Tuesday, January 20, 2009

Something's A-Foot

Let's start with Sunday. Kaitlyn started her day like any other day. Absolutely nothing was wrong....besides our obvious battle. When I got her up from her afternoon nap I decided to give her a saline neb and some coughs as I hadn't done an afternoon treatment yet. I gave her the neb but I didn't do it in-line with the bi-pap, which is the way that we usually do nebs (however we have done nebs without bi-pap in the past). I was suctioning her frequently as the saline makes her drool and we never want her to choke and aspirate secretions. One time I went to suction her and she got a funny look on her face and started to sort of look like she was choking. I grabbed the neb mask off of her face an started suctioning some more, but her sats were dropping and fast!! Suctioning had NO impact. So I turned on the cough-assist and tried to cough her. As I delivered a breath it was making no impact on her sats and she couldn't produce a cough! I personnally have never had this happen before!! I tried coughing her once more but again no cough. It was like she had no air in her lungs to produce the cough. So then I turned off the exsufflation and just did several breaths of 2 second insufflation (we currently do not have an ambu-bag in the house. Something that I think we may have to remedy!). The whole time her sats were still dropping. She hit 70's....dropped into 60's....and then we had O2 hooked up to cough assist. I kept giving her breaths with the cough-assist for another minute and watched as her sats very slowly creeped up closer to 90's!!! We then put her on Bi-pap with 3 litres of O2 and over the next hour, with a few semi-successful coughs, her sats were back to normal. The really odd thing is that she was pretty dry. We weren't getting much out of her. Very odd!!! There wasn't any junk in her lungs, the only thing that I noticed was very reduced air flow in both lungs.

The really odd thing is that 1 1/2 hours after putting her on Bi-pap she was back to room air laying on the master bed begging to taste some supper!! I'm thinking this is CRAZY! Sunday night she was fine and her sats were normal and her lung sounds were perfect! We figured that she must have plugged (mucus in the lung blocking some of the larger airways and collapsing the lung, or a portion of the lung). We thought that we must have gotten the plug out, even though we didn't suction anything much out. Sunday night she slept through the night. Monday morning she got up like nothing had happened! She did dip a little with the first round of coughs and I did get a fair amount of stuff out of her. Then she did fine through physio and more coughs and stared her day the same as normal. She spent the whole morning out with the boys, off of bi-pap sats 98-100. I was careful to do all her treatments really well to get out any risidual junk. She did have a three hour nap in the afternoon. Something that she hasn't done for a few months now. But other than that she was "normal", no lung sounds, no increased secretions and no decreased air flow that I could detect.

Monday night she went to bed and she was a little junky (wet sounding in the lungs). I had to cough her at 10pm at 1am and again at 6am. After the 6am coughs I didn't hear any more junk!?! It's like it disappeared with the sunshine! I thought that whatever had been in there that I must have gotten out. Then she had her morning breathing treatment at 8am and started her day just as normal as always! Sats 98-100 all day...room air...no Bi-pap! Tonight we put her to bed again sounding junky. Am going to bed soon and will cough her again and then throughout the night as needed. Tomorrow we will keep up with the treatments and hope that whatever she has goes away without a hitch!!! We may end up going for x-rays at the very least before the end of the week. But we will avoid a hospital stay at all costs!!!

Kaitlyn watching TV the other morning. Before serial casting we could never have positioned her feet even close to this. Of course she was rolling her ankles about, so it's hard to position her now until we get her into AFO's!!

Daddy reading books to the boys. It's hard to read to both boys at once without battles over who gets to turn the pages or lift the flaps. Tim was doing a good job at disarming arguments!

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