What is that?
That’s the Aorta (major artery coming out of the heart) with a clip over the PDA, a vessel coming off the aorta that normally closes after birth. This is a 1 1/2 year old boy with heart failure from his PDA, which never closed after birth. This operation is called a PDA ligation and is the first one to be done at Loma de Luz. I would be surprised if it is being done anywhere else in Honduras. It’s pretty incredible to have this level of care at our hospital. In order to visualize the heart with a laparoscopic camera that is inserted into the chest, you also have to intentionally drop (deflate) a lung. So, you keep the child alive on one lung while you operate within the chest cavity on the side that is dropped. Incredible. It just happened this past week at Loma de Luz.Here is the boy who had the surgery.
Dr Drew, a pediatric surgeon, came down and performed this surgery. He comes about 3 times per year. The little guy already went home, doing great! Instead of dying young from heart failure, he will have a drastically changed life. Glory be to God!
This is a 3 year old male who came in with an open tib/fib fracture after falling off a stationary motorcycle.
Here we are attempting a casting technique to deal with this complex fracture. The foot is casted first, then the fracture is reduced and a dressing is placed over the open area (where the bone came through the skin). Then the rest of the leg is casted once the fracture is reduced and bones are in good position.
You can see how the foot was casted first in orange here.
Compartment syndrome is where the swelling of the leg within the cast can lead to decreased blood supply to the leg. We avoid this by “bivalving” the cast, which means cutting a freshly applied cast open and then applying a coband over the top of the cast for the next few days in order to hold it in place, while still allowing room for swelling. After a few days, when maximal swelling has already occurred, the cast can be wrapped again (without bivalving) and a window created within the cast in order to do wound care at the sight where the bone went through the skin. It is sort of like doing an Ex-fix in what would be a difficult ex fix given the fracture location.
That’s a bullet pulled out of the abdomen of a man who was sitting in a park when someone drove by and opened fire on him.
Jeff and Dave are operating with Allen (the scrub tech) to fix multiple holes in the small bowel that the bullet created. Fortunately, it missed the major organs, but there was about a liter of blood in the abdomen. The man is very fortunate to be alive.
The white dot on the left is the bullet that has traversed the entire inner abdomen leaving about 8 holes in the bowel that needed to be closed. Some parts of the bowel had to be resected too.
Dr Drew and another visiting oncological surgeon (specializing in Sarcomas), Dr Rick, are here performing a surgery on a young male that went from 10 am in the morning until around 3 in the morning the next day. They were trying to do everything possible to save a section of his bowel and get it to connect in a way that would give him a much more normal life.
Dr David Hastie, a former classmate of Anne’s from medical school, came down to help out with the anesthesia for the week.
A 32 week premature infant born this past week, now being sustained with nasogastric tube feeds until he gets a little more energy to keep up with his feeds on his own.
More construction at the hospital in progress. These are more Samaritan’s houses, built to house long term patients and families who have extended stays and come from afar.
Hospital addition in progress to make 2 more OR rooms which should greatly help our capacity, especially when we have visiting teams.
The other section of Samaritan’s housing that is coming to completion.
Hospital addition, including a new ICU room where nurses will be able to see the patient from the nurses station, making it easier to take care of critical patients.
Another view of the Samaritan’s housing. Left side near completion, and already full of patients. Right side under construction.
A few patients (among many not mentioned) not shown just from this past week:
1. Jose, a young gentleman who has a long complicated surgical history that has left him with a high output ostomy. That’s a hole in his abdomen where his stool is coming out. It means that he is not absorbing nutrition and is emaciated. Dr Dave is working on ordering TPN (IV nutrition) from San Pedro Sula to buy him some time to heal as he is so nutritionally deprived, he may not be able to make it without more time “bought” with the IV nutrition. That costs about $250 for a two day supply. Please keep him in your prayers.
2. A 62 year old gentleman “Oscar” that presented with refractory status epilepticus. That’s seizures that would not resolve with high doses of multiple meds. We ended up placing him on a mechanical ventilator for about 8 hours while on a midazolam drip to buy time while other meds placed down an NG tube could have effect. After battling for almost 4 days in our hospital, we have determined that none of our meds are sufficient to treat his seizures. He continues to have tonic clonic seizures about every 10 minutes despite many meds attempted (Midazolam at high doses, diazepam, klonopin, keppra, Ketamine drip, carbamazepine). Family has taken him home on hospice care, but continue to look for Depakote as an alternative. Keep him and the family in your prayers.
3. A young pregnant woman who delivered a breech baby by c section after presenting with severe gestational hypertension superimposed on chronic hypertension. (basically really high blood pressure in pregnancy). She has done well, by God’s grace.
4. One of the more interesting cases for the week was a young lady who was thought to have a large sarcoma of the thigh. She even had muscle biopsies (that were normal) done. Then she had an MRI of the thigh. After all that, it still was not clear what was going on, but it was thought it still was most likely a sarcoma. We happened to even have a visiting oncological surgeon for the week, who specialized in Sarcomas and even writes guidelines for sarcoma treatment.
Well, suddenly last sunday evening, she started bleeding profusely from her thigh area at rate that you end up dying from very quickly. It had been noted on the MRI that there was an aneurysmal area (large blood vessel dilation) in the thigh. It had ruptured and she was bleeding severely. A tourniquet was immediately applied, almost like in the movies. We rushed her to the OR, trying to save her life desperately. Wouldn’t you know that at that moment, we ran out of bags that hold donated blood. So we were only able to donate 1 unit of blood. Any other bag would cause the blood to clot off too soon to be used. We were left to rely completely on the Lord that she wouldnt bleed more than the capacity of our system with the resources we had. She ended up with an amputation of her leg in order to save her life. Vascular reconstruction would not have been possible with the severity of the aneurysm, according to the sarcoma expert. It is thought that the whole area was probably severely swollen from the aneurysm, and never was a sarcoma, which is actually good for the patient. Praise the Lord, she did not bleed more than what we were able to give her. The next day, more blood bags arrived.
Happy Easter everyone!
PS. Here are some photos from today’s Easter egg hunt at the Children’s Center.