May 24, 2010

Today was a tough one. After a relatively uneventful night, Garrett woke up to doctors in the room preparing us for the day’s events. Unfortunately, talk is cheap and it’s hard to sugar coat the angst, pain, excitement, fear and gremlins that lay ahead.

I don’t know if it will help, but I’ll try to explain the procedure and what it is intended to do. A two-hour surgical procedure was conducted to place a main-line jugular vein double-lumen central venous catheter in Garrett’s neck, just below his ear. They sew it in place to keep it from being compromised and cover the incision with a large gauze pad and a thin, clear tape-like protective guard. Two big ports are available outside of the skin and these are used for the plasmapheresis. For the 25th time, I held his hand, took his first tear and kissed his forehead until he fell asleep.

Sometime this afternoon, the oil change crew came in with three large carts. One held a computer terminal, another was a crash-cart and the third was the machine itself. It kind of looks like a dialysis machine on steroids. The plasmapheresis machine reminded me of something out of “Young Doctor Frankenstein”. It’s used to separate the blood platelets from the plasma. When a person has autoantibody rejection, the bad stuff attaches to the plasma. By removing the bad plasma and replacing it with good plasma substitute, the hope is that if done enough times we can remove the anti-bodies that are hurting Garrett’s heart. About .00004% of the world’s population will undergo a similar treatment.

One of the lumen ports draws the blood out of Garrett, through a clear filter and into the machine. It works its way down into a large impeller spinning at about 1465 rpm. As the plasma is pulled from the blood cells, it is put into a container. The blood then is mixed with the replacement plasma surrogate and sent through another filter to them mix with some other key ingredients and into Garrett via the other tube. 130% of the blood is “cleaned” this way, or one and one-third times. This will happen four times over as many days.

About 4” of tubing about the size of a child’s juice straw extend out of his neck and catches on everything. He has trouble moving his neck around without discomfort and is afraid he will accidentally pull it out during the night. The biggest risk to the site, quite frankly, is blockage or infection.

The first round didn’t go flawlessly, but did get done. The lines blocked with coagulation a couple of times and one of the lines got kinked and stopped the flow. One blockage took nearly 30 minutes to clear, with Garrett holding his neck at a 30 degree angle while they worked to clear it. It was dang tough to watch and he was plenty played out and cranky by the end of the day, but he earned it. He was running a temp by the time it was done though, and that’s a little worrisome.

Tomorrow will resume more anti-rejection infusion through the normal I.V. in his arm, and the second round of plasmapheresis will take place at some point along the way. It’s not going to be an easy few days, as the process requires a lot of lying in bed not doing anything and being uncomfortable and scared. But we have to hold onto the blessings that we learned on Friday last. The coronary arteries looked great! Coronary Artery Disease of the Transplanted Heart is irreversible. What we’re fighting now is not.

Garrett got a visit from his "cousins" Lorin and Maggie today. We love them so much. The nurses Garrett had today were also outstanding and truly helped his mind set. When he got back from the surgical procedure, his room had been done up in pictures of bull riders and biblical expressions. On the outside of his door were two printed sheets. One displayed a photo of a PBR buckle that had the inscription “Cowboy Up”. The other simply said “Cowboy Up or don’t come in”. That pretty much says it all. Enter with a positive attitude or don’t drop by. We cannot afford to allow the poison of doubt enter the room.

Tomorrow’s a new day with new adventures and opportunities for victory. Garrett and I talked about this for a while tonight. It may not seem all that obvious right now, but God still has control with His awesome mercy and love. Somehow the birds will wake up singing outside and we might as well join them.

Psalm 3:5 - I laid me down and slept; I awaked; for the LORD sustained me.


JD