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Didi’s Adenotonsillectomy

If you’ve been following us on Instagram or Dayre, you might have seen some posts and IG Stories about Didi undergoing surgery recently. I’ve had quite a few people asking about what led us to send him for surgery etc, so I thought I’d write a proper post here about it.

We’ve been living in Jakarta since the twins were three months old, and only relocated back at the end of May this year, after living there for 2.5 years. During this period, all three kids have fallen ill repeatedly, and when we returned to Singapore for good, our PD urged us to bring Didi to see an ENT specialist, as his tonsils were enlarged. She had actually mentioned it a few times before, when we came back for the twins’ vaccinations, but those trips were usually very short, so we didn’t have time to see a specialist.

Didi fell sick twice within the span of a month when we returned, despite being in Singapore with better air quality (we thought the bad air quality in JKT caused him to fall sick frequently). Our PD referred him to Assoc Prof Henry Tan at KKH, and when Prof Tan examined Didi, he classified his tonsils as grade 4 (Didi was sick at that time). He then sent Didi for an x-ray to check on the size of his adenoids.

If you look at the x-ray above, the top blue circle is his adenoids, while the bottom one is his tonsils. They were both really large, and the black areas circled in purple are basically his air passages. He wasn’t getting much oxygen, and Prof Tan explained that the lack of oxygen meant that his organs weren’t getting enough oxygen for Didi to grow, and that his heart was being overworked. In the long run, it could lead to heart failure. He recommended getting both the tonsils and adenoids removed as soon as possible, and when I asked if the surgery could be postponed till he were a bit older, he told me that he would be a bad doctor if he said yes.

It was honestly really scary to think about Didi undergoing surgery, but Prof Tan said that in Didi’s case, medication wouldn’t be able to help, and that surgery was the only solution. He attributed Didi’s small size (he only put on 400g in a year) to the lack of oxygen, and said that Didi would be able to grow faster after the surgery. The size of his tonsils and adenoids meant that he couldn’t breathe properly through his nose, and that he couldn’t sleep well. He also found “glue” in Didi’s right ear, which is a build-up of fluids that can affect his hearing.

The earliest available surgery slot for Prof Tan was the end of October, which was about 1.5 months away. I was told that Didi had to be healthy, ie no fever/runny nose/cough, for at least two weeks before the surgery, or we would have to reschedule it. That was a real challenge, as Didi was almost always down with some kind of bug, and his breathing was always loud and somewhat laboured.

By God’s grace, we happened to meet up with a doctor friend, who recommended Dr Tay Hin Ngan at Mt E Orchard. We got an appointment quickly to see him for a second opinion, and he too concluded that Didi needed surgery. He told us that we could send Didi for a sleep study to confirm that he has Obstructive Sleep Apnea (OSA), but from his x-ray as well as my description of Didi’s snoring and sleep habits, Dr Tay was very confident that Didi had OSA.

Dr Tay did a scope to check Didi’s ears, nose and throat, and Didi was extremely well-behaved throughout the procedure. He didn’t struggle at all, and even declared, “This doctor is very nice! I like this doctor!” at the end of it. Haha.

Dr Tay confirmed that there was fluid build-up in Didi’s right ear (top left image), and I was horrified to see the size of Didi’s tonsils (circled in blue in the top right image). In the other two marked images, you can see the size of his adenoids (circled in blue), as well as the amount of space for him to breathe through his nose (circled in purple). One nostril was completely blocked, while the other had less than 10% space. Poor boy! No wonder he snores so loudly when he sleeps. Dr Tay said that Didi had adapted by breathing through his mouth, but his enlarged tonsils didn’t allow him to get much oxygen via his mouth either.

We decided to do the surgery with Dr Tay instead, as he had much earlier surgery dates available. Also, Didi would have to be warded for only one night, which would be easier for all of us (KKH required him to be warded overnight before the surgery itself, as well as a night after the surgery). We scheduled the surgery for the week after we got back from our Legoland® Malaysia trip, so that Didi could have a fun weekend, and play at the Legoland® Water Park as well. There was a good chance that he would need to have a grommets tube inserted in his right ear to drain the fluids there, which would mean that he couldn’t swim or play at water parks for a long time.

