Monday, August 24, 2009

A Medical Update

- Samuel is still critically ill, but the immediate crisis of last night has been averted. The oxygen to his brain was dropping for about an hour yesterday, and was dangerously low for about 90 minutes. Our nurse does not think that this would have had any long-term effects on Samuel. In many ways we feel like we are now in the same place as we have been for the last week or so: very sick, but stable.
- Unfortunately, most of his systems seem to be getting worse as opposed to better. The pulmonary hypertension may be the one exception.
- As Kathryn said, Samuel is back on the oscillator ventilator and is receiving 100% oxygen. While the oscillator has helped his oxygenation levels, it requires them to give Samuel the paralytic again. This is hard. We’d been really enjoying moments of open eyes and moving fingers and toes these last few days.
- The hepatologist (liver doc) looked at Samuel again this morning and still believes that the liver’s struggles are a result of the other problems that Samuel has – lungs, heart, kidneys.
- They did another echo of his heart this morning and the doctors had a new thought about the high pressure in his right ventricle. We may not have mentioned this specific problem previously, but this is not something that his heart can sustain for too long. Previously they thought that the RV pressure was a result of the pulmonary hypertension, but now that the pulmonary hypertension has improved (at least somewhat – though they cannot quantify how much), and they are still seeing the high pressure in the RV, they are thinking that there is another cause. His pulmonary valve (the valve that releases fluid from the RV through pulmonary artery to the lungs) has always looked a little abnormal to them, but they didn’t have any reason to pay much attention to it. Now they wonder if the valve needs to be repaired. If there is good news in this, it is that this procedure could be done in the cath lab, and that, if successful, it might help some of his other systems/organs. Also, they are able to monitor him during the procedure (unlike an MRI), and no incision would be required (as in surgery). On the other hand, while Samuel has already had two heart caths, one of them was really hard on him. Because he is so sick, any procedure is risky.
- His case will be presented in the Monday afternoon “Cath conference” (14+ cardiologists/doctors, and 3 surgeons), and they will consider this and other options. The MRI that was scheduled for tomorrow now seems unlikely. During an MRI, he could be on a special ventilator w/ no metal in it, but they cannot monitor any other vitals during the hour of the imaging. This seems risky to the doctors.

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