Sunday - I was feeding P around 9:15pm. Afterward he had one of his usual coughing/choking episodes only this time it proved to be not so normal. He started choking harder than I've ever seen him and then he turned blue and went limp. I immediately flipped him over and started performing the Heimlich manuver. He vomited and went back to coughing/crying. I calmed him down and I called the pediatrician on call - she was pretty useless during our first conversation but she called me back 10 minutes later and advised me to take him into the ER to have him checked out (covering her self, you think?!)
We went to the local ER and it was PACKED. I explained to them what had happened and apparently a blue baby who had the Heimlich performed is just not that important. We waited and waited, were triaged (his stats were: HR - 171bpm; 99.2 F; O2 99%; Resp rate 44) and waited some more. Finally after 2 hours, I told the registration desk that we were leaving. She asked for his name and said "oh well he does have a low grade fever... let me see if we have an open room" {side note: I personally don't consider 99.2 to be low-grade, but hey no problem in letting it work in our favor this time!] --- within 5 minutes we were in a private room in the ER; 15 minutes later the doctor came in and examined P and spoke with us at length about the past 8 weeks of his life. He did an RSV test just to rule it out (we knew it would come back negative) and he told us to follow-up with our GI doctor (that appt was scheduled for the next morning).
Monday - We saw the GI doctor at 10am --- He weighed in at 10lbs 2oz (such a peanut at 9 weeks old --- I explained P's feeding issues and any other symptoms I could think of. We spoke about P's milk protein intolerance - he strongly advised us leaving him on EleCare because there is absolutely nothing for him to be allergic to in it. He asked me several other questions and then examined P. He said he could hear a II/VI murmur which he believed to be functional; he also stated that P could possibly have a tiny VSD (ventricular septial defect). He said that at times feeding issues are due to cardiac problems. His plan of attack was: (1) Videofluoroscopic Swallow Study (done with a radiologist and speech pathologist to assess for aspiration - food/liquid entering the trachea) (2) EKG; (3) Echocardigram; (4) thicken P's feedings - 1 tbsp of oatmeal per every 2oz; (5) increase Nexium to 20mg per day (10mg - am and 10mg - pm); and (6) 1/2 tsp milk of mag daily. If the speech pathologist saw serious aspirations we were going to be admitted into the hospital and P would get a G tube.
The VSS went well - no major aspirations noted; but we did notice a few other things. P refluxes the ENTIRE time he eats. After the first few swallows hit his belly it plays a constant up and down game with no real break. After approximately 1.5oz of liquid (thin and thickened barium/water mix) his stomach was full - we've been feeding him 3oz this entire time - we've never forced it on him and we only recently moved him up to 3oz. The speech pathologist recommended us taking him down to 2oz, thickened and feeding him more frequently. I walked back to the medical plaza and caught the GI doctor in the hallway. I explained to him the findings of the VSS and it said he was happy to hear that overall P protects his airway. He said to reduce his intake to 2-2.5oz thickened. He also explained that P may not eat more often and quite possibly less often because without oatmeal each oz is 20 calories and with oatmeal it's 25 calories.
We went to the cardiologist's office. His stats were: left leg BP 88/60; right arm BP 99/72; Resp Rate 40; and his HR jumped anywhere from 167-182 (primarily stayed from 172-177). They did his EKG and then the cardiologist came in. He said his EKG looked good and that we were going to have an echocardiogram next. I asked about P's higher than normal heart rate. He said on the EKG his electrical pathways appeared to be working normal and he had a feeling that the echo would support that as well. We walked across the hall for his echo - he was such an amazing baby during all of this testing! His echo showed that his heart is structurally sound, no VSD and no electrical problems. The doctor told me that his feedings issues are GI related only (whew... talk about a huge sigh of relief!)
So for now, here's where we stand: Nexium 20mg a day, 2-2.5oz thickened feedings and 1/2 tsp milk of mag per day. He told me that while he does not anticipate any more blue episodes if P were to have one, we are to contact him immediately and P will be hospitalized. If we don't see any major improvement with his coughing/choking episodes by our 2 week follow-up, we will most likely be hospitalized and P will get a G tube. He completely anticipates this new regimen to do the trick.
We remain hopeful.
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