Riley International Heart Missions

So it is already Thursday and we leave late tomorrow evening…but we just seem to be adjusting to the 8 hour time difference from home. We have 2 cases today, the second case could be more complicated as it is a “redo”.

The first patient is Aseel. She has a VSD and DCRV. She is nearly 3 years old (2 yrs 11 mos). . The OR staff is so efficient that she was in the room and asleep before we finished rounds on the patients in the ICU! I missed meeting her or getting to see her before surgery, so no preop photo.

In the ICU, Bisan, the tiny 2 month old could be ready to extubate. Dr. Khal stopped her sedation and will see if she is ready thereafter. Wasim looks great, ready to eat and perhaps move to the floor later already as well if needed. She is only postop day #1, but looks great. Again, her mother sits by her side with the biggest smile! She waved eagerly as we walked into the room. Rana tells me that her father is a painter of all things in the home. They are not Jordanian born so even though Wasim has never known anything but Jordan, they have no health coverage for care, so she has lived until 17 with this heart condition that they could not afford to address. Her father would paint for very reasonable wages and show all of his customers Wasam’s picture explaining that the longer she waits, the worse her heart condition gets. He called everyone to try to get help. Finally they were referred to Dr. Khal who has hooked them up with Gift of Life. He is absolutely moved to tears by this experience. He says it is so surreal and feels like he has taken his daughter to America for surgery, but even better, America came to them! Wasam has perfect English and tries to bargain with Dr. Turrentine on exactly when she can get her Chest tube out!

Wasim

Melak is going to be moved to the floor. She is still sleeping this morning, but mom said she had a good night. We recently learned that these wonderful parents from Baghdad just lost a younger daughter in the last few months. We do not know the details, but the relief that this surgical repair of Melak’s heart has given them is so obvious. The Tom Deierlein Foundation based out of New York should be very proud of their help with us for this beautiful family. Again, you don’t have to know the language to know that these are very grateful parents, especially in light of the recent tragedy in their family of losing another child. To know that their one living child is healed is obviously great relief.

Melak giving a Thumbs up!

Adian, our other sweet Iraqi redo sponsored by the Tom Deierlein Foundation still has too much fluid in her left lung, so she is not ready for extubation yet. Adjustments are made to her meds and her vent and we shall see how she improves.

Aseel’s surgery goes very well. She has PMVSD, RVOTO, DCRV and PFO for you medical people…for all others, she needed a few “little things” tidied up in there . All goes well and she is returned to the ICU and soon thereafter extubated. She is a beautiful girl with curly hair and gorgeous eyes from near Amman. Her parents are so grateful for the opportunity for her to be helped now. Her mother told Rana that she felt like no one was listening to her that her daughter needed help. So many doctors had pushed her off and did not listen she felt until she met Dr. Khal. Aseel is just an absolute sweetheart!

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Aseel

The second patient this afternoon is a redo- Ahmed. He had Tetralogy of Fallot and his Pulmonary Valve could not be spared in his initial surgery in 2011. Dr. Turrentine was not sure that his father would ever want to see him again because his response was so dramatic about the need for a valve several years ago! He was told the father literally fainted when informed that Ahmad needed a valve replacement! He now has some Right Ventricular outflow tract obstruction. However, for several hours it sounded like this case was not going to happen. We were told during the first case that blood products would not be ready for another 3-4 hours for Ahmad and that would not work to do his surgery today or this mission at all… However, the blood products came sooner and we start this case by just before 3:00. Ahmad is a 3 year old boy from near Petra, several hours away. He has been followed by Dr. Khal regularly since his surgery. His case goes very well and we leave the OR, identifying the instruments we brought to take back to Riley (thanks for the cheat sheets, Jill!). He goes back to the ICU and will likely be extubated this evening.

Ahmed

Adian is postop day #2 and has obviously been on Dr. Turrentine’s mind since even before surgery. His patience seems to have paid off as her evening chest X-ray finally shows significant clearing in the left lung and her sats are improving. It is wonderful to give her beautiful mother Noor some good news this evening. Again, hoping for continued improvement overnight so we can extubate her tomorrow.

Yazeed is doing very well and will likely go home tomorrow. He even gave Dr. Khal a great smile this evening, but that photo was blurry. So here is a different photo of beautiful Yazeed!

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Yazeed

We head out of the hospital in just enough time to clean up for a wonderful dinner at GOLA president, Sirene's beautiful house. I can't say it enough what a welcoming, wonderful group of people they all are. What a great example of amazing things that can be done when people work together on something like Gift of Life. They all make a wonderful team helping to care for the families and patients…and us! . This is such an amazing experience for me as a Rotarian in addition to Gift of Life… Traveling to a completely different part of the world and truly living Peace through Service! These are always life-changing experiences for the team members on these trips and this is certainly no exception!

