Wednesday, March 2, 2011

Ortho Pre-Op Info

The pre-op appointment with the ortho surgeon went fine.  She answered all my questions.  Here's the deal:

Surgery:  Spinal fusion and removal of vertebra in lumbar spine plus ear tube placement and bronchoscopy

Date:  March 28th

Length of stay: 4 to 6 days - give or take

Cast:  Pantaloon, from just below armpits to mid-thigh, on left leg only.  The right leg will be cast-free.  A hole will be drilled on the left side for her g-tube (which is good, because that is the side with the most cast).  The left leg will be bent slightly at the hip.  So, she won't be completely horizontal, which is great.    But, I have no idea if that slight bend will be enough to get her into a reclining car seat.  So, we'll just have to see what they say then.

She might come out of the OR with NO cast.  It will depend on how her body does during the surgery - meaning how her heart and body do under anesthesia and how long she's under.  If they have to give her a lot of fluid, then they will have to wait a few days to let her settle down before casting her.  If she comes out without the cast, they will have to keep her pretty heavily sedated to keep her from moving around.  I really hope this isn't the case.   In July, after her 4th heart surgery, even though she was completely "loaded" with every narcotic, pain medication and sedative around - she STILL sat up in bed just hours after surgery.

Brace: might be an option after the first month.  She said she will have a more specific plan after the surgery when she knows how much work she did and how she thinks it went.  The problems with a brace are 1) she is very active and 2) a brace doesn't fit as well as a cast, which can lead to problems during recovery.  She said she would rather not do a brace for those reasons, but if Harlie isn't tolerating the cast, then perhaps after the first month, a brace might work.  We'll see.

Activity:  The surgeon said that she can weight bear - which totally shocked me.  Personally, I don't see how in the world she could manage the extra weight of the cast - especially since it will be considerably more heavy on her left side.  She would certainly have to be very supported - but perhaps we could do that with her old walker.  I would imagine she would have to hop a little on her right leg - which she can't do now, much less with the cast.  I guess it will come down to Harlie's desire and determination.  I'm pretty anxious to see what she'll do.  But the thought of her falling while in the cast makes me cringe.  So, I'm not sure what I'm going to be comfortable with her doing.  Again, we'll just have to see.

Follow-up Appointments:  None, unless we are having issues/problems.

Incision:  I'm certainly a little nervous about there being an incision under a cast that we can't see for 4-6 weeks.  And she also said that she will have to have a bone graft of some sort when she puts everything together after removing the abnormal vertebra.  In my head I screamed, "BONE GRAFT?!?!?"  ACKKKK!!!! (You might remember the last bone graft experience we had.)   But, in reality I, very calmly, but with a look of concern said, "Bone graft?" Then she said, "If it gets infected, she'll get a fever and we'll know."  Ha!  If only Harlie was that normal.

Future Growth:  Unfortunately, she said she can't do anything to save the growth plates in the area she's fusing.  Once they are fused together, they won't grow.  That is the very unfortunate part about doing this surgery at such a young age.  She still has a lot of growing to do!  So, she will be short waisted - her lumbar spine will be down a vertebra and then two will be screwed together.  So, that's a bummer.  But, something I expected, nonetheless.  Waiting longer will just make things harder/riskier to fix down the line.

So, overall it was a good appointment.  And it was relatively quick - just under two hours.

I was so bummed I forgot my camera.  I would have loved to show you how darn cute and funny Harlie was when she was getting x-rays.  They took a bunch and Harlie was SO good!  She can now stand all by herself - STILL - while they take them.  She follows instructions as to how to stand and where to put her arms.  And she smiles when doing it - like she's having fun!  I think she thinks the light shining on her is funny.  I don't know.  But, it's really funny to watch.  The only ones that we had to struggle with was when she was laying on the table and her hips had to be straight, but her upper body had to lean to the side.  She didn't like that one at all.  Maybe it was uncomfortable for her.

Oh!  During vital check the nurse put a pulse ox probe on her finger.  It read her oxygen saturation percentage at 86% (which is great for her - that number is between 95-100 for a normal person) and her heart rate in the 80s I think.  Well, he looked up at the monitor and said, "It'll level out here in a minute." And so we waited.  It finally dawned on me that he was thinking/hoping that her sats would get higher.  So, I said to Brandy, "Wow, 86, that's great".  And he said, "oh, that would be very bad".  hehe  So, I had to tell him that number was not going to increase any time soon.  We'd all die of starvation waiting for that to happen.  Ahhh, I don't know why that makes me laugh.  I must have a sick sense of humor.

It reminded me of when Harlie was just a few months old.  Back then we were establishing Harlie's doctor list, so the nurses didn't know her yet.  And they would always try to look so calm when asking me, "So, what are her sats normally?"  And then I would tell them, "In the 70s and 80s".  And they would say, "Oh, Thank God!  She had me scared!"  It cracked me up every time.  Weird.  I know.

So, that's it.  Okay, more later!

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