Coming surgery

We currently don't have a date for Raphael's next surgery. We are waiting for Raphael's anaesthetist to return and then, presumably, a date will be arranged for the surgery.

We expect the following will be performed:

• ENT endoscope (performed after the pre anaesthetic medication but before the GA is issued)
• tear duct probe
• G-tube insertion
• fundoplication (here is a video of a fundoplication performed by laparoscopy. Raphael will actually have his performed by laparotomy to reduce the risks of complications.
  

Next operation scheduled for 14 June 2007

I have just been in contact with Raphael's Ophthalmologist who has found the scheduled date for Raphael's next operation which is on 14th of June 2007.

This procedure is currently planned to include

• Installation of a "mic-key button" g-tube
• fundoplication
  
• probing and flushing tear ducts

My wife is still unsure about the open surgery and fundoplication and so she would like to speak to our paediatrician again before the operation.

More on this topic to later.

An informative day in the hospital

Our paediatrician talked to me this morning. All the relevant consultants now agree that it is a good idea to proceed with inserting a g-tube and performing a fundoplication. We have a tentative date booked in three weeks for the operation but this is dependant on there being an intensive care bed available after the procedure.

I also finally managed to get copy of a stack of reports that I was missing. The consultants are generally too busy to chase down reports so the best thing to do is to ask a nurse (or intern/resident/registrar) to get copies of all the reports ready for the consultant so all the consultant has to do is say "give the reports to them".

Still in hospital

Raphael is still on oxygen when sleeping otherwise his oxygen level maxes out at 85% and drops to the mid to low 70's frequently. The paediatricians say that they want him to be above 90-92%.

Early today we had a visit from a paediatric surgeon resident to have a quick chat about having a G-tube surgically placed via a laparotomy and also possibly performing a fundoplication. This initial consultation was mostly fact finding for the paediatric surgeon with some very basic information for us.

At 2:30 pm a session was arranged to give me an introduction to CPAP (Continuous Positive Air Pressure) and how we are going to introduce it to Raphael in the hope that it will overcome his obstructive sleep apnoeas. One thing which really stuck in my mind was when they said that applying CPAP for a child is a life altering decision becuase of the large amount of work involved in maintaining it at night through the alarms and potential issues that itself can cause. The meeting had our paediatrician, two intensivist consultants (intensive care doctors) and two home care nurses who are going to help us maintain this system long term.

Unfortunately (or one could argue fortunately) some of the equipment that was set aside for Raphael's CPAP was intercepted in an emergency for another child so we were not able to start CPAP on Raphael tonight. They pointed out that although CPAP is used widely, it is very difficult to find a mask that fits an infant well becuase the major market for these sorts of devices is for "fat men who drink too much".

We are planning to start the CPAP tomorrow at 3:00pm during Raphael's afternoon sleep.