Tomorrow we hope all the children continue to improve as we go in to visit them all one last time before hopefully a quick trip to the Jordan River and then heading to the airport late tomorrow evening. Words cannot express what a great week it has been!

Written by stephkinnaman

March 7, 2013 at 8:54 pm

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Amman “Mini Mission” 2013-Wednesday

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Wednesday started with some better news in Adian. Her sats have been good, she has diuresed a lot and she is awake and alert on the vent on minimal settings.

She is such a beautiful girl!

Adian

Yazeed is doing well and will be transferred to the floor today. He is sleeping so sweetly this morning on rounds.

Yazeed

Melak is doing very well also. She is extubated and alert, awake and sounds good. Her parents are very grateful and so sweet, relieved all is going very well.

Feras is ready to go home. He is coloring when we walk in the room, smiling. His dressing will be removed from his chest and he will be ready to go! His mother is with him this morning and so excited to go home with her little Feras who has a new lease on life!

Feras

This morning we have added on little Bisan. She is a tiny little little gal of only a little over 8 lbs at just less than 2 months of age from Jordan who has really been failing lately. She has been short of breath, tachycardic, and more blue. She was admitted as a PDA, but Dr. Khal found she actually has a hemitruncus (again, sorry Dr. Cordes!) with her left PA coming off the descending aorta. The last 2 days her mom says she has not been nursing well at all. Mom and Dad are both nurses who work at the same hospital about 2 hours from their home in Jordan. fares tells me they kive about 30 minutes from Amman in a very poor area. They commute to this more southern are 4 days a week each for their jobs. Bisan is their only child and they have a huge group of extended family members here for their support. She has gained only 100 grams since birth. She is really failing to thrive and needs help now. She is taken back to the OR and prepped for surgery before we had time for a photo. There was a very nice view of her defect once Dr. Fadi and Dr. Turrentine get started, but I think I missed the best photo op…

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Bisan’s Hemitruncus Heart

It is a beautiful repair with reimplantation of the pulmonary artery in the normal location now. The ASD is left alone and we are now with PA pressures of 2/3 systemic (for the medical people). She may need a device closure of her ASD in the future, but this is small and may be smaller with less flow across it. This will be a HUGE improvement for her. She should eat better and grow and thrive very well now!

We are out of the OR and little Bisan is transferred to the ICU. Wasim is here for surgery this afternoon. She has not yet been seen by the team, so she and her mother meet us in the ICU for a preop echo. She has a VSD with some aneurysmal tissue around it. She is from Jordan now, but her father is Egyptian and mother is Syrian. She is the third born child in her family with 2 siblings in college and a younger sister as well. She is a very sweet girl! Her surgery goes very well and she is transferred to the ICU.

Wasim

Dr. Turrentine goes to check on Dou’A after her cath. It turns out, it is her 19th birthday today! Her cath shows her pulmonary arteries are reactive, so she can be surgically corrected, he feels with a VSD repair. He hopes to get this done on the next mission. She is such a beautiful young woman with a wonderful smile, how can you not fix her heart?!

We are back to the OR again in the late afternoon for little Bisan. After her pulmonary artery is re implanted and now with less pulmonary pressure, there is a PDA seen in a strange, deep location on echo in the ICU by Dr. Khal. As hard as it is to think of going back to the OR for her, it is worse to leave it, so she is the first and last case of the day. It is a very quick case and she is back in the ICU doing very well with sats in the 99-100% range and pulmonary pressures that are much better! She will stay on the vent overnight to rest. She will gain weight for sure now!

Adian is doing better in the ICU, hopefully off the vent tomorrow. Malek’s is looking great, off oxygen and down to the floor in the am. Wasam is extubated and doing well, asking for water. Her mother is all smiles! Yazeed has been moved to the floor and was hungry and mad when we went to see him (we interrupted his feeding time). A good sign he has lots of energy to so plainly let us know his opinion! Feras has left for home and Fares from GOLA/Rotary tells us he actually rode a bike out! He promised to send me that picture and I will certainly share on the blog!

It should be noted what an amazing asset Fares and Rana have been this week! It has been invaluable to have their interpreter services and insight in general to Jordanian traditions and cultures and places. They have been so helpful in getting more information in every way…I know they have big exciting plans in the making to help the GOLA children as well!

Recent meeting at Starbucks with Fares (left) and Rana(right)-Dr. Steph LOVES Starbucks!

