Post Transplant Day 2

Day 2 was pretty low key. Ford has started to accumulate fluid and is looking a little more swollen today than yesterday. They've upped his morphine to combat his being awake, which was starting to get pretty uncomfortable for him. His epinephrine is being weaned down and his heart rate and blood pressures are tolerating it fine.

Prior to his having the operation the doctors were planning to piggyback two other procedures onto the transplant. The first was to re-plicate his left diaphragm, which had come undone for the 2nd time. But when the surgeon was looking at it in the OR he decided he couldn't risk it . The abundance of scarring from previous operations had fused the lung to the surrounding tissue and muscle, making the delicate process of cutting the lung away so they could fold his diaphragm back down out of the way unnecessarily dangerous (accidentally cutting the lung would mean big problems). It's also unclear how much of an issue his paralyzed diaphragm will be now. With Ford's old compromised circulation and poor heart function any impediment to his breathing provoked big problems, but now that he has a normally functioning heart those problems might just resolve on their own. So we are going to wait and see.

The second procedure was to ligate the major lymphatic duct that runs through his pleural cavity, essentially tying off a leaky pipe in his chest that was maybe the primary cause of his persistent chylothorax. But that also looked risky, and seeing as they were already worried about excessive bleeding they decided not to poke and stab at anything else. We weren't even sure if that was the source of the problem anyway. A competing theory as to why Ford isn't recovering from the chylothorax is that his venous back pressure was extremely high as a result of all the modifications to his single ventricle circulation:

His half-heart was overtaxed and stressed and was only able to pump his blood weakly and sluggishly. Because his blood was moving without much force his lungs were being poorly perfused and were prone to collapse, so they needed to intubate him and assist his breathing mechanically. But then the ventilator was supplying a constant, external, positive pressure into his lungs - to keep them inflated and oxygenated - and the weak pump of his heart was consequently doubly compromised from pushing blood through his pulmonary arteries because of the constant air pressure that was forcing fluid back - a classic hypo-plast catch 22. The result was that his blood was constantly backing up throughout his body creating an exceptionally high CVP (or central venous pressure), which in turn backed up into his lymphatic system. If you have a weak, thin pipe that is consistently stressed with excessive internal pressures it is going to burst and leak, and if the pressure isn't able to resolve the leak will just continue unabated. Again, the hope now is that with his normal circulation that pressure has been relieved and his vessels will be able to heal naturally and the chylothorax will disappear. More wait and see.

He continues to do "really well" and everyone seems thrilled.