To prepare Didi for the surgery, I read ‘The Great Hospital Adventure in Space’ many times with him. The first time we read it together, he asked, “Can you go with me?” when we got to the part about how Monkey Boy had to go in for the scan with the doctor and nurse, without his parents. My heart broke a little, but I told him that I would go in with him, but I would have to leave after a while. I reassured him that I would be waiting outside for him, and he would be able to see me once he woke up.

We also read “Curious George Goes to the Hospital’, as it showed Curious George going into the operating theatre, and I thought it would be good for Didi to have an idea of what the OT would look like.

Two days before the scheduled date, I brought the twins to Mt Alvernia Hospital to do the pre-registration for Didi’s surgery, since Didi’s surgery was scheduled for 730am. The registration can take quite some time, so the nurse at Dr Tay’s clinic advised me to pre-register Didi, so that we didn’t have to be at the hospital that much earlier (we went in at 6am on the day itself). I wanted Didi to see the hospital beforehand too, so that he wouldn’t freak out on the day itself. Meimei wanted to tag along, and I think Didi felt better having her there.

The day before the surgery, Didi started coughing non-stop during breakfast, snack, and lunch. I was really worried, and rushed him down to Dr Tay’s clinic so that Dr Tay could see if he was fit for surgery. Thankfully, Dr Tay thought the coughing was triggered by the small food particles, but to be on the safe side, he suggested that we monitored Didi overnight to make sure he didn’t cough anymore, and also asked us to get Dr Thanaporn, Didi’s anaesthetist, to check his lungs a bit earlier before the surgery.

That night, N led us all in prayer for Didi. No idea why they were so tickled though!

On the morning of the surgery, Didi started coughing on the way to the hospital, and coughed non-stop until the nurse switched off the aircon in his room. Dr Thanaporn called and after speaking to me on the phone, asked me to meet her outside the OT with Didi after he was changed into the hospital’s top for the surgery. I think it really helped that we came beforehand for the registration, as Didi was calm and remembered, “We came here with Meimei last time, right?”

Dr Thanaporn was really kind and checked Didi’s lungs thoroughly before giving him the all-clear for the surgery. She gave Didi a mask to hold and smell, chatting easily with him, and told him that she would give him another similar mask inside to smell. While a nurse played with Didi, Dr Thanaporn explained the process to me. I was relieved that I could carry Didi in, and accompany him till he fell asleep with the help of the GA.

It sounded a lot easier than it actually was, because when I walked into the OT with Didi in my arms, I was really reluctant to put him down on the operating table. Didi looked around, and I reminded him of how there were similar lights and equipment when Curious George had his operation too. There was a small pillow on the operating table, and I talked to Didi about how Monkey Boy lay down on the pillow by himself. Didi was a real champ and nodded solemnly when I told him that he had to lie down on the pillow.

I was holding back my tears as I lay him down, because he looked so tiny and serious. The nurse played some nursery rhyme videos for Didi, so he was busy watching the videos when Dr Thanaporn put the mask on him. She told me to hug Didi and hold his arms down, and she stroked his cheek gently while administering the GA. She reminded me that he would snort a little before falling asleep and that it was very normal, then as he yawned and his eyes started closing, she told me to give him a kiss. My tears fell freely then, as she told me that both of us were doing very well, and reassured me that they would all take good care of my baby.

A nurse escorted me out of the OT, which was really helpful as I was sobbing away. She kept telling me that Didi was in good hands, and that they knew he was my baby, and would look after him in there. Dr Tay was walking in as we were leaving, and he too told me not to worry.

C arrived just before Didi went in, so he was waiting outside the OT for me. We went back to the room to wait for a while, and prayed again for the surgery to go smoothly. I bawled a bit more, before heading back to wait outside the OT for Didi.

The surgery took longer than we expected, and the nurses were very kind, even though I kept bugging them to ask if Didi was done yet. Finally, after about 1.5 hours, one of the nurses came out to tell us that the surgery was done, and that Didi would be out soon.

Dr Thanaporn and Dr Tay both told us that the surgery went well, which was a huge relief. Dr Tay explained that Didi’s tonsils were “stuck” and more difficult to remove than those of children his age, and said that he had to remove them the way he would for adults. He also said that there was a lot of thick fluid, aka “glue” in his right ear, and despite his best efforts to suction and flush the fluids away, he still had to insert the grommets tube to drain the fluid, as there was just too much accumulated inside.

