Surgery

Although I am sure most of the people who read this blog are also are friends on Facebook, I figured I would write a comprehensive post about Claire's surgery since I am sure the FB postings were a little disjointed.

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The day before Claire's surgery (10/15/13) was our second wedding anniversary, so Bo and I had planned on not being in the office.  However, we decided to work anyway since we knew that we most likely would not be in for the rest of the week.  We then took Claire to watch her big brother's gymnastics practice, and then it was off to Cracker's (a tapas bar at the edge of our neighborhood) for a low-key dinner.

After stopping by a couple of our friends' houses for quick hangouts, it was time to turn in for the night.  Since Claire's surgery was scheduled for 9:45 a.m., she could not have milk after 3:45 a.m. (and could not have clear liquids after 5:45 a.m.).  The plan was to wake her up around 2:30 a.m. to feed her and then to batten down the hatches and ride out the hunger storm that surely was on its way (for those of you who haven't experienced it, Claire goes from perfectly content to SCREAMING with hunger in about 5 seconds.  That girl does not mess around when it comes to food.).  Of course, having planned on something doesn't mean it is actually going to happen, as I discovered when I woke up in a panic at 4:00 a.m., realizing that Claire hadn't woken up, and I had turned off my alarm in my sleep.  Bo and I decided that the only thing to do was to wait until she woke up and offer her water in an attempt to appease her.  All I could think about was the poor unhappy baby that we were going to have on our hands for the next 6 hours, so imagine my surprise when, aside from a quick meltdown at 5:30 a.m., Claire was absolutely fine - if not downright happy - right up until the time that the nurse came to take her to the operating room at 9:45 a.m.  

Although we did not have to check in until 7:45 a.m., we left for CHKD at 6:30 a.m. to meet up with my parents and sister.  We were beyond pleasantly surprised when we discovered that Bo's uncle, Joby, had also decided to come to the hospital.  Having family with us definitely helped Bo and I remain calm in the time leading up to surgery.  

Celebrating her 5-month birthday in the CHKD cafeteria

At 7:30 a.m., we said good-bye to our family as only Bo and I could be with Claire during the check-in process.  Fortunately, everyone else was allowed to go to the surgical waiting room, where we would meet up with them after Claire went to the operating room.  Instead of writing about the next two hours, I will let some pictures tell the story:

Claire, fashionable as always in her Loony Tunes gown

Giggling with Daddy

Taking a quick snooze before surgery

The surgery itself took almost exactly 90 minutes (which was what Dr. F estimated when he spoke with us beforehand), but it felt like forever to both Bo and I.  We kept checking the board (which was akin to the arrivals/departures board at the airport) to see if Claire had been moved from the operating room to post-op recovery.  

Dr. F once again proved how fantastic he is when, instead of sending out a nurse or a surgical resident to give us the results (as we saw other doctors doing), he came to the waiting room himself to tell us how things went.  Not surprisingly, things went better than expected.  You'd think we would know by now how much of a fighter our daughter is!  Per Dr. F, he had to make a horizontal incision instead of a vertical one as the O's opening was more oval than circular (something that he was unable to tell until Claire was put under anesthesia and no longer wiggling around).  He also discovered that Claire actually had extra fascia tucked under her sternum, which he was able to use to close the hernia (along with her rectus abdominus muscles).  The existence of the fascia meant two things: (a) there was absolutely no need to use any mesh; and (b) Claire's muscles were not stretched as tightly as Dr. F had anticipated, meaning that she could eat (Pedialyte) as soon as she woke up from surgery and that there was no need to continue to wrap her in the ACE bandage post-surgery.  Dr. F could not stress enough how beneficial the compression wrapping was.  As he put it, the wrapping made it so Claire's liver and bowels easily slid into place; all the surgery did was to "screw the lid on."

Claire and I then spent the next three days in hospital (Bo was with us for the majority of the time, but had to leave on occasion to take care of the animals and to spend time with Cole). The only thing that kept Claire in the hospital past day 2 was her refusal to poop; given that her bowels were involved in the surgery, Dr. F wanted to make sure everything was working (that there wasn't any kink or obstruction) before sending us home.  Claire did wonderfully well in the hospital.  Her only meltdowns were completely understandable and occurred when it took approximately 7 needle sticks to get her IV back in (long story, still makes my blood boil a little when I think about it) and when her temperature was taken in an unmentionable place.  Otherwise, she was perfectly content to hang out in her hospital bed with her books and toys.  She tolerated the Pedialyte on day 1, so I was allowed to start nursing on day 2.  

As I said, Claire could not go home until she pooped, so, on the morning of day 3, the nurses provided her with some "assistance" that moved things along so we were able to be discharged that afternoon (10/18/13).

Waiting for Daddy to get the car

Claire has continued to have a fantastic recovery since we have been home.  Her appetite, which was nothing to mess with before surgery, has increased tremendously, which, in turn, has caused her to sleep longer at night (instead of 3-4 hour intervals, we are getting 6-8 hours).  Bo and I decided to keep her out of daycare at least for this week to give her time to heal, and are again immensely grateful for our moms, who have volunteered to watch Claire at the house while we are at work.

