PA Banding Post Op Day 1 and Day 2

Day 1

My wonderful husband got the cord for our laptop and my mom brought it to me in the hospital so I can finally write about what has transpired over the last day and a half.

Yesterday, May 29 Ryan and I woke up around 4:00 to get ourselves and Melia ready and to Childrens Hospital by 5 a.m.  I was happy with an early morning start time so that her overnight fast did not extend too much into the next day.

As expected we had lab drawn, and EKG and CXR done and visited with the anesthesiologist and surgeon all before her 7 a.m. surgery.  She was not happy to have labs drawn, but it was not as traumatic as her first experience with the lab a month or two ago.  After receiving some Versed to calm her I carried Melia to the surgery doors, kissed her good-bye and Ryan and I watched as the nurse rolled her away.

At this point we were so very thankful for all the prayer preparation that had taken place the days and weeks before this moment because we felt peaceful and calm.  We trusted that God was with her and with us deep down in our hearts.  Let me say, the anticipation of surgery was more worrisome than the actual surgery day.

The Cardiology department then escorted us to a private waiting room where I read, filled out a hospital form and Ryan watched a movie.  A few minutes before 8 a.m. the nurse let us know that they were ready to make the incision.  The first hour had been spent prepping her chest and getting IVs established.

Around 9 the nurse called us to say the surgery had gone very well and that Dr. Hammel was about ready to sew her up after checking her intraoperative echocardiogram pressures.

Finallly, around 9:30 Dr. Hammel came to visit us and was pleased with the procedure.  We breathed a sigh of relief and were then told to go to the PICU waiting room where the nurse would notify us when Melia was in her recovery room.  He also told us a little more about her surgery.

He said he used a teflon Pulmonary Artery Band and that he had never had anyone reject the material.  He put in a piece of Gortex (makes me think of ski gloves...hmmm) behind the sternum so the heart would not, "stick to the sternum."  This will make it easier and safer to perform future sternotomies.  The sternum was wired closed and dissolvable sutures were placed in the chest wall to close up the incision that he made.  He also noted the precise location of her coronary arteries because someday, when we proceed with a double switch, they will be harder to see through the scar tissue and he will have to move them.  We were so pleased with his confidence, precision and attention to detail.

Once we got to the second floor PICU we waited quite awhile for the nurse to welcome us back to Melia's room.  I was blissfully ignorant to what was happening behind closed doors.  I guess the doctors had given her a pretty hefty dose of Morphine postoperatively to help with pain but one of the side effects of this is decreased respirations.  Melia tends to hold her breath when she is really upset, so when she woke up she was not breathing well.  The immediate concern was that her left ventricle was acutely failing so a stat Echo was done while they bagged her to help her breath.  Fortunately, it was not her left ventricle and so they gave her some Narcan to reverse the effects of the Morphine and they started her on a medicine called Pressidex to help with pain instead.  Once she was stabilized they notified us she was doing well and we went back to see her in the PICU.

Ryan and I spent the rest of day sitting with Melia as the anesthesia slowly wore off.  She had a couple more breathing "spells" where they had to bag her to her her oxygen saturation back up, but these were short episodes, thankfully.

The big kids came for a visit in the early afternoon.  Zac's visit was fairly short and he seemed more interested in seeing and spending time with me than focusing on his sister.  Jacob was tentative, quiet and interested in all the equipment and machines.  Hallie was curious about all Melia's tubes and was very attentive to her sister's needs.

By the late evening they removed her nasal oxygen.  She and I fell asleep together around 11:30.  Ryan, my parents and the big kids all spent the night at home which is only 20 minutes away from the hospital.

Her first night was interrupted by doctors and nurses concerned about her dropping blood pressure.  For some reason it kept dropping even though Melia seemed to be doing very well.  After decreasing the Pressidex and eventually eliminating it and then giving her albumin fluid the doctors were still at a loss as to how to get her pressure up.  I was not scared because she looked so good, but I began to pray and God graciously fixed the problem.  Her pressures began to rise.  They did end up transfusing her because she was slightly anemic and since about 3:30 a.m. her pressures and pulse have been great!

Day 2

Post-op day one started early around 5:00ish with Melia feeling so much better!  She smiled, was talkative and even gave me some giggles!  We read books, she ate some food and started wiggling a little in bed and we "talked."  Around 10 a.m. the fun ended.  Melia managed to pull the sticker off her central line in the neck sometime during the night and so they had to redress it.  To do so, she had to sit very still which meant the nurse held her down a little.  This made her mad, which had her cry and sweat so the new sticker wouldn't stick.  Finally, they gave her a small dose of morphine to ease pain and chill her out a little.  It worked well and the charge nurse was able to get the job done.  After this trauma her foley catheter was removed (quick ouch) and by this time she needed some cuddles.

With a little more angst we moved her to my lap and Melia and I decided it was time to take a nap.  As we were going to sleep the echo tech came into do another echo.  She handled this beautifully and was able to stay in my lap the whole time.  She and I slept together in the rocking chair for about an hour.  Things were going great and then all of the sudden she woke up crying.  It took a move to the bed and another dose of pain medicine to calm her down.

That has been the pattern for the day.  Moments of happy, talking, wiggling around and then outbursts of tears.  The trouble is she is two and just adopted from China in January with limited English.  It is very hard for her to tell us what the tears are about...pain, an itch, a piece of tape pulling, constipation etc... So, we are trying our best to figure each other out.

The other issue Melia is having on day one is peeing.  She has not peed since the catheter was removed this morning.  The doctors have ordered Lasix, a medicine that causes her to urinate and we hope this will help get rid of excess fluid.

This evening Ryan and I took the big kids down to the cafeteria and ate dinner with them and Grammy and Grandpa while Nannie and Poppie stayed with Melia.  It was good to connect with the big kids about swim team, playdates and normal life stuff.  While we were eating Dr. Hammel came by to see Melia.  My parents did a great job of getting the information on her.  He told us that the echo performed earlier today to check her heart function was unremarkable and looked good.  She has a flow gradient of 25 or 28 across her PA Band and this was similar to what it was when she got out of surgery.

So, tonight we have a few friends visiting with their newly adopted son from Africa and then it is off to bed after evening medicines.  She just recently started pulling at Ryan and my hand to scratch her chest near the incision.  She "found" her incision tonight and is curious about it.

We are definitely moving in the right direction and thankful that Melia is doing better with each hour that passes.

I can not end this post without giving God thanks for all he has done...

~peace, peace and more peace
~resilient daughter
~skilled hands of our surgeon
~caring nurses
~countless texts, emails, phone calls, fb messages all letting us know we are loved, cared for and prayed for
~grandparents that never stop giving
~my amazing husband, best, best friend and the father of my kiddos.  He is too wonderful for words
~no left ventricular failure
~God bringing her BP up
~a hospital room with a big window to let the sunshine in
~Hallie reading books to Melia
~Artwork for Melia from brother and sister
~dinner with my big kids
~music that calms fears and tears
~a qualified hospital 20 minutes from my house
~cell phones and text messages to stay connected
~when Melia and I understand each other
~when Melia calls out for mama and daddy
~when she pulls my hand to her chest to scratch it
~prayers with friends
~seeing Silas and Melia hold hands with each other
~medical knowledge