Home from the Hospital

We are home from the hospital and Annabelle is doing well. Michael continually updated a post about Bella's surgery while we were at the hospital, but I will share more details now.

We arrived at the hospital at 5:30 AM much happier than expected, given the early hour and lack of breakfast. The air feels wonderful and cool that early in the morning, which made the walk from the parking lot to the hospital very pleasant. Bella was supposed to go into the OR at 7:30, but due to an emergency at a different hospital, her doctor didn't arrive until 9:15. She was starting to ask to eat, but we were able to distract her. Bella got her Versed and Tylenol at 9:20, and she rolled back to the OR at 9:45 or so. The anesthesiologist inserted an LMA (laryngeal mask airway), which is less invasive than standard (endotracheal) intubation but provides better airway control than just a mask.

ENT
Dr. Richter did a scope of her airway to get a better look and take pictures. The picture below is abnormal, but her airway is normal further down. The curved piece in the picture is her epiglottis, which ought to be much more straight. The arytenoid cartilage below the epiglottis is too short and too tight, tying down the epiglottis and pulling it into the curved position. During the scope, he was able to watch that curved tissue close up, further obstructing her airway. Also, there is too much tissue in the arytenoid cartilage, and that extra tissue flops into her airway and blocks airflow into her trachea.


Annabelle's airway
For reference, here is a slide showing what the airway ought to look like in that same view:

The surgical procedures to fix both of those things are very simple and have no expected complications, although it does require an overnight stay in the hospital. At this point, because she has no symptoms other than stridor (noisy breathing), he did not do anything besides take these pictures. Her anatomy is such that she might require the procedure down the line, as her case is the type that will show up between ages 4 and 7 with asthmatic-type problems during athletics due to unresolved laryngomalacia. However, she is definitely not having any problem with her activity level, so we will just wait and see if hers resolves.

Ophthalmology
Dr. Westfall put a stent into the tear duct in her left eye. The stent is a small rubber tube resembling a rubber band (but not a full circle). There are two tear drainage ducts on the inside of the eye next to the nose; one below the eye and one above. He inserted the ends of the stent into each of those ducts, making a small loop in the corner of her eye next to her nose. The ends of the stent were tied down inside her nose. Hopefully she won't pull it out before it is time for her doctor to remove it! I haven't seen the stent yet, but he said that if I look closely I should be able to, although Bella probably cannot feel it at all. The first stent he tried to use (a Crawford tube) did not fit in her tear duct because she has a tight curve in the drainage system that probably further prevents tear drainage. He had a different type of stent which did work, though. He expects her eyes to drain well now that he opened them up again, and once he removes the stent, it should be normal. Her right eye had cleared up on it's own, so he didn't do anything to that eye.


(Image credit, although the text
on that site is unrelated to Annabelle's condition.)
The procedure was finished at 10:50, and we were able to see her shortly thereafter. They gave her some morphine before she left the OR, but when I walked into the recovery room, she was still very upset. She was extremely floppy because the anesthesia hadn't completely worn off, but she was crying and flailing and fighting everything. She had a bloody nose and bloody eye from the stents, so her nurse and Michael kept trying to protect my clothes from the blood. I didn't mind the blood, though; I just wanted my baby to be happy. Bella was so wiggly she actually squirmed completely out of her own hospital gown. She kept hitting anyone who got close to her, so I received many slaps in the face. Her major concern seemed to be the board strapped to her arm to keep it straight so it wouldn't bother the IV in her hand. A lullaby calmed her down briefly, but it didn't last long. Eventually she took a sip of juice, which meant that the nurse could take the IV out. After that, she was able to drift off to sleep in my arms.

Annabelle was discharged from the hospital at 12:30, and she slept most of the car ride home. She was hungry for lunch, but after getting some food in her tummy, she was clearly tired, so I put her down for a nap.




Bella slept for 5 hours this afternoon before I went in to check on her, which woke her up. She specifically requested ice cream for dinner, so she had some sherbet and then some pizza. After that, she just wanted to snuggle and read books until I put her to bed. She seems to be doing fine. The only meds she needs are Tylenol and some eye drops (and of course her usual Prevacid). I hope tomorrow is more back to normal. Gabi deserves to have something fun to do. She is a wonderful big sister and was very understanding of Bella not feeling well, but today was still boring for her. She loved any occasion I gave her to help care for Bella, such as bringing her Lily bunny or giving her a kiss.