Wednesday, August 21, 2013

Day 35: Preparing for heart surgery. (Plus pictures from one year later)

Written August 21, 2012 1:22pm
Jonathan's heart surgery is scheduled for tomorrow morning at 9:30 am. The doctors decided after much discussion this morning that the benefits to the surgery to close the PDA outweigh the risks.

Part of the reason for lung decline over the past few days (in addition to intubation) could be due to the extra fluids he's been given to improve kidney function. The doctor said that typically they like to keep these intubated preemies a little on the "dry" side in hopes that it will help keep their lungs dry.  That didn't work for him as he needed MORE fluid to get his kidneys functioning properly.  Thus, it is not entirely surprising that with improved kidney function he also has extra fluid in his lungs.  They do not suspect pneumonia as the area that is congested moves from one chest scan to the next.

Because of his lower lung function (and in anticipation of even lower lung function as he recovers from surgery), Jonathan is being moved from the conventional vent to the oscillating vent.  In terms of ventilation this is considered a step backwards.  That said, it seems to be what he needs most now.  This new vent will give him quicker breaths of air.  Since he is currently on the highest pressure setting for the conventional vent and even so his blood gasses are not improving, it is clear that extra help from the more invasive vent is necessary.  We hope that with the oscillating vent he will be able to maintain good blood gasses without the same high pressure.

Since he is on the highest pressure possible from the conventional vent, he has no place to go if his breathing starts to decline in or after the operation.  Since initially post-surgery things are harder on the infant, and cardiovascular function gets a bit worse before it gets better, we have every reason to believe that he WILL need more help breathing in the next 48 hours.  Thus, it is good to get him on the vent now.  We hope he responds well to it and that he's in good shape for surgery tomorrow.

We were hoping he'd hit 1 kilo last night, but he still sits at a weight of 975 grams (or 2 lbs, 2 oz).  Perhaps we'll have a 1 kilo baby by tonight?

On a lighter note, he was introduced to a pacifier on Sunday and he LOVES it.  I have NO idea how he manages to get that thing in his mouth, what with the feeding and breathing tube already in his mouth, but he finds a way. Yes, it's a standard sized pacifier.  It's the kind that easily comes OUT of the mouth (the green kind you see in the hospital often) but that just gives me an excuse to help him hold it in.  Since holding him won't be an option for a while (until he's off the oscillating vent), I'm grateful for this one small thing I can do to help calm him.

Thanks for your thoughts and prayers, thank you for walking with us in this, for mourning with our mourning and rejoicing with our rejoicing. The ups have so far outnumbered the downs, and we feel blessed.

TODAY (2013)
At physical therapy J was not interested in practicing his sitting. We think his belly was hurting him. Every time we'd try to sit him down, he'd refuse to bend at the hips. We thus spent a lot of time working on bringing hands to mid-line, rolling, and grabbing feet. Then, since our focus at PT is getting him to be mobile, we made a bit of lemonade out of his stubborn lemons. and J got to WALK. BY HIMSELF!  Okay, so with a fancy walker that was set to the absolutely shortest setting (because how many four month old sized babies walk?) The walker barely fit him, he seemed to think that the handle bars were his goal, and kept staring at them and taking steps to bring himself closer to the bars (which were about 1/2 a centimeter too far away for him to reach) but then when he figured out what he was doing, he had a blast. Since (while physically small) he's cognitively somewhere around a year, THIS is just the sort of thing he's been dying to do.

Photo: Zooom. I am a mobile boy in my baby plane machine. Can't figure out how to take off yet, but I did pretty well on the runway. I figure with my arms out, the flying will happen soon.
ZOOOM!  Ready for take off!

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