Pediatric Surgeon Consultation

On Monday, November 3, Greg & I met with Dr. Gates, a pediatric surgeon located in Sacramento who performs surgery at UC Davis. Our consultation with him was regarding primarily the diaphragmatic hernia and not related to the cardiac issues so we have to keep that in mind when we relate what he shared with us. He also had only received a report from our last ultrasound and not all of them and he didn’t have any details on the cardiac issues that are involved.

However, in talking with him, he seemed to be very optimistic about Caden’s outcome. He said that right side diaphragmatic hernias are usually less severe than left side because there are less organs with the potential of being up in the chest cavity. This was different than we originally believed so that was good. He also said that depending on the severity of the hernia, how much of the liver was in the chest cavity, would determine how they would do surgery. They can either enter from the chest cavity and push the liver down and close the diaphragm, or they can enter from the abdominal cavity and pull the liver down and close the diaphragm, or they can possibly do thorascopic surgery and repair that way if it is minor enough.

We also talked about how common it is for babies with diaphragmatic hernia to be put on ECMO (extracorporeal membrane oxygenation), a machine that gives the blood oxygen outside of the body. We thought it was fairly common, but Dr. Gates told us it is only about 5-10% of babies with diaphragmatic hernia that have to be put on it. We were really encouraged by that information.

We also talked about what to expect when Caden is born. First of all, he did say they really prefer babies to be born vaginally as opposed to C-section, because the pressure of being pushed through the birth canal improves lung function which is really important to babies with diaphragmatic hernias. This was good news to us because we really wanted to avoid C-section if possible.

Then Dr. Gates said that as soon as Caden is born, they would take him immediately to NICU and put him on a ventilator, assuming he couldn’t breathe well enough on his own. From there, they would take x-rays to determine the severity of the diaphragmatic hernia and continue to monitor his blood-gas levels to see when he would be ready for surgery. They watch for a certain ratio to make sure his body is ready.

In Dr. Gates opinion (taking into account only the diaphragmatic hernia), the best case scenario would have Caden in NICU for as few as 10 days. His worst case scenario would mean a NICU stay of up to three months. Of course, we don’t know how the cardiac piece impacts this information. If all goes as he expects, he would anticipate a positive outcome with Caden leading a pretty normal life. Of course, he definitely feels we need to meet with cardiothoracic surgeons in order to get a complete picture of outcome probabilities.

All in all, we felt it was a very good consultation and we liked Dr. Gates a lot. We are very glad we were able to see him before we go to Stanford and meet with all the specialists there. It just feels like we are more informed and can ask more specific questions. The only other thing we talked to Dr. Gates about that causes us some concern is about how babies with diaphragmatic hernia are often born early, as early as 34-35 weeks. So, me going on bedrest at 35 weeks might not work out. And, the plan to relocate to Palo Alto at 36 weeks could be problematic if I’ve already had Caden. So, we will definitely be talking with the doctors at Stanford to see what their opinion is. Please keep us in your prayers as we continue our journey.