Thursday, November 22, 2012

The Cornea Transplant

Yesterday Geri got he new cornea. I honestly still don't truly believe it happened, because she's recovering so well that you can't hardly tell it happened. If she weren't wearing a clear eye shield, you'd never know that she had her eye cut up just yesterday.

The morning of the surgery started with a 4:45am departure for Denver. Our pastor met us as the surgical center, and we got her paperwork completed and brought her back for prep. Pastor waited in the lounge area until she was prepped and ready to go back.

It's sort of sad how good we've gotten at anesthesia. We know every in and out of Geri's surgical prep. At this point, I can tell the nurses exactly when and where they can check her vitals and how in order to keep her calm. Blood pressure on the leg, not the arm. Pulse ox on the toe, not the finger. Change her into the hospital gown as late as possible. I'll do the eye drops myself, thanks. And it's sad when you can tell the anesthesiologist that she does really well with propofol, the Midazolam seems to really screw her up in recovery, skip the laughing gas because it really doesn't help, and you know exactly how to hold your child so that when they go totally limp you are ready. We are pros at anesthesia at this point, and sometimes that makes my heart hurt a bit.

The staff at Harvard Park Surgery Center were really great.  They were very nice, very cooperative, very reassuring. They made Geri's prep as easy as possible, and I really appreciated that. Closer to surgery time, Pastor came back and we prayed over her. Then Dr. R showed up and talked to us a bit before the main event. He told us that we were really lucky, the "tissue" was very good, very healthy. He said that it came from a 2 year old, which sort of floored me for a moment. He double-checked a few things, we put on our bunny suits, and we headed back to the OR. There was a funny moment when we walked in the OR and there was no bed in the room because the nurse was bringing it in and I looked at the anesthesiologist and said "So, are you just gonna hold her the whole time?" The bed was right behind us, and soon Geri was on it getting the gas and being super brave and then she was out. We kissed her, prayed over her, and on the way out I prayed over Dr. R.

An aside, I do this EVERY TIME she has an operation. Dr. B is getting used to it, I think, but it seems to surprise docs when the mom says "May I pray over you?" on the way out to the waiting room. So far, everyone is really cool about it. I have not had any doctor or nurse refuse my offer, I think because they realize that they don't have to be a Christian for me to be one and it matters to me so they let it fly. Which I appreciate, because if a doctor ever said no I think I'd just do it anyway. I really only ask first because I put my hand on them when I do it, and I try to announce myself before touching strangers. Just a policy I have.

We headed out to the waiting room and Pastor was still there. He hung out with us, watching TV and discussing comic books (we have a really cool pastor) until Dr. R came out about an hour later to talk to us. Of course, he comes out while I'm in the bathroom but he was still there when I got back and there really wasn't much to discuss anyway. We would be seeing him in his office at 1230, so he was going to give us the after-care details there. He said that the surgery went fantastic, that everything was in place and it looked great. We thanked him and he left. Pastor said his goodbyes and we prayed with him and then he left, too, and we went back to see Geri in post-op.

Wow, this is turning into a loooooong post. Oh well, if you're still here then I guess you're in it for the long haul so I'll keep trucking. Perhaps all this detail is boring for most people (it's ok, I understand) but I suppose if anyone ever has to go through a cornea transplant for their kid and they want to know about how it all works, this could be useful.

Anyway, when we got back Geri was still mostly out but starting to become more awake. Her eye was thoroughly bandaged and covered with a clear plastic shield. Another benefit of being very used to anesthesia - I know exactly how to handle her when she wakes up! I told the nurses to remove all the stickies from her chest while she was still groggy, that was it pisses her off only briefly. Same thing for the IV, although some nurses don't like that idea. They want to keep the IV in just in case the kid won't take fluid orally. They need to make sure the child stays hydrated. However, I've done this enough times to know that she will take the oral liquids more readily if there isn't an IV in her hand or arm pissing her off. This nurse was awesome and took out the IV when I told her that. I also got them to take off her blood pressure cuff and bring over a comfy chair so I could sit in the chair and hold her in my lap. At this point, Geri was rousing and starting to be pretty pissed, but as soon as we got into the chair she laid her head on me and fell asleep again. She slept for another hour or so. The nurse was great about checking her blood pressure on her leg, to avoid ticking her off again. It worked like a charm.

When Geri woke up she was hungry, so we gave her some vanilla pudding and a BUTTLOAD of graham crackers. Here's another point of interest. When Geri comes out of anesthesia, she gets something I like to call "Drunk Face." Ever get drunk and your nose and mouth area seems to feel numb? Yeah, when Geri is coming off the anesthesia she rubs her nose a lot and won't drink from a cup or a straw. I think it's because her nose and lips feel numb and awkward. She drank apple juice off a spoon, but wouldn't touch it from a straw or cup. Poor thing. But she was loving those graham crackers.

She was in surprisingly high spirits, so when she finished her crackers we changed her and packed up and left. On the way out we knew it was lunch time so we mentioned pizza and she got all sorts of excited. We hit Anthony's Pizza and she ate a huge slice of cheese pizza. She was in an unbelievably good mood. After that, we headed to Dr. R's office.

Another piece of useful post-op info... it's totally normal for your child to run a low-grade fever after surgery. We didn't know this, and it hadn't happened before, so we freaked. Oddly enough, Dr. R's office did not have a single thermometer. I guess with his specialty, it just doesn't come into play. She felt warm, and we were nervous, but he reassured us and recommended we get with her primary care doc to be sure. He was certain, however, that this was not a danger to her eye and the new cornea. He removed the padding, and from what he was able to get a look at he said the eye looked "perfect." He sounded super confident and was very pleased with the results. He said again that the tissue was just unbelievably good and healthy, so he had total confidence that the transplant would be a success and bring a huge improvement to Geri's vision in that right eye.

We headed home, with a pit-stop at her pediatrician's office to find out her temp was 99.2 and she was fine, and then I ran out to fill her prescriptions. The post-op care for this procedure is not terribly complicated, but there's SO MUCH of it. In addition to her normal medications, she now is getting steroid eye drops 6 times daily (works out to every two hours while she's awake) and antibiotic eye drops 3 times. This is the regimen for the first two weeks, until we see Dr. R again and he revises the schedule based on how well she's doing. The eye shield stays on 24/7 for probably a month or so, then she'll wear it when she sleeps for another 3-4 months. She can't be permitted to rub or press on the eye at all. She will have EUAs every 6 weeks until about the 9 months mark, depending on how everything is healing. The stitches stay in for about 6 months, I think. Again, it depends.

What is most amazing about this surgery is how well she is doing. She's had far less of a developmental setback than we had feared. She's being rather clingy with Nick, and she's no eating as well as normal, but otherwise she is doing great. She's still using her words as much as before, so no verbal setback. She's walking around just fine, no gross motor setback. With the clear eye shield we are not seeing a huge setback visually, but she can't wear her glasses right now because they don't fit over the shield, so she seems to be seeing less clearly as a result. Still, she's playing and laughing and there are moments when I look at her and say "Did I imagine that whole surgery thing?" It's really surprising, and I know this is a blessing from God. He has smiled on this process and made it smooth for her, and I'm so grateful.

If you actually read this entire post, thanks. I appreciate it. I hope it gave you some insight into this type of surgery, what all it entails, and perhaps that info might be useful to you or someone you know. Honestly, that's the only reason I do this blog. I hope that our experiences might be helpful for someone else, in the form of info or encouragement, and that's why I overshare so much. Thanks for listening, I hope it was of use to you. :)

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