Tuesday, November 22, 2011

Post-op Day 1

Thomas did well overnight (considering he just had extremely complicated surgery yesterday) and for that we are grateful!

Overnight he had several episodes of SVT (supraventricular tachycardia = very fast heart rate).  This can be dangerous because when the heart is beating this fast, it isn't able to pump well enough to provide blood where it needs to go.  This can cause decreases in blood pressure and other signs of decompensation.  Luckily, Thomas's blood pressure didn't drop during these episodes, and the SVT responded quickly to a medication called Adenosine.  He is also Digoxin and  Precedex to help keep this under control.  It is probably caused from irritability and stretching of the heart muscle from yesterday, and may be caused by some "tickling" from some of the wires in his heart.
He is on Milrinone, Dopamine, and Epi, and has weaned some on these meds. 

Thomas also has significant chest wall edema (swelling).  When you look at his chest xray from yesterday, you see about 1/2 inch of soft tissue (skin, fat, etc) on either side of his ribs.  This morning he had about 2inches of soft tissue (mostly swelling this time) on each side of his ribs.  Swelling is a known complication, which is why his chest was left open after surgery to allow room for this. We need his kidneys to get back into action so he can get rid of some of this fluid.  Sometimes the kidneys can be slow to wake back up after being on heart-lung bypass, so he is on Lasix and Diuril  (diuretics) to help with this.

Because he isn't urinating well, his body held on to the anesthesia longer.  It usually takes 6-12h for kids to wake up after surgery.  He isn't waking up much, but his toes and feet were responsive this morning, which was good.  Also, the Precedex that he is on for his heart is a sedative, so it is hard to tell. Once he really wakes up he will be on Fentanyl.

He is on the ventilator, of course, and his settings have come way down. Yay!
His lactic acid level is monitored to follow his perfusion, and has come down from 98 (after surgery) to 24. We are happy about that! 

 He is on Vancomycin and Gentamicin to prevent infection since his chest is open (its covered, but still a huge risk for infection). He is on Heparin to protect his new Sano shunt in his heart.
He still won't be able to eat for a while, and they are resuming his TPN (nutrition through his IV).

The next goals for Thomas are for the swelling to decrease enough that they can close his chest, and the step after that is to get off the ventilator.  Baby steps!!!

We are so thankful and grateful for everyone's prayers.  They have sustained us and brought Thomas through this first surgery!

Here are our prayer requests for now:
1) Kidney function- pray that urine output will increase
2) SVT/arrhythmia- pray it will stop and be easily controlled with medication
3)  Pray that his chest wall swelling will go down enough for his chest to be closed in the next few days
4) Pray that his overall fluid/swelling will go down so that he can be taken off the ventilator successfully after his chest is closed
5) Pray that he will wake up quickly to look at us :)
6) Pray that he won't have any issues with infection or bleeding
7) Please continue to pray for the nurses and doctors caring for Thomas.....they are amazing and we are so thankful!

Sorry for all of the medical jargon...but I have alot of nerdy buddies who like all the details.   I say that in love, because I'm a nerd too :)


  1. Love you Melissa! And yes, there are many of us out here who really appreciate all the nerdy details you are giving. I'm so thankful he's doing so well, considering all he's been through. I will keep the prayers coming your way! Thomas is definitely a little fighter :)

  2. Don't worry...most of us don't understand most of the medical jargon..so we just skip to...doing better...improved...and please pray for. Praying,praying,praying. Love you.

  3. Loving all the details and I'm interpreting them for others :) Continuing to pray pray pray!

    mary m.

  4. I'm channeling my inner nerd as I read this. It is bringing back memories of working at Children's in the CICU. Thank you again for the update. Praising God for His faithfulness and praying for continued healing!

  5. Praying so hard for all of those invoved through the long road. We hope you are also feeling ok (physically) after the C-section. It is amazing to me all of the strong parents that have been through things like this and the strength you all have!!
    With love, Matt and Heather Jackson

  6. I'm happy to hear Thomas is doing well considering. He's a strong little boy and seems determined to beat the odds!!! Praying!

  7. Yeah, baby Thomas! And while I totally don't get the medical jargon, I buy into anything that basically gets nerds to unite!!

    John prayed for baby Thomas last night at the dinner table. And then told me later how much he "loves the nice lady, Dr. Behm".

    Keeping the prayers coming and you keep these good updates coming!
    Jennifer Copeland

  8. I'm not in the medical profession, nor am I a nerd, but I appreciate all the details nonetheless. :) So glad he's doing well!

  9. All the nurses in the birthplace at Easley are praying for you guys !

  10. Thank you for the nerdy updates! We are praising God for his provision and still expecting more! Thank you too for the specific prayer request list, so we can into what's going on acutely! Thomas is blessed to have you as his parents!!

  11. The updates are wonderful! Your strength and faith is more inspiring than words can say. Thank God for the good news about Thomas. He has and continues to be in my prayers. The specific prayer requests are being lifted to the throne of our Lord by so many. I am looking forward to hearing more good news, and I cannot wait to read that little Thomas has opened his eyes to see his loving mommy and daddy!

    Cynthia (Cindy) Howard

  12. So glad to hear Thomas is doing well! I shared your blog with some of my nursing school classmates, and we're all rooting for him. xo Sarah E

  13. Hope today is a good day for Thomas and all of you. Maybe you can get a little breathing room! G-d is GOOD!! OOXXOO ANNE

  14. Love love love you baby Thomas! You are an Allen boy, very expensive and full of drama although so so so very worth it!

  15. Thanks for all the details! We are praying for your little man - its crazy how familiar all that sounds. We are seriously so close by if you need anything at all!

  16. I love to hear about baby steps! And details! It helps me understand what you are going through, as a mom and a doctor too. Have been praying today too and will continue to, for your strength and endurance and rest. For Thomas' physical healing and that he isn't in any discomfort. Hope you've seen those sweet eyes today.

  17. Yay for nerdy details! We are praying for that precious baby and his Momma and Daddy. Big hugs.
    Erin, Buddy & Mason Cantrell

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  19. thanks for all the nerdy details. We are lifting ya'll up in prayers every chance we get. Hang in there!

  20. We are praying for Baby Thomas and the rest of the Behm Family. John and Tabitha

  21. Continuing to pray. So glad that it is looking as good as can be expected at this point. We are continuing to pray and hope that his kidney's start to function well soon. You both are amazing and your faith is so incredibly strong. Thomas is so blessed.

  22. Thanks for giving specific ways we can pray.
    "More than that, we rejoice in our sufferings, knowing that suffering produces endurance, and endurance produces character, and character produces hope, and hope does not put us to shame, because God's love has been poured into our hearts through the Holy Spirit who has been given to us." Romans 5:3-5
    We are continuing to pray for you!
    In Christ,
    The Fray family

  23. You all have constantly been in my thoughts and prayers today. I hope sweet Thomas is doing well - we are all fighting for him.
    Many prayers to you all. God is good.
    Love, Ginny