Wednesday, July 17, 2013

Tubes Part II: The Re-Tubening

In late April or so, the tube in Walter's left ear made a break for it. This is completely normal and expected--ear tubes often fall out after about 9 months in the ear. What stunk about this particular de-tubing was that, as soon as it came out, Walter immediately got a bad ear infection.  Also, the tube in his right ear stayed put and was draining perfectly.  That made the decision of what to do next a little trickier, because ideally you have one surgery to replace both tubes, rather than two surgeries to replace the tubes one at a time (or no replacement at all, if the Eustachian tube has straightened out enough to drain on its own.)

We weren't very pleased with the Ear, Nose and Throat experience at our local clinic (the doctor who forgot to show up for Walter's first tube surgery retired, and the doctor who prescribed the never-used-on-kids antibiotic after that surgery that Walter had an allergic reaction to wasn't really an option we were excited about.) So we decided to try the only pediatric ENT in our area, even though it was an hour drive and it's harder to get an appointment with her.  She's totally worth it.  Dr. S. immediately shot up into the pantheon of doctors beloved by Walter, formerly only populated by Walter's pediatrician Dr. L. and Dr. Coconut, Walter's macaw puppet.  When his ears hurt, Walter immediately asks to see Dr. S., and is very relieved and pleased when we tell him he's got an appointment.  He trusts her to make things better.  We do, too.

Dr. S's first recommendation was to wait on replacing the tube in the left ear.  Warmer weather usually means fewer colds, and fewer colds fewer opportunities for ear infections.  The longer we held out, the more likely it was that we could do both tubes at once if needed (or decide we didn't need them anymore, at all.) When he saw her, Walt's ear infection had gotten better, so we were hopeful.  And Walt was healthy ...

... for less than a week.  Then another ear infection hit--again, just the left, non-draining ear.  Dr. L.the pediatrician was not amused.  "You've got to go back to Dr. S. and get the tube back in," he said.  Dr. L. usually leaves more room for discussion than that, so I knew he really meant it.  He put Walter on what ended up being a 20 day course of Augmentin (we'd just finished a 10 day course less than a week before that, too.) Augmentin is the least tasty, most awful-smelling, most effective oral antibiotic we've used with Walter. We eventually developed a really good medicine giving and taking routine: Dada gives Walter a hug (holds his arms down) while Mama gives Walter the medicine in a syringe.  Then, Walter gets a glass of milk and a small cookie. With medicine twice a day every day for 30 days, we went through a lot of milk and cookies, and Walter got very, very good at taking his medicine.

And, with the help and blessing of Dr.'s L. and S., we set a date for surgery to replace the tube in the left ear.  When he finished his Augmentin, Walter was so healthy we wondered again if we were doing the right thing.  Then we realized he'd only been healthy for two weeks, and that our perspective on what constitutes a "healthy stretch" has gotten a little skewed. Dr. L. and Dr. S. agreed: it was time.

On Monday I got the call that Walt's surgery had been scheduled.  As we expected, it was today (Wednesday the 17th of June.) Unexpected, though, was the time ... check in at 10 am, surgery at 11. No food after midnight on Tuesday.  One cup of clear liquid allowed before 8 am on Wednesday, but nothing by mouth at all (not even water) after that.

*Kaboom* went my head as it exploded in a pure mama bear rage.

I didn't express any of this rage to the nice surgery scheduling person on the phone, thankfully.  I kept it together. I did say, pleasantly, "Wow, that's really late.  I thought young children were supposed to be scheduled first thing in the morning?" She reminded me that Dr. S. is a pediatric ENT, and Walt was scheduled as early as he possibly could be ... there were just even younger kids getting surgery ahead of him that morning. I asked about switching the surgery to another, less-busy day, but Dr. S.'s receptionist assured me that 10 am was a good time for a 20 month old in their practice, and that changing the date could result in an even later check in time.  I took a deep breath and took the appointment time as it was, and started making plans for how to get through the morning with a hungry, thirsty Walter.

Walter, as usual, had his own plans.  After a big dinner of his favorite foods (pepperoni pizza from Polito's and ice cream from Dairy Queen) Walt went to bed at about the normal time, woke up crying at 11:45 and drank some water, and then slept until we absolutely had to wake him up to get him in the car and drive to Marshfield. He was actually awake when we went into his bedroom; just chilling out calmly and quietly in his big boy bed.  He's been doing that every morning this week.  It's fantastic.  It was especially fantastic because Sean and I couldn't think of anything we could do to keep him occupied without eating if he'd woken up at his former usual wake up time: 6 am. Take a bath? No, he'd drink the bath water.  Go to the park? No, it's a ridiculously hot day, and he'd get dehydrated and need water. Go grocery shopping? No, he'd get hungry and want cheese from the deli. Play quietly inside at home?  That would work for maybe an hour.  We also thought a stroller ride around the block with Hank might be OK.  Watching TV was our emergency back up plan. But we didn't have to enact any of those plans, because at 8:45 Walt was up and dressed and cheerful and we were out the door and on our way to Marshfield.

