I am new here and am looking for opinions. What would you do in this situation?

Dd (age5) has obstructive sleep apnea and has been seen by a couple of ENTs here in Japan. Her tonsils are somewhat enlarged and her adenoids are quite large so both ENTs recommended surgery to remove them.   The first ENT planned to use electrocautery for removal.  I nixed that, so off to the second ENT who said he would do a blunt (cold) dissection and also use a bipolar coagulator.  That sounded a little bit better but it still wasn't what I wanted to hear (I wanted to hear coblator).  The recommended hospital stay is seven days, which to me, seems beyond excessive.  We may be able to take her home after 5 days, if she is recovering well.  Dh, who is quite familiar and comfortable with the Japanese national insurance system, thinks it's fine. I have several problems with it:

1. the trauma (and/or boredom) of keeping a 4 (soon to be 5) year old in the hospital for a week. Parents are allowed to stay during the day but not permitted to spend the night (I've heard that this is negotiable)
2. what to do with twin sister while dd is in the hospital
3. logistically, getting to the hospital is a major hassle (in the 3 yrs we've been here, I have yet to drive on the expressway, and I frequently get lost if I deviate from my known routes)
4. Dh will not be able to take off work while dd is in the hospital, so it will be just me and maybe some help from MIL (who does not speak English)
5. I can't speak enough Japanese to effectively communicate with the hospital staff

Now, I had a conversation with my folks about this and they are equally concerned. So much so that they have offered to pay cash to have the surgery done in the states (about $5000). The surgeon in California has a stellar reputation, she's done the same surgery on both my niece and nephew so we are very familiar with her. The surgery would be an outpatient procedure, so we'd go home the same afternoon. She uses a coblator which I like because it has a faster recovery time and less pain than other methods.  The problem is, we're not going to California until August so the surgery would have to wait until then. Dh thinks that outpatient surgery is outrageous and dd should be in the hospital for at least a few days. Plus, he doesn't think we should wait to have it done.

So here are the options:

a) have the surgery in May, in Japan, and just let her stay in the hospital for a week and deal with the difficulties.

b) wait until August, go back to California and have the surgery there as an outpatient and recuperate at grandma and grandpa's house.

What would you do???

Thanks,
Betsy

Beo wrote:

What would you do???

That's easy.

I would avoid getting in the middle of a family discussion where maybe half of them may be versed in martial arts.

OK, seriously.  Sounds like you know what you want to do.  All things being equal, decision always goes to mother's intuition.
Actually, even if they're not equal, decision always goes with mother's intuition.

BTW, what's your husband's name, in case he posts.

Alright, REALLY seriously.  If it were me, the reason for getting a T&A would factor in the decision.  If it's because of severe OSA, the potential for serious complications is increased, so you have to have confidence in anesthesia, nurses, respiratory care and the post-anesthesia care unit, cause you're watching closely in that immediate post-op period.  Actually, in any T&A, that's the area where you have to have sharp, vigilant people.

Gimme that, and everything else becomes academic.
sleepydave

I also researched the coblation issue. We considered (briefly) flying to Los Angeles from Michigan to get it done. But we found a great ENT right here at Mott Children's Hospital. He said that he uses the cold method because it has fewer complications. Very little bleeding (the major complication of tonsil/adenoidectomy). Instead of 1/20 or even 1/50 incidents of post surgery bleeding, his rate is 1/200. I couldn't bear to listen to my daughter struggle for air one more night than necessary. If I could have done it myself, I would have.

For us, the combination of finding an excellent doctor we trusted, and feeling desperate to see our daughter breathing at night made the decision. And after the fact, for us the cold method worked great. By day 3 Sarah was eating grilled cheese sandwiches and apple chunks (peeled!). The Dr. instructed us to give her pain medication for the first 24 hours whether she complained or not, and we did, but she claimed that her throat wasn't hurting anymore the next morning. Adults are in pain a lot longer (like a week or more), but it could only be the difference of one day less of pain for a child getting coblation.

Now, I don't know how things are in Japan, but your daughter is not a prisoner. When she's well, check her out and go home. I think it's the bleeding they are probably watching for. The danger remains until the scab falls off (7-10 days). If you live close to a hospital, she should be safe enough at home. We haven't had even a drop of blood. But will wait a few more weeks to go back to gymnastics, just to be sure.

