12:30: Swallow Study
1:30: Consult with Speech Therapist about Aspiration/how to thicken feeds
2:00: Cardiology Physician Apt. and EKG/ECHO in Cardiology
3:00: Cardiologist Apt. to discuss results
4:30: Bloodwork (7 vials :( )
5:30: Chest X-Ray (ordered by cardio to get a better idea of degree of pulmonary hypertension)
So as you can see we started with the swallow study which Mila HATED. She had to sit in a feeding chair and drink her bottle. I thought she'd be starved. Well she wasn't digging the barium I guess and just wanted Mama to pick her up! Then they kept trying different thicknesses and nipples and my baby just wanted to eat without all the fuss! They determined that she is likely aspirating on thin liquids (as I suspected). They didn't see any huge aspirations during the study but saw thin liquids starting to go into her lungs but coming back up and correcting itself. The woman said she was positive that througout an entire feed, and when Mila actually drinks more than a few sips, she is aspirating. So we are now thickening her milk just a tiny bit, nothing huge. We mix 2 Tbsp. of rice cereal in with her 4 oz. of formula. She does MUCH better and there isn't nearly the amount of coughing we were seeing.
Next for all the big appointments...the heart stuff. Mila was great for her EKG and ECHO! Such a good girl! We sat nervously waiting for the Cardiologist. A nurse came in and took her pulse ox and it dipped as low as 72, and was as high as 92 (normal should be at least 94). He finally came in with the PA and an intern and had a funny look on his face. He just stood there for a moment not saying anything and my heart sank. Sometimes you can just read people's thoughts without any words being said. He started by saying, "You know she has a large VSD and pulmonary hypertension." And I explained that we didn't know the size of the VSD but had been told that was likely the heart defect. He said that most babies in her condition would need surgery by 3 months old to survive. Gulp. Then he looked us right in the eye and in a very serious tone said, "I need to tell you that the pulmonary hypertension makes this procedure much riskier." Gulp. He said he would have to talk with his colleauges that will be doing the surgery to make sure they feel comfortable operating with the PH, but that this really is her only option. We talked a little about oxyen and how it wouldn't help at all, and that it could actually make the pulmonary hypertension worse. (See below for explanation of PH and VSD). He also said that it's possible the PH is primary and will not resolve after the surgery, but we are praying our hearts out that it is secondary PH and will slowly resolve itself once her heart is fixed. He wanted a bunch of bloodwork to go with the other findings. Their team of doctors will discuss Mila's case and likely call us next week with a surgery date. It could be as soon as 2 weeks away or as far out as 6 weeks. But he was positive that this needs to be dealt with in a somewhat urgent matter. He said her hospital stay will be longer than most typical OHS cases and told us to count on at least a 7 day stay if all goes SUPER. He is keeping her on all three medications for now (Digoxin, Captopril, and Verospiron). He is unsure if the team will want to do a cardiac catheterization to get a clearer picture of the extent of damage before surgery. We should hear from them a week from today.
Honestly it was like a punch in the gut. His words almost took the wind out of me. Yes, yes, yes, we KNEW she was going to need surgery, we knew all of her health needs, we signed up for this, yes we sure did. We knew her condition was serious, yes we did. BUT once she nestled into our hearts as our daughter, this all became much more difficult to grasp. To actually hear the words made it real. We were still holding onto hope that she wouldn't need surgery...that would've been a miracle. We hadn't let ourselves go there because we had to take one step at a time and our first mission was to get her home. Now we can focus on getting her healthy. Yesterday was the first day I let any of these worries penetrate my thoughts. It stung. I cannot imagine handing my sweet baby over for open heart surgery. I know many have done it (and probably some of you reading this are heart moms who've been there done that), but I still just can't imagine the strength it will take to hand her over. The complete and utter reliance on people you don't even know to save your baby's life, which is why we must completely rely on God who can work through those surgeons to fix Mila's heart. We appreciate your BIG prayers. We've seen many miracles with Mila and we're counting on the biggest one yet!
Definitions of heart terms:
Ventricular Septal Defect (VSD): A hole in the septum (the wall) between the lower chambers of the heart (the ventricles). A VSD lets blood from the left ventricle (where it is under relatively high pressure) shunt into the right ventricle which has to do extra work to handle the additional blood, may have trouble keeping up with the load, enlarge, and fail. The lungs receive too much blood under too great pressure, the arterioles (small arteries) in the lungs thicken up in response, and permanent vascular damage can be done to the lungs. With a large VSD (usually one greater than 1.0 square cm in area), there is a significant shunt into the right ventricle, excessive blood flow into the lungs, and pulmonary hypertension. Symptoms this is causing Mila: shortness of breath, rapid breathing, fast heart rate, possibly the cause of the plumonary hypertension (hopefully). VSD is the most common congenital heart defect and when not paired with pulmonary hypertension is usually a fairly "easy" fix.
Pulmonary Hypertension: The arteries that carry blood from the heart to the lungs become narrow. This makes it hard for blood to flow freely through the vesself. Because of this, the blood pressure in these arteries rises way above normal levels. The high pressure strains the right ventricle of the heart, which causes it to expand in size. The heart works too hard and becomes enlarged and gradually weakens and is at some point no longer able to pump enough blood to the lungs. This can lead to heart failure.
As you can see the pumonary hypertension is our big concern. PH can be primary (existing on it's own without being caused by a heart defect) or secondary (caused by the heart defect). We are praying Mila's PH is secondary because that would mean it can be fixed. If it is primary that means it will not go away even once the heart is repaired.
And on a good note I figured out how to get her to sleep more through the night: take her to the hospital and torture her with test all day long! ;)
Thanks for all your prayers. Please continue covering Mila in prayer as this surgery will be here before we know it. If any of you are heart mama's who've dealth with pulmonary hypertension going into surgery, please contact me (spbasile at gmail dot com). Thanks.