Modified Barium Swallow and Cardiac Cath

I saw a modified barium swallow in peds today, even though I'm not on the peds rotation! I haven't been following this pt/case and I only got a brief background on the pt, so I hope this makes sense..

The little girl is 5 yo and as a premature baby, she had a tracheostomy put in to help her breathe. It was taken out a couple years ago. When you look at the stoma, it seems closed, but it's actually not. She has a PEG and has been receiving her nutrition through that. She just started drinking a little, but PO is very low. Her parents want to have a throat resection for her so she can start eating, but insurance is arguing that they won't cover it, because the child seems to be fine. So, the parents came in for a MBS (modified barium swallow) to build their case for why their daughter needs reconstructive surgery. The speech therapist came in and instructed the child to swallow various consistencies, thin, nectar, spoon, and chew and swallow graham crackers. In general, her epiglottis doesn't flap and close the airways properly. However, only the thin liquid aspirated into her airway, and it actually came out of her stoma! This was very strange to see. The other consistencies went down ok. Speech is reporting that the stoma is obviously not closed/healing properly and that there is danger of aspiration. However, the dietitian thinks that insurance will just respond saying that the kid should just keep getting TFs, because she seems to be doing fine with that! I'll try to find out what happens.

Also, I saw a cardiac cath today! The man has aortic valve stenosis due to radiation treatment for his non-Hodgkin’s lymphoma. So they wanted to check the severity of it (how narrow it is), for pressure, and for any narrowing in the arteries. It was very cool to see the dye injected and it flow through the arteries! Luckily, everything looked good!