Caden is doing great this evening after recovering well from today’s outpatient visit. Caden did get ear tubes inserted in both ears today, but he did not get a botox injection. However, there were some major developments on the subject of swallowing. I get to that in a minute. The new ENT (Ear, Nose, and Throat) doctor said that there was a lot of fluid and that we should expect to see a noticeable difference in Caden’s hearing this week which should lead to more rapid speech development. Caden sat at the table with us during dinner this evening as usual. 
The picture on the left was taken this evening and you can see that he is as happy as a pig in the mud.
Now for the new developments. I am going to do my best to just state the facts that were found today. There are a lot of emotions flying and we don’t want to get ahead of ourselves. There were probably as many questions generated today as there were questions answered. It looks like giving this new ENT a try might be a pretty big step in the right direction for getting answers to “Why is Caden not swallowing?” The focus on Caden’s swallowing problems thus far have been centered on the cricopharyngeus muscle also known as the upper sphincter of the esophagus. This muscle was hyper contracted prior to Caden’s first botox treatment back in August. There was some improvement in Caden’s ability to swallow his secretions after that first treatment, but the improvement was nowhere near what we all expected or hoped for in terms of eating. The puzzling question for us and the previous ENT was the last time Caden got botox back in November was that the doctor said that the muscle looked like the cricopharyngeus was already open enough to pass food. She did go ahead and injected 40 units of botox that day anyway. We saw very little swallowing improvement after that botox treatment.
The new ENT doctor took a different approach from the start. He wanted to take a good look around before doing anything. He went in today and scoped Caden’s airway, vocal cords, and esophagus. His findings seemed to surprise him as much as it did us.
I am including a picture to help illustrate today’s findings. 
The picture on the right was taken during the scope of Caden’s esophagus today. I added the dotted lines to illustrate what the doctor believes to be a major vein or artery protuding in on the back of Caden’s esophagus. The other areas of the esophagus shown in this picture are considered to be normal. He believes this lump protruding in on the esophagus to be a caused by a blood carrying vessel because it is about the size of an adult’s pinkie finger it was pulsating at the same rate of Caden’s heart beat. This lump was found approximately one inch below the cricopharyngeus muscle where all the botox has been previously injected. The ENT did not inject any botox today because of the cricopharyngeus was fairly relaxed already and he did not feel that the risk associated with botox was justified given the new findings. He believes that the new found protuder might be a large contributing factor to the swallowing problems.
The doctor would not speculate very much on what corrective action might be available for such a situation. The first thing the ENT doctor is going to do is talk to Caden’s heart surgeon to see what data might have already been collected regarding Caden’s anatomy in that area of his chest. The ENT doctor wants to see if any of the tests have already been done that he might suggest as a next step in determining a course of action for Caden. So for now we will wait for a few days to give these doctors a chance to talk. The new ENT also wants to view all of Caden’s previous barium swallows to see if anything in those might help him understand the impact that this artery/vein is having on Caden’s swallowing functionality.
You can help by simply praying for Caden and the rest of our family. Sherry and I both were pretty upset over today’s news. We don’t know what will develop, but it is hard to keep from imagining the next step in dealing with such a circumstance as was described to us today.
Caden’s grandma did not have surgery today. We got our days and dates mixed up. She will be going in for her procedure on Thursday. Please keep her in your prayers as well. Thanks a bunch for checking up on Caden. God Bless!!!