Thursday, June 19th - Post Op Update

Before we were able to see Kinley, Dr. W took us to see her post op chest x-ray. The difference is amazing. The biggest difference, Kinley actually has two lungs! And both of them have air in them. The upper lobe of her right lung is still compressed/collapsed, but Dr. W feels that it looks better than her previous x-ray. Also, her heart has already begun to move towards the left side of her chest. It is currently sitting right in the middle of her chest cavity.

Now for the moment Kathy and I have been waiting for since 10:00 am. We walk back into the operating room and see immediately that Kinley has already been moved back into her old bed. As we get closer we can see that the majority of her belly is covered in bandages. Her belly looks huge now that all of her organs are in their correct place. The bandages, on her belly, are covering three different incisions: the largest (a bit over 4 inches) was the one made to perform the diaphragm repair surgery, the second (the width of a finger) was made so Dr. S could push the spleen out of the way and the third (the width of a pencil) was made to put in a chest tube which will drain any excess blood from Kinley's chest cavity. Her chest, on the left side, looks like it is collapsed. (Don't worry, it isn't collapsed.) The reason it looks that way is simply because the bowels that were occupying the space in her left chest are now in her abdomen where they belong. The final difference we can see is the chest tube, coming out of her bandages, allowing blood to drain out of her chest cavity. Other than those three items, she looks like the same Kinley we left 10:00 am.


Walking into the operating room after surgery. Kinley is back in her old bed.


Our first view of post op Kinley.


A closer view of her bandages.


The red ball at the bottom is collecting the blood from her chest tube.

Kinley's vitals are looking good considering she just went through major surgery while on heparin. Her BP is at a normal level without the help of hydralazine (BP med to lower BP) and her oxygen saturation is right around 100%. Her heart rate is a bit elevated, but just a bit over normal.

After getting our fill of making sure that our baby was doing well we headed back to our PCU room, where our families were awaiting our return and our update. Once Kathy and I were back we all took turns visiting Kinley to make sure everyone got their chance to see her.

As the afternoon progresses into the evening, Kathy, myself, Jackie, Sarah and Dr. M all begin to notice that Kinley's BP is steadily going down. On top of that, Kinley is not producing very much urine. Dr. M, Jackie and Sarah do not find the urine issue to be too concerning since Kinley just went through surgery and is currently paralyzed (on purpose, by drugs) to limit her movement. The lower BP issue needs to be addressed though and everyone agrees that the main cause is Kinley's loss of blood due to the heparin and her inability to clot. Kinley is not losing excessive amounts of blood, but her chest tube is draining pretty consistently. To offset this loss of fluids and to help bring Kinley's BP back up, Dr. M orders replacement fluids. Replacement fluids can be saline (volume filler), albumin (volume filler), packed red blood cells (to increase oxygen carrying cells), platelets (to help with clotting), fresh frozen plasma (to help with clotting) and/or cryo-precipitate (to help with clotting) depending on what needs Kinley has.

After shift change we find Gayla and Melissa watching over our recently surgerized daughter. (Yes, I just made that word up. Surgerized: to have gone through surgery.) Dr. P is here tonight and the decision is made to continue the replacement fluids to help with Kinley's BP. Dr. P informs us that tomorrow, when they stop the drugs that are paralyzing Kinley, we will be able to get a better idea of what her status and vitals are. The paralytic drug that Kinley is on right now is known for lowing BP and her lack of movement could be directly connected to the lack of urine output. Also, the stress and physical changes to Kinley, from the surgery, will need time to work themselves out before we really know what her condition is.

The care from everyone, nurses and doctors, here has been so amazing and extremely supportive. Dot and Megan were working today and both made sure to stop by and see how Kinley, Kathy and I were doing. Phyllis and Aja both came in on their days off to check on Kinley and make sure that her surgery went well and Julie called in from home to check up on everything. Another thing that happened today that gave us even more comfort in Kinley's care is that Dr. M refused to leave Kinley's side until her BP began to rise.

One item that I would like to correct is that I have not properly recognized Kinley's night nurses in this blog. Please know that Kinley, Kathy and I love all of our nurses, both night and day. Unfortunately for Kathy and I we cannot spend as much time with our night nurses due to lack of sleep and extreme exhaustion, but know that they are the only reason Kathy and I can get any sleep. Overall this lack of time together is probably more of a benefit for the night nurses because they don't have to answer my constant questions and listen to my horrible jokes. (You should see some of the eye rolls I get from Kathy. Lucky for me, Kinley is too young to roll her eyes, but I know that day will be here too soon.)