T + A with a Toddler

As I’ve mentioned in my previous post, my son, who is almost 2 years old, recently had surgery: a T & A, which stands for Tonsillectomy and Adenoidectomy.

Tonsillectomy is a surgical procedure to remove the tonsils, two oval-shaped pads of tissue at the back of the throat — one tonsil on each side. The tonsils are part of the lymphatic system, which is responsible for fighting infection.

Read more: http://www.surgeryencyclopedia.com/St-Wr/Tonsillectomy.html#ixzz33mY0v5fG

An adenoidectomy is the surgical removal of the adenoids—small lumps of tissue that lie in the back of the throat behind the nose.

Read more: http://www.surgeryencyclopedia.com/A-Ce/Adenoidectomy.html#b#ixzz33mXqQwlZ

 

While the procedure is common enough, and is an outpatient type of surgery, the recovery was something I wasn’t quite prepared for. So that’s why I’m writing this post in hopes that someone else may glean some useful info here that I wished I had known going in to my son’s surgery and recovery. What was actually helpful to me was finding mommy blogs that talked about their own experiences with their kids’ T&A, but most of their kids were far older than mine, so there was a slight difference between their experiences and mine.

Prior to meeting with an ENT (an Otolaryngologist), our pediatrician had casually mentioned how our little guy’s tonsils were huge. He didn’t seem too concerned, so I didn’t worry too much about it. I did mention to him how my son had been throwing up after eating–one time at a restaurant when he was slurping an egg-drop soup. I attributed it to a virus–maybe he had a stomach bug–but when the vomiting persisted after meals, I began to wonder if it had something to do with his “big” tonsils. So when I went back for my son’s next well check-up, I told the pediatrician again about the persistent vomiting. He finally gave me referrals to a couple of ENTs.

DIAGNOSIS

The day I took my son to see the ENT, my husband was out of town. At first, we talked about how my son doesn’t sleep through the night, how he snores, how he has a hard time swallowing food. The doctor then took one look at my son’s tonsils and immediately started telling me about what to expect during surgery and the odds of the risks associated with the procedure. I was a little bit shell-shocked and I actually had to tell him to stop and backtrack. Wait, what? You’re going to do what to my baby boy?

After he patiently explained to me what was happening–Your son has sleep apnea. He can’t breathe at night and his oxygen levels are low. His tonsils are so huge there’s not much room for food to pass through, hence the vomiting after eating–I began to see how badly my little guy needed to get this procedure done.

Sleep apnea is a serious sleep disorder that occurs when a person’s breathing is interrupted during sleep. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times. This means the brain — and the rest of the body — may not get enough oxygen. (Source: WebMD)

DECISIONS

I drove home, the boys in the back chattering happily and oblivious to the turmoil going on inside of me. This little guy is my baby. My youngest. At that moment, I couldn’t picture him on a hospital bed hooked up to various things. I’ve always been the one admitted to hospitals–for the birth of my three children, and for a gallbladder surgery–but I’ve never had any of my kids undergo any type of surgery. The thought was…scary. But at the same time, sleep apnea was even scarier, and if my little guy could get the relief he needed, then it would all be worth it. I talked to my husband and then to the ENT’s assistant until we finally concluded with a surgery date, which was 5 days from that day.

If left untreated, sleep apnea can result in a growing number of health problems, including:

  • High blood pressure
  • Stroke
  • Heart failure, irregular heart beats, and heart attacks
  • Diabetes
  • Depression
  • Worsening of ADHD

In addition, untreated sleep apnea may be responsible for poor performance in everyday activities, such as at work and school, motor vehicle crashes, and academic underachievement in children and adolescents. (Source: WebMD)

SURGERY DAY

Prior to surgery, we were given instructions on how to prepare our little one for the big event.

  • No food after midnight, but water, apple juice, or pedialyte was allowed until 5:15 am, and definitely nothing after that.
  • We were told to check in at the hospital at 6:45 am.
  • Bathe the child before surgery day. Clean clothes that are easy to take off.
  • Bring insurance card and identification card.
  • Surgery time was to start around 8:15 am and estimated to last at least 30 min.
  • Because my son was only 22 months old, we had to stay overnight at the hospital for a 23-hour observation post-surgery.

No one tells you how to combat anxiety. You just have to put on a brave front and soldier on.

After we registered at the desk (this is where you sign things and show them your insurance and identification card), we shuffled ourselves to a little waiting room, where other families wait with their children for their own types of surgery. There was a bald boy, maybe about 5, who was sporting a faded scar around his head, most likely from prior surgeries. There was another little boy, possibly 3 or 4, with multiple surgical scars on his upper lip, playing with the toys scattered around the wait room. A couple with an infant carrier showed up, and later on, when we were ushered to yet another room, they’d sit next to me and I would see the beautiful tiny baby girl in the carrier happily sucking on a pacifier. The mom asked me what we were in for, and I told her. When I reciprocated the same question, I found out that her baby girl has a heart problem and was going in for her third heart surgery. Third! I couldn’t even imagine what it’s like for them, or for the other families that were present that day, almost all of them bearing signs that they’ve done this a few times before already. It’s a sad thought. My heart ached for these children and their parents.

