Tuesday, March 25, 2014

Katie's Surgery Day

Our sweet Lady K had her hip surgery today.  We originally planned for a combined femoral and pelvic osteotomy.  We were also supposed to have her eye doctor come in and clean out her tear ducts and possibly stent them.  Why?  Because this is what we had going on for about two weeks. . . 

It started as a sinus infection.

Then moved on to conjunctivitis.  And a sinus infection.

Then that little face had nowhere for all of her infection to go, and her tear ducts don't drain properly.  Because of that, she had bacteria back up in her tear ducts.  

Five days after her first round of antibiotics, we were back to looking like a prize fighter.

We knocked that infection out again, and had big plans to fix the tear ducts today.

Womp, womp, womp.  No go on the eyes.  Our hip surgeon didn't feel comfortable with the tear ducts being flushed, as it could introduce bacteria into the bloodstream.  That would be no bueno, since the hip doctor was also adding foreign material, in the form of a plate and some huge screws, into her body.  And, you know, cutting her bone.  There's obviously a risk of infection with those little details, so we nixed the eye procedure for today.  And we were totally OK with that.  I'd rather deal with some drippy eyes than a bone infection any day of the week.

She went back to surgery like a champ, happily playing on one of the doctor's phones.  She waved goodbye and gave us kisses.  She did so well, it made it so much easier to hand her over.  Her ortho portion of the surgery lasted from 7:20 this morning until about 1:30 this afternoon.  I thought it would feel like it lasted forever, but it really wasn't a bad wait.  The nurse was great about updating us just about every hour.

When the doctor got into the operating room and Katie was sedated, he did a range of motion test and took lots of pictures and videos.  He'll compare that to the pictures and videos he'll take when she goes back to the OR for her cast removal.  On her left side, she had about 180 degrees of range of motion.  A typical person has 90 degress - 45 to the left and 45 to the right.  Her doctor was able to turn her left leg so that her foot was pointing at her head and her knee was pointing at where her foot should be, without dislocating her leg.  While that sounds impressive, it's not great.  It can cause big problems down the road, as she gets bigger and weighs more.  The bone makeup and ligament laxity on the right side is the same, so he's not really sure why she doesn't dislocate on that side, but he thinks it just has to do with the positions she likes to sit in, sleep in, etc.  He was able to adjust the position of the head of her femur and to place it in a better spot in the hip capsule so he's confident that it will be much more difficult to dislocate.  He obviously cannot promise us that it won't happen or that she won't have to have the surgery again.  He did not adjust the pelvis at all today.  He said that, if we have to do a pelvic osteotomy, we can wait until she's about 10 or 11 and has grown some more.  Because she's so little, to do the pelvic portion now he would have to cut a lot more than when she's bigger and her growth plate is open more.  I hate the thought of having to do this again, but we trust our doctor and are comfortable with that if he thinks that's what's best for her.

She's in a spica cast from her mid chest (literally right at her nipples) to her ankle on the left leg.  It's a reclined cast, meaning she cannot sit up at all.  Her leg is in a bent position and out to the side at about a 25 degree angle.  This will certainly make things like riding in the car, going to the bathroom. . . um, ok really everything, interesting.  Her doctor is hopeful that we can stretch this cast out for eight weeks, then go into the OR to check healing and move directly into a brace.  Originally he thought we'd do 12 weeks in the cast with a change at 6 weeks, so we're cautiously optimistic that 8 weeks will be enough.  That puppy is going to smell in 8 weeks.  It's a gortex lined cast, and it's got a big opening for potty business.  We will very likely have to do a diaper stuffed inside the cast and something over it to hold it all in, because she obviously can't get herself to the potty independently, and the last thing we want is a bunch of urine in the cast.  

After her orthopedic doctor finished, her ENT doctor checked out her ears and did an endoscopy to check for obstructions that could still be causing sleep apnea.  She's had two sleep studies.  The first was in August of 2012, and it was horrendous.  She had her tonsils and adenoids out in November 2012 and we hoped that would help.  It didn't really.  She had another sleep study about three months later, and the results were marginally improved, but still not great.  Today her ENT discovered that she has inflammation of her nasal passage, which causes swelling and narrows the area for air to flow through.  She's also got a "floppy palate" and a very wide tongue base.  As she sleeps and relaxes, her tongue slips back in her throat, obstructing her airway more.  At this point, he feels like a surgical repair is necessary.  She will have another sleep study so we can collect that data, but he's pretty certain that this is the best route.  It's not pretty.  He'd like to do a turbinate reduction, a uvulopalatoplasty, and a partial glossectomy to remove part of that tongue tissue.  Those can all be done at the same time, and he said recovery is about the same as with tonsillectomy.  We will revisit that surgery in the summer.  Until then, she will be on two daily nasal prescriptions to help with the inflammation and hopefully open that airway up a little bit.  

So for now, she's resting comfortably.  She's off of all oxygen and breathing room air.  She's been knocking on the cast a little when she's awake, and she's been unhappy about it, but not crazy.  I think tomorrow, as she's awake and aware more, has her catheter removed, and things like that will be harder.  This is, again, another time when I'm so, so thankful she's got a mama and a daddy to love her and help her through this.  

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