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Tuesday, May 31, 2011

Post Operative Pictures, Take Two...



On our previous post, Post Operative Pictures... we showed pictures of Mary's healing from surgery day until five days after. We are now thirteen days post surgery and Mary has now had her external stitches removed this afternoon, and although she did shed a couple tears, we were very proud of her.

I know some will wonder why we would share these pictures. Firstly, to help Mary understand the journey she has been on. One day she will look back and be able to see how strong she was to undergo these procedures to help give her a better opportunity for speech and language development. I was reading online about facial clefts, and there was a figure given that stated 70% of cleft affected individuals have no pictures taken before surgery. I am not sure if that figure encompasses cleft affected children today, or if it in fact refers to a survey taken of now adult age cleft individuals. We strongly feel Mary was beautiful before her surgeries, all anyone had to do was to be around her and they soon realized she lit up the room with her presence. These pictures will help document for her the stages of healing and recovery she has gone through, there is nothing for her to feel ashamed about.

Secondly, when we decided to adopt a child with a cleft, we began doing our research in earnest. We joined an online yahoo group for families who have adopted a child with a cleft. There are many unique features and challenges that our children share with regards to surgery options and language development as their cleft most often was not corrected early in life. From this group we have received fantastic support, and benefited from the knowledge and advice other families have generously shared regarding their child's journey to correct their clefts. We feel it is important to also reciprocate and help other families as well. One of the ways we were able to help prepare Mary for surgery was by showing her pictures of what her lip would look like. We hope other families will be able to do the same.           

*Please disregard the quality of some of the photos, this has made me realize we desperately need a new camera, and perhaps some lessons on how to use it and edit the pictures we take ;)

Five days after surgery...
Six days after surgery...
Seven days after surgery...
Eight days after surgery...
Nine Days after surgery...
Ten Days after surgery...
 Eleven days after surgery...
 Twelve days after surgery...
Thirteen days after surgery (external stitches were removed this afternoon)...
As you can see, the spunk is back in her step!

Monday, May 30, 2011

Recap of our hospital days...

Surgery Day: Wednesday....
We were up bright and early to make it to the hospital by 6:30am. Luckily Grandpa Cliff and Grandma Diane came the night before, so they got to sleep in until Sylvie woke up later that morning. Mary was allowed one cup of clear fluids up until 7:30am, which included apple juice. We registered at the hospital and were in the surgery waiting room by 7:00.

This time around we put the Emla numbing cream on both of Mary's hands before leaving the house (to make the IV insertion less painful), as last time the nursing staff forgot until just before her surgery. We meet briefly with the operating nurse who went over Mary's particulars and then we changed Mary into some unflattering yellow pj's and went into a new waiting room. The anesthesiologist, two plastic surgeons and operating room nurses meet us in the waiting room and discussed their plan for the morning surgery. The anesthesiologist was the same one who was present at her first surgery, and he gave permission for Mama to take Mary to the operating room and stay under she was under. Mary was a bit more apprehensive going into the operating room this time around but did not cry. Mama sang to her and rubbed her tummy while the IV was inserted. Mary did not enjoy having the mask placed over her face, but overall cooperated with the nurses. She was under quickly and I gave her a quick kiss good bye before leaving the operating room.

Cory and I then went to grab a quick breakfast at the hospital, as the surgery was scheduled to take about one and half to two hours. Afterwards we spent time pacing in the waiting room until the plastic surgeons were finished. Dr. V came out to talk with us and told us everything went really well. We asked when we would know that the surgery was successful in staying together and he said at one week we could be reassured. (It is very rare for the lip surgery to dehiss, but we were not taking any chances this time). Mary was in recovery, and we were told to wait upstairs in the Peds ward for her to be transferred.

