Photos from March

As with any plastic surgery, it is a sit and wait game to see how the finished work will turn out.  During the healing process, the muscles have to knit and when they do that they tightened which you can see pulls up the lip bow on Ultan's cleft side.  Once the muscles have relaxed the lip bow should relax back down.  This could take 12 - 24 months.  So, Ultan's face should/could change continuously over the next year.  It will be interesting to do a comparison on the first anniversary.

February Photos - We are Home

It was so good to be home.  

I thought I would be in mourning for Ultan's first smile but surprisingly I didn't even reach for a picture for many weeks.  I definitely mourned prior to surgery and even for those first hours after surgery.  But, with his first smile or second smile, Ultan is Ultan and he shines through with or without a cleft.

Something I thought might happen but wasn't prepared for was the regressing back to a newborn schedule.  Ultan was born on the 25th percentile and dropped to the 10th percentile after surgery so he worked hard to regain his weight which meant he was getting up every few hours during the night.  And as he is breastfed it meant that I had to pump more.  My motto kept ringing in my head - it is only a phase....  

I tell you now, you can conquer the world on a good nights sleep!

Last day of stitches.  8 days post lip repair

First day of no external stitches. 9 days post lip repair.

  Embarrassing confession:

Ultan's shiny face is a result of my fear of going near the wound hence I didn't clean his face from when we left hospital until we returned to get the external stiches out.  Once I did wash his face, it was rather alarming the amount of my make up that was on his face (obviously hugging the wee fella a little too close to the wound!)

Do know that you can wash your child face after lip repair.  I was just too scared!

I have to say, with the external stitches gone, Ultan did not look nearly as delicate .  He was slowly but surely returning to his normal self.

Shiny face gone.  Here is the little man's big smile :)

I didn't think about the nose repair before surgery and Ultan's nose was a complete surprise to me.  I think Dr Lam Lai Kun did incredible job.

January Photos. In the hospital

Ultan at 8 weeks old in hospital getting his lip repair as well as the frontal part of his palate prepared for his palate surgery later this year.

Even the extra small hospital gown was too big for our wee 8 week old Ultan

Morning after surgery.  Mirror was brought as an entertainment tool for the cot.

Kai seeing Ultan's second smile for the first time :)  Ultan's brother's were very relaxed about their brother's new smile and were more interested in given him a kiss and exploring the hospital room.

Ultan's new smile Day 2 post surgery.  I didn't capture the first smile on camera as Dr Lam Lai Kun had the privilege of giving Ultan his second smile and receiving the first smile from his second smile - with me?!

Also, these are the AWFUL arm restraints that Ultan had to wear for almost 3 weeks.  He tolerated them really well but it was obvious he didn't like them.

 4th day post surgery as we are just about to go home :)

Not forgotten

It is embarrassing to look at how long I have neglected to post on this blog.  I haven't forgotten it - far from it.  It has been on my mind as I have a lot that I want to write about.  But presently I find time slips away very quickly.

I have been busy with these 3 little guys..... :)

I am getting photos together so you can catch up with Ultan's journey.  And it is a journey that is going so fast.  He is 5 months now.........

Sharing so you can keep in mind

This post is something I debated about sharing and decided at the time against but as time has past I have changed my mind in order to stop it happening to another baby who has just gone through a lip repair. 

To this day I am still convinced that we chose the right doctor and through him we trusted that he chose the right hospital and I honestly believe he did.  Through my miscarriages in Hong Kong I have experience in a lot of the hospitals on Hong Kong Island but I have to say checking into the Adventist Hospital was a first for me.  Living in Hong Kong I had heard rumours about the hospital having a good cardiology dept and a good ER dept for kids but further than that I really had no idea (except that there would be no caffeine which was fixed by some wonderful friends!).  

Ultan's nurses were, on the whole, incredible.  Through Ultan's stay he had 4 nurses that stood out who cared for him. The nurse who mainly took care of Ultan happened to be Japenese who didn't speak Chinese and had limited English.  I wished so much to have all of my family near by because my Brother in Law, who has craved a profession with Japanese, and his gorgeous Japenese wife would have cemented the bond between our nurse and us with their Japanese fluency.  Nurse 1 (as I shall call her) was born to care with her natural tendency to care for babies.  She completely respected our Son and we love her for that.  You know you are in good hands when your nurse walks through the door and you want to see her.  

