Daily struggles in the post-op period

The night following Emersyn's surgery was hard. Her blood pressure was low so she was frequently getting blood transfusions, albumin, and plasmalyte to increase her fluid volume. They were also concerned because she had stopped making urine when she was in surgery and had not restarted yet. Since she wasn't voiding, the more fluid they gave her, the more her tissue swelled. She was getting pretty puffy and that was problematic. Since her chest was fully closed in the OR, there was little room for swelling before the heart would be compressed. With the amount of swelling Emersyn was experiencing, this became a concern. In addition, her lactic acid levels were on the rise. Lactic acid is produced when muscles are overworked, so the medical team was worried that her heart was being overly stressed and not functioning properly.

Around 3am, the surgeon ordered an ECHO to look for cardiac edema and check her overall function and perfusion of the heart muscle itself. They were able to visualize some fluid around the heart which was not abnormal considering her extreme swelling. They also said the heart was slightly under filled which indicated that the extra fluid in her chest cavity was compressing the heart muscle to some extent. The heart was functioning well though, and there was no concern of leaking at the surgical sites or cardiac perfusion issues. Unfortunately, her lactic acid levels continued to rise and she still was not producing urine, so the waiting game continued.

By 8:30 am December 13th, her lactic acid level was finally starting to decrease which was a positive sign, still no urine though so kidney function became the big concern for the day. Emmy was almost 24 hours with very little urine output...less than 50cc. Her blood pressure was still low so they were continuing to give volume boluses frequently and she continued to swell more and more. Early in the afternoon, one of the doctors approached me to explain that if she continued like this, peritoneal dialysis would be required to drain off some of the fluid and continue giving her kidneys time to recover. Ugh...I hated the sound of that, but I had incredible confidence in the medical team and never once questioned their decision making. I knew they would do what was necessary to keep our little girl on the path to recovery.

That night was more of the same...no urine. Her blood pressure was improving though so that was a positive sign. The decision about dialysis would be made at morning rounds, around 8:30am. I think we had an army of people praying that this little girl would pee! And thankfully, those prayers were heard. Around 4am on December 14th, her second post-op day, Emersyn finally started producing urine. I had never been so excited about pee before and I doubt I ever will be again! By morning rounds, the doctors said they were confident she would not need dialysis. She still looked horrible...looking at her made me cry. She had 2 days worth of fluids collected in her tissues and she looked like a balloon ready to pop. It was a very ugly picture and I hated seeing her like this, but I knew that she was improving now even if I couldn't see it yet...and that was comforting.

 Post-op day #1

Post-op day #2

This brings us up to date. Happier pictures to follow, I promise...she just needs more time! I'm told by all of the medical team that she's doing amazing considering the operation she's undergone. This is how it is in the medical world...everyone wants to see more progress faster. But Emmy is already showing us that she is a girl who won't be rushed...she is very strong and fighting hard, but she will do things in her own time!