Update: Arden’s (First) Pin Removal Trip

Last week we visited Edmonton because Arden was due to have the pins removed that were placed during his last surgery (for the correction of his bilateral vertical talus). Brodi had to work later into the evening on Tuesday night, and Arden’s pediatrician could only see him on Wednesday at 9AM. So…we rose at 3AM on Wednesday morning and headed down to Edmonton. Fortunately we were able to bring one of Arden’s night time caregivers with us on this trip, and because she was on night shift, she looked after Arden in the car while I caught a small nap in the front seat. 

When we arrived, the visit to the pediatrician’s office was short and sweet as usual. Not a lot changed during this visit, except for a few small things. Arden’s doctor was pleased that he’s been able to have a lower volume in his cuff, and has been able to bypass air around it to experiment with his voice. He also promised to put in a call to the ophthalmologist so that we can get Arden into their office a little sooner in order to check out his ptosis. Arden is going through quite a “make strange” phase, and really did not enjoy the visit to the doctor. The most offensive activities included having his ears looked in and his temperature taken (haha). 

Following the appointment at the pediatrician’s office, we then had until the next day to kill, because Arden’s pin removal procedure wasn’t scheduled until Thursday afternoon. We took advantage of the time and ended up having a long family nap because we were all exhausted! 

On Thursday, we arrived at the pre-admission clinic at 12PM, because Arden’s procedure was scheduled to take place around 2PM. Anytime Arden has a surgical procedure that requires him to go under anesthetic, he needs to be admitted because he is trach-vented, and they need to monitor him closely to ensure everything is baseline before he can head home. In the pre-admission clinic, they take Arden’s temperature, check his oxygen saturation and heart rate, and take his blood pressure reading. They also swab for “super bugs” (not a covid-swab!) on any child who has been admitted to the hospital within the past 6 months. In Arden’s case, he needed these swabs because he had been admitted in July for his last surgery. We prepped him by getting him changed into a hospital gown and putting on his hospital wristband. Then it was time to wait. 

Usually surgeries NEVER happen on time, because procedures in the OR always take longer than expected. It’s not unusual for us to have to wait a couple more hours than anticipated. We expect this, but it’s still unfair for Arden, because he doesn’t understand why he isn’t allowed to have any form of nutrition while we wait. 

Arden took a nap in the crib he was provided, and after about an hour and a half of waiting, we were told that Arden’s surgery had been bumped. Apparently, a lot of emergent pediatric orthopedic cases came in that required immediate surgery. Because Arden’s case was not urgent, he was bumped off the list to make room for the others. We were told that Arden’s surgery would be moved to 11AM the next day (Friday), and that we were to arrive back in the pre-admission clinic (P.A.C.) for 10AM. 

At that point, we were frustrated, but we understand how it happens. Urgent cases are the most important, and we knew there was nothing anything could do to prevent Arden’s surgery being postponed. In order to relax that afternoon, I took a couple hours to stroll Whyte Avenue with Arden’s caregiver, and it was nice to get some fresh air and a walk in. After that we swapped out and Brodi went to hit a few golf balls at the driving range. 

That night as Brodi was arriving back to our hotel from the golf course, I got a call from the surgeon saying that Arden would no longer be receiving surgery in the morning, and that it wasn’t imperative that the pins be removed right now. This was shocking to us! We also wondered how the scheduling of Friday was going to go, because we had made appointments based on him getting the casts off and the pins removed. 

To explain, we had to book an appointment with an orthotist in Edmonton in order to have him measured for his boots and bar. The boots and bar are the braces that Arden will use once the casts and pins have been removed. The day would proceed as follows: The orthotist would cut the casts off and take Arden’s measurements for the boots and bar. We would then go to the hospital to have the pins removed. After surgery, Arden would be re-casted and would keep casts on until the boots and bar came in (this takes about a week). 

Without the pins being removed and Arden being re-casted in the OR, we wondered how/where he would be re-casted in order to keep everything in place after the orthotist removed the casts to do the boots and bar measurements. After communicating with the surgeon’s assistant, we were told that they had already made Arden an appointment at the surgical clinic for 3:30PM on Friday to be re-casted. Although we were frustrated that Arden wouldn’t be getting his pins removed during this trip, at least we had a plan.

On Friday morning, the orthotist resident took one look at Arden and seemed highly concerned that he had plaster casts on. We soon realized why. After the resident searched the clinic for a few minutes, he returned and told us that they didn’t have a cast saw. (What kind of orthotist doesn’t have a cast saw?!!) Thank goodness Arden’s casts were already loose, soft, and in rough shape after being on for 7+ weeks…because the resident had to spend the next hour ripping and cutting the casts off. The actual measurement for the boots and bar only took about 5 minutes after the casts were off.

Additionally, as we were taking the casts off, we noticed that Arden’s right foot was quite tender. Once the gauze underneath was fully removed, we realized why. The pins that Arden had placed in his feet during his last surgery were internally fixated. This means that they were fully inside the feet, buried, and stitched up. However, after removing the casts, we realized that the pin on Arden’s right foot was sticking out about a half an inch. We immediately called the surgeon’s office, and we were told to come right to the surgical clinic after we were finished with the orthotist. 

At the surgical clinic, the orthopedic surgeon took a quick look at the protruding pin, and decided that it needed to come out immediately. Because the pin was already sticking out, that meant that it wasn’t really attached to the bone. While they sterilized the area and prepared to remove it, Brodi explained to me that it would be painful and that it would probably bleed a lot. I was terrified!! I did not want them doing anything to Arden that would cause him pain. The whole removal took less than a second. The surgeon essentially grabbed the pin with a pair of pliers, twisted and pulled it out in one motion, and then bandaged the area. It didn’t bleed at all, and Arden only cried for about 30 seconds before getting distracted by our orange hospital “Visitor” stickers. Thank goodness! 

We left the clinic around noon, with the intention of coming back for Arden’s 3:30PM casting appointment. At around 1PM as we were checking out of our hotel, the clinic called and asked what our surgeon had planned for Arden. They then told us that the surgeon’s office had not communicated with them and that they did NOT have an appointment scheduled for him that afternoon. Fortunately, they were able to fit him in at 2:00PM. We were grateful that he was able to get in, but also extra frustrated that we could have waited around in Edmonton until 3:30, only to find out that the re-casting appointment hadn’t been made…as we were previously told. 

After the casting appointment, we started our 5.5 hour drive home. We were all feeling extra tired, stressed, and ready to be home. Arden did not appreciate having his legs re-casted, and he was fairly uncomfortable during the drive home and the next day. 

We understand that things happen, and a lot of what occurred last week could not have been controlled, but it was still frustrating. Brodi had to take 3 days off work, which meant losing 3 days of our only family income. We had to stay in a hotel for 2 days, and drive about 11 hours total. It was a lot of effort and stress for the amount of action that was achieved. 

Arden’s boots and bar will hopefully come in later this week, and we’ll be heading back to Edmonton in about a week and a half to have those fitted, and for another OR time to get his left pin removed. Wish us luck!

XO, Rayel