The second nurse was by far the most confident with dealing with clefts.  She has the most experience with cleft care and with her confidence I would imagine would make a good teacher.  She made me feel completely at ease with her care for Ultan and I trusted her in updating the doctors as she had experience with what she was talking about.  Nurse 3 was lovely, she was an extremely nice person but I had to stop her temptation of cleaning the wound when unnecessary i.e.  the nostril floor is especially tender and as there are no stitches in that area. Blood clotting is relied upon as part of the healing process.  Watching this process it may be tempting to clean the dried blood away but from what I have read, the nostril floor is best left a lone in the days following surgery.  Turned out nurse 3 was new to Adventist and I would love to know if she had worked in Queen Mary because she reminded me of the nurse who wanted to feed Ultan with a syringe!!  

Nurse 4, was on her night shift when Ultan came under her care.  During Ultan's stay I didn't leave his side and at night I would sleep on a sofa bed by his cot.  I would hear nurses come in to do their job checking Ultan and by the third night I didn't get out of bed everytime a nurse came in. Unfortunately I choose the wrong night to stop because when nurse 4 came in to do her check at around 4 am, she, probably without knowing, or realizing, she pulled up the bed blankets around Ultan's chin.  Well, for a baby who has had a 3 hour surgery on his face and has his arms in arm restraints to stop him touching his healing wound, having a wool blanket available for him to scratch his itchy wound = time of his life.  Ultan had a field day ripping his head from side to side probably trying to relieve the itchness of the healing wound that by the time I found him the bedding was filled with Ultan's fresh blood and his face was covered in blood - to the degree that I did not know if his wound was damaged.  Just hours earlier I had been told about two incidents in Hong Kong where the lip had split post surgery and believe me, I was mentally incapable of having to go through this surgery with my son again.

The nurse obviously was shocked that her innocent and to be honest loving action of covering a baby and make him more cosy would end in such a bloody result.  Immediately she changed the sheets and as much as she wanted to clean up Ultan, I think she knew by my eyes that it would be best if she left the room and not to return - which she did.  Thankfully experienced Nurse 2 arrived a few hours later and I trusted her competence to clean Ultan safely (she didn't touch the wound, just cleaned the blood around the rest of the face) before Dr Lam arrived.  Dr Lam did a complete clean and to my extreme relief confirmed all was OK and no damage was done.  I also have to mention that the ward manager came in to apologise for what had happen as soon as she arrived to work.  She was devastated by what had happened and was sincerely apologetic.

From reading this you can tell that there was no way Nurse 4 would have done this on purpose.  It is a natural reaction to pull the blankets up on someone to make them more comfortable but in the case of patient recovering for a lip repair, it happens to be detrimental to their recovery. The wound must be protected from not only the baby's wee fingers but also from all other devices which will help baby scratch the hell out of his/her wound.  This is why I have decided to share now as Mom/Dad/Carer who are taking care of baby after surgery will not allow a loving nurse do this to their lip repair baby.  And for the carer, don't be surprised how instinct kicks in.  

Trust me, trust your instincts!

A relieved Mommy taken a photo after Dr Lam confirms the wound is OK!

PS  Ultan is a clever wee fella and he learned that having a nurse come near him may end up with a needle stuck in him so he would react like any baby know's how and would scream if the nurses crossed the bottom of the cot.  However, to my amazement, Dr Lam Lai Kun did a complete clean, which included using instruments

and Ultan had nothing but smiles.  This is obviously a good sign - one does wish for their plastic surgeon to have a gentle touch!

Feeding post lip repair.

Instructions on how to feed your baby after a cleft repair can differ from doctor to doctor.  Lam Lai Kun's aftercare instructions include no bottle for 2-3 weeks.  Thankfully Ultan has taken to these pigeon bottles with syringe teat!

Day 6 and Ultan is eating approx 50% of what he was pre lip repair.  I don't think I would feel like eating either if I had a 3 hour surgery on my mouth!

Cocktails are optional but highly recommended ;)

Lip repair!

Lams of Hong Kong are like O'Briens of Ireland - they are everywhere and Ultan's cleft team are no exception.

Ultan's Team

• Plastic Surgeon - Dr LK Lam
• Anesthetist - Dr CS Lam
• Pediatrician - Dr CC Lam

with me?!

The last time I spoke to Dr Lam Lai Kun before the surgery, I told him to get a good night's sleep.  He laughed at me mothering him but little did he know that I actually wanted to ask him was he partying over the weekend, not to drink alcohol (I could do that for both of us), eat a good breakfast, and make peace with everyone before he came into theatre.  I restrained myself and just told him to got to bed early!

Sunday night and Monday morning were as if I was being electrocuted in my stomach with the electrodes pulsing through every nerve.  I was sick to my core for having my wee man go through this surgery.  My emotional side wanted to run away with him, for who was I to change his appearance, but my rational side knew this was Ultan's journey and in order for him to speak and eat properly he would have to have his lip repaired.

