Tuesday, June 26, 2007

Diaphragm Update

After the ECMO removal last night, I had a chance to talk to the surgeon (who also did the hernia operation earlier). Apparently I was overestimating things when I said that Andrew had very little diaphragm around the edges.....in fact, he had NO diaphragm around the edges. The surgeon characterized it as 98% missing, and he had to suture the patch to his chest wall. He had to use a 15x10 centimeter Gore-Tex patch and did only minor trimming to fit, which means he 'replaced' 150 square centimeters of left-side diaphragm. Fortunately, the one place there was some diaphragm was in the middle of his chest, where the right side comes together with the left and some major tubes (vena cava, esophagus) come through into the abdominal cavity. He was able to attach the patch to the existing diaphragm at this point, and that portion of it will grow with him and do fine.

Realistically, what this means is that some day he'll have to have the patch replaced. It won't be now, it won't be in the next few years, but at some point it will almost certainly require replacement. They'll keep an eye on him through major growth spurts (puberty, etc), as that time would be the most likely for a new herniation. Whether they would go in and replace it proactively or wait until he has another problem (MUCH more minor and treatable at that point), I'm not sure. The surgeon made the patch he put in very dome-shaped, meaning that he has a lot of extra material that can flatten out and "grow" with his body. It should last many years because of that "extra" area, and it will also show up on a chest X-ray when it begins to flatten out and get tighter.

I'm very confident with the meticulous work of the surgeon (who also suggested his scars would be relatively minor (long, but minor), and I think this solution will be effective for a long time. Baby's bodies are very resilient, and his other muscles will compensate for the lack of a diaphragm when breathing. He also has a full diaphragm on the right side, to go with his full lung, which will hopefully prove itself to be strong and useful in the next few weeks.

The other good news is that his left lung looks better than they were expecting. Instead of a nubbin or no lung at all, his lung is almost half-size. It has also formed two developed lobes instead of being stunted early, so it's not bad, just small. It should be able to expand, grow, develop, and fill a good portion of his left side (perhaps 3/4 of the cavity). That bodes well for his future lung volume.

6 comments:

  1. Dear Danielle and Jaime,
    You are in my daily prayers, not only for Drew's recovery, but for the strength and peace of mind that you both need. Thank you for the constant updates on Drew's Blog. The three of you are never far away in my thoughts.
    Diane Tucker

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  2. That is wonderful news!! Sounds like many prayers were heard and answered for now. I know that there is a long road ahead but I'm so impressed with your ability to even communicate and articulate through all of this. Maybe that is what is keeping you from wigging out! I may even have to start referring to you as Dr. Ryan as you have become quite an educator!! You guys are awesome. I can't wait to see the updated photos. Love you ... Mare

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  3. Fantastic news about the lung. I am amazed at the advancement of medical procedures. Gortex! Not just a raincoat anymore. : )

    Thank you for the lastest update. I will continue praying and sending my positive thoughts your way.

    Please love on Baby Drew and Mom for me.

    Stay strong and rest well when you all can.

    Love,

    Deborah Dodaro

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  4. To the Ryan Family,
    I have been checking in and following progress and everything is sounding like Andrew is a fighter (a Ryan) and progressing well. That is such great news! I am so proud and think of ya'll often for your journey as parents has just begun. Looking forward to more pictures, he is sure a cutie! Congrats! Love, Peggy (Arens)

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  5. Jaime, thank you for putting together this blog and doing the frequent updates. I'm very happy to hear Andrew is past this huge milestone and on his way to recovery. Babies are amazingly resilient; he'll be walking around and terrorizing your place before you know it.

    Post some more pictures! Also post some baby pictures of you and Danielle so we can see who he looks like. We're all praying he gets his looks from Danielle, but the early pictures are looking more like you...

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  6. Dearest Jaime and Danielle;
    I am so happy to hear all the good news! Your strength and courage have been amazing to witness. ( and Jaime you are as always so smart and articulate). Thank you so much for keeping us posted and please know that you are in our daily prayers. And Danielle, you are my hero for saving milk for the little guy! I think that is just so brave and wonderful and he will most definately benefit immearsurably from it because his mommy loves him enough to strap a pump to her self! We love you ALL so much and wish we could be there to help! Lots of prayers...
    Love you...Annie and Family

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