Monday, January 17, 2011

Tonsils Out, Lessons Learned

My poor daughter has been through 3 surgeries in her young life. Not major ones, thank goodness, so I suppose I should be grateful. But no mother likes seeing her child gassed to sleep. Unless perhaps the child was obnoxious. And then there would be momentary relief before the panic set in.

I digress.

So far she has has 1 surgery to put in ear tubes, another to remove her adenoids and put in a second set of tubes and the final (fingers crossed) one to remove her tonsils. The first two were super easy. There was the anger and disorientation coming out from the anesthesia. But both times she sprang back into action and was in school the next day.

But the tonsils?

Oy vey.

Let me just say it is not fun guiding a 3.5YO through the tonsillectomy procedure and recovery. They tend to be an angry and irrational lot. And that's before you do something painful to them.

::: thank you, thank you -- here all week, tip your waitress! :::

So let me share what I have learned from our experience.

1. Allow you (as the parent) about 2-4 weeks for a freak out period.

Because the thought of your baby having organs cut out of her, leaving her in agonizing pain, plus being so little that they insist you stay at the hospital for a night because (as they say ominously) "things can change so quickly with little ones" -- well, you'll just be freaking out. A lot. Unless you are a better person than me and I refuse to believe such a person exists. It's my blog after all. You will research the bleeding out possibilities and while hyperventilating, you will slowly come to realize this is a very common surgery and most people do fine. Then, after you have gone to the brink of insanity and back again, you will be prepared for the next steps.

2. Prepare your toddler.

One of the best things someone advised me to do was to read her some books on it. There is one called "Good-bye, Tonsils" which was perfect. Now there were parts of the book that I didn't agree with -- it tended to gloss over the pain factor afterwards, the general crying and disorientation upon waking up from the surgery, and 4 days of recovery seems like an out and out miracle -- but on the whole, I thought it was good at prepping Peanut for stuff like the IV, what her tonsils were, etc. The book is lengthy for Peanut's tender years so I condensed some parts while reading it. I had two other books -- a Little Critter and a Franklin one -- about going to the hospital too and those helped as well. While I prepared her for the worst ("it's going to hurt a lot"), I also emphasized the good ("you can eat whatever you want! all the popsicles you want! watch tons of TV!"). The night before we had to go in, Peanut also got some new PJs to wear at the hospital (I got the kind that button up the front so it was easier to maneuver with her IV and a pillow pet. It all got her pretty excited about it.

3. Prepare yourself.

First, with information. Find out from your doctor whether your little one will be kept overnight and what the dietary plan will be afterwards. Some doctors don't encourage or want you to stuff your kid with ice cream and prefer more popsicles, whereas others don't care. But the last thing you want to do in step #2 is promise your kid all the ice cream he/she can eat only to discover that your doctor falls into the "no dairy" category. You'll also

Second, prepare yourself for the recovery. This will be a case of prepare for the worst and hope for the best. I have heard of recoveries lasting up to 18 days. I've heard the opposite too, like 3-4 days. Our doctor advised us to keep Peanut out of daycare for about a week. She ended up being out one more day than that. First, consider food and drink. Pick up popsicles (the might minis are a great choice because they are small -- give a great sense of accomplishment), jello and other cold things you think might tempt your child to drink. This is not a time to be a soda stickler! This is a time to avoid dehydration! If your kid will only drink sprite and only eat krispy kreme donuts, a few days will not kill him or her. Be the diet nazi later. A nurse recommended doing homemade popsicles and slushies from pedialyte which I thought was brilliant. Peanut would drink soda (because she rarely got it), iced chamomile tea and "coffee drink" (iced soymilk with a shot of vanilla syrup and a bit of decaf coffee). She eventually moved back to her staples but you do what you can. Think of what tempts your kid and prepare. And think of some other things that might be good on a sore throat -- jello jigglers, plain white bread (the soft kind, no crusts), cooled soup, etc.. The only thing to note that I wish I'd known is to avoid citrus or other acidic foods which can sting (no, she didn't experience that but I did end up with a bit of sorbet we didn't eat).

Second, think about activities and things to do. We stocked up on books and movies from the library, new crayons and a new coloring book and a special new book that she didn't get to read until we were at the hospital in her room (which she picked out herself at the book store). She already had a magna doodle and glow board. Think about stickers, puzzles, small craft things -- whatever can get your kid focused on something else.

4. Once home, stay ahead of the pain.

We got tylenol only. Some kids get narcotics (beware: sometimes these can make kids nauseous and throwing up post tonsillectomy = no bueno). Realize that for the first 2-3 days after the operation, they are still riding on the lidocaine and stuff injected into the site during the operation itself. That wears off and it was a whole new world of pain when that did. I found that even dosing her every 4 hours with the recommended amount wasn't enough. I called the nurse line and discovered that I could give her more in one dose (given her weight, 6.5ml versus only 5ml) but had to scale back to only 5 doses a day. Once I learned that, we were good. We woke her up during the night to dose her as well (very good idea, although she might disagree). It's really painful the first few nights (we stopped dosing her at night so frequently starting the 4th night after the surgery) so I always came up with an enticing beverage like coffee drink, juice or whatever that was ice cold. If you can get yours to take a popsicle then, more power to you. I was lucky to get mine to take a few sips before wanting to go back to bed and whimper in pain. Naturally the more popsicles or ice pops I could get her to eat, that helped numb the pain too. So did the ice pack we absconded with from the hospital.

5. Don't be above bribery.

There are times to retreat to a parental moral highground. This is not one of them. Someone I know would have little gifts wrapped for their little girl but she wouldn't get to have her daily gift until she'd eaten a popsicle and taken her medicine first thing in the morning (when her throat hurt the most). For Peanut, we discovered chocolate. She would eat popsicles only if there was the promise of a little piece of chocolate at the end. Same with medicine. Worked like a charm.

6. Do whatever works.

We ended up having Peanut sleep in our bed. Finally I kicked my husband out to the guest room with the baby monitor (someone should at least be able to get a decent night's sleep) and I took over Peanut care until she was well enough to return to her room (the night before returning to preschool). She wanted mommy. This was no time to engage in that battle again. I could always get her to take her medicine by alternately cajoling her sweetly and consolingly and bullying her with some no-nonsense 'tude. If your child prefers one parent to the other during the recovery, put your own parental esteem issues aside, because it's not about you. It's about what will make your child feel better and if it's your spouse, go enjoy a nice hot drink or surf the web like your partner can't.

Peanut was back in school in 8 days and I would say it took close to 2 weeks for her to finally be seeming like normal. The good thing is that she seems to be feeling a lot better and her eating is slowly improving from what it used to be.

The really good thing is I don't have to go through this with her again.

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