Luckily we were able to wait in Mary's room for her. There was another patient but thankfully they were being released shortly. We were able to get all Mary's toys set up and movies ready before she arrived. We were also allowed to have a bed this time around instead of a crib, but needed to sign a waiver form to sign as Mary is not yet three years old.
Mary was rolled into her room just after 11:30 in a rolling crib. She was lying on her side an had tears in her eyes but was not screaming and hollering like last time. The nurse told me she was asking for Mama as they were wheeling her down the hall. As much as it hurt to see her in pain, I was so happy that she recognized us and wanted us to hold her. When she came out of surgery the first time in January, it was a truly awful experience for the first hour together, she did not know us, and was fighting to escape - we had the bruises to prove it. I crawled into Mary's bed and the nurse lifted her down beside me, and Mary wanted desperately to snuggle into me. We were able to keep Mary on her side, but had to make sure that her nose and mouth were not touching me, which was so hard as she wanted to snuggle. She did not want to face away from me either.
We asked about her pain management and they told us she received a morphine shot in the recovery room. We asked about a morphine drip, which is what she had the previous two surgeries and were told that was not ordered and they were only using Tylenol w/codeine now. We were surprised, but I guess that shows us to ask more specific questions next time and not to assume everything will be the same. Mary spent the afternoon dozing on and off with Mama on the bed. In the later afternoon her pain became quite bothersome to her and we asked the nurse to page the doctor. It was determined that we could also add ibuprofen as needed to help relieve her discomfort.     

We remembered from our last hospital stay how much Mary liked riding around in the little race car. So Daddy went and grabbed it from the play room and we did a hundred or so few laps around the Peds ward. You can also see the arm restraints the OT's came to make for Mary. These were to help ensure that she did not touch her mouth or nose during the first few days.
Mary loved the car so much that we ended up keeping it in our room for the next few days. Mary did not enjoy sitting in her hospital bed, even if it was elevated into a sitting position, so this was the perfect compromise.
Mama stayed the night at the hospital with Mary. She received her next dose of Tylenol with Codeine just before 8:00 and she drifted off to sleep. The nurses needed to check her vitals every four hours, which was also combined with her IV antibiotics and pain management. Overall Mary had a good night in the hospital for her first night. Mary was on a liquid diet today. She began drinking small amounts of apple juice in the later afternoon and even tried some milk. Overall she drank about 250 ml of apple juice. 

Day One: Thursday...
snugglewraps.com/

The plastic surgeon Dr. W stopped by right before Mary's nap today to have a quick look at her. He felt she looked great and was happy with everything. He let us know that the plan would be to stay in the hospital for two more nights to ensure Mary had several doses of her IV antibiotics to ensure an infection would not develop in her surgery site.

Mary spent most of the day either in her little race car or in her bed. She needs to be hooked up to an IV to administer her antibiotics. This makes walking around a bit more challenging for her as we need to follow quickly behind her as her IV tubing was not very long. Since she was drinking so well, the nurses did reduce the amount of fluid dripping into her IV which helped to reduce her puffiness. Even though Mary was down one hand, she impressed us with her tenacity to still click her safety strap herself, no IV is going to slow her down!

Another food hit for Mary today were Popsicle bites, where Daddy would break the Popsicle into little pieces and we could pop them into her mouth. So far orange seems to be her favorite flavor.      

Daddy spent the night with Mary tonight. Daddy reports that Mary had a good night, but needed to be flipped over onto her back every once and awhile (poor Mary is a stomach sleeper, this side and back sleeping is hard for her). We are still putting the arm restraints on her for nap times and bed times, but are leaving them off during the day when we are beside her. Mary is doing well with not touching her mouth or nose, but often wants to rub her eyes, which are dry from surgery. So we are reminding her to ask us and we are wiping them down with a warm cloth for her.

Day Two: Friday...
Mary's appetite has returned! Cory feed her breakfast this morning which consisted of oatmeal, yogurt, and applesauce along with a container of milk. We find that it is most easiest to feed her liquid/soft foods using a catheter syringe, which has a nice long tip on it to guide around her mouth incision. The catheter syringes work best with oatmeal, soups and other pureed foods. We use the 10 ml medicine syringes to feed Mary her applesauce and yogurt.

