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Thursday, May 12, 2011

MBS #3

Raya had her third modified barium swallow study today. An MBS is used to determine whether or not someone is swallowing correctly. In Raya's case, we needed to be sure that when she swallows very thin liquids like water, she is protecting her airway and the liquids are going down the way they're supposed to.
She had her first MBS last May and we weren't even able to complete it because she had been off oral feeds for about 6 weeks while we waited to get it done. She refused to let any of the barium into her mouth, let alone swallow it.
Her second one was last September and she handled it like a champ. She swallowed all of the thicknesses that we tried with her. However, when she was given the ultra-thin and thin consistencies, she did not swallow them correctly and they pooled near her airway before she finished swallowing them. That's a bad thing because it puts her at high risk for aspirating, or having fluid enter her airway/lungs, which then leads to respiratory infections & pneumonia. So at that MBS, they determined that if she was given liquids, they needed to be thickened to nectar consistency in order for her to swallow safely. Lucky for us, we never had to mess with the thickener because she had no interest in drinking liquids anyway. :)
Today, she was not very cooperative AT ALL. Now that her tests are fewer & farther between, they freak her out more. She must have realized that it's not normal to be subjected to all that stuff. :) When they do a swallow study, they take an x-ray table that's normally in a horizontal position and tip it into a vertical position & attach a chair to it. Once the kid is strapped into the chair, the radiologist moves the camera into position on the other side of the chair. That's when Raya freaked out and didn't want to sit nicely in the chair anymore. Luckily she calmed down. We started with the ultra-thin barium that's the same as water. I put it in a cup with a straw/spout that she likes to pour water all over herself with thinking that she might take the barium from it too. Yeah, not so much. When that failed, we just went straight to the syringe. She's no dummy and she knew exactly what I was trying to do with the syringe and clamped her little mouth shut. I did get enough in for the speech therapist & radiologist to see that she did successfully swallow it without any risk to her airway. We moved on to the thin consistency & tried to let her have it from a cup since lately she's been interested in "drinking" from a cup. She wanted to hold the cup but wouldn't let the barium into her mouth, which led to the syringe again & we had the same wrestling match followed by more successful swallowing. See how cute she looks with a little barium mustache? :)

Since that went fine, we jumped up to the pudding thickness from a spoon, which she also hates. By this point, she was getting really stressed and even though I didn't want to push her too hard, I really needed to know that she's safe swallowing so that I'm not paranoid about letting her try food so I kept pushing. I got the pudding thick in her mouth and that's as far as it went. I got it onto her tongue & lip and it didn't move from that spot until I wiped it out of her mouth 2 minutes later. Big fat tears were rolling down her cheeks and she cried like I had really hurt her feelings. So there was no swallowing of the pudding thick but since she did well with the really thin ones, we are considering her to be a safe swallower. When she progresses to really eating different textured foods, we will be able to tell if she has trouble swallowing solids and if needed, we can do another swallow study. Hopefully things will be fine from here on & we won't need to.

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