Discussion With Dr. J.

During my discussion with Jack’s doctor last week I went over my list of questions.  Maybe this will help you understand a little more than the basics of the operation and a little a what we are preparing to go through.

1.       Let’s discuss Jack’s “attacks”

a.       Dr. H recommends no tube under anesthesia

                                                               i.      I’m fearful of not having one and there being an emergency where one is needed and it’s difficult to get in

He listened to my concerns, but I am not clear on how they will proceed

b.      Will racemicepinephrine be on hand?

Given history, yes

c.       Will he be on steroids?

Didn’t get a clear answer here as it may be up to ENT (ear, nose, throat) doctor

2.       How long do you think the hospital stay will be?

A couple of days.  Also said a day or two.

3.       Will he be in PICU?

A PICU (pediatric intensive care) bed will be reserved

4.       How long will the surgery be?

About 3 hours

5.       Will you put the IV in after he’s asleep?

Yes

6.       Can he take a small toy/blanket in with him?

Yes

7.       Will you be the only surgeon?

Other than fellows who will be present, yes.  He will be the main surgeon.

8.       Will he need blood during surgery?

No – Hey, that’s one good thing J

9.       Do you think you’ll find any “surprises” when you open him up?

Given what he’s seen on x-rays, no

10.   Will this be a one surgery day, or might you have to go back in? (when he had his reductions, the doctor tried a closed reduction, but had to take him back in for an open reduction)

Jack should only go into surgery for this procedure once.  There will be another surgery in 12 – 18 months to remove the pins and plate.

11.   Can he pick the color of his cast?

Yes.  There is even the possibility of having a design such as trucks!

12.   What position will the cast be in?

It will go up to his chest and down his right leg.  His left leg will be totally uncovered and free to move.

 

13.   Can he walk in the cast?

If he learns to walk in the cast, we don’t have to keep him off the leg.

14.   Will we have use of a wheelchair?

Normally, no, but they are going to check and see if they can get insurance clearance.  This is especially important given that Jack will go back to school mid-way through the cast period.  I cannot expect the school to use a stroller, wagon or carry him.

15.   Will he needs a brace after the cast comes off?  If so, how long?

No brace.  At least some good news.

16.   Will he need physical therapy given his already weak core / poor gross motor tone?

It is possible, but we will evaluate at that time.

17.   Will he be in much pain after the surgery?  After the cast comes off?

Every child is different.

18.   How will we manage pain?

Hopefully he won’t need pain management.  He has a pretty high pain tolerance.  He didn’t need anything after he came home after his first surgery.  His biggest issues will probably be being uncomfortable, frustrated, itchy, and bored.

19.   What will his follow-up schedule be after surgery?

A week after he’ll be see for a checkup and then not again until the cast comes off.

20.   When will we know if the surgery is successful?

He will be watched until he stops growing – about 14!

21.   What are the chances of him needing more surgery?

Won’t know until he stops growing.  If he does need more surgery it will likely involve a pelvic osteotomy.

22.   Right now he has no leg length discrepancy.  Will there be one after surgery?

Yes, because of the cutting of the femur bone and the repositioning of the head.

23.   Will he have a limp after surgery?

Yes, but he still has a lot of growing to do so the hope is that it will even out as he grows. 

24.   Advice?

Not really.  You were more prepared than most; more prepared than me (referring to my collection of books).

25.   Risks?

The risks are the normal risks that come along with surgery – bleeding, infection.  Along with

a risk of avascular necrosis (where the blood supply to the bone is interrupted and which may result in the bone dying.  There is a risk of nerve damage.  There is a risk of developing compartment syndrome - where the nerves, blood vessels and muscles inside a closed space (compartment) become compressed and die due to lack of oxygen.  Some patients find the plate uncomfortable.

26.   Restrictions in school after cast comes off?

Yes, he will be on limited activity and ease back into his routine.