Tag Archives: probing and irrigation of tear ducts

Surgery Day

I have to admit….this 10:30 am check in for the hospital was pretty strange. I felt like we were late the whole way here! We normally have to check in at 6:30 am! I’m definitely thankful for the couple extra hours of sleep.

We arrived at 10:00 am and had the fastest check-in in the history of check-ins! We were checked in, registered, and in a room by 10:15 am. The nurse took vitals and got all the paperwork started for us. Braxton was starting to get a little cranky so dad took him to find one of the little tikes cars they have and pushed him around in the hallway.

The boys played while we waited for quite a while for all of the doctors to arrive.

Once everyone got there, we spoke with each one individually about what to expect today. We were able to address our concerns with the anesthesiologist about his new RTS diagnosis and risks of anesthesia associated with that. Braxton has not had any issues with previous anesthesia events, but I wanted to be sure they knew exactly what to look for. One of his doctors called me herself and voiced her concerns about Braxton being put under, and she told me that normally she recommends an overnight stay for observation in children with multiple medical issues. Since he has not had issues before, she said she will leave the decision up to the anesthesiologist. We are prepared for an overnight stay, but hoping for a late afternoon release. We did learn that Braxton his having a new type of anesthesia since he is having a circumcision. In addition to the gas he will be receiving, he is also getting a shot in his low back to numb his groin area for 4-6 hours to help curb any discomfort even when he wakes up after the procedure. He’s never had this before, so that’s the worrisome part for me this time. He will have 4 procedures today and I’m not totally sure how long he will be under.

Just before noon, the nurses took Braxton back to the operating room to get everything started. This part never gets any easier.

See you soon, little man.

See you soon, little man.

UPDATE: 1:30 pm – Just spoke with the ophthalmologist. The first procedure is done. She attempted the probing and irrigation of his tear ducts again and if the ducts were big enough, the silicone stents would be put in. She reported that Braxton was doing well and she was able to probe and irrigate the tear ducts successfully. This time she was able to use a few larger probes than the first time when only the smallest would even insert in to the tear duct. She also told me that when they irrigated, that the fluid DID drain through the nose, so that tells us that his tear ducts ARE in tact. There was also a “pop” sound that indicates they were able to push through a blockage. Unfortunately, she was not able to place the stent. It kept running in to a hard spot which is possibly hard tissue or his nasal bone. Hopefully being able to irrigate completely will be enough to help Braxton clear his eyes up. If not, the next step is Jone’s tubes which are the glass tubes I wrote about previously. That would be another couple years away, if it is necessary. The urologist is now beginning the circumcision. Will report back when we get the next update.

UPDATE: 2:08 pm – And just like that, Procedure #2 is done. Spoke with the Urologist and she was able to do the circumcision without any issues. Recovery will be a couple of weeks and some other precautions for a little longer than that. We’ll follow up with her office in a month. Braxton is still doing well under the anesthesia. She said the anesthesiologist is fairly confident that Braxton will not need to stay overnight. *whew* They are getting ready to start the ABR now to check his hearing and see if the hearing loss is better, worse or the same. This part can take up to 2 hours, so update in a few!

UPDATE: 3:35pm Braxton just finished with his ABR. We met with the Audiologist who performed the test and she reported that there was a slight decrease in his hearing. :/ This kinda bums me out. He really seems to be hearing better when he is not wearing his hearing aids, so I was hopeful it had gotten better. He may need a slight adjustment on his hearing aids now, but we will follow up with his ENT and Audiologist later to be sure. He should be finishing up with the final part of today which is a CT scan of the inner ear to check for any structural abnormalities that would effect his hearing or speech. Hopefully our next update will be from the recovery room after we’ve seen him.

UPDATE: 4:33 pm Braxton is done for today. We are in a recover room waiting for him to fully wake up before we can go home.

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UPDATE: 7:27 pm – We are finally home! Braxton is feeling a little more like himself and having some spurts of energy here and there.  When we arrived, a special gift was waiting for us in our mailbox.  Tinysuperheroes is an organization who sends superhero capes to children with various medical conditions to help empower them and make them feel like the superhero they are inside! Braxton received a cape today! He’s sure to make a speedy recovery now that he can officially channel his superhero powers. Fitting ending to a hectic day.

Even super heroes need their rest.

Even super heroes need their rest.

