So what has Super G been up to for the last few days?
Gabe spent yesterday hanging out with Mommy and Nurse "L." He was a bit agitated first thing in the morning, but after a little happy-juice all was good, and he spent several hours wide awake and quite content. Of course as soon as I showed up he drifted off. I enjoyed just sitting with him; holding his hand and watching him sleep, and making sure the crib vibrator never stopped shakin.' Since his right chest tube hadn't put anything out in almost a week, the plan was to remove it yesterday. He had an ultra sound in the morning to make sure there was no fluid before taking the tube out. Unfortunately the ultra sound did show a "moderate" fluid pocket on the right side. Dr "R" tried to get the fluid flowing through the tube, but nothing seemed to work. Since the tube has been in place since September 10, it was decided it would be removed today and a new one placed. Noone wanted to see another tube going in, but perhaps if the fluid was gone, Gabe would be able to get down to the vent settings Dr "R" wants to see him on. Another thing I thought about was that it took almost a week for a "moderate" amount of fluid to build up, while the left side is putting out around 200 mls a day. Maybe the right side is slowing down? Other then waiting to find out if the right chest tube could be removed, and trying to help Gabe get rid of some nasty gas with some tummy massages by Nurse "L," Gabe had a pretty mellow day yesterday.
Gabe had a pretty good night, but was quite agitated, by more gas, when Jesse arrived this morning. The poor little guy was trying to sleep but kept waking up to those darn gas pains. Jesse gave him a little tummy massage and was able to help him work a little out. Jesse helping Gabe pass gas...true Father/Son bonding. In rounds the two big issues discussed were the upcoming chest tube removal and reinsertion, and his low albumin levels. With the amount of fluid his left chest tube has been putting out, we were not at all surprised by the low albumin levels. Gabe received a dose of albumin to help bring his levels back up. The rest of the day was spent waiting for an ultra sound machine to come avaiable for the chest tube "project." Finally around 3:00 the ultra sound machine, and radiologist arrived. The old tube was used as a marker, and the new tube was inserted just below it. They spent a little over an hour trying to get the new tube situated in the pocket of fluid, but were not having any luck. They finally decided to stop becuase the pocket of fluid was so low and so close to Gabe's liver they were affraid to mess with it anymore and cause damage to the lung or liver. The new tube was removed. They pulled back a bit on the old tube and a little fluid came out. Dr "R" and the radiologist decided it was best to leave the old tube, in it's new position, in over night. If no more fluid comes out over night they will remove it tomorrow and watch closely. If more fluid builds up, maybe a larger pocket of fluid will be easier to drain. Poor little Gabe. Even with extra sedation, I can't imagine it's very comfortable to have someone manipulating a chest tube around in your pleural cavity.
Gabe and his chylous pleural effusions, will be discussed at the weekly pediatic surgery meeting tomorrow. We are eager to hear what they have to say about this leaky lymphatic system that doesn't seem to want to heal on its own.
Gabe's current goal is to work those lungs out, to start taking more breaths on his own, and to hopefully be ready to try CPAP again in the near future. At last week's Care Conference a tracheotomy was mentioned, and we just don't want to go there. Come on Bubba! Time to get those lungs working on their own!!!