Our most recent journey to finding the root cause of Levi's frequent respiratory illnesses led us to Duke Pediatric Consultative Services. In April we met with the Allergy/Immunology Specialist where Levi was skin tested for allergies and had some bloodwork done. In May we met with the Gastroenterology Specialist to discuss Levi's diagnosed "reflux" and how it's management affects his asthma symptoms. And, today, we met with the Pulmonology and Sleep Specialist to discuss his asthma care plan, next steps, and sleep disturbances.
Allergy/Immunology: Skin test was negative for all triggers. And after the test, specialist tells me that, while the test was negative, this does not mean that he does not have allergies because many children will not show a proper allergic reaction during a skin test until they are at least 36 months of age. The next step was bloodwork. The results are really inconclusive, but did show decreased levels of Ig-M (Immunoglobulin Type M - which aid in the creation of T-Cell antibodies), good immunological responses to all diseases against which he's been vaccinated, and a very elevated white blood cell count. The doctor is, at this time, not concerned with any of the results and we will follow up in August to see if things have improved.
GI: There is some concern that we have been treating Levi for diagnosed "reflux" since he was 3 months old when his symptoms sound more like Eosinophilic Esophagitis (EE for short). While the treatement for GERD (reflux) that Levi has been on is a part of the treatment plan if he does, in fact, have EE, there will be an added medication to help reduce the swelling and inflammation associated with EE (which may be exacerbating his asthma symptoms when he gets a cold). In order to test for EE, Levi will need to have an Endoscopy. GI specialist will defer to Pulmnology before scheduling endoscopy because Pulmonology may want to do a Bronchoscopy and because Levi will need to be "asleep" for both procedures, it's best to do them at the same time.
Pulmonology: No bronchoscopy at this point so GI Specialist will proceed with scheduling endoscopy. Despite testing negative during the skin test for allergies in April, his diagnosis is Asthma/Allergies from the pulmonologist after speaking with the allergy & immunology specialist we saw there. Will defer to GI to schedule and perform the endoscopy, determine diagnosis of EE, and start treatment if diagnosed. Will follow-up in September to allow for diagnosis and at least 30 days of treatment of EE (if diagnosed) to determine if there has been a significant improvement in asthma symptoms. Anticipate scheduling a sleep study in October to test for Obstructive Sleep Apnea (OSA). If diagnosed, will recommend removal of tonsils, and follow-up to see if there is improvement. Assured us that while he's not making any changes to treatment plan now, he has "a few tricks up his sleeve" but wants to make sure all 3 of our specialists are in agreement on the plan moving forward and can't do that without the results of the testing we anticipate taking place in July.
Basically, we want to be sure that we are treating the ROOT CAUSE of Levi's frequent infections and not simply the symptoms. His frequency and depth of asthma flare-ups are more than are to be expected from a child his age, with his history, on the treatment plan in place right now.
Allergy/Immunology: Skin test was negative for all triggers. And after the test, specialist tells me that, while the test was negative, this does not mean that he does not have allergies because many children will not show a proper allergic reaction during a skin test until they are at least 36 months of age. The next step was bloodwork. The results are really inconclusive, but did show decreased levels of Ig-M (Immunoglobulin Type M - which aid in the creation of T-Cell antibodies), good immunological responses to all diseases against which he's been vaccinated, and a very elevated white blood cell count. The doctor is, at this time, not concerned with any of the results and we will follow up in August to see if things have improved.
GI: There is some concern that we have been treating Levi for diagnosed "reflux" since he was 3 months old when his symptoms sound more like Eosinophilic Esophagitis (EE for short). While the treatement for GERD (reflux) that Levi has been on is a part of the treatment plan if he does, in fact, have EE, there will be an added medication to help reduce the swelling and inflammation associated with EE (which may be exacerbating his asthma symptoms when he gets a cold). In order to test for EE, Levi will need to have an Endoscopy. GI specialist will defer to Pulmnology before scheduling endoscopy because Pulmonology may want to do a Bronchoscopy and because Levi will need to be "asleep" for both procedures, it's best to do them at the same time.
Pulmonology: No bronchoscopy at this point so GI Specialist will proceed with scheduling endoscopy. Despite testing negative during the skin test for allergies in April, his diagnosis is Asthma/Allergies from the pulmonologist after speaking with the allergy & immunology specialist we saw there. Will defer to GI to schedule and perform the endoscopy, determine diagnosis of EE, and start treatment if diagnosed. Will follow-up in September to allow for diagnosis and at least 30 days of treatment of EE (if diagnosed) to determine if there has been a significant improvement in asthma symptoms. Anticipate scheduling a sleep study in October to test for Obstructive Sleep Apnea (OSA). If diagnosed, will recommend removal of tonsils, and follow-up to see if there is improvement. Assured us that while he's not making any changes to treatment plan now, he has "a few tricks up his sleeve" but wants to make sure all 3 of our specialists are in agreement on the plan moving forward and can't do that without the results of the testing we anticipate taking place in July.
Basically, we want to be sure that we are treating the ROOT CAUSE of Levi's frequent infections and not simply the symptoms. His frequency and depth of asthma flare-ups are more than are to be expected from a child his age, with his history, on the treatment plan in place right now.
Have I mentioned that I LOVE THIS LITTLE BOY?!?
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