No surgery ... yet.

We met with an ENT about Esai's many symptoms. Apparently, he has huge tonsils and adenoids. He may or may not grow into them in a few years. The doc said we'll probably have to have them removed. We can do it now, or later. It's not an emergency.

At first, we were going to schedule the surgery for June. But then ... no. We just can't do it. Not yet. After watching the Bug recover from his last surgery, we're just not ready for that again. Selfish as I am, I can't endure it. I can't watch my baby go under anesthetic and pray that he wakes up. I can't let a happy boy go to sleep; then watch a confused kid wake up in pain and not really understand why.

If it were an emergency, we'd do it in a heartbeat. But not now.

At our last pediatric visit, the doc added Singulair to Esai's daily Zyrtec. That seems to have done the trick. In the past week, Esai hasn't had any cough-vomit fits. He hasn't been coughing in his sleep. His boogers have dried up. So, we can do this for a while. He doesn't seem to have any side effects from the drugs ... no sleepiness, no bloody noses, nothing. So, we'll do this for a while. If he gets bad again, or the drugs stop working, we'll re-evaluate the surgery angle.

Ahhh ... a return to cosleeping.

At 2 years old, most parents are struggling to get their kids out of their beds. Not us.

Esai started sleeping with us when he was about 5 months old. At about a year, it became apparent that NO ONE was loving the situation. Esai was not sleeping. I was not sleeping. Daddy was not sleeping. So ... we had to move him to his crib again. It was a rough adjustment for a week or so; but eventually, everyone slept better.

But I missed him so much. I missed hearing his snoring all night. I missed looking at his little chubby cheeks as he slept like an angel. And Rene has always been a fan of co-sleeping.

Then about two weeks ago, Esai got out of his big-boy bed for some water and asked me "Mommy's bed?" ::: swoon ::: And so, he slept half the night with mommy. And I just laid there and stared at him.

And since then, Esai's been spending anywhere from four to seven hours in his own bed; then climbing into bed with us. If he gets too restless or squirmy, he goes back into his bed. But for the most part, he wakes up with mama.

My gut is telling me this might make his transition into big brotherhood a little smoother. Plus, if he's already in bed with me, I don't have to get up in the middle of the night to tend to him when he wakes up. So it's a win-win.

And as a really cute side note: He doesn't ask for nummies when he lays down with me. He likes to hold my belly button. Once the "baby button" is in his hands, he can peacefully drift off to sleep.

Belly Henna by The Bug

How does a too-exhausted-to-play-Mommy-Horsey-or-read-"Going Up with Grover"-again mama keep a snowbound, high-energy toddler with cabin fever occupied?

A Letter to Esai's Doc

March 31, 2009

To: Dr. Chavez/Nurses

From: Sara Ornelas

Re: Esai Ornelas (Birthday: March 12, 2007)

After a very long, rough night, I thought this would be a good time to further address some of the allergy issues Esai’s had. I mentioned them to Dr. Chavez at Esai at the 2-year well-child appointment on March 26; but I don’t think I pressed the issue enough. It’s much easier for me to write these things out then to say them. I always forget to mention something. Plus, a high-energy 2-year-old running around the office is a bit distracting.

I don’t want to be that crazy mom (although, that’s probably not too much of a stretch) who demands invasive procedures on her kid, but I also don’t want to be that mom who just waits for things to unfold at the expense of my child’s health and comfort.

When I look at Esai’s symptoms, I see something very similar to what I saw in Anthony (our older son). Although I’m Anthony’s stepmother and didn’t meet him until he was 8, Rene and Anthony’s mom (Angela) have filled me in on a lot of Ant’s symptoms when he was younger: frequent ear infections, asthma, respiratory issues, very frequent colds and viral infections, snoring, mouth-breathing, and coughing fits that end in vomiting. Ant’s issues eventually led to 80-something percent lung function. However, many of his symptoms were eased when he had his adenoids and tonsils removed when he was 13 years old. He was able to get off daily-maintenance asthma meds (and instead manages his asthma with an occasional puff from the inhaler and allergy medicine), he gets sick A LOT less often, and he stopped snoring altogether. Sometimes I wonder what would have happened if we’d thought to remove Ant’s adenoids and tonsils earlier in his life.

Seeing all that unfold with Ant, then seeing it start to occur in Esai makes me worry that Esai is headed down the same road. And, even Anthony is concerned about his little brother.

OK. So, here are Esai’s issues, which you probably know; but I wanted to put them all together in one place and see if we can come up with some sort of solution:

· Frequent Ear Infections and Fluid: I don’t know how many infections Esai’s had in the past two years, but I’m going to guess that it’s been between eight and 12. And while many of these have been diagnosed at an immediate-care clinic, follow-up visits have been done at your office; and it’s been noted in most cases that Esai’s still hanging onto fluid (if not infection) two to four weeks after the infection. In fact, on March 26, Esai still had fluid in his ears left over from an infection in early February.

