"I'm not cold!!"

[quote="sozobe] She has been especially sleepy lately, even with what seems like "enough" sleep -- that is, she gets 10 hours, which usually is plenty, but acts like she gets far less sleep. That's unusual. (Most of the time she is fine with a total amount of sleep that is on the low end of the range recommended for her age.) Yesterday she took a nap after she got home from school, which she hasn't done since she was, like, 2.[/quote]

apnea can cause that sleepy effect as can spring allergies

http://www.pollen.com/forecast.asp

Not fun for the kid.

Yep, exactly. Probably not obvious from context, I noted it in terms of that being something new for her. We've been trying to figure out if she's had this issue for a long time and we didn't know about it, or whether the sleep apnea is new. The sleepiness during the day (even with enough sleep, hours-wise) is new, which would seem to indicate that the sleep apnea is new.

soz wrote :



ehbeth suffered a lot from what was called "colds" from about age five to nine .
tonsillitis , stuffed or runny nose , NIGHTMARES were one of the worst parts .
after she turned nine our doctor referred her to a fairly old specialist .
"tonsils have to come out " , he proclaimed without even an examination .
so our doctor referred her to a younger specialist who suggested that the tonsils be "capped" (?) .
she went into the hospital cheerfully (we visited the night before the operation , but she hardly had a couple of minutes for us - to busy doing fun things with other kids ) .
when we picked her up after the operation , the nurse instructed us that she could have some icecream - perhaps some jello , but nothing that might irritate her throat .
home we came . what was her first order ?
"please make some potato for me , i'm hungry ! " (she may left the "please" out ) .
so with a great deal of worry , mrs h baked up a stack of pot-pancakes in a hurry .
SURPRISE ! she gobbled them up and had no problems with any food !
it turned her into a NEW GIRL ! no more tonsillitis , runny nose , no more nighmares - she was ready to become a "junior teeny-bopper - in a hurry .
the operation probably should have been done two to three years earlier .
all the best to all of you !
hbg

I'm sorry to hear about sozlet's latest symptoms. (But fairly amused at the image of ehBeth as a junior teeny-bopper.)

http://www.mayoclinic.com/health/tonsillitis/DS00273

Under the Complications section:





http://kidshealth.org/kid/ill_injure/sick/tonsillitis.html

Under the treatment section:

Yep, Mayo's a great resource. Had read all of that. (I think I'd pretty much indicated those same things in my previous comments?)

One thing I'd add to what I've already said is that while the tonsils look large, there isn't any obvious indications of infection. No pus for example.

One thing to reiterate is that this degree of largeness* is NEW (as in, within days) and may be temporary, for whatever reason. I'm not going to jump to operate if the size can be reduced by other means.

Haven't heard back from the ENT yet and it's time to turn off the computer and get to bed, early. Good news is that sozlet is totally fine today. She's a bit on the tired side, so I wouldn't put her at 100%, but she's full of energy and mentally sharp and generally very, very normal.

If I don't hear back from the ENT by say noon tomorrow (24 hours+ after I wrote to him), I'll start making some calls.


*I think she's always had tonsils that are on the large side -- again this thread was a resource there, when I found a tossed-off comment from a nurse I'd recorded a while ago -- but the ENT examines them regularly, most recently a couple of weeks ago, and hasn't been concerned about them at all. It's been about adenoids and tubes, not tonsils. And everything (new sleepiness, newly labored breathing in the morning, newly large-looking tonsils) seems to indicate that the sleep apnea is new.

i'm sure that both of you will sleep well !
all the best !
hbg

Reading along, Soz. Computer hugs to the sozzies.

Thanks osso and hamburger!

Reply from ENT:



"Turbinate cautery"?

Uh-oh:



http://www.entconsent.co.uk/ENTcons/reduce%20turbs.html

bluhbluhbluh

Thoughts:

- No mention of tonsils or tonsillectomy.
- Cautery was mentioned a while ago in terms of the cure being worse than the disease, so to speak. If he "suggested" it at the last appointment, I didn't see it (but that's possible since I didn't have an interpreter).

Meanwhile, she is doing great. Whatever was causing the inflammation of her tonsils seems to be easing... she was breathing much more normally this morning. She's been full of energy (much peppier this morning than she has been in a while), and generally not showing any ill effects.

From June of last year:

If the doc suspects sleep apnea, then they ought to do a sleep study. Jumping into surgery of some sort on the simple suspicion of sleep apnea sounds a bit premature.

And how about a non-surgical intervention, such as a CPAP machine?

I haven't read the whole thread, so forgive me if I'm re-covering old ground, but has she had an allergy test?

A little allergen wash in her sheets might do a world of good.

Hi DrewDad,

Yep, she had a thorough allergy test -- 60 allergens, I think. She came up clean.

I still don't know what I think about her and allergies. As in what I quoted above, the ENT seems to think she has a sensitive nose that reacts to pollutants in the air, very minor things, not anything that can really be controlled for. (If you follow the wormhole from where I quote him above, you'll see that below that he says that really all we could do in terms of protecting her from irritants is to put her in a bubble.)

