Sorry for the long wait on the update.  The last few days have been very emotional and the last thing me or Tim really wanted to do was write about it.  However, I really want it written down so we can remember it all.

The last thing we talked about was getting his CATH procedure done.  This was done on Tuesday. This procedure is when they take a catheter tube and put it through a large vein in his leg.  They run it all the way up to his heart where they release a dye and they can see where the blood flows.  They can also measure pressures in different parts of the heart and vessels surrounding it.  This information was the last piece of the puzzle the doctors needed to figure out the best way to move forward.

On Wednesday, Joshua was moved out of the CICU and up to the floor.  This has been nice, since they are not as strict with visitors and we have a little more room to breath.  The only reason we are still in the hospital now are feeding issues.  We are working with him on that.  He needs to be taking about 65cc (I think it is about 2 oz?) of breast milk at each feeding.  Right now, he can handle about 10-20 cc (about 1/3 of an oz) by mouth and then another 35-40 by feeding tube.  We will work more with him over the next few days and hopefully get home soon.

Now, for the really hard update....once the doctors got all the pieces to the very complex puzzle that is our son's anatomy, we anticipated them coming to us and telling us what they thought was the best way to proceed...then we would simply tell them that we agree and move forward with that plan.  What we did NOT anticipate was having to make a choice, a very difficult choice: To operate or not to operate.

There are several issues with Joshua's heart, and all combined, make the surgeries very high risk and very complicated.  The first surgery would most likely be at Stanford if we chose that route.  The surgeon at Stanford is the best in the world for the procedure that needs to be done.  He's done the most, but not as complex as our little guys.  He's only operated on about 14 kids in the last 25 years with what our son has--6 of which are still alive.  There isn't much information on how to treat this the best.  And this is just the first of many surgeries he would need. On the other hand, if we simply felt him alone, there is a possibility that he would live a relatively long life, but not necessarily.  He could live 2, 5, 10, 20, maybe 40 years...we just don't have any idea. What makes it even more difficult is that half the cardiologist say not to operate, the others are saying it's the best option.  The vote is very split and ultimately, it comes to what we decide.

We have been relying heavily on our Heavenly Father to help us make this extremely difficult choice.  We went through a session of the temple this evening and Tim and I felt some very strong promptings, but we still plan to get as much information as possible.  In the mean time, we are soliciting the prayers and faith of all our friends and family at this time.  We are going through a lot of turmoil as we try to make the best decision for Joshua and for our family. 

Now, for tomorrow, Joshua gets another test done.  This test will tell us if his stomach is on the wrong side and if he has mal-rotation.  Mal-rotation (i'm not positive on the spelling) is when the intestines are not rotated correctly, thus a kink in the intestines becomes much more likely. (I think of a garden hose when thinking of this concept).  If there is malrotation, we would have to consider a surgery to fix that as well, depending on the severity of it.   

The doctors are great here and we feel very supported from all sides--family, friends, coworkers, medical staff, and of course, the Lord.  Again, please keep little Joshua and our family in your prayers.  Thanks for everything!!

Saturday 8 AM: Stephanie woke up and felt her first strong contraction.  With Logan, her water broke and they were able to get her an epideral before she felt serious contractions.  Such was not the case on Saturday.  I went to work at worked from 8-1:30 PM.  After getting off of work, I called Stephanie.  She said she was laying down, unable to move due to contractions.  They were occuring every 15 minutes or so.

After getting home, I started to pack the car and finish packing our bags.  We had plans to meet the siblings to go to festival of trees around 4:30.  4:30 came and we were still in Spanish Fork, not in Sandy--where the Festival of Trees was.  We finally started toward Salt Lake.  All the while, Stephanie still had contractions every so often.  Stephanie ended up calling University Hospital Labor and Delivery and asked questions on when she should come in.  She then tracked her contractions for the next hour.

Excited for the Festival of Trees, I convinced Stephanie to go in and see some trees.  After meeting up with family, it was about 2 minutes of viewing trees when we left the event and started our way to the hospital.  We arrived at 7:15 PM with Stephanie ready for that epidural.  7:45 we were admitted to the hospital and moved to a temporary delivery room.  Stephanie was dialated to a 4.  @7:18: Contraction; @7:21: Contraction; @7:26 Contraction...I think you get the picture.  I've never seen Stephanie in so much pain--it was hard to watch.  I wanted to take the pain upon myself when I saw it.  Unfortunately, I couldn't.  Luckily, the epidural was given @9:05.  At 9:45, she was measured again and she was complete.  Right about then, the nurses started to panic.  (In my mind, I thought we still had a few hours--boy was I wrong!)  We were then rushed into an Operating Room that was connected with the ICU.  Upon entering, I helped the doctors clear a spot for Stephanie's bed and a route to the window that led to the NICU.  At 10:02 PM, Joshua Kent Ipson was born.  Within 10 seconds, he was handed through the window and started to be stablized.  A kind nurse took our camera to capture a few photos for us.  I tried to look through the window, but Joshua was surrounded by 4-5 doctors, allowing me to only see a foot or hand here or there.

Soon, Stephanie was moved back into the 'temporary delivery room' where we were before the OR.  After about 15 minutes there, we were moved to a recovery room.  We then were able to visit Joshua in the NICU for a little bit, in which we also were able to hold him for the first time.  Absolutely a precious moment!  This was unexpected but absolutely amazing!  After 15 minutes, we were asked to leave as another baby was being brought in and they needed the area cleared.  We went back to Stephanie's room and waited for Life Flight to arrive.  Around 1 AM, Life Flight came with Joshua on their stretcher.  After a few pictures (can be seen on Facebook), I left with Life Flight to take him to Primary Children's Medical Center.  We walked over using the bridge that connects the two hospitals and arrived at the Cardiac ICU. 

