We are few days late for the one month heartiversary, but close enough. Zayne is doing amazing and slowly putting on weight. She wanted to bake a cake to commemorate this occasion – she made the cake all by herself (following the directions on the box).
Cath results are good – her pressures are great. When I saw the pathology results come back as a 1R (mild acute cellular rejection), my heart sank. But it isn’t a concern since jumping between 0R and 1R is common (you can’t get rid of rejection 100%). We are still waiting for her AlloSure results. This special blood test will quantify the amount of donor heart DNA floating around in her blood stream. Donor DNA in blood is bad. We don’t expect to have high amounts, but it will be good to get a baseline. In the future, we may be able to use AlloSure to check on possible rejection instead of having a cath with a biopsy.
Zayne had her first right side cath on her new heart. The hospital called Tuesday afternoon to change the procedure from Friday to Wednesday. It was a really long day at the hospital, since the cath was scheduled for 1:30 pm, but we had to be at the hospital by 7:30 am for blood work. For the first time as out-patient, the cath was inserted into her neck – this means no mandatory 2-hr down time. We were able to leave much more quickly and Zayne has less restrictions (not that it matters too much since she is still on sternum restrictions). The doc said her new heart looks amazing and the pressures look like a normal heart. It is the first time in 4 hears that I received positive news from a heart cath. The transplant team was not expecting such good results just 3 weeks from the 10 hour surgery and the emergency that followed.
We still have to wait for the biopsy results to see if she is in rejection. Zayne has no signs of rejection, so if she is in rejection, it will be easier to treat. Stay tuned for the biopsy results. We’ll be going for blood work on Friday – if her immunosuppression levels look good then she can drop 3 meds.
It is good to be home. We still haven’t unpacked everything from the hospital stay, because we have to pack for another possible stay. Zayne has a right side heart cath on Friday, May 24. Right side (vein) is safer than going to the left side (artery). The primary reason for this cath is to check for rejection by looking at heart biopsy samples under a microscope. Flows and pressure will be measures and calculated.
Once Zayne’s immunosuppression level for Tacrolimus have stabilized, she will be able to remove 3 meds from her regiment. These are the meds she takes every morning. Some meds are prescribed for up to 6 months post Transplant, and others will drop off as pain and heart function improve.
Zayne had her final IVIG infusion (4 hours long), and we will be going home on Saturday, if her kidney levels are reasonable. Her incision still hurts quite a bit, but the pain is helped with oxycodone. We walked to the hospital pharmacy and picked up another couple of medications. We are going home with 10 prescriptions. With time, most of them should go away. If her heart loosens up and she can stop using blood pressure medication, she should be down to only 3 ongoing prescriptions after 6 months. The risk of rejection is highest right after transplant, but this doesn’t mean rejection is out of the picture. Zayne went into rejection with her last heart after nearly 5 years.
I’ve been required to have discharge appointments with various departments. I think there is only one left that will occur just before we are let loose. I hope we can go home on Saturday! We’ll have 2 transplant clinic appointments each week for the first 3 months that include early morning blood draws. Since Zayne still has a little bit of fluid around her lungs, she will also continue to have X-rays.
Zayne receiving her Bag of Fun
An order of oatmeal had a piece of plastic wrap in it – discovered while I was eating and wondered what I was chewing on. This was after eating eggs that had a surprise and unwelcome taste of bacon for one bite. I showed the nurses, and soon after received a new oatmeal order with a note “please make sure there’s no plastic in the oatmeal”. Zayne stopped eating most hospital food a while ago and threw away the new bowl of oatmeal.
Zayne holding platic wrap from oatmealRidiculous message from the kitchen
Zayne has impressed the medical staff with how quickly she has recovered and progressed. Her heart transplant and following open heart surgeries all took place last week. No one thought she would be discharged the week after her complications following the transplant surgery.
Zayne needs to rebuild muscle and get back to her previous weight. She will be on sternum restrictions for a while (no bikes, horses, scooter, etc). But, we go places that we couldn’t go to before since we aren’t required to be available 24×7 on the phone.
Yesterday consisted of 3 different walks around the CPCU. We had to drag around an IV pole since Zayne needed 3 infusions: Potassium, Magnesium, and intravenous immunoglobulin (IVIG). IVIG is pooled antibodies from other people that helps to rebuild her immune system.
