Anatomy 101

And now for your biology & anatomy lesson!

Sylvie, Michael and I met with Dr. Valda yesterday in his office which was a treat since we'd only seen him before in the hospital.  He's a VERY nice guy.  Sylvie was her usual beserk self and after a 10 second physical exam, Dr. Valda's amazingly kind receptionist offered to play with Sylvie at her desk while we talked in depth about the procedure.  We didn't hear even 1 millisecond of screaming so we knew Sylvie was having fun outside.

So here it is.  Sylvie thank goodness does not need a liver transplant but there is no such thing as "simple liver resection."  Dr. Valda said they will perform one of two different procedures depending on what Sylvie's liver looks like after they open her up (*you will read later about the incision).  The first is an Extended Right Hepatectomy also called a Right Hepatic Trisectionectomy, which involves the resection of segments IV to VIII and often includes resection of the caudate lobe (segment I). This resection is necessary to treat right-sided tumours that extend into segment IV. Basically, this is removing the right lobe and some other parts of the liver leaving just the left lobe.  The other procedure is would just remove the right lobe.

The procedure itself will take roughly 4 hours with two surgeons working simultaneously, Dr. Victor Valda and Dr. Frederick Alexander, M.D.  Dr. Valda, as you have read already, is the chief of pediatric and adolescent surgery.  Dr. Alexander actually designed the surgical facility at HUMC and is the chief of general and thoracic pediatric surgery at HUMC and is also a clinical professor of surgery.  When I hear "professor" it also reminds me that HUMC is a teaching hospital however with this type of procedure, there might be an attending surgeon in the OR but no residents. 100% of the procedure is performed by Drs Valda and Alexander.  Dr. Valda said that with the exception of a transplant facility (like Pittsburgh or Nemours/DuPont), most surgeons would only perform one or two of these procedures annually.  Dr. Valda did it recently on a newborn baby who had a full recovery.

Onto biology, once you remove the diseased or necrotic (dead) tissue, the liver has several arteries that all go to the vena cava which drains right into the heart.  Yikes.  So they have to very carefully close them off.  In addition, the liver is essentially a bloody sponge so they have to carefully monitor for excessive bleeding.  Sylvie's gall bladder would also be removed.  She would have a drainage tube in her abdomen for 4 days post-surgery.  And an NG tube until they confirm her intestines were not disrupted during surgery and she can eat again.  Sylvie will need blood, at least a pint, during the procedure.  He uses some sort of spray sealant protein to seal up the bloody tissue which gets reabsorbed by the body.  Stitches will be dissolvable. 

I asked Dr. Valda if the incision would be small like my c-section scar and he said, "Oh no, it will be across her whole belly."  YIKES.  No bikini's for Sylvie this summer.  At least.  If they need to go higher in her abdomen, they may make a perpendicular scar which he compared to a Mercedes symbol.  I am REALLY hoping this is not the case.  I have a scar from my neck down to my butt with a zig zag one on my hip (just like my friend Tina!) and have never been self-conscious about it however it's not the most-visible either.  "Oh Lord, won't you buy me a Mercedes Benz, my friends all drive Porshes, I must make amends!"   Always a song going through my head.

Sylvie would be in pediatric ICU ("PICU") for 5 to 7 days and then home.   As soon as her blood levels are good and the liver begins to regenerate a little, Dr. Harris would begin more chemo.  No more than 3 weeks after surgery.  We don't have the post-surgical chemo plan yet but that's when/how it will start.

Since the liver controls glucose absorption (the reason for my psychotic aversion to high fructose corn syrup!) they need to monitor this closely following surgery.

Knowing that the two most experienced and regarded surgeons at HUMC would be performing the procedure is reassuring.  That being said, we are still doing due diligence and meeting with Dr. Steven Dunn at Nemours/ Alfred DuPont Children's Hospital in Wilmington, Delaware next Tuesday.  

All of the aforementioned doctors are out-of-network, too.

When we exited Dr. Valda's office, Sylvie was literally being cradled in the arms of his receptionist.  They had become fast friends and Sylvie even hugged her goodbye.  We stopped to pick up Sylvie's pizza, had gelato ("Sylvie, Gelato is a fancy word for ice cream") and headed home.  My parents came over to babysit and we ran into the city to see Into the Presence play their last night at Piano's.  We met Tim at Spitzer's Corner on Rivington Street.  We skipped the pork fat popcorn but otherwise the food was surprisingly great.  For being one of the best and most celebrated drummers in rock music, Tim is incredibly cool.  We talked about their record being available on iTunes and that Maynard was going to Twitter about it.  Then we went over to Pianos where we found Luis and Ana. It was like a little family reunion.  The show was pretty spectacular.  I hope to see them all in a week or so again since their tour dates continue along the east coast beginning with Atlanta. I offered some sight seeing suggestions based on my crazy business trip with my friend  co-worker Tim there last year and we all agreed the south is very different from anyplace else.  Luis offered to babysit Sylvie and I said to my young friend, be careful what you wish for although she'd like his long hair, eyeliner and that he can DEFINITELY sing and play guitar better than mommy & daddy.

OK need to apply Emla cream to Sylvie's chest (*note to self, pick up more cream at pharmacy this afternoon!) and get ready for outpatient chemo.  My mom is going to come today so that I can show her the whole procedure in case she needs to do this when Michael and I are back at work.  Once you get the hang of the different parking garage, elevators (or "alligators" if you're Sylvie), check in, vitals, blood/lab room, Siobhan, Yoomi, movies, art, music, doctors, nurses and food, well then it's easy.  Otherwise, I prefer to not have 'guests' on outpatient day because it prevents Sylvie from bonding with the nurses and doctors.  Today Sylvie is seeing Dr. Steele and I am hoping that Sylvie will be nice to her.  She's the one doctor who she has not warmed up to which doesn't surprise me because of our earlier trials with her however Dr. Steele has made a greater effort than most to be warm and fuzzy towards Sylvie.  I might put some Princess stickers in my purse and give them to Dr. Steele before entering the exam room.