For OR Nurses with Peds patients?

[LydiaGreen]

My six year old has been having difficulties with obstructive sleep apnea since forever. I have been discussing this regularly with our family physician since she was at least two. The entire time, he said that surgery was a last resort and we should avoid it. In June he finally did x-rays and the report states that she has moderate swelling of the soft tissue (adenoids). In September, she had tonsilitis and adenoiditis. Our family physician was booked so we saw the walk-in doctor on call that day in his clinic. She went up one side of me and down the other saying that my daughter should have had her adenoids removed years ago. At that time her tonsils were +3 and I cannot imagine how swollen the adenoids were. Her breathing was severe enough that I carried her from her bed to my bed for the night, and I am used to her breathing and snoring and apneic spells! I went back to my family physician for the first available appointment (October) and told him what the other doc had said. At this point, he explains to me that HE had T&A surgery as a child and was one of the kids who had post-op bleeding and had to be readmitted to the hospital. So, I asked for a referral to an EENT who visits our small town three times a year.

The family physician at first suggested saline drops. While my daughter has no problem with them, they do nothing. Then, he felt there might be some allergic rhinitis so we tried Claritin. She has never had a problem with bed-wetting, not even when potty-training. We used the Claritin three days in a row and each of those three nights, she wet the bed and her urine was coloured and had an odour to it. We quit using the Claritin and the problem went away. Then, we were given a script for Nasonex. She hated it! She said that it burned and would NOT do it again.

We saw the EENT last night. This was her first visit with him. He did not have her chart, nor her x-rays. He asked me a few questions, looked in her nose, ears, and throat and said he could "do it" tomorrow (this morning). This caught me off-guard completely. He spoke as if she wasn't in the room, did not speak to her AT ALL. I stopped things there and started over. I thought a complete history might be pertinent to the decision. I told him about our family physician, the walk-in physician, and that I needed an expert opinion now. He said that her adenoids aren't huge but that "they are there", her tonsils are small and fine and he would leave them in. Then he says that the adenoidectomy may not resolve her sleeping problems but if it doesn't then we can send her for a sleep study in the city (4 hours away). I asked him if he didn't think that the sleep study would be less invasive then surgery. He said yes, but that the surgery could be over and done with and then we could go from there. The waiting list for the sleep clinic is 2 years.

I just wasn't comfortable making such a quick decision on such an important matter especially when the EENT was just going on a few things that I said. What if I was one of those mothers with Munchausen's by Proxy? I WANT him to look at her chart, I WANT him to read her history, I WANT him to look at her x-rays. I don't think that that is asking too much. So, he says that he'll leave the decision up to me, whatever I decide.

So, I have one family physician telling me to avoid it if at all possible, I have another family physician (the walk-in) thinking I'm a terrible mother because it hasn't already been done, and I have an EENT who really doesn't have a position on it. The EENT is coming back in June so, I said that I would like her to see him again then so that I have more time to do my own research (since this seems to be my decision rather than a medical professional's) and prepare my child psychologically for surgery if that's what I decide. He said that was fine, he would have a quick look at her then and then do the surgery if that's what I want.

I am sure that I made the right decision last night. As we were leaving my daughter made it very clear that she thought he was just going to reach up her nose with tweezers and yank them out! Poor kid was terrified. I know that most surgeon's don't have the best bedside manner, but come on! He could have at least said "hi" to her. Anyway, I explained to her that IF the doctor removes her adenoids, it won't be now and she would be sound asleep. I explained that the nurses and a special doctor called an anesthetist would give her medicine that would make her sleep and she would wake up when it was all done. She was still worried and asked "What if they forget to give me the medicine?" I explained to her that the special doctor would make sure that she had had the medicine and that the other doctor couldn't start until the special doctor KNEW that she was sleeping. She was satisfied with these answers but, if she is going to have surgery, I want to be sure that I make the right decision for the right reasons, and that she is PREPARED for everything.

I still wonder though. The walk-in doc feels it should have been done years ago, our family doc wants to avoid it because of his own personal experience, and the EENT doesn't have a firm position. So, it's being left up to me to decide. I know that the decision always rests with the parents, but they usually have a specialist telling them, "yes, we need to do this". I am doing my preceptorship right now and will be graduating in May and will write my boards for RN in June. I have been thoroughly researching the subject for some time now, but I still do not KNOW the right thing to do.

My husband doesn't think we should allow this EENT to operate on our daughter and we should see someone else in the city. I have spoken with our OR nurses here and they say that his bedside manner is terrible (not the greatest communicator) but that he is an excellent surgeon with a very low incidence of complications. Another surgeon may have better communication skills but not as great a track record in the actual OR. So, now my husband says that it is up to me, he'll go along with whatever I decide.

What I'd like to ask is this. Do surgeon's often have no real medical opinion but leave the decision up to the parents? Do surgeon's often decide to operate (the next morning) without a complete medical history and at least reports of the tests that were done to confirm a diagnosis?