Thursday, September 13, 2007

Medical Update

So yesterday we had a meeting with the Pediatric ENT Surgeon who will be working on Rowan the moment she is born.

During the consult we reviewed the results of a fetal MRI that Emily had the day before, and talked over the different scenarios, good and bad, that might play out during and after delivery.

The news was generally quite good: The cyst in Rowan's mouth is, as was indicated on the ultrasound, just one large cyst, rather than a number of smaller cysts, and it appears to be liquid filled. All this tends to support the initial differential diagnosis that the cyst is a ranula. (you can read our original post on the diagnosis here.)

IF all this is accurate, things should go pretty smoothly-- they should be able to drain the cyst immediately to establish an airway, then take Rowan to surgery to remove some of the extra tissue. Recovery could be quite quick and she could be released from the NICU within a day or two.

This is the best guess scenario, and it is obviously the scenario we are hoping for.

However, there are a number of things that could alter this. One possibility is that the cyst could have caused developmental problems for her tongue, which may result in short or long term speech or swallowing issues. We won't know anything about this possibility until the doctors are able to see the tongue without the cyst in the way. Another possibility is that to effectively establish an airway (if for instance the cyst doesn't drain they way they hope it will) they might need to perform a tracheotomy-- the major problem with this, is that tracheotomy openings made in infants can't be allowed to close until they are fully a year old as the scar tissue could impede their breathing, so if this happens we'll be dealing with trach tubes for a year or so. Perhaps the worst possibility, though, is that the cyst is not a ranula, but might be one of any number of worse options (although the ultrasounds and MRI don't show any indications that this might be the case). If that happens, all bets are off, and our lives could get very complicated for some time.

In any event, we were encouraged, but also sobered, by the meeting yesterday. The doctor seems amazingly competent, and is recognized in the field for this sort of work, we're at one of the best hospitals for dealing with this sort of thing (some of the people we overheard in the waiting room had driven in from such distances that they needed to stay in a hotel the night before). And we have every indication that our best case scenarios are also the likeliest. It is difficult, though, to think about the other possibilities, but also good to have an idea of what they might entail so we can be prepared for other eventualities.

All in all, we are expecting and hoping for the best.


We're pulling for all 4 of you.
We are also expecting and hoping for the best for you. Thanks for keeping us posted.
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