Of Cones and Toes

Patrick enjoyed a routine visit to the Cardiologist this afternoon {“enjoyed” may not be the right word…but he was fairly brave and tried to curb his indignation, tears, and requests to “go back to the gold car.”}

P’s troublesome ticker looks pretty much the same as it did in July. While there is no imminent danger, we will need to do something {in coming years} to reduce the amount of blood that regurgitates into the atrium–enlarging the right side of his heart. Dr Rhee feels that a surgical procedure called a cone repair will do the trick. The idea is to move the three leaflets of the tricuspid valve up where they should be and reshape them into a cone.

Before doing a cone repair, the surgeon(s) will probably want Patrick to get older/bigger. In the meantime, they will call us in soon to do a study on his heart to see if he still has electrical pathways in his heart that could cause SVT (rapid heart rhythms). If SVT is still a potential problem, then they’ll do a low-risk catheter ablation to get rid of the SVT pathways. Both the study and the cath procedure would just be overnight procedures (so that they can monitor him after he’s been under anesthesia).

In other news, we are loving our new house (will share photos in the near future) and getting excited to meet the soon-to-be fourth member of our family. My due date is May 1 and so far the baby is healthy and whole. We had a fetal echo done in January to take a close look at his heart–it looked totally normal. The only item of not was that Patrick’s baby brother has 12 toes! The better to kick me  with, of course…

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Steady as He Grows

Patrick had a cardiology check-up yesterday and Dr. Rhee said that while his heart is still enlarged, it has not become any worse. If his heart stays as it is, he may not require any future open-heart interventions!

It is likely that P will need a couple of less-invasive procedures in the cath lab (one to test the electrical pathways again and make sure he’s not in danger of an arrhythmia, and one to further close his ASD). But we can handle quick over-nighters at the hospital for these types of procedures. We’re so grateful things are holding steady!

I would upload a photo of P wearing nothing but a diaper, hospital anklet, and sandals in the exam room (playing with cars of course). But I don’t have my phone  (which contains the photos)with me, so instead here’s one that Braden took on Monday (also with cars). You’ll just have to imagine that you can see his pot-belly and chicken legs ♥

Patrick Burrito

Sometimes Patrick’s love for his blanket combined with his love for perpetual motion results in a Patrick Burrito…

Note the heart monitor sticker peaking out of his onesie. Yeah, there was supposed to be a sensor thingy attached to that sticker, but those often came unattached for some reason. I’m sure that you can’t imagine what the reason was.

The cardiologists had Patrick on an Ambulatory Cardiac Telemetry (ACT) Monitor for 21 days so that they could make sure that his heart rhythmn is healthy now that the amiodarone has cleared out of his system. You can see the sensor battery pack by his leg below:

We were pretty sure that things went well since the only time the monitor buzzed at us was when either a) Patrick had pulled off, rubbed off, or otherwise removed one of the sensors, or b) the sensor battery was nearly dead. Yay for no “events”.

Today we saw Beth Rumack at the new Phoenix Children’s Hospital (PCH) clinic {St. Joseph’s and PCH merged, so the pediatric clinics moved to the children’s hospital}. The new facilities seemed nice and very colorful–but it sounds like we won’t need to spend much time there anyway. Patrick’s echo looked good. His right atrium is still enlarged, but it hasn’t gotten enlarger. His tricuspid valve is still leaky, but it always will be. If things continue this way, Patrick may not even need another heart catheter until young adulthood. We will keep seeing a cardiologist once every 4-5 months for now, but only 2-3 times a year will be SO nice. We are pleased with how well our little P is doing and very glad that he had the surgery when he did.

Stats:

Weight: 8.8 kg (19 lbs 6oz) – 30th percentile

Height: 2.5 feet – 50th percentile

Head Size: 90th percentile!!!

And that’s why they call him Mega Head (or at least Aunt Aubrey does).

We are told that his proportions will start to even out eventually–the Glenn procedure is still playing a large part in the crazy growth curve his head size is on. Credit for that is also due to his genetic inheritance (Patrick says, “thank you, daddy!”)

Adios Amiodarone

Patrick had an appointment with Beth at the heart center today. Gary was the unlucky one who was tasked with weighing, measuring, monitoring, and echo-ing a squirmy, opinionated 7-month-old. Gary was great. Patrick was…difficult. But they were able to get enough information to tell us that Patrick is doing well. Things look the same as last time–the tricuspid valve is pretty leaky but that’s why they did the Glenn procedure. As long as the right side of his heart holds up under the pressure from the regurgitated blood, there may not be a need for more surgery in his future. This is sort of uncharted territory so we’ll have to see how it goes, but the cardiologists seem pleased with how he is doing.

