Thursday, June 20, 2013

Day 22 NICU

Our girl is spending more and more time awake and quietly alert. I really enjoy sitting next to her and having "conversations" when she's like this. She continues to be a champion bubble blower, as you can see from the picture. The volume of her "oral secretions" continue to amaze each new nurse who has her.

She was showing signs of withdrawal overnight so they upped her methadone dose. As the nurse put it, there's no need for her to go through withdrawal symptoms and they can eventually just gradually decrease the methadone in intervals that don't stress her body. Her job right now is to get big and strong and grow a lung. She kept falling asleep today and then waking up 1/2 hour later, crying, especially when she was due for a dose in the near future. Poor baby.

The doctors are currently a bit baffled by the volume coming from her OG tube. That's the tube that drains her stomach and they expect it, by this time after surgery, to be producing just a couple of clear mls every few hours. Unfortunately, it's producing more like 15-25ml and it's rather green, which suggests bile. Ideally, the bile should be draining into her intestines and not collecting in her stomach. What is keeping them from being worried is that they are putting lots of milk through her NG tube, which goes directly to the beginning of her intestines and all of it is clearly getting processed and going through the entire intestinal tract. This means that any sort of bowel malrotation (a CDH fear) is extremely unlikely.

If everything past the stomach appears to be in working order, the question becomes, why isn't the stomach draining? The NG tube can apparently block good flow through the pylorus (valve at the base of the stomach), preventing drainage but we can't pull it back into the stomach until the OG tube can be pulled. We can't pull the OG until the stomach is draining it's contents through the pylorus.  Starting to see the paradox?

I'm going to manage to get there early enough for rounds tomorrow to listen to what's been decided. They were consulting her surgeon, Dr. Crombleholme, today for his opinion. They may wait a couple more days to see if it decreases on its own or they may embark on some sort of diagnostic course. I hope it gets resolved soon. It's clear that she is even more anxious than I am to get it out. She mouths around it and tries to spit it out. I think it will also go a long way toward solving her drooling problem and she'll be more able to start working on using her pacifier (which she already likes).

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