the day before...

On the way to the pre-operation appointments today, Sadie and I talked about how we never got around to her posting her pre-surgery thoughts as intended. Then we talked about sitting together tonight and doing the post together on the appointments today and her feelings going forward into tomorrow. Here I sit, her packing for the hospital stay, overwhelmed by the information today and clearly not in the mood to write anything about tomorrow. "You update it mom, you are so much better at saying what's on your mind".

So, without saying what's on my mind, I will give you the information:

1) registration 9:15 - surgery 10:30.
2) she will be in the hospital for 24 hours, hopefully no more.
3) they will be getting out the very obvious "marbles" that don't belong there and Dr. M expects to find a lot of inflammatory tissue and remove any all pannas that is present.
4) then there was more...

Sadie had xrays before meeting with the doctor today; he looked at those xrays and said... "Sadie's calcaneus is not lined up with the tibia as it should be, but it has shifted to be under the fibula which is causing some bone on bone issue which I am sure is why she is in pain". hmmmmmmmmm??? So, rather then going back in forth with our dialog, I will just tell you that another surgery looms... when? not sure yet, but we should know more tomorrow. He wants to look in there to see what the problem looks like from the inside and then see. I think he also wants to see if we can buy Sadie some time before this surgery to correct the placement of the calcaneus in the correct position. The surgery would involve cutting bone and placing it in the correct position - to place a bone... things must hold it there, so he is not really jazzed about doing this until Sadie is in dire need!
All this came as a surprise, not totally, but somewhat. The reason for this problem is just the ongoing disease in that ankle joint and the damage it has created and the compensation her foot has gone through for a long time to make weight bearing possible.

This is the best picture I could come up with... the Calcaneus on Sadie's ankle is shifted all the way to the outsdie.. toward the fibula and is not supporting the tibia at all.

Onto another subject: growth. We have a post operations follow up in mid-December, but I told Dr. M that appointment was scheduled months before this surgery was in our minds, the appointment was to monitor her growth in her right leg and the fact that leg is shorter. Because she will not be weight bearing in December, he opted to do xrays to confirm the leg difference and to see where her growth plates were (bone age). The did the xrays of her legs and then also of her left hand (which shows how "open" or "closed" the growth plates are and ultimately tell you how "old" your bones are). We were told to do the xrays and leave and we will discuss those in December.

We drive away... get to the stop sign at the bottom of Children's drive way and get a call "um, this is Dr. M's nurse... are you nearby? well, Dr. M would like to talk to you, can you come back".

I immediately had a feeling it was about the xray results so as turning around and re-parking - Sadie and I talked about it.

We get back in the room we were previously in, Dr. M is there within seconds to explain that Sadie's bone growth is a year older than her age. He said he thought she probably had 2 years, but the xrays tell us she only has about a year of growth left. After much discussion (I mean tons... calculations, measurements, etc) he advised that he felt cutting the growth plates on the left side should be done tomorrow. With that he feels there is still a chance her legs will not catch up 100%, but they "might" get within the "normal" leg differential range (we all have a small difference, but usually to small to notice). He explained the procedure; he explained what it looked like if we didn't do it; he explained what it looked like if she wanted to do it AFTER her bones were done growing (which include removing a section of bone and inserting a rod); he explained why that option doesn't work for kids with JRA. The greatest part of all this... he explained this directly to Sadie and made sure she clearly understood. The he again suggested we do it tomorrow, she will all ready be under and it just shouldn't' wait.

Sadie's big concern was that it means she is done growing and although she is tall, she doesn't feel "done". Dr. M explained that girls spines grow about 2 years AFTER the lower extremities, so she probably will grow between 2-3 more inches within the next three years. This helped her feel much better about the procedure.

The other big thing is that she will not be able to put weight on her left leg for 7-10 days. Usually if you have this procedure you can use crutches for those days, but since Sadie will be having surgery on her ankle too she will not be able to put weight on either leg for that time. Obviously this will bring a set of challenges, but finding the good is that she won't have to undergo anaesthesia more than once, which is a big deal.

One of Sadie's "feelings" she was planning to write about is the fact that she can't "remember" before and after surgery. She said it is a strange feeling to just not remember, but know it happened. The nurse made a great comment to her today when she shared this concern which was "giving control up can be a very hard thing to do". I thought this was a very interesting way of putting this as I have never had surgery myself and don't know what it is like, however, I do know what it is like to feel like you don't have control over something.

So, today came with a lot of things we didn't expect... it also came with new information and new plans. However, I feel very grateful that Billy is able to be with us tomorrow - God's plan! That the xrays were done today for the growth surgery (maybe we would have missed an opportunity or she would have had to undergo another surgery very soon)- God's plan! I am grateful that she has an amazing doctor - God's plan! I am glad that we have Children's Hospital (even though I struggle sometimes with sadness that Sadie knows this place too well, too young). I am grateful for our family and friends. Thank you for all who have been praying and will be praying.

There is much to pray for tomorrow, Sadie's procedures, her protection, her healing. For the doctors wisdom, patience and attention. For the staff that has to coordinate all that goes into each single surgery. For myself and Billy as we wait to hear how she is and the heartache that comes in being patient. Any one of these places and probably many more I am not thinking of need attention in prayer.

I will keep you all updated tomorrow as things progress. Although they say the surgery will take about 3 hours, we know from past experience, it is usually longer.