Tuesday, March 18, 2014

The Mommy Side of "Routine" Surgery

My son got ear tubes today--bilateral myringotomy with tympanostomy tubes in medical jargon.

I watched dozens of these surgeries when I was a third year medical student rotating through Pediatric ENT, which was actually a surgical subspecialty I enjoyed.  I'm really not a surgeon type, in case you couldn't tell. Wearing hot scrub gowns and masks while holding retractors all day is not my image of paradise.  But ear tubes and tonsillectomies were pretty cool.  First off, you didn't have to gown up so no sweating and having to avoid scratching your face the entire day.  Second, the kids were pretty healthy and super cute before you put them to sleep.  And, last, the procedures lasted 30-45 minutes tops (and this was rare).  Ear tubes were the most minimal of the surgeries.  They take about 15 minutes.  They are very quick and purely routine.  In other words, not a big deal.

Until you're the mom.

From my understanding and experience, ear tubes were usually placed after struggling with many, many ear infections.  Liam had had one that we knew of.  But he had fluid in his ears that may have been there since the fall and he had since started developing a speech delay that was becoming concerning by his 15 month check up.  His pediatrician sent us to an ENT who recommended ear tubes.  To explain why, the ENT told us to stick both fingers into our ears.  That is how my baby was hearing.  His tympanogram backed this up, showing that the ear drum on one side was not moving at all and barely so on the other.  But the ENT also reassured me that I had time to think and decide.  A few weeks would not change anything.

I agonized over the decision of whether or not to have my son undergo this surgery.  No surgery is without risk.  The dangers of anesthesia (though it's really more like sedation in this case and is about as low risk as it gets) are not a joke.  I know about those rare cases where a patient can start breaking down their own muscle in reaction to the anesthesia, get acidotic, overheat, and die.  Of course that's the extreme but some studies are blaming general anesthesia for lost IQ points, increased ADHD and other behavior problems.  And there's the more common and well-known risks of breathing disturbances, aspiration, nausea, vomiting, and headaches.  Then there's the possible complications of the surgery itself: needing more ear tubes, scarring of the ear drum, a permanent hole in the ear drum, hearing loss... the possibilities go on and on.   I knew too much and couldn't help worrying about it.

Different doctors advised us to do different things.  The fluid could clear.  It was almost spring; fluid clears in the spring.  Or he could get retractions and scarring.  But that's rare and the surgery could cause it too...  It was confusing to say the least, but the overwhelming message seemed to be "get the tubes...they will help him hear and feel better.  You won't regret it."

I did some research and found a great article from the AAP that I thought I would share with others who are in the processing phase after being told by a physician that their child needs ear tubes.  Here's the link: AAP Practice Guidelines: Otitis Media with Effusion The article restated what I already knew: that tubes are overused and that the surgery is not without risk.  But there are instances when it is the best choice.  It shared some criteria that have been identified in children to predict better outcomes when tubes are placed.  Liam fit the criteria because he has a speech delay.

 During the period of time (a few weeks) that we were thinking about whether to go ahead with the surgery or not, we started noticing more and more that he didn't seem to hear very well.  My mom tried the blink test by snapping near his ears--no response.  One of my friends tried to get his attention by clapping loudly--not even a flinch.  His speech delay seemed to worsen instead of improve.  He stopped saying "Bubbo" (for our cat Bubbles) and even went through a period where he stopped saying "Mama."

So, we decided. We needed to give him the best chance for building his vocabulary as soon as possible.  I went to his ENT the next day and scheduled the surgery feeling that we were making the right decision.

From my rotation through Peds ENT, the thing I remember the most is actually the part that I dreaded the most.  The part where the kids are wheeled away from their parents, sometimes screaming at the top of their lungs.  Back then, my son was about 5 months old.  With my new-found maternal love, I felt the heartbreak of the parents each time, and I teared up frequently. (The hormones were still flowing strongly...but perhaps they never stop for us moms because I never was a crier but I still am today).  I was thinking how terrible it would be if that were me...

Fast forward a year to today and it was me.

 Liam is a typical toddler and did not wait quietly in the pre-op room.  We roamed the hallway with him.  He was hardly anxious. But I teared up as I saw other kids being wheeled away. I was surprisingly dry eyed when it was our turn.  We had refused the Versed they wanted to use to ease the separation anxiety because I felt it unnecessary to add to the many medications he was already going to receive (much to the disappointment of the anesthesiologist who I could not assure that he would go back to the OR without shedding tears).  But I tucked him in on the gurney with his security blanket and paci.  The nurse pretended the bed was a choo choo train and I advised them not to force him to lay down so they let him ride sitting up.  I clapped for him as they wheeled him off and thankfully he didn't shed a single tear while I could still see and hear him.

Those 15-20 minutes we waited felt like an eternity.  I was just beginning to worry when they called our names.  My husband says I ran to my baby.  He couldn't even keep up (that's saying a lot if you know my runner).

Liam was a champ.  He was the happiest of all the babies that were in recovery (the nurse told us that the distraught baby next to us had received Versed and in his opinion with short procedures like this, it irritates them much more upon awakening due to leaving them with a drunken feeling that they can't shake as the anesthesia wears off).  My baby was pretty happy as he snoozed once I was holding him and he had his paci firmly back in place.  Then, in about 15 minutes, the anesthesia mostly wore off and he woke up. We dressed him and we were off.  He even downed a Mango squeezy snack and some crackers in the car on the way home.

Now, 12 hours later, I feel even more confident in our decision (thank goodness!).  Besides sorely needing a nap when we got home and being a little dizzy and somewhat grumpy intermittently, he has acted pretty happy today.  (Though he despises those ear drops we have to give twice a day!)  He loves his prize from the OR, a pretend sword and shield.

But the biggest thing that we are overjoyed about: our baby boy can hear so much better!  We can already tell.  He's started making new vocalizations (of course no new words yet since it hasn't even been a day).  But there is change.  Even the way he says "uh-oh" is different. My husband described it sounding as if Liam can finally hear himself and can self correct the sounds.  He's also more sensitive to noises. He jumped and covered his ears when I dropped one of his books onto the carpeted floor in our living room (never has he done this!).  He also announced proudly "Uh-ooohhhh!" when the Keurig hissed out my hot chocolate after lunch.  I'm excited just thinking of all the new sounds he can hear now!  I can't wait to hear his precious voice talking to us soon!

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