June 27, 2010 to June 29, 2010 – Thankful to be Home

There is so much to be thankful for in our home as we brought Katelynn home on Sunday.  Dr. Zusman did come around late Sunday morning and was not all too concerned with the slight droopiness on the right side of Katelynn’s face.  Given the endoscopic work that was done on her left lateral ventricle, it did not surprise me too much to see this effect, but the main concern was whether this would temporary.  Time will tell, but we will keep watch and keep asking.  Since Sunday, I have seen some improvements, ever so slight.  What is simply amazing is how strong my precious Katelynn has been since Friday’s surgery.  The only time she cried in pain was when her IV line was removed from her left hand just before she was discharged from the hospital.  To be on the safe side with any post-surgical pain, Dr. Zusman sent us home with a prescription for Hydrocodone/Acetaminophen (http://www.nlm.nih.gov/medlineplus/druginfo/meds/a601006.html) in liquid form.  We used the medication on both Sunday and Monday night, to make sure Katelynn slept as comfortably as possible.  She did not make a peep through the night, and that is perfect.

As much as I am hoping this will be Katelynn’s last neurosurgery for a very long time, there are still many unknowns that dot her course of treatment.  Dr. Ciricillo had explained that Friday’s fenestration procedure for her entrapped left lateral and fourth ventricles would, in all likelihood, be followed eventually by another operation further down the line.  In six months we will have Katelynn go through yet another MRI to see how much the two affected ventricles have receded.  The recent operation was intended to allow the entrapped ventricles to “communicate” with Katelynn’s right lateral ventricle, which has the functioning shunt system.  At some point, this system will malfunction, and that is when there will be another procedure performed.  I will have to confirm this with Dr. Ciricillo when we speak next, but I thought he had mentioned the endoscopic cerebral aqueductoplasty with a fourth ventricular approach as an option.  Over the phone last week, I believe he had also talked about a endoscopic ventriculostomy (http://www.hydroassoc.org/docs/FactSheet_Third_Ventricular_Endoscopy.pdf), or ETV, as the next step.  No matter which procedure, the next time Katelynn would require neurosurgery should be preceded by a shunt failure and the ensuing operation may actually make her shunt independent.  This would be an answered prayer, since Jenn-Jen and I never felt comfortable knowing that Katelynn’s shunt will malfunction sooner or later.

Until then, we are just excited to have Katelynn back home.  The timing of the discharge on Sunday worked out perfectly to allow Katelynn to take her afternoon nap, while I hit the shower and cleaned up with a nice shave.   After three days of doing neither, I felt amazingly clean after stepping out of my bathroom.  I suppose I did not really feel the full effect of the summer heat that has finally come to Sacramento, since I made the Pediatrics floor of Sutter Memorial Hospital my temporary home.   After the discharge, we have spent most of our days enjoying the air-conditioned comforts of home, but it is probably safe for me to speak for both Katelynn and myself to say that our beds have not felt this good in a very long time.

I am taking the rest of the week off from work to make sure all continues to go smoothly with Katelynn’s recovery.  Things have been slow and, truth be told, very normal since we have been back.  Jenn-Jen and I do take extra measures to keep Katelynn from bumping her head with Daria or anything else for that matter, but everything has turned out as well as it could.  It just feels rejuvenating to have my whole family safe at home together.  I could not ask for more.

June 26, 2010 – One More Night in Pediatrics

Katelynn slept through last night relatively well, despite the regular vital sign checks and a dose of IV antibiotics at 2:00 AM.  I became best friends once again with the sleeper chair, which is basically an armchair that folds out flat.  Thankfully the rigid arms saved me a couple of times last night from rolling straight onto the ground, and I must reluctantly admit, it was more comfortable than I remember.  At 5:45 AM, Katelynn’s nurse gently woke me up with a reminder that we would no longer be able to give my daughter any more clear liquids after 6:00 AM to prepare for her morning MRI.  Feeling more refreshed than expected, I washed up quickly and mixed a few ounces of unflavored Pedialyte mixed with some apple juice for Katelynn.  She was already waking up, so I was very glad I did not have to disturb her much-needed rest.

 A couple hours later, the day shift nurse came by to tell us that we would be transported downstairs for the MRI.  Sometimes I wish I was not so familiar with this hospital, but having spent the better part of four months practically living out of this facility two years ago has allowed me to imbed most of the layout of the first and second floors into my long-term memory.  I probably could have brought Katelynn down myself, and if we do this enough, I may just consider moonlighting as an Imaging Technician.

