Every day happenings and surgery details

Things have been pretty quiet around the Hanway household. We have been enjoying our time at home and it has been wonderful not having to go to Little Rock every week. Abby has been going to physical therapy twice a week and is improving. She is able to take a few steps unassisted, but doesn't have the confidence to try very often. It is a huge improvement to not hear her say, "I can't walk yet" every time we try and get her to stand up. She can climb onto the couch and chairs on her own again and even managed to climb onto the counter height kitchen chair on her own.

Alexis is doing wonderfully. She is crawling everywhere and cruising along the furniture. She is starting to get daring about the size of gaps she will go between. Yesterday, she climbed into the kid sized rocking chair that Leonard's grandpa made and stood up. She got a little scare when it almost toppled over backwards and she hasn't tried standing on it again...yet. We have started trying finger foods other than puffs and yogurt melts. She loves the real food and doesn't want much to do with purees anymore. It's hard to believe she will already be a year old in a month.

Last Thursday, we made a trip to Little Rock to meet with the surgeons who will be performing Abby's tumor removal surgery on Tuesday, the 7th. The first step of surgery will be to remove the portion of the tumor that is not around the brain. There will be three ENTs working on the tumor removal and, even then, it is expected to take four to five hours. They will have to cut the skin, starting at the hairline in the middle of her forehead, then follow it all the way around the side of her face down to the center of her neck. The will then dissect out the facial nerve and fold it back along with the skin to expose the entire right side of her face. Even with keeping the facial nerve separated out, there is still the possibility of nerve damage because some of the extensions of this nerve go through the tumor. They will have to cut some of the bones of her face to get to all of the tumor and those bones will be put back into place with dissolvable plates. She will likely lose some of her jaw because of it being eroded away by the tumor or the tumor is embedded in it. She will likely lose a large part of her masseter muscle, which gives her chewing power. This is where most doctors believe the tumor originated and where the most damage is.

Next, the portion of the tumor inside her skull will be removed. The head of the neurosurgery department will be performing this portion of the surgery and we do not know how long it will take. A portion of her skull will have to be removed in order for the tumor to be removed. The parameningeal part of the tumor is relatively small - 2cmx3cm - at least compared to the rest of the tumor. Thankfully it is only pushing the brain out of the way and has not infiltrated the brain. The neurosurgeon feels that this portion of the surgery will be relatively simple. Once the tumor has been removed, the piece of bone will be put back into place.

The third and longest portion of the surgery will be reconstruction. This is expected to last about 8 hours. A free flap reconstruction will be done. Muscle will be taken from either her belly or her thigh and attached to her face to replace muscle that has been removed and to add stability to what remains. If bone is needed, it will come from the fibula. The fibula is the non-weight bearing bone of the lower leg. If parts of this bone are taken, she will be unable to play contact and intense sports because the leg will always be weaker. She will still be able to run, ride her bike, and things like that. This portion of the surgery takes so long because the arteries and veins will have to be reattached. Basically, it is like reattaching a severed finger. Her pharynx and palate will also have to be reconstructed and she will have to learn how to swallow again. She will still be able to chew, but it will be a little more difficult on her right side because the muscles won't be as strong.

After surgery, Abby will be kept sedated for several days so that she doesn't pull anything loose or detach anything in the flap. Blood flow to the flap will also be monitored hourly for the first seven days to watch for blood clots. There is about a 10% chance of clots. About 50% of the time, he is able to repair it, but the other 50% of the time, the reconstruction has to be redone. If everything goes well, she should be released in about two weeks. She will also restart chemo before she leaves the hospital.

Please keep Abby in your prayers the next several days, as well as our families for safe travel as they come to support us during Abby's surgery.

And now for pictures.