Re: tenotomy question

[Guest guest]

My daughter was 12 months old when her tenotomy was done and it was under

general anesthesia. However, it was an outpatient procedure. I would imaging

that your doctor is erring on the side of caution in wanting to keep overnight

possibly because of the anesthesia. It can be a tricky thing to manage in

young children.

Jenni

veekayc wrote: Hi,

My son was born with bilateral clubfeet in Feb. His tenotomy is

scheduled to happen in a couple weeks. The doctor wants to do a

general anesthesia instead of local anesthesia and have my son in the

hospital overnight for observation. Is this normal? Shouldn't it be a

out patient surgery?

Thanks in advance

Veekay

[Guest guest]

Veekay,

My first question is how old is your son? Generally the procedure is

done under local anesthesia. However, for older children, some drs.

feel more comfortable using the general anesthesia. Some Drs. aren't

comfortable at all with the local anesthesia and therefore don't even

offer it as an option. I think the local is safer for the baby if at

all possible. My son had 2 tenotomies; one at 1 1/2 months and one

at 5 months. By the second tenotomy, his Dr. already wanted to use

general anesthesia. Definitely have a conversation with your Dr.

about the pros and cons of general. It is always risky for anyone to

be put under, but babies, being so small require special care and

concern. Make sure all your questions are answered.

>

> Hi,

> My son was born with bilateral clubfeet in Feb. His tenotomy is

> scheduled to happen in a couple weeks. The doctor wants to do a

> general anesthesia instead of local anesthesia and have my son in

the

> hospital overnight for observation. Is this normal? Shouldn't it be

a

> out patient surgery?

> Thanks in advance

> Veekay

>

[Guest guest]

Veekay,

The percutaneous tenotomy can be done as an in-office procedure with

local anesthesia or under general anesthesia. The procedure should be

an out patient procedure as you're describing under normal

circumstances. Typically it's a 15-20 minute procedure including the

application of the cast.

However, there are different types of tendon lengthening procedures.

You should find out if your doctor intends to use a percutaneous

tenotomy (small puncture wound in the heel area that requires no

stitches to close and is followed by a 3 week healing cast) or

something more invasive. There are open-incision

lengthenings/releases which require stitches to close the incision and

generally are followed by 4-6 weeks or more of post-op casts. For

example, you may hear/see the term " Z-lengthening " or " posterior

release " and these are more invasive procedures which can be

categorized under " tendon lengthening " as a general category.

I would recommend calling to find out exactly what is planned for your

son's procedure and get the exact details. Then you'll know if your

doctor is just being cautious in wanting him to spend the night or if

the planned procedure is actually more invasive in nature than the

standard percutaneous tenotomy.

I hope this helps!

& (3-16-00, left clubfoot)

>

> Hi,

> My son was born with bilateral clubfeet in Feb. His tenotomy is

> scheduled to happen in a couple weeks. The doctor wants to do a

> general anesthesia instead of local anesthesia and have my son in

the

> hospital overnight for observation. Is this normal? Shouldn't it be

a

> out patient surgery?

> Thanks in advance

> Veekay

>

[Guest guest]

Hi Veekay

We live in Brighton in the UK and when it came to tenotomy time our doctor too

wanted to do it under general. I too was really unsure about this as I too had

heard about it being done under local. At the time I spoke to Naomi a

ponseti listed doctor the uk and got a second opinion. She told me that the

risks of serious complications due to general anaesthetic on a child under 4

months were much higher than the risk of our son being able to wriggle at the

critical time and therefore it would be better to have it done under local. I

also checked out the worst case scenario of what could happen if for some tiny

chance Ethan did manage to get free at the wrong point and move. I found out he

would have to make a very big movement before the doctor would damage anything

major. Therefore the odds for me were definately on the side of local.

I had to arrage to see our consultant and with quite a lot of persuading (he

even told me at one point 'they only do it in the US under local as it's

cheaper!') and a refusal by me to let my son go under general at 3 months old, I

was also willing to go to another doctor if our consultant wouldn't change his

mind. He finally relented and did his first ever tenotomy under local. Nerve

wracking day as I was worried that our consultant had never done it under local

before but it all turned out fine.

