We are still on the schedule for Job's auxillary fistula on Tuesday, March 7th, at 12:15 (10:45 check in). It is so weird to go through the process of going to a scheduled, outpatient surgery! We've always been inpatient for previous surgeries, which is much different. We have pre-surgery appointments and phone calls and meds to give - all things that were just taken care of for us while inpatient.
I vaguely referenced a potentially happy development last week and meant to explain it further. It no longer applies, but to gloss over it rankles at my perfectionist record keeping tendencies and I know that, if I don't explain it, I'll be frustrated when, someday, I go back and reread these entries. So this is purely for me and totally unnecessary to read:
Last week's echo confirmed a reason that Job's sats haven't declined as sharply as we were all expecting (because of his pulmonary AVMs): aortopulmonary collateral arteries. These APCAs are small arteries that develop to take blood to the lungs to be reoxygenated.
We first learned about collateral arteries when Job's right leg clotted off back in May (because of his first cath). At the time we marveled that the body could form "side street" routes when the "freeway" artery was blocked off - but we had no idea we would be revisiting this concept again, but this time in his heart!
Job is certainly still very oxygen-dependent, but his sats have crept up rather than dropped dramatically, despite his AVMs. We all got a little excited last week when the possibility that maybe, just maybe, his body could cooperate just enough to at least postpone his auxilary. The idea was that these new collateral arteries could essentially create a natural fistula taking the liver-filtered blood from the IVC (connected to the aorta) though the collaterals to the lungs for both oxygenation and AVM killing.
We then scheduled an extra appointment on March 3rd to check whether or not these ACPAs were significant enough to postpone surgery or even cancel it altogether.
We talked about it leading up to Friday's appointment and then I talked to Dr. Files about it quite a bit at our appointment. We could postpone and maybe his body would surprise us! Though the risks of this fistula are minimal, comparatively, there are certainly risks.
Ultimately, I decided I want to go through with it. Being on oxygen once Job gets mobile but before he has the understanding/obedience to leave his cannula alone sounds awful. Like maybe even the straw that could break the proverbial camel's back of this delicate balancing act. This seems like it could work and I want to try it. Now. Job's not sick, we have a plan for childcare, our emotions are all keyed up. Especially because we would likely have to do this fistula anyway, just later on.
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