Mar 11, 2009

Videoflouroscopic Swallow Study

Not too happy.

Even with bubbles.

The x-ray video screen. The black is aspiration of thin liquid.

Ainsley's has always been protected from truly aspirating food and/or liquids because her upper airway was virtually swollen shut. Even with an ineffective swallow the food and liquid couldn't really go down the wrong way because the swelling stopped it. After her Nissen Fundoplication in Oct. 2008 the swelling of her airway started to decrease. In November when I put some blue dye in her foods, she coughed some after eating and I found a tinge of color in her trach secretions. I stopped trying to feed her regularly for fear the food or liquid would further damage her lungs, since she has been diagnosed with bronchiectasis. Lung health is nothing to mess with.

Over the following months I would periodically try the dye tests again and things looked okay. However since her airway opened up some she has been less interested in eating and drinking. This concerned me that perhaps the reason is that she is protecting her airway. So I had been anxiously waiting for today's VSS to know if it was safe to proceed with feeding.

Unfortunately Ainsley's greater degree of comprehension has made it more difficult to perform tests and procedures because she isn't as likely to simply go with the flow anymore. She was immediately very unhappy when placed in the seat in the radiology room. And when they moved the x-ray machine into place she really started crying. Why this scared her I don't know. We had our nurse blow bubbles while I attempted to feed her the different foods that were mixed with barium (the substance that makes the food show up on the x-ray) while the speech pathologists viewed the results on the screens. The fact that she was so unhappy really didn't help but we did manage to get enough swallows to perform the tests.

The findings were better than expected really. She did okay on nectar consistency (think melted milk shake) and thick (like baby food). But she did aspirated on thin liquids.

What all this means is that she is okay to proceed with trying to eat baby foods as much as she tolerates. There may be times she may tire quickly and only be able to safely eat a few bites or other times she may do well and eat much more.

Her liquids will have to be thickened with a powder or gel that we were given. The good thing is that she coughed afterward to get it up out of her lungs. Silent aspiration is worse because the food/liquids can just remain in the lungs.

They thought they could see no appreciable vallecular sinuses (they hold the food/liquid before it's swallowed). I was very concerned that there was an anatomical problem but at the laryngoscopy the next day the otolaryngologist said they were there.

So really that leaves us pretty much where we were before in regards to eating. I hope that perhaps her airway swelling will continue to get better and some of these swallowing issues may be helped by that. As with so much with Ainsley only time will tell.

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