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Surgery is No Easy Decision

Welp, we saw the Ocularplastic Surgeon today, and Braxton will definitely need surgery to have Jone’s Tubes placed in his tear ducts. BUT, the surgeon doesn’t think there is any need to rush in to the surgery just yet because the procedure is so high maintenance.

The doctor confirmed that Braxton’s upper tear ducts are absent and he agrees that his lower tear ducts are incredibly small, and probably still too small to try the silicone stents.  Since probing was already tried and unsuccessful, the next thing would be the silicone stents, but if a probe won’t go in a tube won’t either AND it’s more of a temporary fix, so it’s time to consider other options. I asked about possibly surgically opening the entrance to the tear ducts so we could do the silicone tubes, but the doctor said if the probe won’t go in, it’s likely the tear duct system isn’t functioning properly, so it wouldn’t help.  He explained another procedure called Dacryocystorhinostomy (DCR) Surgery that would be done IF Braxton had upper tear ducts. With DCR surgery they would break a small part of the nasal bone to redirect the tear duct to drain to the nose and bypass his natural tear duct system.  This is ideal, but Braxton doesn’t have the upper ducts. So, the only other option now is Jones Tubes. With the insertion of Jones tubes, a small piece of the nasal bone is still broken, but in addition, a GLASS tube would be inserted into the tear duct to physically construct a passage way for the eyes to drain.  Yes, you read that right, a glass tube will need to be inserted into my child’s face.  When we were told about this previously, I didn’t realize it was a glass tube! (Image source)

This. In Braxton's eye. o_O

This. In Braxton’s face. o_O

The doctor explained that he said the procedure is high maintenance, not because it requires a lot of care, but because it requires a lot of follow up and adjustments with complete sedation any time any adjustments need to be made since Braxton is so young.  In adults, the adjustments can typically be done in office.  Some of the issues he mentioned were having the tube fall out, the tube breaking, the tube being moved out of place and needing to be repositioned, etc.  My mind was reeling at this point and about 50 questions poured out. If it’s glass, does that mean just bumping it the wrong way can break it? If he falls on his face the tube can break? Can it break and just sit in there? What? It can? So how do we know if it’s sitting in there broken?! How can it just fall out? If it’s broken and part of it comes out can the other part injure him inside? What about recovery time?  etc, etc, etc….sooo many worst case scenarios immediately came to mind and poured out (better than my own tears instead I suppose) The doctor told me these were all valid scenarios which is why this is a decision that really need to sit down and consider heavily before proceeding.

What if it was your child? [If you are ever unsure, ask this question and you’ll get an honest opinion.] I did ask.  The doctor said if this was his child, he’d wait.  He said he would give the child more time to grow and wait until he could walk and some of the danger of falling, crawling into a wall, or bumping his face would be removed, but that he would definitely have the procedure done.  For Braxton, he said this is really probably the only option if the ducts don’t open on their own as he gets older, so we could give him more time and just deal with the goopy, crusty eyes for now, and re-visit the placements of the Jones Tubes in a couple years.  He said he didn’t feel the procedure was extremely critical right now, but that Brax would most likely need it done and that he would talk to our ophthalmologist to see what she thinks and why she was recommending the tubes now to begin with.  Ultimately, it is our decision, but he wants to speak to her directly to see realistically what can be expected.

*sigh*

Now, it’s time to weigh our options and decide what we are going to do for Braxton.  On the one hand, waiting is great. He doesn’t need it right now? Awesome, see ya in a few years doc. But on the other hand, Braxton wakes up with eyes crusted over at least 80% of the time. Even taking a nap, when he wakes up goo is all over his eye, making it impossible to see.  The skin around his eyes is so red and irritated from all the cleaning we do throughout the day with warm washcloths and baby wipes.  If I go anywhere near his eyes, he just freaks out.  He barely tolerates having his eyes cleaned anymore.  It kills me to see him like that.  While it doesn’t appear to cause him any physical pain, I know how I feel when my eyes are crusted from allergies or pink eye so I can’t imagine what he feels like! The doctor says he is fairly certain it doesn’t affect his vision, but I don’t see how it doesn’t. Surely, trying to see through goop all day can have some effect, no? OH, I dunno. All I do know is that I need to wrap my head around this and make some decisions.  We follow up with our ophthalmologist at the end of May and hopefully she can provide some more answers.

you can see some of the goopiness...it's usually worse, but today is a good day.

you can see some of the goopiness…it’s usually worse, but today is a good day.

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