Another day of angst for us, as we went for a follow up appointment with the surgeon we saw a couple of weeks ago about getting Lea’s abdomen surgically closed. We first saw him as a referral from the delightful lady who showed up on our doorstep to buy Lea’s business car. This is the 3rd surgeon we have consulted about this surgery, and went back to see him after having a CT scan performed last Saturday.

He stated that upon reviewing the results of the scan he was happy to report that there were no complications or medical problems apparent in the abdominal cavity (Thank you, Lord!). He said the lungs, liver, gallbladder, kidneys, bladder and adrenal glands all look normal. The pancreas shows an 8mm cyst tail with adjacent ductal dilatation (results of the rupture of her pancreas in July 2005).

The appendix has an unusual appearance demonstrating fat within the wall and a central filling defect, but there is no associated inflammation. (No worry.) There is no evidence of bowel obstruction, nor free fluid within the abdominal cavity Praise God for miraculous healing! This could have been SO much worse! I had been in prayer asking God for no surprises as a result of this scan, and once again, He showed His mercy in her healing!

Dr Mah had advised me upon her release from Hartford Hospital that the fistula might close up on its own some day, cutting off the drainage of the fluid from her abdomen, and that the body would either absorb the fluids, or they could build up in pockets of fluid which would have to be drained about every 90 days through a drain in her side, We didn’t have that problem, and thank God for that blessing.

The surgeon stated that the scan indicates that there is actually a little more muscle tissue at the base of the ribs than he had imagined, and that it appears the surgery might be possible. He thinks that he would probably use a bio-based mesh to close her up so the organ tissues would attach to it and gain a little more stability over time, rather than using a stronger mesh that doesn’t have that feature. The stronger mesh might prevent future hernias through the resulting scar, which is fairly common with abdominal closings, but the stabilization of the internal organs is more important.

The procedure would be “a big deal,” requiring 4 to 5 hours of surgery and possibly more than one surgeon, he said. Problems that might be encountered include the possibility that when they stretch the skin up over her stomach to close it, it might be so tight she couldn’t breathe and they would have to put her on a ventilator. He isn’t sure she could survive that because she is really still in the recovery stage from Hartford and is very frail.

Peeling the skin graft off the underlying bowel tissues could result in minuscule holes or tears in the bowels, leading to peritonitis, an infection caused by a bacterial inflammation of the abdominal cavity. It wouldn’t show up until after the abdomen was already closed up, and would be very difficult to treat effectively.

He said that she is still so close to the major trauma she suffered, it just doesn’t seem reasonable to put her through another life-threatening surgery when she is doing so well. He said that he could not in good conscious recommend that she have the surgery because there are so many things that could go wrong during the procedure and so many complications that can occur later.

The doctor said that while he would love to perform the surgery, he just can’t recommend it . . . it is too risky. He feels that we should have her knee replaced, which will greatly improve her mobility and stability, and delay the abdominal surgery until she just can’t tolerate wearing the binder any more.

While it means that she can’t push, pull, stoop, lift, or drive, her overall quality of life will be improved without putting her through a life-threatening surgery with a difficult recovery. It is likely that she may have to wear a binder to protect her tummy for several more years, and we have to continue being diligent about protecting that skin graft from damage or infection.

We thank God for leading us to a doctor who understands her condition, the ramifications of the surgery, and is honest enough to explain our options and his recommendation. And, while we are grateful for the many blessings we received today, we won’t soon overcome the disappointments. We will just have to leave this day behind us and carry on, looking ever forward, seeking His will for us. That’s the way it is when you have to live with mixed emotions.

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