Friday, May 27, 2011

Surgery postponed to tomorrow

You may have seen our updates to Twitter or Facebook that Keegan's surgery will be postponed until tomorrow morning at 8am.  His transplant surgeon, Dr. Kristine Guleserian, will be coordinating and leading the surgery to remove his port.  She has been planning, researching, and assembling her team all evening.  They are of the opinion at this time that it has been in the artery for some time, if not from the beginning, and that waiting 12 hours to fully prepare was more beneficial than rushing him to surgery tonight.

Dr. G has asked for the leading vascular surgeon at UT Southwestern, along with their chief interventional radiologist to assist her in this surgery.  Our chief of interventional cardiology (i.e. head of the cath lab), Dr. Zellers, will also be assisting.  Our favorite cardiac anesthesiologist, Dr. Turner, will be there, and the bypass team will be ready if needed.  This is not something that anyone can ever really remember seeing in a pediatric case, so they are trying to be as prepared with a plan as they can before getting to the OR in the morning.  There are about 5 different ways they could go in to try to get this catheter out.  On a scale of least invasive to most, the most likely way they will go in is #4 on the list.

Brother-sister bonding while waiting to hear about surgery

The surgeons believe that the port may have been placed incorrectly from the get-go back in December.  Keegan was very swollen coming off dialysis at that time, making placement a bit tricker.  However, other options could be that the vein was accidentally punctured during placement, or the catheter truly did erode through the vein into the artery.  They are prepared to repair any damage they detect after removing the port.

Our biggest risk and concern from this surgery is a stroke.  The catheter can develop a fibrin sheath, a clot of lipids, or a blood clot in it.  All of which can break off as the catheter is removed.  The team will use as many precautions as they can, but there is not a lot they can do to stop it if it's going to happen.  We won't know if any neurological complications have happened until they try to wake him up.  We believe this line has been throwing clots already because there were two areas of infarction in his spleen shown on the CT scan, along with the mini-stroke he had back at the end of March.

Trying to make Keegan laugh and feel better

We have no idea how long this surgery will take.  He will be in recovery afterward in the cardiovascular ICU for at least a few days.  We are still chasing every possible source of infection down (including culturing the port once it's out), but when this is all said and done, we still are planning to proceed with the steroid pulse.

That's all the actual information I have to share tonight.  My brain can hardly comprehend the technical stuff.  I have not let my heart start to process it yet.  I simply can't.  I have to be present physically, emotionally, and spiritually for Keegan.  My sheer ability to understand and come to grips will all of this has pretty much disappeared.  I don't know what else to do but soldier on.  We have one hell of a fighter on our hands and an awesome God who will never leave us.  Tonight, I have to place my hope and trust in the Lord, that He will raise us up and out of this depth.  That He will surround Keegan with his strongest angels to cover him with their mighty wings.

So many of you have offered your prayers and support - people we know and those we have never met.  Please keep them coming.  They may be all we have right now.  Thank you.  We will post tomorrow to the blog as the surgery progresses.

For He will command His angels concerning you 
to guard you in all of your ways.
They will lift you up in their hands,
so that you will not strike your foot against a stone.
Psalm 81:11-12


Dustin & Kate said...

Praying for healing and protection over Keegan and comfort and strength for your entire family. I will be anxiously awaiting an update.
~Kate W.

Anonymous said...

We're praying for all of you! CMC is awesome and the care team that's taking care of your sweet boy is the best around!! We've used most of them including Turner and Zellers. We'll be watching for updates and praying!
~Kimberly and Seth Rippentrop (HLHS)