The Surgery Post

Whew. Finally found out more details on the surgery today during rounds! They had The Big Meeting last night. Originally I thought it was something that we would be privy to, but it turns out it was just between the doctors that are involved on his case. They reviewed his case together and jointly decided what kind of surgery they would be doing. The set of surgeries that I described yesterday is, in fact, the final course of action.

The surgery is set for Thursday (tomorrow) afternoon. They generally do two cases a day, and he's the second, so his start time is dependent on how the first case goes. They'll probably pick him up anywhere from noon to three o'clock to take him back and prep him, and he'll be NBO (nothing by mouth) from about six a.m. onward. They'll supplement with an IV of sugar water from that point on, but to reduce the risk of aspiration while he's under, they like to keep his stomach empty.

During the surgery they'll be placing a BT (Blalock-Taussig) shunt that will replace the PDA that they're currently keeping open with medication. This isn't a permanent fix, but it will make him stable enough to allow him to grow for a few months before they tackle the next surgery. With it, at least, they can close off the PDA and take him off the meds that are currently keeping it open. The blue arrow in the picture kind of shows what the shunt will look like, but I don't know that it will be in that exact location, or if something else will work a little better when they actually get a good look at it.

There will actually be a second step to tomorrow's operation that we just learned about today, and that is what they call a PA-plasty (PA meaning pulmonary artery, -plasty meaning "molding, grafting, or formation of a part). Because of the low amount of blood flow through the main PA (blue circle) while his heart was forming, the left branch of the PA formed too small ("no flow, no grow"), a condition they call hypoplastic. So while they're in doing the BT shunt, they'll also reform the left artery so that it can handle the amount of flow that it will need to.

We don't know how long the surgery will take, but they guesstimate about 4-6 hours from the time they leave the room til the time they bring him back again. Nothing horrendously long. When they bring him back, he will have a breathing tube that will remain for a couple of days, partially because he'll be heavily sedated, and partially because the lungs often get a little waterlogged from all the IV fluids he'll be receiving during the surgery. He'll also likely be on blood pressure medication to keep it up to where it needs to be, because coming off the bypass pump, the heart often takes a little while to readjust to doing its job. There will be drainage tubes, as well, one from his side and another from the chest, to relieve pressure. Finally, he may actually have an open incision, if things get a little too swollen to close it back up. If that's the case, it'll obviously still be totally covered, and they'll close it back up within a couple days when the swelling has gone down a little bit.

So, in all, lots of new stuff, but at this point, we'll get to move from the waiting stage to the recovery stage, which means the countdown is on to our return home! Generally, they look at about four weeks of recovery time, which obviously varies from case to case. So hopefully I'll be home before March, just in time to get my garden planned! ;)

We've been working with a social worker the last couple days, and she was able to hook us up with a program called Angel Flights, which is a charity that offers free compassion flights to people in our situation. They managed to find Tanner a seat on a flight back home Sunday night, so he can get back to work after the surgery. Coincidentally, Mom is coming in on the train Sunday afternoon for a couple days!

Tomorrow, we have Tanner's parents coming up from Oregon with Wade (who, from the sound of it on the phone this morning, is getting a little homesick), so it'll be nice to spend time with them while the surgery is happening. Aside from that, I think we'll probably do best without visitors for the next few days, while he's getting sorted out again.

For those who have asked for a mailing address, I'm looking into it, and will probably post one on here in the next couple of days. I'm guessing that having it sent to the RMH would be fine, but I'd like to double check that before broadcasting it as fact.