Follow-up report on surgery

Melissa is out of the hospital and resting at her parents' home in Sacramento. She'll fly home on Saturday afternoon. Here's the scoop on our follow-up visits with specialists at UCSF yesterday prior to Melissa's discharge.

The general ultrasound revealed that the pocket of fluid around Spencer (the donor twin) has more than doubled since the surgery (1.4 cm to something over 3.0). Further, his bladder was visible. That's good since ultrasound only picks up the bladder if there's fluid inside. Dehydration and malnutrition are Spencer's most dangerous enemies, and he seems to be in good shape on both fronts as of the moment.

We later underwent a fetal EKG, and both babies' hearts seem fine. They're pumping as they ought (both in terms of rhythm and volume). Micah's ventricle walls are still thicker than we'd like, but that's to be expected: the overloading condition that caused them to thicken in the first place could only have improved starting yesterday. Here's an analogy to explain what's going on:

- Suppose that the average human heart works at a level equivalent to "curling" a 5 lbs. barbell constantly with one arm.
- The TTS condition placed a greater load on Micah's heart--something like swapping that 5 lbs. barbell for a 10 lbs. model. As one would expect, the muscle involved grew bigger and stronger. If you're talking about an arm, that's OK. If you're talking about the heart, not so much: flexibility is preferable to raw power where the heart is concerned.
- Yesterday's procedure returned the load on his heart to a more normal level--analogous to swapping back to the 5 lbs. barbell. Since the heart is still moving a load (albeit a smaller one), its return to normal size will be gradual in the same way that the arm would gradually return to pre-10 lbs. size.

The specialists indicated that we might consider having fetal MRI done on Micah to see if we can learn whether he sustained brain damage during the brief slowdown in his heart-rate (see post below). Since the purpose of this exercise would be informational rather than actionable (i.e. the outcomes wouldn't inform any treatment or preparatory steps by the doctors, they'd only help us prepare emotionally), we're likely going to pass over this opportunity. We'll take him any whichaway.

The lead surgeon visited us just before we checked out to express that he was very pleased with the procedure and its apparent outcomes. He feels that the odds of both babies surviving has improved from 10% (given no treatment) to 80%. Better!