Recovery - look at that cute little nose!
Ready to go home
Where's my stuff. Lela had better not be touching it.
Charlotte's request - the short version. Lian had a tooth extracted form her palate, ear tubes inserted, her palate lengthened with a Z-plasty procedure, her nose rebuilt and her upper lip re-done. She recovered amazingly well and come home the next morning, is eating, drinking, running around and playing - talking too. She's feeling the pain more now that the hospital meds have worn off, but regular Tylenol is enough to keep it under control.
The long version
Lian had her surgery at North Shore Hospital Friday, January 4. It went very well, even though we had a “surprise” palate repair. Since we had no one to leave Lela with at that hour, we all arrived at the hospital at 5:30am. We got the girls up at the last minute and packed them in the car in their pj’s. Two little girls in pj’s and parkas garnered a fair amount of “ohs” and “how cutes” in the pre-op waiting room and I think brightened up the day a bit. Lela had one of her sayings. As we were waiting I was teaching her how to spell a few words with the letters she can write – L,E,A (in her name) F, I and O. She looks at the straggling collection of “hill, hall, hello” and says, “I can write a lot of words. I might be a genius.” Which cracked up everyone in range. We were the last out of admissions at 7:45 since we were waiting for three surgeons. Lian is so little they had to put her ID bracelet on her ankle as her wrist is too small for even the last notch. Even the child’s gown was ankle length on her. Lian charmed everyone and was quite happy and cooperative right up to the point where the anesthesiologist put the mask on her. Then as the Dr. had predicted, she started to cry, took one deep breath and that was all she wrote.
Dr. Ditkoff the ENT went first and even though she had come off antibiotics for an ear infection only the week before there was a lot of fluid when he inserted the ear tubes, so they were very much needed. Dr. Siegal the oral surgeon went next. Lian had a tooth up in her palate. The bad news was that he doesn’t think it was her missing front tooth, but an extra tooth. He said it was very misshapen and had a lot of decay so she’s well rid of it. He’s going to do a full X-ray scan when we come for post–op visit so we will know what kind of orthodentistry we are looking at down the road. Then Dr. Ruotolo and Gallagher started. We didn’t know that Dr. Gallagher was coming and were happy to see her too.
We were upstairs, waiting and waiting. Dr. Siegal came up about 9 and told us how the early surgery went. Jamie took Lela to his mom’s house for the day and returned. We took turns running for meals. I had some sushi and a crab cake - it sounded good, tasted delicious and settled into my stomach like a lead weight that could wiggle. Fish and anxiety are a bad combination. Jamie brought back our laptop, but we couldn’t get the wireless connection to work. AHCH – cut off from my e-mail. He thinks it was the tech guy’s “fix” in China at the hotel in Xi’an when we had a problem with the hotel Internet firewall – so apparently we can get wireless in Xi’an but not anywhere else until Jamie figures out how to undo his fix. I think it was the top-secret spyware he loaded, NOT. We were pretty sure they had decided to try and extend her palate when they went past 11, but weren’t sure until Dr. Ruotollo came up to talk to us at 1. Initially the surgery had been to redo her nose and lip. We started with them fixing an oozing blood vessel that gave Lian a permanent little crust under her nostril and putting off any palate surgery until the spring. We could see in pictures from the SWI that the bleeding had been going on ever since her lip repair at 3 months. Then I told her that the speech therapist was telling us she had almost no mobility of her upper lip, so Dr. R. decided to add a redo of her lip. At our pre-surgical visit on Wednesday, Lian was relaxed and chatting away and she really got to hear how much air she loses during speech, so she tentatively added palate repair, though it didn’t look too bad to her on visual inspection – but inspecting a wide away 2-yo is apparently not too easy.
It turned out that Lian had a complete redo. The bleeding vessel was a crusted mass that had to be cleaned out – and while they were at it they tweaked her nose up and evened out the nostrils – her little nose is even cuter now. Her whole lip was adhered to the gum ridge and the muscles were not properly connected, so that was completely opened and redone, with stitches on the inside and dermabond on the outside to lessen any scarring. Her palate was completely repaired in China – but the scar tissue pulled it forward due to the way they did it, leaving her palate very short and sending half her air up her nose. So they lengthened her palate using a Z technique, so that the scar pulling can’t recur. She told us Lian did very well, and came out of the anesthesia very well too – even waving at her when they brought her out of it. She said she had to be drinking and peeing before she could go home.
