Eat Happy!

Eat Happy!


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Saturday, December 22, 2012

RSV 12.13.2012 Hospital Discharge Day & AFTER

Well, now that Ian has been home for ten days, I guess it is finally time to get that last “discharge” blog posted......

Ian came home on Thursday, December 13th. He was given Rxs for two nebulizer medications at home. He will continue with the Flovent as his everyday steroid respiratory medicine. The new nebs are his “go to” respiratory emergency meds. The first is a mixture of his previous Albuterol inhaler, with Atrovent. This is called Duoneb. The Douneb will not only use larger Albuterol particles than the inhaler to help with his lower lungs and small passageways, but the larger Atrovent particles will help with his upper respiratory passages. Ah ha! Inadvertently, this will also help decrease vagal mucus secretions during respiratory distress.

Albuterol-Atrovent Nebulizer Inhalation Solution

The second neb is 3% hypertonic solution....... salt water! I’ve had many parents mention saline nebs before. I had never heard of them and wasn’t sure what made them different. The saline will wick away mucus from the respiratory passages. A little science here.......

**Hypertonic solutions mean that there is a higher concentration of solute proportionately (more salt than water)

**Mucus has a higher osmotic pressure, AKA: is more hypertonic.

**Since areas of high pressure always move to areas of low pressure....... the pressure from the saline neb moves into the respiratory passageways. (High moves to low in order to equalizes the pressure.)............

**This means that water form the hypertonic saline neb moves to the mucus.

Think of it in proportions:

Hypertonic Saline Neb: 4 parts salt, 3 parts water
Mucus secretions: 4 parts salt, 1 part water

Water moves from the saline neb into the mucus until it equalizes

= 4 parts salt, 2 parts water on each side (saline solution and mucus)

The movement of water:
The scenario of the nebulizer solution and mucus is the image on the Right:
Water moves from saline neb into the mucus, adding water to the mucus

As the pressure and osmolarity equalize, the water will move from the hypertonic solution into the mucus. This helps to loosen the mucus and makes it easier to break (cough) apart and expel. It also helps lubricate the passageways of the respiratory track and moisturize them. Some also believe that it helps disturb the stability of the environment of “salt-liking” bacteria causing illnesses and troubles.

3% Hypertonic Solution Saline Nebulizer Inhalation Solution

When Ian uses the nebs, he uses them together. His chronic lung disease in and of itself doesn’t necessarily warrant the regular use of hypertonic nebs. He isn’t prone to continuous thick secretions. Those types of indications often follow a Cystic Fibrosis, or other respiratory secretion illness.

Ian's Nebulizer

Ian was able to stop the oral steroid, thankfully! His artificial steroids were already high enough to suppress his body’s own cortisol production. Typical cortisol levels for someone of Ian’s size, weight, and age are between 3.0 and 19.0. Ian’s were 4.0....... not good. In addition to 4.0 being pretty much at the low end of normal, they were even lower perspectively. When your body is in a time of crisis, ie: being sick, your steroid (cortisol) levels should be higher in order to help fight the infection and keep your body going. If Ian’s were 4.0 when he was sick, I wonder what they would be during times of wellness................. not that we know what that is here in the last four months.

Once we got home, Ian was to use the hypertonic and Duoneb for three days, every four hours. We noticed on the second day that Ian’s voice was very hoarse and he seemed to have laryngitis. He also had diarrhea and had small tremors. I know the Albuterol shakes, and this wasn’t them. We assumed Ian was sick, again. I thought for a moment and immediately went to review side effects of the new meds. I know these sites and apps like the back of my hand by now. Under Atrovent, I found: hoarse throat, pharyngitis, diarrhea, and tremors. Voila!!! It was a relief that Ian wasn’t getting sick, but now we were trading in for “sickey” side effects. Thankfully, Ian only needed to use the Duoneb regularly for three days, as he kicked the rest of RSV. Now, he hopefully won’t need it on a continuous basis for quite some time.


The following day, Sandy Hook occurred. Suddenly, I was holding Ian a little tighter, kissing him a little bit more, and snuggling longer. In the midst of grieving for all the children and families, I was also feeling very thankful for the things I have. Suddenly, pharyngitis and the inconvenience of diarrhea didn’t look so bad. We have had times where Ian has almost slipped through our fingers.......... not that it would in any way compare to Sandy Hook! But the thought of losing a child isn’t a foreign idea to us. Sandy Hook aside, many families within our medical support community have angels. Children, like adults, can only fight for so long before their bodies simply surrender. During those scary times, Ian has always come out ahead. I can only hope that he will never find himself in a losing battle.

Tom and I can never express enough love and appreciation for our hugely supportive community. We wish each of you peace, love, and joy during the holiday season. January 1st is right around the corner....... a chance to start the year fresh and new. Best wishes to all of you!

Practicing his coloring skills

Looking a little too "GQ" in this pose!