 After a bit of a wait for the anesthesiologist to arrive, we were ready for the scan.  It was quite amusing to listen to the assisting nurse explain to me how he once had forgotten to remove his cell phone before entering the MRI room and ended up with all of his stored names and numbers erased by the tremendously powerful magnet.  It just would happen that I brought along my backpack, which contained my laptop, digital camera and digital video camera that conveniently stores recordings on a forty gigabyte hard drive.  Listening to the nurse’s story, I reached for my cell phone in the right pocket of my shorts and slowly began inching away from the caution sign hanging in the doorway that boldly proclaimed, “Warning – magnet is always on!” 

 The anesthesiologist came through the door roughly fifteen minutes later, with the aroma of a freshly toasted onion bagel attached either to his breath or scrubs.  He certainly must have tried to eat on the run between his last procedure and this one, but I was just glad to know the scan would be complete soon, meaning we would be able to move closer towards bringing Katelynn home.  I expressed some concerns regarding Katelynn’s seemingly long lasting post-surgical lethargy yeserday, but the nurse explained and the doctor affirmed that today’s use of the short-term sedative, Propofol (http://en.wikipedia.org/wiki/Propofol), would be metabolized by Katleynn within an hour or so after its administration.  Ironically, Propofol has gained notoriety as the drug implicated in the overdose death of Michael Jackson, which occurred exactly one year and a day ago.  Nonetheless, Katelynn’s past MRI scan a couple months ago involved the use of the same drug, so we knew what to expect.  It was not even ten seconds after the doctor depressed the syringe connected to Katelynn’s IV line before I felt her going limp in my arms with her eyes rolling backwards.  Thirty minutes and we would be done.

 Thankfully, my parents and one of my sisters have been instrumental in keeping Adam and Daria busy during the course of the past two days.  This allowed Jenn-Jen to join me at the hospital as the MRI concluded right on time.  We followed the anesthesiologist and assisting nurse as they wheeled Katelynn in her hospital-grade crib towards the same recovery room we sat In yesterday after the surgery.  An hour later, our daughter regained consciousness and we were brought back up to her room on the sixth floor.

The rest of the day seemed very promising, especially because we noticed Katelynn was showing more alertness and an improved appetite.  My sister came by the hospital around noon with Adam to pay a quick visit to Katelynn and drop off a thoughtful care package.  Katelynn was still looking a bit tired, but it was very reassuring to see her interactions with everyone today.  Eventually, we were even able to have her removed from the IV fluids that have been connected since her surgery, and this allowed us to comfortably bring her to the pediatric play room a few doors down.  After lunch, Jenn-Jen and I spent some precious moments with Katelynn, coloring with markers and encouraging her to pretend to feed us play food.  On today’s menu was a sausage, jalapeno and what appears to be a Serrano chile, but it was probably the best play food I have enjoyed in a very long time.  During the course of our play time, our daughter would periodically lift up her left hand, which had her IV line and fingers taped onto an arm board, and try to use it to no avail.  Instead of getting frustrated, Katelynn’s good-natured personality shown through and she used the dangling IV connector to tap on the table just for the fun of it.

 Later in the afternoon, we learned that Dr. Ciricillo’s colleague, Dr. Zusman, would come by during her rounds to assess Katelynn’s MRI results and provide a timeline of when we would expect discharge.  She recommended we stay one more night if we felt that Katelynn was not showing signs that she was back to her “normal” self.  Jenn-Jen and I conferred and agreed that Katelynn was certainly looking and acting much better than yesterday, but her need for several naps during the day made us lean towards the side of caution.  We decided it would be best to stay put and avoid any unnecessary returns to the hospital.

 Dr. Zusman did come by a couple hours later after consulting with Radiology over Katelynn’s scans.  She said that the left lateral ventricle does look a little smaller and there was not much change in the size of the fourth.  This news was a little disappointing, as both Jenn-Jen and I had expected more immediate results.  Perhaps we were a over-ambitious, because Dr. Zusman explained the actual change may be a more gradual process.  Of course, we already knew that Katelynn would require another MRI in half a year to determine the effects of yesterday’s surgery.