The big excitement today was the nurse deciding to cap Mary's IV. The needle still needed to stay in her hand so they could administer the IV antibiotics, but she didn't need to be attached to the pole anymore! Mary was so happy to walk freely around her room and the playroom. This made going to the bathroom so much easier too, so Mama was very happy as well. I think the nurses were happy too since we spent most of our time in the playroom or walking the halls which drained the battery on the IV machine which required them to reset the IV machine each time we returned to our room to plug it back in. By this time we were already on our second IV machine since we killed the battery on the first one. After being released from the IV pole, this is how Mary spent most of the day in the playroom...


Big sister Sylvie was able to visit with Grandpa Cliff and Grandma Diane. I think the girl's missed each other, but Mary certainly didn't miss having to share toys!

 Riding around in the wagon was a big hit!

Day Three: Saturday...
Mama stayed last night with Mary again. Unfortunately Mary did not have a great night. The Peds ward was VERY noisy last night. There were quite a few new patients being added all night long, and many were on monitors, and the alarms continued to go off ALL NIGHT LONG. Every time the alarms would go off (we could still hear them in our room from next door, Mary would wake up crying. I stopped counting the number of times she was up crying after ten...at that point I think she was so tired that anything would wake her up, including the nurses coming in to check her vitals, which she used to sleep through before. It took me ten minutes of rocking and singing to her at midnight to get her calm enough to take her Tylenol with codeine and her IV antibiotics, and she is usually a rock star with taking medicine. The real bummer was being woken up at 5:30 am to change rooms. Unfortunately they needed a private room for another patient and we were moved down the hall to a room for four patients. I was glad we tidied up the room each night before bed, but it is still a bit disorientating to try to grab everything and move it when you are still half asleep. We forgot the camera in the bedside table drawer, but luckily it was still there later in the afternoon.

When the nurses came this morning at 8:00 to give Mary her last dose of IV antibiotics they discovered that her vein in her IV had collapsed, and the meant the antibiotics could not be pushed in. Since the nursing staff needed to call the doctor anyway to request oral antibiotics, I asked for them to inquire when we were going to be discharged, since today was the plan. We found out the surgeon gave us the ok to go home as soon as we wanted and he would call in the oral antibiotic prescription to our local pharmacy. I quickly called Cory and began packing and feeding Mary her breakfast. Cory was at the hospital by 9:00 and we were back home as a family of four by 10:30. Mary was happy to be home and immediately began playing with her toys.

Even though our last night in the hospital was not fun, we can't say enough about many of the nurses who helped take care of Mary. We were lucky enough to have some of the same nurses as our last stay and they were very excited to see Mary again. However, there is nothing like being at home...


 

Wednesday, May 25, 2011

Two years ago today...

On the other side of the world, in Nanning, Guangxi, we met one of the most beautiful baby girls in the world...

May 25, 2009


You were scared and unsure of us, but you didn't cry (that would not come until a week later in Beijing)


Over the next week we were able to slowly gain your trust and coax some smiles out of you...


We have had the privedge over the last two years of watching you grow and blossom into a kind, caring and sweet little girl...








It has been an honor to be your parents Sylvie, we love you more than you can ever know. You make our hearts sing...

May 25, 2011

Sunday, May 22, 2011

Post Operative Pictures...

One of the things we found most helpful when trying to anticipate Mary's surgery were the pictures other parents shared of their children's healing progress. We didn't know exactly what to expect to see when Mary cam out of surgery, or how the healing progress would go. So to help Mary understand one day what she went through, and to help other families that are about to undergo this process, here are the first few days after surgery for Mary's bilateral cleft lip (third surgery). 

Surgery Day, just after arriving back from the recovery room and having a nap beside Mama...
 One day after surgery, our little Rocky prize fighter. There were actually fingerprint bruises on the left side of her face...


