Pre-op check list

We’ve been to see the ENT (yes, they are going to replace your ear tubes, the left has fallen out and the right is on it’s way, as expected), the cardiologist (VSD is 2 mm and PFO is apparently covered with a thin layer of tissue, so things are improving in that respect), we’ve arranged for labwork papers from the geneticist, and yesterday we had your official pre-op appointment with the craniofacial surgeon’s office.

We’ve visited this particular office  many times, so we “know” all of the receptionists, med techs, the nurse coordinator, and the PAs.  The office is shared with the orthodontist who fitted and adjusted your nasal-alveolar molding appliance (NAM) weekly, which you had from about 5 weeks until your lip repair surgery at almost 5 months old.  And then we’ve been in for evaluations, pre-ops, and post-ops for your lip repair.  So, we know the routine.  A pre-op appointment basically consists of a general physical for you (weight, height, temperature, blood pressure, blood oxygen, listen to heart, lungs and stomach sounds, look in ears and mouth), and an opportunity for us to ask questions.

Right now your palate surgery is scheduled for 11am on June 8th, though the exact time could change.  The routine is that the hospital calls the day before to give us the official check in time and all of the stages when we have to stop various foods/liquids, but I know all of the rules by heart and the phone call is just a formality.  We arrive 2 hours before your scheduled surgery time, 4 hours before arrival we have to cut off all liquids, 6 hours before arrival we have to cut off formula, 8 hours before arrival we have to cut off all solids.  With a morning appointment, though not a first surgery appointment, the only one that really matters is the cut off time for formula – and yes, we will wake you at 2:30 am and give you your formula so that you aren’t starving when we arrive at the hospital at 9am.  We take care of you that way, and you will likely be too distracted by the change in routine to even notice that you’ve missed your morning drink.  They are anticipating that you will be in the hospital 1 night, though it is not uncommon to need to stay 2.  You’ll be in the IMC after surgery (intermediate care – we know ALL of the lingo now, the nurse starts to explain what the IMC is and your Dad says “oh, we know, we’ve spent several nights there, it used to be our favorite until they almost overdosed her there” – your Dad is nothing if not blunt).  The IMC has the ability to resuscitate children – we know from experience that they’ll have a 8 1/2×11 sheet of paper taped to the wall above your crib listing all of the doses for your weight for an emergency resuscitation.  Unlikely, but due to the swelling of your mouth/throat after palate surgery, it’s a standard precaution.  You’ll have a stitch through your tongue for the first day, which lets them pull your tongue out of the way easily in case you have any breathing problems due to the swelling in your mouth.  You’ll be on IV morphine until about the next morning (we’ve requested dilaudid, since you tend to get itchy from morphine), and you’ll be on the standard T3, antibiotics, and a few doses of steroids to keep the swelling down.  You’ll have to wear arm restraints for 2 weeks, until they have seen you at a post-op appointment, to check the sutures before removing them.  Feedings will be similar to your previous surgeries, and for you basically there are no restrictions since you still only eat purees (anything that can pour is ok)!  So, now we hope that you don’t get this stomach flu that has been ravaging all of the kids/parents at daycare (your brother had it last week, I had it this week), but if so we’ll call them and let them know.

Your pre-op is over.  At this moment, the next “milestone” is your birthday party on Sunday.  So now we get to have fun.  I cannot wait to dress you in your adorable pink and white seersucker dress with the embroidered cupcake with a “1” on the front, which I asked your Grandma to sew for you (Grandma loves to sew, and you are her favorite model), decorate the house with all of the adorable things I’ve been collecting and making over the last few weeks, and have a lovely ice cream party to celebrate your first year.  You are a survivor, and a fighter, little Miss M, and we are going to celebrate!


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