Katherine Arnold Wolf Updates

This Wednesday, April 29th, beginning around 8am, Katherine will undergo facial re-animation surgery at UCLA. We have been preparing, researching, getting different opinions, and praying about this specific surgery since the beginning of 2009. Though it will be a major surgery, lasting more than 6 hours, we feel a deep peace about the entire situation.

As a little background…

During Katherine’s life-saving, brain surgery on April 21, 2008, the 7th intracranial nerve (the “facial nerve”) on the right side had to be sacrificed in order to help decompress the hematoma (bleeding) forming around her brainstem. The 7th intracranial nerve innervates the entire face, and thus, as most of you already know, the right side of Katherine’s face is paralyzed, left without movement or sensation. As you can imagine, not being able to feel/move your face presents a multitude of problems from protecting your eye to eating and speaking, much less aesthetic and emotional issues associated with a significant difference in physical appearance.

After nerve damage, there is the possibility, particularly if the nerve is not completely severed, that it can regrow and regain function. Unfortunately, if no signs of regained function are seen around a year after such an injury, it is considered unlikely to ever be regained again spontaneously. Moreover, once the muscles associated with the nerve-damaged area have been deprived of nerve innervation for over a year to a year and a half, those muscles can atrophy to an irreperable degree and be unable to ever regain function, even if the nerve is artificially repaired.

We were familiar with the possibility of having a “facial re-animation” surgery throughout this process; however, it was never high on our priority list, given the other significant issues Katherine was facing in her recovery. Early in 2009, we received multiple emails from our online supporters alerting us to an article on a new facial paralysis surgery. Those emails were the impetus for us to pursue Katherine’s options for facial reanimation surgery. We then sought advice from medical professionals who the Lord has put in our lives, from a reconstructive surgeon in our church in LA to Dr. Gonzalez, Katherine’s neurosurgeon, to a top maxillofacial surgeon who Katherine and her sister knew. All of them detailed Katherine’s options and explained the time-sensitive nature of the procedure (ie. a year to a year and half, the right facial muscles may be irreparably atrophied). At that time, Katherine was 9 months out from her injury and was quickly approaching the atrophy deadline. Because of that time pressure, the past 3 months in our lives have been an intense time of weighing options, undergoing medical testing, consulting with doctors, interfacing with insurance, and making decisions that are beyond our 27 years. In the end, we felt undeniably drawn back to UCLA and to a particular reconstructive, microsurgeon, named Dr. Joan Lipa (who was separately recommended to us by both Dr. Gonzalez and the reconstructive surgeon from our church). We can so directly connect the beginning stages of exploring this surgery with people the Lord specifically placed in our lives that we know it is His will and not our own. Also,we have received so much confirmation in our spirits and from people in our lives that this miraculous medical procedure is a unique tool that God will most certainly use to bring about the promise of His continued healing in Katherine’s life.

Wednesday’s surgery will entail two separate procedures done simultaneously:

1) CROSS-FACIAL NERVE GRAFT – this procedure will involve the removal of the sural nerve, a long nerve which runs up the back of Katherine’s leg. That nerve will be used as an extension cord of sorts. It will be grafted into the functioning facial nerve branch that creates the smile function on her left side (the side that is still working), then that nerve will be rooted through her upper lip where it will be waiting to grow over the next several months. In a potential second-phase surgery, down the road, that nerve would be grafted into the facial nerve branch that creates the smile/upper lip function on the right side, with the hope being that the nerve impulses from the left side will be re-routed via the sural nerve, across the lip, into the non-working right facial branches, reinnervating them and creating new function.

2) 7/12 NERVE TRANSFER (aka 7/12 SPLIT) – this procedure will involve the splicing of the 12th intracranial nerve, which gives the tongue function. A third of the 12th nerve will be grafted into the base of the 7th nerve (aka – the facial nerve). Given the fact that Katherine has no hearing in her right ear, the surgeon will be able to perform a special (and hopefully more efficacious) version of this surgery, which involves removal of the 7th nerve from behind the ear via a mastoidectomy (removal of the bone by the ear), which will free up a greater length of the 7th nerve and will hopefully allow a direct connection to be grafted between the 7th and 12th nerve (rather than the more normal version of the surgery which requires a separate nerve to connect the 7th and 12th making the reinnervation less powerful). This procedure would create a different affect than the cross-facial nerve graft. While the cross-facial nerve graft will predominantly focus on the smile function and the upper lip movement, the 7/12 nerve transfer will hopefully reinnervate the entire facial nerve. This will hopefully restore tone to the entire right side of Katherine’s face (improving speech and appearance), as well as possibly giving her right eye20lid greater closure, preventing droop in her lower eye lid and face and even restoring function into her mouth.

Unfortunately, neither of these procedures will be able to restore feeling to Katherine’s face.  Also, there is a risk that the 7/12 nerve transfer could damage the tongue’s function (because of the splicing of the 12th nerve) and thus impair Katherine’s swallow siginficantly (though in this UCLA Head & Neck practice group, this has NEVER happened, thank God!) PLEASE PRAY AGAINST THIS!  Katherine will likely stay at UCLA for 2 nights after her surgyer.  Please pray her recovery will go smoothly.  PRAY AGAINST PNEUMONIA AND INTERNAL BLEEDING.  It will take approximately 3 – 6 months to see any results from this surgery.  At that point, they will determine whether or not they will need to do a follow-up surgery, upon which they will complete the grafting of the cross-facial nerve into the right side of the facial nerve (if necessary into a transplanted muscle from Katherine’s thigh).

We also humbly ask for your prayers that the Lord would work through these incredibly talented medical professionals to effectuate his healing in Katherine’s life while giving them a greater revelation of His power and presence. The 3 main doctors who will be attending in this surgery (whom the pre-op RN referred to as “3 heavy hitters at UCLA”) are Dr. Joan Lipa (http://www.uclaplasticsurgery.com/our_doctors/joan_lipa.html) and Dr. Brian Boyd (http://www.uclaplasticsurgery.com/our_doctors/jbrian_boyd.html), who will be performing the CROSS FACIAL NERVE GRAFT, and Dr. Rinaldo Canalis (http://www.uclahealth.org/body.cfm?id=458&action=detail&ref=4479) who will be performing the 7/12 NERVE TRANSFER. Also, please pray specifically for the anesthesiologists and any other assisting medical professionals. Again, this will be at least a 6 hour surgery, so pray for their focus, stamina, wisdom, and precision.

In this newest phase of Katherine’s journey, we know that the Lord will continue to make Himself known in her healing. This surgery (very much like the surgery on 4/21/08) has a rather wide spectrum of potential outcomes. Worst case scenario, her right facial muscles are already atrophied beyond repair and NOTHING WILL HAPPEN. Worst, worst case scenario, her tongue will be negatively affected by the surgery and thus her swallow will be impaired. We deeply feel that God has not lead us to this place to have either of those scenarios come to fruition, but we still ask for your prayers against those negative outcomes. Rather, we pray that the Lord would be glorified in an incredibly positive surgical outcome that is beyond what anyone thinks might happen (very similarly to her surgery on 4/21/08, where it was very likely she would end up in a vegetative state) and that the doctors, like Dr. Gonzalez, would only be able to give the ultimate glory to God.

We thank you for getting to the end of this update (sorry for all the technical information, but specifics matter!) and for your indomitable commitment to journeying with Katherine on her road to restoration through your unceasing love and prayers.

All the Best,
Jay III