On the long drive there, Walter played with one of his "hellos" (in this case, a leap frog music player that was a gift from Aunt Andrea, Uncle Jimmy and Cousin Casey.)  He sang along with the toy and on his own; lots of ABC's, some good counting, some Old MacDonald.  We looked for and spotted many cows, horses, trains and trucks.   I noted that the cows were brown, white and black, and Walter said, "Blue cow?" and then laughed to let us know it was a joke.  We joked about all kinds of unlikely cow colors for awhile. At one point, he asked for water, please. I took a deep breath and explained that none of us could have any water until after we saw Dr. Stone and she fixed his ears. No water or food for Mama, Dada or Walter until after the surgery.  He accepted it immediately and didn't ask about food or water again (until after the surgery.) Walter is amazing.

Walter's Mama, though, can be a little crazy when she's worried about her boy. In the waiting room I got upset because people were eating and drinking in front of Walter (he didn't notice, or noticed and didn't care.)  I nearly bit the hand off a 5 year old boy who tried to steal Walter's Elmo doll out of our diaper bag.  We were in the waiting room for 30 minutes before we could go back for pre-op, and I was sure that meant everything was going to be late and delayed all morning long.  It wasn't.  It just meant Walter got to play and run around for 30 minutes instead of going crazy in a pre-op bay for 30 minutes. The surgery was right on time.

When I heard we were still expecting surgery at 11, I started to calm down a bit, but was still wound pretty tight.  I asked the intake nurse if we could "slip him some C-R-A-C-K" during phase 2 of recovery.  Sean pointed out that we probably shouldn't ever give Walter any C-R-A-C-K. Exasperated, I said, "C-R-A-C-K-E-R-S! I stopped spelling because she knew where I was going with it!"  Then I looked a the nurse and realized she probably hadn't known, and probably was genuinely wondering if I was on C-R-A-C-K and planning to slip some to my toddler in the recovery room.

Right after that, the intake nurse remarked on how good Walter was being.  "He's doing great," I agreed.  "He's doing much better than I am."  Saying it out loud made it real, and immediately I relaxed and regained perspective.

Pre-op is pretty much a parade of people asking the same questions and explaining the same things over and over, which sounds annoying but is really comforting and reassuring before a surgery. We talked to the anesthesiologist and the nurse anesthetist. Dr. S. came in and Walter was thrilled.  A really nice nurse, Nurse K., came in and bonded beautifully with Walter. He talked to her right away, which is pretty unusual for him.  She brought him a bunch of stickers, which he put on himself, on me, on Sean and on Nurse K.  Nurse K.'s patter with Walter during the sticker-giving was based largely on gender stereotypes and almost set my teeth right back on edge. I started writing a protest song in my head titled "Even Though the Baby in my Womb is a Girl, Her Brother Can Give Her A Car Sticker Rather Than a Barbie Sticker (The Shoop Shoop: Stop Your Gender Norming Song.)"  Then I realized that Nurse K. was awesome and in a short time had built actual trust with my son, who was going to need to leave us in the pre-op bay and go by himself to surgery soon.

The plan had been for yet another nurse, Nurse H., to take Walter to the OR, but when the time came to go Walter asked Nurse K. for uppaday and wouldn't let go, so she got a mask on and took him in.  They often give a sedative to kids Walter's age about 15 minutes before surgery so they don't struggle when leaving their parents or while being put on the operating table, but Walter didn't need it.  Dr. S. said he was scared for two breaths and then the general anesthetic kicked in.

Less sedation meant a shorter recovery time, and before I could update my Facebook status the surgery was over and Walter was ready to see us.  Dr. S. reported that the right ear still looked great and healthy, so other than taking out some wax she left it and the tube alone.  The left ear drum was thick (a bad thing,) but with no infection and just a little mucus trapped behind it.  The thick eardrum scared me a bit, but Dr. S. said she found it reassuring: "If the ear had been perfectly healthy, I would have wondered why we were doing the surgery.  It's clear he still needs the tubes."

In recovery Walter was thirsty, hungry, "owie" and a little crabby.  Mostly he wanted us to put him down and let him walk out of the clinic. The post-op nurses discouraged us from letting him do this. But they didn't keep us too long, and on the way out Walter got to ride in a big red wagon and pick out a beanie baby to take home (he chose a very nice little yellow duck, which he told us later belongs to his Ernie doll.) We went straight to Perkins, where Walter drank some chocolate milk and didn't eat very much muffin or pancake, but did enjoy some bacon (way to jump back onto the solids train, Walter!)  By sheer force of will he stayed awake the whole ride home, and once in his bed settled in for a very nice three hour nap. He woke up bright-eyed and a little silly. We went grocery shopping and then home again for chicken taco dinner.  He had good phone and video calls with family, played wonderfully with his Sesame Street puppets and Dr. Coconut, and went to bed with some (short-lived) reluctance and a dose of Advil that we hope will see him through the night.

The first time he got tubes, Walter had a raging double ear infection that continued for months after the surgery.  We were just starting to see the benefits of the tubes when the left one came out.  I'm hopeful that, because his ear was relatively healthy already for this surgery, Walter won't have any ear infections this time. When I go back and read old posts and realize how much of his first year he spent sick, I get pretty sad.  He had a great first year in spite of it, but life is so much better when he's healthy.  So, here's praying and hoping for 9 months (at least) of a healthy-eared Walter Paul!

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