Another Day . . . Another Medication Combination

Well, we were very hopeful that the Flecainide was going to do the trick.  It seemed to be working, as the SVT episodes were only lasting a few minutes and maybe once or twice a day.  Then yesterday afternoon, Crew's little heart went into SVT and stayed there for almost two hours.  None of the usual vagal maneuvers worked, so the decision was made to place another IV for Adenosine administration.  However, after three attempts and no success at IV placement, he finally converted . . . on his own.  Crew does "fine" during these episodes.  He came off his nasal cannula yesterday and is on room air doing great. When he is in SVT his oxygen saturations are typically 100%.  He's also wide awake and looking around.  He just gets worn out after a couple hours with his little heart racing at 250 beats per minute. They've been placing bags of ice water on his face for 20 second intervals in attempt to create a "gasp" and decrease his heart rate. Poor guy, he takes it like a champ.  It actually worked this morning . . . most of the time it doesn't.  He otherwise gets his nose suctioned, saline drops in his nose, knees-to-chest, or rectal stimulation.

So, last night the Cardiologist made the call to once again try yet a different approach.  They cut his Flecainide dose in half, and added Sotalol.  These two medications supposedly work well together, but have to be in lower doses.  Unfortunately, because of the decrease in Flecainide, and the fact that it's going to take at least 5 doses of Sotalol for it to truly be in his system, Crew had a rough day.  At last count this evening, he had already experienced 5 or 6 episodes of SVT today. After about 6 or 8 attempts to place an IV they were finally successful with a scalp vein.  Poor dude!  They've had to use Adenosine 3 times . . . but each time it only took one dose to convert him.  Hopefully by morning, the Sotalol will be fully in his system and will be assisting the Flecainide in directing his heart electricity down the correct path.  If not, there are still more options to try.  Each time they make a change in medications, we have to wait a couple of days to allow them to absorb into his system before we know if they are working.  This whole process is giving all of us ulcers . . . including the Cardiologist.

On a positive note . . . like I said earlier . . . he is off oxygen! This is a huge step in the right direction.  Hopefully he can keep it up.  He is  still eating very well and gaining weight.  He has the feeding tube in place just for medications.   As of this morning he weighs 6 pounds 4 ounces. His hematocrit levels are up to 28 . . . still low, but better than 25.  His ANC (the fighting army of white blood cells) was in the 1000's this morning . . . which is a really good thing.  And all his other lab work looked great.  Whoops I almost forgot . . . his Thyroid levels were low. The Endocrinologist suggested they start him on Thyroid meds . . . so he'll start those tonight.

The scalp IV looks scary

A binki makes everything better