Sorry this is being posted so late, I have been a little busy :) Just to let everyone know, I fixed the comment link to where everyone and anyone can post a comment and it will not just let you if you are a registered user. Sorry about the trouble.
The evening of July 31, 2009
Jenna spent most of the day sedated so that she will not attempt to pull any tubes from surgery and also to let her relax. The attending doctor, Dr. Wong rounded on Jenna around 6pm today. He is very pleased with her progress at this point and that we are still moving in the right direction for recovery. He said that he is wanting to just let Jenna take it easy and not push her to work to hard at this point. He said he was able to stop her Vasopressin which helps keep fluid in her kidneys and helps relax the heart, keeping blood in the heart to help heal. Because at this point, he would like for her to be able to push blood out to her body. Also the medicine was to help keep her blood pressure low, and her level was getting to low, which meant it was going down on its own and she did not need to medicine. He decided to lower the dose of her Fentnyl(sedative) and start Versed drip to run continuously and keep her calm. He had the nurses start TPN so that she could start receiving nutrition. Also, he would like to start diuretics soon to help get the fluid from surgery out of her body. He could possibly have to give her fluids in case she pushes too much out and her levels are not normal. Her oxygen at this point has lowered from earlier today (it was in the high 90's) and is now low 90's. He said that she has some "junk" or fluid in her lungs from the surgery and is not sure if this is why her oxygen is dropping or not. So decided to increase the oxygen that she is receiving in her ventilator to see if she responds. If so, this is a good indication that is her lungs and not that her heart is failing to pump correctly in the right direction. Her CICU score today is 85. This number indicates her progression of recovery based on her status, test resuts, etc. In order for her to get out of CICU she has to be a 19. SO we have a little ways to go, but at least we are improving. He said at this point, the earliest we are coming off of the ventilator would be Monday, it may even be Tuesday depending how well she tolerates coming off of medicines. He said that the lungs need time to bounce back after surgery. Plus, it takes a lot of oxygen for the heart to work, so since her oxygen is low from surgery her heart will have to work harder. At this point, they do not want her to do that, they would rather her be assisted and recover well. Plus being in surgery for 12+ hours and on the bypass a while, we need to take our time with the situation. Her echo came back good, left number is 100 and right is 54.
This evening, Justin and I were given a lesson regarding a little how Jenna's heart works and her road to recovery, courtesy of her Cardiology Fellow-Mark. He was very helpful showing us how she works and what could happen. Earlier I stated that her left pressure on echo was 100 and right was 54. Well, he explained the situation like this. The heart is separated into 4 chambers-left (LA) and right (RA) atrium-top and left (LV) and right (RV) ventricle-bottom. The lower parts-LV and RV are separated with a wall (septum) and considered to be 2 pumps. The LV moves blood to the entire body (brain and organs, etc) and back, which means it has to work really hard to get to all of these places. The RV just has to send to the lungs and back. Therefore it does not have to work as hard. So this meaning the a normal RV is supposed to be less than 1/4 of what the LV is. (i.e. left being 100, right should be less than 25) So, with Jenna has levels are 100 left and 54 right. Even though the right is higher than normal, this is ok because considering how high her pressure was after surgery this is improvement. Plus Dr. E (her surgeon) stated that if after surgery her right side is 50% higher than normal this is ok, but if goes up to 100 or 200% higher than normal, he will be concerned. They expected her numbers to be 80, 100 or even 120 compared to the left side. So, this is a sign that she is tolerating her hole being closed. Yeah!! An indication that her levels are changing are seen in her blodd pressure and her oxygen levels. The direction blood is supposed to go on her right side is from the top(RA) to the bottom(RV). Her heart is a little stiff from the hole closure, and if was too stiff to where the right bottom does not want to work, the blood finds another way to go to the lungs. Jenna has a hole(ASD) in the top of heart, if her heart stiffens too much the blood from the RA will jump over to LA(it's neighbor) and decide to go out to the heart this way. The problem with this is that the blood has no oxygen, so it will drop her oxygen saturation levels. He said that since Jenna was tolerating the oxygen level on her vent being raised earlier to determine if the drop in oxygen was from her lungs or right heart(oxygen is maintaining) than this incidcates that the drop is from her laying flat so much and the fluid from surgery is just laying in there causing her to not breathe as deep. He said that it is fine for her to be on the vent a couple of days, because the risks of her being pulled to early are too much to take. They want to take "baby steps" on taking her off of her medicines/drips so that they will not have to put it back in. He said that since she has some fluid in her lungs from surgery and she is not completely "dry" then if pulled, her muscles are sore, she hurts, too much sedation she would probably have to be vented again. So the it is ok for now to be on and the level of oxygen being pushed in is within normal limits. We asked if she is considered "stable". He said that these children in the unit are never considered stable. They are critically ill or seriously ill. He said that Jenna could change at any time, they are being very cautious with her. He said that they were advised by Dr. E that just because she looks good on the outside, don't ever take her for granted. She could change in a heartbeat. Those who know her know that this is just how she does it, her way. So, he said that goal tonight would be to get her off of the Nitric oxide and epinephrine by the morning. Before we left for the evening Jenna attempted to pull her self up in the bed. Yes, attached to all these lines, she is attempting to bust out of this joint. She is having just a little trouble coming out of sedation and anesthesia. They were able to calm her and give more medication to calm her.
We are very pleased that she is going in the right direction and so glad that they are being so cautious with her. We would rather they take their time then rush things. We are so thankful that he explained her situation so well and hope that this blog assisted everyone a little more in understanding. Thank you so much for the support, love and prayers. Talk soon.
Love, Jenny Justin and Jenna