Thursday, January 22, 2009

Midday update (Thursday 1/22)

Great news today: the preliminary report from Max's MRI came back this morning. The early report is that the brain tissue around Max's ventricles was not damaged by the swelling of the ventricles or the small leak one of his ventricles developed. More technically, Max does not have PVL (warning: scary link). Carolyn asked Dr. B.--who gave her the news--whether this meant we could relax. (By the way, has President Obama appointed a Surgeon General yet? If not, I nominate Dr. B.) The answer is that there's a small chance (10 percent) that Max could develop PVL in the future as his ventricles change shape. If they shrink rapidly, for example, the surrounding brain tissue could tear. In addition, we don't have the formal report from the radiologists. But Dr. B. isn't one to sit on good news.

Although Max did eventually tolerate his feeds when they were compressed to 90 minutes, the NICU team have decided to give him a break and slow the feeds down so they go in over 105 minutes instead. Max did vomit and desat when they first moved him to a 90 minute feed. Although he shows no signs of lung damage as a result, they are taking a less aggressive course in response. Carolyn asked why and was told "because we want him to succeed". The NICU team also discussed whether we'd be comfortable taking Max home with a feeding tube in case he couldn't get all of his nutrition orally. However, it looks like Max has at least another couple of weeks in the hospital to look forward to.

In sadder news, tomorrow is Dr. B.'s last day on rotation as the NICU attending. She has become our favorite physician of all time. We know the incoming attendings and they are formidable intellectuals covered in professional glory. I hope that they continue Dr. B.'s tradition of giving us excellent news.