We leave the unit again with Dr. Khal who takes us by a nearby hospital to check on another patient, then have a little late dinner before getting in a little earlier (at least before 10:30- a new record! The Jordanians are late night people!). More falafel and kenafe (although not sure how we can eat any more this week)…Nevertheless, we have two more cases to finish up in OR 5 tomorrow before heading out Friday!

Written by stephkinnaman

March 6, 2013 at 7:25 pm

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Amman “Mini Mission” 2013- Hoping for Two on Tuesday!

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Another chillier day today in beautiful Amman. Dr. Khal takes us in this morning and tells us no calls overnight from the unit on the children, so all must be going well…and it is!

Yazeed was extubated last night and is doing well. His bleeding has stopped to the point of normal chest tube drainage. He may even go to the floor later tonight. He will start nursing today and see how he tolerates his normal diet. There is a little fever, but overall he looks very good.

Yazeed

Feras is complaining of some belly pain and not thrilled about eating today…more tears at the time of rounds/breakfast, so I don’t have the heart to snap a picture…we give him a little bag of goodies for him to do and hopefully enjoy. His mom seemed to think he will like the crayons and coloring book. At the time, he isn’t thrilled about anything!

Adian is taken back to the OR to be prepped. Her mother carries her back and the OR team gets to work straight away…again, their efficiency is impressive. Dr. Sami, the anesthesiologist works diligently and is so welcoming and kind to our GOLA visitors in the OR. He really taught Fares and Rana a lot yesterday, talking them through the surgery from the head of the bed yesterday. They loved it! Today is Sirene’s turn! She is a founding member of GOLA and the current President, as well as a Rotarian. She is an absolutely wonderful, inspirational woman who continues to do so much for GOLA and the children of this region. It has been such a pleasure to work with all of these amazing Rotarians and GOLA friends!

Sirene in OR

Dr. Turrentine has been thinking all morning about Adian’s big surgery today…she was first operated as mentioned yesterday in May 2012. Her surgery was much more complex than they had planned. She was originally billed as a VSD, but when she traveled from Iraq and was studied here, they found all kinds of anomalous arteries off the descending aorta and no clear pulmonary arteries at all. This was a big surgery of creating pulmonary arteries and creating a centralized shunt (unifocalization) that is probably not yet ready to be reversed, but she needs a bigger shunt for now…since this is a redo it takes a bit longer to get down to the area of most interest. Tough decisions are made in the kind of shunt and whether to fenestrate the VSD, but finally Dr. T and Dr. Fadi decided to not touch the VSD and replace a larger shunt. Her heart was not so happy when warming up…she went into an abnormal rhythm for some time (VT and VF). That required some work and meds, some defibrillating, and some praying by some of us and then some cooling with another “shock”, then little Adian’s heart finally started to cooperate and came back into sinus rhythm. The pulmonary arteries look very full from the flow off the shunt per TEE by Dr. Khal. Little Adian had a rough go today, will have to watch her closely as her HIGHLY complex and abnormal anatomy has presented quite a challenge over the last year for Dr. Turrentine and Dr. Fadi! She may need a cath in the next week to check on things………she needed a lot of volume to get her pressures and sats up after she was off the pump. This was a little stressful for all of us… This is a fantastic team at Al Khalidi Hospital, but especially in these stressful, complex cases, it is so obvious that having our full team from Riley here to do their magic and anticipate what is needed would be incredibly helpful! Dr. T has said this many times this week that it would be nice to have the usual team here, but never more apparent than with Adian’s complex surgery.

She goes to the ICU and receives more blood products and will be watched closely by the ICU nurses. In the meantime, Dr. Fadi goes to the OR to prepare for Malek’s surgery which will get a late start and Dr. Turrentine goes to evaluate some more patients with Dr. Khal in his office.

Muhammad is a tiny little guy from Syria whom Dr. Turrentine evaluated and operated on in October with a pulmonary artery band and atrial septectomy, but still has his VSD and Mitral stenosis. His sats are still 82% but he is still entirely too small to fully correct his DORV (Double Outlet Right Ventricle) and Mitral Valve Stenosis. He has only gained 100 grams in 5 mos. He has terrible reflux and some hydronephrosis. He is still only 3 kg (6.6 lbs) at 8 mos of age! They are limited in his feedings by his terrible reflux, so he can only take very little at a time (25 cc). Dr. Khal tried to put in an NG (nasogastric tube) only to find the reflux was much worse. They are thinking he needs a Nissen fundoplication and G tube to get better nutrition and cure his reflux, but this is not done here often. Dr. Khal plans to talk to his pediatrician and get a more firm plan for that and perhaps next mission, if he is growing better, he can have surgery…

Muhammad

Muhammad with his sister and father.