· Mouth-breathing: Esai almost ALWAYS breathes out of his mouth. This has been happening since he was just a few months old. It’s worse when he has a cold, or when his allergies are especially bad. And his dry mouth wakes him up at night, asking for water.

· Coughing and Vomiting: Esai almost always has a cough. The severity of it varies with the weather. But many times he coughs so much, gags and vomits. And he vomits A LOT! Tons and tons of vomit. But almost immediately after he’s done vomiting, Esai’s fine, asking for food. He also tends to cough a lot after intense physical activity. I really don’t want to limit his physical activity or outdoor time if I don’t have to. The child loves outside, and he loves to run around (probably like every toddler).

· Snoring (and maybe mild apnea): Last night was particularly rough. Esai coughed several times each hour. He doesn’t wake up much (although, I can’t imagine he’s getting the quality of sleep he needs with that much coughing), but I can hear him; so I decided to go lay down with him in his bed. Now, I know Anthony (and Rene, for that matter) had pretty severe apnea, where they would stop breathing for several seconds. I didn’t notice Esai doing that last night, but he does hesitate in his breathing (maybe for about five seconds), particularly after coughing. I don’t know what qualifies as apnea though. Also, he does snore, even when he lays on his belly. Granted, most of the time it’s a light snoring; but it can get quite loud at times.

· Frequent colds and respiratory issues: Esai had RSV twice before he was a year old. Additionally, he tends to get colds very frequently. Granted, he’s in daycare, but he seems to get colds even more frequently than other kids in his daycare. And his colds tend to hang on longer and increase the intensity of his other symptoms (coughing, vomiting, snoring, etc.).

· Allergies: Esai’s been on once-daily Zyrtec every night for about a year, I think. He started out with half a teaspoon, which helped. But then, things got worse, so I gave him about two-thirds of a teaspoon. Again, he got better and I gave him three-quarters of a teaspoon. When he turned 2, I started giving him a full teaspoon. At this point, he’s still coughing quite a bit. And while I believe allergies are worsening whatever problem Esai might have, my intuition is telling me it’s not allergies that are the problem.

Also, Dr. Chavez gave us some samples of Nasonex to try with Esai; and I have some questions about that, as well:

· Is there some way to give this to a toddler without feeling like the most horrible mother on earth? Esai hates it, and I feel like I’m abusing my child. I have to hold him down, while he cries “Mama, no. Stop.” It breaks my heart, and I would be open to any suggestions on how to make this easier on him.

· Are there are behavioral side effects linked to Nasonex? Esai started the Nasonex on Thursday (March 26). He’s always been a very easy child. He listens well, very agreeable and loving. Sure, he throws the normal toddler tantrums, but not more than one a day; and they generally don’t last long. Since Friday, he’s been an irritable bear. Tantrums that last for 30 minutes or more, and several times a day; and I have to wrestle him to get the simplest tasks done (things he usually loves or at least kinda likes), like baths, diaper changes, getting in the car seat, etc. I might just pass this off as normal 2-year-old tantrum; but the timing on starting the Nasonex on Thursday; and the behavioral changes on Friday … it’s too much of a coincidence.

One other long-shot I’d like to mention is that a friend of mine has a child (who is a teenager now), who had almost identical symptoms to Esai when he was a toddler. They tried allergy meds, steroids, asthma meds, etc. Finally, the child was referred to a pediatric pulmonotologist (not sure if that’s the right name). After some evaluation, it was discovered that the child was developing frontal sinuses, which I guess is very rare? The family then met with a GI and they did a scope on him. The child was diagnosed with reflux and esinophilic esophagitis (again, not sure about the spelling). The child was put on prilosec twice a day and his symptoms GREATLY improved. Eventually the child outgrew the issue, as he grew into his esophagus.

Anyway … I thought this might be something to consider as well. Just throwing it out there.

So, with all this information, I’m hoping to get one (or more) of the following solutions:

· A referral to an allergist (if we still really think it’s allergies, although my non-medical brain is thinking it’s something else, which is exacerbated by allergies, rather than just allergies).

· A referral to an ENT doctor to check Esai’s adenoids and tonsils.

· A referral to a GI to explore the reflux angle.

· Or, if Dr. Chavez does not want to refer this out, perhaps some more careful evaluation of Esai’s symptoms, a more distinct diagnosis and more effective treatment – especially considering his family history.

Again, I’m sorry for not bringing all this up at once at Esai’s 2-year appointment; but I’m much better in writing than I am in person. J I hope having all this written in one place can help to give Esai some relief of his symptoms. I just know how active he is, and how much he loves to be outside and play. I’d hate for him to have to limit any of his activities because of something that we can fix (or at least help).

Please let me know what you come up with.

Thanks so much!!!!

Sara Ornelas

316.680.8268