The Vest

I've mentioned several times that Madeline uses a vest as part of her CF treatments, but I've never really explained what it is. Before I get into the details, doesn't she look lovely modeling the vest with her fake pearls? There's no reason you can't be stylish even when you're wearing a vest that is shaking you like crazy.

So, when Madeline was younger we did her chest physical therapy (CPT) manually, with a hand-held percussor that we pounded on her chest, back, and sides. The vest has the same purpose: it's used to loosen and clear out the mucus in Madeline's lungs. It inflates with the two hoses that you see in the pictures and then vibrates at a prescribed frequency, essentially sending pulses of air through the vest at incredibly fast speeds. This shakes her chest wall and loosens the mucus in her airways so she can cough it up.

You can see the actual machine running the show in the picture below:

We first got the vest back in September, when Madeline was about 19 months old. We had been told not to expect it before she was two, but she had gotten big enough for it to work. Her chest had to be 18 inches around before the doctors would fit her with a vest.

Getting a vest is really a major life change. And although there was a big learning curve, just like there is with any new treatment, having a vest has been nothing short of amazing. When we were still doing manual CPT, Madeline was just getting so wiggly and resistant and all-over-the-place that it was difficult to do her treatment at all, much less feel any confidence that she was actually getting an effective treatment. Now, as long as I can convince her to put the vest on in the first place, we're good to go. We usually spend most of the time reading books, but Madeline is much more free to play with toys or color or do other random activities while she's vesting, and she really thrives on that freedom.

Another bonus of the vest is that we can do her nebulizer treatments at the same time. This saves us a half hour of treatment time each day when she's healthy, and a full hour of treatment time each day when she's sick. (She nebulizes hypertonic saline when she's sick in addition to her regular nebulized medication, which is Pulmozyme.)

We do the vest for an hour each day, 30 minutes in the morning and 30 minutes in the evening.

For the most part, Madeline is easygoing about her treatments. She hardly ever wants to get started, but she rarely makes a big issue out of it, and she's almost always fine once she just gets going. It's actually remarkable to see how completely unfazed she is when you see how hard the vest actually shakes her. She likes that it makes her voice sound funny, and she also really likes to clip all the buckles and snap on the hoses and press "start." She knows how to set it up all by herself, actually, although I doubt you would ever catch her doing so voluntarily.

Madeline also prefers to hold her own spacer (for albuterol before her vest treatment begins) and nebulizer and is actually fairly responsible at keeping them in place. I like to let her do as much as possible for two reasons: (1) She's more willing to do things if she has some control over them. She's two, after all, so independence is a big thing. (2) Her treatments are a lifetime thing, and she needs to learn to be responsible for them at some point. She might as well start young and be completely comfortable with how everything works.

And on that note, there's nothing like asserting your independence by cramming yourself into a small box just because you can.