Oct 1, 2008

We Scheduled The Nissen Surgery

We just got back from the appointment with the surgeon at Children's. Even though he performs a lot of Nissen Fundoplications he tries to avoid doing them unless he thinks it's absolutely necessary and that it will relieve symptoms for the patient. It's an interesting approach to have a surgeon who is hesitant to perform surgery. He had an interesting thing to say in that her vomiting and coughing is like the chicken or the egg question . I've heard this before but what he firmly said that I liked hearing is: It is unanswerable and irrelevant. She has an irritated airway, issues of vomiting and reflux and a lot of coughing. Is the coughing causing the reflux or the other way around. We will never know. But what we do know is that it's here and we've tried all other possibilities to eliminate the vomiting and they have not worked. We know that she has bronchiectasis, that is damage to her lungs, and that the reflux could have caused it and could make it worse. It is also possible that the swelling of her upper airway (that is the reason for the trach) could be caused by the reflux or vomiting. She is underweight due to the vomiting and inability to tolerate larger quantities of food. And of course there is an issue of quality of life because of the stress it causes for the whole family. Not to mention the additional laundry. (Ha, ha.) Vomiting can cause oral aversion and complicate oral feeding. All in all, a whole lot of reasons why she is a good candidate for the surgery. He did say that there is no way to know for sure that the surgery will resolve her airway issues and there are risks and side effects to the surgery but we are really out of other options. We have to try it to know if it would help her. Because of his approach to Nissen surgeries Steve and I feel reassured that it is, in fact, necessary. It's scheduled for October 21st, just 3 days after her 2nd birthday. It will be done with an open incision as opposed to laparoscopically. I wish I felt 100% at peace with this decision. I've suspected for a long time that it was inevitable. With her starting to crawl in September a small part of me still wonders if it would resolve itself over time. Because she's developmentally delayed it could resolve when she starts walking but when will that be? Darn, I forgot my crystal ball again! But at the same time we've put up with this hell for 2 years. How much longer is long enough? I'm sure once it's done I'll be glad just like when she had her gastrostomy surgery last year.

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