Let Me See You BOP

BOP, BOP, BOP a little harder

Look at how she BOP she a party starter

[*Modified lyrics from the J. Dash song "Wop"]

We've mentioned bopping a couple of times on the blog and you might have heard Lance and I talk about it some in person.

What is bopping?

Bopping is a cutesy name for the Respiratory Therapy we do on Crosby.

Respiratory complications are the leading cause of death in patients with CF. The thick mucus present in a CF patient's lungs can cause inflammation and recurrent infections. With each infection, more damage or scarring occurs causing lung function to progressively worsen (why we don't want Crosby to get sick and why we limit his exposure to peeps with sickies). This is why regular, routine treatment is so very important to keep secretions cleared and prevent infection. Crosby's routine treatment is performed 2 times daily just for maintenance - once in the morning and once before bed. Each treatment takes about 30 to 40 minutes, depending upon his cooperation. 

When Crosby was first diagnosed, Lance and I went back to ACH twice in the following week to learn CF care. We had just gotten the results from his first CF clinic tests and his lungs were clear. As the respiratory therapist was demonstrating the bopping, I didn't understand why we had to do this twice a day when his lungs were fine! However, I now understand that with good, routine treatment, the lungs are kept healthy and the decline of pulmonary function can be slowed.

Crosby's daily regimen includes aerosol therapy and chest physical therapy (CPT or bopping). The purpose of aerosol therapy is to deliver a fine mist of medication into the lungs. Because he is an infant, we give Crosby's aerosol treatments with a mask.The inhaled medication he currently takes is Albuterol. Those with asthma will recognize the name but the use of this medication for Crosby is not the same as an asthma patient. We give two puffs with the inhaler prior to bopping. Each puff is administered separately, with about 30 seconds to a minute in between. I watch the little flange on the mask to make sure he has inhaled each puff 6 to 10 times. After the inhaler (and subsequent fit that always follows... what can I say, he hates that mask!), we start bopping.

Bopping involves placing Crosby in various positions, allowing segments of the lungs to point downward, then clapping firmly over his chest and back on part of the lung segment to shake the mucus loose. The idea is that once the mucus is loosened, gravity will help it fall to the large airways, then can be coughed out. Bopping is not painful, but can be time consuming since you spend 3 minutes of clapping over 10-12 lung positions. And it totally looks like we're beating our baby. Timing of bopping can involve some strategy as well. We can't bop him right after he eats because it could cause him to throw up. We can't bop him when he's hungry, because well, screaming will ensue. We also hate to interrupt nap time and if he's wide awake, you can bet he'll let you know he'd rather be playing then be held down!  

I should point out here that Crosby is not a fan of respiratory therapy. It's not sweet cuddle time or little pat-pat time. He has gotten so much better about tolerating the bopping and I must reinforce "tolerating" as the operative word here, folks. The first several weeks of bopping twice daily were rough. And I mean REALLY rough. Thirty minutes of listening to your newborn scream because you're doing something to him that he seriously does not like is very stressful. Even though I knew it was for his health and well-being, beating my baby just felt, well, mean. I was often in tears. Lance would be at a breaking point. My mom was frazzled. In those early days, whomever was administering the bopping would have to wear ear plugs just to get through it. We'd make it through a morning bop only to have to turn around and do it again at night. Then we'd start all over the next day. Dreadful! Not fun. Now, we strategically start the bopping when he's tired but not asleep. If we're lucky, he'll tucker out and the bopping will put him to sleep. I usually sing to him while we bop and we can usually make it through the 30 minute treatment without too many tears - his or mine. 

Crosby will require Respiratory Therapy for the rest of his life. As he gets older, the methods will change but the routine will remain. The treatments will be twice daily for maintenance and increase when he's sick. Bopping is an important part of keeping him healthy and now, it's just a normal part of our lives.

(Two things about these photos below: This depicts a good bopping session. He was happy. However, the sacrifice to that is Momma isn't looking her best. My BFF and Granny will both question my decision to not at least put on lipstick. You can't win them all folks. At least Crosby behaved! Second, some of them are blurry. My apologies. There is a lot of movement in bopping and our camera ain't the high speed kind.)

This is the Crosby doll given to us by the Respiratory Therapist. It marks all the lung lobes that we position the bopper over and what direction we need to hold him in when we bop. It was a great reference when we were first learning.

This is the bopper. It's hollow on the other side and insures that you are properly doing the back claps. We use this on him as an infant because he is so small.

I try to be very intentional with Crosby. I always show him the mask and tell him what I'm about to do before I do it.
It's a respect thing. So he knows it's coming but he's still not amused.

Holding the mask on while he fights can be difficult. I don't want to break the seal around his face
while I'm making sure he takes the 6-10 breaths.

Time is up, Momma!

It's over but Crosby is not happy and is expressing his feelings about it.

Because he's an infant, we combine positions 6 & 7.
For these, we place him on his side.
The motion is a steady beat for 3 minutes. We have to do it fairly hard to be effective, but it doesn't hurt him.

Position 8 & 9
He is on his tummy.

He's smiling, but positions 3 &4 are his least favorite.
He has to be flat on his back for these.

You can see my phone in this pic. We use it to time the bop to ensure we give each position 3 solid minutes.

Patience is wearing thin!

Position 5 is performed with Crosby lying on his side.

It took me a long time to get the hang of this
and be able to do this smoothly!

I always try to remember that the purpose of bopping is to loosen mucous.
Keeping that in mind helps me perform the bop properly and gets me through it. It's for his health!

Positions 1 & 2 are probably the two most tolerated.
We hold him straight up for those.

Back on his other side for combo positions 10 & 11.

Also on his side for position 12.

I would like to take this opportunity to give a shout out to my sweet Momma, who graciously bops Crosby every weekday morning. I don't know what I would do without her help! XOXOXO

Love,

Carmen