Friday, May 3, 2013

Day 16, Post Op Fontan (May 3)

Yesterday I wrote that Eli's wound vac dressing would be changed today.  This morning we found out that in addition to the wound vac he needed another chest tube.  The fluid built up again on the right side where his chest tube had been pulled out (accidentally) the other day.  Instead of just getting Versed like he did yesterday, he had to be knocked out for all of it.  

Once they had him asleep I had to leave the room.  I waited about 30 minutes before they came to get me.  He was still asleep but starting to wake up.  The wound vac was pretty much the same as yesterday's except they added a piece of foam over the clear dressing.  Through the morning Eli had some breakthrough drainage come out of the dressing.  It was covered with gauze & Tegaderms (clear dressings usually used over an IV site).  I noticed his blanket moving over his chest at one point this morning and found he had picked a hole in the Tegaderm.  He had two fingers underneath it just feeling around!  He wasn't close to his incision, but close enough!  This foam might help prevent some of his exploration.  

Dr. Abraham placed a chest tube in almost the same spot the other one was.  He drained off 130cc of fluid (4 1/3 ounces) and sent a specimen for culture.  They want to see if there's any infection in the chest fluid that may need an alteration in antibiotics.  As of now, because of what was seen yesterday in the OR, Eli is being treated as if his sternum is infected.  That's an osteoitis (bone infection).  The treatment for that is 3-6 weeks of antibiotic therapy.  You know, kind of what we're already doing.  If the chest fluid is positive for anything, we'll have to add another antibiotic to our routine.  

We'll stay in the PICU again tonight because Dr. Abraham wants another dressing change tomorrow.  He won't be here for this one so the hospitalist and wound care team will do it.  He said he would leave it up to the hospitalist to decide how much sedation Eli has (Versed versus just getting some morphine).  After that's done we'll find out if we'll stay longer in PICU or go to the floor.  We're okay wherever he is, it's just weird not knowing.  They're working on setting a time for tomorrow's dressing change.  He'll have to stop eating and drinking four hours prior to it, so we have to figure out what time frame he can have food and feed him.  It's funny because nutrition is extremely important to wound healing but we have to keep him NPO so much because he has to be somewhat sedated for the dressing changes.  Thank God he has a feeding tube.  

Dr. Belcher didn't round today but his nurse practitioner did.  We even knew her because she used to be the nurse practitioner for the PICU during Eli's first two surgeries.  We had noticed she wasn't here when we were in PICU after surgery a couple weeks ago and now we know why!  It's nice that she's the NP for infectious disease because she really knows Eli's history. 

Eli's now resting in his crib.  He's craving diversion and is watching a movie on the portable DVD player and demanded the tv be on also.  He was finally able to get some milk (first bottle since about 6 this morning) and I can order him a tray soon.  He was hurting a little but ago but a dose of morphine made him almost talkative!  The nurse pulled another 35cc from his chest tube (just over an ounce) so getting that fluid off has to feel better.  

Bryan and Zachary got the yard/jungle mowed today and even squeezed in some golf time (in the yard).  Bryan said Z had a good day at school and they ate leftover Bobe's for lunch.  I think some Daddy time was exactly the medicine Zachary needed.  They're going to come up here on Saturday to visit.  The last time I had to wait a week to see Zachary, he looked like he'd grown a lot in that week!  I'm sure it will be the same this time. 

Thanks for all the prayers and encouragement.  They really do help.  I was having a very rough morning.  I felt so sorry for myself but kept trying to remember that Eli is the one who is physically suffering.  At just the right time, I got a text from Caleb's mom and she was saying some very sweet things.  Reading things like that and all the messages you leave on Facebook and in the cards you're sending really help me cheer up.  And we get to see Zachary tomorrow!  That will help cheer all of us up!

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