Narcotic withdrawal

Turns out that narcotics are just as addicting to babies as they are to adults, and this poor guy is going through withdrawals. From which drug, they aren't quite certain, but suspicions are pointed at the drug used for sedation (precedex...not sure on the spelling). Generally, when a kid is on it for less than a week, it isn't a problem to come off of it. Any longer and there's addiction involved, so they take it down really slowly. We were right on the cusp of that time limit, so they took a chance and weaned it quickly. Now he's pretty miserable, but there doesn't seem to be much to do but wait it out. He's tired but doesn't sleep well, somewhat interested in food but can't eat much at a time, clammy, quivery, cranky, the works.

Then we're also having problems with a drug called melronin (again, not sure about spelling), which essentially does what the nitric oxide did: dilates the blood vessels throughout the body. They did it at first to take some strain off of his heart as he healed; opening up the veins and arteries provides less resistance for the heart to push blood through and lowers the blood pressure overall. He was receiving it through an IV, but yesterday afternoon, he managed to kick the IV out of his foot! They were already weaning it off, so they decided not to try another stick to finish it off. Instead, they'd just watch him for signs that his body wasn't handling it well. Side effects would include general irritability, loss of appetite, hard to console, etc. Very similar to withdrawal symptoms, and since they were both discontinued close together, it was hard to tell which was causing it.

Why does it matter? Because if it's caused by the lack of precedex, it's withdrawal. If it's caused by the lack of melronin, it could be heart failure. (Mind you, I said could be, not would be.)

I haven't really talked about this before because I didn't know what sort of impact it would have on Brandt's recovery, but we've known for a while now that his heart function isn't what it should be. Aside from the defects, the muscle itself is weaker than a normal heart should be, and doesn't squeeze hard enough to with each pump. I'm not sure how much weaker it is, but enough that it is mentioned frequently by the doctors and consistently monitored to the point that I've lost count of the number of echos he's had these past few weeks. They did tell me that they've noticed the function deteriorating slightly during our stay here from echo to echo, so it does seem to be an active development to some small degree.

The purpose of the Glenn surgery is to take pressure off of the heart. Instead of having to pump blood through two separate systems (one loop to the lungs, one to the body), it handles about two thirds of the original volume at once and just pushes it all in one direction. With its job made easier, even a slightly weaker heart should be able to keep up the pace without a problem. We put him on melronin to help his heart in the first few days as it came off of bypass, because essentially restarting the heart takes a lot of effort. If it turns out that his body actually depends on it for good daily function, then that means that his heart isn't strong enough for the long term, even with the Glenn helping it out. At that point, we would look into "other options". Essentially, a transplant.

Now please understand that we are NOT looking into transplants right now. This was just what was communicated to me this morning when they were trying to figure out what was going on. For now, we're treating him for withdrawal, but they've done another echo to check up on his heart one more time, just to be on the safe side. We'll probably get the results of that in the morning at rounds.

For now, he's sleeping. He's eaten a little (about an ounce an hour, all day), he's got his Tylenol in him...he's content as can be for the time being.