Thursday, September 27, 2007

Monday, September 3, 2007

Details of Dylan's Big Day

Another commonly asked question is : Will Dylan to straight into surgery?

The answer to this is: Your Guess is as good as ours!

The way it looks is that Dylan will not go directly into surgery. I will be laboring in the beautiful "Golden Gate Bridge View Room", then when I am close to delivering I will be moved into an OR. The reason I will be moved into an OR is because it is such a sterile environment and Dylan has organs outside of her body therefore she needs such an environment. After she is delivered they will pass her through what looks like a drive through window. On the other side of this window is a team of doctors and surgeons in another sterile environment. They will immediately place Dylan into a bowel bag. A bowel bag is a plastic bag (the same kind that they use on adults in the ER) that Dylan will literally be placed in. It will got up to her armpits and then kind of wrap it around her, this is to ensure that her organs stay moist and that they stay sterile. The nurses will clean Dylan up while the pediatric cardiology team assess her heart (every time they check it they say it is great, but they just want to be SURE), the pediatric surgery team will assess her intestines and general state in order to game plan their next moves, and the neonate team will be getting her into her isolette and move her into the NICU. At this point Casey and the grandparents will be leaving and going with Dylan to the NICU. I will be finishing labor in the OR.
If Dylan just had a few loops of her bowel out then she could go straight into surgery and they could do what is called an "enclosure surgery". They would assess that bowels to make sure that there is no atresia (endings, deadspots) and then insert the bowels into the body and sew her up. The baby would then be medically paralyzed in order to make sure she didn't move. Adults breathe with our lungs and our chest go in and out, whereas a baby breathes with their diaphragm going in and out of their belly. If she now has organs in there that she is not used to then she could squirm and be in pain or possibly stop breathing.
The most likely scenario is that she will not go into surgery for two weeks. From our last couple of Ultrasounds it looks like all of her large and small intestines are out of her body, as well as her liver. Her little body was not made with an empty whole to place all of these organs. Therefore the surgeons have to make room for her organs. They will place all of her external organs into a plastic bag that is known as a SILO. The only way that I can explain it is as a cake icing tube. They will place her organs in this and then a spring loaded piece is inserted into her opening. The bag is then suspended above her body. Gravity then does the rest. The nurses could twist down the bag a little everyday in order to get more to go into her body. This allows gravity to just create space for her organs. The doctors will then preform the surgery closing up her abdominal cavity.
If Dylan's intestines come out black that means that parts of them or all of them have died. She will then go into surgery very quickly. But during my current Ultrasounds they have detected great blood flow through the intestines which indicates that nothing has died. She could also have to go into surgery right away if her intestines stop at a certain point. As you know our intestines loop around and loop around, but if she has atresia this could mean that is just stops looping.
We are hoping that Dylan will not need this last surgery that I discussed. But you just never know!

Sunday, September 2, 2007

What it feels like to be pregnant!

Everyone wants to know what I feel like being pregnant. I think the following clip sums it all up in a matter of seconds!

http://www.youtube.com/watch?v=Ms3QdGIzltU

Enjoy!

Saturday, September 1, 2007

To "C", Or Not to "C": That Is The Question

One of the most common questions that I get asked when people hear of Miss Dylan's Gastroschisis is " You will have a C-Section, right?". So, I thought that would be one of the first topics that I addressed in the long list of questions that I am asked. The answer is "No!". Dylan will be born naturally. Or at least that is the plan. My initial thought was that she would have to be delivered by Cesarean section. How could she be delivered any other way with her intestines like they are? But after talking to many doctors and doing my own research I have found out that C-Section is not the answer. According to UCSF (where Dylan will be born), a premiere research hospital, there is no outcome difference of babies born via c-section versus vaginal birth. And because it is safer for the mother's to have a vaginal delivery not only during this pregnancy but also in future pregnancies they advocate for a natural delivery if at all possible.
After meeting with the Neonatologist in Phoenix I learned USC pediatric surgical and obstetric group differs with this opinion and advocate for cesarean at 35-36 weeks. Other obstetrical or pediatric surgical literature or practitioners do not support this approach (that of cesarean). UCSF advocates for induction of vaginal delivery at 36-37 weeks. The plan is to induce me at 37w1d. If all goes well I will progress in a safe and steady amount of time and Dylan will come naturally. I will be on close monitoring throughout the labor and if for some reason Dylan gets distressed and needs immediate delivery we will then proceed with a c-section. I will be administered an epidural fairly early in the delivery and they will up the dosage if c-section is required. My goal is to deliver Dylan naturally in a fairly quick, low pain labor. But, I also want a million dollars, so we will see what happens! I will labor in one room surrounded by family (at least the grandmothers and husband), as as labor progresses I will be moved into a sterile OR/Delivery Room for the actual birth. Dylan will not go in to her surgery right away, but because her organs will be outside of her body we want to make sure she is delivered in as "clean" of an environment as possible. I will go into more detail of Dylan and her surgery in an upcoming blog. I feel like I am overwhelming people with information.

I do want to take a minute to thank everyone that has sent me an email about the blog. I really appreciate all of the kind words that have been expressed. Everyone that reads this has a special place in My Family's heart. Thank you for taking your time to read this and take interest in our daughter's fight. She is such a blessed little girl to have so many people praying for her and already loving her before she has even entered this world. I cannot wait to tell her that the reason she recovered in such a record time was because of all of the love she had from so many people. I just don't feel like I could ever say "Thank You" enough. Please know that Casey, Dylan and I appreciate it more than you will ever know. THANK YOU for being a part of our new family and THANK YOU for being a catalyst in our daughters survival.