Next up in the office is Nour. She comes in with both of her lovely parents from Damascus, Syria. She has really grown taller since her last visit in May. She looks adorable all dressed in her skirt, tights, and pretty coat with her bow on her headband…she walked in so confidently and smiled to shake Dr. Turrentine’s hand and say, “Hello, Dr. Mark! How are you?” She had some complex anatomy when they first met 2 years ago as well…she was shunted and staged for her pulmonary arteries to grow. They will close her VSD in the future when they are large enough. She has gained 3 kg (6.6lbs) since her last visit. Her father says her color has been better lately and she really has been acting as if she is feeling better her father says. Her pulmonary arteries are growing nicely and may be 9mm per echo, pretty close to the size Dr. T wants them to be before her correction is completed. She will get a CT angio tomorrow to check the anatomy more…what a beautiful girl! I am sure the full team will be delighted to see her next mission and in the meantime enjoy how much she has grown in this picture! What a lovely family and a beautiful girl!

Nour with Dr T

Dr. T saw the tiny Bisan with Dr. Khal when I was not in the office. He is the less than 2 months old that Dr. Khal just saw in the office recently with heart failure, elevated PA pressures and an aberrant left pulmonary artery. He went straight for CT angio to better see his anatomy and make plans. Looks like he will be added on tomorrow. He has gained less that 1lb since birth.

Dou’A came in to Dr. Khal’s office next. She is a beautiful 19 yr old girl from Amman who met Dr. T and Becky in October for the first time. She was born with Transposition of the Great Arteries and had that repaired along with a VSD closure. Soon after, they found a residual VSD but no one wanted to operate on her again. She has impressive pulmonary hypertension and has been on some medications since seeing them in October, hoping there is some reversibility of her heart. Dr. Khal interprets for us after the echo that she has been very down and feeling like there is no hope for her due to her heart. Dr. T and Dr. Khal are encouraged by her echo and tell her that there is definitely hope for her and after a cath soon, they hope to make firm plans for her. She smiles a huge beautiful smile. Obviously, this lifted her spirits!

Dou’a

In the meantime, Dr. Fadi is in the OR ready to go with Melak from Baghdad,Iraq. She has been here since Saturday ready to go. Her parents are very sweet people who work in the medical field as well. They have been very patient and thankful despite putting off her surgery another day. She was questionable for today as well, but things looked good to go for her today. The staff stays late tonight to ensure we do Melak’s surgery today…her surgery goes very well with a patch over her VSD and she is transferred to the ICU.

Of note is that we started even later today than we would have yesterday with Melak’s surgery…when discussing when would be best to do her surgery yesterday, Dr. Fadi recommended waiting until the next day…he would even skip lunch to get her surgery done…for those of you who know Dr. Fadi, this is truly an impressive sacrifice and he was obviously serious about getting Melak’s surgery done- that man LOVES lunch! He almost made good on that promise today as he didn’t have time to eat until 3…luckily for him, he had to briefly scrub out on the first case early on to get to a computer to calculate z scores for Adian. He was caught red-handed with a sandwich on the run at that time! That somehow got him through until 3! Sacrifices!

Dr. Fadi on left with Dr. T on right

We are told Adian’s vitals and labs are improving in the ICU. Yazeed next to her has tried eating some but is a little sleepy yet mom says. Feras has been moved to the floor and doing well. After seeing the tiny 2 month old for tomorrow, we see Adian is extubated and her sats are down…her oxygen level is low on her ABG as well as her sats. Dr. T decides he must stay despite a nice dinner planned welcoming us with the GOLA members and many Rotarians…I leave to represent the team and the rest join us all later. Adian was in acute pulmonary edema and after reintubation and Lasix, her sats are back in the 70′s and things are looking better. Fares and Rana had been sent to collect Dr. Turrentine for the dinner and he eventually joins as well.

We had a wonderful time and entirely too much food at a Lebanese restaurant with the GOLA group. What a warm and inviting, amazing group of people!! How can you not love Amman with these beautiful children, beautiful scenery, and beautiful people!!

