halfsies

yesterday they put a picc line in Ford's arm - he's all out of veins for an iv start. since they'd be anaesthetizing him for that, they decided to do a cardiac cath to check his venous pressure while there.

they learned that the Glenn pressure is totally normal, but it's flow is entirely preferential to the right lung. they learned that, while they knew the blood flow to the left lung was bad (and he's got that pesky chronic left lower lobe collapse), that it is in fact "horrible". effectively, of late, he has been breathing with just his right lung.

"i think we all agree Ford is not well" said Dr. Sanatani last night, and indeed, one can hardly be expected to be well breathing with one lung and half a heart. yikes.

we basically had him at home, ie off any breathing support, long enough to totally tucker him out, and once we saw signs of respiratory distress, and were admitted back to the hospital, he's getting a chance to get some rest again, on the ventilator.

i hate seeing him intubated - they have to keep him sedated for it - but his colour is much better today because of it, and the mottling in his arms, which was severe yesterday, has also shown a marked improvement.

it is because the Glenn is only sending blood to the right lung that they are thinking of putting a shunt to the left pulmonary artery.

the thing is, if the lung is collapsed it can't ventilate blood anyway, regardless of what you send it.

also, part of doing Ford's Glenn so early on, was so that he no longer had the Sano shunt that they put in during his Norwood (first surgery). having a shunt increased the volume load of blood on the heart, and the thinking in the summer was that it was this increased workload that was keeping Ford from thriving.

so what's worse? no flow to the left lung? no, that's bad. or increased volume to the heart? hm, that's not great either.

which is why Sanatani dropped to "T word" on us - if there's no fix for this, Ford would need a transplant.

but they're going to try the shunt.

luckily to put the shunt in, they don't have to open his chest - they can go in from Ford's left side/back. he already has a scar there from the diaphragm plication - this will be a parallel incision slightly higher. also, he won't have to go on bypass for the procedure so that's good too. overall it's a less invasive procedure that his previous heart surgeries (you know you've seen the worse when sticking a shunt in your baby's heart doesn't seem like such a big deal).

while there, they are going to ventilate the left lung, and possibly perform a bronchoscopy to suction out any stuck goo, to try and open that lung fully so that it can do something with the blood that will be shunting to it. they're also going to remove all the collaterals that have formed, or as many that are accessible, to get rid of the conflicting blood flow - Ford's body, in an attempt to get blood to his lungs on its own, has grown a bunch of collateral veins. but we need the blood to forge on through the pulmonary artery. removing the collaterals will increase the flow in the PA.

performing this procedure won't make anything worse, but they aren't certain it will make anything better. it might, but there are so many variables in Ford that there is no clear path to proceed on. today plans kept changing as different doctors weighed in with their opinions, and it seems they are actually still somewhat in debate. when Dr. Campbell was describing the above plan, his train of thought kept wandering off into other possibilities and it was a bit of a confusing conversation as he included me in his thinking it through. later on, Dr. Human assured me they will come to a clear consensus before operating...

and they may operate tomorrow (friday) late afternoon, or on the weekend, TBD.

sooner is better than later in my opinion - Ford is just biding his time on the ventilator, and we're biding ours at his side, waiting for the next step.