Luka's surgery: inguinal herniotomy

On Tuesday at 0400, Luka woke screaming inconsolably for the first time since his birth.  We tried everything to calm in, including the 5 S's of Happiest Baby on the Block fame, which seemed to help temporarily, allowing us a few more precious hours of sleep.  However, he awoke once again and was screaming terribly.  We figured this was indeed the next challenge in raising Luka, the 'colic' we have read are so prone in preemies.

To our horror, there was indeed a clear reason for his screaming - a bulging lump in his groin.  Having studied the essential guide for any parent of a preemie, we were at least partially prepared for the occasion insofar as we were pretty sure we knew what it was, and also, perhaps most importantly, that it would require what was indeed the most common surgery performed on preemies*.  So after calling the pediatrician and all that followed as explained here, we found ourselves once again in a NICU setting.

The little patient immediately after the operation. 

Of course, when your infant is in terrible pain, and you are rushing off to the hospital, one does not necessarily always stop to think and pack - and so, for the second time in ten weeks, we found ourselves under-packed for one of Luka's adventures.  Having reached the hospital and being passed on from our pediatrician, Dr. Carl Wicht, to the pediatric surgeon, Prof. Rob Brown, we knew we would be stuck over an hours' drive from home, at least overnight, but possibly longer - not a distance acceptable to us.  Unfortunately, Luka's surgery was an emergency, so there was little time to plan or adapt until after he came out of theater.  Prof. Brown explained that while a hernia is not necessarily an emergency, it is when the bowel is trapped in the connecting tube, causing a 'strangulated' hernia that requires immediate transport to the nearest emergency room.  After examining Luka, he informed us that his was indeed wedged in tight and would require immediate surgery to avoid permanent damage (read: removal of part of the bowel), then carefully sketched out the procedure for us on a pad and paper.  He immediately instructed his receptionist to book space in the OR, and started rescheduling his entire day to fit Luka's surgery in ASAP.

While waiting for an available operating room, we were booked into the nursery, Luka bathed and changed into a hospital t-shirt, and I administered a dose of caffeine done to assist the lungs in post-operating recovery (of course Chris and I were at this point still caffeine-less and almost demanded our own dose).  We were able to take Luka out to a waiting area with couches where we proceeded to wait for a few hours.  Eventually, the anesthesiologist Dr. Hanli van Dyk came out to the waiting area, introduced herself, pulled up a chair and proceeded to walk us through the entire process of putting our baby to sleep.   She explained that she would be using a general anesthetic, combined with a once-off regional anesthetic, which allows her to reduce the amount of general needed significantly (a good thing for someone born as prematurely as Luka).

Poor guy all swollen from the IV fluids...but so alert and happy
to see his daddy!

Once we got the green light that surgery would proceed, Luka was returned to the nursery where he had to board his incubator. The head nurse and a hospital porter then wheeled him to the operating room on the top floor, with Chris and I in tow.  At the operating ward, I was dressed in scrubs, shoe covers and a cap and followed the porter to a 'holding' area before surgery.  Here Luka was somewhat antsy, so I took him out of his incubator and soothed him. Dr. van Dyk came out and along with the porter pushed the incubator into a large operating room where Prof. Brown, two nurses and a young (presumably student) doctor was waiting.  I was able to hold Luka as Dr. van Dyk administered the gas, before laying him down on the bed, planting a big kiss on his forehead, and then being escorted all the way back out by Prof. Brown all the while explaining what he would be doing during the procedure.  At the door Chris and I went to get our much-needed coffee and a newspaper to try and occupy our minds for the hour we anticipated it would take.

Luka was not kind to the drips in his
arms I believe he went through five...

At roughly an hour and ten minutes Prof. Brown came out to explain that the bowel was so wedged in the sac that it was near impossible to pull it back through, he did manage, but it caused a minor tear in the bowel.  As such, it was not the 'uncomplicated' surgery we had hoped for (during which there was even talk of fixing a potential hernia on the right, should one exist), instead, now it would require an extended stay in hospital and nil per mouth (i.e, now milkies for our boy).  We followed the head nurse and porter back to the nursery with a now very distressed (read hungry) and groggy baby.

Kangaroo care - the only way to go!

The three days in hospital was not great, as we were once again thrown back into the lull of nursery-life, but at least we knew our departure there was rather imminent, unlike the newly arrived prems and their distressed parents.  Seeing Luka in pain, and discomfort the first two days was truly a challenge, but we knew he was being cared for well.  Probably the hardest thing for me was not being able to feed him for three days, since, despite the IV fluids, he was clearly hungry and smacking his lips for a feed - to try and mitigate this we had to revert to a dummy (pacifier), which our boy did not think was funny.

While he lay recovering, slightly sedated, and absolutely starving!  I managed to find a guesthouse nearby thanks to a recommendation from one of the nurses, while Chris ran to Woolies (JC Pennys) to get a packet of underwear and a clean t-shirt for each of us.

Luka being examined on Chris' chest by his pediatrician
Dr. Carl Wicht

For the next three days, we kangaroo cared Luka again for close to ten hours a day in the NICU while we waited for the pediatrician and surgeon to do the rounds to see whether we would be spending another night in hospital - from where we would quickly phone the guest house back to reserve our room for that night again.  Each day Luka was more wakeful, and clearly in less distress than the day before - but we were still waiting patiently for the all-changing bowel movement to manifest!  Imagine a a gaggle of nurses and two doting parents all rooting for the same thing - a big poo!  Well, it eventually happened on the second night, the 26th - which set the ball in motion for us to leave.

And so it were that we were once again released from hospital (after settling the bill of course!) on Luka's due date.  For some thoughts and ponderings on that, please see the next post, From Birth Date to Due Date.

For now, it is nearing sunset here in Scarborough on a gorgeous winters day on the southern point of Cape Town.  Luka is peacefully resting on my lap after his umpteenth feed for the day, and following two fabulous poos - we are closely monitoring him for pain and discomfort and administer Panadol-based seppositories as needed.

The backside of Table Mountain as we drive away
from the hospital this morning.

We are due back for a follow-up with the pediatrician, the surgeon, and at the same time his final ophthalmologic examination next week.  During the visit with the surgeon he may do an ultrasound on the right side of the groin to determine whether there is any need to mitigate that side in an elective surgery as well before it too becomes strangulated, risking another emergency surgery in the future.

Note: I can safely say infant surgery is one of the tougher things of the whole experience so far, but thanks to the amazing staff, we felt confident and calm most of the time.

* 3-5% of healthy, full-term babies can suffer from hernias, this number increases up to 30% for preemies.  Source