Friday, January 30, 2009

Surgery

Little A had her tonsils and adenoids out yesterday. For most people, this is not a big deal. However, there were a couple of issues that made the decision to have this done extremely difficult for me.

First, even though I am a nurse, I don't totally trust the medical profession. Especially surgeons. Surgeons were educated and trained to operate. If you go to a surgeon for a problem, they fix it with surgery. So, when our doctor (the ENT) recommended a T&A, I had my doubts. I thought he just wanted to do surgery because he is a surgeon. I wouldn't commit right away. I wanted to know the opinion of A's doctor...a family medicine doctor, not a surgeon at all. He said go ahead. See, A has (hopefully had) moderate sleep apnea. While her spells of apnea were not big (although almost 1 an hour), her sleep efficiency sucked. It was 75%, it should have been greater than 90%. Her respiratory disturbance index was 9.5 and it should have been less than 1.

Second, her tonsils weren't big, according to the ENT. When I did decide to schedule the surgery, the nurse said that the notes said they weren't big. This only seemed to confirmed by concerns from above...surgeons operate. I did what any mother would do -- I prayed and prayed. I needed a sign or something. Not that God always gives signs. But He has given me knowledge (being a nurse and assessment skills). Plus, call it being a mom, or maybe God helped my gut feeling, but I had one. Even though all the evidence said "her tonsils aren't big" and my logic said "there could be something else" my gut was screaming "GET THEM OUT!".

A couple of weeks ago, I was napping with A. She usually sleeps in a shirt, but for some reason (hmmm, God?) she was only in a diaper. I got the sign I needed. She started having intercostal retractions. Retractions are when your abdominal and/or chest wall muscles have to work so hard to breathe, you see "dips" between the ribs (intercostal), under the ribs (subcostal), etc. (Okay, so I think all of those are right!). Anyway, retractions are a sign of respiratory distress.

The night before surgery was horrible. Little A had a sore back or something. She fell the night before, so I think it might have been sore. She hardly slept. I hardly slept. I thought this was a sign we should cancel. But, I didn't. And, I couldn't nurse my all-night nurser after 3:45 am. That was hard, but I only had to say no once. She does usually like to nurse right before I get up. It is really hard to say no to a cute little baby saying "milk, milk".

The morning of surgery was smooth. Once we got to the hospital (the one where I work, so she didn't suspect a thing), things went extremely smoothly. The first case cancelled, so we didn't have to wait at all. We were supposed to go at 8:45 and we were now scheduled for 8 am. Everyone from the anesthesiologist (Dr. Y, loved him!) to the ENT (Dr. D) to the nurses and the CRNA rocked.

I got to go to the OR with A. I wasn't planning, but decided I would go back. She went to sleep in my arms. It wasn't scary or anything. Mostly because, I was under the impression A would be on a ventilator (letting a machine breathe for her, which is necessary with enough anesthesia). Dr. Y said that he doesn't to that. He puts a tube in her mouth, but she's breathing...basically he creates an airway for her. Because of this, I totally relaxed.

Dr. D said he'd be done in 20 minutes. Not a second past 20 minutes, he was out talking to us. He said her tonsils were much larger than he originally thought. And, he said her adenoids were taking up 100% of her airway...or something like that. Whew! I know that sound terrible, but what a relief. We didn't do surgery for nothing.

We spent the day & night in the hospital. A was groggy most of the day. About 5pm, she stood up and started jumping in her bed! She was ready to go! The night was fair (better than the sleep study) but not great. However, she has fallen asleep already, but who knows how long that'll last. I'm not holding my breath. :)

I hear it takes about 2 weeks to notice any difference. I do know that A has had difficulty breathing during sleep for her entire life. She snored. She sweated at night. Tossed and turned. Fussed. Never slept through the night (less than 10 times in almost 20 months). I just hope that she heals well and she is able to breathe at night!

I'm glad we did it. But, more than anything, I'm glad to be home. Resting peacefully in our own space...without the germs of the hospital. Ugh! Grossness.

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