Surgery tomorrow...

We have been busy today getting ready for a full day tomorrow. Mary will be having her fourth surgery since coming home. On the slate for tomorrow is quite a bit of dental work: front teeth capped, several cavities filled, a thorough cleaning followed by a sealant being placed on her teeth. Kids with clefts often have very soft baby teeth, and Mary unfortunately seems to fit this category. Additionally, since her cleft lip was not corrected for the first two years her front teeth were exposed to the air constantly, which eroded away much of the enamel. The dental surgeon has been a little concerned since you can actually see the pink showing through the back of her teeth. I wonder if she has been in continual pain due to teeth sensitivity, but since it is her constant that she has never known any different.

Also on for tomorrow is adenoid removal. Our ENT (whom we love!) was able to coordinate the operating time with the dental surgeon and piggy back onto his OR time. This means that Mary will have both procedures under one anesthetic, subtracting an additional surgery this year. We are very thankful that the dental surgeon agreed to this as OR time for both surgeons at our hospital is in demand. The dental surgery is expected to take about an hour, and the adenoid removal about 20 minutes. We will then be staying at the hospital for about 6-8 hours after surgery before being released - as long as there is no bleeding from the adenoid surgery from earlier in the day and Mary is eating and drinking. Mary is having her adenoids removed due to her moderate sized adenoids and her predominate mouth breathing. Mary, also known affectionately as our little "Darth Vader" sleeps throughout the night, but is not well rested and often has circles under her eyes. She snores like a trucker, has choking episodes in her sleep when she is congested from a cold, and kicks her feet in frustration while sleeping. We are hoping that this will help her be able to breathe easier through her nose and sleep deeper.  

We are told these surgeries are all routine and not to worry, but since we have a history of nothing going exactly as planned I am a little nervous. List of things I am worried/concerned about:

•  Pain Control: I worry that Tylenol and Advil will not be enough for her pain. Sometimes I feel that children's pain is not considered as important as adult pain. Factor in a kid that can not speak clearly...
• Anesthesiologist: We have been lucky enough in 3 out of 4 surgeries where the anesthesiologist has allowed me to accompany Mary back into the operating room. I usually sing to Mary and hold her hand while the IV is inserted and the breathing mask is placed on. Usually Mary cries silent tears as this is going on, showing me that she is trying to be brave - but is scared none the less. We don't want her to have to be brave by herself. Additionally, we know that Mary will have several more surgeries over the years. It is our goal to make these surgeries and hospital stays as comfortable as positive as possible. We know that it is important to have a calm and in-control demeanor in front of the anesthesiologist, so I will ensure I am the epitome of that tomorrow morning. At our pre-op appointment the anesthesiologist and I discussed accompanying Mary back and she said she would write a recommendation that I would be acceptable. So, here's hoping...
• Miscommunication after surgery: we have been lucky for our previous surgeries to be able to meet Mary right after she is brought to her room after recovery. Standard procedure is for parents to hang out in the surgery waiting room while surgery is preformed. After surgery, the doctor comes to talk to the parents and explain how the procedure went and then parents are then sent up to the Peds ward to wait for their child. Unfortunately, we have known two families who have sat and sat in the surgery waiting room for the doctor who never showed up (maybe called into the next surgery and mix up in communication?) and the child was taken to the Peds floor without the parents there waiting. So I know I will be asking clearly who will be coming out to talk to us after surgery is completed and when we should be heading up to the Peds ward.
  
• After effects from surgery: We know from past experience that Mary's sleep is considerably disturbed after surgery. Sometimes this has lasted a month or so, other times just a couple weeks. We know this may be due to the anesthetic from the surgery. We also know this may also be due to the trauma of surgery and the hospital stay. We are grateful that Mary is a bit older this time for surgery and can understand us when we are explaining to her what is going on, but she is still just a toddler. So while we are exhausted the weeks after surgery from lack of sleep, it is more heartbreaking to see Mary having the nightmares and wish we could see into her thoughts to help comfort her better. I also worry about how these surgeries and trauma affect her attachment to Cory and I. I know that us providing the care and love after surgery can help promote attachment, but I also have to wonder how us taking her to the hospital and handing her over for a medical procedure which will cause both emotional and physical pain. It is complicated. I feel very thankful that I was granted three days from work to stay home and care for Mary, I see lots of cuddling on the couch together and nice bubble baths. Cory will stay home on Thursday and Friday, and then I am off again on Friday as well as it is a district holiday. I am sure Sylvie will most likely ask to stay home during some of that time for extra cuddles as well. So next week will be busy and maybe a little draining to make sure the girls are able to get their needs met. 

I have several other worries ranging from: Will she be able to eat popsicles to help her throat - but then will that hurt her teeth?, How will she be after coming out of the anesthetic - it has not been pretty either time...but these are the main thoughts on my mind right now.

Mary and Mama will be up E.A.R.L.Y. (around 5 o'clock) in order to leave for the hospital at 5:45. Daddy will be getting Sylvie ready for day care and dropping her off before heading to the hospital to wait with me while Mary is in surgery (I hope he is bringing coffee and breakfast for me!). After surgery Mary, Mama and Daddy will be hanging out in the day surgery recovery room on the Pediatric wing of the hospital. I think this might be the only room we have not stayed in on that floor. We have the Kai Lin bag packed up with all things essential to occupy a toddler: IPad (loaded with lots of Elmo's World), stuffies, magnetic paper dress up dolls, felts and coloring pages. Since we have spent time on this floor before we know where all the Popsicles, pudding, jello, and ice cream is stored, so Mary should be quite happy tomorrow with her food choices. Hopefully we will all be home together for supper tomorrow night. We'll keep everyone updated through FBook tomorrow and I will try to update the blog from my phone. And some cuteness to leave you with..."M" is for Mary!