He also has been reasonable thus far about cost/ benefit, though, and I'm far from convinced at this point that the benefits outweigh the costs. She's functioning so well. If the sleep apnea fades, then I'm again back to not being sure that ANY (surgical) intervention is called for. If the sleep apnea doesn't resolve, then yes, I'd want actual tests and confirmation before surgery.

The CPAP machine might be a middle road for the putting her in a bubble route. In addition to providing additional air pressure, it also filters the air that it provides.

So much for my $.02.

Basically, the ENT had already recommended an adenoidectomy because of recurring serious ear infections. (She didn't have any for 2.5 years but then had one a year ago, and then another a few weeks ago.) That's the main reason it's on the table.

She hasn't had sleep apnea until this past week or so. My own theory is that she does indeed have enlarged adenoids which make breathing through her nose at night difficult -- and that for some reason, her tonsils recently swelled up which caused temporary sleep apnea. I'm hopeful that it will go away again, completely, and that a CPAP would be moot.

If the sleep apnea does prove to be temporary, though, the ENT still wants to removed the adenoids for other reasons. So I'm researching and readying myself for a meeting with him at the end of April to discuss that. I'm not unilaterally opposed -- if it's necessary, it's necessary. But I do need to be convinced. (Among other things, adenoids atrophy naturally starting at about this age, which means that delaying for a while might mean that we wouldn't have to do it at all.)

Just wanted to get this down...

Sozlet had a what we now call "allergic to pie" episode last night. The basic outline is that she is completely normal, goes to bed, wakes up nauseous, barfs, and then she's fine. No fever at any point, and completely fine after barfing. If she makes it to the toilet in time it's basically have her blow her nose and brush her teeth and put her back to bed, and that's that. If she doesn't make it to the toilet in time, it's longer and unpleasant-er before she gets back to bed (last night involved an emergency shower), but still very finite.

We originally called it "allergic to pie" because it seemed like it would happen after a social event of the type we would bring a pie to. But it's happened many times when no pie was involved.

Main variables are:

HEAT -- this is a constant. On Saturday it was very warm and she was outside almost all day.

Activity -- especially in the heat. She was running around like crazy, plus biking.

Not enough to drink. E.G. brought her home from one event and immediately said "she needs something to drink." She'd been complaining of thirst all the way home, which is very rare for her.

Too much rich/ fatty food.

Possibly pop/ caffeine, not sure. She had a Sierra Mist at a party in the middle of a busy day (three distinct events, each with associated food) and root beer later, and she pretty much never has pop. ***edit: Sierra Mist doesn't have caffeine***

This whole thing is really not a concern -- it happens sometimes, not a big deal -- just seeing if I can maybe figure out what the key elements are to prevent it in the future. Hydration seems big. (I wasn't there to make sure she got enough to drink yesterday and she's not good about seeing to it herself when there's all kinds of interesting things going on. Yes, there's been A Talk.)



Meanwhile, the apnea eased after just a few days -- one or two days after I wrote stuff here, I think. (As in, she didn't have any more episodes of breathing becoming shallower and shallower until she had to "reboot" -- it's possible we just didn't see them but they were pretty easy to see, earlier. Plus she wasn't as tired during the day.) She still had some labored breathing a while after the apnea part stopped -- regular and deep, just had to work at it a bit -- then that eased too. E.G. says she's still sometimes breathing "loudly" but the breathing is much easier/ back to normal.

She's OK with the idea of adenoidectomy and I think we're getting closer to that. It seems to be a core issue for a few different problems. Not sure about tubes or turbinate cautery yet. We'll see.

Problem Solved!

If some rooms are colder than others, simply install baseboard heaters for zone heating. It's a lot cheaper and more efficient than increasing the average heat of the entire house with central heating.

Of probably no relevance -
I don't remember throwing up much as a child, but I do remember doing it twice in early grammar school, say, 2nd and 3rd grades, both times after... root beer.
I didn't drink root beer after that until I was way into adulthood.

When Jane was younger and birthday parties seemed to be a weekly thing,
she did get sick a couple of times on those awfully sugar frosted birthday
cakes, as well as sticky lemonade drinks. She herself opted to bypass the cakes
after a while, and one time she was the only one not getting sick since everyone
else had the cake.

As difficult as the clean-up may be, sozlet's barfing is probably a blessing
in disguise, otherwise she'd feel a lot worse.

Interesting about rootbeer, Osso. I'll keep an eye on that variable -- she has it so rarely that who knows, that could be the culprit and the rest is red herrings.

So. Lots to report. I want to do a brain dump, may be long and boring reading for most.

She's shown a few signs of not seeing so well -- the main one I noticed is that she didn't want to sit on the couch to watch TV anymore, wanted to sit up closer. The couch is pretty far and she talked about it in terms of captions which are pretty hard to see, though, so I didn't really think that much of it. Asked her teacher how she was doing in school, and the teacher hadn't noticed any vision issues. Etc.

Went ahead and scheduled an appt. with the eye doctor though. Thought she'd need glasses, hadn't thought about exact prescription but thought it'd be lowish.

