Post Op Procedures

With Kennedy, each of her procedures have been done as outpatient since we wanted to bring her home and make her comfortable. I really felt that staying in a hospital would freak her out and do more harm than good. Therefore, following each procedure, there are some requirements before we can leave. Although our experience has varied slightly with each time we are usually in recovery for about an hour - a little longer with the open reduction. The nurses monitor Kennedy's oxygen levels, blood pressure and breathing (listening to her through the stethoscope). She's usually hooked up to the IV until they feel she's hydrated enough and it's usually encouraged for her to eat something light - whether she nurses or has a bottle of apple juice. Also, during this time Dr. Rubin and the anesthesiologist brief me regarding how the procedure went, what to expect and when to call them. Overall, the post op procedures are fairly simple and we're out of there pretty quickly - thank goodness!

Going to Sleep!

Each time that Kennedy has been put under has been roughly the same experience. For her comfort and mine, I have accompanied her (and her ribbon blanket) to the operating room and participated in the process. With each procedure, I sit in a chair holding Kennedy while a gas mask is put tightly over her face. She has yet to enjoy this so I sing and talk to her while she cries into the mask. It usually takes about a minute or less for her to relax and fall asleep. We then transfer her onto the bed and I kiss her on the cheek.

*An important note here is that they will start the IV (& monitors) after you leave the room. First they will try to start an IV in the hands, then in the foot or the head (sometimes the dr prefers the head over the foot since the foot location can interfere w/ the casting). During the recasting and the open reduction we were lucky enough to have the IV in her hand and it was put in her foot during the closed reduction. This last time (for removing the cast) the IV was actually placed in her neck since other locations were proving difficult. However, as freaky as that was it's still preferable (in my opinion) to the head. During each procedure the possibility of having Kennedy's head shaved w/ an IV really freaked me out - she's got such great hair!

As a mother, it has been great to be involved as they're putting Kennedy to sleep. I've always coped with situations by trying to educate myself and attempting to understand what is happening (thank you internet). Therefore I find this involvement theraputic and reassuring. Despite it's emotional toll, I would recommend that you take this opportunity if it is offered.

Post Procedure Swelling

One thing I really wasn't prepared for with the closed or open reductions was the swelling and discoloration that is caused to the diaper area. With both procedures Kennedy experienced swelling to her genitals, especially after the open reduction. With these procedures you can expect for some swelling to occur, usually on the affected side, that can last (in my experience) up to a week. With Kennedy's closed reduction the swelling was mild and only lasted two to three days but the swelling from the open was much more significant, making diapering difficult for the first couple days. But, after four to five days the swelling resided and was almost gone by a week's end.

The first three to four days following the open reduction, Kennedy was so swollen that I was unable to stuff the inside diaper up the front opening. During this time I used panty liners to line the cast opening and, although I don't recommend using them regularly, they were a big help in protecting the cast by providing a barrier between the cast and her skin. Considering the diarrhea that Kennedy had post op, the panty liners were a real blessing the first week. So, although I discourage their use regularly they were helpful in avoiding disasters immediately following surgery.

Waking from Anesthesia

So far Kennedy has had 3 experiences with anesthesia (3 more than I've ever had - poor girl)! I wanted to dedicate a post specifically to anesthesia since each experience has been different - varying from calm and relaxed to frantic and terrifying. Therefore, don't take your child's initial reaction post surgery as what life will be like for the next couple months or you'll be jumping off a ledge. With each procedure, once Kennedy was detatched from monitors and IVs, dressed and being carried out the door she immediately relaxed and was more like her normal self.

A possible side effect that we've experienced is a raspy throat. With Kennedy's first procedure she had a real raspy voice/cry for the first two days. However, this really didn't seem to bother her and, aside from me fearing she had caught a cold, it was forgotten pretty quickly. For the following procedures I mentioned it to our anesthesiologist and we haven't experienced it since.

Closed Reduction Procedure

Kennedy's first hip procedure was done on Nov 24th 2008 as an outpatient procedure and it was a closed reduction and spica cast. We arrived at the Sac Surgery Center at 6 am and after she was prepped for surgery (blood pressure, oxygen levels, weighing, betadine scrub, baby gown and I don't remember what else) we were ready to begin at 7 am. I was able to accompany Kennedy into the operating room and assist with her being put under by comforting her while he pressed the gas mask to her face.While being gassed she was very unhappy and cried, but it only lasted a minute and then she relaxed (still clutching her ribbon blanket). We then laid her on the table and I was brought into the waiting room. I definately advise bringing an assortment of materials (books, magazines, breast pump) to occupy youself as the wait is grueling.

Once Kennedy was out of surgery and waking up, Dr, Rubin came and told us that the reduction had gone well and he was happy w/ the results. He then took me into Kennedy's recovery area where she was pretty upset . Her throat was very raspy while she cried but when I was able to pick her up (it's pretty awkard at first) and hold her she calmed down quickly. We were probably in recovery for about 45 minutes before the nurses started reviewing cast care with me and getting us ready to leave. Once we were ready I was able to put Kennedy's first spica outfit on (start with a really easy one!), give her a snuggly blanket and leave! Kennedy was still pretty heavily sedated so she slept all the way home and was pretty relaxed and comfortable when we got home - she even slept for 2 hours, waking up right in time to leave for our CAT scan.

Kennedy continued to be drowsy through the evening, which I believe made the initial adjustment easier on us all. At bedtime I started with the Tylenol w/ Codeine dosing to make sure she was comfortable and she slept well those first couple nights. After the first couple days I discontinued the Tylenol use and she started having some really bad nights. Therefore, I suggest continuing to use medication during the nights for about a week following any procedure since discomfort is always harder to ignore at nights then with the daytime distractions.

As with just about anything the time leading up to the procedure was worse than the actual experience. I'd had visions of never sleeping again, my cute funny girl becoming an unhappy monster, and of not being able to put her down - ever. Although we have experienced days like this, life in the spica has been so much better than I had imagined. I remember sitting with Kennedy the evening of the closed reduction and being just amazed and relieved that she was actually smiling and playing with her "Get better" balloon. If these past 4 months have taught me anything it's that life really does go on.