Rudy had two check-ins down at UCLA this past week.  The first was at the dental clinic.  I think we’ve mentioned here before that good dental hygiene and care is a surprisingly critical issue for heart transplant candidates.  In order to keep on top of this he gets to travel all the way to LA for what usually amounts to a quick checkup–but this one had a little more excitement than usual.  Some roughhousing recently led to Rudy losing a front tooth and left the one next to it pretty loose.  Upon further inspection in the dentist’s chair (you see where this is going, right?) the second was pulled as well making Rudy the embodiment of a fine Christmas cliche.

Thursday, we had his six-month appointment with the transplant team.  While Rudy isn’t listed as a transplant candidate, this serves as a means for the team to stay current on his condition.  Trips like this to LA are significant not just because of the appointment itself, but all that comes with just being in that place again–the memories evoked by stepping over a familiar crack in the sidewalk, recalling a conversation had at a particular lunch table, the emotions that come from walking by a bench that you once tried to gather yourself on, and the likelihood of running into some of the incredible people that were such skillful and compassionate guides during Rudy’s fight there.  Add to this the fact that Rudy was consistently emphatic about walking instead of riding in the wheelchair.  Not sure how much he knew about where he was but it gave me a lump in my throat to see him stomp down hallways with his mix of determination and mischief.

He had an extensive echo done and then we met with Dr. Alejos.  Nothing really significant to report in either direction there.  Everyone is extremely impressed by Rudy’s weight gain and developmental growth–Dr. Alejos always comments on how much he likes to hear the racket of an impatient kid waiting in the exam room and welcomed Rudy’s rambunctious energy.  He observed that no change is a good thing and didn’t see anything on the echo that would make him want to do a cath.  Even though he wouldn’t consider Rudy a candidate for any surgical intervention at this point, he also doesn’t see any imminent need.  We asked him if it surprised him that Rudy would be doing as well as he is and he answered, “If I was just looking at files and reports, I would envision a very different kid–but I know how Rudy fought his way through challenge after challenge here in the ICU.  There’s some things we just can’t define in medical terms.”

After wrapping up at the clinic, we decided to pop up to the 5th floor.  We weren’t going to bug people by ringing the bell to enter the ICU and only intended to take a lap around the hallways and let Rudy see the pictures of penguins and puffins we used to look at–until Dr. Andy popped out just as we were walking by and waved us in to say hi to the crew on duty.  So great to see Dr. Andy M, Dr. Andy S, Dr. Myke, Dr. Julianne, Jennifer, Roger and several of the nurses still there.  Rudy didn’t disappoint and strutted up and down the hallway, saying hi to everyone, wanting to play with their computers and machines and trying to run away from us.  Hard to put into words what the feelings were to see our seven year old strutting past his old room–in the unit where he was the first patient–and rooms where other kids were now waging their own fights.

Unbelievable.

There were several times during the seven months he was in the CTICU when I wondered if Rudy would ever make it out of the unit.  I don’t think I ever imagined I’d see him walking through it with his trademark giggle and chatter.  A sacred moment caught us by surprise.  So grateful for this place and the exceptional people there–and glad they could get a glimpse of the rich life the little baby boy they watched over seven years ago now has.

After our quick visit there, Dr. Rick left a meeting to greet us in the lobby and Dr. Dan (who had already read the echo report) and Dr. Greg came and met us on the sidewalk outside the lab.  In both instances, they were visibly surprised when Rudy walked up to them and we enjoyed visiting in between taking turns running after him.  All of them were so affirming of his progress and we were so grateful for the amazing people who have come along us in this journey and focus so much incredible expertise on Rudy.  (In fact, we were so amazed, we forgot to take any pictures…boo!)

We have, however, captured some Christmas fun so far this month…

Trish, Max, Olivia and Rudy braved the frigid temps (of about 55 degrees) and helped officially usher in the holiday season in the annual Santa Barbara Holiday Parade.

Saturday included our family’s favorite Goleta tradition…Christmas at Stow House!!!  Santa recognized Rudy and greeted him with outstretched arms & great enthusiasm as Rudy walked up to the man in red all on his own.

Anticipation for Christmas is growing!  We have the SBRM staff celebration to look forward to this week and the arrival of both Oma and Wilson on Thursday.  With the bulk of Rudy’s key doctor appointments behind us, we are ready for some more serious Christmas fun.

