A New Technique

I didn't think I would bother with an entry today as there was not much new to say, but on my way downstairs I ran into our Lung Specialist. I guess the past week gave her some more time to think and do research and they have now decided to do a different approach then what they would have done had they done the procedure a week ago.

The original plan was to do a very extensive broncoscopy. Using a bronchial tube they would go down into the lung and wash section by section. There are some reports of sucess doing this and others have been unsuccessful in getting the lung completely clean. She was concern about this and also felt this partial washing would be harder on the blood circulation in the lung then the new technique she hopes to use. In an adult Whole Lung Lavage (WLL) they use what's called a double lumen endotracheal tube. I won't pretend that I completely understand how it works, but I do know that this is when two tubes are connected together allowing them to use one ventilation system while going into each lung at the same time. These tubes have cuffs at the end allowing it to block off a lung if necessary. How the washing is done using this I am not completely sure, but I think it means that they would pour the saline water down one side and ventilate the other side. Whatever the case these are too large for children.

I guess our doctor began to think about how we were going to be putting two tubes down, one to ventilate and then the broncoscopy tube, so she wondered why we could put two single lumen tubes down instead. This would mean that they have to have two ventilation systems running. So over the past week she did lots of research and feels that they could do this. The advantage of the lumen tubes is that they have cuffs on the end, allowing them to completely block off one or another lung. Using this technique they will test which lung seems strongest and proceed to clean out the weaker on, which at this time they believe is the left side judging by the CT Scan. The main advantage of taking this approach is that we will then be able to actually do a WLL instead of just a Partial Lavage as was planned last week. Because of how the lungs function (which I also don't completely understand) she feels that this would be an even safer route as it will prevent the lung from having to go through big blood circulation issues with each partial wash. So she is confident that this a better route.

Of course my question was ... if this seems to make so much more sense and seems to be a safer route then why have they not done it before? She could not answer this, but felt part of it could be the technology advances we have in recent years where they have smaller tubes that have cuffs on them, therefore now allowing such a technique.

In the end there is not much choice to make. We fully realize that we have no real choice and that we have to put our faith and trust in the Lord to guide the doctors in the right direction. On the other hand, can we be thankful for this extra week of waiting? this extra week to make the doctors think and possibly come to a better result? Only time will tell and we pray that that time will come tomorrow as schedule.

When I ran into our Lung Specialist she was just on her way back up from the ICU. She had scoped out the place and feels that unless something major happens we should be able to move ahead tomorrow. She advised that she has also spoken to the ICU Centre about using an ECMO (extracorporeal membrane oxygenation) system if this technique does not work. This is when they put both the heart and the lungs on by-pass. We often hear of heart by-pass, but this is a step further and this means it involves even further risks. I have not had much time to read on it yet and hope that I will not need to. This is not something that would happen immediately but only after much consideration if we find out that tomorrows treatment is not effective.

We thank you all for your continual prayers. Please pray that the procedure may go ahead tomorrow. Please pray for the doctors and the work that they will be doing that it may be safe and effective. And once again, please pray that whatever the outcome we may accept this as the Lord's will.