Surgery Anniversary - one year

We figure it is time to close on this chapter after a quick but seemingly very long 12 months after the excision.  Conner has really blossomed into a wonderfully energetic and feisty two year old. We are very pleased with the job that Dr. Elwood did in surgery.  There were various checkups throughout the year and everyone commented about how good the outcome is.  Scarring is minimal and the skin graft looks great!

This is the side where the mole came across his forehead to his eyebrow.

This is one of the scars, right where his part would be, great placement by Dr. Elwood.  It blends in very well and the hair falls naturally.  There are other scars above and behind his ear that are never seen due to hair coverage.  He won't sit still for a haircut so they likely won't be seen for a loooong time.  

Thank you to all our family and friends for your support!

Nevus Removal Surgery Day

Day of the giant hairy nevus excision at OSF Saint Francis Hospital, Children's Hospital of Illinois.
Surgery time is 8am so we checked in at 6am.  Everything went smoothly.  Of course "C" got hungry, but between the toy room, riding in the kid car and blowing bubbles the wait was a snap.  At about 7:45 we handed "C" off to the surgical assistant Cassie who took him with his favorite stuffed animal "Dog" back to the OR.  At this moment Jamie and I had the classic knot in the stomach, but because the wait had gone so smoothly and we'd been in this situation before the anxiety was less.

The procedure:  the mole was 11 cm from front to back and about that top to bottom.  It included hair growing tissue as well as non-hair growing, a bit of eye-brow and tiny bit of eye-lid.  The surgeon was able to remove the entire mole plus 2mm around the perimeter that also contained melanocytic cells that were invisible to the eye.  The mole was excised.  The rear expander was deflated and scalp stretched forward to reconstruct the hairline.   The expander in the forehead was removed, tissue pulled toward the scalp and a piece of expanded tissue was removed.  The stitches in the forehead cut are in the hairline.  The severed tissue was then grafted to the side of the forehead where the mole was removed.  Doing it this way avoided puckering of the skin and additional scars in the forehead that would have resulted from turning the extra tissue instead of grafting it.  The yellow gauze is stitched to the surrounding skin to put downward pressure on the graft to avoid sub-dermal clotting and funny stuff thereby allowing it to get established.  Long term C will be missing about 1cm of eye-brow.  A small sacrifice. 

Without

With Nevus

The wait during surgery is always hard.  We were packed with enough snacks and word finds for a week, can never have enough.  After 3 hours and 15 minutes we were notified that the surgery was over and we met with Dr Elwood.  Dr. Elwood explained that the surgery had gone very well.  He drew out the incisions on a dry erase board and explained what tissue had been moved where.  It was interesting to hear the doctor's thought process, get a glimpse of what plan A was, contingencies, and reflection on what other surgeons have done with various outcomes.  Even having talked multiple times with the surgeon I went into the day with a self-fabricated expectation of the process and outcome.  Because I am not a plastic surgeon my fabrication was a bit off...    At this point we felt a lot of relief knowing it was over and had gone well.  It's a whole different anxiety wanting to get in and be with him to help through recovery, the physical reassurance.

One visitor is allowed in the preliminary recovery room and one person is allowed to spend the night.  We split up the one-person duties, Jamie spent the night and Erik saw C first.  I was taken into the recovery room.  From a distance I could see him crying and upset, demanding "Dog".  He had not seen me and when I arrived at his side the crying changed to "da, da,da" and reaching toward me he sat up abruptly.  I have been in this situation 3 times now and even though I knew that everything went well, with relief that the whole thing is over and the kid is going to thrive, I got the lump in my throat and a pang of guilt.  Pain management is not fun.  So C was moved from the bed to my lap, he stopped crying and seeped a little blood on me (signs of love and affection).  He drank voraciously from the Thomas sippy cup I brought along and then refused to let go of it for the next 3 hours.  After 30 minutes we were moved out of recovery to another room for overnight monitoring.

C was reunited with Mom!  Dad was now chopped liver.  He had some morphine and took a nice long nap on Jamie.  It was wonderful!  Recovery continued to go well.  C ate oatmeal and some banana that night.  A good sign of recovery from anesthesia.  No vomiting at all.  

The IV and monitoring instruments came off in the morning and C was discharged at about 9am Thursday.   Our first nurse's son had a skin graft done by the same surgeon, a good bonding experience.  Erik and the kids picked Jamie and C up from OSF at about 9:30 to head back to the house.  Yay!    

