The New Plan

For those who didn't follow Roscoe's progress on facebook, here are links to the posts about the anticipation, the diagram, and the results. The another doctor told us today that given what they knew about him going into the procedure, things went about as smoothly and the results came out about as good as anyone could expect. I certainly attribute this success to God's powerful hand working in response to prayer.

Today the doctors explained their plan for Roscoe's future. If this kid has taught us anything so far it's that nothing is certain (see "Dottie"), but these are their tentative plans for dealing with Roscoe's physical issues. They found that Roscoe has 3 physical issues: 2 breathing issues and 1 digestion issue. I'll describe each issue that they found and how they plan to deal with it.

One breathing issue is that his lungs have chronic lung disease, also called BPD. The BPD is partially caused by prematurity and partially caused by being on a breathing machine for an extended period. Essentially BPD means that Roscoe's lung vessels are smaller which makes them have more difficulty exchanging air to oxygenate his blood. Some medicines help these passageways to expand and spur normal lung development. If Roscoe's lungs hadn't responded to any medication, it would have basically been a death sentence. The doctors plan to treat Roscoe at UCSF with bosentan (which his lungs responded to) until Monday, when he'll get transferred back to Kaiser Roseville. They will monitor him until Monday to make sure that there are no negative reactions, especially with his liver. If there are any problems, they'll stop the treatments and try another medication.

The second breathing issue is that one of the two pulmonary vessels from Roscoe's left lung to his heart has roughly half of the capacity that it should. This is like his heart drinking through a smaller straw, so it gets less oxygenated blood than it should. They considered inserting a stint during the procedure, but opted to let Roscoe's body grow and to track the growth of this abnormal vessel as he grows (not sure how often). If the vessel doesn't grow at all, they will intervene with a stint. If the vessel grows at a rate matching his body, then it will remain undersized and they'll eventually do a stint or surgery to fix it. They said the likelihood of the vessel growing faster than the rest of his body (to catch up to where it should be) is very slim, but as we've seen already with this boy, prayer can do powerful things.

The third issue with Roscoe is pyloric stenosis, which the doctors at Kaiser suspected earlier. This is a problem where the muscle which controls outflow from his stomach is too tight, so it doesn't let enough food into his intestines. Once Roscoe arrives back at Kaiser early next week, they plan to surgically repair this problem. As the UCSF doctors described it, this is a fairly routine surgery and in fact the surgeon who would perform it at Kaiser recently transferred there from UCSF.

After starting Roscoe on bosentan and surgically repairing his stomach issue, the doctors are hoping that he will grow faster due to being able to consume more food and not having to work so hard against high blood pressure in his lungs. Only time will tell if their plans bear fruit.