Friday, November 28, 2008

Evening Update (Friday 11/28) -- Not a bad day at all

We spent the day at the NICU, and we also spoke with docs at Children's. In sum, not a terrible day at all. In fact, almost a good day.

On the northern front, we met with the attending for the day, who told us that he wasn't shocked by Max's head circumference growth. He also said it's not unusual to get a reduced volume of fluid via the LP, and that some of the CSF leaks out through the puncture anyway. He characterized the situation as a "holding pattern" while we wait to see if Max's body can learn to properly absorb CSF on its own. If Max's body doesn't, Max will need a shunt. But Max's doc doesn't expect any kind of emergent need to tap Max's ventricles in hurry. He's happy to wait a week or two to see what happens.

Max's attending also told us, and perhaps I misheard because I'm optimistic, that, at the moment, the hydrocephalus per se wasn't doing Max any damage. Any damage would have happened within a day or two of birth, but might not become visible until now as the body cleaned up waste, dead blood cells etc and the resulting holes in the white matter were uncovered. Is this bad news or good? It's a dilemma that has divided frequentists and Bayesians for a long time. But the midnight thought that somehow Max is suffering damage right now turns out to be wrong, and that's oddly comforting.

On the southern front, my personal diagnosis is that Max has scary constipation. His bowels don't move, gas builds up, his belly swells and the night staff freak out and quit feeding him. During the day today he got most of one feeding before spitting some of it back up and all of another while Carolyn held him. The high-tech medical team will convene again shortly to decide if it's appropriate to hit Max with the strongest medicine in their arsenal...prune juice. I'm not kidding. Well, he's too young to eat an unripe green apple, which always does the trick for me.

More on our conversations with docs at other hospitals later.

But on balance Carolyn and I feel much, much better this evening than we did this morning.