Ryan had a pretty quiet weekend. Except for a few dips in sats, he stayed comfy and cozy.
Henry went to see him on Sunday with the girls while I stayed home to rest. My idea of resting was going to be cleaning out my car and then dozing in my bed. Somehow, I never got around to cleaning out the car, which turned out okay since Natalie convinced Henry to be her ‘little helper’ tonight while she cleaned out my car to surprise me. I don’t even think she knew I wanted it cleaned. She also convinced him to take her to vacuum and wash it. Boy, did I luck out!
I went to visit Ryan today and found out he is having a rhythm issue when an electrocardiologist came to stick a Holter monitor on Ryan. A Holter monitor records the patient’s heartbeat over a set amount of time to be studied in detail later.
Just a warning that this is about to get super-technical (okay, only as super-technical as an English major can get) so you may want to put your thinking caps on. I’ll try to make this as simple as I can (which will be easy since the docs had to make it simple enough for me to understand).
The heart beats in what is called a sinus rhythm. The electrical impulse originates in the sinus node (a group of cells located in the right atrium) and travels to the A-V junction. Here the electric impulse is sent into the ventricles causing them to contract and send blood into the body. The sinus node is known as the pacemaker of the heart because is pulses slightly before the other cells in the heart thereby setting the pace. This is why the normal rhythm is named after the sinus node. A more detailed description of sinus rhythm is found here.
Junctional Escape Rhythm occurs when there is a disconnect between the sinus node and the A-V junction. The A-V junction is the natural backup pacemaker in the heart and takes over sending out the primary electrical impulse when the sinus node fails. However, the result is an inefficient heart beat causing bradycardia (a slow heart rate), lowered oxygen saturations (which makes sense since there is less blood flow) and lower blood pressure. On the monitor, the P wave is missing or masked by the QRS wave. Need more details? Click here.
With me still?
Created by (Anthony Atkielski)
Here is a photo of a normal sinus rhythm. The P wave originates in the sinus node. When the sinus node is either not firing or is blocked from the A-V node for some reason, the P wave goes AWAL. That is called Junctional Escape Rhythm. That is what Ryan has been experiencing yesterday and today in small bursts. As I studied the monitor, it seemed to me like he would have 2-5 Junctional Escape Rhythms and then would go back to regular Sinus Rhythm. The Holter monitor will give us a better understanding of how much and how long when we get the results tomorrow.
So what does this mean for Ryan?
So far, Ryan’s ox sats and blood pressure remain stable although he is experiencing abnormal rhythms. This is awesome! He’s sitting in the mid-70s for ox sats which is his baseline pre-tissue expander surgery in June. Yeah! So right now there is no damage being done to his heart or body that we can tell. He is showing signs of bradycardia instead of his normal baseline of borderline tachycardia (high heart rate). Before knowing this was a symptom of Junctional Escape Rhythm I even said to the nurse that Ryan’s heart looked like it was beating slower (one perk of being able to see your child’s heart. Sidenote: another perk is that you don’t have to watch for a moving chest or put your finger under his nose to see he’s still breathing. You just have to glance at his heart! Not that I’ve ever checked to see he’s still breathing…wink wink. End sidenote.)
Why is he doing it?
Good question! It is the same question the doctors (and I) have. We may not really ever know, but we know it is a sign that Ryan’s heart is stressed. Cardiologists see Junctional Escape Rhythm often after a patient has heart surgery and perhaps the surgeon gets into the path of the electrical impulses and upsets the apple cart so to speak. Many times, either by meds or time, the Junctional Escape Rhythm reverts back to normal sinus rhythm.
But, Ryan hasn’t had heart surgery recently. He hasn’t had any surgery recently. So, we are wondering if the stress of the weekend upset his normal rhythm. The team is assessing him and gathering as much information as possible to determine if this is cause for further concern or if it will right itself within a few days.
Summary –
Ryan had a great few days of resting peacefully without any major episode. He is certainly way better off than Friday. As the team likes to say, ‘he was very sick on Friday’. He is still at 60% supplemental oxygen on the ventilator, he is up to goal feeds, his nitric oxide is almost all the way weaned down, and his oxygen saturation is sitting in the mid-70s with his PO2s in the 40s.
