Sunday, September 26, 2010

Upcoming: Surgery #4

Yup, we're going in for another surgery this week.

At last week's audiology and ENT appointments, we determined that Becca is again having trouble hearing because she has fluid behind her eardrum. (This is the same issue that made her functionally deaf by the end of her NICU stay.) Her first set of tubes was placed at the beginning of February 2009, and her hearing dramatically improved instantaneously. Since then, we've gone through, "Hmmmm...I can't see the tubes...but they are so small, I'm not sure I would..." and, "Well, I don't know if she's hearing and just doesn't want to participate in the tests...or if she's just not hearing..." and (from our now ex-ENT), "She's got irreversible nerve damage; let's get her fitted for hearing aids ASAP," and, "No, let's sedate her and test her hearing first [this past February]...Ha! He's wrong!" and, "Hmmm....maybe she does have fluid again...let's give it a few months and see if it drains..." and then, last week, "Yep, the tubes are definitely gone, and she's definitely got fluid keeping her eardrums from moving, so it's time for surgery."

Well, at least we know we covered all our bases. :)

So, on Thursday morning at the crack of dawn (who am I kidding - before dawn!), the three of us will head up to Vandy, where Dr. Goudy will place a new set of tubes and remove Becca's adenoids. Right now we don't know if her adenoids are enlarged or anything, but when a kid gets a second set of tubes (most don't need a second), removing the adenoids reduces the chance of needing a third set by 50%. The hope, then, is that by doing both now we'll give her itty bitty ears a better chance of draining the fluid so that a) she stops getting ear infections (though she hasn't had that many...maybe 3 this year); and b) her eardrum can move, thus enabling her to hear clearly. She obviously still hears, but we have noticed that her new words are not very clear, and I'm putting the pieces together to realize that the muddled hearing might be the explanation for the mildly-delayed expressive language score we saw in her Bayley exam.

We're feeling good about the surgery. The difficult bit is figuring out how to maintain her blood sugar when she won't be getting all of her overnight tube feeding on Wednesday night. (Before surgery you have to stop all food, milk, formula, etc at midnight.) Remember, when she misses a night feeding, she gets hypoglycemic - and that's when she had her seizure in the hospital. We are working with the anesthesiologist, our endocrinologist, and our pediatrician to come up with a plan (other than mama putting the beatdown on any nurse who says that she doesn't need IV fluids, and the extra-sugary ones, to boot), and our current thought is to stop her formula at midnight and switch over to apple juice (through the tube, via the pump) until we have to stop all fluids at 4 am. While she's in surgery at 8, they will place an IV and begin fluids (D-10), which we will keep giving her the whole time she's in recovery (about 5 hours, probably). I don't know if this will be enough, since apple juice is not nearly as rich as her formula, but we'll also be checking her blood sugar periodically to make sure she's doing okay.

If none of the ear stuff made sense to you, here's a diagram that may help. (The tubes go where the eustachian tubes are labelled - they help kids with small or underdeveloped eustachian tubes drain fluid. See how enlarged adenoids could also block the tubes?) If you have specific questions, feel free to ask in a comment. Also, if you have experience with adenoid surgery, I'd love to hear any tips or stories! I hear the post-op breath is AWFUL! And, as always, we'd appreciate everyone's prayers, for the prep time/feeding issues, the surgery, and the post-anesthesia hysteria we tend to see with Becca.


  1. Hey, Nancy. My Parker has had three sets of tubes. Our ENT does a tonsillectomy and adenoidectomy with the third set always, and so Parker had that done when he was 2 1/2. Jackson has also had his tonsils and adenoid removed; however, it was when he was almost five.

    Anyway, yes the breath is bad afterward. My boys had their tonsils removed too, so they had some swelling in their throat/jaw area. I don't know if you should expect that with an adenoidectomy or not. Jackson had a problem afterward called velopharyngeal insufficiency. (I know you'll Google it.) He lets a little bit of air escape through his nose when he says hard consonants. But then again, he was almost five. Parker didn't have that problem at all, but if he had, he would have had more time to take care of it as his speech was still developing.

    On a side note, I have been able to tell when Parker's tubes are out, and his ears are full again because his speech gets worse. When I start having to really try to figure out what he's saying, I take him to our ENT, and sure enough, he needs tubes again. :) We'll see if this T/A has helped after this set of tubes come out, and we go through cold season. (He still had one in as of a couple weeks ago.)

    If I think of anything else, I'll come back and comment again.

  2. Give us a buzz. Riley had adenoids removed with second sets of tubes. She had an additional third set put in though...em had two sets and then third surgery to remove last set years later and patch a hole in the eardrum. Girl, when it comes to tubes and ent procedures we got info. So far so good with Lucille! Chat later about adenoids.....and yes the breath is kicking!

  3. Our daughter had her tonsils and adenoids out last September at Vanderbilt. It was an absolute nightmare. We were stuck on the 3rd floor in a surgery holding room for 29 hours. She also did not eat or drink for 8 days straight post surgery and got dehydrated. Just remember it will be a very long few days.

  4. Addie had her adenoids out (with her third set of tubes) four months before she turned two. I do not remember the stinky breath, but it sounds like my selective memory is kicking in, huh? :) Addie was a little cranky that day and didn't have much of an appetite, but was completely fine the next day. Her doctor advised us to stick with soft foods for a few days and that seemed to work great.

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