 

 

 

It’s been awhile since I (Rolf) posted on the blog, but since I did the run with Rudy down to the UCLA Transplant Clinic, we figured I should provide the update.  With the end of the school year upon us, it seems like there’s some activity or event every day.  Thursday it was Livy’s turn as she got inducted into the National Junior Honor Society.  Trish stayed home for that and Rudy and I rolled out of town shortly after 5am to make it to UCLA for an 8am appointment.

Not long after we were underway, I realized that the CD case wasn’t in the car, but Rudy wasn’t bugged because his recent favorite–“Hola!” a Spanish-language Kid’s album of songs about the sea–was on board and entertaining us.  Enjoyable for both cultural and education purposes for a listen or two, but assuredly crazy-making by the fourth repeat (“Yo soy un pi-ra-ta!  Yo soy un pi-ra-A-A-ta!!)  (“Cuantos peces diferentes colores hay en el mar?”  How many different colors are the fish in the sea?  EVERY BLASTED COLOR!!–and there’s a verse for every one of them!!!)   My subconscious desire to bring an end to this caused me to accelerate faster than I normally would as was pointed out by the law enforcement official who pulled me over. Full disclosure:  I’m ashamed (but admittedly relieved) to report that my smiling son singing his Spanish fishy songs in his wheelchair spared me a pretty expensive ticket.  During the traffic stop, I was able to locate the only other CD in the car–Olivia’s Taylor Swift–and begged Rudy for a switch to even this, but “Hola” remained the soundtrack for our day.

Anyhow, we got to UCLA and the action started:

After that, we went to the exam room to wait for the doctor.

But Dr. Alejos was delayed up at the hospital…

Nurses were apologetic as they kept us posted.  When Dr. Alejos came, Rudy held the door closed and giggled when he couldn’t get in.  When he did let him in, Dr. A took a look around the trashed room and said, “This provides us with most of the information we need about how Rudy’s doing.”  He did go on to do a thorough review of meds, recommended a few changes because of Rudy’s weight gain (he just broke 40lbs–yay!) and filled in history since our last check-in.  We then talked through the Echo report on the computer and he liked what he saw.  The heart function looks good with very little valve leakage.  While Rudy has been previously classified as “Moderate Heart Failure”, Dr. A would still categorize him as “mild” (or maybe “mild-plus”). After a quick listen, he pushed out the date of our next clinic visit to six months–no need to come back sooner.

Rudy knew it was time to go and before I could get his stuff picked up and his chair ready, he had already given Dr. A and the nurses his “See-Ya”s and headed down the hall.  Wouldn’t get into his chair (“no! no! no! Dad!”) in the lobby or by the elevator and walked all the way out of the building.

Before we left UCLA we had a few folks we wanted to see, so we made our way up to the hospital and enjoyed a quick visit with Dr. Rick (who is now the Chief Medical Officer of the entire Reagan Medical Center, but we knew him back when he was just the best doctor in the world).  Rudy’s got friends in high places!  After that we had a fun lunch with our friend Melanie in the Development Office.  (Panang Chicken from Mr. Noodle is really yummy even when you aren’t stress-eating it as an CTICU parent!)

Didn’t get to see Dr. Dan, but it really lifted my spirits when I got an e-mail from him while we were still on campus:

“Saw Rudy had an ECHO today here at UCLA – the stent we put in his aortic coarctation continues to look great with no significant gradient and his RV function has not changed much (still fine) but he has less hypertrophy in his heart since the stent and less tricuspid valve leakage (both good things).  His Sano with all those stents in it is still open but very small compared to his heart now.  Right atrium is big but not bigger!

How is he doing?  Were you seen by someone today?  Let me know if I can help with anything – just looking at his ECHO made me happy and hopeful so I wanted to e-mail you guys!

 Dr Dan”

So, a pretty good check in and report.  As we’ve been so amazed at Rudy’s stamina and progression, it is comforting to have the internal report be consistent with this.  We’ve had our share of the more confounding “not sure exactly why he’s doing as well as he is based on what his heart looks like” consults.  Rudy and I headed home and I can report that I did much better at obeying traffic laws (but the traffic and rain likely had a lot to do with that).  There’s much excitement to come in the next month and we’re so glad Rudy is at the point he’s at to really enjoy it.  Stay tuned!

Thanks for praying us through a loaded day yesterday. Given the haste with which this cath was scheduled–and some of the past experiences we’ve had of cath results being a kick to the gut–we were a bit apprehensive leading into things and probably even steeling ourselves for some tough news.

