Monday, March 14, 2011

I apologize for the delay in posting.  I spent about an hour writing an update, then the internet connection was lost when I went to publish it, and the entire post was lost as it hadn't saved as a draft.  AGGHHHH!!! 

We've had a steady stream of doctors, nurses, and visitors all day and night.  Selah is in intermediate care, the floor between PICU and the regular floor.  She is closely monitored, with the nurses having 2-3 patients per nurse.  Selah's nurse today was Serbian!  I just about fell over when she mentioned she was Serbian!  How crazy is that?!?

Due to an unexpected finding during surgery this morning, the procedures didn't go exactly according to the neurosurgeon's plan.  Dr. George was able to successfully place one catheter through Selah's skull into the subdural hematoma (massive pocket of blood between her brain and skull), and he drained quite a bit of blood initially.  They need to drain the hematoma slowly to avoid complications, so the catheter will remain in place for at least a few days, slowly draining the blood from the hematoma.  Selah catheter is stitched in place at her scalp, and bless her heart, it's taped to her head of curly hair.  Every time she moves, the tape pulls hair out.  She has some dressing around her head to help alleviate the tugging and pulling, but it's still pulling out her hair because Selah's been pretty active today.

The part of the surgery that was not successful was the shunt revision.  Dr. George unexpectedly discovered that Selah's shunt was not in a brain ventricle where it should have been.  The shunt was also not on the correct side of the brain, but he was unable to fix the shunt problems because Selah's brain ventricles have collapsed.  I don't know much about brains, but I was told that we all have ventricles in the center of our brains, which are basically tubes that are filled with fluid.  Selah's tubes are not filled with fluid (as they should be), they are completely collapsed, making it too risky to try to shove the shunt into one of them.  (If she didn't have a shunt at all, her brain would swell with too much fluid, so it's necessary to have the shunt placed properly with the correct amount of drainage.)  The current shunt has completely overdrained Selah's brain, to the point of shriveling it up and collapsing the ventricles.  The hematoma has added extra compression on the brain, so this big moist sponge is now completely rung out and squished!  Not good.

This overdrainage happened because the current shunt was sucking too much fluid out of the brain.  There are apparently 3 different sizes of shunts (small, medium, and large), and Selah's neurosurgeon at birth chose the medium-sized shunt for Selah's brain because of the volume of fluid on her brain at birth.  (She had 3 pounds of fluid on her brain at birth, with very little physical brain matter due to lack of space from all of the extra fluid.)  Programmable shunts, which can be fine-tuned to perfect the amount of fluid that is drained, are available, but they're normally not used in infant hydrocephalus cases because they're not as effective in newborns.  Now that Selah is 5 months old, and the medium-sized shunt is obviously draining way too much fluid from Selah's brain, the neurosurgeon wanted to replace the shunt valve with a programmable valve so that he could fine-tune it and properly balance the amount of fluid in Selah's brain, no more, no less.  But because the ventricles were collapsed, there was no way to properly place the shunt, as it must be placed in a ventricle.

The neurosurgeon decided to temporarily leave the shunt as is in the brain, but the tubing that runs from the shunt into her abdomen was adjusted.  Instead of having the shunt drain into Selah's abdomen, the neurosurgeon opened Selah's abdomen and ran the tubing outside of the abdomen.  The tubing is stitched in to place in Selah's tummy as it exits.  Having it drain externally allows the rate of flow to be adjusted and monitored, so hopefully this will decrease the amount of fluid being drained from Selah's brain so that it will be able to rehydrate, but not swell.

The neurosurgeon is hoping that once Selah's hematoma is drained, the brain will then have more space to rehydrate and allow the ventricles to become round again, instead of flat.  If the current shunt's rate of draining slows down with the drainage tube outside of Selah's body now, that should help as well.  Once the ventricles are full again, Dr. George will do another surgery to completely replace Selah's shunt.  He'll remove the old one and put in a new programmable shunt, with proper placement. 

Selah will remain hospitalized until she receives her new shunt.  The earliest would be Friday or maybe Monday, so please be in prayer that this will all happen in God's perfect timing.  Selah must remain lying in bed, with her head at between a 15 degree and 30 degree angle.  We're not encouraged to hold her, as it's challenging due to the brain/skull catheter and the tubing out of her abdomen, and the angle is too steep most of the time.  If she is upright, too much fluid drains, causing risks.  Selah is doing well with her pain meds, although she has had a few really hard times with lots of crying and pain.  Please pray for Selah's timing without any complications, infections, etc.

Please also pray for our children who are doing an awesome job of taking care of things at the house.  We're so grateful for everyone God has placed at Forgotten Saw Ranch, as everyone serves our God with joy and brings honor to His name by their selfless actions.  We're so proud of everyone, and so grateful to have so many willing helpers.

Thanks for praying and for your sweet encouragement and support.  Thank you to everyone who is physically helping our family by providing meals to our family, to us in the hospital, for visiting us, but most of all for PRAYING!!!  Prayer is the greatest, most powerful gift available, so we are incredibly blessed to have so many of you lifting us up to our Father.  Thank you!

PS  I will definitely update the blog if there are any emergencies, but if you don't hear anything, please know that no news is good news!

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