24 Hour Followup

As of 4:00PM today, we are all home.

After I picked up Jonathan from school this morning, we went down to Children's to visit and ended up staying the balance of Ethan's stay.

The bandages were removed this morning so the doctor could check everything out. They were very pleased with how things looked.

There is a discoloration of the iris where the dermoid used to be. It appears as an area of opaqueness. From a distance it is not noticeable but closer up, you can definitely see it. Apparently this is not so much the result of the what may still be left of the dermoid (in fact, there is very little left of the dermoid - you would probably need a microscope to see what cellular material may be left) but more a function of the way the dermoid formed and affected the layers of collagen that comprise the cornea. Hence, this opaqueness will never go away or get lighter. Still, it is a marked improvement over how it looked before the dermoid excision.

At our request, the doctor put the bandages back on and we will leave them on for another 24 hours and remove them ourselves sometime tomorrow. This is primarily due to my paranoia about letting the surgical site heal without any disturbance from Ethan rubbing the area. (The upper most layer of the cornea (I believe it is the corneal epithelium) regenerates within 24 hours and this is why I wanted to have the bandages put back on just to be on the safe side).

The part of the sclera where the dermoid was (the white part of the eye) is pretty bloodshot at the moment due to the surgery. This will subside in about 2 weeks.

We will have a followup with ophthalmology in one month. This will more or less coincide with our next visit with Nutrition and at that point we believe the decision will be made to leave or remove the G-Tube.

On another note, the anesthesiologist who presided over Ethan's surgery came to talk to Dina today on his day off because he felt it was important to explain what had happened during intibation. The intibation itself actually took about an hour and he had to call in two other anesthesiologists to assist. A scope was placed in through Ethan's nose in order for the doctors to see better and then a tube was also placed through his nose this time to intibate. The anesthesiologist drew Dina a picture of what he saw once they could see in his throat. The vocal chords form a triangular shape and all three sides should be visible. This was not the case in Ethan. Only two sides were visible. The other side was obstructed by extra throat tissue. Once the anesthesiologists had gotten the tube in his throat, the excess tissue kept closing up onto the tube causing the whole intibation process to stop. Once the tissue opened up again, the doctors were able to continue with the initibation. This is what made the process so long. The anesthesiologist felt that Ethan's intibation should have been easier than the intibation in June because he is bigger, but that turned out not to be the case. He warned us that we need to tell any anesthesiologists of Ethan's difficult intibations should he need any further surgery at another hospital in the future. The anesthesiologist also feels that the next intibation Ethan has in 5-7 years should be easier.

It is just speculation at this point, but the extra throat tissue could be causing some of Ethan's breathing and/or swallowing difficulties. The anesthesiologist is going to talk to Ethan's main Craniofacial doctor and his Ear, Nose, and Throat doctor about what he observed during the surgery.

- bob