Echo of Hope

They say every publication has its own special lens through which it reports the news of the day.

Let’s say, “World to end tomorrow at noon.”

You might find:

• New York Times: “World to end tomorrow at noon.”
• USA Today: “World to end tomorrow at noon. American’s share their reactions. See pie chart.”
• Wall Street Journal: “World to end tomorrow at noon. Stock markets to close early.”
• Fox News: “World to end tomorrow at noon. Still under Obama’s watch. Romney poll numbers rising.”
• Boston Globe: “World to end tomorrow at noon. Kennedys gathering at compound. This just the latest in the list of Kennedy tragedies. See page 6 for the Kennedy tragedy timeline.”

Then there’s us. If it were another day, you’d find here on Echo of Hope, “World to end tomorrow at noon. Ari to climb Everest naked with one hand tied behind his back carrying a Sherpa. To finish by 11:30 a.m. so he has time to write his memoir before  sun winks out.”

But, like many men of his stature, Ari has his dark times. Funks of depth that would crush a mortal man.

About a week ago, Ari was eating well, looking hale, and seemingly well on the road to recovery. His echo maybe 10 days ago showed surgical success, lower mitral valve stenosis (he’s always had a little – nothing of note), and improving heart function.

Before surgery his left ventricle was “moderately” dysfunctional and his right was “severely” dysfunctional. In the post-surgery echo his left had improved to “mild” dysfunction and his right to “moderate.”

We couldn’t have been any prouder of our mildly to moderately dysfunctional boy!

Ah, parenthood.

Then he stopped eating by mouth, started throwing up every meal (that went in through the tube), and looked about has happy as the man in the man in the chair ad. Besides throwing up, he slept for two days straight. His oxygen saturation dropped into the 80s, thus he had to go back to oxygen up the nose.

After this mini funk he came around for a few days, posed for the pic in this post, and then headed back into funktown. Couldn’t keep a meal down. Sweaty. Unhappy.

The medical team thought the culprits could be, in order of likelihood:

• 9 serious medications messing with his stomach and his general comfort
• Reaction to heavily fortified breast milk
• Withdrawal from narcotics (he’s been weaning over last 2 weeks)
• Some combination of the above
• Heart function deterioration

Big bucks. Big bucks. No whammies…and stop!

Heart function deterioration.

Set condition 2 throughout the ship.

Nobody thought the problems were cardiac related, but yesterday’s echo of hope turned echo of nope.

His pulmonary hypertension, while not back to systemic level, has returned. This is causing his right heart to enlarge and struggle, likely causing the bulk of his problems.

In other news, his mitral valve stenosis, which was a 4 in the last echo, is now a 10.

Since we had never discussed mitral stenosis, we had no frame of reference for how to react to the numbers. (We’re not pediatric cardiac surgeons like all of you.) All we had ever talked about was aortic stenosis. We learned all about the numbers with the aortic valve, including that numbers of 40 or so may need to be ballooned, and numbers over 60 or 70 would likely need immediate action.

Imagine our surprise when we learned that, with mitral stenosis, an 8 is short-term surgical.

Oy.

However, the doctors currently believe that the measure is off. Echocardiograms are imperfect, and readings can be off a little to a lot. They told us quite forcefully not to worry about it, that they seriously believe we don’t have to do anything there yet.

Cardiology Today: World to end tomorrow at noon. But the reading might be off, so don’t worry just yet. We’ll go to the cath lab to confirm if we need to.

Meanwhile, here’s the plan.

1. Increase sildenafil dosage. This is a very common drug used for another purpose (look it up for fun) that, as it says in  Wikipedia, the drug information source of choice for cardiologists, “Sildenafil citrate is also effective in the rare disease pulmonary arterial hypertension (PAH). It relaxes the arterial wall, leading to decreased pulmonary arterial resistance and pressure. This, in turn, reduces the workload of the right ventricle of the heart and improves symptoms of right-sided heart failure.”

2. Back on oxygen. This is also effective for treating pulmonary hypertension.

3. Echo (of hope) on Wednesday or Thursday.

I don’t usually mull headlines or story angles until something actually happens. But I’m going to take a risk and prepare at least one headline for later in the week. If I have to prepare anything else, I’ll jump off that bridge when I come to it. Meanwhile…

World to end tomorrow at noon. Ari’s heart on the mend. Private jet in air to Tibet.