May 15 - Day After Heart Surgery

Today is a better day than yesterday...

...but then that's not saying much if you've been following this blog. Read on.

For whatever reason, Max's recovery from heart surgery is going much smoother than his physicians anticipated. I got an early indication of this when I was at the hospital late last night, but was just too tired to post about it when I got home. Even then, his CO₂ had returned to pre-op levels (high, but manageable). His oxygen supply was only at 35% (normal atmosphere that you and I breathe is 21%). He had been requiring 45%-60% O₂ assistance.

We had been told to expect Max to have a post-op decline in his condition before he would improve, even if the surgery had been successful. So when the surgery went badly, we became pessimistic about what we could expect this week. However, today they're saying that there is a possibility that he'll be able to get back onto milk via a feeding tube and off the intravenous TPN feeding as early as tomorrow. He may also be able to switch back to CPAP from intubation. Both of these are milestones originally anticipated for four(-ish) days post-op.

This morning, his primary neonatologist, Dr. D, said that Max had a "very reasonable night". For Dr. D, this comment is almost like his running around cheering with pom-poms. He described yesterday's surgery as "intense".

So Max is on a drip to control his pain. His platelet count is at 60,000. Low, but similar to how it's been his whole life. He's still getting blood products, but at a slower rate that might have been expected in the circumstances. It looks like he may not need any at all today!! His blood pressure is a little high at times - this is an indication that he's experiencing pain - so they respond to that by giving a little extra pain meds.

Dr. D is just finishing up his 20 days straight in the NICU. Dr. R will take over tomorrow and will make the call as to how soon Max will transition from the IV feeding and intubation.

Forgot to mention yesterday that Dr. D ordered an arterial line be put in. This is similar function to the UAC (umbilical arterial catheter) that was removed last week. It allows a more accurate blood gas reading than the heel pricking. Since they need more frequent readings, it also means that they don't have to stick him every few hours. Also, they're able to get a real-time blood pressure - allowing them to see momentary peaks or dips. Otherwise, with the hourly cuff readings, they only see a momentary blood pressure snapshot each 60 minutes.