Seven-year-old Dahnika Zyk of Pottsville can take over a room immediately. Her outgoing personality and beautiful smile make it easy for her to be the center of attention.
As her mother, Eduana Garcia, watches her energetic daughter show off her charm, she breathes a huge sigh of relief. Something she and Dahnika were unable to do before a three-month stay at Geisinger Janet Weis Children's Hospital in Danville.
Dahnika was born in March 2006 at 38 weeks. She was breech and had to be delivered by Caesarean section at her family's local community hospital. Dahnika was born with Down Syndrome and her breathing was a little raspy after delivery. After their examination doctors at the community hospital, decided Dahnika was able to go home.
At home, things did not go as well. At six weeks, Dahnika had only gained an ounce and was very jaundice. Her mother also noticed that Dahnika was having trouble breathing when she ate.
"Whenever she would eat, she sounded like a seal," Garcia said. "Her breathing was really hard and her ribs were protruding through her skin."
Around Easter, things got much worse. As Dahnika's father, David Zyk, was feeding her, Dahnika stopped breathing.
"She had stopped breathing," Garcia said. "She was dead in his arms."
Garcia resuscitated Dahnika by administering CPR and Zyk called 911 for an ambulance to take her to the nearby community hospital.
"She was so tiny and malnourished. They could hear her wheezing but they couldn't find anything wrong. They were having a very hard time finding her veins," Garcia said.
Doctors at the community hospital decided to have Dahnika transported by LifeFlight® medical helicopter to Geisinger Medical Center in Danville. She was first taken to the emergency department, where the staff tried to find the immediate source of her breathing problem.
"While she was in the emergency room, she was hungry, so I fed her. The second she started feeding, her oxygen levels dropped," Garcia said.
The emergency department transferred Dahnika immediately to the Pediatric Intensive Care Unit of Geisinger Janet Weis Children's Hospital, which would serve as her home for the next three months.
"She came to us after a life-threatening event and was in severe distress," said Frank Maffei, MD, Medical Director of the Pediatric Intensive Care Unit and the Vice-Chairman of Pediatrics. "She was having a difficult time maintaining her airway, which was collapsing. After closer testing, we determined she had tracheobronchomalacia (flaccidity or floppiness of her tracheal cartilage). We placed her on a ventilator to help keep her trachea open."
A multidisplinary team of doctors, including pediatric cardiologists, gastroenterologists, endocrinologists and pulmonologists, worked to identify Dahnika's problem. The gastroenterology team discovered that Dahnika had severe acid reflux and decided to treat the condition with fundoplication surgery, a procedure to strengthen the valve between the esophagus and stomach to stop acid from backing up into the esophagus. Gastroenterologists also inserted a feeding tube to try to help Dahnika receive nourishment and get stronger.
After the first surgery, the pediatric cardiology team began to investigate why Dahnika was having trouble breathing when she ate.
"We did an MRI of her heart, the blood vessels in her chest and her airways. It showed a double aortic arch," said Robert Mangano, M.D., Director of Pediatric Cardiology at Geisinger Janet Weis Children's Hospital. "The condition is very rare; it's where there are two blood vessels instead of one. These two blood vessels had wrapped themselves around Dahnika's esophagus and trachea, compressing her breathing passages.
"In addition, an ultrasound of the heart showed a ventricular septal defect and an atrial septal defect, holes in between the two upper and the two pumping chambers of the heart," Mangano added.
Garcia was told that her daughter was going to need two more surgeries to try to improve her breathing and her sick heart. She was told Dahnika would need to stay on a ventilator and the feeding tube to help her continue to get stronger.
"I don't know how many times her blood-oxygen saturation levels would go down and they would come in to assist her breathing," she said. "The entire time in the hospital she was hooked up to the ventilator and other equipment. I couldn't hold her. I wasn't able to feed her. I couldn't hear her cry. There were times she was lying on the bed looking like a doll."
Garcia says she is very thankful for the special treatment from the PICU staff and the accommodations made available to her by the Ronald McDonald House of Danville®.
"The nursing staff was wonderful and very compassionate. I still visit them if I have an appointment in Danville," she said. "Through all her problems and people in and out of Dahnika's room, I never felt like I was in the way. They were always helpful and always accommodated me."
During her second surgery, the pediatric cardiovascular and thoracic surgeon removed the aortic arch.
"Double aortic arch is a rare defect and it is not easy to diagnose. Once it is found, it is a straight forward repair," Dr. Mangano said. "Our cardiology MRI scanning equipment really made a huge difference in finding this defect."
Following the arch repair, Dahnika remained in the PICU on mechanical assistance to help her rebuild her strength and nutrition. Finally in June, she underwent her final surgery, to repair the two holes in her heart.
"By the grace of God she came through it all and they took her off the ventilator following the final surgery," Garcia said of Dahnika's three-month stay in the PICU. "She was home within a couple days following the last surgery."
Dahnika now is a healthy, energetic bundle of joy, according to her mom.
"She loves musicals, any kind of movie that has music or dance in it. She likes to do puzzles and loves to play outside and swim," Garcia said. "She has been in dance for two years now and also was on a bowling team. I try to keep her active."
Dahnika is healthy and is only followed for a thyroid problem by Pediatric Endocrinologist Mustaq Godil, M.D., at the Geisinger Janet Weis Children's Hospital Outreach Clinic at Geisinger-Pottsville.
"Dahnika was a child who came in with a problem that was not clear at first and it took a team of specialists and a lot of testing to get her through," Dr. Mangano said. "After the surgical repair, she was like a new child.
"If you look at her now, you would never know she had a heart problem, because she is bouncing all over the place, is very active and is a very friendly little kid."
Donations to Children's Miracle Network at Geisinger were used to purchase echocardiography equipment used to help diagnose Dahnika's heart condition and has provided echocardiography equipment at the outreach clinic at Geisinger-Pottsville where she is followed.