Two days after surgery, swelling is going down slowly, you can see how her left side is still more swollen than the right...



Three days after surgery (finally at home!)...


Four days after surgery, this is Mary trying to say "Cheese"...


Since this is our third go around, the surgeons have told us that we can start relaxing one week after surgery. I am counting down the days until Tuesday. I think one of the hardest parts for me right now (besides the most obvious - seeing your baby in pain) is the fear. The fear that she might develop another infection, the fear that the surgery site may not hold, the fear that she might have to go through this all over again. We check her surgery site throughout the day and night so ensure everything is as it should be. When the kids got up this morning I had to ask Cory to look for me and report back, I was just too anxious to even see. Mary was in the hospital those extra couple of days to be on IV antibiotics and she is continuing with oral antibiotics at home now to prevent the development of an infection this time. Continued prayers and positive thoughts are appreciated and welcomed.

Thursday, May 19, 2011

Day Two...

Sorry, still no pictures today. The internet on the Ped's ward is not working - even though Cory couldn't resist slipping into the room and resetting the server. So no chance to update the blog while Mary was napping or otherwise entertained. I will try to remember to send Cory home with the camera tomorrow and see if he can upload so pictures then, otherwise you will need to wait until we are settled back at home.

Mary is doing much better today. Her appetite is back and she has been enjoying eating her applesauce, yogurt, soups and pudding. She also has developed a hankering for Popsicles and Daddy has been a sport cutting them up into little "Popsicle bites" that we can slip into her mouth. Her pain is being managed with Tylenol with Codeine, and although we needed a dose of Motrin yesterday when that was not being effective, she has been fine with just Tylenol and Codeine today. It was nice to see more and more of her personality show through as the day progressed.

She is definitely back to her two and a half year old active self, we spent a good portion of the morning and afternoon completing walking laps of the Ped's ward. Mary enjoys walking by the nursing station and calling out a loud "huuuuulllllllooooo" to all the nurses and doctors on duty. It has been hard keeping her calm and quiet, as we walk we are having to remind her no jumping down the hall. We have commandeered a ride on car toy from the playroom and Mary spent most of her waking hours in the car. She does not want to be in the bed unless it is sleeping time, so we have parked the car in front of her bed and this is where she eats her meals, plays with her toys, and watches TV.

We saw one of our plastic surgeons today and he felt everything is looking good. There is quite a bit more swelling today and her face is also puffy (maybe also due to the IV) but there are no signs of infection or the surgery site dehissing. She is still bleeding a bit through her nose, but it is less than yesterday. Mary hates feeling the blood on her face though and keeps pointing and telling us "Boogers" and asking us to wipe her nose! Gotta love two year olds!

Our surgeon has said we will continue to stay in the hospital to be monitored tonight and tomorrow night. If everything is looking good we can go home sometime on Saturday. The other plastic surgeon will be seeing us tomorrow and Saturday, and will be the one to discharge us. They are being extra cautious and want Mary to continue for the next little bit on IV antibiotics, and after we are discharged she will continue a course of oral antibiotics.

So that means Daddy is staying tonight in the hospital with Mary. Cory and I have been texting and he said she is sleeping soundly and snoring like a log. Cory is keeping himself busy with the nine seasons of MacGyver that he down loaded in preparation for his turn overnight. I was lucky enough to make it home in time to tuck Sylvie into bed and hear about her adventures of the day with Grandma and Grandpa. The big event of the day was the chance to hold a snack - eek! Apparently the local park they went to had a bunch of exhibits open to the public to learn about the environment and someone was there giving a presentation on snakes.     

Anyhow, I am exhausted from these last two days and after folding some laundry I am off to bed. I think I am going to sneak in and sleep in Sylvie's room, it has been hard not seeing her these last two days. Looking forward to when we are all home together...

