his subglottic stenosis
It occurred to me tonight that I haven't posted any pictures of Ike-a-saurus' airway. Probably because you have to actually scan the pictures to be able to post them.
Now that the pictures are tucked away safely onto my hard drive, I thought maybe you'd like to take a peek. It may not look like much, but I'll try to help you see what's what.
First, a picture of a normal trachea. This is NOT Ike's trachea, it's a picture from tracheostomy.com:
This next picture is Ike's airway from 2/17/09 – the day of his tracheostomy:
The top left is his lower airway. It's almost normal in size. But the top right and the bottom right are his upper airway. See that pinprick hole? That's where the ICU doctor managed to squeeze in a coffee straw sized endotracheal tube to save his life the night of 2/13. She is a brilliant doctor. We owe her everything.
The picture below is from the bronchoscopy he had done on 4/21:
It's harder to tell what's going on in these pictures, and they don't correspond with the others. You can see in the top right, the tiny hole is still there. At first it looks like the opening is larger, but there is that layer of whatever (tissue, cartilage, edema, all three?) and barely in the middle, you can see the small hole. The top left and bottom left show the swelling and redness that have been persistent since the beginning. Are they caused by reflux? Are they exacerbated by the week of coughing he'd had prior to this scope? Probably both, with reflux being the biggest problem.
So what do we do? Wait for him to outgrow the stenosis? Is that even possible? The ENT is doubtful. Have a cricotracheal resection? A laryngotracheoplasty? We don't know. Frankly, we still don't know anything. Except that the reflux is really mucking things up as far as getting a good idea what his airway is like when it's not constantly barraged with damaging acid.
This is why we're going to see the GI doc today. All of her answers are going to be unpleasant, I think.
I can remember, sitting with itty bitty Ike-a-saurus in the NICU, holding his bare skin against my bare skin, and listening to the nurse tell me that all preemies have reflux. He had, amazingly, shown very few signs of being refluxy, though. He was tolerating his milk, even breastfeeding when he could. And I thought to myself, as I stared at all the monitors and wires, and listened to the beeps and alarms, what if reflux – reflux – is what bites us in the ass one day. I vividly remember thinking that.
So here we are. I grasp onto the hope that the last set of pictures from his April bronch are just showing redness and swelling from the illness and the terrible coughing he had. I want to believe that his reflux isn't that bad, it's controllable with a tweak of his meds. But we'll see.
Just writing this post has probably jinxed everything tenfold. Why does that happen? Damn blog!
I'll leave you with another picture. Way cuter than a minitaure airway – a ginormous head:
Sweet baby boy. We have to get you fixed.