14 September 2004 - Under the Knife

If you recall, Nicky had a nasty ear infection and spent several days in the hospital between when I adopted him and when I brought him home. They treated him with antibiotics in Ukraine, and his ears cleared up enough for the trip. He had a history of ear infections at the orphanage, but my only records were the verbal reports of the orphanage staff relying on their memories. They didn't remember any specific diagnoses or treatments, just that he often had ear problems. I put a pediatric ENT on the list of specialists I wanted Nicky to see in the States.

I had Nicky checked at the American Clinic in Kyiv before we came home, and the doctor there noted some scarring of the tympanni, but since Nicky still had otitus media, he couldn't do a proper examination.

Once we got home, the doctor here gave him more antibiotics, but we had to wait until the infection was completely cleared up before going to a pediatric ENT. They did some audiological testing at the American Clinic in Kyiv, too, but the types of tests they used (and the numerical results therefrom) are unfamiliar to doctors in the United States. So, for all of this time, we haven't really known if Nicky's hearing loss was permanent or due to the infection, and how severe it might be.

We finally got in to see the pediatric ENT today. The good news is that his hearing is almost normal. He has some thickening of the tympanni, but no calcification or scarring. Thickening happens when there are inner-ear infections that go untreated. As long as the ear drum still responds to vibrations, and as long as none of the inner-ear bones are damaged, the thickening results in only minimal loss at some frequencies. Both Nicky and Zack have a small permanent hearing loss, but in both cases it's mild enough that it won't interfere with school or other activities. Yay!

The bad news is that Nicky's sleep apnea is getting worse. I noticed his heavy snoring our first night together in Kyiv, and since then, I've heard him stop breathing several times while asleep. He gasps, wakes up a little, draws in a long breath, then goes back to sleep. Since I have obstructive sleep apnea myself, I had little doubt about what was going on. However, I didn't know WHY Nicky's breathing was obstructed, or whether it was something that would clear up on its own. The ENT took one look at Nicky's throat, whistled in surprise, and did a full examination. We spent three hours at the ENT today!

Even when awake, Nicky has less that one third of his trachea open for air. When he's sleeping, the soft tissues collapse further, and he ends up completely blocked. There's no option but to remove both the adenoids and tonsils. The doctor wants to do it within a few days, but we need to wait until I can explain to Nicky what's going on, and until I can line up someone to watch Zack. We'll probably have it done sometime in the next week.

Zack also has enlarged tonsils, but not enlarged enough to warrant surgery. The ENT suspects a genetic predisposition to larger-than-normal glands, and says he needs to see Zack once a year to make sure his tonsils stay okay.

The next bad news is that Nicky's come down with another urinary tract infection. Although the urologist said that he didn't want to do anything before (thinking that the previous infections were probably due to poor hygiene at the orphanage), he's now thinking that it would be better to circumcise Nicky. Nicky had just gotten over an infection when I met him, had another right when we got home, and now has a third in under two months. I still would hesitate to do the circumcision, hoping that we could deal with the infections without the risk of general anesthesia, except that Nicky's going to be under general anesthesia anyway. The doctors suggested doing both things at the same time to save time and money, and to minimize Nicky's exposure to anesthesia.

Poor little guy! He's going to be hurting at both ends for a while.

The good news is that Nicky's doing WONDERFULLY at school. He barely cries at all when I drop him off, and he's participating in class happily for the rest of the day. I got a chance to observe him yesterday without his knowing I was there, and it was a treat to see him smiling, looking other kids in the eye, and doing the class exercises right alongside everyone else. When he finally glimpsed me standing there, he came over, hugged me, and just smiled. He didn't cry or demand to go home right away as usual. It's so fantastic to see him adjusting!

Zack continues to spend the mornings with Aunt Judy, and the honeymoon is finally over. Judy's getting to see some of the behavior problems, but it's nothing she can't handle. They're forming a good bond, and Zack is working on colors, shapes, animal names, and other pre-kindergarten stuff. Zack's English is also starting to catch up. He's much more willing to ask for things in English now, and says "please," "thank you," and "you're welcome" without any prompting. His two favorite words right now are "go" and "fast" and he uses them together when we're in the car. The boys have figured out about traffic lights, and Zack wants me to stomp on the gas the moment a light turns green. He absolutely loves it when we take a large road and go fast enough that we have to roll the windows up, but he doesn't quite understand why I can't go 100mph down side streets.