Wednesday, May 18, 2011

Day One - Sleep One

Day one went well... Our munchkin is one tough little trooper I must say... Joyanne is at the hospital tonight with Mary, and I am back at the house to regroup for the morning. Surgery seemed to go as planned according to the doctors while she was in recovery. She was upstairs and back with us shortly after we talked with the surgeons and was in fairly good spirits. They had talked about several options for the surgery but the result was a fairly clean lip repair and not much in the nose area... So she only looks like Sylvester Stallone in Rocky 2, not Rocky... She has a pretty good fat lip or two, but is not nearly as 'puffy' as the last time we went through this... At any rate, she faired pretty good this afternoon/evening and even started to sport a little of her personality (read - spunk and attitude) by the end of the night... We will see what tomorrow brings :)

More to follow.... C & J & S & M

And we're off...

Well, it is 08:00 and Mary and Joyanne just headed back into the operating room. We had quite the entourage this morning since we arrived at the hospital... Met with everyone so far... Admitting, Pre-op nurses, op nurses, anesthesiologist, doctor number 1, doctor number 2... The list goes on. Suffice to say, Mary is the star of the show today and she seems to be doing fairly well... A little cautious perhaps, but doing ok. I expect to see Joyanne in a few so we will have more news soon. Until then...

C & J & M (S is at home getting spoiled by grandma and grandpa :)...)

Tuesday, May 17, 2011

Surgery Redux....

So, we are at the eve of surgery number three for our dear Mary. She will be heading into the operating room first thing tomorrow morning for the next crack at her lip surgery. We have met with doctors, nurses, anesthesiologists and the like and all have our munchkin's best interests at heart... So we just have to get up bright and early and head to the hospital and prepare for another bought of unknown. I have no doubt in anyone that we will come across in the upcoming days, but it will still be hard on everyone, especially Mary. Trying to make the best of what will happen is foremost in my mind, but so is the past few months that I have seen her heal and finally "recuperate" from her surgeries past... And here we go again... With that, we will try and keep everyone in the loop on how things progress. Wish us luck and we will keep your thoughts, wishes, prayers, and the like all in hand to get Mary through the next weeks. Stay tuned...

C & J & S & M

Monday, May 9, 2011

Six Months together...


Wow…has it really been only six months since we became a family of four?

Mary is doing so well and we are constantly amazed by our youngest daughter. She has grown like a weed and now at almost two and a half, looks like a little girl much more than a baby girl… sniff sniff! Mary has gained 8 pounds since coming home and is now starting to sprout up as well. When we look back over the past six months we are in awe of how far she has come in such a short period of time.



Cleft Surgeries
Mary had two surgeries for her cleft lip, both in late January. The first was a planned procedure to close her bilateral cleft lip and to position her protruding pre-maxilla back into her mouth. Her first surgery went well and we were amazed at the change in Mary’s face. She was a trooper after the surgery and we were released to go back home late the following day.

Unfortunately a couple of days later her lip began to open again and we returned quickly to the hospital. The surgeons tried to reattach her lip and discovered she had an infection in her surgery site, as well there were complications removing her breathing tube after surgery. After a late night flight in the air ambulance to the provincial Children’s hospital, and subsequent successful removal of her breathing tube the following afternoon we never want to experience another stay in the Paediatric Intensive Care Unit again. After all this, even with the administration of antibiotics, the already present infection resulted in Mary’s lip opening up completely over the next week. This was very disheartening and we felt awful for Mary having to go through two surgeries and still not have a successful result. After a three month healing period, Mary is scheduled to have her lip re-repaired again on May 18, and we are hopeful that this will be last surgery required this year.    


Communication/Language
Mary has a large single word vocabulary, we stopped counting her words after she hit about 75 words. Most of her words are nouns, so we have been focusing on adding verbs and adjectives to her repertoire, which our Speech Language Pathologist has advised to help develop Mary’s move toward 2-3 word sentences. So far she has a few 2 word sentences that she uses and she is so pleased with herself when we respond positively to her attempts.

