Over the weekend the doctors assured us patience was the key and she would slowly improve, even though it might be a little trickle at a time. I tried my best to accept that. The steroids were not budging her FiO2 at all but her blood gases remained good. My patience wore thin though as she spent more and more time at 90-100% O2. Sunday night I could not sleep. I kept going over in my head what I wanted to tell the doctor and I simply could not shut out the fear.
Monday I had our first parent day at Annie's preschool. It was very sweet seeing her class in action and having play time with her. I then went to the hospital where Natalie was requiring 95% O2 but only sating low 80's.
Her nurse was on break and the babysitter could not tell me much. I stood at the glass and glared at the doctors on rounds. It is a cliche, but there have been SO many times in our NICU stay where I have had to suppress a Terms of Endearment Shirley Maclaine outburst from surfacing. I know I will be less successful at conveying my concerns if I am crying or inconsolable, so I did my best to get a grip. Luckily our nurse yesterday is a total sweetheart and great at distracting me. She had a student with her and after about 15 minutes of talking about toddlers I was calmer and ready to make my case.
We had ruled out infection, edema and the steroids did nothing. My fear has been that the surgery aggravated her pulmonary hypertension and that the doctors wanted to wait things out rather than escalate her therapy by adding a new med. I know there would be extreme reluctance to resume nitric oxide. Rumor has it that Natalie alone consumed 1/3 of the nitric oxide used in the NICU this year. At the same time, I did not want to wait it out if she was going to be so close to 100% O2. There is no wiggle room if she gets sick and that level of O2 is simply not healthy.
I was fortunate that the doctor had reached all those conclusions on his own before we talked. Once again I was spared a dramatic outburst to make my point. He said he would request a consult with cardiology, get another echo and see what they thought.
I was able to hold Natalie, although she was agitated. Just as she fell asleep they came to perform the echo. This is about Natalie's least favorite procedure. I left to pump and Steve stayed to hold her hand. Usually we wait 2 days to hear back on an echo. By the time I was done pumping Steve was outside her door with the full report.
First, she loved having Daddy with her for the test. They joked that they were going to write an order that he must be present for all future echocardiograms. She actually fell asleep with him holding her hand.
There was no evidence of worsening PH. That is great, except now we still do not know why she is requiring so much O2. The cardiologist (who happens to specialize in PH) did not feel she would benefit from iNO. Instead he increased her sildenafil (Viagra) dosage. If she does not improve he will look into further treatments.
Once that was over ENT came in to perform her first trach change. Poor baby. It went very smoothly and they say she has healed nicely.
During all this time, Natalie was requiring large amounts of oxygen and just could not get comfortable. Steve and I had to take turns leaving the room. It was just too stressful watching her at 100% and only sating in the low 80's.
The nurse decided to get her blood gas before trying to get her to sleep and that is when things turned around. Her CO2 was only 32. That is way, way too low. I am going to skip the technical parts, but thanks to a lot of discussion between the respiratory therapists and doctors her settings were tweaked and she slowly improved. Sometimes the right person shows up with the right idea just in time.
She was still agitated but it turns out she really likes being tapped on the chest with a face mask (the cushy kind used for hand bagging). This is called pulmonary toilet, or PT. She just melts and relaxes. By the time we left she was down to 86% and sating in the 90's. Who knew you could be grateful for 86%?
Last night she was 80's to 100% again. Her CO2 seems to be under control and they have gotten her down into the 70's today. We are very hopeful that this is a turning point but of course know better than to get ahead of ourselves.
Today is Ms. Anneliese's 3rd birthday. So far she has had a wonderful day that has been just for her. I am not going into the hospital until after she is tucked in.
Thank you for your continued prayers and support. I feel like I am held together by paper clips and Elmers glue right now but am hopeful that this week will bring good things for Natalie. For starters, I now intend to hold her every day. While she had the ET tube it was dependent on her stability, but now she is free. I know it will take her some time to get used to it, but I think she will be a snuggle bug. This also means that grandparents can hold her as well. I look forward to her family getting to know Natters that much more and finally get her in their arms.