Needless to say, arriving at the pediatric ward in Adventist hospital was nothing but a bag of nerves.  The team visited us.  I reminded LK Lam to try and save Ultan's Cupid's bow and off he went to get in his scrubs.

Ultan having his very last thumb sucking with his cleft lip

745am we were escorted to the 8th floor to where Ultan's lip repair would be conducted.  For an 8 week old baby who is in the midst of being obsessive with lights, bringing him into an Operating Theatre was the equivalent to Disney World for him.  His wide smile gaped open as his head went around in circles for which light would he would start with first.  I felt like traitor seeing his joy but knowing what was going to happen within minutes.

I was an emotional mess.  To distract myself a little while Ultan was busy checking our the lighting system, I checked out the team.  The atmosphere between the team was extrmely relaxed.  Although this is Dr Lam Lai Kun's territory, his OT nurse (wish I knew her name) came across gentle and caring but would have everyone whipped into shape in an instant.  CS Lam, was towards my left preparing the gas mask.  He has a posture that if he were an English man you could imagine him wearing a tweed waist coat, smoking a pipe dispensing his worldly knowledge while walking in the garden.  He brings a bit of character to the theatre.  And then there is LK Lam.  A Plastic Surgeon by day but I am sure he was a rocker in a previous life.  Maybe he is in this life!!  I was allowed to stay with Ultan until he slept and needless to say it was horrific having to walk away from him.

See you in 2 hours was the last thing I heard and Mark and I went back to the room to wait and wait and wait.  We walked the room, picked up a paper, left down the paper. Picked up a book, left down the book.  2 hours came and 2 hours passed and our anxiety was filling up with no word from the theatre.  Finally after 3 hours we were called to recovery to find a very relaxed CS Lam and OT nurse.  I know and understand that this is their bread and butter but little do they know how close I felt to being admitted to the heart ward waiting for news on Ultan.  LK Lam met us and was extremely pleased with Ultan and with the repair.

For parents who are diagnosed or are about to go through a lip repair with their child, this is the moment that is written about a lot.  Meeting your baby for the first time with their second smile.  For me, I froze, I was numb.  The nurses told me to go ahead and pick Ultan up but I didn't know how.  He was attached to a drip and a heart monitor and had arm restraints on.  A parents job after the surgery is to cuddle, sooth and also to protect the wound.  I was so scared of all of the above.  Mark just jumped in and was immediately attached.  I was happy for Daddy to take over until he had to go to work (someone has to bring home the bacon!).  He put Ultan in my arms and bam, I was on my own.  It was an awkward afternoon because I was aware my son was in my arms but the baby in my arms didn't look anything like my wee man.  I know some readers may find this cold of a mother but I felt detached, maybe not detached - probably numb would be a better way to describe how I was feeling.  I felt like a babysitter rather than a mother.  That was until around 5pm as I moved my arm to check the time, Ultan woke up, the sedation had worn off and, wow,  his ocean blue eyes just drew me into him and he made his apptly timed sound of awwwooooo.  This was the moment, the line when I finally said goodbye to Ultan's first smile and embraced his second smile for it was Ultan and once I recognised him through his eyes, I finally realised it was my wee man in my arms!

Guess who got his first second smile - well it wasn't his Mommy who had rocked him all night.  8am day 1 post op Ultan chatting and cooing, smiled at the man who gave him his new smile.  LK Lam had the privilege of receiving it and it is a beautiful smile.

Day 1 post op

The rest of our stay in hospital was thankfully uneventful.  It was very much supporting Ultan through his recovery.  I am of course certain that I will soon have Michelle Obama's upper arms for Ultan's post op care calls for a lot of lifting Ultan in the air for he loves that weightless feeling!

Day 2 post op.  What do you think of his new smile?

So, here we are.  For all parents who feel like their heart is breaking having their baby go through a lip repair.  Well, 5 days on we are at home surprisingly back in the same routine as pre op.  Family life has resumed, homework has to be done, dinner has to be prepared and movie nights have to be organised and Ultan is back where he belongs, amidst his family.  As for introducing Seán and Kai to Ultan's new smile.  We brought them to the hospital, they ran into the room "Hi Ultan", kissed him on the forehead and proceeded to explore the hospital room, for to them it doesn't matter to them what smile their brother has.  He is, has and always will be our wee Ultan, our wee Ulsterman!

Just have to go through this again in 6 months when Ultan's palate is being repaired!

PS  We thank all of you for all your good wishes.  Mark and I read every message that was sent to us.  Also, thank you friends for the delivery of caffeine during my stay  (for those who don't know, Adventists don't serve caffeine in their hospital!).