We were taken up to recovery at 1:30 and though I was prepared to do battle, since the policy is only 5 minute visits twice an hour, we were immediately told not for kids, and can we get you chairs. A nurse stayed with Lian until she went up to pediatrics. We called our friend, Donna K., who works at the hospital but was out that day, and she sent an emissary to make sure we were doing OK. Lian was sound asleep when we went in but began to surface, still very groggy. The anesthesiologist came by and told us she’d given her a lot of meds and Lian wouldn’t be really awake until tomorrow – she didn’t want her to cry and stretch the lip. Since she’d been in surgery for almost 5 hours they kept her in recovery for a couple hours. We went up to pediatrics, Lian being wheeled in her crib just before 4pm. Pediatrics is very family friendly. They have reclining chairs beside every bed, snacks in a little kitchenette and a microwave and fridge if you are ordering out, free TV in the rooms, a playroom and a resource room full of books and DVDs. There’s a computer with a permanent Internet connection if you can kick the kids out of the way. There’s a shower for parents and they gave us a bag of toiletry supplies and extra pillow right away.
Lian started to become more alert, and Jamie realized that she wasn’t trying to pick at her mouth – she was signing water. We propped her up and started dribbling water into her mouth. Thank goodness we taught her sign – she wouldn’t have had anyway to “tell “ us otherwise – and what a smart little cookie, she knew how to get her needs met. I was giving her a teaspoon or two at a time, since the Dr. said go slow, we don’t want her tummy upset. We started her on a little apple juice too. I chatted with her roommate’s mom. Her 5yo was having mysterious chest pains, it was their third stay with no resolution.
Neither of us was prepared for an overnight stay, but since we only live about 15 minutes away it was not a big deal. Since I had taken a shower that am and he had not, Jamie left to get cleaned up, bring back changes of clothes, sweats to sleep in, the phone charger, and pick up Lela for a visit. While he was gone, Lian continued to sip juice and water, eventually downing almost a cup of fluids. Since she was doing so well the nurses decided get her a “clear” tray for dinner – broth, juice, jello, and Italian ice. They moved us to another room closer to the nursing station since they couldn’t hear her monitor and this is an older part of the hospital- the monitors aren’t hooked to the desk. Since she was pretty alert I put a Carebears DVD in the laptop for her to watch in her crib, since the plastic curtain on her crib prevented her from seeing the TV, and she liked that. When I checked her diaper she had produced, so all systems were working. When Jamie returned with Lela, he told me Lela really needed me at home and he would stay over. Lian’s new roommate was a little girl from California, who was also turning 4 in January just like Lela. She and Lela hit it of and went off to her nest at the window end of the room. Since Lian’s tray had still not arrived, Lela and I went off to the kitchenette to see what we could find – and of course, it arrived while we were gone. Lian liked the orange jello, but not the strawberry, had a few sips of broth, preferred the watermelon ice to the lemon (no surprise) and really wanted Lela’s ice cream cup. I did give her a few small spoonfuls. She dozed off again. Her nurse decided to give her anti-nausea meds just in case she needed a painkiller later on. Lela and I left about 9 and Dr. R. showed up 15 minutes later, so Jamie called as soon as we got home. She was very pleased with Lian’s progress. Lian will probably be released this morning between 9-10.
So how did Lian do overnight?
If you are a mere mortal who has just had two kinds of oral surgery and your nose and upper lip rebuilt, you would be curled in a fetal ball whining for more pain meds (that would be me.)
If you are a trooper, you would be bravely smiling and sipping a little liquid since that is what the Dr. told you to do.
If you are a Super Trooper, your surgeon on her discharge visit discovers you polishing off a plate of scrambled eggs and remarks incredulously, “She’s eating?”, you also make serious inroads into a cup of orange jello, are prepared to “work” your condition in order to wrest possession of a toy cash register from your sister, pick sweats over pj’s for your going home outfit, only cry when they yank your IV and it bleeds, walk out the door on your own steam waving bye-bye (then immediately want to be carried the rest of the way), eat an Italian ice in the car, and speak your first post-operative words upon arriving home, “Ats MINE.”
Everyone told us, “Kids bounce back” Well Lian is made of rubber I guess, since her recovery amazed even the peds ward nurses. We are so thrilled that the palate is done and she did so well, and if she doesn’t splat on her face and split her lip open – a real source of anxiety since she took off running as soon as she got home, she now may not need another surgery for several years. It will be exciting to see her new look once the swelling goes down.
Birthday dinner. Notice that Lian is drinking with a straw. This is a big deal, something she couldn't do before her palate extension repair.
Adoption from China $20,000. Palate and lip surgery $60,000. Being able to blow out your birthday candles: priceless.
Opening presents with Grandma Pines
Lela and Lian's version of the Push Me-Pull You.
