she could make. We went home with 2 cans each of PurAmino, Neocate, and Elecare, and she told us we could get whatever we wanted for free, apparently she was willing to keep giving us as much as we needed, indefinitely (when we went to this practice two years ago for my son we left with 6 cans of Neocate, too). Insisted compounded Prevacid was better than solutabs, but that we still should give it on an empty stomach for maximum effectiveness (oy vey), and now we're on 5mg 2x's a day (anyone have success with so little for an 8-week-old baby?). Also prescribed Hyoscyamine. Said that to have any success with simethicone we need to do .9ml in every bottle, not .3. Also recommended adding in more probiotics even though the Gerber Soothe has some in already. We have a follow-up with the actual GI in 2 1/2 weeks. The nurse said if nothing else we can put her on gabapentin (Neurontin) for her "hypersensitivity." Gabapentin is a WEIRD drug, my husband's been prescribed it before for chronic back pain, and an ex boyfriend of mine was on it for OCD. I said if they thought it'd work, I'd give it a shot, but we're going to try everything else, first. So I thought I won't change formula just yet. One thing at a time. We'll try the Prevacid and the hyoscyamine, also more probiotics. The testing place is going to call us early next week to schedule the upper GI test, which my husband insisted we do.

Friday night: 11 to 3, then 4 to 830.

Saturday: One good morning nap, and a 1-hr afternoon nap. Still cranky, still acidy.

Thursday night
Slept 915 to 11(1hr 45 min), took 3oz bottle but gulped it fast, like she couldn't catch her breath. Tried switching out the nipple for a brand new one but it didn't matter. Fell right back asleep but didn't burp (I tried and tried to get her to). Couldn't put down until 1230 because was so acidy; further raised top of bassinet and gave a ml of Rolaids.
Slept 1230 to 3 (2hr 30 min). Gulped another 3oz too fast. Some small burps. Lots of gasping after when not fully upright.
Slept 4 to 8 (4 hours) but with lots of fitful sleep, squirming, gasping, even with elevated bassinet.

Friday morning
Won't nap. Keeps waking up. Not a lot of screaming, but gave Rolaids when it started. Eliminated the crying but baby's still too uncomfortable to fall asleep or stay asleep. Another diarrhea diaper.