Recovery Day Five

Fortunately, skipping the 1:00 a.m. dose went without incident.  I felt a mom of a newborn when I woke up feeling "refreshed" at 4:00 a.m.  Amazing what a bigger chunk of sleep does for the body. In an effort to tempt fate, we stuck with the 4 a..m. and 7:00 a.m. doses and let him sleep in until 10:00 a.m.

He started out the day fine but very quiet.  He ate, said he was not in pain, but also really not speaking.  He had a slight temperature of 99.4 in the morning but the nurse said it isn't unusual to run a fever afterwards and they're only concerned if it gets over 102.  Sort of wondered if this was the beginning of the scabs falling off stage, which they said could happen between days 4 and 8.

We tried going out to Red Robin (his favorite!) for dinner thinking that some soft macaroni and cheese might be just what he needed to get something other than ice cream and pudding in his system.  He ate about half of his mac n cheese (which he normally gets refills on) and then started to cry that his throat hurt.  That was the first time I've seen him actually cry since surgery and that should have been foreshadowing of what was yet to to come during the night.

Hard to get him to bed this night... he was stacking his pillows and rearranging his stuffed animals for at least an hour.  Still happy and in good spirits but barely speaking.  He finally fell asleep around 11:00 p.m.  Woke up him at 1:00 a.m. for that dose and had planned to skip the 4:00 a.m. in an effort to get everyone some more sleep.  Unfortunately, he woke up at 3:15 a.m. in extreme pain.  Crying hard that his throat hurt and could barely swallow water.  Gave him some of the oxycodone and watched him writhe in pain for 10 minutes until it finally kicked in.  Really hoping this is the scab falling off issue that the nurse warned us of and hoping that it really only lasts 24 hours like she promised.  So hard to watch your child in pain.

Recovery Day Four

Well, we were due.  I was feeling like this was all a little too easy.  At the 1:00 a.m. dose, he did not want to wake up.  No really, he did not want to wake up. Acted all floppy, whiny, and would not sit long enough to drink the Tylenol.  So, to make it easier, I put the medication in a syringe.. What it did was make it easier for him to spit it out.  And so the battle began.  After a bout of screaming, we ended up only getting about half the dose in with the rest going on the floor. In the moment, he said it was because his throat really hurt.  So, we gave him a dose of oxycodone, which was also quite the battle to get in him.  Now, in the light of day, I'm not so sure his throat really hurt that bad or if instead he was just super tired.  I don't blame him.  This getting up every three hours is getting really old.

Fortunately, the took the 4:00 a.m. and 7:00 a.m. doses much easier and woke up just before 10:00 a.m.  Fatigue seems to create amnesia in my little guy and he barely remembered the bad night.  We, on the other hand, were quickly seeking coffee.  With boredom setting in, little guy asked to go to the aquarium.  I was honestly a little worried that going out would be too much but also felt like it would do the entire family good to not sit around and watch him (or the TV).  So, we packed up and headed off the Pointe Defiance Zoo and Aquarium.

He LOVED it.  We rented a stroller when we got there and tried to the ignore the sideways looks and occasional comments about how we had an adult in a stroller.  My little man is 57 pounds and 4 ft tall so I imagine it did look a little strange.  He rode in between exhibits and got out to have closer looks at the animals and sharks.  He literally was in heaven - especially when we bought him seed sticks for the bird exhibit.  He had so much joy having birds land on his arms, I knew immediately this was a good idea... for all of us.

After a relatively uneventful day, we decided to skip the 1:00 a.m. dose so that we could also get a better night sleep.  Here's hoping we don't regret that decision. 

Recovery Day Three

Waking up every three hours to give medicine is wearing.  Its amazing how fast three hours goes when you are asleep. Our efforts are paying off big time though in that we had another relatively uneventful night.  Our little guy does not like the taste of the ibuprofen so getting him to take at 4:00 a.m. was a bit of a challenge . He was so sleepy.  Like a champ though, he finally agreed and was quickly off to dream land.

He woke up again around 9:00 a.m. and, again, seemed pretty content.  Quietly asked for something to eat and snuggled in to watch cartoons.  I noticed he was getting really quiet by around noon time frame.  When I asked him if he was ok, he just said it hurt a lot to talk.  Figured it was time again for some oxycodone and 20 minutes later, he was a new kid.  By 5:00 p.m., he was playing BeyBlades with dad and sis and screaming "1, 2, 3.... let her rip!"

