Friday, 10 May 2013

Does Maria need any surgery?

Nurse Maria
Maria has suffered from involuntary gagging and choking since she was born. She was initially examined by her Speech & Language Therapist, then the Occupational Therapist, then both together then finally by the paediatrician, who referred her to the Clinical Imaging department of our local hospital for a fluoroscopy. This involves swallowing a barium solution and recording the results with an x-ray video camera. 

Maria wouldn't drink the barium solution directly but I knew she loves hot chocolate milk. Unfortunately the department didn't have any so the radiologists scurried around for about fifteen minutes and eventually tracked some down. I was impressed by their tenacity.

Once we made the hot barium-chocolate concoction, Maria refused to drink it lying down so we sat her up and turned the machine at right-angles to see the image of her throat. Everyone in the room except Maria was wearing a protective lead-lined jacket. The barium made a mess when spilt on hands and clothes and was difficult to clean off, leaving a white stain similar to calamine lotion. 

At first I thought the barium was radioactive but when I checked on Wikipedia I realised that it wasn't. However the fluoroscope contains an x-ray source, so exposure to children and pregnant women should only occur as a last resort.

Once we got the results, the radiologists said they couldn't see any obvious abnormalities with Maria's swallowing. The follow-up appointment with a gastroenterologist concluded that it was safer not to operate. He believed that Maria would learn to cope in time, and it seems he was right. 

Nowadays, when Maria shows signs of choking then she adopts a special breathing posture, taking deep breaths through her nose and mouth. She even demonstrated it to her mummy the other day to suggest that she calm down after becoming stressed!

A more common form of surgery for RTS children is to the thumbs and big toes (halluces). Fortunately Maria hasn't needed this type of surgery.

Maria's dentist is on the lookout for talon cusps, which may appear in a few years. This would require surgery too but, fingers crossed, she might never develop them.

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