Congenital Diaphragmatic Hernia
Nineteen-year-old Al Guarisco from Daphne, Alabama is a quiet young man who loves math, music, building complex Lego models and beachgoing with his younger brothers. His medical journey has been long and winding, but he and his family are grateful for the care and guidance provided by Children’s of Alabama. Al was born with a birth defect called a congenital diaphragmatic hernia, or a hole in the diaphragm. Ninety percent of his right diaphragm was missing, allowing his liver and some intestines to move into his chest cavity and block the growth of one lung. He was also born with a hole in his heart. Al has undergone 26 surgeries, including the repair to his diaphragm at birth, and has seen doctors in 10 subspecialties at Children’s. “His other health issues have basically been a domino effect ever since birth,” said his mother, Laura. “It’s wonderful to have all of the doctors he needs for his care in one place.” Al’s defects were discovered pre-birth. During the first few months of his life, he was admitted to Children’s Neonatal Intensive Care Unit and placed on a heart-lung bypass machine and a ventilator, and underwent four surgeries. At 3 months old, he went home with an oxygen tank, monitor and feeding tube. At 2 years old, Al lost his hearing and received a cochlear implant and speech therapy. At age 4, his heart defect was repaired. A year later, Al was diagnosed with growth hormone deficiency. Injections were prescribed to help him grow properly. “Over the years, he has experienced a number of other health issues, but as he got older, most of his health issues got better,” Laura said. “If you need the best, you need Children’s.” As Al grew, he developed pectus excavatum – a condition in which the breastbone sinks into the chest – which compressed his good lung. At 14 years old, a metal rod was surgically placed in his chest to correct the development of the bone. It was then removed when he was fully grown. As a young adult, Al anticipated his last visit to Children’s. “I thought I had my very last checkup at Children’s in October, but little did we know I would return,” he said. In March 2020, he developed a respiratory illness with a cough that caused his repaired diaphragm to weaken and detach. As a result, he developed a hiatal hernia, when the upper part of the stomach protrudes through the diaphragm. Although this happened during the COVID-19 pandemic, it was not related to the virus. Al met virtually with his Children’s doctors to evaluate the situation. His diagnosis was confirmed during an in-person visit and surgery was performed in June 2020. Before his surgery, his parents had worked with Daphne High School’s administration about Al’s graduation. “I couldn’t be around a large crowd because of COVID-19, so they set it up where I could receive my diploma on stage with my family there, a few hours before the regular students and crowd,” he said. Al not only received his diploma and took pictures in his cap and gown there, but he also took pictures at Children’s. “Children’s is ‘my hospital,’” he said. “It has been a consistent part of my life, too, so I thought it was only appropriate to remember my ‘graduation’ from there as well!” Al graduated with honors and was inducted into the National Honor Society and Mu Alpha Theta mathematics honor society. While in high school, he played percussion in the school’s marching band. His mom stated, “Yes, my deaf child learned to play percussion! With his Cochlear Implants, it has never prevented him from playing music or anything else.” Al’s future plans include attending the University of South Alabama, where he will major in mathematics and minor in biology. “I hope to provide statistical data and other forms of math used in medical research to help doctors who help others with health issues like mine.”