Appetite today was good and at 10:00 p.m., he said he was hungry for more and ate yogurt and a granola bar.  The granola bar being the first non-soft food he's had since the procedure.  He ate without complaint and then goofed around in bed for a good hour before falling asleep.  Not good news for parents that have to wake up at 1:00 a.m. for a medication dosing.  If that's the worst of Day 3 though, I'm grateful.

Recovery Day Two

After an uneventful night, likely due to our diligence in waking up every three hours to give more pain meds, our little guy woke up at 9:00 a.m.  If I didn't know better, I would have had a hard believing anything had even happened.  He happily got out of bed and headed downstairs for morning cartoons.  Before we knew it, he was jumping around, playing with big sister, and trying to wrestle the dog.  Biggest challenge of the morning was keeping him quiet.

The nurse from Children's called to check in around 11:00 a.m. and was happy with his progress. Reminded us that keeping him quiet was very important and that he'd likely have a tough day between day 4 and 8 when the scabs come off.

His appetite was good throughout the day and his energy level was good.  It wasn't until about 6:00 p.m. that he started using sign language because he said it hurt to talk.  This was about the time we noticed his voice pitch had changed slightly.  We gave him some oxycodone to make him more comfortable.  He honestly probably would have been fine but the oxycodone doesn't seem to make him groggy so figured we'd make him as comfortable as possible.  He ate a great dinner - ice cream, jello, applesauce and soup.  In fact as we were all about to eat steak and salad (which he hates), he bowed to his dinner and said "Thank you, tonsils, thank you".  Very pleased to not be forced to eat steak I guess.

After another dose of oxycodone and Ibuprofen around 10:00 p.m., we had to force him to go to bed. He was definitely not 100% on day 2 (or even close) but so much more comfortable, happy, and energetic than I expected.  On to Day 3!

Recovery Day One

With the first big hurdle past us, my attention was now focused on pain management.  Dr. Inglis and the nurses explained that they have developed a new pain management regime and asked us to record the medication administered over the next several days so that we could report back to them for their research.  Expecting something complicated, I was surprised to hear the regime is simply this: Give Tylenol and ibuprofen every 6 hours but alternating them every three.  So, first Tylenol, three hours later, ibuprofen, three hours later Tylenol, and so on.  Do this 24 hours a day for a minimum of 3 days, longer if needed. Oxycodone was prescribed for "break through" pain as needed. Although they said we would likely not need much of the narcotics.

I was skeptical.  Really? Tylenol and ibuprofen?  No way is that strong enough.  But these guys are experts so we figured it was worth a try.  And at 1:00 p.m., my little guy received his first dose of Tylenol.

For the rest of the day, my little guy lounged around, watched TV and asked often for food.  Prior to surgery, he had proclaimed that he was planning to eat ice cream for every meal and he took this mission very seriously.  As soon as we got home, he asked for ice cream.  20 minutes later when he saw us eating lunch, he was insulted that he had not received ice cream for lunch.  The ice cream he had 20 minutes prior was his "makeup breakfast".  My heart was singing at the quick return of his witty personality and big appetite.

We maintained the pain regime, offered water often and stayed attentive to him.  He would quiet down the last 30 minutes of each 3 hour stretch between medication but other than that, seemed relatively normal.  He seemed a little quieter than normal around 8:45 p.m. so we offered him his first dose of oxycodone before bedtime.  10 minutes later he was jumping and throwing stuffed Angry Birds at me.  Clearly not inducing the sedating effects promised on the bottle.

We set up him for bed in our room so we could keep a close eye on him.  My big snuggler had not problem with this arrangement.  We got the humidifier going as we had been told this helps keep the throat moist, thereby reducing pain in the morning. And, we set our alarms for three hours later.

It was an uneventful night.  And much, much harder on mom and dad than our son. We dutifully got up every three hours, gave him his meds and went back to sleep.  Without one peep or cry of pain from him.  I know there is a long road still ahead, but honestly could not have imagined a better first day.  On to Day 2!

Surgery Day

With a check in time of 10:30 a.m. and a typically voracious eater, we were understandably concerned about the whole "not eating breakfast" thing.  Concerned would be an understatement. I was dreading it.  During the pre-op call, we were instructed that he couldn't have anything solid after 4;15 a.m. and no clear liquids after 8:15 a.m.  Believe it or not, we actually woke him up and gave him yogurt at 4:00 a.m.  Not sure this was completely necessary but figured getting something in his tummy couldn't hurt.

