Our sweet, sweet George is having surgery on Wednesday. Wouldn’t you think that since he’s sailed through four surgeries already in his brief 2.5 years that I’d be confident that all will go well?
And what about Danny? My experience with him should be helping me now. He’s had general anesthesia more times than any person of any age I’ve ever known. Shouldn’t it all be so routine for our family by now that I don’t waste valuable emotional resources worrying?
But George is so little, and so sweet, and so perfect… I just want to protect him from anything even remotely painful or risky.
George has obstructive sleep apnea. His has two causes besides just the Downs. He has laryngomalacia, so his airway is floppy (like the rest of him) and just collapses, keeping the air from flowing freely. He’s had this since he’s been born. And he has huge tonsils, in a posterior pharynx that’s smaller than usual due to the Downs.
So the tonsils have to go. This sleep apnea is putting terrible stress on his heart, and it’s not good for his brain, either, although that’s harder to quantify. The problem is that tonsillectomy in children younger than three is riskier. Tonsillectomy in children with DS is riskier. Tonsillectomy in children with laryngomalacia is riskier.
Here’s one way to visualize it: He has this little, floppy airway with BIG tonsils in it. The tonsils have to go. BUT…. what if (and this happens) George’s big old tonsils are actually providing some scaffolding to hold up and open his airway? Take them out and it falls down worse. Uh oh. Plus, those huge tonsils have sort of been like barriers, keeping his tongue forward and out of the way of his airway.
All children have swelling where the tonsils were after surgery. Remember from high school physics about the inverse relationship between flow and radius? And it’s actually squared, so a little decrease in size of the tube can lead to a big decrease in air flow. When you start out with a little tube, and that little tube gets smaller, it can stress a mama out.
And then there are the down syndrome anesthesia risks… low heart rate, slow recovery and resumption of independent breathing….
You know what else? We all think George is a pretty smart guy, but he’s just not going to understand what’s going on, and why he hurts and why all those people keep messing with his mouth and his monitors and his IV and all…
Taking too many flash pictures right before bedtime can stress George out… sorry, sweet boy!
So anyway, George is having this surgery Wednesday. It just couldn’t wait until he’s three years old. Obviously, he’s not going to be having this outpatient in the surgi-center… he’s getting admitted to Presby for the duration.
You know I try to avoid micromanagement in my prayer life. “Thy Will Be Done” is about as specific as I get sometimes. However, Wednesday calls for details.
First, I’m praying that Dixon has an easy night at work tonight… his last night for a week… so that he’s fully recovered and back on regular day/night schedule FAST. He’s going to stay with George in the hospital, I’m just not strong enough.
I’m going to pray that little George is a good sport about not being able to eat or drink until 11:00 (his surgery time… WAY late for a little guy, but that’s one trouble with having to be in the big main hospital…)
I’m going to pray that he goes off to sleep peacefully and that anesthesia is safe and easy, with no troubles with bradycardia (too slow heart rate), no troubles getting him intubated despite his crazy airway, and that they get his IV on the first try (now THAT would be a miracle!!!)
I’m going to pray that the surgeon scoops those tonsils out carefully and precisely, so that there’s no bleeding and no excessive tissue trauma that would cause swelling.
I’m going to pray that when he’s all done, and they take the breathing tube out, his airway stays WIDE open, and that his tongue stays forward. And along with that, I’m going to pray that this dramatic change in airway mechanics doesn’t cause pulmonary edema (fluid in the lungs…. complicated story involving PEEP… not the marshmallow kind either….)
So basically we’re praying for ZERO obstructive apnea after surgery.
I’m also going to pray that he has very little pain, because he’s going to be a good boy about taking all his medicine. And I’m going to pray that his IV stays in and working so that we don’t have to fight too much with him about eating and drinking until we make sure everything else is fine.
But come Thursday or so, I’m going to start praying that he can eat and drink easily, so that as long as he’s not in the ICU, he might be able to come home soon.
Please pray with me. George needs you.