Questions, Questions, and More Questions!!!
Questions, Questions, and More Questions!!!
My daughter Renee will have the mod quad surgery at TIRR on 2/26/02. She will be 13 1/2 months old. I am very nervous about handing her off to the nurses because she is going through an extreme case of stranger and separation aniexty. If my husband and I are around she gets upset when someone else gets too close to her, even my sister who babysits twice a week. (When she had the primary surgery she was only 5 1/2 months old, and she screamed until she was knocked out.) Can the doctor(s) give her something to make her groggy before surgery to make it easier for her to leave us? If so, when do we have to request it (before our trip or at our clinic appt. the day before). I have seen Francine's posts about PCA pumps for pain management. Should we automatically request it because we don't know how Renee is going to deal with the pain? (She seemed fine with the primary surgery, but she is older and it is a different surgery.) Has anyone requested that the IV be put some place other than the non-BPI hand? Renee sucks her thumb and if they put the IV in the non-BPI hand and tape her arm to a board she is not going to be happy and everyone in the hospital will know it!!! Do we have to ask for a different placement (i.e. foot) the day of surgery? Unrelated to the surgery, we have to have Renee tested for lead. I have seen the medical alert cards on this website, but I was wondering should we not prick the finger (or thumb-not sure which they do)on the BPI side either. I was thinking that maybe since her sensation is decreased that she wouldn't be as bothered by it. (Please be kind in your responses. I'm still learning about all this!) I truly appreciate all the support and advice that I receive from this message board. I'm a little stressed because we have to take our 3 yr. old to the hospital Mon. to be put under general anesthesia to have her teeth worked on. Can't believe both of our girls will be under anesthesia within 2 weeks of each other!
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DebbieJean
- Posts: 72
- Joined: Wed Feb 06, 2002 10:51 am
Re: Questions, Questions, and More Questions!!!
Julie,
There is medicine to give the child, before surgery, to make them groggy, and giggly.(In some cases.)
As far as the PCA,
I would agree with Francine, about how that really helps pain management. If they start the pain pump, and pain med infusion right away, that will,"get head of the pain", if you will. If you don't start meds for pain, until after the pain forms, or increases, it will not help very much. You have to get on top of it,
for it to be effective. I really feel for you right now, and hope that this stress will pass soon, and that your children will be on the road to recovery.
God Bless,
Debbie
There is medicine to give the child, before surgery, to make them groggy, and giggly.(In some cases.)
As far as the PCA,
I would agree with Francine, about how that really helps pain management. If they start the pain pump, and pain med infusion right away, that will,"get head of the pain", if you will. If you don't start meds for pain, until after the pain forms, or increases, it will not help very much. You have to get on top of it,
for it to be effective. I really feel for you right now, and hope that this stress will pass soon, and that your children will be on the road to recovery.
God Bless,
Debbie
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DebbieJean
- Posts: 72
- Joined: Wed Feb 06, 2002 10:51 am
Re: Questions, Questions, and More Questions!!!
Julie,
Also forgot to mention, there are many places to put an IV, a foot is not a bad place, but you have to watch, if they would want to get up and walk. They would not want them to. Also make sure you have an experienced person putting the IV in. Preferably a
anesthesiologist(sp?). They have a lot more experience putting in hard IV's,(like in the foot), then most Registered Nurses do. Just my opinion.
Good luck.
Also forgot to mention, there are many places to put an IV, a foot is not a bad place, but you have to watch, if they would want to get up and walk. They would not want them to. Also make sure you have an experienced person putting the IV in. Preferably a
anesthesiologist(sp?). They have a lot more experience putting in hard IV's,(like in the foot), then most Registered Nurses do. Just my opinion.
Good luck.
Re: Questions, Questions, and More Questions!!!
Hi, Julie. Good questions / concerns. I will try to help based on our experience. Also, fyi, our daughter, Nicole, was 10 months at primary Jan '00 & 23 months at Mod Quad Mar '01 and we were at TCH for both (haven't been to TIRR, so I don't know how that might vary).