Today, an IV was removed, and Zayne has a single PICC line left. She was free all day and had a good walk about. Some time in the teen room to play Mario Kart where her support team brought a wheel chair. Zayne felt great, and I (alone without medical staff) took her down a flight of stairs and outside to walk on terra firma.
Later, Zayne walked up to the 11th floor from the 9th floor, and then down 11 flights to the 1st floor. Her heart feels great but her skinny legs are tired.
Tomorrow Zayne will have an MRI of her brain to check function after being on ECMO. She also has an appointment to pick up her Bag of Fun – she is looking forward to seeing what she gets. When I spoke with the coordinator last week, I didn’t think she would be able to walk to the office to pick up the bag herself. Zayne has come a really long way in a week. It was just last week where she had a heart transplant followed by emergency surgery to install ECMO, another open heart surgery last Tuesday to remove the ECMO cannulas, and her breathing tube was removed last Wednesday.
Pasta dinner
Ghirardelli hot chocolate
Going down stairs for the first time with the new heart
I had a 5am apple request, then a 7am announcement “I’m hungry”. Zayne downed her first protein shake since April 26. During this mornings ECHO (ultrasound of her heart), she turned on the TV to watch a cartoon. This may not sound like much, but she has just been blankly staring at walls and equipment. It is a good start to the day.
Zayne had a couple of questions and comments about her new heart: 1)Will I always see my heart beating in my chest, 2) I can feel my heart beating in my fingers and toes. I’ve never felt this before. She wrote down this questions to ask the transplant cardiologist during rounds. We never know when rounds will happen. Anytime between 8 and 1, but usually around mid-morning.
Unfortunately, the night nurse seemed to have a heavy hand when stripping the chest tubes (squeezing the tubes to push fluid into the floor receptacles). Zayne has a lot of pain at the entry point and new pain where she feels the tube inside of her: I feel the tube in my lung. She is telling me that she will ask for morphine but she just received her Oxycodone, so that may work.
I’ll post updates later today.
Zayne is free from support lines/wires/tubes. Both chest drains came out along with the pacemaker wires. She is still pretty sore on the side, but she said “I can breath” after the right drain was removed. Zayne said every movement and every breath hurt with that right drain. Her body should absorb any remaining fluids. She still has some air and fluid in the pleural cavity – these are being closely monitored. She is on room air (not using the oxygen nasal canula anymore) and has no support other than medications. As soon as the drains were removed, we moved to the Cardiac Progressive Care Unit (CPCU). These rooms are more modern – larger bed for me, a bathroom, more counter space, …. and a better view from the 9th floor.
Zayne hasn’t been sleeping well, and it all seemed to catch up to her. Instead of going for a walk, she slept for hours. I asked the nurses to have Zayne step on the scale again and grab another scale to make sure I was seeing her weight correctly. She has lost 10% of her body weight. I guess that happens when you don’t eat for 1 week. Her stomach has shrunk, so she is stuck with being hungry but not able to put the food in.
She will have blood work every day and the therapies: respiratory, occupational, and physical. Speech (for eating) made their last appearance today and will not come back. Other staff that just show up are child life, psychologist, and social workers. Multiple doctors stop by, along with the charge nurse, and her assigned nurse and care assistant. Everyone knocks, but they just come into the room.
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Zayne is slowly getting more mobile each day. Today was her first walk with 4 people escorting her. All of her IV medications are out, but she still has the two chest drain tubes (both are still painful). She is eating a little, but doesn’t always feel well and needs to get used to eating after a week of no food. Once her drains are out, she will be in less pain and able to move around a lot better.
I was wearing my hospital slippers and my foot felt wet – for the first time in many years, I had pee on me that soaked through my slipper and sock (due to a little commode mishap). I’ll be doing laundry tomorrow.
There is a chance that drain tubes (at least one) may be removed along with the pacemaker wires. The newer right drain is still producing, so we’ll see if it can be removed. Zayne gets an X-ray every day between 4:30 to 5:00 am. I’m sleeping when this happens, so I am not protected. In addition to the X-ray, there will be more bloodwork. If the tubes do get removed, we will probably move from the CICU to the CPCU on the 9th floor. The digs are a little more comfortable, and I look forward to have a private bathroom with shower.