They threw up the big "E" -- top line on the eye chart -- and she couldn't see it.

Holy crap.

20/400 vision (2.5 and 2.25 dioptres)

That threw me for a loop, not completely sure why it affected me so much. It's eminently fixable (with glasses/ contacts), but it's permanent, and it's major. My vision is 20/200 and that's bad. 20/400!

That turned out to be the least of it this week, though.

Had that long-awaited follow-up appt. with the ENT yesterday. (Last appt., the ENT suggested tubes and adenoidectomy but there was no interpreter for that appt. and I wanted to discuss, so this appt. was scheduled.) It was an endless wait, and when we finally were seen by a doctor, it wasn't my guy, but some resident. I sputtered a bit about that -- I wanted to talk to my guy, that was the whole point -- and the resident assured me he'd be in soon, but the resident would get things started. Fine. Sozlet had some wax in her left ear and the resident went about getting that out. He did a good job. Looked in her left ear, hmm. Looked in her right ear, hmm again and then, "She has a hole in her right eardrum."

Um, WHAT?

That's the eardrum that perforated in March, but it had already healed when we saw the ENT in April. Where did this come from?

He said "It's a small hole..." in a "yes this is serious but I'm trying to be reassuring" way. Then he was paged, and left.

Sozlet and I looked at each other. I said, "Can you think of any reason you'd have a hole in your eardrum? Did you put anything in your ear...?" No, no.

Then our guy showed up. I told him what the resident said, and he got to work. Hmmming. Silence. "Oh, it's gotten worse." Silence. (I had an interpreter, the ENT wasn't talking directly to me.)

My blood pressure is going through the roof.

Eventually ---

She doesn't have a hole in her eardrum. However, it looks like there's a hole because there's pretty severe retraction. That's when the eardrum curves inwards because of a vacuum left in the middle ear when fluid that had been there retreats. There still isn't a clear path from the middle ear to the throat via Eustachian tube, so the pressure hasn't stabilized. This is very bad for her eardrums (it's worse in the right, but present for both) and while there currently probably isn't any permanent damage (not clear), it's the kind of thing that has to be fixed, stat.

OK.

I had already come around to the idea of getting an adenoidectomy because of sozlet's recent sleep issues, which have gotten better but are still there. He listened to my account of the issues and looked at her tonsils and said that yes, they're enlarged, and he recommended a tonsillectomy too.

<sigh>

So on the table were now 1) tubes (necessary re: retraction), 2) tonsillectomy, 3) adenoidectomy and 4) turbinate cautery.

I basically went through each one and discussed why it was necessary, long-term effects, possible complications, etc.

For tubes, he said it should be straightforward. There is some small risk of problems when he makes the initial incision on the right eardrum since there is so much stretching right now. He thought it should be OK, only a very small chance of problems. I asked what she wouldn't be able to do in the pool this summer, and he said "nothing." I said "dive?," he said "fine." (I didn't expect that.) He said that the audiology dept. can make very tight earplugs for about $75, (which sounds worth it to me) that allow the child to do whatever in the pool.

Adenoids seem to be a base problem and they atrophy anyway, so I had pretty much come around to the idea of having them out even before this meeting. Sozlet actually likes the idea. She's so tired of always being stuffy and having a hard time breathing through her nose.

Once we'd decided on tubes and adenoids, it wasn't a big jump to the others. He really thought a tonsillectomy was called for due to what they looked like and how she's been sleeping. Just adenoidectomy + tubes have a recovery time of about four days. Adenoidectomy, tubes + tonsillectomy have a recovery time of about a week. He really recommended grouping them both in terms of keeping it to one bout of general anesthesia (always a risk) (pretty much what I'm most nervous about at this point) and also in terms of having one recovery period -- everything at once -- rather than one four-day recovery period and then later, if necessary (and he seemed to think that was very likely), another week-long recovery period.

I said that I'm very familiar with tubes and tonsillectomies and adenoids atrophy eventually anyway so I wasn't as concerned about long-term effects with those three, but what were the long-term effects of turbinate cautery? The turbinates have a function, to protect the lungs, and would we just be trading lung problems for nose problems?

He said that they use "low heat" cautery and reduce the size without removing them entirely. He said that they've really only been doing this for ten years so it's hard to say what the long-long-term effects are -- I'd asked whether this would affect her when she was 40. He said that they've had very good results with it though and that it's a pretty mild procedure, the most mild of any of them, but again is done under general anesthesia and he really recommended doing that as well.

So, she's having the whole shebang on Monday. This coming Monday. The 4th. (They actually suggested the 13th first, and I made the mistake of joking "it's not a Friday, is it?", because then sozlet got freaked out about doing it on the 13th -- unlucky!!! [Kid's read too much Lemony Snicket.] But then it turned out that the ENT wanted to do it ASAP anyway, and Monday was better.)

I was pretty shook up yesterday, now I'm more calm about it. Sozlet is amazingly gung-ho. I keep saying "you realize this is going to hurt, right?" and "you're going to miss at least a week of school, you know...?" and she's like, "Yeah, I know. It's OK. I just want to get this over with."