Our anxiety was heightened by the discussions during pre-op. The primary goal was to see if there were any things that could be done to lessen the strain on Rudy’s enlarged heart. Signs pointed to the coarctation in his aorta (fancy doctor-speak for a tight bend which restricted flow–like a stubborn kink in a gardenhose). The team has previously tried to correct this by inflating with a ballon, but the bend acted like a crease and it popped back. The way to fix it would be to insert a metal stent, which is common in adult patients, but Dr. Dan couldn’t think of a patient as young as Rudy in which he had ever done it. The main problem is “getting the equipment to the jobsite”. The large stent and catheter they would need to do the job would need to be threaded up the femoral artery from his leg and there was concern it just wouldn’t fit. Additionally (and admittedly a bit disheartening) is the fact that the left femoral artery is Rudy’s last un-occluded path to his heart.  Even the most skillful intervention creates scarring and an artery can only be used a limited number of times before it becomes impassable, leaving more complicated surgical cut-ins as the only option. So the team needed to weigh whether any intervention was worth that cost, but they wouldn’t really know for sure until they got in and assessed things.

Needless to say our heads were spinning more than usual as we headed downstairs–but at least it took away our appetites and kept us from stress eating our way through the waiting. Good company and a lot of drop-bys from docs and nurses helped to pass the time. We got a progress call from the lab nurse around 3 hours in that they had stented the Sano shunt (which had narrowed significantly) and were finishing up–no action on the aorta. Not bad news, but we kind of prepared ourselves for a “there was really nothing much we could do” conference.

Just a few minutes later we got paged again and Dr. Dan was on the phone rattling through the positives: heart function looks better than everyone feared (perhaps the reason we suspect they rushed us in), they were able to open up the Sano to its original size, and now they had just finished a consult with Rudy’s surgeon and did feel that they should attempt to stent the aorta.

The significance of the moment only hits me in hindsight, but almost unnoticeably things shifted into the quiet intensity that one can suddenly find themselves in in the cardiac world. Just as Dan told me that Brian Reemtsen (surgeon) was coming coming out to speak to us, Brian stepped around the corner. We had a brief three-way exchange with Dan in my ear and Brian in front of me to make sure I understood what was happening and that they were in agreement. Dan finished with, “we will stop at any point if we feel it isn’t safe, but do we have your permission to proceed?” Of course, I agreed but it was only later that it struck me that this was not a routine procedure.  Even with the global consents we had signed in pre-op, there was something about what they were attempting that they felt like they needed specific consent for.

Dr. Brian spent time with Trish and I expressing encouragement over Rudy’s condition and that, given the strength of the heart muscle, it was very worthwhile to attempt a step like this to reduce the strain.  While any future surgical course is still unclear, successfully addressing the coarctation would have to happen first. Brian certainly wasn’t promising anything specific, but there was a note of wonder that we might be talking about that someday.

We had a bit more to wait before Dr. Dan showed up to give his report and walk through the imagery. He was very upbeat and told us right away that the aortic stent could not have turned out better. The arc had narrowed to 9mm and they were able to insert and expand a stent to 16mm–the size of an adult aorta–which means there is no pressure gradient across it and the blood flows freely!

As the nurse told us over the phone they were also able to fully rehab the Sano shunt to its original 5mm diameter. It had shrunk down to 2.2mm at it’s smallest point, but they used multiple stents and balloons to get it back to its original diameter. As this is supposed to be the primary means Rudy’s heart has to oxygenate his blood, it’s very good to have it free and clear (and gives us chills to think how tiny it had become). Dr. Brian also commented on how amazing that little shunt has performed–he hasn’t seen one last so long and serve a patient as well as Rudy’s has. That could raise concern that we are well past borrowed time, but Dan said he’s now given the Sano and the aorta “full metal jackets” by lining them with stents which will keep them stable, open and clear for a long time.

Dr. Dan was very pleased, but also wanted to get back to Rudy as he was very concerned about the femoral artery. He said they would watch that very carefully overnight as a bleed there would be a major issue.  As you can already tell, the time in recovery went really smoothly and Rudy was peaceful and content to lie still like he was supposed to for the rest of the day and slept through the night.   Among the more significant developments was that his 02 sats were consistently in the high 80s (compared to the low to mid 70s where they’ve been of late.  Since this was his first post-trache cath, it was also the first time he was intubated, so he had a scratchy throat and barely spoke above a whisper–until the moment he saw his big sibs at home had him squealing with his trademark joy.

We’ve learned to navigate this journey and all its big uncertainties by looking for reasons to celebrate and embracing them.  That’s what this day meant for us.  The big questions didn’t get answered and the major issues didn’t get resolved–but who knows if and when they ever will.  For now, we’ll celebrate Rudy’s armor-plated arteries and the positive step they are.