Barium Test

Maria had another barium swallow today. In this test, she swallows a liquid with barium in it, which is opaque to x-rays. The use real-time x-rays to watch how the liquid moves through as she swallows to be sure none of it goes into her lungs (aspiration).

As most of you probably know, Maria has a history of aspiration and as a result has to have all of her liquids thickened with a commercial thickener called Simply Thick. The three levels of thickness, from thinnest to thickest, are nectar, honey, and pudding. With Maria's problems they wanted her on pudding, but that has to be spoon fed which is just freaking ridiculous. So she was on honey for a while, but over time has been on something less than honey but more than nectar.

Her gastroenterologist had said that if this test showed she was aspirating, she was going to get a G-tube (that's where they cut an incision into her abdomen and put a feeding tube directly into her stomach). Now since Maria's been drinking just fine from a bottle for two months now, Cathy and I felt that was completely absurd. We understood the possibility of a G-tube before when she was getting all her milk from the tube in her nose, but to do that to a baby who's drinking just fine just boggles the mind.

Despite the fact that Cathy wasn't about to let them slice into her daughter without a really good reason, we really just wanted to test to go well so we could say "nyah nyah" to the doctor. Hey, we may be immature, but at least we admit it.

The problem is that over the last couple of weeks, Maria has started to breathe rough after drinking and that could be a sign of aspiration. However, we also noticed that this roughness seemed to be in her throat rather than her lungs which implied that it wasn't aspiration but something else.

So we headed into the test, fingers crossed, just hoping she wouldn't aspirate on honey-consistency liquids.

Well, the miracle baby made fools of us all. They didn't even try honey, but went straight to nectar (thinner than honey). Not only did she drink nectar without aspirating, but she drank thin (milk-like) and ultrathin (water-like) liquids, and didn't aspirate them either! That's phenomenal.

However, she is "pooling". That means that some of the liquid pools in hollows in her throat when she swallows and doesn't go into her stomach right away. That liquid can, in turn, drain into the lungs so there is still risk of aspiration. But she clears the pooling on her own, so we just need to slow down when we give her liquids and give her a few breaks to let her clear things out. Plus, since she's been drinking thick liquids for months now, her throat just isn't used to this thin stuff and she needs to learn how to swallow it right.

The recommendation is not only does she NOT need a G-tube (though we still have to see the gastroenterologist tomorrow for it to be official), but they said we should drop down to nectar consistancy and do another barium test in 3 months. What we will actually do is try her on nectar, see how she does for a few weeks, then start thinning it even more (under the supervision of her speech therapist).

So Maria is, as usual, not only improving, but improving faster than any of us could have predicted.