Morning at the Park & Surgery Follow up

We spent our Labor Day morning at one of the parks in town. The summer heat usually prohibits playing outside for any extended period of time, but this morning the temperatures were only in the upper 70s. Seemingly perfect weather for playing outside...that is, until after I spent over an hour standing in the beating down sun. Yes Drew managed to get nice and sweaty while running and jumping and climbing. He could barely be bothered to stop for water breaks every now and then.

Who can drink water when there's slides to be slid down (or climbed up as the case may be)...

Bars to climb... Bridges to run over... And monkey bars to swing across? He started out just wanting to hang on the monkey bars and then I helped him cross it once. Then while this Mom was helping her own kids cross it Drew got right in line and she was kind enough to help him too.
Drew is so funny about swings. He typically begs to go on them and after 30 seconds or less is screaming to get off because he's scared. Today was no exception. We were headed to the car after over an hour at the park when Drew spotted the swings and pleaded with me to go on them (even though he said he had to go potty and refused to go in the public bathroom at the park). He promised he could hold it so we went to the swings. He could hardly contain his excitement over getting on the swings and then after I pushed him a couple of times and took this picture he screamed to get off. He's such a funny little guy.

Oh, and for those who asked, after his surgery Drew had to wear his big bandage for 5 days, then he was okay with just a regular band-aid. With a shower the morning of his surgery, we were able to get away with just one additional shower while he had the bandage on. He was quite amused at the concoction of plastic bags and tape that Daddy fixed up.We head back to the doctor for his follow up appointment tomorrow but everything looks good to us and he has full range of motion in his thumb, so we expect to get the all clear from the doc.

Doctor Fixed My Thumb

Since we received the information that Drew would have surgery on his left trigger thumb at the beginning of July, Drew has told us (and anyone else who will listen) that "Doctor's going to fix my thumb." After a trip to the dentist he also came out with this gem a few times "Dentist is not going to fix my thumb." We told him we thought that was probably a good idea.

So Friday morning was the big day. Originally the surgery was scheduled for 11 in the morning, with arrival time an hour and a half before that. But two days before the surgery, we were relieved to get the call that, due to his age, his surgery time had been moved up to 9:15. While this made for an earlier morning for Mommy, Daddy, Grandma & Grandpa, it was much easier to deal with the "no food or drink" pre-surgery rule. Drew is usually not awake for more than 5 minutes before requesting his morning milk. We were not optimistic that he would take the no eating and drinking well. Fortunately, we were half way to Tucson before his first requests for milk and we were able to distract him with questions about the things he could see outside his window.

Shortly after arriving at the outpatient surgery office we were taken back to get Drew's vital signs and get him changed into a gown. The vital signs did not go well. Drew screamed and squirmed through the attempted blood pressure reading, the ear thermometer, the oxygen finger reading, and even the putting on of his hospital bracelet.


The pictures to the left are from the room we waited for the doctor in after the horror of vital signs was over. As you can see, we were able to sway his mood from really not happy to mildly amused to showing off his thumb with a smile.

We sang songs, played peekaboo with his blanket, had a short nap, and practiced counting with the stars and stop signs on his gown. He was quite funny about the gown. He kept saying "I no like these jammies." "I need take these jammies off." But then he'd spend the next 5 minutes enthralled by looking for stop signs on the gown.

Anyway, eventually the surgeon and anesthesiologist came in to talk to us. The plan was to take Drew back to the operating room (without us), cover his mouth with a mask to put him out, then do the IV and surgery. After the vital signs tantrum we were not optimistic he would do the mask without us and without being restrained. The wonderful anesthesiologist mentioned that there was a quick shot up the nose (I can't remember the name of the drug) that would make Drew groggy and not remember leaving Mommy and Daddy. Basically a little like being drunk. The only downside was it was supposed to sting when it went in (like snorting

soda out your nose). The doc said most kids didn't like that. Drew, on the other hand, barely reacted. We get more of a rise out of him trying to give him Tylenol in his mouth! So then we just waited for the medicine to kick in and he happily left with the anesthesiologist. While we were waiting for the medicine to work we tried counting again, and as the medicine started to take effect Drew would very groggily say "I'm thinking!" after every few numbers. It was quite cute.

The procedure took just about 15 minutes and we were only in the waiting room for about 45 minutes (with pre-op and waiting for him to wake up). I handled the wait remarkaby well although my parents were amused at my drinking two cups of coffee during that time. I very rarely drink coffee...and I'm not sure the extra caffeine was really what my nerves needed, but I had to do something and I couldn't concentrate on the newspaper or anything like that.

