Well, all things are a go for Monday. We met with Dr. Superina today and we are very satisfied with his demeanor, knowledge and expertise. I have to admit that I was watching his hands most of the time and did not detect a tremor, so that is a good thing. (Who really does that, this girl, apparently) Reilly interacted well with him and seemed very comfortable.
A neat thing is that one of the fellows on the surgical team knows Dr. Noel from a long time ago. Such a very small world. There is a significant measure of comfort in that too. Everyone took a lot of time to make sure that we, the parents, are comfortable and knowledgeable about the situation.
After the appointment, Reilly had lab work done. 15 tubes of blood for 23 tests! That's a lot of blood for a little person.
Dr. Superina showed us the significant gastric varices and the collateral veins that Reilly's body has formed and how the blood is flowing through these unstable veins. He indicated that waiting, in this situation, is not really an option unless you are waiting for something to happen.
On Monday, the team is going in prepared to perform the meso-rex shunt. Before taking her jugular vein, they will attempt to use one of the collateral veins that have formed in her abdomen. There is no way of knowing if these veins are viable until seen. If not, the jugular vein will be used. The meso-rex shunt will restore normal blood flow to the liver by bridging over or around the blockage in the portal vein. This reduces the pressure in the portal venous system and things will basically operate the way they were intended.
Also, our plan B is the mesocaval shunt. This will direct the blood flow from the portal venous system (and most of the gut) to the inferior vena cava. This has the intended effect of reducing the hypertension in the portal venous system and reducing the pressure in the varices. This procedure has a high effective rate in young children, with few complications, encephalopathy being the major one IN THEORY. Dr. Superina indicated that they have performed this procedure many times in children and have not seen encephalopathy in their patients.
The surgery itself may take up to 12 hours (because of its highly delicate nature). Reilly will be in ICU for several days post surgery and then moved to a regular room for the last few days of her hospital stay. I will post about her status as often as possible.
Thank you for all of the well wishes and the prayers. Please continue as the toughest part of this starts on Monday.
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