The very first night after the surgery, Sarah slept beautifully. Just a little gunky sounding, but regular, even breathing!! I am so, so, so happy to have it over with. Five days later, the gunk has cleared up. And seriously, only about 3 days of recovering, and only one of painkillers.

Good luck with whatever you decide. I agree with the moderator. Go with your gut. I just wanted to share our experience, because I had similar concerns.



Last edited by Northern_grl on Fri Oct 17, 2008 2:25 pm; edited 2 times in total
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Northern_grl

We went ahead and has the T/A done for him and they assured us all would be okay!   Thank god we took him to Rochester Mayo Clinic here in MN.  Because it did not all go so well.  For this procedure being a in and out kind of surgery!  We were in ICU for a week period.  My son did not react to the surgery the way they wanted him too.  He stopped breathing on them and they had to have aleast 30 Dr's in the room to hold him down to re insurt the Tube in his throat to help my son breath...all of this was a week of Hell.  To see him in the condition he was in was just horrifiying to know when I took him into have this done he was fine other then his Severe Sleep Apnea....then it all turned ugly!

After about a year well actually it has been a year now!  On the 18th of April.  I am sitting here and I notice the same pattern in which we had him treated for.  I am thinking to myself...What do I do now?   I know they say the Surgery would not take it away but after all that he went through my son is so scared of the Mayo Clinic now.   He is not wetting the bed again and getting more tired after school.  I am a bit concerned!  I would like to know what other's think I should do.

I just can not afford anymore of this...I Have not even paid the last bill off yet.  But I know his HEALTH IS WAY MORE IMPORTANT THAN ANY BILL.......

So any advice would be appricated ....
Thank you

Hi glenda72:
Thanks for that post, just goes to show that plenty of times, a routine T&A is anything but routine.

While most people usually think bleeding and obstructed airway secondary to swelling top the list of complications of T&A in children, as much if not more of a concern is this thing called Post-Obstructive Pulmonary Edema, which results in terrific oxygenation and breathing problems in immediate post-op period (hence the need for a vigilant PACU).  Based on your brief description and a little speculation, I'd say that's what occurred, given that it was a re-intubation and it doesn't take 30 adults to hold down a patient suffering from respiratory arrest because of the persistent effects of anesthesia.

Regardless of the cause, there's no way to avoid another sleep study.  If the OSA was that bad going in, you'd have to assess the surgery on that alone.  If the symptoms have returned, and the next logical step is CPAP, once again, slam-dunk.

Say, how bad was the OSA going in anyway?
sleepydave

Just wanted to follow up on my original post.

We waited and had the surgery done in California because I just couldn't get past the language barrier and the idea of a weeklong hospital stay.  I couldn't be happier with the outcome.  We had our initial consultation on a Thursday and surgery the following Tuesday.  I was very glad to be able to hold dd while she was knocked out - surgery lasted about 45 minutes and dh and I were able to go back and sit with her after about 20 minutes.  She had no post op pain and we were home 4 hours after we first walked into the surgery center.  She ate a huge normal dinner that night and never complained of pain.  2 days later she had a sore throat that was alleviated with plain Tylenol and a week post op she complained of an ear ache and a headache (also alleviated with Tylenol).  The worst problem she had was the post-tonsillectomy BREATH!  She could have killed an elephant with one breath.

Seriously, the most important fact is that her sleep apnea is gone!  She is a totally silent sleeper now, no more blocked airway passages, no more snoring, no more sucking in her chest, no more of that choking sound she used to make when she wasn't breathing.  And, I'm not sure if it's related but, she has almost completely stopped her bedwetting.  No accidents in the last 6 days!

Anyway, thanks for the input.  I just wanted to follow up and let you know the great news!

Betsy

Hi Betsy,

I think sleepydave may be on hiatus right now, but I'm sure he will be pleased to hear the good news.
Congratulations with the great news.  And I figure, not only did you get the care for her you wanted, you all got to visit with her grandparents, right?
Best of both worlds.  

Again, congratulations, and thank you for letting us know.


Linda