On Sunday evening Carson was having a hard time breathing again. He was breathing very, VERY rapidly (around 80-90 breaths per minute) was in drawing, nasal flaring and head bobbing. Mark and I took him back to the emergency at the children's hospital. It was very busy and crowded, but because of Carson's history we were seen immediately.
They did all our old routine tests - blood sugar, blood gas and a chest xray. The blood sugar and blood gases came back normal and his heart rate and oxygen saturation were perfect. His lungs sounded great and the chest xray showed them clear and fully inflated (yay!). When the doctor was telling me all this I started to feel as if maybe we had over reacted and he really wasn't breathing that hard. But that's when he broke the new news....
The chest xray showed Carson's heart to be enlarged - significantly compared to all of his past chest xrays. I asked if this could be due to how they took this chest xray (sitting up right) compared to the past xrays (laying flat). The doctor said it could make a tiny difference, but not as much of a difference as they were seeing. I was trying to stay calm and optimistic, but your mind immediately starts thinking about holes in the heart, valve issues and open heart surgery (especially since friends of ours are going through heart issues with their newborn son.) They paged cardio for a consult, scheduled an echo for the morning and immediately did an ECG (which came back completely normal). They were going to admit us, but unfortunately, they had no where for us to go, all of the units were full. So we spent a very long, UNCOMFORTABLE night in the ER. (Carson at this point was just being monitored, not on oxygen (his breathing had slowed down) or any medication. They had tried to start an IV (just incase) when they took blood, but they didn't secure it well enough and it came out - causing blood to go EVERYWHERE!)
The bed situation didn't change any in the morning. They performed the echo in our ER room. Right away the technician gave us excellent news. His heart in fact was NOT enlarged - instead it was an enlarged thymus gland. The technician assured us an enlarged thymus is not something serious. When the doctors came to do rounds (again, still in the ER) they decided to keep us overnight for observation. They said they were worried Carson's thymus was pressing on his windpipe - which would be the cause of his rapid breathing. However, we got the feeling that they didn't really know a lot about the thymus, as they weren't able to answer a lot of our other questions (ie why did the thymus grow so big so fast in the last two weeks? How do you fix an enlarged thymus? etc). Once we were fiiiiiiiiiinally given a room in Unit 2 (around 2pm), the doctors came back. They had gone and spoke with an oncologist (which again made me jump and start envisioning scary things like chemo treatments etc). The oncologist said he sees large thymus quite frequently in infants and most of the time its nothing to worry about. He also said that in infants the thymus is quite malleable so it shouldn't be pressing on his windpipe, so something else must have been causing the respiratory distress. They settled on mucus, and sent us home. I was so tired and so sick at this point that I gladly went home, and didn't get answers to all the questions I had.
So I made an appointment with my family doctor, and we saw her this morning. She isn't super familiar with the thymus either, but after speaking with her I feel a whole lot more comfortable and certain that Carson is ok. These are the answers she gave us:
Why is Carson's thymus enlarged?
The thymus is responsible for creating white blood cells and plays a huge role in the body's immune system. She believes Carson's thymus may be enlarged due to how sick he was last month. His body had to work very hard to fight the RSV - so she believes it may just be large from all the tough work. She also felt that it could have been large already when we were in the hospital last time -but this type of xray (sitting upright) showed it at a better angle.
Should we be worried that it is enlarged?
At this point, no. As long as Carson continues to grow and gain weight, we shouldn't worry as this would rule out anything significant. And Carson is excelling at weight gain! He now weighs 11.3 pounds - jumping from the 25th percentile to the 50th in just over a week!
How do you "cure" an enlarged thymus?
The thymus should shrink back to a normal size on its own. But to be sure the ER doctors have also reffered us to a pediatrician (I've requested the same one we saw with Katie) for monthly check ups. These check ups will also include a chest xray and blood work to keep an eye on things. My family doctor has also offered to see us every 3-4 weeks (or whenever I feel something is not right).
What is causing Carson to breathe so rapidly?
Carson continues to breathe faster than a "regular" baby. A regular respiratory rate is under 4o breaths per minute - Carson is typically in the 60's (although he does have his moments of slower or faster breathing). Dr. Bennion (our family doctor) believes Carson may still be breathing rapidly as he is still recovering from the RSV/bronchiolitis. Even though his lungs sound fine and the chest xray is clear, he still may be battling the last bits of the bug.
Is it bad for Carson to continue breathing this fast?
Yes, but only if its causing indrawing, head bobbing, nasal flarring etc - visual signs that he is struggling to breathe. Carson hasn't shown any of those signs since Sunday. He is very content, sleeping, eating and peeing great. The rapid breathing on its own isn't a huge concern if he's not struggling as infant's already have a higher heart rate. Should any of the other symptoms return, we're to bring him back to the ER again.
Overall Dr. Bennion was VERY pleased with how well Carson is doing. He's doing everything a baby his age should be. Which makes me feel much, MUCH better. Sometimes I feel like I am a first time mother again with Carson. It's hard to remember what normal breathing is and I often feel paranoid that something is wrong, or worry that I am overlooking something. But thankfully we have a great support team, and I know that if ever something doesn't seem right, I wont be scoffed at for bringing him in to be seen.
1 comment:
I'm so glad you got some answers from Dr. Bennion and, most of all, the reassurance you needed. You've been through some very scary moments and it's no wonder you had worries about "normal" breathing patterns, etc. I can't wait to get home and give that little one some cuddles!
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