MEDICAL UPDATE

Tuesday, September 15, 2015

You might remember, back in April, when Dayton spent 9 days in the hospital (between Tallahassee and Shands). He was admitted due to low oxygen and a chronic cough that presented itself first in January. At the time he was diagnosed with "Chronic Lung Disease of Prematurity" and had suffered from Atelectasis in his right lung which was preventing him from keeping his oxygen levels where they should be. Breathing treatments, inhalers and steroids seemed to help and we were eventually discharged. Just under a week after discharge his cough returned despite the continued use of his inhaler twice a day. Over the next new months the cough turned into daily vomiting and refusal to eat anything besides purees (prior to this he was doing really well eating mostly table food.)

Then, in July, during one of our visits to Shands they discovered an ear infection that had apparently not responded to previous antibiotics so they started him on something stronger. Unfortunately, despite clearing up the ear infection, they made him so, so sick. We were all thankful when he finished the dose. Two weeks later he began having an excessive amount of runny dirty diapers which had a horrible distinct smell (more than normal!). So, after day or two his pediatrician tested and treated him for C Diff. Close to two weeks later all had cleared up. Poor guy was miserable for those two weeks. 

Following the April hospital stay, the bout with C Diff, and in light of the continued cough and a number of re-visits to see his pulmonologist at Shands, we decided to have a broncoscopy to give the doctors a good look at his airways and lungs. It was a quick and easy procedure and we learned that he had severe aspiration but no anatomical issue. No anatomical problem was great news! The pulmonologist also said he believes Dayton does not suffer from any long term respiratory issue (like asthma) and that his cough and other respiratory issues were most likely caused from the aspiration as he is not "protecting his airways". So in addition to secretions (food, milk, reflux, saliva, etc) making their way into airways and lungs, viruses essentially have a straight shot into his lungs --- he gets sicker, quicker than most babies. At the time of the broncosocpy, his airways were inflamed and irritated.

So, now that we know he is aspirating, we are faced with needing to find out how and why this is happening. In early September they did a swallow study to identify any possible anatomical reasons that he is misguiding whatever he is swallowing and that didn't show anything too alarming. That said, swallow studies can be slightly misleading as they are only a small "snap shot" of the big picture. However, we were happy to know they didn't identify anything that they felt would require any surgery. But, since we do still know (from the broncoscopy) that he is aspirating , we begin next week working with a speech pathologist to identify any issues with suck, swallow, eating and they will also help us with diet, & nutrition since we have not been given the go ahead to transition D to whole milk yet based on all of the recent findings and his continual cough and vomiting.

We are also scheduled to see a gastrointerologist at Shands in November, as his reflux might be the cause of the aspiration. Basically, we are trying to find out if he aspirates while things are going down, coming up or both! More to come.....

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