 My parents came by in the evening with dinner and our spunky little Daria in tow.  I really think the twins missed each other and it warmed our hearts to hear Katelynn say “hi” to her sister.  Daria had spent a very busy day with my parents, and the plan was for Jenn-Jen to bring her home for the night.  One cause of potential concern actually arose while I was outside the hospital, reattaching Daria’s car seat to our vehicle.  Jenn-Jen noticed during the interaction between our girls, Daria had made Katelynn laugh, but there seemed to be some paralysis on the right side of Katelynn’s face.  Neither of us noticed this earlier and the rest of Katelynn’s extremities on her right side did not seem to be affected either.  I brought up the issue to the night nurse and will have to follow up with Dr. Zusman upon her return tomorrow morning to get her opinion.

 As the night is now wrapping up for Katelynn and me, I am hopeful for a quiet, uneventful night.  Katelynn’s nasal passages seemed a bit congested earlier today and has not improved much tonight.  I hope this does not affect her sleep, but since I put her down in her crib an hour and twenty minutes ago at 9:00 PM, she has stirred several times and almost sounds as if she has a cold.  At least she is not connected to the IV pump and there is no need for antibiotics tonight.

June 25, 2010 – 8:25 PM – Sutter Memorial Hospital Pediatrics Floor

I’m up here on the sixth floor of Sutter Memorial Hospital, rooming with Katelynn for the night.  Dr. Ciricillo met with Jenn-Jen and me after surgery and the first words out of his mouth were “Cool would be an understatement!”  It was so very reassuring to hear the enthusiasm in his voice as he shared the good news surrounding the operation.  We reviewed some amazing photo printouts showing various steps of the endoscopic procedure, and it was hard for me to believe that I was staring at high-quality images of my daughter’s brain ventricles, captured internally by a tiny camera mounted on a thin, flexible endoscope, only minutes ago. 

Apparently, the existing shunt in Katelynn’s right lateral ventricle had become somewhat occluded and was not functioning as well as it could have.  With some manipulation from the instrument on the endoscope, Dr. Ciricillo was able to remove the coagulant that was affecting the shunt.  Additionally, we learned Katelynn’s choroid plexus (http://en.wikipedia.org/wiki/Choroid_plexus), which is essentially the cerebrospinal fluid (CSF) factory in our bodies, was actually not filling her fourth ventricle because a web-like layer of membranes had virtually trapped the flow into the space.  Had the CSF been entering the ventricle properly, we would have seen a severe dilation in the matter of a day or two.  This would have led to a much more alarming situation, which thankfully, we were able to avoid.  While the operation was a huge success, there will inevitably be another sometime down the road to help ensure the outbound flow of CSF at the base of Katleynn’s fourth ventricle is functioning properly.  We are scheduled for a MRI tomorrow morning to see the immediate effects of today’s surgery and will have a follow-up scan six months out to see the longer-term results. 

Katelynn did extremely well with her surgery, but has been very sluggish since she came out of recovery.  She also received the relaxant Versed (http://en.wikipedia.org/wiki/Midazolam), also known as Midazolam, before going to the operating room.  This pre-sedation medication was given to help Katelynn not feel anxious while she was separated from Jenn-Jen and me before she was put under anesthesia.  We haven’t been able to get her to eat much since surgery, but that may be due to some soreness in her throat from being intubated during surgery, or perhaps this is a slow recovery out of anesthesia.  Hopefully, Katelynn will bounce back to her normal self tomorrow after her MRI scan.  At this point, we may be able to take her home in the afternoon, but I am not completely sure. 

Tonight will be a little bit of a long night, punctuated by periodic visits by our nurse for vital signs and another dose of antibiotics that will come due at 2:00 AM.  The good news is that Pediatrics is unusually quiet with very few patients on the floor and we are fortunate to have a room to ourselves.  The sleeper chair that adorns the room is an old friend of mine I have not visited for over two years, but we will be reacquainted very soon.  I joke now, but only because things could not have turned out better today.  I would gladly spend many more nights in this sleeper chair knowing that my daughter is given every chance to reach her full potential.  Katelynn is quietly sleeping in the crib only a few feet away and I wholeheartedly thank God that I am blessed to be her father.

June 23, 2010 to June 25, 2010 – In the Surgery Waiting Room

Katelynn has been in the operating room now for the last thirty minutes undergoing an endoscopic fenestration of the entrapped left lateral and fourth ventricles.  Dr. Ciricillo is looking to create a pathway for the cerebrospinal fluid in the dilated ventricles over to Katelynn’s right lateral ventricle, where her shunt system is working fine.  The operating room nurse called a few minutes ago and says the procedure is going well.  We will hear from her again as Katelynn’s surgery is wrapping up.  She should awaken from anesthesia about an hour after the operation is complete, and Jenn-Jen and I will be there to watch her come to. 

