A 3 for 1! 3 surgical procedures under 1 general anesthesia. Matthew's large tonsils and large adenoid were surgically removed on October 26. Ear tubes were also put in both ears.
A Little Background
He didn't go through a sleep study to test if he had sleep apnea but my mommy instincts told me he did. We watched him on the video monitor. He sometimes woke up in the middle of the night with a little *gasp* and sat up, was restless and sounded congested. After discussing our concerns with his pediatric ENT over 3 visits, we decided to go ahead with the tonsillectomy and superior adenoidectomy as a solution for the sleep apnea issues. (See blog entry from June 2009 ENT Appointment - Surgery?).
A superior adenoidectomy means that only the top part of the adenoid will be removed. The pediatric ENT will leave the bottom part of the adenoid so that the palate still has something to go up against.
"A child with Down syndrome has a naturally hypotonic palate," the ENT explained. "This is different from a submucous cleft palate but similar in that the palate is softer to the touch than it usually is. The adenoid is basically a 3rd tonsil in the back of the throat and nose which pushes against the palate allowing us to make certain speech sounds accurately. Removing all of the adenoid may cause voice quality issues." Bill and I viewed this as undermining the structure of Matthew's palate. Leaving the bottom part of the adenoid was a precautionary measure to preserve Matthew's voice quality - a way to avoid developing a nasal resonance in his voice.
Ear tubes were needed to help his ears drain middle ear fluid more efficiently. This would be his 2nd set of ear tubes. The first set that was in when he was about 8 months old had already fallen out and the holes from the 1st set of tubes had healed well. He has had fluid in his right ear for many months now and the doctor noted that his ear drum was "purple and bulging." His left ear, however, was fluid-free. Despite the clear ear, both ears still got tubes - a procedure called bilateral myringotomy.
7:25 am: Matthew had 6 ounces of apple juice, a clear liquid that he was allowed to have until 7;30am. He wasn't allowed food after midnight.
9:10 am: We arrived at the waiting area half an hour earlier than we were told to be there. Matthew enjoyed looking at fish while waiting our turn. I had a knot in my stomach from the anxiety that had been building up over the past few weeks, anticipating today's surgery.
10:00 am: Matthew was called in to prep for surgery. While waiting, he enjoyed coloring this book, the bed and pillow. He also enjoyed watching Elizabeth play.
11:00 am: Matthew was becoming irritable from hunger. Several times, he said, "Bibi, crkrs" (Mommy, crackers) while signing crackers. I felt so sorry that I couldn't give him what he wanted. We turned the tv on to the Mickey Mouse channel in our pre-surgery room to keep him occupied.
11:30 am: Versed, an anti-anxiety drug, and liquid tylenol were administered orally with a syringe. A few nurses and the anesthesiologist came to introduce themselves and talk to us about their role in Matthew's surgery.
12:00 pm: A very calm and drowsy Matthew was taken to the operating room. I bought sandwiches for Bill and I to eat while waiting. Elizabeth was so tired.
1:00 pm: The ENT came to talk to us with a post-surgery update. "The surgery went well. Matthew's adenoid was large," he said, "and it may be the chunk of his problem. Our priority now is pain management. Regular tylenol every 4 hours works the best for kids in Matthew's age group. Prescription tylenol with a narcotic called codeine would knock the pain down a few more levels but it seems to cause stomach problems and other side effects in young children. The pain will subside over a few days but may suddenly peak around day 7 of recovery. A few streaks of blood in saliva can be expected but if he starts coughing up bright red blood, call the office and he may need to be taken to the emergency room." So we agreed that we would use regular tylenol and only switch to tylenol with codeine if needed. A nurse led me to the recovery area. Matthew was just waking up from the anesthesia. He was upset, cranky and disoriented. The nurse reassured me that this was nothing out of the ordinary and that Matthew was probably seeing double or had blurred vision as he was waking up. With the tonsillectomy, his voice was also very rough and rattly due to the swelling in his throat and felt like he had something caught in his throat. Matthew eventually calmed down, hugging me, but still attempted to pull his IV out of his hand.
2:00 pm: A nurse wheeled us up to our post-operation room in the Pediatrics unit of the hospital. Bill and Elizabeth were already there waiting for us. Bill and I took turns snuggling with our very tired little guy. Matthew had given up on trying to pull the IV out of his hand.
5:00 pm: Matthew received his first post-op dose of regular grape-flavored Tylenol (acetominophen) for pain management. The next dose was in 4 hours. After Elizabeth had another bottle of milk, she and Bill headed home. Matthew and I watched cartoons on TV and snuggled in bed. He still refused to drink any water or juice even with a syringe. At least he was getting IV fluid so dehydration wasn't a concern at this time. The ENT came by to see how he was doing.
9:00pm: Another dose of regular tylenol. He had been sleeping in approximately 1-hour increments. He snored due to the swelling in his throat. Coughing would wake him up and upset him. I wanted to take the pain away from him but all I could do was comfort him. So far, the regular tylenol seemed to be working just fine.
11:00pm: As expected, it was a long and sleepless night for me, a restless night for Matthew, but I was thankful for a successful surgery. I was thankful for being at the hospital and for the IV fluid Matthew was receiving. He was still refusing to drink and the IV fluid was keeping him hydrated. I was thankful for all the thoughts and prayers from family and friends. Thank you!
Now, we begin the 9 to 14 day recovery period.
ENT Appointment - Surgery?
Recovering from Surgery: Days 1 to 9 Daily Diary