DorrieDorrie

Blast from the Past2

It’s been a while since Dorrie has done anything truly scary, but last week she decided to prove she can still pull it off.

We have been finding lately that changing her trach tube has gotten more and more difficult — getting the old tube out has taken more pulling, and getting the new tube in has taken more pushing. As a result, Dorrie has tended to desat a bit while we are trying to get the new tube in, but generally it has not not too bad. Well, not last week: even though the change did not seem to take any longer than usual, she desatted dramatically, stopped breathing, and went totally limp (although I am not exactly sure of the order). Thankfully, we got the tube in, and we were able to bring her out of her spell by me switching the ventilator to give her automatic breaths (and pushing the button for manual breaths too, since I found that button first) while Mom did some vigorous stimulation. Dorrie was a little out of it at first when she came around, and her heart rate was elevated for a little while afterward, but she recovered pretty quickly and seemed perfectly normal again after that.

Not so for Mom and Dad, of course. We were badly shaken, I think because we had gotten used to Dorrie not having this problem any more. We were a bit divided on what exactly went wrong: my theory was that we had not let Dorrie spend enough time on elevated oxygen beforehand to let her build up a good reserve, while Mom believed it was one of Dorrie’s classic laryngospasm spells. So, we called the hospital to talk to someone, and their opinion (I can’t remember if it was Dr. Optimist or the nurse) thought it could have been a combination of the two, or possibly that she had passed out from pain during the procedure. (Not a happy thought either.)

What we ended up doing was packing Dorrie up the next day and heading up to Lebanon so that the neonatologist could have a look at her (and draw blood for some labs while we were there), and then the otolaryngolist could check out her stoma and see if there were any reason we were having so much trouble.

Dorrie was acting perfectly normally, so the neonatologist did not have any concerns about her episode, although she did express a little concern that Dorrie’s motor skills were not as developed as she thought they should be, so she made sure she took enough blood to test for a few things. (Some of those tests came back, and everything seems normal so far.) Then it was off to the otolaryngolist, who first checked with an endoscope, and he didn’t see anything wrong (mainly he was concerned there might be granulated tissue above the stoma causing a problem). Then he tried taking the tube out and putting it back in, and he didn’t feel there was anything wrong there either. His final opinion was that the stoma had healed to the point where it is basically the size of the tube that is normally in place, which meant that when we tried to push or pull the cuff part of the tube — which is wider — past the stoma, there was more resistance. We also learned that our technique for putting the tube in was probably making it harder for us: he showed us a grip we could use that made it much easier to control the tube as it goes in, and I think that will help a lot.

Well, the proof will come Thursday next week, when we change the tube again. Normally we change the tube every week, but everyone agreed we could take a week off, because next week, the nurse from Lebanon will be visiting us, so she can help out and be there as backup in case we need it.

Posted by dad, under we interrupt this blog