Wait, he's not breathing!?-Chapter 2: ER Visit-[Mutta and Hibito #4]

Hello. I am Dr. Kunpas.
I am currently raising two children while working as a doctor.
Eldest son: Mutta (pseudonym), 3rd grade
Small in stature, but his way of thinking and speaking are mature. He is kind. He says his favorite time is playing with Hibito. He hasn't hit his rebellious phase yet.
Second son: Hibito (pseudonym), middle year of preschool
Shy, but a show-off once he gets used to people. He loves Mutta very much. His special skill is making a smug face.

Last time, in Chapter 1, I talked about Hibito's[Adenoid hypertrophy/Tonsillar hypertrophy].

The initial consultation appointment at the general hospital's ENT department wasn't available for several months...

ENT departments, whether at general hospitals or local clinics, are always crowded, aren't they?
In these days when allergies are common not only in adults but also in children, many patients visit the ENT department not only for bronchial asthma but also for hay fever depending on the season.

After I noticed Hibito's apnea, the symptoms worsened day by day.
I started to wonder if it was okay to just leave it until the initial consultation appointment months away, and decided to try to dispel my anxiety by researching.

Yes, humans are creatures prone to vague anxiety.
When I feel anxious or uneasy about something, I shift into a mode of researching and analyzing. By doing so, I can clarify what exactly I am feeling anxious about, and transform the emotion of anxiety into concrete actions like 'identifying issues -> exploring solutions'.

My anxieties

1. Is there any negative impact on Hibito's body if I leave it in this state?
2. If so, what kind of negative impact?
4. What can I do while waiting for the initial consultation?

I researched them one by one.

1. Is there any negative impact on Hibito's body if I leave it in this state?

2. If so, what kind of negative impact?

Watching Hibito sleep from the side, he looked like he was struggling, but my impression was that his oxygen saturation was maintained and he didn't seem to be waking up many times at night or failing to sleep soundly.
However, as I researched properly, I found out that there are various negative impacts.

It's all written with things that are very worrying as a parent, isn't it?
- Growth retardation: Because the secretion rhythm of growth hormone is hindered by not being able to sleep well
- Bedwetting
- Attention deficit
- Hyperactivity
- Aggression
- Poor academic performance

As I thought, I realized that the state of apnea must be resolved as soon as possible.

4. What can I do while waiting for the initial consultation?

In some parts, there were also such literature reports.

Having learned that there was a possibility of improving symptoms through these conservative treatments (this is what we call treatments other than surgery), I revisited a nearby ENT clinic, explained the situation, and had them prescribe medication.

Apnea worsened to the point where they couldn't sleep unless sitting up

I started the oral medication and nasal spray at the same time, but by then, it seemed like they weren't sleeping soundly while lying in bed at night.
I tried putting a rolled-up bath towel under their shoulders like a shoulder pillow and tried various positions, but I couldn't find a position where their breathing would stabilize...
Sometimes, there were days when my husband would hold them in a sitting position while they slept.

After much worry, the method we came up with was

A child safety seat

Yes, that thing children sit in in the car.
When lying down, their breathing just wouldn't stabilize.
It seemed easier for them to breathe in a sitting position.
So, in order to finally be able to sleep while sitting, we ended up taking the child safety seat out of the car every night and bringing it into the bedroom.

Since it was winter, to prevent them from catching a cold due to mouth breathing, I set up a humidifier so close to Hibito's face that the mist was almost falling on them.

One day, while I was wondering if we could keep up this life for months to come...
A new change occurred in Hibito.
When I woke up in the morning, their lips were quite chapped and peeling badly.
"I wonder if they dried out from mouth breathing. Even though I had the humidifier on, I wonder if they need to wear a mask to sleep." I applied lip balm, put on a mask, and slept with the humidifier running.
The next day...

It's gotten worse!

(I will post an image of the chapped lips below. If you are sensitive to this, please scroll down significantly.)
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Because their lips were so chapped, they couldn't eat as they wanted.
Hibito would cry and scream just from the spoon touching their lips...
They couldn't even use a straw.
And, unfortunately, that day was a Sunday.
But since they seemed to be in so much pain that they couldn't eat, we decided to go to theERat the general hospital where we had a first-visit appointment.

