Update: Arden’s Bilateral Vertical Talus Surgery

This week was a bit of a whirlwind and we’re definitely all playing catchup at the Lockhart house! You could say that all three of us are played out…especially Arden! However, we are so proud that our little man came through this most recent surgery with a more swift recovery than we’ve ever seen from him. Arden truly is our little superhero! 

For six weeks, Arden had casts on (serial casting) due to his bilateral vertical talus. Essentially, a vertical talus is the opposite of clubfoot. Whereas club feet point down and inward, a vertical talus causes the feet to point up and outwards. The talus bone usually sits between the heel bone, and the two lower bones of the leg (the tibia and fibula). In the case of a vertical talus, the bone is positioned wrong. Arden’s casts for the past 6 weeks helped to stretch the muscles and ligaments around the bones so that the surgeon’s job was made just a little easier. 

On Thursday July 8, I took Arden to the pre-admission clinic at the Stollery. For appointments like this the hospital still only allows one parent to attend, so Brodi had to wait at our hotel. Upon arrival, the nurse took one look at Arden and said, “Oh! You’re vented…” (Cue the exasperated jaw drop on my end….) Apparently the hospital had failed to read the forms we filled out, or the communication sent by our pediatrician, because they were under the impression that Arden only had a trach, and not a ventilator as well. Our “day surgery” quickly changed to being at least an overnight stay at the hospital. 

That said, we had brought one of our night time caregivers with us, and she needed to be home by a specific time on Saturday. So after we left the pre-admission clinic, Brodi and I were in a crunch to figure out how to get her home if Arden was to stay in the hospital for any length of time. 

On Friday, the day of surgery, we were told to arrive at the pre-admission area at 9:30AM and that the surgery would take place at 10:50. Luckily, they allowed both Brodi and I to go into a room with a bed to wait with Arden. That way he could at least play and rest beforehand. After waiting a long time, we were told that an emergency case was put in ahead of Arden, and that it would be a little while. A little while turned into a long while, and we didn’t actually head down to the operating room until almost 2:00PM. 

Although the surgery was supposed to take 2 to 2.5 hours, and we were told to go eat and relax, we were also told that no one would call us when he was out of surgery and in the PICU. We were told to “keep checking back,” which for me meant lingering outside the PICU like a stalker until my baby arrived (haha). 

The surgery took a lot longer than anticipated, and Arden did not arrive in the PICU until around 6:45PM. Luckily at that time we received a warm welcome from the doctors, nurses, and respiratory therapists that we knew from Arden’s 4 months in the PICU last year. Although a huge part of me dreads being back in the hospital, the familiar faces made it feel a little bit like home. 

During and after surgery, Arden was kept on an ICU ventilator for safety. However, we were delighted to see that they had not had to increase respiratory support. His vent settings remained mostly unchanged, except for a small increase in his breathing rate and oxygen level during surgery. He was kept on the ICU ventilator for Friday night just to be sure that he was stable. 

When Arden was in the hospital last year, it was a long haul. Brodi and I would spend 12-14 hours per day at his bedside. That said, when it came time for sleep, we did have a place across the street where we could go, and we had to place our confidence in the medical staff for the night, because we knew sleeping well would help us endure. Arden is older now, and he is no longer accustomed to strangers at his bedside. Just like any little one, he craves mom and dad. For his overnight stay at the hospital on Friday, Brodi and I took shifts watching over him. As the night owl between the two of us, Brodi stayed up for the first watch, while I went back to our hotel for a short sleep. We then swapped out at 4:30AM. 

Throughout the night, Arden was naturally uncomfortable following surgery, but overall he did so well. To be honest, our biggest concern was that he did not pee for the whole night. This was concerning for us because when a patient can’t pee after surgery, oftentimes a catheter is inserted. Every time Arden has had a catheter placed in the past, he’s also contracted a urinary tract infection. We knew that if this happened, he’d then be placed on antibiotics and our quick hospital stay would likely turn into a much longer ordeal. 

Luckily Arden did pee in the morning, and those concerns quickly faded. The next concern was that his heart rate was unusually high. After giving some toradol for pain, it did seem to come down, and when he was sleeping, his resting heart rate was closer to his baseline. During this time however, the medical staff was quick to push us to give Arden hydromorphone (Dilaudid) for pain. Hydromorph is a narcotic, and a drug that Arden had to be on last year following his tracheostomy and g-tube procedures. Although effective, the drug is addictive, and we spent months weaning Arden off of it. I would say that the weaning process was one of Arden’s biggest barriers in progress last year. That said, we did not want him to have any of it this time. Fortunately, he continued to do well without it, and his pain was manageable with Tylenol and Advil around the clock. 

Hospital protocol is often that patients move from the PICU to the “floors,” the less intensive units in the hospital, before being discharged home. On Saturday morning, we could see that Arden was doing well, and all he needed was rest. We pushed for him to be discharged, and after multiple conversations between the intensivists and managers, and our pediatrician and surgeon, they agreed to discharge him. We were able to leave the hospital around 2:30PM. And let me tell you, we peeled out of there as quickly as we could!! (haha) 

We will need to visit our pediatrician again in 2 weeks for a checkup, but we’re grateful to be finished with our weekly casting visits for now. In 6-8 weeks, Arden will have to return to the city to have his current casts removed. He will then be placed in what is called “boots and bar” full time for 3 months in order to keep the progress of the casts and surgery in place. After the 3 months, he will need to wear the boots and bar during nap and night time sleep until he is 2 years old. 

The next step in Arden’s development will likely be to look at his knees, and potentially try serial casting on those as well. In the meantime we’re also waiting on our referral to ophthalmology to go through so that we can potentially fix his ptosis so that he’ll be able to see better. 

Since Saturday, Arden has been resting and recovering at home. He has done well with pain management, and is mostly back to his usual, playful self. Despite some extra increase in thicker secretions due to the heat lately, he continues to do well with his 10 minute off-vent trials. Yesterday I was once again able to place him on ¼ litre per minute of oxygen. We’re hopeful that soon he will not need extra oxygen tied into his ventilator at all, and that would be a huge step forward. 

Although this hospital stay was short, it took a lot out of us all. A few days of family time, extra naps, and relaxation was much needed. We truly appreciate everyone who has taken the time to message, call, or comment their best wishes for Arden’s latest surgery. It means the world that we have such incredible people in our corner. 

XO, Rayel