As Mary’s lip is still separated there are many letter sounds she is unable to reproduce (ie. p, b, w), but she can clearly enunciate all the vowel sounds so we are able to understand her wants and needs most of the time.

 It is funny, but as we have been encouraging Mary to use her words to express her wishes, instead of relying solely on body language/actions (believe me, if you need a charades partner you want her on your team – she is a ringer) Sylvie has gotten annoyed with Cory and I. Sylvie will get exasperated and say sternly, “Mama, Mary wants more milk” and look at us like we are complete morons who are unable to get what her younger sister is clearly demonstrating with her pointing and whining. 



Food Security
By far the biggest issue we have had to help Mary with has been her anxiety around food. From the first days together on, Mary has shown us she is very concerned and preoccupied with food. Her appetite was simply insatiable, and she would eat a larger adult size portion of food at every meal as well as having snacks throughout the day.

We were unconcerned while in China, knowing the stressful transition she was undergoing and her not knowing we would provide food for her consistently. After arriving back in Canada this continued and she began to tantrum at every meal opportunity when she finished eating, wanting yet more food. Unfortunately offering her more food would not work as she would eat until her stomach was as hard as a rock, to the point of gagging but still insisting on more.  To say that meal time at our home was stressful was an extreme understatement, now imagine going through this three times a day for meals and twice for snacks. In response we continued to give her large portions of food at every meal and snack time and dished up food in the kitchen instead of having it on the dining room table. We wanted Mary to know there was always enough food available, and that there would be more food at the next meal time.

It was also challenging not being unable to prepare food for meal time in front of her, as she would cry and whine throughout the preparation. We feel that Mary was unaware that food took time to prepare, where in the orphanage they would be led to the eating room and food would instantly appear to be eaten.       

In the past month or two, Mary has made ENORMOUS strides in reducing her anxiety around food. Yes, she is still concerned with food and watches others carefully to ensure she has an equal or larger portion but she is less consumed by it. She still has not really developed any food preferences yet, and we know this will come with time when she is secure in knowing we will always provide for her. We were giddy with excitement a few weeks ago when she actually left some breakfast on her plate, after she left the table Cory and I took a picture just to document the occasion. It hasn’t really happened again, but this is a step in the right direction…slowly but surely.


Attachment
We feel that Mary is developing a secure foundation for attachment to both Cory and I, as well as to her sister. She turns to us to receive comfort, and continuously checks in with us when we are out with other people and their kids. She is sleeping much better at night time (it was simply awful for a month after surgery) and wakes every morning and after nap time with a smile on her face. Her eye contact is improving all the time and she will now snuggle deeply into our arms to cuddle and gaze a little longer into our eyes when we are singing to her each evening. She has a very outgoing personality and it does not take her long to warm up in new situations and she confidently jumps in.  


Gross Motor
One area that Mary has been working hard on is developing her gross motor skills. Mary was extremely bow legged which our pediatrician feels it was due to a Vitamin D deficiency, and very weak in her core and leg muscles. Our weekly gymnastics program and wanting to do everything her sister does, has helped her to learn to climb up on her bed, couch and chair, go from a slow walk to finally running, developing a two foot jump and last week I saw the beginnings of her skipping down the hall way. She is still working on climbing up stairs and ladders easily, as her leg muscles are getting stronger every day.  

We feel very grateful for the opportunity to love and cherish this beautiful girl. We can’t wait to see how her tenacity, confidence, kindness and yes… a little stubbornness will help her to overcome any obstacles in her path. We love you very much Mary Dang Yundan!     

Sunday, May 8, 2011

Mother's Day

Is such a bittersweet day for me. I miss my own mom terribly and wish that somehow she could see her two newest granddaughters, they would have loved being spoiled by her.

I think of my daughters and my heart is so full with happiness and love for my girls, but at the same time sadness for their birthmoms. I wish there was a way for their birthmoms know how well they are both doing and to see how amazing and strong both girls are. Today we will take time to recognize and remember both Sylvie's and Mary's birthmothers.