This past Thursday I had an appointment with Dr. V (our pediatric cardiologist). These appointments are spaced 4 weeks apart, but for whatever reason, I always feel like I was just there. Dr. V's staff is so sweet and I absolutely love my ultrasound tech, Michelle!
These appointments are simply to make sure that Josiah's heart is still strong and functioning. At my last appointment I was in and out in an hour. This time it took about and hour and a half...Josiah was being a little stubborn =) Once Michelle finally got the pictures she wanted, Dr. V came in a did a little scanning of his own. After he was finished, he mentioned he noticed something that was a little concerning. Dr. V asked if I had the drawing he had given Anthony and I at our first appointment. I told him yes, but not with me (guess it would be a good idea to keep it in my purse). No worries though, he drew another one and went on to explain what the ultrasound was showing. He started by saying that Josiah's heart still has a very strong squeeze. He even drescribed it as a little above average!! After the good news he went on to explain what the ultrasound was showing.
Ok, are you ready for a little science lesson??
When a baby is in the womb, its blood circulates differently then when they are born. When a baby is born, there are two parts of their heart that will close shortly after birth: the PFO and the PDA (I won't confuse you with what those letters stand for, lol). The PDA (which connects the pulmonary artery and the aorta) closes between 72 hour and 2 weeks, and the PFO (which allows blood to flow from the left atrium to the right atrium) closes between 6 months and 1 year.
When Josiah is born, he will be given prostoglandin to keep the PDA open until his surgery. This needs to be open so that at least a portion of his oxygenated blood from the left side of his heart can flow back to his lungs by flowing from the aorta to the pulmonary artery.
Here are some pictures that might help you get the idea:
Picture showing the PDA
Picture showing the PFO
What Dr. V believed he noticed had to do with the PFO. The ultrasound can measure the pressure of the blood flow from the left atrium (LA) to the right atrium (RA). A normal pressure measures around 1. Dr. V mentioned that the ultrasound was showing Josiah's measuring at 2. So, what does that mean? Simply put, the flap was being partialy closed from the pressure of the blood flowing from the LA to the RA...not a good thing. Because Josiah's left ventrical (the chamber right below the left atrium) and aortic valve are small, it does not allow a lot of blood to flow through. Therefore the PFO being open is critical for Josiah so that the blood has somewhere to flow and does not get backed up.
If the PFO does become partially closed in HLHS babies, then blood flow becomes backed up. The blood has no where else to go but into his lungs. I asked Dr. V what that would mean when Josiah is born, and he said it would mean that he would be a little more sick, and we would need to get him to Egleston sooner. This condition is called restrictive patent foramen ovale or Pulmonary Hypertention. Before Josiah could have his first surgery, he would have to undergo another procedure that would open up the PFO. This procedure is similar to when a person has to have stents put in. They go through a vein in your leg, in through the inferior vena cava and insert a little balloon to open up the PFO.
**Interesting fact: during Josiah's first surgery Dr. Kanter will actually permenantly open up Josiah's PFO flap. This will allow the blood to flow freely from Josiah's left atrium to his right atrium**
I don't know if this is a good thing or not, but I felt like I was numb to the fact that more bad news had been added to Josiah's condition. I wasn't taken aback, I didn't panic, I wasn't mad, I simply just began asking Dr. V questions and listened as he drew a picture and explained. Maybe it just hadn't had time to sink in. I thanked Dr. V and I remember telling him we're just going to add that to our prayer list and scheduled another appointment in 4 weeks.
After handing my stamped parking pass to the attendant I decided to call Anthony and let him know what I had just found out. After he answered I asked how his day was going and he said it was fine, but before I could go into detail about what I had just learned a number beeped in. I noticed it was the number Dr. V's office usually calls from. Normally, I would have just let them leave a message and I would have called them back, but for whatever reason I told Anthony to hold on for a second. I answered and it was Michelle (my ultrasound tech) and she sounded very happy. She went on to tell me that after I left, she and Dr. V went to his office and he did some calculations of his own. And, come to find out the pressure of Josiah's bloodflow was NOT measuring at 2, but instead it was measuring within the normal range!!! PRAISE THE LORD! It was measuring a little on the higher end of normal, but none the less, MUCH better than what we had thought! Michelle said Dr. V would be more then happy to talk with me if I would like, but I told her it was ok, that I was just happy to hear everything was actually fine! She added that after Dr. V recalculated, his reaction was "This is factastic!!" Haha..I can totally hear him saying that. I clicked back over to Anthony and began to explain everything that went on at the appointment. He was glad to hear everything turned out to actually be OK!
Now that I have had time to actually think back on what could have possibly been another thing wrong with Josiah I am so so thankful the Lord decided to step in and perform this little miracle. It was a reminder that HE is in control of everything, and all I have to do is lean on Him to give me the strength I need. I told Anthony the other day, I feel like I am OK right now, but that the real test of my faith will come when Josiah is actually here, especially the day of his surgery. I will be completely helpless...the only thing I will be able to do is to place Josiah in the hands of my Lord and Dr. Kanter and pray. I can't even fathom that now, but the good thing is I don't have to. The Lord gives us what we need, when we need it.
Thank you again to all who have mentioned that we are in your prayers. I just ask that you continue to pray for Josiah and his little heart. I didn't even think to ask Dr. V if pulmonary hypertenstion is still something we need to be concerned about popping up before he is born, but I am asssuming it can. We are still praying for a miracle, but that most importantly that the Lord's will be done and that we are accepting of it.
All fears and anxiety aside, I can't wait for the day that we get to meet this little boy that enjoys kicking my blatter and right rib!
"So do not fear, for I am with you; do not be dismayed, for I am your God. I will strengthen you and help you; I will uphold you with my righteous right hand."
~Isaiah 41:10
SUCH a blessing to hear that the office beeped in on the call to change the news!!!! Keep strong in your faith, which you are obviously doing!!!!
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