Today’s meeting with the doctor was tough. We knew it would be going in. As of now, we’re still waiting. I feel like the boy who cried wolf actually. Surgery, no surgery, surgery, nope, not yet.
I won’t sugar coat it, Sam has a lot of issues/complications he’s facing.
Until this weekend, Sam was doing ‘fine.’ Great actually. Doc did point out though how relative his ‘fine’ is: he’s a past term baby, only able to handle less than 3mL/hour of feeds, still needs breathing support, etc. Point taken.
Yesterday we were all ready to go into surgery today, to do exploratory surgery, find out what’s going on in his belly. Scott brought up to the doc a possible heart issue? Was that the cause of him going over the edge this past weekend. She didn’t think it was, but she found the point valid and ordered an echocardiogram. Clinically she didn’t think there would be an issue because he wasn’t showing any signs. The results were bad. Bad. So bad that the cardiologist can’t explain why or how he’s doing as well as he’s doing. He has something called pulmonary vein stenosis. I just looked this up myself:
“Pulmonary vein stenosis is a rare and serious condition in which there is an obstruction (blockage) in the blood vessels that bring oxygen-rich blood from the lungs back to the heart. It can be isolated to a single pulmonary vein, but most often occurs in multiple veins simultaneously.
The stenosis occurs due to an abnormal thickening and, thus, narrowing of the walls of the veins. Pulmonary vein stenosis frequently progresses. As a result, partial loss or even total obstruction of flow to a vessel or vessels may occur.
Surgery to widen the narrowed veins and catheterization to stretch the vessel are usually short-term solutions since the obstruction typically recurs within a month to six weeks.”
What she doesn’t understand is that this situation, along with the pulmonary hypertension, how in the world he’s doing so well, how his oxygen saturation so high, in the 90s. There’s no reason or explanation they can determine. For surgery to even be an option for this, he needs to be much bigger, like 15lbs bigger. And even then it’s risky, may not solve anything.
He’s also dealing with the pulmonary hypertension. Yet they can’t treat it. Typically the treatment is to relax the bloodflow, but they can’t do that for him because it would make his lungs and heart worse because of the obstruction. It’s possible the hypertension is situational, that it’s gotten bad just right now. The obstruction, though, isn’t situational and will require bypass surgery.
Something tipped him over and put him in his current situation. What was it, we don’t know. Is it temporary? Only time will tell.
The doctors still think there’s an obstruction in his belly. At the moment, he’s considered too unstable for surgery. Oddly, his abdominal xray this morning showed gas patterns — he hasn’t had this in a few days. He’s getting another specialized ultrasound/xray done to help them get a clearer picture of his belly since the xrays only show so much. They have no idea what they will find in his belly. What will they have to do? What will his outcome be?
Other current concerns: he experience a lot of bleeding from his last PICC line insertion. Do they need to add proteins to help him better clot. Are his platelets stable enough? He’s also not tolerating being placed on his right side; they’re worried that his swollen liver is now painful.
Speaking of pain: he’s, as I mentioned, past term now, so he’s more aware of pain, feels it much more. So we have to start managing that. We have to start considering his comfort, his quality of life.
Moving forward, no one has an answer. The doctors aren’t comfortable with performing the abdominal surgery on him because they’re not sure he’ll survive it. But he also needs it (he won’t survive without it). Regardless, they won’t do anything until they can completely rule out an infection. He may definitely benefit from releasing the pressure in his belly; but the risks are great.
Statistically his chances aren’t great. But they also never have been. He had 0 chance of making it to birth.
So what do we do? Where do we want to see him in a few weeks. We want him back to his baseline from last week, where in our mind he was doing great. At least then we can grow him, get him bigger and healthier. We also want him to have the surgery. This risks are huge, we know that, he may not survive, odds are against him. But we have to try. Starting at 20w gestation, we were at a crossroad. We decided that it was up to him, that we’d give him a chance. He took it. In the delivery room, we were at a crossroad. We decided that it was up to him, that we’d give him a chance. He took it. Now we’re at another crossroad with another decision to make. We’re giving him a chance. It’s up to him.
Let’s get him stable again and take him into surgery. Let’s fix what’s currently wrong and go from there. Having said all that to the doctors, they’ll support our decision. We don’t need them to tell us the risks, we know them. We’re very aware. But we have to try and give Sam that chance.
Update: Sam’s now on a morphine drip to help with his pain management.