a procedure

I don't think I've taken the time to update all my readers regarding the transesophageal echocardiogram Aubrey's cardiologist recommended we have done when we saw him last December. It's taken a while to move forward with this, but we finally have a plan.

Anyway, rather than try to explain the whole procedure myself, I'm just going to copy excerpts of the letter I received from Dr. Smith (the cardiologist who will do the TEE) that does a much better job than I ever could:

I am writing to confirm my phone conversations with Mrs. Paladin over these first days of February 2009.  Dr. Byrum has presented Aubrey's cardiac tests in our cardiac case conference and we all [the 6 cardiologists at that office] felt that Aubrey should have a transesophageal echocardiogram in order to visualize certain important parts of her heart anatomy.  Specifically, we feel that this test would be the best way to look at the veins that bring blood out of Aubrey's lungs and direct it to the heart.  The exact location of the veins and their entry point to the heart could be very important in deciding what operation is best for Aubrey in the future.

A transesophageal echocargiogram is an echocardiogram that uses the same type of ultrasound that we use for Aubrey's routine echocardiograms in our office.  With this study, however, a smaller echo probe is placed on the tip of a small endoscope.  An endoscope is a tube that can be placed from the mouth down the throat toward the stomach through the esophagus...  When we place this small transesophageal echocardiogram probe down the esophagus, it can take a picture of the heart from the back of the heart in a way that is much clearer than any other echocardiogram.  In particular, it takes very good pictures of the veins coming back from the lung...

I've also spoken with the anesthesia department at Crouse Hospital a couple times now. One of my big concerns was the frequency of Aubrey's breastfeeding needs and whether or not attemping a procedure that requires general anesthesia-- and therefore no food or fluid intake for many hours beforehand-- would be worth the misery it would induce (I wondered if perhaps we should wait several more months until she is nursing less often since it technically isn't an "urgent" procedure). Fortunately, the anesthesia department doesn't consider breastmilk solid (not all anesthesia departments agree on this: some treat it like formula) and so I can nurse her like normal up until 4 hours before the TEE, which is scheduled for March 2nd at 8am at Crouse Hospital.

The risks of anesthesia aren't any greater to her than to a "normal" child. And the risks of the actual procedure (bruising of the back of the throat and perhaps a mild amount of bleeding) are very minimal , especially considering how qualified and experienced Dr. Smith is (my words, not his!).

Keep Aubrey and this procedure in your prayers, if you would. I think the hardest parts for her will be waking up in the morning and not nursing and then being taken from us just before the procedure (neither Daniel or I will be able to go into the OR with her).

And, of course, please continue standing with us in faith for a miracle. We keep believing that one of these times the cardiologists will be astounded to see that Aubrey has a new heart. I wonder to myself if perhaps March 2nd will be the day.