>Can the doctor(s) give her something to make her groggy before surgery to make it easier for her to leave us?
Yes, they can give her an oral sedative, aka a "happy cocktail" before she goes into the OR (while she's in the "holding room") that will ease her separation anxiety.
>If so, when do we have to request it (before our trip or at our clinic appt. the day before)?
At TCH, the way it works is on the a.m. of surgery you check in at the reception desk, then you get called in to do paperwork related to insurance / billing, then you meet with a couple nurses including an anesthesiology nurse. When all that's done, you eventually go into the "holding room" until you see the surgeon(s) and anesthesiologist(s). You sign more papers and then take the difficult walk to "the last set of doors" outside the OR. Now to answer your ?, I would request the oral sedative when you initially meet with an anesthesiology nurse and also as soon as you get into the holding room. If your daughter still hasn't gotten the meds by the time the anesthesiologist comes in, let him/her now immediately that you want this "cocktail." The reason I say this is b/c it takes about 20 minutes to take effect so you want to make sure it's timed appropriately for them to bring your daughter into surgery.
>...PCA pumps for pain management. Should we automatically request it because we don't know how Renee is going to deal with the pain? (She seemed fine with the primary surgery, but she is older and it is a different surgery.)
It was our experience (and many others' from what I've heard), that the post-op pain was the worst with primary surgery and was much easier with the Mod Quad. So, if she seemed fine with primary surgery, is is hopeful that she will do even better with the Mod Quad. I don't think they would do the pain pump for your daughter b/c i hthink she's too young for it. When we were there a couple months ago, we asked Dr. Nath about the pain pump for Nicole (who was about
2 1/2 y.o.; we really didn't think we needed it, but just wanted to findout more about it and his recommendation). Anyway, Dr. Nath said that they don't even usually use the pain pump for children as young as Maia (about 3.5 y.o. at the time) and that it was an exception. So, you can ask about it to prepare yourself, but I don't think they will want to do it for your daughter.
>Has anyone requested that the IV be put some place other than the non-BPI hand?
Yes, they put it in Nicole's right (non-BP) hand once and held it secure with a board and she couldn't bend her R arm. This was awful b/c she couldn't feed herself Cheerios. I mean, how cruel is that to do that to someone who had pretty much no use of her other hand??!
>Do we have to ask for a different placement (i.e. foot) the day of surgery?
Yes, I highly recommend talking to the anesthesiologist the a.m. of surgery. You might not want it in the foot though. When Nicole had her MQ, I asked the to put the IV in her foot so that she could freely use her R arm/hand. They honored my request, but it was pretty awkward with trying to go to the potty / changing, etc. Also, Nicole did not like it there (of course, I don't think she would like it anywhere! LOL!). Sooo, this past time, when I talked to them about putting the IV in her foot, they said that is a painful place to put the IV and that they'd rather put it in her (non-BP) arm. I expressed my concerns and they told me that they would do it in a way that wouldn't require them to immobilize Nicole's R arm. Well, they were successful and this was our best option so far.
>I was wondering should we not prick the finger (or thumb-not sure which they do)on the BPI side either?
I don't know the answer, but I would say, no don't let them prick the finger on the BP hand. If you're concerned about pain, then perhaps you could get some of the EMLA cream that Francine posts about.
I hope this helps. I also hope everything goes well with both of your daughters. BTW, I'm tired and sorta falling asleep at the keyboard, so if this doesn't make sense please keep in mind that my eyes are half shut as I type! LOL! Keep asking ?s!! Great job!!
-Tina
-Tina
>Can the doctor(s) give her something to make her groggy before surgery to make it easier for her to leave us?
Yes, they can give her an oral sedative, aka a "happy cocktail" before she goes into the OR (while she's in the "holding room") that will ease her separation anxiety.
