04/26/10 Monday Blues

After a relatively uneventful weekend I made it into the hospital around 5:30pm Monday evening. Late last week we asked Seattle Children's to schedule the G-Tube surgery for Eli. We were told it would happen Tuesday. All weekend we've been asking if the surgery was scheduled and if we had a time for Tuesday. As I arrive at the hospital the first thing on my mind is to find out when are we due in surgery tomorrow. Patricia's been asking all day and the answer remains the same, we don't know yet. How can we not know when the surgery is going to take place? It's 5:30pm on Monday! Apparently we're waiting on a consultation from the urology department regarding our desire to have Eli circumcised while they have him under general anesthesia.

When I arrive at the hospital I find a trio of doctors looking Eli over. The three doctors are from the hematology department. Eli's hematocrit has now fallen to 25.8 and the NICU doctors asked for a consult. It's nice to find out they ordered another consult for an issue we were told was resolved when I walk in to find three hematologists looking over my son. Chalk this up to one more issue where lack of communication is the norm. Now that I had a chance to speak with the hematologists I figured it would be a good time to get a few things figured out. Eli's hematocrit has fallen a little more but his retic count is increasing so the hematologists feel things are going in the right direction. All babies bottom out after birth around the 8 week mark. They feel like Eli is an exception because of the massive amount of blood that was drawn during his first few weeks of life. He is simply bottoming out later than normal.

As I mentioned previously, the kidneys actually play a significant role in red blood cell production. The kidney secretes erythropoietin (also known as EPO) when the body needs to increase red blood cell production. Usually the kidneys kick in when your oxygen level is low which stimulates red blood cell grown and red blood cells help carry oxygen through the blood stream. For example, people living at altitude usually have a higher hematocrit level than people living at sea level because the oxygen is thinner at the higher elevation. When you are on oxygen like Eli is the kidneys think everything is going ok and they don't secrete as much EPO to make new red blood cells and therefore his hematocrit level drops.

After I get done with the blood doctors I get a chance to speak with one of the residents to ask why we haven't scheduled the surgery yet. We are waiting on a consultation from urology. They need to come by to see Eli to determine which circumcision procedure they can do. Since it's already almost 6:00pm I come to the conclusion that we're not going to have the surgery tomorrow.

Not more than 15 minutes after my discussion with the resident I have 3 more visitors from urology. They quickly examine Eli and look through his chart and they all agree that they can do a local procedure with what is known as a plastibell. I won't describe the plastibell procedure; if you're curious and would like to know how it works feel free to go look it up on the internet. We had both Ian and Obie circumcised and Obie had the plastibell. Unfortunately the plastibell didn't work correctly on Obie and we had to have the circumcision corrected by a urologist about a month after he was born. I was a little skeptical about going the plastibell procedure on Eli but one of the urologists laughed and asked if Obie has the procedure done by a urologist. I said no. It was done by Patricia's OBGYN the day after he was born. I like doctors who are confident and I told them they could either do the normal procedure or the plastibell if they think they can go it right the first time. The doctor said they'd get it done right the first time. One of the nurses mentioned that Eli was going to be under general anesthesia and the urologist said they could do the circumcision either way then. I don't care one way or the other as long as we can get it done.

After the consultation with urology and hematology I was worn out. Eli had a pretty quiet night and seemed to settle in on the nasal pillows just fine. The doctors have told us they are trying to schedule the surgery for Wednesday now and they'll let us know as soon as they get it scheduled.