Matt is an 8 year 4 month old Caucasian male who is being re-evaluated with a number of concerns. In the past, Matt has been diagnosed as infantile autism. In addition, there are concerns about Matt having a lactose intolerance and gluten sensitivity. These have previously never been confirmed by lab testing. There are concerns that in school Matt is not making enough academic progress. There are concerns about weight gain. There have been multiple changes in the family system recently and a number of the children are showing signs of stress related to the change. Finally, Matt and I think at least 2 other siblings have extensive histories of periodic failure to thrive…There is also a family history of people who have had similar GI history….The genetic and functional implications of these historical problems have never been fully explored and are of great concern to the family…..
Okay, it looks like we are going to start things off lightly by talking about my family history of GI problems. My dad and grandpa have had several ulcers. I vaguely remember my grandpa and Aunt Grace drinking out of the antacid bottle. I remember Aunt Grace drinking it before going to bed at night. It probably would not surprise you too much to find out that 3 out of us 4 siblings have issues with acid re-flux, myself included. My brother that doesn’t have acid re-flux also has other stomach ailments.
Back in 1984, when this psych eval was written, my mom got into the organic food kick. It was hard to come by in our area. By this time she removed all unhealthy foods from our diet including macaroni and cheese, sugary foods, and anything containing artificial colors or sweetners. Our diet was very bland. Oftentimes, my mom would make two separate meals for the family due to Matt’s dietary restrictions. She would place Matt’s food in separate containers and label them Matt. We knew better then to eat his food, although my dad would do it just to piss off my mom. Matt’s food was not allowed to come in contact with our food in any way because this would cause contamination.
At dinner time is when most of the fights occurred in our house. It was the time that the family was all together. My dad would come home from work at 6 PM sharp to dinner on the table. I remember the thud of his tool box hitting the floor as he walked in the door. My dad generally complained about the food my mom served. “What is this, dog shit?” My brothers Matt and Luke had to be tied to their chairs for supper because they were too hyperactive to sit down unless they were tied down. They couldn’t sit quietly either. My parents would fight. My dad would bang his fist on the table then leave to eat in the other room. Eventually, he didn’t come to the table with us at all. He just came home, turned on the TV, and ate in the living room by himself.
Matt’s issues went far beyond the normal acid re-flux. He had a failure to thrive. He could eat twice as much as the rest of us and lose weight. My mom always said while I was growing up that he had a metabolic disorder where he could not absorb nutrients. His acid re-flux caused him to gag, choke, cough, and belch loudly at the table. It was enough to make people lose their appetite. At times, he would even throw up at the table. I remember hearing that one of the first few times that Luke brought his future wife home, Matt threw up at the table. He also made other noises while eating that most would find disconcerting like chewing with his mouth open, smacking his lips, and scraping his fork against his plate making a nails on chalkboard sound. He was also a messy eater. He got food all over the table, on his clothes, and on the floor. He needed all of his food cut for him.
We were not allowed to have napkins at the table. Matt was hypersensitive to toilet paper, tissues, and napkins. If someone would bring a napkin to the table he would gag and they would be asked to put it away.
He would also drink a tremendous amount of water and tea a day. I have never seen someone drink as many liquids as he does. At times my mom would have to tell him that he is drinking too much. He is constantly thirsty.
Sitting next to him at the table was hard to stomach. No one wanted to sit by him. In Matt’s late teen years, the gagging and choking got worse. He threw up first thing in the morning and then sometimes after eating. He never made it into the toilet so my mom had to scrub the bathroom floor sometimes several times a day. Then he started to throw up on a daily basis. Then it was several times a day. My mom kept a filled scrub bucket in the bathroom. At 5’7″, Matt barely weighed 100 lbs before this happened. After he started throwing up on a daily basis, Matt lost an additional 20 to 25 lbs. My mother thought he was going to die.
Matt was also very energetic at this time. He would rock back and forth every night to get to sleep. During the day he would do what looked like jogging in place while flapping his hands together. It took a long time to find out what was wrong with his stomach.
Matt’s doctor ended up finding out that Matt’s pyloric valve closed. From what I know, this valve opens to empty the stomach contents into the intestinal track. Matt’s valve was not opening to empty his stomach which is why he was throwing up. He was essentially starving himself. The doctor went in to force the valve back open. Thankfully, after that he started gaining back weight. Although, he would still throw up at times when he was anxious or agitated.
Looking at him now, you would never guess that he struggled with this. Now he has the middle age family gut. He still gags a lot while eating, but it is so much better now. We are the same height. For the first time in his life he weighs more than I do.
These were just some of the struggles we faced associated with eating in particular.