>If so, when do we have to request it (before our trip or at our clinic appt. the day before)?
At TCH, the way it works is on the a.m. of surgery you check in at the reception desk, then you get called in to do paperwork related to insurance / billing, then you meet with a couple nurses including an anesthesiology nurse. When all that's done, you eventually go into the "holding room" until you see the surgeon(s) and anesthesiologist(s). You sign more papers and then take the difficult walk to "the last set of doors" outside the OR. Now to answer your ?, I would request the oral sedative when you initially meet with an anesthesiology nurse and also as soon as you get into the holding room. If your daughter still hasn't gotten the meds by the time the anesthesiologist comes in, let him/her now immediately that you want this "cocktail." The reason I say this is b/c it takes about 20 minutes to take effect so you want to make sure it's timed appropriately for them to bring your daughter into surgery.
>...PCA pumps for pain management. Should we automatically request it because we don't know how Renee is going to deal with the pain? (She seemed fine with the primary surgery, but she is older and it is a different surgery.)
It was our experience (and many others' from what I've heard), that the post-op pain was the worst with primary surgery and was much easier with the Mod Quad. So, if she seemed fine with primary surgery, is is hopeful that she will do even better with the Mod Quad. I don't think they would do the pain pump for your daughter b/c i hthink she's too young for it. When we were there a couple months ago, we asked Dr. Nath about the pain pump for Nicole (who was about
2 1/2 y.o.; we really didn't think we needed it, but just wanted to findout more about it and his recommendation). Anyway, Dr. Nath said that they don't even usually use the pain pump for children as young as Maia (about 3.5 y.o. at the time) and that it was an exception. So, you can ask about it to prepare yourself, but I don't think they will want to do it for your daughter.
>Has anyone requested that the IV be put some place other than the non-BPI hand?
Yes, they put it in Nicole's right (non-BP) hand once and held it secure with a board and she couldn't bend her R arm. This was awful b/c she couldn't feed herself Cheerios. I mean, how cruel is that to do that to someone who had pretty much no use of her other hand??!
>Do we have to ask for a different placement (i.e. foot) the day of surgery?
Yes, I highly recommend talking to the anesthesiologist the a.m. of surgery. You might not want it in the foot though. When Nicole had her MQ, I asked the to put the IV in her foot so that she could freely use her R arm/hand. They honored my request, but it was pretty awkward with trying to go to the potty / changing, etc. Also, Nicole did not like it there (of course, I don't think she would like it anywhere! LOL!). Sooo, this past time, when I talked to them about putting the IV in her foot, they said that is a painful place to put the IV and that they'd rather put it in her (non-BP) arm. I expressed my concerns and they told me that they would do it in a way that wouldn't require them to immobilize Nicole's R arm. Well, they were successful and this was our best option so far.
>I was wondering should we not prick the finger (or thumb-not sure which they do)on the BPI side either?
I don't know the answer, but I would say, no don't let them prick the finger on the BP hand. If you're concerned about pain, then perhaps you could get some of the EMLA cream that Francine posts about.
I hope this helps. I also hope everything goes well with both of your daughters. BTW, I'm tired and sorta falling asleep at the keyboard, so if this doesn't make sense please keep in mind that my eyes are half shut as I type! LOL! Keep asking ?s!! Great job!!
-Tina
-Tina
Re: Questions, Questions, and More Questions!!!
The "happy coctail" was great for our daughter (2 1/2) before heading off to surgery. I sat with the resident to sign papers, answer questions while my husband played with our daughter. They told us to watch her closely and stay close by because she would start getting wobbly pretty quickly. Bingo. We laid her in a wagon to be pulled off to the OR and she had the most serene and angelic look on her face! She had no clue what was going on. Perfect.
She also had an iv in her foot. I had her in diapers while at the hospital so she wouldn't have to get up and go potty so, until the iv came out, she didn't get up much. The only thing she remembers from that surgery is the iv in her foot ("it stings"). She talks about it like a badge of honor because her older brother & sister have never done anything like that...she gets all kinds of sympathy from them about it!
