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Surprising Diagnosis Brings Cure
It's one thing to act out in class and be asked to leave, but what if your teacher dismissed you because you coughed, "like a barking dog?" That you coughed so loud and so often, you disrupted the classroom?
Such was the case for 13-year-old Leah Cunigan of Norfolk, Neb., in late fall of 2007.
"At first, we thought Leah had a cold that persisted," explains her mother, Vicki Hibl. "It began with a sore throat and then a cough which just wouldn't go away. We made multiple visits to the urgent care center and to her pediatrician. She was prescribed antibiotics, steroids and even an inhaler. Nothing seemed to tame her cough. A few times, when her coughing could not be controlled, the staff at her school advised me to take her home because she wasn't well and her cough was disruptive to the other students."
Nights were even worse. Whenever Leah would lie down, the cough intensified. And with any exertion, the cough flared. It became increasingly more difficult for Leah to sleep through the night. As fatigue set it, Leah's class work began to suffer. "She had to sit out during physical education and couldn't participate in her dance classes," says Vicki. "The whole situation wore her out. She was feeling so down in the dumps, telling me that she just wanted to feel normal again."
Leah's pediatrician, Daniel Blomenberg, M.D., became concerned when medications did not help. He recommended that Vicki and her husband, Shannon Hibl, consult Heather Thomas, M.D., a pediatric pulmonologist at Children's Hospital & Medical Center in Omaha.
Dr. Thomas's examination included testing to rule out various causes of chronic cough, as well as cystic fibrosis. Leah's lung function test was normal as was her chest X-ray. Cultures for pertussis and various viruses were also negative. Although Leah's history suggested gastroesophageal reflux disease (GERD), given the dramatic nature of her cough and the degree to which it was disrupting her life, it was decided to perform a CT scan of her lungs and a flexible bronchoscopy to ensure nothing was missed. The chest CT scan was performed first but did not reveal anything concerning.
Dr. Thomas then performed a bronchoscopy, which allows a physician to examine the anatomy and dynamics of the airways. Flexible bronchoscopy is performed in the operating room so that sedation can be optimized. When the Hibls realized anesthesia would be necessary they asked the staff if they could contact a former Norfolk friend, Cynthia Farris, M.D., a staff anesthesiologist at Children's, hoping that she would be able to check in on Leah. Dr. Farris immediately rearranged her schedule so that she could be there to administer the anesthesia during the procedure.
Based on the findings of the bronchoscopy Dr. Thomas was confident there was no foreign body or anatomical reason for Leah's cough. The washings performed during bronchoscopy ultimately supported the diagnosis of GERD.
GERD can develop anytime during infancy through adulthood. Oftentimes it causes much more serious symptoms than just a sour taste in the mouth but can lead to a variety of complications including severe inflammation of the esophagus, asthma, chronic, persistent cough, choking episodes at night, chest pain, difficulty or pain when swallowing, chronic sore throat and laryngitis. Symptoms of GERD can usually be controlled with medications. In a few children however, especially those with other medical conditions, surgical intervention is necessary.
Leah's day at Children's went like clockwork, says Vicki. She was especially pleased that the staff was able to organize most of Leah's lab work and diagnostics as an outpatient, getting her through the tests seamlessly.
Leah went home the same day supplied with a medication to treat gastric reflux. After three doses in two days, she was cough free, says Vicki. After six months, she was able to completely discontinue the medication.
"We were impressed with Dr. Thomas and the staff at Children's," says Vicki. "They were very accommodating and took into consideration our work schedules and the two-hour drive from Norfolk to Omaha. Just getting all those tests ordered and Leah through the process was amazing."
Within a few days of her Children's experience, Leah returned to school, tackling her classes with enthusiasm. She has resumed her regular routine of dance and competitive dance, and has recently been accepted into modeling school. "Her turn-around was very quick, and thanks to Children's, she's back to being the same outgoing person she was before," says Vicki.