To the holiday ER visit

The pediatric ER was a walk-in style.
As an internist, I couldn't think of any treatment other than applying ointment to the lips.
I went to the ER thinking that the pediatrician would be troubled too.
As a result, multiple doctors, including a resident and a supervising physician, took great care of us.
"I'm not entirely sure, but there is a possibility it could be herpes labialis."
Huh?
My head was so full of adenoids and tonsillar hypertrophy that I had completely overlooked the possibility of overlapping diseases.
Herpes?
Indeed, it is a disease that should be considered in the differential diagnosis for lip erosion.

"Just in case, since it's the ER today, I'll prescribe a painkiller for you to take, and I'll consider whether we can arrange for a walk-in first visit to the ENT department tomorrow, so please come back to the ER tomorrow. However, please understand that since I will be making the request to the ENT department on the day, you may have to wait quite a while."

Oh! What a wonderful doctor...
My goodness.
To think they would try to speed up the first ENT visit...
I had nothing but gratitude for them taking into account the circumstances of us suddenly appearing on a holiday. I felt like crying.

At this point, I am completely a mother, not an internist.
When it comes to one's own child, one completely reverts to being a mother, doesn't one.

I was able to get an appointment at the ENT clinic, which was supposed to be months away.

So, since they weren't in a condition to go to kindergarten, I took the next day, Monday, off to visit the ER and then the ENT clinic.
However, it really took all day. It couldn't be helped.
I have nothing but gratitude for the doctors who saw us.
Since I am in the same profession, I told them so and expressed my repeated, heartfelt thanks.

What we found out there
・The adenoids and tonsils are quite large.

・It is likely apnea and respiratory distress due to adenoid and tonsillar hypertrophy.
・Surgery is indicated.
・I'm not sure about the lips. However, suspecting herpes, I will prescribe an antiviral medication.
And, the earliest date for surgery is

5 months from now.

is when it will be.

What!!??

What did you just say!?
It's winter now, but the surgery is in the summer...?
Are we going to skip over two seasons...?

"They are quite large, so I would like to operate as soon as possible, but there are no openings. I'm sorry. We will have you come in for pre-operative tests three months before the scheduled surgery, so if those tests are completed, we can notify you if a cancellation occurs."

Yes... I understand. All the other children are waiting for surgery too, aren't they.
But are we going to continue the life of sleeping in a child seat for nearly another half year?
I wonder if we parents will hold up...

So, although I was able to get the initial consultation I had planned two months early, the surgery was scheduled for nearly half a year away.
We decided to monitor the situation with conservative treatment until then, and to visit as an emergency if it worsens again.

After that

What happened to Hibito after continuing the daily morning and evening medication and nasal drops before bed?
We are currently about two months away from the surgery.

He is able to sleep lying down!

Thank goodness...
He only slept sitting in the child seat for about two weeks, and since then he has managed to sleep in his bed.
He still has labored breathing at times, but I feel like the time he spends sleeping soundly has increased.
We parents are also sleeping soundly next to him.

Conservative treatment, I can feel the effect!
I still believe the surgery is necessary as planned, but I'm glad we've been able to spend the waiting period with peace of mind.

I will write again about the surgery, the post-operative progress, and how much the post-operative symptoms improve.

To be continued in Chapter 3.

I will conclude by introducing a favorite picture book that Hibito has been reading before bed recently.

The 'Henshin' (Transform) series of picture books by Tadashi Akiyama, famous for 'Hanakappa'.
The theme is wordplay; for example,
when a chicken goes through a tunnel saying 'niwa, niwa, niwa...',
it turns into a 'wani' (alligator)!
It is full of such playfulness that children can enjoy over and over again.
Hibito enjoys the rhythm and reads it to himself many times.
It is a book that parents and children can enjoy together.
Believe it or not, there are 23 books in this series!
It's great when kids get hooked on a series, as it makes it easier for parents to choose books.
I think many libraries carry this series, so please take a look.

Thank you for reading.