Fifteen minutes later, (2:00 AM) one of the cardiologist started Joshua's first test: an echocardiogram.  I then went back to Stephanie's room at the University Hospital to get some rest.  We later found out the Echo took around 4.5 hours.  I thought it was only 2.5 hours, but apparently Joshua's heart condition was more complex and very unique.  Some of the diagnosis are as follows: 1) Dextracardia--Position of the heart is on the right side of the chest, not on the left side; 2) Heterotaxy--the heart is basically flipped.  He also has two right sides; 3) Main pulmonary atresia--the main pulmonary artery is not found.  The pulmonary artery is the main artery that carries blood from the heart to the lungs.  4) Hypoplasia of the right ventricle--underdeveloped right ventricle 5) Lungs appear to be supplied by arterial collaterals with no MPA segment noted--Lungs are getting blood, but they aren't sure where from.  They are suspecting arterial collaterals are delivering the blood.  6) Bi-lateral superior vena cavae without bridging vein 7) 3 Pulmonary veins drain into an upper vertical vein which dump into the right atrium--pulmonary veins are veins that take blood from the lungs to the heart.  Typically there are four and they should dump into the left atrium.

In addition to the 7 items mentioned above, there are a few other complications which we won't go into at this time, however, the 7 are the major issues we are looking at. 

Today, Joshua had an abdominal ultrasound in which they looked at his anatomy and specifically, if he had a spleen.  I asked the nurse this evening and she said she didn't think they found a spleen.  We have not heard the official results of the ultrasound, but from the sounds of it, he doesn't have a spleen--which is the immune system for infants.

Stephanie has officially been discharged from the University Hospital and she seems to be recovering really well.

Tomorrow morning at 9:30, he has a Cardiac CATH test scheduled.  This is where they will put a tube with a camera into a vessel in his leg.  From there, they go up the vessel to the heart and then release a dye.  They measure the pressure in the veins and watch the blood flow.  This will give them the missing puzzle piece they are looking for--How the lungs are receiving blood.  (Since the MPA [main pulmonary artery] is missing, and his oxidation % is staying around the 90's, they are slightly puzzled how the blood is getting there)  After this test, they will then meet together on Wednesday morning.  (They being ANYONE that is SOMEBODY--aka All cardiologists, all surgeons, all etc)  They will come up with their game plan on how to proceed and when the first surgery will occur.  We pray for the best and that the doctors will be led to the best decision for our little guy. 

We appreciate all the prayers, messages, and love you have all shared with us.  We have felt power from on high and know that the Lord is watching over us and our little Joshua.

I know I already posted today, but I wanted to write down what the findings were at our last appointments, even though it has been over a month since those happened.  We have another cardiology appointment on Friday and I want to make sure I remember where we were at before that.

1) AV-Canal Defect:  This is still the case.  However, because of the under-developed Right Ventricle, we probably won't be doing surgery for this.

2) Under-developed Right Ventricle:  This was the big find at the last appointment.  The right ventricle, which is the one that pumps blood from the heart to the lungs, is not going to be strong.  Because of this, little man will goes through a series of surgeries to bypass the ventricle completely and divert the blood directly into the lungs.  Normally, this is done with three different surgeries, but it is looking like we may be able to skip the first one and make the second one his first surgery.  This would be done when he is 4-6 months old.  This is really exciting news because the first surgery would normally be done pretty quickly, which makes some of his developmental milestone difficult to reach.  The longer we can wait for surgery, the better.

3) Missing Main Pulmonary Artery:  Honestly, this in one that I don't understand completely and I am hoping to after this next appointment.  From what I can understand, the pulmonary artery takes the blood from the heart to the lungs. With our little guy, it looks like the aorta (which takes blood from the heart to the rest of the body) actually has an artery coming off of it that looks like it goes to the lungs.  Obviously, if blood is not getting to the lungs, this is a VERY serious thing.  It will be one of the very first things they check to make sure there is blood flow to the lungs.

4) The 4 Pulmonary Veins:  When the blood comes back to the heart from the lungs, it does so through 4 veins (called the pulmonary veins).  In our little man, it looks like they are all there, but the veins are longer and taking a "weird" route back to the heart.  This can be a problem for several reasons, including a) more space for blockage and kinking.  b) underdevelopment, which decreases blood flow.  I know there are more, but I can't remember right now.

5) Heterotaxy:  This is the issue of organs being backwards and/or on the wrong side of the body.  From what we know now, little man's heart is flipped (so the heart is pointing to the wrong side of the body...the left side is on the right and the right side is on the left).  Also, we know that his stomach is on the wrong side.  These two things can be indicators that other organs in the body could be mixed up. Some of the common ones they have talked with us about are a) missing or multiple spleens and b) issues with the intestines.  The spleen plays a key role in children in the development of their immune system.  While adults don't really need them, children who are born without one can suffer from very low immunity.  The intestines can have issues like being twisted, kinked, and knotted.  They will do a test before anything is fed to little man to make sure everything with the intestines is alright.

Needless to say, there are a LOT of issues...and most likely, I forgot something.  Hopefully, I will continue to improve my understanding at this next appointment this week. :)