She also had an iv in her foot. I had her in diapers while at the hospital so she wouldn't have to get up and go potty so, until the iv came out, she didn't get up much. The only thing she remembers from that surgery is the iv in her foot ("it stings"). She talks about it like a badge of honor because her older brother & sister have never done anything like that...she gets all kinds of sympathy from them about it!
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AshleysMom
- Posts: 20
- Joined: Thu Feb 07, 2002 8:16 am
Re: Questions, Questions, and More Questions!!!
Hi Julie,
Seems you've gotten LOTS of great advice so I won't try to offer you anymore cause I think everything has been covered. Off the record I did notice that you mentioned your 3 yr old going under anesthesia to get her teeth worked? Well my 3 yr old is to at the end of March because she has 6 cavities already. Terrible huh? She's had flouride from day one (Our town water doesnt' have flouride) so we had drops for her. She's been to the dentist routinely but for some reason her teeth have been prone to decay & she will NOT let the dentist even put the mirror in her mouth. It was a tough choice but we know once the decay is severe she would have some terrible tooth aches so we opted to nip it in the bud. If you don't mind would you let me know how it went? Thanks Alot, Melissa
Seems you've gotten LOTS of great advice so I won't try to offer you anymore cause I think everything has been covered. Off the record I did notice that you mentioned your 3 yr old going under anesthesia to get her teeth worked? Well my 3 yr old is to at the end of March because she has 6 cavities already. Terrible huh? She's had flouride from day one (Our town water doesnt' have flouride) so we had drops for her. She's been to the dentist routinely but for some reason her teeth have been prone to decay & she will NOT let the dentist even put the mirror in her mouth. It was a tough choice but we know once the decay is severe she would have some terrible tooth aches so we opted to nip it in the bud. If you don't mind would you let me know how it went? Thanks Alot, Melissa
Re: Questions, Questions, and More Questions!!!
Hi julie - you got great advice. The one thing I will comment on is the PCA pump and personally I think that every child should get this. Maybe I've paved the path here with this one I don't know..but since the parents are with the child at all times, then a pump like this is now possible for a young child....just for the asking.
This PCA pump allows the child to get through those horrible hours after surgery without having to have too much pain.
Maia had pain after primary but she had unbelievable pain after Mod Quad - she was basically on the ceiling - bucking her whole body freaking out. I had no choice but to seek out pain relief for her that would work. I actually told Dr. nath that we were not going to do any more surgery unless we had a pain specialist working with us because I refused to have Maia so tortured.
How does it work? It allows you to dose your own child with very small amounts of morphine. It is a pump that is attached to your child's IV line - so there's no additional invasive procedures to have it. The IV line is already there. All it does is allow you to administer the drug more often BUT it is in smaller amounts. So we were allowed to press the button every 20 minutes and the machine locked us out inbetween so we could not overdose her.
The child is not as in much pain and therefore does not get as fearful - this is my take on it (with our experience with Maia). And within a very short time, Maia was more able to cope on her own because she trusted that it would be ok. By that first night her dosing was VERY far apart... we went from 20 mins to just ONCE that first night until the next day - at splinting, then we pumped it 3 times before splinting and that was it. So in essence Maia got much LESS drug than she got last time with the mod quad AND she got MORE relief becuase it was spaced when she needed it rather then when it was just time for her to get it. She never dropped down and never freaked out. Am I making sense?
I feel very strongly that our kids go through enough in their little lives and that if they have to have multiple surgeries, they should get pain relief. If you have had surgery yourself, then you know that the pain right after surgery is just horrendous. I did not want Maia to suffer like that anymore. Made no sense to me.
On the other side - everyone has to make their own decision. And if you feel that your child has a high pain tolerance and won't have the need for pain relief then great. Unfortunately - Maia is a very sensitive child and gets very upset easily.
good luck and take care,
francine
This PCA pump allows the child to get through those horrible hours after surgery without having to have too much pain.