I will spend the night here at Sutter Memorial Hospital with Katleynn up on the pediatric floor.  Hopefully we will be able to bring her home tomorrow or Sunday at the latest.  Thank you all for your prayers and I’ll provide another update this evening.

June 12, 2010 to June 22, 2010 – Surgery Scheduled

After many phone calls and messages back and forth with Dr. Ciricillo’s office, we were able to find out that Katelynn is going to be admitted to the hospital this Friday, June 25^th, for an operation to relieve the cerebrospinal fluid (CSF) pressure in her fourth ventricle.  It has been a little difficult to be hanging on the edge, waiting for the surgery to be scheduled.  Dr. Ciricillo is renowned in his field of pediatric neurosurgery, and getting on his calendar with a date that is also suitable with the Anesthesia department can be a challenge in itself.  Apparently, there has been a cancellation, so the opportunity arose for us to schedule Katelynn much sooner than the anticipated delay until mid-July.

Jenn-Jen and I are now anxiously waiting to hear back directly from the doctor, as I have specific questions relating to the operation he is seeking to perform.  I know that he wishes to proceed with the less-invasive endoscopic procedure, which will equate to a shorter recovery time in the hospital for Katelynn.  If all goes well, we anticipate being able to bring home my daughter within two to three days.  In my personal research, I was able to locate an abstract from the Journal of Neurosurgery (http://thejns.org/doi/abs/10.3171/ped.2005.103.5.0388) for a surgical treatment called an “endoscopic cerebral aqueductoplasty” with a fourth ventricular approach.  When I do receive the return call from Dr. Ciricillo, I would like to find out his thoughts on this research and see if this is the surgery Katelynn will undergo.

Sitting here in my home office, I find myself battling the old and familiar demons of fear and doubt that have not stepped through my doors the past two years.  Deep inside I knew that Katelynn’s shunt revision in June of 2008 would not be the last time she would require the services of a neurosurgeon, but it still leaves me very unsettled that this is happening again so soon.  I know that it is through times such as these that I am to lean on my faith in God, in which He calls me to trust and follow daily.  Yet I have to admit that it is so difficult to fully let go and believe that all will be well.  What is to come in less than three days honestly scares me, but I also know it must be done.

June 11, 2010 – Three Options but None Desired

During our appointment with Dr. Ciricillo two weeks ago, he and I discussed three options as potential next steps to treat the hydrocephalus in Katelynn’s fourth brain ventricle.  Honestly, none of them were desirable, as I could only recollect painful memories of past procedures.  Still, I knew we could not just leave this alone, as the repercussions of increased pressure on the mid and hindbrain would be potentially life-threatening if left untreated.  Dr. Ciricillo explained that each procedure would essentially relieve the build-up of excess cerebrospinal fluid (CSF), and we may even see potential improvement in Katelynn’s motor skills within a week if the operation is successful.  With the inflated fourth ventricle pushing up against Katelynn’s cerebellum, this may actually explain some of the decreased coordination and jerky movements I have noticed in my daughter.  The potential of improving Katelynn’s motor skills and chances of walking independently sooner sure was a welcome bonus, but the heart of the matter is still to ensure this problem does not become critical.

As for the three operations, we first talked about placing another ventricular shunt and connecting the tubing in a “Y” arrangement with the existing shunt system in her right lateral ventricle.  This option did not settle well with me from the start, since Katelynn had already experienced the need for a shunt revision when the catheter in her ventricle leading up to the shunt became blocked with a blood clot roughly two years ago.  The idea of a shunt malfunction is terrible in itself, but adding another shunt would only increase the chances of something going wrong sooner than later.  Additionally, connecting the two systems would only complicate troubleshooting, since it would not be an easy task to locate blockage.

