It looks like Sofia will most likely be coming home tomorrow. I felt like I had a lot of unanswered questions when I came in today primarily because she hasn't been weaned from oxygen because her pulse ox hasn't been staying up when the oxygen has been reduced. She was lowered to 1 liter of oxygen today, which she is tolerating. We had a good chat with Dr. Hill, who is the cardiologist on the floor this week, who has been great. So helpful today and he really spent a lot of time with us. He drew us pictures, which I feel like always helps. He thinks there is 1 or 2 things or both that are contributing to her lower pulse ox. 1- She has a little bit of "wet lungs" which is called atelectasis, which is basically a side effect of surgery. It is a collapse of the lung, or when the lung doesn't inflate. Walking and moving around a fully using her lungs again should resolve this. 2- The other contributing factor is that she has some small collateral vessels, which are common in single ventricle patients. Apparently she had them prior to surgery, but they were small and didn't need to be addressed, aka coiled off. The collaterals act as kind of a top off for blood flow. If the flow finds a higher resistance in the pulmonary arteries (if she were upset and not breathing deep) then the body makes these collateral vessels and the blood might flow through these collaterals instead of through the PAs). This can cause a lower pulse ox because when blood goes through the collaterals then you have a bit of mixing of red and blue blood. The plan is to let her fully recover from surgery and and monitor where pulse ox is. Best case scenario is that it was all related to the lung collapse and not the collaterals. Dr. Hill's opinion is that if her pulse ox is still between 80-85 percent after she has recovered then we may consider going through via a heart cath and coiling off some of the collaterals, so blood cannot choose to go through them and that will eliminate the mixing. She may go home on oxygen for a short while. We are going to see how she is today on 1 liter of oxygen and then experiment with no oxygen. I guess she has already been scheduled an appointment on Monday to have a chest x-ray and follow up with surgical nurse and with Dr. Edwards the following week (her cardiologist), so it appears we will be going home soon. I know she is looking forward to being home and normal again and so are we.
It is evident that Sofia is feeling better. She is walking standing straight instead of hunched over, and she has been on her feet a lot in the past day. She actually tried to run today! We got to take her off the floor and go walk around the lobby, see the aquariums and art work and go see the tunnel of lights. I'm so glad she is returning to her normal self.
The nutritionist stopped by and said we should continue to vamp up Sofia's protein intake. Her albumin was on the low end and meat and dairy are encouraged. Her appetite has been pretty good and now they're bringing her snacks.
And the other development is that she was taken off coumadin and put back on aspirin. I guess cardiologists are divided 50-50 on preference, and Dr. Edwards prefers aspirin. According to the doctors, there is no clear consensus on which one is better post Fontan, so we will keep her on aspirin for now. This is kind of a relief as we will be able to avoid the frequent blood draws and dietary issues that come with coumadin.
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