   
 

Tissue Expansion Nine

At long last this is the final fill.   Yay!  

Erik got to accompany Jamie and C to the Illinois Medical Center in Peoria two days after Christmas.

Peoria Illinois Medical Center

  It was a good thing they had the retractable measuring tape in the exam room again.  The fill went fine.  (Although I don't recommend mom wearing a white scarf to a procedure where blood oozes out of the injection point for 2 minutes after.)  We got the pain killers ordered for after the excision and got things wrapped up in a pre-operation sense.  Surgery date is January 22, 2014.  It is an outpatient procedure and they will keep him overnight for observation.  We are anxious and in preparation.  

C at the Peoria Riverfront Museum

Doctor Elwood is hopeful that he will be able to accomplish all the planned excision in this surgery.  The plan is to rebuild the hairline and side-burn area.  The parts of the mole that will remain as planned are in the eye-brow and eye-lid, a very small bit.      

Tissue Expansion Eight

Uncle Caleb got to accompany the troop to expansion eight.  Jamie picked him up at home the morning of the appointment after some inconsequential drama the night before involving a vehicle stalling on the Murray Baker Bridge, snow storm, and getting pushed off the interstate by a state trooper.  At this point the procedure is becoming routine, but we still cannot wait to be done with the waiting room drama, our heightened blood pressure, etc.  This time round we found a new object of curiosity to kill the waiting time....a retractable mini measuring tape in the doctors office.   C pulls on the end, it clicks out, Jamie pushes on the button to make it retract.  Endless fun - it occupied the 20 minutes until the fill began.

This fill injected 35 cc's into the rear balloon and 15 into the front.  The usual numbers, and we have now surpassed the stated expansion size of the balloons.  They do have room to stretch and we will be back with C one or two more times for further injection to expand confidence.

 

We have had to be careful about what shirts we put him in the day of expansions.  One might think that the size change is incremental enough that if you can get it on that you'll be able to get it off.  Well....we had to cut the collar of a shirt to get it off him because it wouldn't stretch back over his head.  

Tissue Expansion Seven

Headed in for saline fill number seven, Momma, brother and "C".  "C's" uncles met us for the fill.  Older brother "D" decided he didn't like when "C" screamed during the fill so he and uncle left the room when the doctor arrived.  The fill went as expected.  We did learn that the expanders are now at their rated capacity, however they are made to be pushed past that capacity if necessary.  We'll be coming back for one or more fills to get in as much stretch as possible before the final surgery.  The challenge for the surgeon, as it has been explained to us, is that once the balloons are removed in surgery the stretched skin immediately begins shrinking down.  So it is better to expand and have more tissue than the anticipated need so you surely have enough to cover the excision area.  The scalp only stretches so much and skin elasticity is different from patient to patient.  The joke, "I cut the darn 2x4 twice and it's still too short", just doesn't fit very well in this case.......

"C" is taking it very well.  We can tell that his head is cumbersome to him in size.  He easily bumps the forehead on things because it protrudes so much.  Thing is that it is more like bumping on a pillow to him then bumping his head because of the fluid cushion.    Surgery looks like it will be later January.

Tissue Expansion Six

Fill six happened today and if our math is correct "C" has one more fill after this to reach full capacity of the expansion balloons under his scalp.  The additional size and weight of his head we think is throwing off his balance a little as there has been some added teetering and awkwardness.  Really, though, who's to say...he's 17 months old, all toddlers teeter.  The fill went well, a bit awkward as the doctor filled both balloons simultaneously himself (with no nurse help).  It worked, just have to make sure the kid's flailing arms don't hit the needles.  

Fill six, happy kid

We learned today that the surgery to remove the mole will probably have to occur in late January due to the surgeons schedule.  We were a bit disappointed because we thought it would be wrapping up in December which would maximize insurance benefits.  Keep in mind everyone is trying to wrap things up in December and the holidays make it a short month.   So if you are planning something like this make sure to get in early in the calendar year to keep it in one insurance year.  

Tissue Expansion Five

We've entered the "fill rhythm" now.  "C" just gives the doctor a high five when he comes in with the syringes and graciously puts his head on the table so doc can fill the balloons.  *syke*

My wife reports that she has to hold him tighter every visit.  The expanders are doing their job and "C" recovers quickly.  Up to 75 cc's in front and 190 in back.  

After expansion 5