Yum!

"Oral viscous budesonide made by mixing 0.5 mg Pulmicort Respule with five 1g packets of sucralose (Splenda) to create a volume of 8-12 mL"


This is what Nate has to look forward to tonight.


Anticipated Questions:
Q. Why, oh g-d, why?
A. Because the biopsies he had last week show that he has eosinophilic esophagitis, best described as asthma of the esophagus.  The allergic cells (eosinophils, or eos for the indoctrinated inner circle) that attack your lungs in asthma are hanging out under the surface of his esophagus, in large numbers, releasing histamine and other nasty compounds, causing inflammation and discomfort.
Q. So what?
A. Symptoms of untreated EE mimic GERD (heartburn/acid reflux) and include heartburn, poor eating, failure to gain weight appropriately.  Plus, adults with EE have esophagi that look like this:

when they should look like this:

and right now no one knows if early and effective treatment will prevent the chronic change.
And because we are hoping to get rid of his symptoms and make him comfortable.  Even when he doesn't truly throw up, he tells us multiple times a day that he is having a "yellow spill" in his mouth or tummy.
Q. What's Pulmicort?
A. It's a liquid steroid mixture designed to be put into a breathing machine (nebulizer) and turned into vapor for breathing into the lungs and treating asthma.
Q. Um, he doesn't have asthma.
A. I know, but right now the only way to get steroids into the esophagus is to swallow them, and there's no medicine marketed to do this specifically for EE.  The goal is to give a small dose in a thick liquid that will coat the esophagus and sit there (like putting on a skin cream) and will not be enough to get absorbed into his bloodstream and cause all those nasty steroid side effects.
Q. Why Splenda?
A. Have you ever tasted liquid steroids?
Q. Will he take it?
A. Only time will tell.  Sadly, we can't bribe him with chocolate because he can't eat or drink for 30 minutes after taking it.  We'll try sticker bribes, but he drives a hard bargain, so don't be surprised if there's a new playground in our yard come spring :)