We arrived at the Seattle Children's Outpatient Surgery Center in Bellevue at 10:30 a.m.  I'm sure there are a lot of great places to take your children for surgical procedures but Seattle Children's is top notch  They aren't just pediatric specialists.  They get kids.  And they get how to put them at ease.  And this starts the moment the elevator doors open to the surgical floor. Our check-in was quick and the wonderful woman checking us in was attentive to my son, not just having me sign the typical forms and procedural steps.  She even gave his favorite stuffed animal an ID bracelet that matched his.  Needless to say, he got a big kick of an ID bracelet on his walrus' tail.

Minutes later, we were called back by a nurse and we were immediately greeted by his 3 person anesthesia team; which included an anesthesia student, an anesthesia tech and the anesthesiologist. They immediately started playing with my son, giving him high fives, low fives, etc. and gave him the mask to play with filled with the root beer smell he had picked out.  All three were engaged with us on some level.  While one was playing with him, another would be asking us the usual questions; like family history of anesthesia reactions, last time he ate, etc.  Given our son's pretty dramatic wake up from his ear tube surgery two years prior, we spent a lot of time talking about the go to sleep and wake up strategy (Side note: there was nothing abnormal about his wake up from his first surgery, but he screamed and flailed for 40 minutes before the rational part of his brain woke up.  Definitely an experience were hoping to avoid again). The anesthesiologist offered an alternative that would slow his wake up time in recovery but would hopefully decrease the agitation.

After that it was just the basic "get yourself ready" for surgery procedures.  He got dressed in a gown, we answered more questions, and the dr came by to visit.  Seattle Children's allows parents to be with their child when they are put to sleep so all of this takes place in an Induction Room.  The room has your typical medical equipment but it is also littered with distractions appropriate for children.  A movie playing, a Nintendo DS, toys, etc.  Before we knew it, it was time to go to sleep.  My boy decided he wanted to watch a movie, play a DS and hold our hands while he went to sleep.  Quite the multitasker.  He did get a little upset when the gas came on.  Ironically the only tears we would end up seeing the entire day.  But after a few tearful breaths, he was asleep and we were quickly ushered to a private waiting room.

And this is where mom fell apart.  I've seen it twice now but there really isn't anything like watching your child be put under anesthesia. Your brain knows it is the right thing to do and that it is relatively safe. But watching your child go limp and know that a breathing tube is about to be placed stirs up emotions that surprised me.  If I had the choice, I would still choose to be present for it because I feel like it helps the child but it is pretty uncomfortable to watch... to say the least.

20 minutes later, the doctor came to our waiting room.  Procedure went well, tonsils were large enough to feed a family of four (his words, not mine) and then he made some jokes about a guy in the waiting room wearing a University of Oregon shirt.  We are all Huskies so bonded in our collegiate commonality.  Another side note: my son's doctor, Dr. Andrew Inglis, was just voted one of Seattle Top Doctors of 2012.  I imagine it is because he is an amazing surgeon and other notable accomplishments.  But he's also human, explains things in layman's terms and brings parents back to the big picture.  In those moments, I appreciated the Oregon Duck humor.

20 minutes after his visit, we were escorted back to the recovery room.  Based on our last experience, we were expecting to be greeted by a screaming and agitated child.  To our surprise, he was sitting up in bed, being fed an otter pop by the recovery nurse.  I can't say he looked comfortable, but he was calm, alert and happy to see us.  All three members of the anesthesia team quickly checked in on him and it was all I could do not to jump up and hug them for making his wake up experience so much more positive.

I immediately the got the silly sign for "it hurts really bad". Since he was already full of medication, the nurse got him to focus on eating the otter pop for relief.  He quickly remembered the present and did the silly sign for "I want my present now". Which looked something like a monster roaring. He was ecstatic with the BeyBlade and the stuffed sock monkey. Seeing his delight, the nurse brought him another stuffed animal as a gift from Seattle Children's for being so brave.

Once we determined that he wasn't going to be sick to him stomach, his pain seemed under control, and we was able to take in liquids, the nurse removed his IV. My boy was anxious to get out of there! In his morphine induced slurred speech, he begged to get dressed, collected his menagerie of stuffed animals, and asked for his wheel chair ride to the car.  And just like that, less than two hours after we we walked in the door, we were headed home to start his recovery.

Prep Work

Knowing my little guy like I do, I knew that springing the procedure on him the day of would not go over well.  But we also wanted to make sure we weren't dwelling on it either creating unnecessary anxiety.  We talked about it a few times in the month leading up to it but saved the detailed discussions for the few days before the surgery.  Seattle Children's Hospital sent us a great prep book talking about the procedure and what would happen from the child's perspective.  Not sure this would have worked too well with a toddler but for my 6 year old, it really helped him visualize what he would experience.  The prep book also prompted decision points for my boy... things like what smell would you like in the gas mask? or what would you like to be doing when you fall asleep?  Looking back now, giving him some control was key.  He was part of the procedure rather than having it done to him.