Maia had pain after primary but she had unbelievable pain after Mod Quad - she was basically on the ceiling - bucking her whole body freaking out. I had no choice but to seek out pain relief for her that would work. I actually told Dr. nath that we were not going to do any more surgery unless we had a pain specialist working with us because I refused to have Maia so tortured.
How does it work? It allows you to dose your own child with very small amounts of morphine. It is a pump that is attached to your child's IV line - so there's no additional invasive procedures to have it. The IV line is already there. All it does is allow you to administer the drug more often BUT it is in smaller amounts. So we were allowed to press the button every 20 minutes and the machine locked us out inbetween so we could not overdose her.
The child is not as in much pain and therefore does not get as fearful - this is my take on it (with our experience with Maia). And within a very short time, Maia was more able to cope on her own because she trusted that it would be ok. By that first night her dosing was VERY far apart... we went from 20 mins to just ONCE that first night until the next day - at splinting, then we pumped it 3 times before splinting and that was it. So in essence Maia got much LESS drug than she got last time with the mod quad AND she got MORE relief becuase it was spaced when she needed it rather then when it was just time for her to get it. She never dropped down and never freaked out. Am I making sense?
I feel very strongly that our kids go through enough in their little lives and that if they have to have multiple surgeries, they should get pain relief. If you have had surgery yourself, then you know that the pain right after surgery is just horrendous. I did not want Maia to suffer like that anymore. Made no sense to me.
On the other side - everyone has to make their own decision. And if you feel that your child has a high pain tolerance and won't have the need for pain relief then great. Unfortunately - Maia is a very sensitive child and gets very upset easily.
good luck and take care,
francine
Re: Questions, Questions, and More Questions!!!
Julie - one more thing....
about the pin prick... ask your ped for a prescription to EMLA...it is a numbing cream. One hour before you go to the doc for the test, put on EMLA and she won't feel a thing.
Don't prick the bpi hand. I thought the same as you when Maia was a baby but have since learned that needle pricks in the bpi arm is bad - decreased circulation, increased chance of infection.
EMLA is unbelievable!! use it for vaccinations, IV's, any invasive procedures.... and if the IV falls out at the hospital and they have to put it back in...ask them for EMLA for that as well.
-francine
about the pin prick... ask your ped for a prescription to EMLA...it is a numbing cream. One hour before you go to the doc for the test, put on EMLA and she won't feel a thing.
Don't prick the bpi hand. I thought the same as you when Maia was a baby but have since learned that needle pricks in the bpi arm is bad - decreased circulation, increased chance of infection.
EMLA is unbelievable!! use it for vaccinations, IV's, any invasive procedures.... and if the IV falls out at the hospital and they have to put it back in...ask them for EMLA for that as well.
-francine
Re: Questions, Questions, and More Questions!!!
Hi Julie- just me again....
Your post brought up something in me...and it's a reminder that no matter what hospital we take our children to, it is still a hospital and we still have to be complete advocates for our children.
A chief of something (forgot which department) came to visit us when he did rounds with his associates (it was the pain service team - but I still don't know what he was chief of LOL) - anyway - I asked why PCA pumps have to be asked for and why EMLA has to be argued about and he said something very interesting.
He said that I was going to be shocked at the next thing he was going to say and that he was telling me this from his own experiences as a patient in a hospital: 'HOSPITALS ARE NOT THERE FOR THE PATIENT'S SAKE'... hospitals are corporations with employees and everything that's done there (in terms of the running of the hospital) is for means of efficiency and cost effectiveness.
So you know your child best. Trust your gut. Hospital visits can be very traumatic for your child. Do anything you can to lessen the trauma and to make your child feel at ease. When your child is at ease - then there are less stress hormones and healing comes much faster.
