May 14th, 2008

Kinnick seen her ENT today.  He scoped her in the office and was able to see that the left vocal cord is definitely paralyzed.  He believes this to be related to the PDA ligation or multiple infections while in the NICU.  The cord is in midline position which he says is the best position to be in if the left vocal cord is paralyzed.  He says that having a paralyzed vocal cord can allow for aspiration, but since it is midline, it isn't as big of a risk.  He seen no evidence of aspiration, but says that there is still a lot of swelling due to acid reflux.  Kinnick is still refluxing with her Fundo.  I suspected this since she has so much gas (it has to go somewhere).  I believe the leaking g-tube and reflux are all related to a gut problem.  I believe the gut problem is related to the NEC she had while in the NICU.  She had part of her intestine removed due to a block.  I believe there is some scar tissue from the NEC that is causing a partial block that slows her gut down.   We will see this ENT again in 3-6 months.  He considers the paralysis to be permanent, but says the right vocal cord should compensate for the left and that she will be able to speak.  He doesn't recommend doing anything at this time.  He is more concerned about the reflux and is going to send a note to our GI doctor.  He was pleased with how well her baby food feeds were going - he considers this to be very positive considering the paralysis.  We are very lucky that the positioning of the left vocal cord is not allowing aspiration.  I will see the GI doctor again in about 4 weeks.  I asked if there was a better reflux med and he said that he believed the drug she is taking is the best for her age.  He also believes that until the reflux is under control, she will have a hard time coming off the O2.  So, we're back to figuring out the stomach issue.