Our ENT finally came to give us a walkthrough of what he’s going to do. I secretly hoped that my husband was paying attention to the doctor’s words because I couldn’t focus. And then it was time. My husband carried the little one and it was him who gave over my baby to the nurse when it was time for him to go in to the operating room (we weren’t allowed in there, of course). I hid behind my husband, partly because I didn’t want our baby boy to notice how we were handing him over to strangers, and start reaching for me. That would break my heart. And then partly because I didn’t want him to see how scared I was.

We were told to go into another waiting room.

WAITING

I was so darn tired. I hadn’t slept the previous nights because my son’s snoring and sleep apnea had gotten so bad he was waking up gasping for breath and crying. I called my mom briefly to tell her what was going on. And then we waited.

Our ENT came not too long after. Said the procedure went well, and that all we had to do now was wait (again) for someone to call us into the recovery room. He left, and then we waited some more.

RECOVERY

Prior to the surgery, the doctor had assured me that I would be there as soon as my son wakes up. I envisioned waiting by the bedside and watching my son stir from his anesthesia-induced sleep.

That is not what happened.

They called us and gave us a slip of paper with my son’s name on it and a number (13). We hurried to the Recovery room, but as soon as we entered the doors, the first thing I heard was screaming. And it was my baby boy’s voice. Screaming. Just screaming. He was at the end of the hall, stall numbered 13, and he was just plain screaming in some nurse’s arms. I took him from the nurse immediately but he wouldn’t stop screaming. I held him and rocked him and told him over and over again that Mommy’s here, but nothing helped. The nurse assigned to him told me that he woke up too soon. That one minute he was soundly asleep, and then the next, he was wide awake and screaming. We couldn’t move him to his overnight room because patients have to stay in Recovery for a certain amount of time. And this nurse was getting frazzled. She was injecting meds into his IV and checking his stats and injecting more meds into his IV and calling someone for help. She asked me if my little guy holds his breath when he cries, and I told her he is my “tantrum-throwing boy”. That seemed to placate her–I think she was worried about his oxygen levels (which were low because he kept holding his breath) and his heart rate  (which was high because he was upset).

Finally, we were given the green light to move to another room. Baby boy did not stop screaming the whole time. When he saw that we were in another room, it only made him even more upset. He cried “Purse! Purse!” and when I picked up my purse, he pointed to the door and said “Go! Go! Home home home home”. They gave him another dose of morphin, I think. I whipped up my Kindle and began scrolling through YouTube video clips of the movie Frozen. He finally settled down in my arms and watched the vids with me until he fell asleep. I didn’t dare move or go to the bathroom. He stayed in my arms and we rocked and rocked in that uncomfortable rocking chair.

sleepy

GOING HOME

Before we were discharged, the attending nurse gave us instructions on what to expect:

  • Watch out for fevers over 102 F. Post-op, it’s expected for the child to have a high internal temperature, maybe even a low-grade fever (99 F-100 F), and that’s ok. But anything above 102 F signals an infection. (They gave us a prescription for antibiotics, which my little guy had to take twice a day for 10 days).
  • Expect the child to be pale. If he throws up and there are specks of dark, old blood in his vomit, that’s normal (it’s the blood from the surgical procedure). If the blood is bright red, however, go to the ER ASAP. That signals bleeding.
  • Child may not want to eat, and that’s ok. As long as we keep him HYDRATED.
  • The scabs from the procedure usually come off around the 7th day. Some bleeding may result from the scabs falling off, in which case, we’d have to call the doctor and meet him at the hospital so he can fix the bleeding problem before there is a significant blood volume loss.
  • When the scabs come off, it’s supposed to be really painful. Child may be fussy again. Keep him hydrated and stay on top of the pain. Pain meds around the clock.
  • Expect the child to lose weight.
  • Soft foods only. Usually the cold kind during recovery.
  • Recovery time ranges from 10-14 days for a kid his age. The first seven days are the hardest, but after that, he should start to feel better.
  • Avoid crowds for at least 2 weeks because his immunity will be low.
  • He can’t blow his nose for the first three days to avoid dislodging the clot that’s in place where his adenoids used to be.