In fact, he has graduated from his amiodarone–a once daily med he has been on since he was born. Amiodarone prevents the SVT (super-high heart rate) episodes that Patrick had a couple of times as a newborn while still in the PCTICU. At this point, P has outgrown the dose he’s been on and since they have been planning to take him off of the drug anyway, it is better to do it now rather than up the dose. It will take awhile to clear from his system, so in a month or so we will start a 21-day ACT monitor again (he had one for the first couple of months last Fall). I’m not that excited for the monitor, but it will be so nice to have the peace of mind knowing that the doctors (and us parents) will be alerted if his heart does something funky. AND we are happy to have him off of one more drug. Now all he will be taking is aspirin once a day for the rest of his life (to avoid any blood clots in his heart–particularly the troublesome right side).

Patrick doesn’t need to go back to the clinic until after we’re done with the ACT monitor–so not for two months! After that we may only need to take him every 4-6 months. How rad is that?

We should be hearing from someone regarding physical therapy–Patrick  is lagging a little on some of his physical development. His sternum is wired together, and you can feel the bumps under his scar. As you can imagine, this makes tummy time a bit uncomfortable. Also, because the Glenn procedure re-routed the blood from his upper-body, a natural bi-product is that his head has gotten bigger (in relation to the growth of the rest of his body). With his head so heavy, he hasn’t quite gotten sturdy in the sitting position. He’s a strong kid, though, and he’ll catch up. He just wants to skip sitting and crawling and go to walking–if he had his way we’d have him standing, jumping, or walking (assisted) ALL the time.

These photos are from his last regular pediatrician appointment–he’s getting caught up on the immunizations we had to postpone during the pre and post-surgery time period. (Tia, Patrick’s nanny, was nice enough to come with me to the appointment. Six needles…three in each leg! He was a trooper, though.)

Six Months + Cardiac Follow-Up

A week ago our baby boy crossed over to the second half of his first year. What the?!
Here he is in all his 6-month glory:

And a couple of days later…

Also, we had an appointment at the heart center this morning. Patrick is doing well and no longer has any restrictions. Just regular baby precautions. Now we need to help him catch up on his tummy-time and sitting skills. In a couple of months he may get to quite his daily meds. And stay tuned because we get to start solid foods this week!

Postponed

We were nervous about Patrick having surgery with the congestion and cough he has had this week, but his lungs have been clear so on Tuesday they cleared him for surgery. This morning, however, once the anesthesiologist checked him out and discussed it with the surgeon, Dr. Nigro, they recommended that we postpone. We want it to be as safe as possible, so it makes sense to wait until his cold clears up. Coughing and increased pressure on the lungs are definitely not what we want for Patrick while he recovers from having his pulmonary artery (which takes blood to the lungs) messed with, among other things.

We have an appointment to meet with Beth on Tuesday, the 11th and we’ll go from there to reschedule. It’s a bit of a roller coaster but this will be best for Patrick. It has been awesome to have such an outpouring of support–thanks everyone!

Here are some photos from Braden’s ipod–taken in ped’s pre-op and the O.R. waiting area this morning.

It’s a Date

We met with Patrick’s cardiothoracic surgeon, Dr. Nigro, and Beth on Friday to discuss surgery. We were relieved to find out that Patrick’s surgery is not an emergency and can wait until after the holidays. Patrick is scheduled for a tricuspid valve repair and possible Glenn on January 6th, 2011.

The valve repair requires open-heart surgery. Once they look at and work on the tricuspid valve they will decide if Patrick also needs the Glenn Procedure to take some pressure off of the right side of his heart. The Glenn would connect the superior vena cava (the vessel that brings blood from the upper body to the heart) directly to the pulmonary artery (which normally takes oxygen-poor blood from the heart to the lungs), skipping the right side of the heart entirely.

Once Patrick has gone under anesthesia, he will get a breathing tube and an echo tube. They will make an incision in his chest and open the bone.

He will be on a heart-lung machine–his heart will be asleep while they assess and repair the valve as well as possible. Then they will decide if we need the Glenn. They will wake up Patrick’s heart and, if the Glenn is needed, they will do that procedure. They will also patch up the ASD (hole between the right and left atriums), although they may leave a little bit of a hole to relieve pressure.

Patrick will be in the PCTICU for 7-10 days. Recovery is straight-forward after he leaves the hospital. They expect him to rebound quickly. Risks are minimal–Dr. Nigro estimated a risk factor of 1-2% for major complications. Patrick will need a blood transfusion, so Braden and I had bloodwork done to see if we are a match to donate. He’ll need 3 units of FFP & platelets. We are waiting for the hospital to contact us with the results of our bloodwork, and to let us know what Patrick’s blood type is.

We feel very blessed to not be spending the holidays at the hospital. AND we were given clearance to drive to Southern California for Christmas! We are looking forward to taking our mind off things for a bit as we vacation both in California and then with my side of the family who are visiting Arizona after Christmas. Patrick has many aunts, uncles, cousins and a grandpa to meet!

Leaky

I’ve never seen Patrick SO happy to be back home, but after all of his tests at the Heart Center yesterday afternoon Patrick looked like he could’ve kissed the living room floor upon returning to familiar surroundings. One of his favorite things to watch is the ceiling fan, and he was full of smiles for Mr. Fan. Next he was thrilled to sit in his swing again, and he sat and talked to the little lambs on the swing mobile and smiled at his own reflection in the mirror above the swing. He sure seems to like the handsome dude that looks back at him!

