We hate the smell of medicine in the morning

We just checked into UVA and are now in the waiting game for Molly's surgery. She is the second case of the day so the exact timing will depend on how well the first case goes. We were told around noon, so we'll see. We had to stop feeding her at 5am this morning and so far she is doing ok. We're expecting crankytown anytime now.

Yesterday we were here for all of Molly's pre-op tests. She had an echo, pacer interrogation, blood draws and x-ray. All this was just to make sure she is a-ok for surgery. Luckily, Molly is old hat at these and sailed through it all (except the blood draws of course). She slept through the entire pacer interrogation and even gave the x-ray tech a smile. We almost had a big snafu when I casually asked if it was ok that she had thursh. Rebecca's, the NP, eyes got real big and said it was not ok and that it would probably delay surgery. After quickly consulting the surgeon, the EP and someone in infectious diseases, she was cleared for surgery because it is a minor case and they will not need to be entering her bloodstream during the surgery for any reason. They are giving her a super-powerful anti-fingal to knock it out just in case. Always some drama when Molly is involved, as usual.

We met with the surgeon and found out the details of what is going to happen. Here goes:

She'll be put to sleep with a mask of general anesthesia before they do anything else to her. Phew. Once she is knocked out they will intubate her (just to be safe that she maintains an open airway) and put in the iv's that will keep her under during the surgery. Dr Gangemi, the surgeon, will make two new incisions—one just under her armpit to about the bottom of her ribcage and a second horizontal on her stomach just below the last incision from her first surgery. The side incision is so he can easily reach her left ventricle (which is more underneath the heart and so harder to access). Once in there he will attach the new lead to the outside of her heart. The second incision is so he can replace the pacemaker box itself. New kind of pacemaker requires a new box to run it. He feels strongly about not reopening her first incision because of how hard it was to get it to heal in the first place. He just didn't even want to mess with it. During the surgery, Molly's heart will continue beating on it's own (making it a much less complicated surgery). When he switches out the pacer box, they will stop the one pacer and connect alligator clips to her lead wires to pace her temporarily while he works at hooking up the new box. Yes, alligator clips. Like a car battery.

Speaking of her tragically non-healing first wound that required us to be here 7 weeks longer than expected...one thing we will not know until surgery is over is whether the surgeon will stitch her up or put on a wound vac from the start. He needs to see how her skin has matured in order to make the decision. If she is able to be stitched up, we're looking at a 2-3 day recovery and checkout. Let me repeat that: TWO TO THREE DAYS. It's almost a bit too good to be true so we're not banking on that option. If he puts the wound vac on from the get-go, we're looking at 2-3 weeks recovery. And this is all dependent on things going smoothly with no complications. And Molly has been the queen of complications. So we're hopeful that this could be her time to finally have something go her way, but also know that something could always come up.

The surgery to put in the bi-ventricular pacemaker is step one. Step two is seeing if it makes any difference with her heart function (the cardiomyopathy). We have a 60-80% chance of it improving her function. The docs say that we could see a change in as little as 6 weeks and as long as 1 year. Right now, we're thinking short term...like hoping they can take Molly quickly and this first surgery doesn't go long. Baby steps...