Up next, ear tubes!

I took Arron to see a new specialist today at Seattle Children's, an otolaryngologist. (Commonly known as an Ear, Nose, and Throat doctor.) Our eye Dr had mentioned a possible diagnosis that could explain some of Arron's various symptoms and that at some point we should have him evaluated for it. Of course the name of it escapes me now, 3 months later & somehow I didn't write it down anywhere. At any rate, we thought he was going to start walking any day, but as that didn't materialize, I decided to call & get an appointment & I'm glad I called when I did. There are only 2 or 3 OTOs that work with the craniofacial team and their schedules are BUSY! 

So anyway, he said the number of ear infections Arron had last winter would qualify him as a candidate for tubes. And, on inspection, he still has a lot of fluid behind the right eardrum and almost done behind the left. He said it's absolutely possible that it is impacting his balance. His torticollis also has him tilting right, which only further stacks the deck against him. So while he can't say for certain that it will help, he wouldn't be surprised if he started walking shortly after the tubes go in. I am anxiously awaiting the call from his scheduler. 

He also mentioned that he is 1 of 2 providers at Children's that can perform a procedure through the nose to fix Arron's tear ducts if they become an issue again. It's about a 2.5 hour surgery, completed by him and our opthalmologist as a team. He doesn't think it is necessary at this point, but wanted to put it on my radar as an option in the future, if needed. I believe it's called an endoscopic dacryocystorhinostomy. 

She's all done

Her Dr came out to talk to us and once again, she's the weird kid. The good news is, her pathway is low risk. So we don't have to worry about sudden cardiac death! The less awesome news is, while testing the pathway she went into true SVT, which is what he was looking for on her heart monitor she's had for the last month. So, since she went into SVT, he decided it made sense to find the pathway & try to destroy it. So the leg caths went in, meaning 4+ hours of recovery. But once he found it, it's right next to her AV node. Which means destroying the accessory pathway has a risk of destroying the AV node, and then she would need an immediate, emergency pacemaker placement. He decided that the risk of destroying the path outweighed the benefit since we know it's a low-risk path & she's never had SVT documented before. 

So we're just kicking it in recovery, watching Netflix with dad, waiting for 4 pm, when they'll get her up & make sure she's clotted correctly & then send us home. 

1st Update

They book Bri to the OR about 8:45, and we just got our first update. Dr. Salerno was planning to start with just testing the pathway & determining if she had a high or low risk pathway. If it was low, the procedure would be over with just one catheter in through her neck. 

Unfortunately she had sustained episodes of SVT during the first part of the procedure, so they are going to locate & destroy her accessory pathway. That means she needs the catheters in her groin on both sides, and a minimum 4 hours of recovery to allow for clotting. This next part of the procedure can be 3-6 hours. 

Seattle Children's Part II (a bit belated)

So we took Bri up to meet Dr. Salerno. The cardiologist & electrophysicist who will be doing her heart procedure. He is the head of electrophysiology at Children's, has done more than 500 procedures in his own and has done another 1,000+ as part of a team. He's very knowledgeable and has a 12-year old daughter too. 

I realize that I haven't really explained what WPW is, so this post will be a bit longer to fill in some background. WOW is an arrhythmia that occurs when you have an extra bundle of conductive tissue in your heart. The electrical signals that cause your heart to beat SHOULD go from the sinus node, to the AV node which causes the bottom of the heart to pump, and then dissipate to start again. In WPW, the extra conductive pathway is called an accessory pathway, and where it is & how strong it is, determine if it is low risk or high risk. A high risk pathway can lead to sudden cardiac death if she has a tachycardic episode that travels down the accessory pathway and puts her into a rhythm called v-fib. So nothing to take lightly. 

The first step was to meet with a cardiologist (Dr Trippel) & do another EKG. She was still in WPW, so the next step was a 24-hour Holter monitor. So it recorded 24-hours of heart activity & when Dr Trippel reviewed it, she never converted back to a normal rhythm. So the next step was a cardiac stress test. They hook you up to an EKG machine, put you on a treadmill, and every 3 minutes it gets faster at a higher incline until they max out your heart rate or you have to stop for some other reason. Bri called it quits at 5 mph & 18% incline because of knee pain. She really hasn't done much running or rehab since her surgeries. Her heart rate was just over 200. The good news was her heart responded appropriately to the exercise & recovered appropriately after. The bad news was, she never converted out of WPW. So we know her pathway can conduct up to 200 beats per minute. It's only considered high risk if it conducts at least 250 bpm but we don't know if hers will since we couldn't get her heart rate that high. 

So, they sent us to meet Dr. Salerno because they aren't able to prove that her pathway is low risk. Since her last knee surgery, she has also started reporting bouts of tachycardia. So, Dr Salerno said it would be helpful to catch some of these episodes on a heart monitor. They may give him a clue as to whether or not her episodes are dangerous. For the actual procedure, Dr Salerno doesn't usually recommend destroying the pathway if he can prove it is low risk. The risks of other heart damage during that process often outweigh the benefits. If it is a high risk pathway, it definitely needs to be destroyed. 

So, the initial plan, is 1 catheter into the neck to map her heart, find the pathway, & test it. If it's high risk, 3 more catheters will be inserted through the groin, 2 in one leg, 1 in the other, and they will destroy the accessory pathway. Unless the heart monitor she's sporting right now shows Dr S what he's looking for & knows up front that it's dangerous & needs to go. They'll still have to map it & find it, but there may be less testing. 

