Megan and I arrived early this morning to catch the surgeon's rounds, as they were to discuss the possibility of Muriel having another surgery. Dr. Ilbawi has been out of town this weekend; not sure he had been briefed beforehand. He did decide the surgery was the best route for Muriel, and they managed to fit it into today's schedule. She is already NPO - no food or drink - and they expect her to go down about noon.
This surgery will do two things. First it will widen her ASD - the hole between the atriums - to better handle the increased flow that resulted from her last surgery. After performing that operation they will take measurements and may decide to perform a fenestration (see the section on post-operative complications here), which will act as a pressure relief valve.
It is generally thought by the surgical team that she is seeing higher than expected pressures in her cardiovascular system (mainly her lungs) as a result of the last procedure. The result of the higher pressures (which is common) is fluid buildup around the lungs and in her abdominal cavity, which is of course exactly what we are experiencing. The fluid eventually exerts pressure on everything in the two cavities. Around her lungs it makes it difficult for her to breathe, and even collapsed her left lung for a day. In her abdominal cavity it affects her stomach (the frequent vomiting), her liver, her kidneys, etc. It is no small wonder that she has been miserable up until the chest tube was re-inserted yesterday.
She actually had a much better day yesterday with the fluid draining. Her sisters got to visit and we had a nice time all together. She ate like a horse all day and there was no vomiting. It got a little more difficult last night as she approached her fluid restriction limit and couldn't have anything to drink. She got to sleep again with help of sedatives.
She is laying in mom's lap right now and sleeping with a larger dose of phenobarbitol. Just a few more hours before we will go down and prep for the surgery.
The blow is lessened by the fact that we have been discussing this potentiality with Dr. VanBurgen all weekend, though I didn't believe that it would happen so soon. Even so we are having an emotionally tough time with the idea this morning. Its hard to imagine that she will come back this afternoon with all the same cables, cords, and tubes that we have been working so hard for the past ten days to get rid of. That said we are assured that the recovery will be quicker.
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