Dr. Prasandan sent this update on Friday:
Francis is still in a critical situation, though some problems have got settled.
The important problem that looks settled is the air leak, which was causing swelling all over his body and face. Also, he has become more stable lung wise and is mostly off ventilator for over 5 days. He had breathing problems last night and needed ventilator support for a few hours. His left lung is OK and right lung is also partially working. He is needing very low support of oxygen since morning and is breathing by himself.
He is still paralyzed below chest. Can write and communicate. Both upper limbs are OK.
We took him for a CT Scan of chest and neck a week ago. At the same time we did a barium swallow study to assess the status of Oesophagus. They were very informative.
The CT Scan of neck – shows shadow of metallic shrapnel within the spinal cord at the Vertebral level T1, or at the junction of chest and neck. The neuro-surgeons here are of the opinion that it should be removed by surgery and are confident of doing the operation. But he is still not stable for that major surgery.
The CT Scan of chest showed what we expected – the problems with the lung and pleura.
The Barium meal study was done principally because we found that food from his stomach was coming out through the right chest tube. The film clearly shows the barium contrast leaking from the neck (Oesophagus) to the right Pleural cavity/chest. This means that there is a communication between his Oesophagus (Food pipe ) and right chest cavity.
After seeing this, we had to stop giving him feeds through naso-gastric tube and had to start on Total Intravenous (parenteral) nutrition, which is very expensive and having its own risks too. The ENT surgeons and Cardio-thoracic surgeons in this country are not operating on Oesophagus regularly and hence not coming forward to do a surgical correction. Also, it is very risky to operate on neck unless one is experienced and confident. (as it has a lot of vital structures in small area).
Oesophagus is routinely operated in many other countries, including India. So, I had contacted Dr.Radhakrishna P., senior consultant surgical gastro-enterologist in Apollo hospital, Chennai, India, who is a friend of mine. He had advised to do Esophagoscopy, locate where the leak/defect is and close it directly with a covered/metallic stent. We cannot do this as we do not have experts who can deploy Esophageal stents (stent is not available also) here.
So, he advised to do an alternative of surgery to insert a tube into lower part of intestine (feeding Jejunostomy) to give him food, so that he can survive and another surgery in the neck- Esophagostomy/ opening of Esophagus out, so that saliva can be diverted from going down to the chest. The defect can be repaired later when he is more stable. This will improve his chest also.
Dr. Moses has done the feeding jejunostomy 3 days back. But 1 day after the surgery, he vomited greenish(bile containing ) Fluid, which started coming through the chest tube also. This has improved and we have started giving liquid food through the feeding jejunostomy tube.
Esophagostomy is yet to be done.
Dr.Edward (ICU in-charge) was suggesting to get surgeons from abroad to operate on Francis and settle the problems. We are still looking for options. Family was also asking about this possibility. Getting a surgeon from India also is not very easy.
He is maintaining good blood pressure and pulse. Urine output /kidney function is good and is looking forward with hope! So is the family.