Friday, July 29, 2016

Tonsillectomy and Adenoidectomy on 3 Year Old

So Bailey had her tonsils and adenoids removed a few weeks ago. Obviously tonsils is a fairly common surgery for kids - but having them out at such a young age was a bit scary but overall everything went really well and the recovery was better than I thought it would be (that being said, I never want to do that again!)

Pre-surgery tonsil pic (NOT inflamed, just an average day. This is how big her tonsils were
Enlarged toddler tonsils.

Backing up to the beginning, I took Bailey to the ENT a few months ago because of her speech delay. I was wondering if there was fluid trapped in her ears. She had a ton of ear infections when she was between 1 and 2, but none between 2 and 3. Honestly, she probably should have had tubes in. She had five in a row over three months. But anyway. I also wanted to ask the ENT about her snoring because Bailey snores like a grown man (or did, not now!) and wakes up pretty frequently at night still. Would you like to hear how bad her snoring was? I made a recording for the ENT (and he diagnosed her with sleep apnea based on the video):

Anyway, the ENT resident came in and I told him my concerns. He asked Bailey to open her mouth and say "ah". Without hesitation he said "those need to come out." Then he disappeared to get the attendee doctor who would do the surgery. He looked at her tonsils and said they same thing. He said she had giant preemie tonsils. Is that a thing? Apparently yes.

They wanted to schedule the surgery ASAP but between my brother's wedding and a few other things it wasn't going to happen. So we put it off until July.

In typical fashion, I bought several books on Amazon to try and help her understand the surgery, as well as OR scrubs for her doll and this very cute animal hospital set. Judge me ha. My baby has surgery, she can get some extra toys. Per the advice of the "your child is going to have surgery" booklet the Cleveland Clinic gave us, I told Bailey about the surgery a few days before. I explained to Brooklyn and Bailey that Bailey was going to go to the hospital and have surgery to make her feel better. She would be sick for a little bit, but then she would feel much better. Before I can say all that - all I have said is that Bailey is going to the hospital to have surgery - Brooklyn yells "no, me!" To which Bailey responds, "no, me!" and so on. Morgan continued to eat her dinner, uninterested.

The morning of, we woke Bailey up a little early. My parents came over to take the other girls to daycare. We got to the main campus of Cleveland Clinic around 7:15 am. Bailey was very happy thinking she was having a fun adventure with mom and dad. We did all the paperwork and checked in. They took us back to a pre-surgery room and Bailey was starting to get a bit iffy and suspicious. A child advocate person came in and was WONDERFUL. She had bubbles so was instantly Bailey's new best friend. She also had the mask they would use to put Bailey under and was showing her how it worked. She let Bailey pick out flavored chapstick (she picked the Belle kind of course) so the mask would not smell like plastic. I somehow coaxed her into the hospital gown (though she refused to take her shoes off) and put my own scrubs on. Then the doctors, aides, nurses, anesthesiologist all came into the room to take her down to surgery. This is about the point where Bailey was like oh hell no and started to get really panicky. I carried her down to the operating room, her unease growing. I sat in the chair with her as they put the mask over her face. This was the worst 60 seconds. I was crying. Bailey was fighting the mask and screaming. The nurse told me to sing to her to calm her down. I could barely choke out a sound. "What is her favorite song?" they asked. "Hush little baby," I managed to say. And the nurses sang to her while the mask did it's work and she was out.

The surgery itself went pretty fast - maybe 45 minutes or so? We went into the recovery room and she was still out. She slowly started stirring after 30 minutes maybe. Right when kids come out of anesthesia they are confused, disorientated and a little hostile. She was not a happy girl. I laid in the bed with her. She actually chugged four mini apple juice containers within that first hour which is really awesome. She refused Popsicles. I learned that Bailey does not like Popsicles, despite my careful stocking of our freezer ahead of time.

Bailey did awesome that first day. She wanted lots and lots of ice cream. She even ate macaroni and cheese for lunch. Darren left to pick up Brooklyn and Morgan and I stayed overnight with Bailey. The children's unit was really nice. They have tons of toys and DVDs you can use, as well as books that you keep (they can't be cleaned). But Bailey was obsessed with the salt water fish tank that had Dory and Nemo fish in it. We spent a lot of time sitting looking at fish. I am also thought it would be hard for Brooklyn and Bailey to be away from each other overnight. Figure they have never slept more than maybe ten feet apart from each other. Darren kept Brooklyn up a little later so she went down pretty easy. Bailey had a bit of a harder time falling asleep. We snuggled in the hospital bed and watched a princess DVD until around ten. She did good all night but woke up right around medicine time crying.

My main tip for anyone with a kid recovering from T&A surgery is to stay on top of the meds. Every three hours means every three hours. Do this until about day 11 or 12 post surgery. Set your alarm at night. Alternate Tylonel and Motrin.

The third day seemed harder than the first two. She wouldn't really eat or drink anything. And I mean anything. No more ice cream. No juice. Clearly no Popsicles. No Jell-o. No pudding. No mac and cheese. No water. I finally got her to drink a little milk. She really didn't eat or drink much for a few days. She seemed to perk up around days 5-6 and then crashed some when the scabs fell off around days. She would be fine 80 percent of the time (like super happy and playing) but then very upset and throwing tantrums for the other 20 percent (like kicking and just screaming, which she NEVER does, but was obviously in pain). Brooklyn was very sweet to her!

So she's fully recovered now. I was hoping for a miraculous improvement in speech but she seems about the same. We had her first speech therapy session post surgery and are shifting the focus from getting her to say anything (now that she has a good vocab and uses sentences) to focusing on her articulation. I still think she has apraxia of speech but for now the SLP wants to focus on her articulation before we label it as anything. Right now we are focusing on the P sound. Bailey can't say P's at the beginning of words (though she can say the P in up for example). She is unable to close her mouth to form the P used at the beginning of the word. So instead of pie she just says "eye." or "ur-el" instead of purple.

Typically the P is mastered at age 2. She does have the M down though! I don't want to diminish her progress. For a kid that said almost nothing in March to the progress she's made now is tremendous. I just feel awful as she's communicating now that it's so difficult to understand her. There is nothing worse than your 3 year old repeating the same sentence over and over again and you just can't understand her. We try very hard to never say, "I can't understand you," and figure out with context clues what she wants, or ask her to show us. But it breaks my heart when she starts crying and getting upset because we can't understand her. (As a side note, Brooklyn is doing awesome too with her speech. She is much more clear and easy to understand, but still a bit behind her peers in how she uses her language.) Anyway, we only worked on M and P at this last session, but here's when kids typically master specific letter sounds:


No comments:

Post a Comment