The earlier posts were quick to keep you all informed. To provide a bit more detail... Laura did very well in surgery, but it was hard and took over 10 hours. The second transplant is more difficult, there is scaring that must be dealt with as well as numerous other details. We were aware of some but not all. The amount of blood and fluids that were needed for the surgery was staggering. 10 units of blood during surgery and 2 units after, platelets...etc. Everything was described as 10 units of this, 12 units of that. Scary volumes.
After Laura was back in ICU there are a few issues were are dealing with. The right lung was harder to replace due to scaring. Managing the scaring caused serious bleeding. As of this evening her right drainage tubes had collected about 1250ml of blood. With the addition of two units and platelets this afternoon as well as a lowered blood pressure we hope this will naturally correct itself. If it does not we will have to go back into surgery to have the blood and fluids removed.
This surgery would entail them making an incision to access the lungs and essentially vacuuming out the remaining blood and cleaning the area. Not a technical description but accurate. My new book, Lung Transplants for Dummies will be released soon. Not a complicated surgery but non the less a serious surgery. This is not uncommon and the team is not worried.
I remember from the last transplant the tree of meds looking so intimidating with two rows of pumps and medication hanging off the top. Laura out did herself this time with 6 drainage tubes in her chest and over a dozen IV meds.
They accessed her internal jugular vein and then added another tree on the side of that. The drug list is long and serious. She is on propofol and it is amazing to see her reaction when she is on a lower dose and wakes us. The effectiveness and speed at which these drugs work is pretty incredible.
Two of the new pumps are related to issues with the pericardium.This is the membrane that encloses the heart. As part of the first transplant they had to cut through this membrane as a result when healing it thickens. For the re-transplant it becomes more difficult to manage the bleeding and the fluid can build up requiring another pair of drainage tubes.
They did have to insert another NG tube (nasogastric tube) to remove the air that was building up in her stomach. This NG tube is about the diameter of a pencil and inserted through her nose into her stomach. The tube is then connected to a pump and the gases and fluids are collected. Luckily she was out cold and will not remember this.
Laura is still intubated and will remain on the ventilator until we have a grasp on the bleeding. If she was to have surgery tomorrow they would have to reinsert the breathing tube so they thought better of it to leave it in over night.
She was able to respond to voice commands, move her fingers and toes, squeeze my hand and open her eyes at multiple points in the day. Tonight they will sedate her and let her sleep through. Tomorrow we have rounds at 7 and will learn more based on the progress of the evening. 37 hours later it is time for some sleep.
We cannot thank the team enough #UCSFLungtransplantBadasses. All of the Doctors, NPs, RNs, RTs, anesthesiologists, endocrinologists, pharmacists, chaplain... all amazing!
To share a story, our pharmacists came by today jumping up and down so excited that the re-transplant went well. As she was one of the people managing the pre-op testing she knew in advanced what was going on. She was so excited that Laura was going to receive the transplant she avoided us all day yesterday because she did not think she could keep it a secret. She thought she would give it away. That is an example level of connection we have from the team. A similar story happened with one of the RNs. Just can't say enough positive things about this team.
A big step forward. More to come tomorrow.
Love,
The Z's
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