Next craps table

Riley has been sick - vomiting, diarrhea and a fever earlier this morning. If he has an infection or a virus, it could disrupt the timing of everything discussed in the rest of this post.

We had a meeting with Dr. Karl and Dr. Moore (the cardiologist who directs the cath lab). Suzanne also had a lengthy phone conversation with Dr. Tarnoff. Since the surgical fenestration was a failure, they would like to attempt a fenestration in the cath lab using a cloth-covered stent. This would be a shorter, straighter connection but it still runs the risk of clotting over. They would give Riley more aggressive anti-coagulation medication immediately after the procedure. Despite the possibility of failure, the doctors agree it is worth taking the chance.

Here's the ugly side: since Riley has had recent surgery, the recent dissection in his chest increases the possibility of bleeding. How much? They estimated a less than 20% chance but a greater than 5% chance. If a patient bleeds in the cath lab, they need to rush them from the 13th floor to the 4th floor OR, which is dangerous. The doctors are negotiating with the vascular surgeons to use one of their ORs that has equipment found in a cath lab. Dr. Karl and his complete team would stand by while Dr. Moore does the procedure, and if there's any bleeding, they could place him on bypass and operate without having to move him.

Of course, even if the cath fenestration works, it could still clot over like the first one did. And even if the fenestration doesn't clot over, there's still the underlying possibility that it won't cure Riley's PLE (remember, that's the whole reason we're here).

Everybody wants to act fast - the longer we wait, the more Riley's developing scar tissue that could complicate a later operation (if we need to go to takedown). Also, Riley's current condition is not good - left unchecked the PLE will kill him and he is being kept stable in an ICU with lots of drugs and the continuous risk of developing an infection (especially with his asplenia). If we wait for a procedure, he'd likely be too sick to leave the hospital until then anyway.

The surgeons are still negotiating about the OR, but it could happen as early as this afternoon or tomorrow morning.

Suzanne and I are working through things and trying to ask as many questions as possible (thanks to this blog's peanut gallery for all of the suggested questions :-) Looking back on the past few weeks, we feel we were too concerned about the downsides of success (a lifetime of coumadin) to worry about the possibility of failure (a failed surgery that would lead to a cath lab fenestration after all).