 

What they didn’t tell us:

  • You won’t get any sleep. At all.
  • The pain medication they prescribed my little guy, Hydrocodone, will sting his throat when he takes it. He will resist any and every attempt to administer his medicine. You will have to hold him down and force it in his mouth…every six hours.
  • They gave us medicated suckers/lollipops that’s supposed to numb the little guy’s throat after he sucks on it for 30 seconds. If he sucks on it. IF. Because once the novelty wears off, even when he’s in a lot of pain and you know that IF he’ll only just suck on the medicated lollies, even for just ONE second…IF you could just get that thing in his mouth so he’ll get pain relief before his next dosage kicks in, he will NOT, and I mean NOT NOT NOT let you get that thing in his mouth. He’ll clench his teeth and scream at the same time (how is that even possible? I don’t really know), and no matter how many times you try to explain to him that it’ll make the owie go bye-bye, he’s not even 2 and therefore doesn’t care, doesn’t understand, but just wants you to magically take away his pain without him taking any meds for it, or sucking on a lolly.
  • You will be up at odd hours in the night rocking that baby in your arms, never mind that your back feels like it’s about to snap in half, you’re not allowed to sit down because the screaming will just start all over again.
  • That you’ll sleep anywhere, if you do manage to sleep while the little guy sleeps. Hello, lumpy couch!
  • That baby boy will snore loudly. Rattling sounds from his throat. And you’ll stay awake watching him sleep and snore like a lumberjack with a power saw because you’re convinced the rattling sound in his throat is him gurgling blood because he’s bleeding and you just can’t see it. (He wasn’t bleeding).
  • That you’ll suddenly wake up and swipe your fingers on his lips just to make sure there’s not any blood there.  (Yeah, I was very paranoid about the bleeding).
  • His breath will stink. Badly.
  • He will drool a lot. And when he wakes up in the morning, his drool is sticky and somewhat yellowish.
  • I read somewhere that the scabs look like some kind of whitish film on his throat, or where his tonsils used to be. I really don’t know. I couldn’t get that kid to open his mouth wide for me. He even bit me once when I tried to pry his mouth open to get him to suck on that medicated lollipop. Ouch!
  • But you’ll see him with his mouth hanging open a lot, full of drool. You just can’t look inside his mouth, no sirree.
  • Recovery time varies for each child. They told me to expect the scabs to fall off around the 7th day post-op, but he really started screaming in pain again around the 5th day. This went on for 3 days and nights. I suspect that the scabs didn’t fall off all at once, but gradually, or in pieces maybe.
  • That sometimes, no matter what you do, no matter how you try, you just CAN’T get that kid to eat or drink anything. BUT YOU HAVE TO KEEP TRYING. It happened around the 6th day post-op. My little guy’s face was so pale and gaunt, his coloring off, his lips a hint of purple, but he wouldn’t eat or drink anything. I was ready to rush him to the ER because I knew he was getting dehydrated. It was so bad that I felt close to tears, and I had to utter the same prayer over and over again: Please, let him eat or drink anything. Anything at all. Finally, I decided to distract him by giving him a bath. Then after he was cleaned and happier from having played in the water, I made him a slushie out of  Lemon-lime Gatorade, raspberry sorbet (he can’t have dairy because he’s allergic to it, so no ice cream), and ice. We made a big deal out of it, clapping our hands when the ice got crushed in the blender, making a big production of pouring that slushie concoction into a cool plastic cup that had a lid and a straw. He was so distracted he forgot about the pain, and I was able to get him to finish the whole dang thing.

Needless to say, we didn’t have to go to the ER, thank God.

  • That you will need DISTRACTIONS. Any kind of distraction, if you are to survive this. Let him help you bake muffins? Yes. Let him destroy the muffins you just baked? Why the heck not. Paint a coloring book at 4 am? Of course. Watch the movie Frozen bajillion times on your Kindle at various times of the night? Thank you, Disney. Go for a car ride at 1 am? Let’s go! Take him for a walk in the stroller at 7 am in your pajamas? Sure thing. Pajamas and ratty hair are the rage in mommy fashion nowadays, anyway.

photo 2 (6)   photo 1 (7)

  • And lastly, that this is not forever. There’s an end to it. One day he will wake up without screaming (possibly around the 8th or 9th day post-op). That doesn’t mean that he won’t have episodes. He will. But you’ll see your little person slowly come back to his lovable, happy self. Those first smiles, those first giggles, will make your heart swell.

 

I hope that our experience will shed a little bit of light on what it’s like to have your toddler go through a T&A procedure. Recovery wasn’t easy, but we made it through. The risks of sleep apnea far outweighed the risks associated with this surgery, so I knew that we made the right decision for our little guy. It’s been 2 weeks since the surgery, and while we’re not quite getting to the “sleep soundly and through the night” deal of this whole operation (he’s still a bit needy and insecure), he’s no longer snoring and gasping for breath in the night, and he doesn’t have trouble swallowing his food anymore. He’s a happier kid, and I hold him close to me whenever I can because in the grand scheme of things, he’s one of the luckier ones. While we were staying overnight at the hospital, we heard the Code Blue warning go off at least 5 times in the night. Code Blue meant someone was dying. And in a children’s hospital, that meant that someone was a child.

The other day, my little guy held my face in his hands, his tiny fingers splayed over my cheeks. He smiled at me, said my name, and gave me many, many kisses. I think that was his way of saying: Thank you.

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