The top left image shows the grommets tube in Didi’s right ear. The top right image shows his tonsils (circled in blue) before the surgery, and the second image on the left is of his throat, after the tonsils have been removed (the spaces circled in red). The blue circles in the next two images show his adenoids, and the purple circles below show the space that he has to breathe. The last two images with red circles show the amount of space he can now breathe through. Such a huge difference!

After the surgery, Didi was drowsy and slept for another hour or so. He woke up briefly, but went back to sleep again when I lay in his cot with him.

When he woke up again, his first words were to ask for cartoons. Haha. Dr Thanaporn told us that his mouth would feel a bit strange initially, and we had to remind him to swallow his saliva normally, and prevent him from putting his hand into his mouth.

Didi was generally calm, and only cried when I wanted to have my lunch. I had to carry him while eating, as he didn’t want C or my dad to hold him. He ignored Meimei when she came to visit him, so they just watched cartoons together in silence. He cheered up considerably in the afternoon, and asked to play with the Shape Up Activity Pod from Peas in a Box that I brought along. He was also really happy to hang out with N and Meimei when they came to visit him in the evening.

We gave him some sips of cold water when he asked for it, and thankfully, he didn’t vomit, so he was allowed to have some cold milk, followed by ice-cream. He found the ice-cream too cold, and basically ate melted ice-cream over the next few days.

The nurses gave him a “robot hand” so that his meds could be administered via the IV tube, and he didn’t protest at all. He also let the nurse wrap his arm in plastic so that I could bathe him.

Didi was given painkillers round the clock, which meant that we couldn’t really sleep very well, as the nurses came in to check his vital signs as well as to administer medication. I planned to sleep on the couch next to his cot, but when he asked softly, “Can you sleep here with me?” I couldn’t say no, and squeezed in there with him.

Dr Tay came early the next morning to examine him, and gave us the all-clear to go home. Didi was actually asking to go home when N and Meimei went home with C, and also a few times during the night, so he was really happy to hear that we could go home in the morning. It was the first time that we didn’t sleep with the rest of the family, and it was especially tough on Meimei because I’m still nursing her to sleep. C said she cried twice, but thankfully, she was able to go back to sleep on both occasions.

On our way home, Didi told me that he wanted to “play princess with Meimei”, but was afraid that she wouldn’t want to play with him. He was extremely shy when we got home, and wouldn’t even look at Meimei! After a lot of coaxing, he finally joined her in playing with the building blocks. He’s such a funny little boy!

It has been two weeks since Didi’s surgery, and we just saw Dr Tay for Didi’s post-op review. He said that Didi is healing well, although he caught a bug from N and Meimei, as there is mucopus in his nasal passage. Didi still isn’t allowed to eat deep fried food or hard biscuits, to prevent his throat from being scratched. He can now have slightly warmer food/drinks (he was only allowed cold food/drinks to prevent the blood vessels from expanding and bursting), but we still need to be a little more cautious in general.

Didi still experiences some pain in his throat, and I think on the fourth day after his surgery, he was banging his head on the pillow in the middle of the night, because his throat hurt a lot and he didn’t know how to deal with it. I quickly gave him the painkillers with some cold milk, and he was able to go back to sleep after that. I’m so proud of how brave Didi has been throughout this experience!

Dr Tay sent Didi’s tonsils to pathology after the surgery, and shared with us that the report showed that Didi had suffered from repeated cases of tonsilitis, which explains why his tonsils were more difficult to remove. Look at how huge his tonsils were! Dr Tay said that these two are actually smaller than the actual size, because they usually shrink about 30-50% when put into the formalin. Gosh.

It’s really good that the surgery was done, as Didi no longer snores when he sleeps, and can sleep for longer stretches of time. His appetite is increasing, and he has gained 400g in a month. C and I have also noticed that he seems happier and more active, which is quite interesting.

Thank God that we are now back in Singapore and that our PD pushed us to see an ENT specialist, or we would never have known that Didi needed this surgery, because none of the doctors we saw in Jakarta mentioned anything about Didi’s enlarged tonsils. C said that THIS was probably the reason why we came home a year earlier than expected from Jakarta, and indeed, it must have been in God’s plans for us.

PS. I am not a medical professional, and may have gotten some of the medical information wrong in this post. If you think you or your child may require this surgery, please do check with your doctor or PD.

#Didi

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