I have one more picture left to post, but I am going to first say my thank yous to everyone before posting it since it is a picture of Claire's O and her "new" stomach, which some people might not want to see.  Honestly, it is not all that graphic, but then again, I am not the best judge as to what is graphic and what is not since it was our reality for the last 5 months.  So here is fair warning to stop reading after this paragraph if you do not want to see it.  Anyway ... thank you so much to everyone who has kept Bo, Cole, Claire, and I in their thoughts and prayers throughout this journey.  The love, support, and understanding that we got from each and every one of you, the kind words and thoughtful gifts, the prayers, the offers of assistance, and so much more are valued beyond measure.  I honestly cannot find the words to adequately express how much everything meant to us, so I will just leave it at this:  THANK YOU.  From the bottom of our hearts, thank you.  We would not be where we are without our friends and family.

Claire has a follow-up appointment with Dr. F on November 5th.  I will, of course, continue to try update this blog, although I anticipate that, from here on out, it will mainly be used to share cute pictures and stories as Claire continues to grow (which I am sure doesn't bother anyone).

Much love to you all,

Val & Bo

P.S.  Okay, here is the picture I mentioned above.  It shows Claire's O right before surgery, her incision right after surgery, and her incision on Day 3.  It is currently covered by steri-strips, which should fall off by this coming Friday (if they don't, we are allowed to remove them ourselves).  Claire's stitches should dissolve on their own.

Photo Dump!

As promised, here are some photos of Claire Bear!

One of my favorite pics

Happy baby on her 4 month birthday!

Hanging out with Daddy before getting her shots (4 months)

First UVa tailgate

Meeting her Great-uncle Bo and her Great-aunt Linda

Hanging out with her ball and monkey

With her BFF, Dr. F.

I will try to do this more often since, as I am sure you will have no trouble believing, I have a TON of pictures of Miss Claire.

Happy Thursday, everyone!

~~Val

So much time and so little to do ...

Oops.  Strike that, reverse it ... I don't think there could actually be enough time to prepare for what's ahead, but that is probably for the best.  

Sorry again.  I know this is probably the most confusing start to a post ever, but my mind is honestly in such a jumble that I don't even know where to begin.  As mentioned in the last post, Claire had her pre-op appointment with Dr. F. today.  Bo and I knew going in that we would be picking her surgery date during the appointment, and we had been planning on trying to get something at the beginning of November (mainly because I am awesome a nerd and insisted that we avoid the end of October so I could take Claire trick or treating).  You would think, however, that we would know better than to even TRY to plan something given our track record (we thought Claire would be in the NICU for at least a month, that we wouldn't be able to put her in daycare prior to her surgery, etc. etc.).  

Okay, okay, I will get to the point.  Really, I blame Claire Bear, who apparently has a strange way of celebrating her monthly "birthdays" ... at two and four months, she got shots, and now, at five months, she will be having her closure surgery.  That's right, Claire's surgery is scheduled for next week (Wednesday, October 16th).  It really hasn't started to sink in that, at this time next week, I will be sitting in the waiting room anxiously waiting for the surgery to be done.  I keep thinking it's too soon, but honestly, it was our only choice.  Between our work schedule and Dr. F's surgery schedule, it was either next Wednesday or right before Thanksgiving, so it was a no-brainer.  Dr. F also stressed that the sooner we got it done, the better recovery time would be for Claire since she isn't at the stage right now where she is really using her stomach muscles (e.g., she isn't trying to crawl, or to pull herself up, or to walk, etc. etc.).  Plus, as Bo put it, we are better off having only a week to stress out about the surgery than five weeks.  And really, it couldn't come at a better time since our schedule over the next week allows us to spend as much time with Claire as possible.  We already planned to take off the afternoon of Friday the 11th to take Cole to Busch Gardens (teacher work day, so no school for him), the office is closed on Monday the 14th, and Bo and I had already blocked off the 15th so we could celebrate our second anniversary.

And now for the details for those who want to know, although I will try not to be too graphic:

• Dr. F will be making a vertical incision right in the middle of Claire's O (cutting out existing scar tissue) for the surgery.  He confirmed that her O is too high up for him to create a belly button (usually one is made at the incision site using the leftover skin), so Bo will get his wish ("No belly button rings for her!").  

• After pushing her liver and bowels all the way back into her abdominal cavity, he will then stretch her rectus abdominus muscle (her "abs") to close the hernia.

Image source

• If he absolutely has to, Dr. F will then put a layer of biological mesh over the muscle to form a lattice that the tissue can grow into (essentially, it would provide extra support to avoid the chance of Claire developing an incisional hernia down the line).  The mesh would eventually dissolve, but since it comes with a risk - albeit a slight one - of infection, he is really hoping to avoid having to use it at all.

• The surgery itself should take about 90 minutes, and Bo and I should be able to see Claire within 30 minutes after completion.  Claire is not supposed to eat anything the first day since Dr. F. wants to avoid her stomach expanding unnecessarily or her throwing up (both of which would stress the closure site).  Instead, she will get her nutrition via IV until the second day, when she should be able to eat normally.

• We should expect Claire to be in the hospital for a couple of days, mainly for pain management.  At that point, she should have some good scar tissue forming that will assist with the recovery.  At three months out, she should have 70% of her strength back, with "full" recovery at six months after the surgery (or, as Dr. F put it, by that time it will be "as good as it gets").  We will not need to do any more compression wrapping, but will still probably use the ACE bandage for a little while after the surgery just to provide some additional support while she is healing.

I think that is about it (or at least all I can think of right now).  Please feel free to ask any additional questions you might have.  In exchange, we once again ask that you keep Claire Bear in your thoughts and prayers as she prepares for (hopefully) her last big hurdle in her omphalocele journey.

Love,

Val and Bo

P.S.  Sorry about the lack of pictures in today's post, but my brain is a little scattered.  I promise I will (try to) post some pictures between now and next Wednesday.