Wednesday, September 29, 2010

2nd Surgery-Frontalis Sling replacement

At 2 years & 2 months old, just about 2 years after his first, Danny had another Frontalis Sling surgery. As mentioned in previous posts, his eyelid had progressively become droopier over these two years so they decided it was time to either shorten or replace the sling. I'll try to be as detailed as possible and take you through our day.

The day surgery, from 12am-4:30am Danny was supposed to drink only clear juice, water, Sprite. Then after 4:30am he was not supposed to eat or drink anything. We woke him up to leave for the hospital at 5am. He was happy, although he did want a sippy with milk. Besides that he did not ask for any food and was pretty good with the whole situation.

Surgery time was 7am, so we had to check-in at "Same-Day Surgery" at 6am. Danny had fun playing with all the toys. When the nurse called us back to get his measurements and check his vitals, Danny got a little nervous. He sat on my lap clutching his backpack while the nurse took his temperature, took his blood pressure, etc. We changed Danny into hospital clothes and the nurse took us to the O.R. waiting room.

Danny again started having fun and playing with the toys. The education nurse brought by a very non-descript doll wearing a hospital gown for him to color and play with. That was really nice because he had something to take with him back to the operating room.

The surgeon, Dr. Patel, came and talked to us and Danny for a minute and marked Danny's eye. He lifted the lid a little and looked at it. He told us that when kids are older they can adjust it better because the kids can tell them what feels right, but when they are littler they kind of have to guess. He was followed by the attending nurse, who just had us sign some paper work, and the anesthesiologist. The anesthesiologist told us the it was pretty safe, safer than driving in a car. He said they would give him gas (he chose cotton candy scent) and get him to sleep before they gave him an IV or anything. That was nice knowing he wouldn't be freaking out about getting a shot without me there. When he was done talking to us, he walked us back towards the OR, with me carrying Danny. He took Danny and his doll, then they waved goodbye and walked out of the hall at 7:30am. We went to the waiting room. Dr. Patel came into the waiting room around 8:30am. He said everything went fine. He drew a diagram of what they did, showing two incisions with dissolving stitches just above his eyebrow, another one on his forehead, between the other two, two on his eyelid, then a longer one across his eyelid. He explained that when they went in there was a lot of fatty tissue that was preventing him from opening his eye as well as he would otherwise be able to. He explained that this was because his muscles don't work the same as ours. So they decided to trim some of that fat, which is why he had the extra incision along his eyelid. Dr. Patel explained that this will make the sling last longer. He said that he has some patients who he has done this to 8 years ago that have not needed the sling replaced yet. In the diagram he also showed us how the sling was positioned across the eyelid, up on each side to the two incisions, then together at the top incision. He explained that when Danny raises his eyebrow muscles it will pull the eyebrow up and the eyebrow would pull open the eyelid. We were instructed to put an antibiotic ointment on the incision 2-3 times a day for a few days just to keep them moist. We are also supposed to put Refresh PM ointment in his eye every time he naps or sleeps until we go to the post-op appointment 8 weeks from now. According to Dr. Patel, his eye will be open about twice as much as it was before when he is sleeping. But he also said that kids adjust to his very easily, and judging from last time, that is true. Dr. Patel also said that Danny would be trying to rub his eye because it would feel weird and numb and that was fine. It wouldn't matter if the tape came off and as long as he didn't bump his head hard enough for the stitches to split open he should be fine. He left us with a warning that it would get worse before it got better.

After talking to the surgeon we waited for the nurses to call us back to recovery. Around 9am they let me (only one parent) into recovery. The nurse was holding a sippy of apple juice for Danny to drink out of. I don't think he actually drank any, though. The nurse said he had been calling for me. He was mad about the IV in his ankle and the oxygen monitor taped to his toe. The first thing he said to me was "Foot," holding it up, "Off." The nurse had wrapped stuff around it but I think that made it bug him more. The nurse told me she had put arm restraints on him because he kept rubbing his eyes. I didn't bother to tell her the doctor said it was probably fine. I held Danny and took off his arm restraints (with the nurses permission). He was very tired and grumpy. He REALLY wanted to rub his eye. I didn't let him very much though because I didn't want it to get infected or anything. His eyelid looked a little bloody and swollen. His tears were a little bloody, too. It was pretty sad. We waited until the nurse got a call from "Post-Op" that they were ready for us, then took us over to a different bed where my husband met us. (I have no pictures from recovery since I was trying to soothe Danny. Sorry!)

In Post-Op the nurse decided to take out the IV so Danny would relax. He kept throwing a fit and his oxygen levels would go down. She did warn us, though, that if Danny did not drink some clear liquids they may have to put it back in. In Post-Op they just want to make sure he is stable, that his oxygen levels stay above 90 for 20 minutes, and he keeps some liquid down. Danny was very grumpy and defiant. He did NOT want to drink his apple juice. And he really still wanted the oxygen monitor off his toe. He was snuggled against me and drifting in and out of sleep while we were in post-op. Every couple minutes he would cry again or rub his eye. I told him not to rub very much so he would kind of just touch it then put his hand back down. Anytime I asked him to drink his juice he would get upset. The nurse brought him a popsicle and a slushy but he wouldn't drink those either. The nurse gave us discharge instructions. The main thing was to make sure he was breathing normally, including checking on him through the night. She also told us signs of infection which were pretty much just goopy discharge. A slight fever is normal after surgery so she said not to worry about that in the first 24 hours. We got a prescription for Tylenol with Codeine. The nurse told us the best pain management would be to alternate Tylenol and Motrin every 3 hours. Danny was also prescribed an antibiotic just to make sure that there was no infection from the surgery. Around 10am the nurse called the anesthesiologist and told him that Danny's IV was out, he would not take liquid, but that she thought he would be fine as soon as he left. Luckily the anesthesiologist thought Danny would be fine too and didn't make us put in another IV. Actually, as soon as the nurse was off the phone Danny decided to drink his whole sippy of apple juice. The nurse came in and told us we could get him dressed and go. After drinking his apple juice he was a lot happier. He even asked for more! He was alert and happy as we walked through the hospital and to the car.

In the car the sun was a little bright. Danny tried closing his eyes and could do it fairly well, but he said, "Bright," to me so I put a blanket in front of the window. He fell asleep about half an hour into the drive. His eye was closed pretty well, but it is still very swollen (see bottom picture). He is now asleep in his bed. I'll try to take a lot of pictures of his recovery and post on that tomorrow.


chanelle said...

I'm glad it went well!

Kayla said...

I'm so glad you made this blog, I'm about to take my almost 3 year old in for his first surgery and your story and pictures have made me feel much better about it. Thank you!

Nicole said...

Thank you for being open and sharing your journey. Our son has partial 3rd nerve palsy in his right eye which also results in ptosis of the eyelid. We are now facing the decision of having an eyelid sling to preserve vision. He just turned 3 and after having 2 surgeries already on the eye itself I am nervous to have another one for the ptosis. Nervous about the overall outcome and how it will look. From your pictures you can barely tell.
I was told that to open the eyelid he would have to raise his eye brow, like a surprised look - is this true? As I feel this would look odd.... always having to raise your eyebrow to open the eye.
Is this something that I should be worried about?
Thank you