Malia gave us a pretty good scare this weekend with a similar breathing episode to the one that landed Austin in the hospital back in December. The only difference was that her breathing troubles were not brought on by a cold, so it was a bit puzzling to us when she started wheezing last Thursday night. By Friday afternoon, her breathing had become labored enough to warrant a check from her pediatrician's office, and she was prescribed Albuterol and Pulmacort. The meds were working well enough to give her some relief, and in her usual form she was trucking through it without complaint through Saturday. But we knew something was wrong by Saturday night as her breathing had become more stridorous, and by then she was pretty pissed about it. By then the nebulizer treatments weren't having the same effect as before, so it was time for an ER visit to see what was going wrong.
You never know how quick you'll get in to the ER, but as with Austin in December, she was taken straight back to triage. She was given Albuterol, a stronger aerosol steroid, and then eventually an IV steroid, all to no avail. Finally, the only thing that gave her any relief was a racaemious epinephrine treatment. It gave only temporary relief, so they had to repeat these treatments hourly. At this point, it was apparently a forgone conclusion that she would be coming home, so the debate then became whether to admit her to the CHOC regular pediatric unit or the CHOC pediatric ICU. So as she was going through the admitting process in the pediatric unit at CHOC, she had reached a point of exhaustion (probably from so many epi treatments) and was approaching respiratory arrest. The nurses signaled the hospital alert system, and within a minute there were about 20 people in the tiny room with us. They got her back on track, but it was no longer a debate - she was going to the PICU.
 |
| Malia about to be admitted into CHOC |
After a trip to the 6th floor, and a middle of the night summons to her mommy, three of us rode the last hour of the night in her PICU room.
 |
| Getting another Epi treatment |
 |
| 1st night in the PICU |
So by morning, the doctors were seeking to figure out Malia's condition, calling it Croup at least for now because of the obvious signs of a narrowed airway. Several of the doctors kept coming back to the possibility of a foreign body in her airway, which was a most unusual and unlikely diagnosis since she's not quite to the age where she could easily get a foreign body into her airway. Sunday was spent administering periodic epi treatments, but otherwise no significant improvement in her condition.
 |
| Malia got her own PJs for a little while during her stay |
 |
| Malia was super antsy prior to her procedure. The epi treatments made her super wired most of the day and night |
 |
| We traded places a few times this weekend, and Austin was happy to see his Mommy while staying with his Nana |
By Monday, the doctors had brought in an ENT specialist, who recommended a laryngoscopy for later in the afternoon. The procedure requires sedation, and as the name implies, a scope sent down towards the vocal cords to see what was going on. Before too long into the procedure, the doctor emerged to reveal a pretty unusual finding - Malia's airway was about 90% blocked due to a subglottic mass. The problem besides the obvious need to remove the blockage, was what was underneath the surface. Either the mass was a cyst, benign and filled with fluid or puss; or a hemangioma, a mass with its own blood supply. In draining the mass, once the doctor attempts the excision there's no turning back. And with a hemangioma, it would require a more invasive incision through the neck to stem the blood loss.
 |
| The doctor ultimately found 3 cysts - the two "buddies" in front, and then an additional one posterior. Amazing any air was getting through there! |
 |
| The surgeon proceeds with the excision |
After giving consent to proceed, Cheryl sat and waited for followup from the doctor as to what was found. Any amount of time was agonizing, but after about an hour the doctor emerged once again to say that they were successful in removing all three cysts.
 |
| After: this is what the airway should look like |
 |
| After: cysts removed, little signs of the cysts that were originally causing problems |
In recovery, Malia was noticeably groggy, and would belt out an occasional cough with a pretty peculiar sound, literally like a frog was in her throat. The doctors decided to put her on NPO till morning, which proved to be a miserable experience for her and Cheryl who stayed with her Monday night.
 |
| Post-op, feeling groggy and weird |
By Tuesday morning, things had improved significantly due in part to the fact she was now allowed food. She wolfed down a large portion, and was starting to get back to her usual self. It was strange to notice that her characteristic whistling breath was now silent. We are now quite sure that this obstruction has always been with her, and it could have been related to her intubation on her first day of life. We'll never know for sure what caused it or whether Malia was in any imminent danger, but we are pretty lucky to have avoided anything catastrophic in discovering the problem. It's quite possible that this was a hindrance to Malia's development, so we're glad to have overcome this one and close this chapter, at least for now.
 |
| Cutie Patootey |
 |
| Just before hospital discharge, all smiles with daddy |
 |
| The new tower at CHOC is pretty cool, complete with the Nemo tank (since Disney donated so much to the hospital) |
