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Update on Nico's surgery

Just a quick follow-up to our Twitter updates (on the left): Nico's surgery and post-op recovery have gone very well. This morning he was smiling and making faces with us and the medical staff during his admission and surgery prep, right up to the point where he fell asleep. He awoke pretty distressed due to his pain and discomfort from being restrained, but over the past few hours, with more sleep and recovery time, he's really perked up. Rick and I paid them a visit tonight, and Nico was starting to swallow water from a syringe and seemed pretty settled in Ali's arms. It helps that he is being entertained by a very active three-year-old in the bed next to him (just like at home!).

Given his progress, we're pretty confident he'll get the all-clear to come home tomorrow. Here's hoping they have a restful night.

What's Up with Nico?

The short version: Nico is healthy and his development looks good. He has palate repair surgery scheduled for Thursday, May 21, and this time he's not sick so it appears the surgery will go ahead!

The long version after the jump ...

Since we returned from China, Nico and I have made four visits to CHEO, our local children's hospital. (We were fortunate to get his OHIP card even though there's been some kerfuffle recently over insuring international adoptees.)

February: Audiologist, Plastic Surgeon

Our first visit, in February, started with a hearing test, which is required because many children with cleft have hearing problems because of fluid in their inner ears. Unfortunately, the results weren't conclusive. When they tried to administer the hearing test, Nico was too interested in looking at the audiologists and their toys to bother with the flashing lights he was supposed to turn his head towards! So we scheduled another hearing test for a month later.

Then we had an assessment with the plastic surgeon. Nico has a level III cleft lip and palate on the left side. His lip was repaired in China when he was about 8 months old, but he still has a cleft through his hard and soft palate to the back of his mouth (he actually has two uvulas [uvulae?]). The cleft palate allows food to come through his nose, which makes for some interesting projectile sneezing!

The surgeon told us that we could schedule the palate repair soon, and that he would also need a lip revision after that. The palate repair involves making incisions on either side of his palate, near his gumline, and then bringing the tissue together over the cleft in his palate. There will never be bone there, just tissue, but it will enable him to speak and eat more normally.

We chose to schedule the palate repair surgery on April 16. We wanted to give Nico enough time to get settled with us, and maximize his time on the bottle (he won't be allowed to have a bottle after surgery because the sucking action could damage the repair). But we also wanted to have his recovery complete before we got too far into summer. (Of course, that surgery was rescheduled because Nico had a cold and ear infection ... more below.)

March: Anaesthetist, Audiologist, ENT

Our second visit to CHEO, in March, was quite a marathon. First we saw the anaesthetist for Nico's pre-surgery assessment. He will have general anaesthetic, and also some “giggle juice” beforehand to help him relax. I will be able to stay with him until he's fully unconscious. The anaesthetist ordered some blood work, so we spent an hour waiting in the lab to have his blood drawn. The phlebotomist was awesome and got what she needed in a matter of minutes with minimal trauma to Nico.

Then we returned to the ear clinic. Nico was worn out by this point (it was after 11 am) and he fell asleep in my arms in the waiting room! About this time I met the nurse for the cleft team at CHEO. She started answering my questions about the upcoming surgery and Nico's recovery. I woke him up for the hearing test but he was quite grumpy and crying. I'd forgotten to bring a bottle for him, and when I lamented this to the nurse, she disappeared to fetch him a cleft bottle full of formula! Now that's patient care.

We were going to reschedule the hearing test, but within a few minutes Nico was back to his cheery self so we gave it a whirl. This time he was fabulous; they easily trained him to turn his head when he heard sounds, and he was quite responsive. The results showed that his hearing is quite muffled; he can't hear below 50 dB. No wonder he's such a sound sleeper!

With the hearing test results in hand, we were ready to see the ENT doctor. Because of the ear congestion and muffled hearing, he recommended placing tubes in Nico's ears, to drain the fluid and allow air into the middle ear. This is a quick procedure that can be done during his palate surgery.

