4 1/2 yr old with frequent pneumonia

[JaceandWillsmom]

My son is 4 1/2 and has had pneumonia on and off since he was 5 months old. He was on Pulmicort and albuterol after a short visit in the hospital at 5 months old but the pediatrician gave me no valid reason for him to be ont hem so long so I swithched pediatricians when he was 7 months. The new pediatrician took him off of the pulmicort only to put him on albuterol when he would get pneumonia; which was about 5 times a year. The Dr. would not listen to my concerns about him having frequent pneumonia, he just acted like it was no big deal. Or I would get that the chest xray was read wrong one time and the other time not. The Dr. that we were seeing moved to a different city so I switched Drs in Dec of 06; these new Drs (husband and wife) are wonderful. He was hospitalized in January with sever broncholitis put on pulmicort, albuterol, steroids, and omnicef. The Dr. also diagnosed him as having asthma. The dry hacky cough that he had almost all of the time seemed to go away.
In May of this year, he got really sick again 104 temp and was having trouble breathing. I took him to the ER they said it was just bronchitis and the chest xray was clear. He was not getting any better so I took him to his Dr. the following day. The Dr said that the Xray showed pneumonia and put him in the hospital. I am so glad that he was in the hospital because the first night he was there his o2 dropped to 75 and they had to put him on oxygen. The Dr. came in the next day and said that he had atelectasis. We stayed in the hospital for 4 days and came home. He finally got back to his normal self. In the mean time he got switched from pulmicort to flovent. In Sept he was complaining of his chest hurting really bad but had no other symptoms. I took him to the Dr and she did a chest Xray and sure enough he had pneumonia. She immediately reffered us to a pediatric pulmonologist. He saw her and we went for a cf sweat test which came back normal.She said that when we come back if there is any sign of pneumonia on a new xray she is going to have him get a chest ct because if the pneumonia is in the same spot all of the time there could be an underlying cause. Well I had to take him to the ER the day before thanksgiving and he was complaining of his chest hurtng again and sure enough he had pneumonia again. The ER Dr pulled up the Xray from Sept and said that the spot is in the same place but she don't think that it's residual because it's alot darker than the one in Sept. We go and see his pulmonologist this Wed. What questions should I ask her about this and is the Ct Scan the only test that should be done? I feel like more tests should be ran. He also has severe leg cramps that which he is flat footed and we got shoe inserts for in Sept that seemed to help for awhile could this have anything to do with the spot on his lung? Thanks So Much

[JaceandWillsmom]

Well we had our visit with the pediatric pulmonologist on Wed. We are schedule for a lung cat scan on the 13th at the Children's hospital. They are going to sedate him slightly for this. I brought in all of the xrays from the past year and they all showed that he had a spot of pneumonia; some of which the spot was larger and some the spot was smaller. She seems to think that the cause is a congenital cyst that is getting infected. She said that if it is a cyst that it will have to be removed. The thing that I don't understand is that the pneumonia in Sept (which he was not hospitalized for, was not running a high temp, and was not coughing) was way worse on the xray then when he was in the hospital with the 104 temp and the actelectasis in May. So I guess only time will tell. Untill then, I will be on the edge of my seat. My son is only 4 1/2 but is very smart because he had a dermoid cyst removed from his eyebrow last April and heard the Dr say she thought that it might be a cyst and that if it was it would have to come out. So I'm not only trying to keep my nerves under control but also his. We go back for the results on the 19th. I will keep you updated. Have a good Week. Thanks. Danyeil

[Melissa6703]

Ironically my 4 1/2 year old daughter battles recurrent pneumonia as well.  She was hospitalized with her first bout in Feb of '06.  She was on O2 and IV antibiotics for 3 days, then discharged home on pulmicort and albuterol.  She had another bout in Sept of "06, another in November of "06 and then our pediatrician referred her to a pediatric pulmonologist.  A CT was done in Dec "06 and it was thought she had scar tissue on her right medial lobe of her lung, and that each time she got a cold this area had a hard time clearing the mucous, then she would develop the pneumonia.  We were told to cont with the pulmonicort 2x/day and add the albuterol when she developed a cold to try to prevent anything more from occuring.  We also were taught how to do chest physiotherapy, which involves "clapping" her chest and back with a little rubber device to aide in clearing the lungs.  We did all of this and she still developed 2 more bouts of pneumonia last winter.  She had a good summer and this Oct and November had 2 more bouts.  We went back to the pulmonologist who ordered a bronchoscopy.  This was done last Wednesday and it was determined she has a narrowed vessel (I just talked on the phone with the dr today so hopefully I took all of this in accurately) in the right middle lobe.  She said this should be the consistancy of nose cartilage, however with Olivia it is much thinner and also it is damaged from the recurrent bouts (it bled easily when the scope was passed through it, where in the other areas of the lung there was no bleeding).  They ordered another CT scan with dye to determine if there has been a worsening since last Dec or if things have been improved.  She said if things are better, we will do agressive flowvent (which we switched to recently) and albuterol with the chest PT this winter and basically hope for the best.  If things are worse than last year, we will try a new albuterol medication (which I cant remember exactly what the difference is b/w this and the old albuterol) but I think it is basically stronger and they do not put kids on it right away because it is much more costly.  She also mentioned a vest which vibrates instead of the chest PT (this part I dont know about, when I told my pediatrician about this, she said it is $16,000 and kids typically dont tolerate it well because it vibrates so intensely that it literally can move them across the room).  I also work in health care and have a pt who has one of these vests and she said she is yet to see a difference in using it.

So....what I would suggest is the bronchoscopy.  My daughter also had an immune lab drawn to see if she just wasn't fighting things off as most people do.  That was normal except they determined she did not respond well to her immunizations, so she has to go back in for boosters of her dtap for sure...I dont know yet about others.  When she had the bronchoscopy done they also took a sample from the right medial lobe and irrigated the area (cleaned it out).  I would doubt that the flat footedness is related.  Please let me know if you find out anything else....and if anyone else reads this and knows about the vessel thinning I have described please respond!!! Thanks from Olivia and her mom!