Post Transplant – Day 8

Anya had a setback yesterday.  As soon as we arrived at the hospital, the surgical team told us that they were going to take her back to surgery in an hour to remove some fluid surrounding her lungs and patch up some of the bleeding.  It wasn’t an emergency type thing, but more of a “there’s an open operating room right now, so let’s do it now” type thing.  I wasn’t sure what to think, but after talking to the surgeon’s assistant, he assured us that although it wasn’t a common thing (<10% of patients), it was something that they’ve done many times before.

Essentially, there was too much fluid surrounding her lungs and the one remaining chest tube was not properly draining all of the fluids, which was preventing her new lungs from fully expanding.  He told me that the adhesions were causing pockets of fluid buildup which had to be surgically cleaned up and removed.  The pulmonary team was also going to perform a scheduled bronchoscopy while she was in the OR.

She left for the OR around 11am and the nurse didn’t call us until 2:30pm.  After talking to the surgeon’s assistant, he told us that the surgery took about 30 minutes.  They had to cut the full length of the clamshell incision, but did not have to undo the sternum wire, so Anya was in quite a bit of pain immediately after the surgery.  So much that she was crying after she woke up.

They had to put another chest tube back in, so she has two chest tubes in her now.  One is not draining much and the other draining a lot less than it had previously.  Mostly clear with a tinge of red.  They gave her 3 units of blood during the procedure.

The bronchoscopy showed quite a bit of mucus, which they cleaned up, so there’s still some work to be done with the pseudomonas infection.  Her white blood cell count was down today (which is good), so I think it’s just going to take some time for the infection to clear.  The pulmonary team is doing another bronch some time today.

Neither the surgical team, nor the pulmonary team seem too concerned about her fluid retention or the infection.  They made it seem like it was somewhat routine, but I don’t think any surgeon wants to go back in unless it was absolutely necessary.

Anya seems like she’s doing pretty well though.  Pain management is probably at the top of the list now.  The doctors seem to be doing a good job at minimizing her pain.  She didn’t get much sleep last night either.  According to Anya, two of the ICU nurses started having a loud conversation around 5am, so she asked if they could have the conversation elsewhere.  Don’t mess with Anya’s sleep.

She’s been put back on the ventilator for now.  The team is going to give her body and lungs a little break from the past 24 hours.  They tried to put her back on the trach collar this morning, but she desatted.  The hope is that once she sits up in a chair or maybe even walking, the fluids in her body will start to drain properly again.  The bronch this afternoon will help as well.

I don’t think there’s too much to be concerned about right now.  The fluid retention is definitely slowing.  The bleeding is definitely slowing.  Her lungs are working great.  The infection is finally being treated with an antibiotic that works on it.  All other bloodwork looks great.  With that said, getting out of the ICU looks more likely to happen next week, instead of this week, now.

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