questions about bronchoscophy and lipids test

[Anonymous]

does anyone know where exactly they do the wash and test for lipids? Is
it down in the lungs, or just in the top part? Sorry, I don’t lknow
names for everything, just trying to sort things out in my head. The
pulmonologist is saying he is reflux aspirating, and the gi argues
saying there is no evidence of reflux on his scope. I am baffled. Could
having laryngeal penetration cause his lipids to be higher without
actually aspirating? The gi told me that the place they test is a
couple centemeters from where the mouth is… whatever that means?

[Anonymous]

what are his symptoms..

i dont know i thing about the testing .. just curious what the symtoms are that you are refearing to.. cuz my daughter has constant congestion in her chest.. .. and no one is really telling me why.. the pulmonologist is having me use an inhaler on her..

[Anonymous]

none! Other than knowing he was a silent aspirator over 2 months ago on a barium swallow test, he has no symptoms. That is why I am so baffled by it. now had you asked me that when he was under a month old, I would have told you he sounded gurgly, congested, fussy. Since then tho he has been on Zantac, and thickned feedings all but once a day when I was allowed to straight breastfeed him.

[Anonymous]

I believe the wash that you are referring to is called a bronchoalveolar lavage (BAL). The sample is taken from both the bronchioles(the smallest part of the airway “tree”) and the alveoli (air sacs) in the lung itself. Laryngeal penetration should not interfere with the test results unless the fluid is going further and he’s actually aspirating rather than penetrating. Evidence of reflux on endoscopy means acidic damage. Even if the acid is well controlled, gastric contents can still reflux up and be aspirated without causing esophageal damage. So if he’s on meds, they are working and thats great! We have had issues with reflux aspiration since birth and have gone through 3 pneumonias, all but one landed him in the hospital. Our pulm feels that he has a chance to outgrow these issues and is managing with meds rather than surgery unless he continues to get frequent lung infections. If you have any questions let me know. This is a rough road, so its nice to have someone who has been there done that/going through that if you want to talk.

[Anonymous]

hmm… I don’t know then. He has never had pnemonia, a cold or anything… Were you using formula when he got pnemonia? I only ask bc I was told that aspirating breastmilk gives less likly chance of getting pnemonia. We were giving ultra thin liquids via breastfeeding once a day, and the rest necart thick…his lipids count was 106… if he were refluxing, would I know it?

[Anonymous]

He was BF for the first and FF for the rest. He too has his feeds thickened to nectar. I’ve heard that too about the bm being absorbed and not causing issues. You wouldnt necessarily know if he were refluxing, its not always obvious. Also, I just read your intro, on the pH probe, it only measures acidic reflux. Nonacid reflux can cause just as much issue, but wouldnt be “caught” on the probe. So he could be refluxing more than what the probe read, unless it was done with impedence(it measures the flow of liquid in the esophagus).

[Anonymous]

did your lo have the bronch, wash done? if so, what was his number?

[Anonymous]

Also, aspiration doesnt necessarily cause pneumonia. The body will tolerate so much, its just at what point is too much that allows infection to brew. DS lipid index was 104, which our pulm said was indicative of chronic aspiration.

[Anonymous]

oh, and no it was not tht kind of ph test as far as I know. I do know it had two channels and the reflux only went to the first channel, but it was all based on ph level. I am considering getting another opinion, but not sure how to go about finding another good doctor. The first gi we saw was HORRIBLE…

[Anonymous]

ours was 106, was the 104 when he was straight brestfed? Have you had a repeat one done? when you got the 104 score back, is that when you were put on thickened feeds? How did all your issues come about? sorry so many questions..
lovemypies2009-09-24 03:03:04

[Anonymous]

It hasnt been repeated yet. Those results were 2 months ago. He was started on an inhaled steroid after the scope and had been doing sooo much better until a couple weeks ago when he had his 3rd pneumonia. He has another endoscopy next month and we see pulm again monday to see if they want to rescope too at the same time.

[Anonymous]

Our GI isnt horrible, but it does take a lot to impress her, for lack of better words. She doesnt get concerned about anything and I have to push for everything hes had done. Our last pulm visit he told us that as long as the chronic aspiration isnt causing life threatening issues, ie frequent lung infections, difficulty breathing, failure to gain weight, etc, DS would eventually grow out of it and not cause long term damage.

[Anonymous]

Oh, he was put on thickened feeds at 6 weeks, after a failed swallow study. The swallow study was prompted by him coughing and gagging all the time, especially while feeding, and then came the constant wheezing. I knew something was wrong at 2 weeks when he had his first pneumonia (which we were told was from a c section delivery). He’s also had lots of allergy issues too. (I see that you are dairy/soy free) I tried eliminating for awhile, but he continued to have bloody stools and wasnt gaining weight, then came all the swallowing issues, so we switched to formula. I really wish I would have had more support in that area since he has since skin pricked positive to every ingredient/formula on the market. If I would have continued to pump, I feel like he would be better off now. jillynjacksmom2009-09-24 03:26:34

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