April: International Adoption Clinic, Lab

In early April we visited the international adoption clinic. This program thoroughly assesses children's health and development in their first year after adoption. Nico was weighed and measured, and then we had a long consult with the paediatrician and a resident. They asked all kinds of questions about his history and transition, and they watched him walk and play. The good news is that there are no developmental concerns, and no signs of any syndromes that can be associated with cleft.

Nico had a cold at this time, and the resident noticed some fluid coming out of his ears when she examined him. The conclusion was that he had probably perforated his ear drum. ??? His cold was worse a few days before his scheduled surgery, so the procedure was postponed until May 21 and they put him on antibiotic eardrops.

We went back to CHEO once more, to have blood drawn for tests ordered by the international adoption clinic, and to drop off stool samples.

May: Palate Repair Surgery

Nico's surgery is at 11:00 am on Thursday, May 21. We'll arrive at the hospital a few hours early for admission. It's a three-to-four hour procedure. I'll stay at CHEO overnight with Nico, and hopefully he'll be able to come home on Friday. Official recovery time is three weeks. He'll be on a soft foods diet, and won't be able to have a bottle. He'll also be wearing arm restraints to keep him from touching his mouth.

There are some blessings to having the surgery postponed. Nico is not as attached to the bottle as he was a month ago, and he has learned to drink from a cup really well. He goes to bed more easily and uses his puppy for comfort instead of his sweatshirt. And my mom's health has improved enough that she's able to come and help us out for a few days.

Thanks for your thoughts and prayers; we'll let you know how everything goes!

In Your Eyes

Dear Nico,

Today you are eighteen months old. You were still a babe when we met and now you're a toddler. You've learned to walk--actually, swagger is more like it. You've got a cute gun-slinging bow-legged posture that says, "Here I come! Watch out, world!" You've even started dancing, turning in circles and raising your hands above your head.

You've learned to drink from a cup and eat with a spoon. And you have started to stridently express your preferences! Oatmeal from your bowl is no good, it has to be from Mommy's bowl. If Lia starts eating yogurt, you have to have some.

No surprise that your first words and signs have to do with eating. You've been doing "food" (a finger pointed at your mouth and an "ooo" sound) since our first weeks home from China. Last week you added "cracker" ("ah-uh" and a hand knocked on your forearm) and "apple" ("ah-oh" and a hand twisted near your temple).

You love to wave good-bye and blow kisses with a nice "mwah" sound. You have an adorable bum wiggle when I take your diaper off to change you ("Ah, feels good to be bare!") I no longer rock you to sleep, but cover your face with kisses and then lay you on the back in your crib awake. You and Lia go to bed together now and keep each other company as you fall asleep. You don't wear your puffy sweatshirt to bed for comfort; instead, you've been imitating Lia and giving kisses to your puppy.

The vast majority of the time, you are happy. Cheerful, giggly, delighted, curious, beaming. You are starting to cry and complain when you can't do what you want, which we take as a good sign for your development. But you seem to approach the world as a playground of wonders: you love your Charlie Monkey book, and the bead maze, and climbing on your sister's big bed, and trying to turn off the television.

Your baptism was a wonderful event, chaotic and messy and joyous. You seemed to blossom over the weekend, opening up to the family and friends who surrounded you, moving out of the tight circle of your parents and sister. Oma and Opa took you to the park, your first time away from us, and you had a riot. You asked to be picked up by others and you let them hold you instead of immediately reaching for Mama.

Your eyes are remarkable. The other day you and I just sat and gazed at one another, and I get such gentleness, mischief, and soulfulness from these looks. You may not be this bright and sunny forever, and that's okay, but for now we're just drinking it in.

We are so privileged and thankful to be your parents. We love you like crazy, and Lia's getting pretty fond of you (even when she expresses it with a whack over the head).

Nico's first 18 months in pictures--a slideshow that Shawn put together for the baptism

Bring Us to Light and Life

All are welcomed to the baptism of Nico Han-Kun Gresik de Raaf

to be held on the Fifth Sunday in Easter (Mother's Day), May 10th, 2009 at 10:00 am

at the Church of the Ascension, 253 Echo Drive, Ottawa, Ontario