Eventually the nurse came to tell us Drew was awake and we could go back. They let all of us go back to see him, which was nice and, I think, comforting for Drew (Grandma & Grandpa hadn't been able to go back with us before the surgery). He was still pretty dazed when we got back there, but happy to see us and very happy to be able to drink some Gatorade and munch on a few graham crackers. I had wrapped George's left hand in an ace bandage before Drew went in to surgery but after the nose shot and behind Drew's back so he wouldn't notice (they let him keep his Nemo blanket and George with him). But when we got back to him we realized the doctor had really fixed up George's bandage with a sling and everything. So nice of them. The doctors and nurses were all so wonderful. I realize they probably say this to a lot of parents, but they kept going on and on about how sweet he was and how he well he had tolerated everything. They warned us that many children wake up mad after the surgery and very angry about the big bandage, but Drew showed no signs of this at all.



Little man and George after "their" surgeries. Having George bandaged up too really helped with Drew's protests during the car ride home about keeping the "big band-aid" on. "I need take it off. I no like big band aid."

The time in the recovery room was quite brief and we were on our way back home about an hour after the surgery had began. Drew was acting fine other than his protests about the bandage, and I almost thought I might not need to fill his Tylenol with codeine prescription. Thank God I decided to do it anyway. Drew woke up from his nap that afternoon screaming and crying in pain. Heartbreaking to see your child like that. Fortunately the medicine kicked in within 15 minutes and he was happily playing with his train set like nothing had ever happened. He had no side effects from the anesthesia or Tylenol with codeine and even his complaints about the bandage subsided by Saturday morning.


We are very grateful this is the most serious health concern Drew has had in his 3 years and that he did so well with it. Thanks to everyone for your concern and prayers.

Drew's bum thumb

So a few months ago Bill and I noticed that Drew's left thumb was stuck in a bent position. He could still move it around, but he couldn't straighten it out. It didn't seem to be causing him any pain, so we figured we would wait until he had a doctor's appointment for something else and ask about it then. So last month Drew had his health assessment to get registered for Children & Youth Services on post and we asked about it. The pediatrician thought it might have been like that since birth, perhaps it was stuck in a weird position in utero or something. She referred us to a pediatric orthopedist.

Yesterday Drew and I went to see the orthopedist in Tucson. Drew was very excited about going to see the doctor and kept saying "This thumb's broken. Doctor's going fix it," to anyone that would listen. Sometimes he would also say "All fingers broken. Doctor's going fix all fingers." Anyway, we spent about 10-15 minutes with the doctor and literally the first 1-2 minutes was all he needed to tell us exactly what was wrong with it. The rest of the time was spent trying to explain the problem and how to fix it to the science-idiot (me).

So, since I understand but the level of understanding does not translate to being able to explain it to other people and actually have them understand, I looked up the condition at:

http://www.childrenshospital.org/az/Site1025/mainpageS1025P0.html

And the explanation that follows is theirs:

Trigger thumb refers to a thumb that clicks, catches, or locks as the tip of the thumb moves from a flexed (bent) to extended (straight) position. At times, the thumb may become "locked" in a flexed position.

Trigger thumbs are caused by a size mismatch between the flexor tendon of the thumb and the A1 pulley, a fibrous band under which the tendon normally glides. When the A1 pulley is too tight to allow for easy tendon gliding, the tendon can become swollen and inflamed, ultimately leading to triggering or inability to fully extend the thumb. Trigger thumbs occur sporadically and are not associated with other hereditary or congenital disorders.

The exact incidence of this condition is unknown. It is estimated that trigger thumbs comprise approximately 2% of all hand problems in growing children. While often referred to as "congenital" trigger thumbs, multiple studies of newborns indicate that this problem does not appear at birth (so his pediatrician was wrong about this and the orthopedist said this is a very common misconception about the problem).

Patients with trigger thumbs typically present with a flexed, or bent, thumb. Early on, the thumb can be extended, though often this is accompanied by pain, swelling, or a noticeable click. In the later stages, the thumb will remain in a flexed position (we never noticed it until it was stuck). Often a palpable nodule, or bump, is felt at the base of the thumb in the palm (Drew has this...it almost feels like a little piece of bone at the base of his thumb).

How are trigger thumbs treated? Surgery is recommended for trigger thumbs in patients over the age of 1 year. Surgery involves releasing the A1 pulley overlying the flexor tendon. Patients are typically in a bulky soft bandage for 1 week. The risk of recurrent triggering following surgery is very small.

I tried to take a picture of Drew's thumb, but I'm not sure how clearly you can see the permanent flexed position, though his goofy face is very clear.

Anyhow, the little guy is scheduled for surgery on August 22nd (Grandma Mary's birthday). It's done on an outpatient basis. His doctor said he performs the surgery at least once a week, so it's apparently a fairly common affliction in the orthopedic world. The surgery itself is a very short procedure (15-20 minutes). Thank goodness for that. My nerves couldn't take very long with my baby under anesthesia. Poor Bill is probably going to wish he could sedate me in the waiting room (he's so much calmer about these things)! Drew should be in recovery afterward for less than an hour and won't have to wear a splint or cast of any kind, just bandages over the incision for a few days. He should have full mobility restored immediately. We'll keep you posted the day of the surgery but please say a little prayer for Drew, his thumb, and his mommy's anxiety.