Dec 26-27

December 27, 2013

Today was a busy day.  Rokus got a lot of surgical treatment done.  The surgeon came into work today especially for Rokus.  I believe he had time off scheduled but when he got back into town, he came to check on Rokus yesterday and perform surgery today.  I really appreciate him.

What happened in surgery-
1.  G-tube placement.  A g-tube was placed in his abdomen and into the stomach.
2. Epidural catheter.  The anaesthesiologist placed the catheter in his lower back to treat pain.
3.  "String" placement.  A plastic tube was inserted through his left nostril, down the esophagus and out the g-tube through the stomach.  It is connected in a loop so Rokus cannot pull it out.  It serves as a line that will allow the doctors to access and align the tools necessary to dilate the esophagus.
4. Esophagus dilation - The esophagus was dilated from about 2.67 mm to 7.0 mm.  The scarring was very significant which made the dilation difficult.
5.  Bowel Revisions - The small bowel has been completely connected from the stomach down to just before the colon.  The colon has been connected to the rectum.  A double barrel stoma has been placed outside his abdomen and it includes the two ends of the ileum just before the colon.

So, to make sense of this, during surgery, the surgeon planned primarily to install the g-tube and "string" as well as dilate the esophagus.  If it took a relatively short amount of time he would investigate the bowels and begin revisions or reconnections although it was earlier than planned.  Well, everything went well so the surgeon continued the work on the bowels.  The beauty of it is, if the portions that were reconnected heal properly, then Rokus doesn't need more surgeries that require his abdomen to be completely cut open again and his bowels removed.  The final gut surgery will be relatively simple and near the surface of the abdomen.  I am grateful for the surgeon.

Rokus is in a great deal of pain and discomfort.  He is now back to having tons of wires connected to him.  His abdomen has been cut from his waistline directly up to just below his pneumothorax.  That means all muscle is sore and unusable in his belly again.  Poor guy. He doesn't have a feeding tube down his throat but it's replaced with a plastic loop (aka the "string") so that still sucks.  Tons of tape is holding all kinds of wires down and he hates tape.  This next week will be very uncomfortable for him.  He also has a urinary catheter which bothers him but we need to very accurately account for all of his outputs to make sure he is healthy.

At the end of Rokie's surgery, Stephanie and I waited with him in the recovery room.  Normally that takes about one hour but this time it took three hours.  The post surgical floor wanted him to go to PICU, and PICU, along with the surgery team, wanted Rokus to go to the post-surgical floor.  Ultimately we ended up on the post-surgical floor.  Now we are back in our room. Rokus is somewhat sleeping.  The surgery was about 4-5 hours long with about 2-4 hours of pre and post operation care, not accounting for the post-operation dilemma.

December 26, 2013

The surgeon showed up today and evaluated Rokus.  He decided he will operate on Rokus tomorrow.  During the operation he will install a G-tube into Rokie's belly as well as dilate his esophagus.  He will also inspect his bowels to see their current condition.  If the bowels are good then the surgeon may begin reconnecting the intestines.  This is a big deal and one we did not expect.

Rokus will go on IV drip beginning at midnight tonight and will not get oral feeds for a few days.  He has really wanted to eat food so that will be difficult for him.  The sucky thing is he doesn't know what is going to happen tomorrow.