Progress is being made, albeit at a slow pace. Today we got news that Grair’s blood results measuring new growth of strep viridans was negative once again. This is good news, as it now means we can begin to move forward with the next steps.

The next steps involve 3 tasks, each of which Grair has to be completely sedated:

  • The cardiologists need to do an transesophageal echocardiogram
  • Dental caps must be put on Grair’s teeth and a few teeth may need to removed
  • The central IV line needs to be moved

As you may recall, the initial surface echocardiogram showed no signs of vegetation (bacterial growth) on Griar’s heart. However, that test only sees the front and sides of the heart. The transesophageal echocardiogram is done with a probe that goes down Grair’s esophagus and allows for pictures from behind the heart. The concern is that bacteria could be growing around the valve and stent area.

Normally, the antibiotics attack bacteria in two ways: As they pass it in the bloodstream, or by soaking through tissue. In many cases, bacteria can begin to grow in the nook and crannies inside the body where passing antibiotics can’t reach as they float through the bloodstream. However, these pockets are surrounded by tissue and the antibiotics reach the bacteria by absorbing through the tissue. Unfortunately, Grair’s heart valve and conduit are not his own; it’s actually dead tissue. Dead tissue can’t absorb the antibiotics, and therefore can’t attack any vegetation that may be growing inside pockets in his valve.

If there is vegetation in the heart valve, we’ll likely continue on the same path as if there isn’t. That path is six weeks of hardcore antibiotics administered through the central IV. We’d cross our fingers the antibiotics grab hold and defeat the bacteria. If, after the antibiotics have run their course, we still have bacteria, the only solution is open heart surgery to replace the valve.

This type of bacteria is abundant in the mouth, however it takes special cases for it to get into the bloodstream. Wouldn’t you know it, Grair is a special case! Being born with a calcium deficiency, Grair has had teeth problems from the beginning. Unfortunately, the problems have seemed to expand beyond his teeth. Caps should help prevent this situation again, as would removal of teeth with bad decay. Thankfully these are all still baby teeth and we’re praying his permanent teeth are stronger!

The third procedure is to move the central line. There are two reasons for this: 1) To place the line (which is now in his neck) into a spot less likely to get disturbed and less noticeable, and 2) to place where there is less chance of bacteria getting into the bloodstream. So they’ll move it to his chest or arm. Actually, they’ll continue to use the same vein in his neck, but instead of coming out at his neck the tube will be tunneled through his body and out his chest. This uses his body as defense against bacteria before they get to the vein.

We’ll do the echo and dental work tomorrow. We’re scheduled for 1:00, so that means 4:00 in hospital time (they make the DMV seem like the quickest place in the world). Then on Monday we’ll shoot for the central line move. If all goes as planned, maybe we’ll be out by Wednesday! Then we learn how to administer IV treatments three times a day for six weeks. Then we wait for honorary medical degrees.