Swallow Study

I mentioned in an earlier post about a swallow study that Ainsley had to do.  She's been gagging or choking on fluids/food which then leads to coughing and sometimes eventually throwing up.  When I mentioned this to the doctor, she thought we needed to have a swallow study done to make sure the fluid was going to the stomach correctly.  Last Thursday, Ainsley and I headed to Memorial in Springfield to get the swallow study done.

Reading a book in the waiting room

We went back to the imaging department, where Ainsley had to sit in a seat on a big xray machine.  They would be taking images and video of her swallowing various liquids/foods.  While we waited for an x-ray technician to come in, the speech language pathologist (SLP) blew bubbles for Ainsley to play with while she sat.

Watching the bubbles while we wait for the Xray tech

Such a big girl!

In order for the xray to pick up Ainsley's swallow, they had to coat the food/drink with barium, which was white and sticky.  Ainsley started out drinking from her sippy cup we brought from home, and then the SLP put some barium in her cup which Ainsley had to drink.  She did pretty good with it.  We gave her a few yogurt bites to try to make her thirsty and she drank a little more for us.  Then, we coated some peaches in the barium for Ainsley to eat.  She did pretty good with those, but was more interested in the plastic spoon I was feeding her with than actually eating them!  After coating a few yogurt bites in the barium, she decided she was thirsty again.  This time, the SFP gave me a different sippy cup, called a Klean Kanteen, and had Ainsley drink out of it.  It was a little harder to drink out of because Ainsley had to actually tip it back and suck a little harder to get anything out.  The whole thing latest about ten minutes and we finally called it quits after trying unsuccessfully to get to her drink more.

Ainsley and I headed over to a waiting room while the SLP and the xray tech went back to look at the pictures and video.  I was hoping to hear that everything looked fine and they didn't know why she coughed and gagged while eating/drinking, but that wasn't the news I got. 

The SLP came in and let me know that Ainsley has dysphagia.  Her assessment actually states:

"Ainsley presents with mild dysphagia.  She has difficulty controlling liquids resulting in premature spillage to the level of the pyriform sinuses.  Intermittent episodes of deep laryngeal penetration was observed with thin consistency liquids with the Playtex sippy cup which is the product used at home.  No aspiration observed on the study.  Ainsley presents with coughing with drinking thin liquids by sippy cup.  A trial of nectar consistency liquids is recommended to improve the safety of the swallow.  A product change to a sippy cup requiring suction to draw the liquid from the cup may be recommended.  Swallowing therapy is recommeded to improve the safety of the swallow."

So, you may be wondering....what does all of that mean????  There is no aspiration, so it's not going into the lungs.  It just started going that way, so no aspiration is good!  However, when Ainsley swallows, the liquid is hitting her recepter or vocal chord, which is causing the liquid to come back  up because she wants to get it out (so she coughs/gags).  What the SLP is worried about is the penetration.  She said that everyone has some penetration, which is when liquid hits the wrong thing and we start coughing.  Ainsley didn't have a lot of penetration, but when she did have it, the SLP said it was deep penetration and that's what she's worried about. 

What causes this issue?  They don't really know.  Like the SLP said, everyone has some penetration.  Ainsley just has more than normal and is a lot "deeper" penetration than everyone else.  She said it may be because Ainsley was use to the thicker formula and making the switch to regular milk, which is thinner, may be the issue.  Hence, thinkening her liquids.

Does this issue correct itself on its own?  The SLP said that by making Ainsley's suck stronger, it will help her correct itself on its own.  Hence, a different type of sippy cup that requires more sucking.

The end result of this is we have to switch to Avent sippy cups.  Our other option was to go with the Klean Kanteen sippy cups, but at $19.00 a piece we decided the Avent sippy cups you can get at Babies R Us was the way to go.  On top of switching the type of sippy cup we use, we also have to thicken her liquids.  Of course, insurance doesn't cover the thickening agent we need, and at $300/month for the "Simply Thick" thickening product, we decided to try a more "natural" route to thickening her liquids.  The SLP said we could use dry pudding mix with milk and applesauce with juice to thicken.  I'm hesitant to go with the dry pudding mix, because I don't want Ainsley to get use to it.  I bought the vanilla fat free sugar free pudding mix and mixed it with some milk, and it was GOOD!  Do we really want our daughter getting use to drinking vanilla milk?  She already has a terrible sweet tooth!  We're instructed to cut the pudding back a little so the flavor (hopefully) isn't as strong, and to add 1/4 tsp of pudding mix to 2 oz. of milk.  We had also switched Ainsley over to 2% milk a few months ago, and we're going to switch her back to whole milk which is a little thicker. 

As far as juice, we mix 4 oz. of juice with 6 oz. of applesauce.  We can also try drinkable yogurt or yogurt smoothies with her, which are thicker.  They want her liquids to be "nectar consistency", and said there are some juices that are a little thicker by nature.  One is Bolthouse farm juices that you can find in the produce section, or they also said to tried some mango juices which are thicker. 

The other thing they said to do was to put her sippy cups in the refrigerator and pull it out right when she's ready to drink.  The SLP said that Ainsley will be more aware of the liquid going down when it's colder, and it should help her to remember to swallow. 

After I thought about the whole situation more over the weekend, I realized that when we made the switch from formula and a bottle to regular milk and a sippy cup, it really was quite a change for Ainsley.  We had been putting rice cereal in her bottles from the time she was 3 weeks old because of her acid reflux.  She was use to the thicker liquids.  When we switched her to the sippy cup and regular milk (which is MUCH thinner than her formula and rice cereal), that is really when we started seeing this problem more often. 

I asked the SLP earlier this morning what would be causing Ainsley to gag/cough/throw up while sleeping.  Last week after the study, I was on information overload and didn't even think to mention how much Ainsley chokes and then throws up after she falls asleep in her car seat.  The SLP was a little concerned about this issue and said that there may be another issue with Ainsley if she is doing that, and said we should probably see an Ear, Nose, Throat (ENT) doctor for further evaluation.  She said it could be acid reflux, which I then told her Ainsley had when she was an infant was on medication for it and that's when I mentioned the rice cereal added to the bottles.   She also mentioned something about a "post nasal drip", that the ENT may look for.  She asked if Ainsley had colds or was congested a lot, and I told her that she was.   Ainsley's been really good the last two or three weeks and hasn't been congested at all, but before that, it seemed like she was always congested and had a runny nose and cough.  After telling the SLP all of this, she seemed a little more worried and thought an ENT would be able to help us out, especially if it's reflux or some sort of allergies.  I told her when Ainsley was congested, she was more likely to choke/gag during the night while sleeping and Joel and I just figured it was drainage from her cold.

I'm anxious to see if there is another problem and some of these mysteries solved.  I feel like it's always something with Ainsley, and at times feel like everyone must think I'm a hypocondriac.  I'm really not!  I've never understood why Ainsley chokes and gags, but I think we're getting closer to the answer.

We went to Springfield on Friday night to get the new sippy cups for our precious baby girl, and Ainsley had fun walking around Babies R Us.  We grabbed something to eat at Chili's, where she had lots of fun playing with Daddy in the booth, and then we found her some new shoes (always a necessity) at Target before heading home.

Hmmm...what's in there???

Wouldn't you know that on our way home, we would have to pull over along the interstate because Ainsley choked and threw up in her carseat?!?!  I'll be glad when I don't have to clean up vomit two-three times a week and I have a normal, healthy baby.