Option number two was an endoscopic procedure which would essentially create an artificial channel between Katelynn’s swollen fourth ventricle and her shunted right lateral ventricle.  By creating this pathway, the increased CSF would ideally flow toward the existing shunt and empty out as it has faithfully been since Katelynn’s revision surgery.  The procedure would involve the use of an endoscope, a medical instrument consisting of a very thin, flexible tube with a light and camera system at the tip.  There would also be attachments to allow Dr. Ciricillo to make the necessary manipulations to create this channel or perforation to relieve the CSF pressure.  The endoscope would be inserted via a small incision and the whole operation would be completed in thirty minutes or less, which means this option is the least invasive of the bunch.  I am not certain and will need to check with the doctor, but we may be looking at an Endoscopic Third Ventriculostomy (http://www.hydroassoc.org/docs/FactSheet_Third_Ventricular_Endoscopy.pdf) operation.

The last choice would be a fourth ventricle cyst fenestration, which is essentially the creation of an artificial opening to simulate the normal CSF draining pattern Katelynn would have experienced had her intraventricular hemorrhage not blocked the natural “drains” with scar tissue.  My initial reaction to this procedure was positive, as it sure seemed like it would be the most effective solution to remove the “plug” that is causing Katelynn’s fourth ventricle to inflate like a balloon.  However, Dr. Ciricillo informed me that this procedure would actually be the most invasive, as it would require drilling near the hindbrain, and we should expect a two-week recovery period.  Needless to say, my optimism faltered heavily and door number two began to look much more promising.  I was not able to locate any free information on this procedure, but a study done in 1998 by the Pediatric Neurosurgery Service at Duke University (http://content.karger.com/ProdukteDB/produkte.asp?Doi=28745) seems to have found the fenestration to be successful in treating five out of six pediatric patients.  Of these six, four had experienced “five or more failed shunt procedures.”  After reading this abstract, my doubts swung the other way, because I would not wish to put my poor Katelynn through any additional neurosurgical procedures.

Katelynn and I left Dr. Circillo’s office to report the news back home to Jenn-Jen and Adam.  The doctor informed me that he wanted to review the CT and MRI scans and make a recommendation within the next week.  In the meantime, we were instructed to help Katelynn recover from a lingering cold she had been battling for a couple of weeks and stay healthy.  Apparently, even a mild respiratory issue such as a common cold puts unwanted risk in a surgical operation.  This basically meant that we should avoid crowded places and stock up on hand sanitizing gels and wipes.

Dr. Ciricillo’s office did finally call back after we followed-up twice, anxious to know which procedure Katelynn would be undergoing, as well as when the operation will take place.  We learned that the endoscopic procedure is the route the doctor wishes to take, but will need to wait until Monday to get a surgery date.  A large part of me is breathing a sigh of relief, since endoscopy’s diminished invasiveness is welcome anytime.  Yet, there is still that lingering thought that makes me wonder what if this is not successful in stopping the swelling.  I am trying so hard not to be anxious and am working on giving this to the Lord, but it gnaws at me throughout the day.  Please continue to keep us all in your prayers and, hopefully, I will have even more to share on Monday.

January 28, 2010 to June 10, 2010 – New Developments are Underway

Has it really been almost six months?  While I wholeheartedly admit raising Adam, Katelynn and Daria keeps my free time at a minimum, I also feel a peculiar tug of guilt or regret that I have not put out a better effort to capture in words all of the experiences the Owyang family has undergone.  There just always seems to be that “something else” that needs my attention, and unfortunately, posting in my journal falls on the wayside just like the well-intentioned resolution to take more pictures or record more video footage of my wife and children for the sake of posterity.  As cliché as it may be, I suppose it is still better late than never.

Today’s post will focus on my beautiful Katelynn, who continues to amaze us with how much she has developed.  Jenn-Jen and I do not have a week that goes by without one or both of us expressing how thankful we are that Katelynn has thrived despite the grim prognosis that clouded her birth.  We have spent most of the past two years and four months wondering about the severity and potential impact of Katelynn’s developmental challenges, praying that God would continue to bless us with more miracles, and preparing ourselves to be able to handle any situation that may come our way.  Dear friends and family, there is much in the way of good news to share, yet there is still much more in which we ask for your commitment in prayer.  Let me begin with the positive.

Both Katelynn and Daria have been in a long-term struggle with acid reflux that has been mostly remedied with the use of Prevacid.  Without this medication, I honestly do not know how we would have made it this far.  Katelynn still seems to have a chronic problem with a build-up of phlegm that causes her to vomit just about every day, but through the suggestions of the Dietician at our Pediatric Gastroenterologist’s office, we have been successful in boosting enough calories in Katelynn’s diet over the past few months to finally have her show up on the growth chart for weight.  Of course, we are looking at roughly the seventh percentile for her age, which seems quite pathetic in itself.  Nonetheless, just seeing that mark on any percentile curve was an accomplishment Jenn-Jen and I have yearned to see for well over two years.  Katelynn is weighing in at a relatively hefty twenty four and a half pounds, and we feel encouraged to keep working on this upward trend.

