I did not realize I hadn’t updated this site with Tiptoe’s situation.  Here are some excerpts from my journal:

Tiptoe was fussy all night long. Her wound finally stopped draining last night at around 7p, but her breathing was labored. She was inconsolable, and as the night wore on her breathing got worse. M said she was grunting and whining at every breath.

At around one o’clock, after a number of promptings from M, the night nurse took a good long look at Tiptoe, and declared that there was something wrong with her. One x-ray later, they discovered that her lungs were surrounded by fluid. They gave her a dose of diuretics to try and clear the fluid up, but when they took a blood gas, her stats were terrible.

They wound up having to put a tube back in her chest, and pulling out 50 mL of fluid within the first 5 minutes.

Scary. The fluid was pressing on the lungs, making it difficult for her to breathe.

What’s happening is that either during surgery or shortly thereafter, the thoracic duct was torn or otherwise damaged. The thoracic duct is responsible for conducting things like anti-coagulants, white blood cells, other immuno-system liquids and lipids (fats) all over the body, and to the heart. The liquids from Tiptoe’s feeds were being dumped out of the thoracic duct into the sac surrounding the lungs. This wasn’t a problem when the wound from her chest tube was still open, because there was an incision in the wound that made a pathway for the fluids to escape. When that wound closed up finally last night, the fluid around her lungs built up.

After the second chest tube was put in, she began breathing much better. The drainage has slowed up (since there’s nothing left in the lungs’ sac to drain). Tiptoe’s stats look really good, and this afternoon, she drank everything they gave her. The speech therapist helping her was very impressed.

The treatment for the thoracic duct is this: they are giving her a special type of low-fat formula to keep the duct from being stressed. Hopefully, it will heal itself. If that doesn’t work, then they will give her her nutrition through her IV; if that doesn’t work, then we’ll have to do surgery again.

The low-fat formula treatment will last at minimum of two weeks, during which time, Tiptoe will probably be here at UVa. If unsuccessful, the IV treatment will last another 6 weeks; also here at UVa. The surgery will take about 70 minutes (according to the Internet), and I’m not sure how long recovery will be. We want to avoid surgery any way we can.

Mortality rate for this problem is 10%; apparently, the cardiology/thoracic teams here at UVa are familiar with the problem.