Warnock, Lisa

[left:f05c45797c]http://www.cherubs-cdh.org/Album/new/Warnock-Lisa1.jpg[/left:f05c45797c]When I was pregnant with Lisa I had gestational diabetes. It was an uncomfortable pregnancy and as the due date neared, I was getting nervous about the size of the baby. My first baby had been 4.44kg at birth and I knew the diabetes would probably make this one bigger. My endocrinologist predicted she would be “a 10 pounder”.

Nothing had been picked up during my pregnancy besides the diabetes. I had an amniocentesis and a couple of ultrasounds because of a late miscarriage the year before.

Lisa was born after 2½ hours labour and no pain relief. She weighed 4.81kgs (10 lbs, 10 oz. in the old school). My doctor had obviously looked up the biggest baby born at the hospital because while she was being weighed, he said if she topped 5.1kgs she would be the biggest!

She was just beautiful and 2 hours later she was introduced to her big brother Lachlan.
When Lachlan was a baby he had severe oesophageal reflux. It had been a traumatic time for all of us until he was diagnosed at 5 months and I weaned him. Therefore, with Lisa I was particularly attentive to any potential feeding problems, so if need be I would address possible reflux as early as possible.

My milk came in on the second day and I was able to feed Lisa. Unlike Lachlan, she was a sleepy baby who wasn’t particularly hungry. She took the feed well but immediately vomited. Fortunately, I knew the difference between a vomit and a posset. I nursed her upright watching for further signs of some reflux. Instead, she vomited again and again and by this time it was looking like bile. I called the nurse who also noticed she was panting. She called the paediatrician who examined Lisa but couldn’t find anything and suggested we wait a little while longer to see what happened. By this time we were into Lisa’s third day and I knew something was wrong. The paediatrician examined her again and although he didn’t hear anything, ordered an ultrasound of the chest. By this time she kept regurgitating and I was starting to feel ill as well. A short while later, the paediatrician came to see me and told me they found Lisa had a diaphragmatic hernia. Thinking along the lines of a hiatus hernia I didn’t feel too worried! He must have thought I was remarkably calm!

The surgeon came a short time later to explain the hernia. He started by saying that if you were going to have a baby with a diaphragmatic hernia, ours was the baby to have. She was a ”pink puffer.” He even drew diagrams as he explained that Lisa’s spleen, stomach and bowel had pushed up through the hernia collapsing her left lung. He believed it hadn’t been picked up during the amnio or ultrasounds because the spleen had blocked it. He explained the surgery would take place that evening and they were waiting for an anaesthetist who would work on such a young baby.

Everything was almost surreal for me, as I did feel strangely calm. The only alarm I felt was when the nurses came in to take Lisa and suggested I wait until they prepared her before I came to the special care nursery to see her.

Lisa was born at the Wesley in Brisbane and was operated on at the Mater Mothers. They were superb. Every step was explained to us. We followed the ambulance and they had a special parking bay next to the ambulance for us. They walked us in and let me hold her little hand while she was wheeled down to the theatre. It was here we met the anaesthetist who explained why he wanted to narcotise Lisa rather than have her ventilated after the operation.

The hardest part was kissing her goodbye before she went into the theatre. The operation took longer than expected and a couple hours later the surgeon came out to see us. He explained that Lisa’s diaphragm hadn’t actually herniated but had eventrated instead. The effect was the same and the diaphragm would probably be affected but he was very pleased with the outcome. As we walked with our baby and the team back to intensive care, the anaesthetist explained he had been so pleased to see that Lisa’s lungs, albeit the left was damaged, were the size of lungs one would see in a 6 week old. Ironically her weight and size – the only thing I had been worried about during my pregnancy – was to now be her saving grace!

Lisa stayed 3 days at the Mater. Because she was so heavily narcotised, we weren’t allowed to touch her for the first 24 hours and I ached to hold her. I found out later that early the next morning after her operation, there were several groups of nursing and medical students, interns, etc., sent to see her, as she was a truly successful case!

Lisa came back to the Wesley and we stayed 2 more days before coming home. The surgeon told us to make sure we had a good paediatrician and to ensure that her heart was always checked during examination – but we didn’t know why! We had a post op visit with him 3 weeks later and he was very pleased with her progress. He asked if we would mind letting him know now and then how she was. Most unusual for a surgeon!

Things went reasonably well for a couple of months until Lisa got her first cold.

She developed a very rattly chest and coughed like a heavy smoker. It was quite frightening and worrying as she struggled to cough up the mucus. At Christmas time, I took her to the Royal Children’s one night as she struggled to breathe. They examined her and heard bowel sounds in the lower left lung. She was x-rayed and then had another cine swallow. By this time we had decided to change paediatricians and in the meantime, took the results of the tests back to the surgeon. The results were fine in that the diaphragm hadn’t herniated and no further surgery was required. But her left lung was much smaller, her heart was pushed over towards the middle of the chest and her diaphragm although not paralysed, did not move in-sync, therefore was ineffective. It was important we had a good paediatrician to guide us through and monitor Lisa’s progress.

Lisa had continuous colds and coughs for months. She was put on Ventolin and Intel as a preventor. These eased her breathing but as the winter months loomed she struggled. Eventually she was admitted to hospital struggling to breathe. Her O2 stats were below 90% and she was on continuos oxygen. She was also intravenously hydrated as Lisa refused to eat. Another irony was my fear she wouldn’t breastfeed properly as Lisa prefers breastfeeding to ALL other nutrition. When she is ill, she flatly refuses to take other liquids or food, hence the IV.

We understand it will take time for Lisa’s lung functioning to improve although her left lung may not grow anymore than it has. She is now a petite baby not yet 10kgs – another irony. But she is intelligent, feisty and cheeky. We are blessed to have her and her brother.

And the final irony? I have always called Lisa a little cherub so after we came home from hospital this last time, when I searched the net for information about diaphragmatic hernias and found CHERUBS. I knew we had found something really special!


Written by Lisa's parents, Cheryl & Mark Warnock (Australia)
2003