Although the core of our philosophy on Gwendolyn's care is based on several synergistic factors, in our opinion her routine respiratory treatment regimen is probably the most important. When Gwendolyn is in good respiratory health we religiously perform this regimen five times a day; four times during the day (7:30am, 11:30am, 3:30pm, and 7:30pm) and once in the middle of the night (2:00am). When Gwendolyn is having respiratory issues, such as when she is fighting a common cold or when her lung collapsed, we perform respiratory treatments as often as needed, sometimes up to several times per hour, to help her clear her lungs and airways and keep her as clear as possible. When Victoria and I see signs of Gwendolyn starting to go into respiratory distress, the first thing we do is run through a full respiratory treatment to try and dislodge and clear whatever may be restricting her breathing.
This is what Gwendolyn's respiratory treatments consist of (in this order) and the entire routine takes about 30 minutes:
- Nebulizer treatment – The nebulizer is used to administer liquid medicine in a mist form into Gwendolyn's lungs and airways. There are several medicines (e.g. Albuterol, Pulmozyme, Mucamist) that we have given her at different times through her nebulizer but in general the medicines work to either open up her airways, break down sticky junk (the “bad guys” as we call them) in her lungs, or move her secretions up and out of her lungs/airways. Different medicines are used at different times and frequencies depending on her overall health. Currently, Gwendolyn is only getting Albuterol, a medicine that helps open up her airways, through the nebulizer. The nebulizer treatment takes about 20 minutes.
- Chest percussion therapy (CPT) – The purpose of CPT is to break up or mobilize junk that may be in the lungs and airways that the nebulizer treatment is or has just loosened up. We use either a soft rubber massage cup or a small massage wand to gently tap or massage each of Gwendolyn's lung lobes. We CPT for approximately two minutes on each side of Gwendolyn's chest and two minutes on each side of Gwendolyn's upper back and typically do her CPT during her nebulizer treatment.
- Cough Assist – After the nebulizer treatment has opened up Gwendolyn's airways and the CPT has loosened all of the junk up in her lungs, we use the Cough Assist machine to force Gwendolyn to cough the junk out of her lungs and into an area where we can suction it out for her. The Cough Assist is a machine that forces air into her lungs then automatically pulls that air out, forcing her to cough. We do three sets of three coughs with every respiratory treatment and I wouldn't say that she necessarily likes the Cough Assist part of the treatment but it is very effective.
- Suction – Once we have mobilized the junk in her lungs and used the Cough Assist machine to help her move it up into the back of her throat or mouth, we use a suction machine to get the junk out. During her respiratory treatments we suction as needed but always before, in between, and after each Cough Assist set and always in her mouth and throat (each time) and through her nose with an attachment called a BBG (after the last set).
UPDATE (March 16, 2009): As Gwendolyn has grown and regained strength, we have altered the above routine a little bit. We now do three respiratory treatments a day: morning, noon, and before bed. At the slightest concern, however, we add treatments back in.