Although he was pretty unhappy about being held down for a chest x-ray, echo, and EKG–not to mention having blood drawn from his little arm–for the most part Patrick was smiley and friendly to the doctors and nurses. Even while the cardiologists were giving us some serious news, Patrick grinned and grinned at Doctor Rhee. Braden and I were not quite so cheerful about the doctors’ report that Patrick’s valve has gotten very, very leaky. Right now the x-ray shows that his heart has not become much more enlarged, but the echo showed that his tricuspid valve is allowing much more blood to leak back into the atrium. His heart is working SUPER hard, and it is only a matter of time before his atrium becomes so enlarged that his heart fails.

Fortunately, Patrick has been eating well and gaining weight, because it looks like the doctors will need to intervene earlier than we had planned. The bloodwork they ordered will tell us how far into heart failure he is, and in the next couple of weeks they will probably do a heart catheter to get a better look at his valve. On Tuesdays the doctors all meet to discuss certain cases and Patrick is on the docket for next Tuesday. Hopefully they’ll have a plan for us after that. Beth indicated that once they decide that he needs surgery, it will probably be about a month before the procedure happens.

For now we are watching for signs of heart failure like vomiting, appetite issues, or labored breathing. Our travel plans are on hold and we are to continue our germaphobic precautions. Airplane rides are definitely out of the question, and even road tripping may be kiboshed so that we stay close to Patrick’s medical team.

Our Little Morning Person

Today Patrick is two months old! To celebrate, we took off the pesky old stickers that attached the leads for his LifeWatch ACT Monitor. Now we will box up the monitor, phone, etc. and send them back to the hospital for someone else to use. Bon Voyage!

I will say that it was SO nice to have the monitor for peace of mind and as opposed to noisier alternatives–we are grateful for the technology and even more grateful that Patrick is doing well.

Early this morning I found my boys in the midst of an amicable conversation–and Patrick was quite entertained.

Who has two chins and likes the morning-time?

¡Este muchacho pequeño!

Ten Pounder

Patrick saw his cardiologist, Beth Rumack, last Thursday for a routine checkup. He weighed in at about 10 pounds!

Left: 10 Days Old, Right: 6½ Weeks Old

He has been growing steadily and according to the chest x-ray and echo done on Sept. 30th, his heart has not really become any more enlarged than it was at discharge. Also, the tests showed that his ASD (a hole between the right and left sides of his heart) has actually closed up a bit on it’s own. This might mean that the ASD could be repaired via a heart catheter rather than open heart surgery–which I think could buy us more time before the tricuspid valve repair is necessary.

Patrick had occasionally been trying to sleep longer between nighttime snacks, and Beth told us that we could start letting him do so. She told us that as long as he is getting about 20 ounces of breastmilk per day then he should be fine sleeping through the night. At the time Patrick was only eating about 15-16 ounces a day, but once I started letting him go longer between feeds at night, he really picked up his game. Over the last few days, he increased his intake from about 18 ounces to 24 ounces. So far he has still been waking up once or twice during the night to eat (most consistently at 1 or 2 am), but even that has been so nice for me (he was eating every three hours before). Yay for more sleep! I went from a total of 4-5 hours to a total of  nearly 6-7 hours of sleep each night. Amazing.

Patrick literally changes every day. He is developing so quickly, and we are having a ton of fun with him. He has become a lot more smiley and talkative with his little Patrick sounds.

At 7½ weeks old, Patrick likes to:

  • Keep his legs and arms in constant motion (often in his sleep as well)
  • Kick with his right leg more than his left
  • Have his hands balled up in fists still (although we are starting to see him keep them open occasionally)
  • Grip things in his fist (i.e. our fingers, toys, hair–unluckily for Braden’s chest hair, etc.)
  • Pee in the bathtub
  • Poop on Daddy
  • Hang out on the changing table. He has come to appreciate diaper changes more (he HATED them as a newborn) and he really likes to look around at his toys and monsters that hang by the changing pad. Some of our best conversations take place there–he likes to be sung to, talked to, and to learn new tricks while he’s laying there.
  • Hold his head up. Patrick has the head control of a 3 or 4 month-old (as per his pediatrician).
  • Put a halt to ALL other activities in order to concentrate on going #2.
  • Hold Daddy’s thumb while being bottle-fed
  • Look at himself in his crib mirror and the mirror above his swing
  • Sit in his swing, whether it is moving or not. And he loves to sleep there.
  • Watch the lights on his activity play-mat
  • Follow toys with his eyes when we move them back and forth in front of his face
  • Fight sleep with all of his might
  • Ride in his baby bjorn carrier
  • Take his heart medicine–seriously, he thinks it is super tasty and he’s sad when his daily dose is gone
  • Video chat with his grandparents
  • Sleep on Dad…