As for Katelynn’s motor skills, the battalion of therapists working with our daughter on a weekly basis has made a very significant impact in reversing the debilitating effects of cerebral palsy.  Of particular note is Katelynn’s participation in a treadmill study offered by the Physical Therapy Department at the University of the Pacific.  Over the course of six weeks in April and May of this year, we had the blessing and use of a toddler-sized treadmill, as well as the oversight and coaching of a very compassionate Professor, researcher and physical therapist.  We watched and recorded Katelynn’s progress from spending ten minutes a day at 0.05 meters per second at the beginning of the study to an impressive minimum of forty minutes daily at 2.50 meters per second at the conclusion.  We were also allowed to borrow a small walker which we continue to use in helping Katelynn reach the goal of walking independently one day.  I simply cannot express the true joy in my heart through the words expressed here whenever I reflect on how much Katelynn has changed from the frail infant, literally fitting into my palm, to my determined little girl with the most precious and victorious smile on her face as she grasps her walker, traveling from one end of our local Target store to the other.

Katelynn has also been surprising Jenn-Jen and me with her ever-increasing use of language.  While we have our doubts as to how much of it is meaningful conversation versus simple mimicry, I can tell you that Katelynn is saying things like “Mmm… that’s so good,” and “Wow!  Cool!”  That second phrase must have come from Adam, or Katelynn is really growing up way too fast.  Now I just need to see if I can record these on video, in addition to her giggling like Elmo from Sesame Street and calling a banana an “apple.”

As much as I wish I only had positive news to share, new developments are underway, and they concern us heavily.  At the end of April, Katelynn underwent a Magnetic Resonance Imaging (MRI) scan of her brain at the request of Dr Ciricillo, her Pediatric Neurosurgeon.  Two weeks ago, I brought Katelynn in to have the scan reviewed in what I would have expected to be a routine follow-up visit.  As the doctor brought up the images of past Computerized Axial Tomography (CT) scans, he studied them with a calm focus and compared them to the more detailed image from the MRI.  The silence did not sit well with me, and the matter only worsened when he informed me that Katelynn would need to go through another operation on her brain.  In my mind, it was practically a foregone conclusion that all of Katelynn’s major surgeries were a thing of the past.  At most, I feared that there may be another revision or her ventriculoperitoneal (VP) shunt (http://www.nlm.nih.gov/medlineplus/ency/article/003019.htm) many years down the line, but this was much too soon to hear of such unwanted news.

As Dr. Ciricillo placed the MRI and CT images of Katelynn’s brain on the LCD screen, he showed me where the Grade IV intra-ventricular hemorrhage (IVH) had created scar tissue that caused one of Katelynn’s lateral brain ventricles to swell with cerebrospinal fluid (CSF).  The ensuing hydrocephalus was remedied by the VP shunt that was put in place shortly after birth and all had been fine, so we thought.  Apparently, over the course of the last two years, CSF had been building up and not properly draining in Katelynn’s fourth ventricle (see the red zone highlighted in the picture below).  The MRI provided such a highly detailed image that was not fully captured by the previous CT scans, so this very unfortunate development came as a surprise to us all.

Fourth ventricle - highlighted in red

As I sat there, quite stunned by what I was seeing, Dr. Ciricillo went onto explain how the fourth ventricle has expanded significantly and is, and will continue, to put pressure on Katelynn’s brain stem and cerebellum.  The brain stem includes vital areas that play a significant role in basic functions such as sleep/arousal, movement, attention, breathing and other vital reflexes.  The cerebellum is another extremely important part of the brain that controls and coordinates muscle movements.  Holding my increasingly-fidgety Katelynn, I still could not fully absorb the fact that we would need to subject my young daughter to another surgical operation.  This just cannot be happening.

There is actually much more I could write on this, but I would like to continue on tomorrow with more details, including Dr. Circillo’s recommendation as to how we should proceed.  Right now, Jenn-Jen and I would appreciate all of your prayers for Katelynn and our family, as we prepare for the inevitable operation.