If it's EMLA you want for a procedure and the nurse scrunches up her nose at it - so what? - let her scrunch - you're there to make your child's visit less traumatic - not save the nurse a couple of extra steps.
So I guess my message is..... BE YOUR CHILD'S ADVOCATE.
YOUR CHILD COMES FIRST!
stepping off my soapbox,
francine
ps - make sure renee has pain meds before splinting ok?
Your post brought up something in me...and it's a reminder that no matter what hospital we take our children to, it is still a hospital and we still have to be complete advocates for our children.
A chief of something (forgot which department) came to visit us when he did rounds with his associates (it was the pain service team - but I still don't know what he was chief of LOL) - anyway - I asked why PCA pumps have to be asked for and why EMLA has to be argued about and he said something very interesting.
He said that I was going to be shocked at the next thing he was going to say and that he was telling me this from his own experiences as a patient in a hospital: 'HOSPITALS ARE NOT THERE FOR THE PATIENT'S SAKE'... hospitals are corporations with employees and everything that's done there (in terms of the running of the hospital) is for means of efficiency and cost effectiveness.
So you know your child best. Trust your gut. Hospital visits can be very traumatic for your child. Do anything you can to lessen the trauma and to make your child feel at ease. When your child is at ease - then there are less stress hormones and healing comes much faster.
If it's EMLA you want for a procedure and the nurse scrunches up her nose at it - so what? - let her scrunch - you're there to make your child's visit less traumatic - not save the nurse a couple of extra steps.
So I guess my message is..... BE YOUR CHILD'S ADVOCATE.
YOUR CHILD COMES FIRST!
stepping off my soapbox,
francine
ps - make sure renee has pain meds before splinting ok?
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DebbieJean
- Posts: 72
- Joined: Wed Feb 06, 2002 10:51 am
Re: Questions, Questions, and More Questions!!!
Julie,
Another comment, I would agree with Francine, in that you have to be there for your child. If you have to argue about the PCA pump, do it. There is no difference in side effects of oral meds vs. IV meds.
They have the same complications, basically.
The IV meds, just have a "sustaining effect". Where with oral, you have to give them every couple of hours, and if you miss giving it on time, then the
pain threshold will decrease, and you could lose all the pain effects of the medicine.
I would talk to the pain management crew of the surgery. Child should not suffer needless pain.
We have to discuss this with our doctors, and they have to discuss our opinion of this. For when one doctor says they don't give IV meds, another will.
Stick to what you feel is right, for your child.
I would also question, why the doctor does not use a PCA pump? What is the reason for this? Is it just a personal opinion? Ask them about the meds they would use orally. The meds that they would use in an IV.
What is the difference. How they access a child in pain, on what levels. What will they do if the pain meds they give, doesn't not work good. Some people certain pain medication does not work for them very well, and have to find a med that does. (It all depends on their own body, and tolerance.)
Well, I hope this helps. It's just my opinion.
Take Care.
Another comment, I would agree with Francine, in that you have to be there for your child. If you have to argue about the PCA pump, do it. There is no difference in side effects of oral meds vs. IV meds.
They have the same complications, basically.
The IV meds, just have a "sustaining effect". Where with oral, you have to give them every couple of hours, and if you miss giving it on time, then the
pain threshold will decrease, and you could lose all the pain effects of the medicine.
I would talk to the pain management crew of the surgery. Child should not suffer needless pain.
We have to discuss this with our doctors, and they have to discuss our opinion of this. For when one doctor says they don't give IV meds, another will.
Stick to what you feel is right, for your child.
I would also question, why the doctor does not use a PCA pump? What is the reason for this? Is it just a personal opinion? Ask them about the meds they would use orally. The meds that they would use in an IV.
What is the difference. How they access a child in pain, on what levels. What will they do if the pain meds they give, doesn't not work good. Some people certain pain medication does not work for them very well, and have to find a med that does. (It all depends on their own body, and tolerance.)
Well, I hope this helps. It's just my opinion.
Take Care.