Not much happened today – my big excitement was taking a shower and doing laundry at the family resource center. Each day Zayne is able to do more and have more medical devices removed. Unfortunately, yesterday’s new drain is still very painful so moving around is difficult. She was ready to go for a short walk, but the nurse was not comfortable with her mess of tangled lines and the extra respiratory device that would need to be hooked up to a portable cylinder. She should be able to go for a short walk tomorrow since she has switched to a regular canular, had her arterial line removed, and will have her neck central line removed in an hour (yes, late at night). Meds are being switched from IV to oral.
Zayne ate a little more and kept everything down. Hopefully, she will eat more each day. She spent a lot of the day just sitting – not wanting to use an iPad or watch TV. I did get an iPad in front of her for a bit, but put it on a stand so she would have to keep her head up and raise her arms to touch the screen (I’m doing my own therapy).
Lots of line and tubes, and the larger nasal cannula (which is now gone). Zayne’s side hurts where she has the new chest drain, and her back is hurting from all the sitting. Unbelievably, her chest doesn’t hurt much.
I missed rounds in the morning because they didn’t wake me (both Zayne and I slept better in this quieter section of the CICU). It seems that I need to advocate every day:
I did get to speak to the transplant cardiologist and CICU doc and was able to get them to turn on the ability to order food (I had asked multiple nurses but they weren’t able to figure it out or just didn’t bother).
I asked what time respiratory therapy was scheduled, but the nurse told me it was cancelled. I told the nurse it was a mistake and had her contact the doc. It was an error and Zayne has started daily respiratory therapy.
I requested meds be changed from liquid to pills. I have no idea why she was receiving liquids when she can swallow more pills than I can. Tonight she had pills and taking meds became easier.
I noticed that Zayne’s neck central line dressing had come off. I was shocked because I had taken the central line classes last week and they told me to never let this happen. If I noticed that the dressing may be getting too loose, I was instructed to take Zayne to the ER. It is a big deal to change the dressing – sterile gloves are to be used (not just the nitrile gloves) and everyone in the room is supposed to wear masks. A central line infection is serious since the line goes to her heart which then pumps blood to the rest of her body.
I think there was something else, but it all starts to blur together.
Weekends are usually quiet at the hospital but plans include: – Physical therapy (includes a short walk) – Occupational therapy – Respiratory therapy
She is still producing from the new drain and the medial drain, so I don’t know when they will come out. The pacemaker wires are no longer needed – the new heart is working! The wires will need to come out. I was hoping the wires and the medial drain would come out at the same time. I’ll have to ask during tomorrow’s rounds.
Today’s surgery was a little step back, but will just be a blip in her recovery. Over 1.5 liters of fluid were removed from her right lung and a new smaller drain was installed in her side. Two of the larger drains were removed (she has one large drain left). The pumps were left in place, so she is draining to the floor storage device where output can be measured. Air was accidently introduced into her lung during the surgery. Hopefully, this pneumothorax will be sucked out with the chest drain.
This is not Zayne’s device, but it shows where the chest tubes are going. She is down to two from three.
The new drain on her right side is extremely painful. Zayne told me it is more painful than the heart transplant. She looked at me and asked “Why did you let them do this to me?”
Since the Foley is out, she has gotten out of bed numerous times through the day. It takes at least two people to get her out of bed without ripping out something important (like the IV that was ripped out last night). There are sternum restrictions, so Zayne cannot use her arms to push or pull herself. Also, she cannot be moved with pushing or pulling her arms, or lifting her under her arms. It was much easier when she was 4 because I could easily lift her by myself. I find myself doing more and more nursing duties, so I am pretty busy with her most of the day. I advocate for her and attend all “rounds”. Today, I got her additional pain medication, anti-itch meds, and stopped a 9 pm dose of Lasix (she is asleep and I don’t want her to have to get out of bed), switched a liquid med to a pill, etc.
Zayne was able to eat a little today without getting sick. I told the surgeon that she made the stomach pain go away with the new chest tube pain. Zayne is doing so well that we got bumped out of the critical care room to a slower part of the Cardiac ICU. The new room could not fit 15 medical staff, but I hope those days are behind us.
In addition to eating yogurt, Zayne tasted some chocolate ice cream. There is a skin tear below her left eye where an adhesive was removed. I place Aquaphor on the tear.
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