Depending on where it is determines if they burn it or freeze it & also dictates the various potential complications. Those range from bruising to stroke, pulmonary embolism to destroying her AV node requiring immediate placement of a pacemaker, and death. But, if it all goes off without a hitch, we go home same day. It's scheduled for March 14th. 

Seattle Children's Part I (for the week)

Today we are at Children's with Arron having his eyes rechecked to see if his tear ducts are blocked again. He's got the dye in his eyes now & the Dr should be back soon to check him. 

Dr came back & all looked good! Just needs to be seen around his second birthday to have his eyes dialated & the whole shebang. 

We will be back on Thursday with Bri to meet the cardiologist who will do her ablation. 

Always the "interesting kid"

Today's post isn't really about A2, other than to say he's making huge strides at PT recently and has started crawling!! 

So today, we took my oldest stepdaughter to Group Health for her 3rd knee surgery (she's 12). The plan was to just remove the whole meniscus because it looked on the MRI like it was basically disintegrating. But our Dr knew the images weren't very clear & there was lots of signal from scar tissue left by her last 2 surgeries. So anyway, that's not what was going on with her knee. Her plica band was out of place so he removed that & part of her previously removed meniscus was attempting to regrow itself, so he cauterized that to remove the frayed tissue. 

But I knew something else was up because he took us to the consult room to discuss things. He said something about it being for patient privacy, yada yada. But the last 2 surgeries, he didn't take us there & I even commented that when I worked at Harborview you only went to that room when things didn't go according to plan. He chuckled it off, but then after he told us about her knee he said that she was fine, but she's always the "interesting kid" and nobody wants to be "interesting" in the OR. This time, the anesthesiologist noticed a slight change in her heart monitor. All her vitals were fine & whatnot, but the rhythm was indicative of Wolff-Parkinson-White Syndrome & they were going to get a full 12-lead EKG to confirm & consult with a cardiologist to make sure she was ok to discharge home & follow up with our pediatrician & then a pediatric cardiologist later. (Which they gave the thumbs up for.) From the little bit I've read about WPW, it sounds like it can be a complete non-issue or it can be full on life-threatening. 😕 There's only one symptom Bri's ever complained of that could be related, so I'm assuming she's on the non-issue end of the spectrum if she does have WPW. But, better safe than sorry!

So they are sending a report to her Dr. to be able to make the referral. It looks like Group Health's only ped cardiologists are in Bellevue. If that's the case I will probably just ask them to send us to Children's since we already know their routine & I'd rather drive there than Bellevue. Besides, maybe I can combine her appointment days with A2's! 

Obviously the clinic is closed tomorrow, but I will call Friday morning to see if Dr. Asomaning will just give us the referral without being seen in the clinic. Keep you all posted. 

Kidneys, aka trouble makers...and other things

Today we went up to Children's for yet another kidney ultrasound & consult with our nephrologist. Things got off to a bumpy start in radiology when I realized that he had a minor blowout somewhere between the car & the ultrasound room. So, after we got him cleaned up, we were ready to go! The tech was able to get all the images she needed but it was a lot more work to keep him still than last time! The kid got ultrasound jelly up to his armpits, on his nipples, all over my arms, and even on my necklace! It's a good thing he's cute!

Waiting for the tech to confirm that she had everything she needed. 

Then we headed up to Nephrology to meet with Dr. Hanevold. Everything was very encouraging. His right kidney is greatly improved & downgraded from grade 2 to technically still grade 1, but the radiologist even commented in the report that it was a "minescule trace" amount of hydronephrosis. The left kidney was also downgraded from a 2 to a 1, but was still much more obvious. She still wants to be sure that it resolves so we will see her again but not until sometime just before his 2nd birthday. She said no need for a special trip up, just combine it with another visit day. Plus by then we will have results from his genetic testing so just in case it turns something up, we can talk about that too. 

Which reminds me, I owe you guys several other updates! 

Yes, he got a third helmet. We went all out decorating this one since he was going to be in it for Halloween. 

Boooooooo, lame white helmet we ordered. Until dad fixed it up:

Aaaaand complete with the costume on Halloween: 

No results from Children's in Philly yet. It's been a full 6 months now, so hopefully soon, but they did say it can take up to a year. One thing I realized today is I never got super clear about what all this testing is looking for. I'm pretty sure when we started all this I posted about the whole amount of DNA vs the spelling of DNA issue. We know he has the right amount. We just don't know if he's got "spelling errors" or not. The study in Philadelphia won't analyze the spelling of all his genes, just some. But I don't know if they select those genes based on his personal health history, or if it's a predefined set. Guess I ought to call & find out. 

Last but not least, his clogged tear ducts. He had an appointment to clear the duct on September 16th. Dr Weiss had said that since he was doing it in the OR with full sedation, he would put in tiny little stents to hold things open & improve the long term outcome. Unfortunately, he couldn't get the stents in. He was afraid he was going to tear Arron's tear duct. So he cleared the blockage & put him on some antibacterial eye drops because they had been blocked for a while & there was lingering infection. This was the first time in his career that he couldn't get the stents in. And of course the CT scans Arron had done before & after surgery didn't have the fine facial details he needed to take accurate measurements & find small enough stents. So fingers crossed they don't clog again & if they do, he will probably order a new CT to have a better look at what's happening internally. 

But I'm falling asleep typinv, so I guess it's time to go.