So, taking that theory a step further, we allowed him to come up with the types of foods he would like to eat after surgery.  Even took him to the grocery store the day before surgery and let him pick whatever he wanted.  Sky was the limit.  He had a ball at the store and giggled when he picked out not one, but TWO kinds of ice cream.  He sure thought he had pulled a fast one on me. 


We also came up with signs for things like pain and things he may want after surgery.  My little creative boy came up with lots of silly signs for pain, like pretending to pull his finger off when it really hurt.  


I had read on a website that giving your child a present to open after surgery would give them something to look forward to after waking up. Nothing huge obviously but the anticipation of something positive after they wake up is a great distraction. My son is huge into BeyBlades at the moment so I picked up one he'd been eyeing as well as a small little stuffed animal and wrapped up with a big bow. 


Other than that, we just kept the tone very positive but also made sure he knew how to communicate with us if he needed help or something hurt. Giving him a picture of what would happen as well as giving him some control over what was happening was the best thing we could have done.  Oh, and the BeyBlade didn't hurt either. :)

Our road to a tonsillectomy

I'm not going to lie... I abuse Google.  Especially when in comes to my children and their health.  Search engines can be a scary thing when you are innocently looking for information on a particular condition.  For example, when I "googled" information on my son's upcoming tonsillectomy, I got a lot of rather scary results.  People (including parents of children) who have had horrific experiences recovering from tonsillectomies, including a few catastrophic examples. I'm not saying those experiences don't happen, or that they won't happen to us, but I had a hard time finding tips on how to help my son during his recovery as well as what the experience was like first hand without reading something alarming.  So... I'm deciding to chronicle our experience with tonsillectomy recovery in the hopes that it helps even one anxious parent out there.  And, before I proceed, I must give the disclaimer that I am not a medical professional nor is a medical professional reviewing this blog.  This just my experience with my son.  Period. If nothing else, a good story for me to look back on someday when he's big and doesn't need my mom cuddles anymore.

Background -

My little man is currently 6 1/2 years old.  At the age of 2 1/2, he began developing frequent ear infections, some of which were drug resistant and required antibiotic injections to resolve.  Well meaning doctors continued to tell us that it was very unusual to begin developing ear infections so late in life (vs. in infancy) and he would "grow out of it" in no time.  At 4, he was still getting them as often as ever so we got a referral to Seattle Children's Hospital for an ENT evaluation.

It was determined rather quickly that he was a candidate for ear tubes so in August 2010, at the age of 4 1/2, my little guy had tubes placed in his ears.  Since his adenoids were fairly enlarged when the doctor got in there, they removed those as well to better allow his Eustachian tubes to drain.  At the time, his tonsils were "normal" and, given the increased risk with tonsil removal, we left them alone.  He recovered from surgery fairly quickly and was back to his normal energetic self in 2-3 days.

The ear infections didn't stop all together but the frequency was greatly reduced and the tubes allowed us to administer antibiotics through the his ear tubes.  In October 2010, my little guy woke up with a terrible sore throat, fever, and vomiting.  After a quick trip to urgent care, it was determined he had strep and his first bout of tonsillitis.  He would only have one more tonsil infection a short three months later but the damage was done.  His tonsils stayed the size of enormous grapes in the back of his throat.  The ear tubes required us to take him back to the ENT every 6 months for follow up, which gave them a good baseline to view his growing tonsils.  In August 2011, they urged us to consider removing them.  Our little guy seemed fine so we held off given his apparent lack of symptoms.  In February 2012, the ENT asked about his sleep.  Huh?  What did that have to do with anything?  But, being every compliant, I answered her questions.  Up at night? Check. Snores?  Check. Sweats when he sleeps?  Check and check. Apparently these were all symptoms of apnea and a little guy struggling to breathe at night.

Still concerned about the risks of surgery, we took him to a sleep specialist to determine if he really did have apnea.  The sleep doctor took one look at his throat and said "If we do a sleep study and it comes back abnormal, I'll recommend doing a tonsillectomy ASAP.  If we do a sleep study and it comes back normal, I'm going to recommend a tonsillectomy."  Given that recommendation and the ENT surgeon's description of his tonsils as "spectacular", we decided to push forward.  And that brings us to today, July 26, 2012.  The day my little guy said "see ya later" to his spectacular tonsils.