One Step Forward, One Step Back

Today, we heard a lot of encouraging news. Peter's heart rate is more normal (about 130bpm) and the blood pressure seems better too. The nurses have found that the primary method of measuring his blood pressure is not as reliable with him, leading to lower readings. A secondary method appears to be more accurate and it shows his blood pressure at about 70/50, which is quite acceptable. Doctor Moga, one of the surgeons, removed two of the four tubes in his chest, and they have further reduced a number of medications. He is now almost completely off morphine; he only receives it incidentally now rather than on the constant drip, and he has been started on methadone. Peter has also been further weaned off the nitric oxide.

There was, however, one very annoying development about which we covet your prayers. During the night, a milky fluid started leaking from his chest cavity through one of the two remaining drainage tubes. This is called chyle and is a mixture of lymph and free fatty acids. This sort of leakage out of the lymph nodes into the thoracic or abdominal cavities is quite common with children like Peter who have had some trauma to or blockage of the pulmonary veins or arteries. Essentially it is a bad reaction to fat in the diet, though Dr. Overman explained that chylothoracic leaking is not at all well understood. Since it is linked to certain fats, the primary method of treating it is to eliminate these fats completely from the diet, but other things may need to be tried too if the leakage does not stop (which may include medication or even surgery).

For the next three months at least, Peter will have to remain on this fat-free diet. This means that he is not allowed to have breastmilk but will have to be fed with a formula (which includes some other types of fats) for three months. (It is possible for Betsy to process her milk and skim the fat off, but we will have to look into this.) Also, until this situation is resolved, Peter will not be able to go home, though Dr. Overman said that Peter is likely at least two weeks away from discharge anyway, because he is still on the ventilator. Perhaps the chyle leakage will be resolved by then. Please pray that this new problem will be resolved soon.

Despite this disappointment, we do hang on to the thought that Peter is doing better day by day. The chyle leakage is not unexpected and should have no impact on his treatment and recovery; it is mostly a nuisance.