Dr. T and Lamia

Written by stephkinnaman

March 5, 2013 at 9:11 pm

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Amman “Mini Mission” 2013- Arrival

Amman “Mini Mission” 2013- Starting on Sunday

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We started the day with a breakfast at the hotel overlooking beautiful Amman. Several gorgeous old mosques are a notable part of the skyline. Everyone is excited to have Dr. Turrentine back in Amman..even his familiar friend who makes omelets every day recognizes him and says, “Welcome back!”. Once at the Al Khalidi Hospital, the first patient of the trip, little Feras Mustafa Ayyoub is ready to be wheeled back to the OR. He is a strikingly handsome little 5 year old boy with thick dark hair from Jordan, approximately 20 minutes outside of Amman. Feras is smiling and interactive as he is wheeled by us and I stop them for a brief picture…

Feras

Once in the OR, Dr. Khal (the pediatric cardiologist) and Dr. Fadi (the pediatric cardiothoracic surgeon) are ready to go. TEE is done by Dr. Khal to ensure everyone is on the same page for his perimembranous VSD repair. There is a small membrane near the aortic valve as well with a trial amount of AR. A Dacron patch is used the close the VSD, the membrane removed and Dr. Khal returns for TEE to ensure all looks good and it does. Closing begins and we plan to go to clinic with Dr. Khal. Feras is transferred to the ICU and looks good.

In clinic with Dr. Khal, we meet Ahmed from the last mission. Dr. Turrentine loves to tell of this confident young man from Syria who last trip (October 2012) came in with sats seen as low as in the 40′s, but after a cath and a shunt, he was riding his bike a week later! He is 95% sats now and will need another surgery on the next big mission in April. His echo is done and plans are made for his surgery…

Ahmed and his father

Next up is a beautiful young boy of 9 yrs who looks so much like his brother with him that I ask if they are twins. They are not, but Hammoud Abdo Hammoud is from Syria as well, now living in Amman. He has been told by multiple consultations elsewhere that his heart is not repairable. He has a VSD, PA (pulmonary atresia), and MAPCA (bear with me, I don’t have my normal cardiology interpreter with me!). Dr. Turrentine recommends he needs a CT angio to get better look at his pulmonary arteries and make plans for possibly later mission as well.

Hammoud and his brother

After a lunch with Dr. Khal and Dr. Fadi and a large part of the incredibly welcoming GOLA team, we go to ICU to see Melak. She arrived yesterday we were told, but had not yet been evaluated by Dr. Khal until this morning. We go over to meet her in her preop room. She is a sweet, very quiet girl with a VSD who has travelled from Baghdad, Iraq with both of her parents. They are so incredibly grateful for this opportunity. Many emails and coordinating have finally led to this time for Melak. They have been anxiously awaiting this moment to get the help she needs. They ask some excellent questions after her procedure is explained.

Melak with her parents, Dr. Fadi and Dr. T

Feras is doing well up in the ICU and has been extubated. His mother is holding his hand and he is in good hands with the Al Khalidi hospital staff. Heba is his nurse this afternoon and very familiar with postop care of these kids.

We head over to see more preop patients. Intisar is a beautiful young woman of 26 years old who was born with an absent pulmonary valve and Tetralogy of Fallot. She is from Sudan, but is living in a refugee camp close by with family and no money at all. An adult cardiologist evaluated her with a heart cath and sent her for help with a congenital specialty team. Plans are made for the kind of help she needs, including asking for donations for the valve she needs from supply companies and then more firm operating plans can be made. More complicated issues are involved as she is an adult with a problem since birth that was not identified until much later in life due to her circumstances. Discussions will continue about Intisar.

Yazeed from Amman, Jordan arrives as well with his mother, father, and paternal uncle. He is 8 months old identified with Tetralogy of Fallot. He has been seen at the local Army hospital and scheduled for surgery in January of 2015. When our team tells the family that he will have surgery tomorrow, they are confused about the difference in opinion. Apparently, the other local hospitals are so overwhelmed by the number of cases, this is how far out they are booked in addition to the family being told they should wait until he is over 1 yr old. Dr. Khal and Dr. Turrentine explain that this is more typically done at 6 mos (at least it is in the US). The family seems relieved and we bid them farewell until tomorrow.

Yazeed

We have a brief outing for Kanafe in downtown Amman with Fares and the newest addition to Gift of Life Amman (GOLA), Rana, and we head back to the hotel. It has been a long day. Hard to believe we have been gone from home three days already, but just getting started!! Looking forward to a day full of operating tomorrow!

Dr. T with Rana and Fares in the long line for the famous Kanafe!

Written by stephkinnaman

March 3, 2013 at 6:10 pm

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Riley International Heart Missions

Amman “Mini Mission” 2013- Final Follow-up

Amman “Mini Mission” 2013- The Finale Friday!

Amman “Mini Mission” 2013- A Full Thursday!

Amman “Mini Mission” 2013-Wednesday

Amman “Mini Mission” 2013- Hoping for Two on Tuesday!

Amman “Mini Mission” 2013- Arrival

Amman “Mini Mission” 2013- Starting on Sunday

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