Action Stations, Action Stations. Set condition one throughout the ship. This is not a drill.
Times change. Foreign policy evolves.
The blockade worked for a while, but intelligence suggests that the enemy is gathering, and in possession of weapons of mass destruction. Possession of weapons of mass destruction is an act of war. Boston Children’s Hospital forces are thus preparing to invade.
After progressing nicely for a while, Ari’s weight has been flat for a month. In the middle of the last month he had his first stomach bug and survived well enough (though the washing machine took a beating, and we can’t watch the movie Bridesmaids anymore), but his weight hasn’t progressed since.
His breathing is a little faster than it has been, and he throws up (not spit up, we’re talking straight-up hangover-like heaving), now several times a day despite measures to keep the ship steady. He’s not taking any food by mouth – milk or solids – and never gets hungry.
Mind you, all of this evidence is circumstantial. He could have a twitchy stomach. He could be a slow recovery from the bug. His formula may simply not agree with him, though it is pre-digested (ewww…).
We don’t know because our weapons inspectors have not had complete, unfettered access to cardiac weapons storage sites for a while. The borders are closed. If we want to see what’s going on, we have to go in.
And in we’re going, weapons free. Maybe George Bush had it right…if you know the enemy is going to attack, might as well get in there and get them first before they get any stronger.
The plan is to go in on January 7 to look around and see what’s happening, and shoot any enemies we come across. The most likely target is the mitral valve. If you remember correctly, Ari has a Melody valve in his mitral position, and had a 2.7 millimeter fenestration put in his heart, partly so we could access the valve in the cath lab for dilation.
Since Ari is only the 5th person in the world to have a Melody valve in the mitral position (it’s intended to be a pulmonary replacement valve…it’s not FDA indicated for use as a mitral valve), it’s not an insignificant procedure to balloon it. Indeed, it’s not an insignificant procedure to balloon any valve, but you gotta do what you gotta do.
By the way, it’s not that the valve is necessarily going bad. You may remember that babies grow, and inanimate objects don’t. (How’s that for a biology lesson.) So he’s getting bigger and his heart is, we think, pumping more volume with more force, but the valve is still the same diameter. It hasn’t grown with him, so it may simply need to be right sized.
Imagine spraying the lawn with the hose and an everyday pistol grip nozzle. You turn up the water flow. What do you get? More resistance at the nozzle, and more spray. You can hear the spray, too.
During an echo, you can “hear” the spray as well. It’s called a gradient. The noisier the gradient, the more resistance at the bottleneck. If you widen the bottleneck, the flow comes faster, the spray goes away, and the pump doesn’t have to work as hard to get the volume of flow it’s trying to achieve.
At the last echo, while his heart looked spectacular, there was, indeed a gradient across the valve.
Thus the desire to dilate it.
Perhaps if we do that, he’ll tolerate food better, breathe easier, and start growing again.
Then again, it may be the busted pulmonary valve. It was busted last time we looked, and we’re pretty sure it didn’t magically fix itself. Maybe that’s it.
Maybe his pulmonary hypertension is getting worse again. Can’t know that until we get to the cath lab. Perhaps the problem is that his left ventricle is not relaxing. There’s nothing we can do if that’s the case short of waiting for it to get better or transplant, so we’re hoping that ain’t it.
We might also find out his heart is fine(ish), and shoot no enemies. It could just be a coinkydink that he has twitchy stomach or needs a new formula. However, just like Dubbayah, we can’t take that risk.
So we are where we are, gathering at the border for a strike. Unless you hear different, prepare for news somewhere around Jan 7.
Condition one is set. All decks report ready for action.