He is scheduled to have his tissue expansions done tomorrow. Please pray he will respond well to these as we need to continue expanding his skin so he can have the Glenn at the end of the month. Not enough skin = postponed surgery.
Here is a picture of Ryan on Friday…
and then a picture of Ryan today…
It is amazing the difference.
I leave you with a video of how my baby really is… off the vent and off the sedatives. I took this last week before his cath. He’s so stinking cute it makes me cry. Enjoy!
(c) 2016 Leighann Marquiss
Comments (23)
You’re talking my language! So happy to hear Ryan is stable enough for another tissue expansion tomorrow. We’re praying all goes well.
-Brent and Julie
Brent and I have been checking hourly to see how things are going. Being off the NO2 is amazing!!!! Remember, life in the ICU— slow and steady wins the race….
I know people tell you this daily- make sure you take care of yourself so you can take care of Ryan.
Crossing our fingers, praying, doing rain dances and everything else from Hyattsville!
Kirsten, Brent & Madeleine
Back from vacation and wow did I miss a weekend. Glad to hear he is holding steady. We are praying continually for Ryan. Love you.
Wow! The difference between Friday and today is absolutely stunning! It’s amazing how quickly he rebounded! I can imagine how good it was to be able to look into his eyes today! He is so engaging and looks like he’s trying to get you to pick him up. He is such a PUDGE! I could just eat him up! God is SO GOOD!!!!!!
I check in on your family often and I’m so glad to see that he’s improving. I will be praying for a successful procedure tomorrow.
I want to watch that over and over again! He is so chunky and squeezable! I did cry too! THNAK YOU for sharing him with us tonight and letting us see the joy of his sweet smile. That was precious.
Cont to pray for your little man! He is so cute, I just wanted to pick him up and cuddle him!
Praying in Martinsburg
The Seavey Family
Ryan is precious. I think this is the first video I have seen and it touched my heart so much to see him and to hear his mama talking to him so sweetly.
My husband and I are praying here in Kansas for Ryan and for each of you.
In Christ’s Love,
Linda @ Truthful Tidbits
What a cutie, I just want to give him a squeeze and a hug!
The video is making me cry here at work…
I don’t know how you have the strength, but I guess you find it when necessary…
I hope for the best for your family and your beautiful baby boy.
LOVED that video, Leighann!!! he is SO cute! those CHEEKS!!! wow!
So glad he is doing better! Am praying for him today with the tissue expansion!
Heidi
I checked your blog all weekend and was glad to see that he was doing better…..been praying hard for him! ♥ Lori Musacchio
More love and prayers being sent your way!! It is so cool to watch him watch every move you make…so intense! He is precious!! Love ya!
Richelle
What a sweet video of your baby! That is encouraging! Your strength is inspiring…to God be the glory!! Hang in there. There are prayers from strangers amidst your wild life! We love your little Ryan!
Elizabeth Miller, W-S
Wow, I’m totally in tears right now after watching your video. He is so unbelievably cute! We’re praying non-stop for you guys, and will be right behind you in this ride. You do a fantastic job of keeping us updated!
p.s. so glad you made it out to hoops…re-energizing!
In those first pictures, does he have edema from the heart not pumping correctly? I know, I ask you the most random questions. It’s my charm.
i’m totally tearing up. you can just tell he tries SO SO hard to communicate! his eyes are so alive and he balls up his fists like, “mom, i have so much to say!” praying always. <3
I am SO happy to hear he had a calm weekend! He looks so much better! I just want to squeeze his chubby little cheeks! You all continue to be in our prayers!
still praying for you and Ryan. Love you. Amanda L
What a cutie that boy of yours is. Still praying for a successful skin expansion and for your family. I constantly have you guys on my mind. God bless you all. Aunt Karen
Hello I am John Hinton and I live in Quitman Louisiana We attend the COG at North Hodge La where Sis. Sarah Ingram is our Pastor we were at LIcking Co. COG campmeeting this year and Bro. and Sis. Marquis have been down to our place for Revival a few years ago. we love your family Sis. Willia and her sisters singing and all. We are praying For Ryan and the Church family also.Thanks for keeping us updated even though we dont understand much of the tech…stuff. Bro. Johnny
Ryan is just beautiful. I wish I could just come over there and give him a big hug (and squeeze those lovely fat thighs).
Lynnette
you’d better kill him, then spend money and make new ione