Sunday, August 9, 2009
Alright everyone, here's a new update on Logan! On August 4th we took him into see his pediatrician, Dr Elias. He's up to a hefty 9 lbs, 15 ozs, and his oxygen remained in the high seventies. Last week, however, I received a phone call from Dr Carrie about her conversation with Dr Mitchell (the cardiac surgeon). Dr Mitchell felt that Logan was an appropriate weight for surgery and wanted to up his surgery date to mid-August. Kireta and I were a little disappointed at first, as we wanted to wait as long as possible with the hopes of upping Logan's odds for the valve-sparring technique. After further talking with Dr Carrie, however, we discovered that his odds would more than likely not increase, due to the fact that even though his pulmonary artery might grow, Logan would also, and it's simply a matter of ratio. Dr Carrie was also concerned that waiting until October would put Logan into surgery during prime time for RSV (a respiratory illness). So after much thought on the matter, we decided to heed the advise of the professionals and schedule Logan's heart surgery for Monday, August 17th.
Kireta and I had a chance to meet with Dr Max Mitchell about a week ago. He's a very nice, down to earth gentlemen, and we both feel comfortable placing Logan's life in his care. When we met him, he had actually just come from the same surgery that Logan will be requiring! In fact, the other boy was the same age, with the same size pulmonary artery! When I asked Dr Mitchell about how often he does this particular surgery, he replied that this was the third one this week, and assured me that's it's all he does. That being said, it's still open-heart surgery, and Dr Mitchell informed us that Logan has a 95% chance of no major complications, with an even higher mortality rate.
I'll now let everyone know a little of what to expect in the short future. On Friday, August 14th, Logan will go in for his "Pre-Op Surgery." This is an all day event, and since they'll be sedating Logan to get a perfectly accurate echo-cardiogram, as well as some other tests, we'll have to stop feeding him at 5:30 am, which should be interesting to say the least:) He'll have his blood tested, followed by a Lateral Chest X-ray. They'll then do another echocardiogram since he'll be knocked out. Kireta will then meet with the Nurse Practitioner that will be giving us an hour by hour update during the day of surgery. (I'll be updating his blog every hour the day of surgery for those of you interested). Kireta will then go on a tour of CICU (Cardiac Intensive Care Unit) and the step down unit or CPCU (Cardiac Progressive Care Unit). Next is an appointment with the Anesthesiologist, followed by another meeting with Dr Mitchell.
On the big day, Monday, August 17th, we'll be arriving at the hospital at 9:00 am. The surgery will last anywhere from 5-8 hours, and we'll be updated every hour by the Physician's assistant. Here's what to expect... The anesthesiologist will put Logan to sleep (this period is called induction). A breathing tube will be placed down his throat and one or more IV's will be established to help maintain Logan's fluids. His chest will then be swabbed with iodine and a perfusionist will operate the cardiopulmonary bypass machine. Open-heart surgery means that the heart will be opened to perform the repair. An incision will be made on Logan's chest, just below his collarbone to just below his nipples to give Dr Mitchell access to the heart. Logan will then be placed on the bypass machine to enable Dr Mitchell to operate. They'll place several special tubes called "cannulas" into his aorta and the right atrium and/or the vena cavae (which collects blood coming back to the heart from the body). Blood is then transferred from the bypass machine where it is filtered, warmed or cooled, and oxygen is added before pumping it back into the body. When the tubes and monitoring wires are all in place, a clamp is placed on the ascending aorta (and at this point forward is called "cross clamp time")
The heart usually stops when the child is cold, but a drug called "cardioplegia" is used to help protect the heart. The heart will also be bathed with a cold saline solution during surgery to further protect Logan. At this point Dr Mitchell will open the heart, and decide whether or not to do the valve-sparring technique, or to do the trans-annualar patch. Sometimes, surgeons attempt to do the valve-sparring technique first, and then see how his heart works when blood pumps through it to see if the patient can handle it. If the heart has too much pressure, however, then the trans-annular patch must be used, but not without a cost. At this point, it becomes a little more complicated, which is why the surgeon has to weigh this option very carefully. (In other words, don't be surprised on Monday when I'm giving you the play-by-play that Logan got the valve-sparring technique, only to be followed by a transannular patch)
Dr Mitchell will have to resect (cut away) the muscle beneath Logan's pulmonary valve, as well as the area above (the supra valve). At this point they'll also fix Logan's VSD (Ventricular Septal Defect) by closing up the hole with Gortex. This will never again need to be fixed. Once the repairs are completed, they will warm Logan back up and the cross clamp will be removed. The heart usually begins beating once it is warm and blood is flowing through it again. Logan will be weaned off the bypass machine at this point, which is a very critical time period. After this period Dr Mitchell will place two to three drain tubes attached to Logan's chest area near the ribs. These tubes help drain fluids that accumulate inside the chest because of the surgery.
Logan will at this point be transferred to the CICU and the next 72 hours are critical. Kireta and I will be able to be right by his side, including modest sleeping accommodations. After about 2-3 days in the CICU, Logan should be transferred to the CPCU. We'll continue to keep everyone updated as best as we are able. Logan should be out of the hospital entirely in one weeks time, and they expect a total of six weeks to recover. (Good thing Logan's not crawling around all over the place...Try telling an infant to "take it easy!")
Never wanting to end a post on such serious news, I'll update you on some remarkable progress by our beautiful boy! First, as you can see, Logan has begun smiling! It's so cute when he does this, and it's awesome when we can capture it on film. Also, he's begun cooing which is a relief, because his cry can be quite shrill! Also, Logan has rolled over once!!! He did it a day before he turned 8 weeks! He beat Noah! Way to go Logan!!! Logan never ceases to amaze us and we are so grateful to have him in our lives! He is such an incredible blessing and we don't know what we'd do without him.
Finally, Kireta's dad and brother came out to see Logan before the surgery and it was refreshing to spend some time with them. Kireta's mom, Barb, will be flying out for the surgery as well, and of course we have Brad and Lisa right here in Parker to help us for support. Thanks for all of your prayers, we need them now more than ever! Please keep Logan in your thoughts and prayers, especially August 17th! That's all for now. We'll keep you posted.