Jump forward another few months - by this time Ethan was 6 months old. We had

changed doctors to be see by Naomi in Manchester. This was due to the

first hospital not correcting his feet fully before doing the tenotomy so in

other words it was absolutely a waste of time! Ethan was now fully corrected and

due for his second tenotomy. This time Naomi said it would be much better

to have it done under general as although she would do it under local if we

wished he was much more likely to wriggle at a critical moment now he was 6

months old. Ethan had his second tenotomy under general and again everything was

absolutely fine.

Obviously no-one else can make the decision for you but I would definatey

question your doctor as to why they wish to carry out the procedure under

general when it can quite easily and safely be done under local. Listen to what

they say and then go with your gut instinct. I don't know where you are based

but is there a possibility you could ask to see another doctor if they still

want to do it under general and you aren't happy? I know in the UK you have the

right as an NHS patient to be treated wherever you like and to definately get a

second opinion. I kind of hoping since you mentioned 'out paitients' and that

sounds like a UK term you too might be in the UK!

Would you mind replying with where you are based and which doctor you are seeing

as we might be able to help further by suggesting who you might be able to see

if you still feel unhappy with your doctors choices.

Kathy

veekayc wrote: Hi,

My son was born with bilateral clubfeet in Feb. His tenotomy is

scheduled to happen in a couple weeks. The doctor wants to do a

general anesthesia instead of local anesthesia and have my son in the

hospital overnight for observation. Is this normal? Shouldn't it be a

out patient surgery?

Thanks in advance

Veekay

[Guest guest]

Thanks to everybody for your suggestions

I am based in St ,Minnesota in the US. The Dr is Theresa Cappelo

in the Children's Clincs and Hospitals.She is good doctor and seems to

ahve a lot experience. Initially during the 1st casting she said we

will have the surgery under local anesthesia, then on the 5th she said

she will do it under general anesthesia. I have great Medical

Insurance where I dont have to pay a dime to get anything done. So I

think based on that she changed her mind. Kathy did bring up the same

point so I am convinced that it is cost issue. I know that risks are

higher with general anesthesia I will discuss again with my doctor

this week and get more clarity.

My son will be about 7 weeks old when the Tenotomy will be done.

Thanks

veekay

Hi,

> My son was born with bilateral clubfeet in Feb. His tenotomy is

> scheduled to happen in a couple weeks. The doctor wants to do a

> general anesthesia instead of local anesthesia and have my son in the

> hospital overnight for observation. Is this normal? Shouldn't it be a

> out patient surgery?

> Thanks in advance

> Veekay

>

>

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>

>

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[Guest guest]

when lorenzo had tenotomy he was 7 month old.

initially our dr in italy intented to do " Z-lengthening " under

general anesthesia.

then, dr Ponsety wrote to him and so he decided to do percutaneous

tenotomies under local anesthesia with some sedation.

The tendon is much better after a tenotomy than a lengthening

because the lengthening leaves scarring.

i think it is very important that you are sure about the type of

tenotomy your doctor intends to use.

ciao

anna mom to lorenzo 0805 rcf

> >

> > Hi,

> > My son was born with bilateral clubfeet in Feb. His tenotomy is

> > scheduled to happen in a couple weeks. The doctor wants to do a

> > general anesthesia instead of local anesthesia and have my son

in

> the

> > hospital overnight for observation. Is this normal? Shouldn't it

be

> a

> > out patient surgery?

> > Thanks in advance

> > Veekay

> >

>

[Guest guest]

We are in Minneapolis and take our son, Aleksander, to Gillette in

St. . They only use the local anesthetic for the tenotomy, and

it is an out-patient procedure. In fact, our visit wasn't much

longer than a normal casting visit when the tenotomy was done.

Definitely make sure she isn't doing an invasive procedure. Really,

the local is all that should be needed (although I know sometimes for

older children it is different since they are bigger and stronger).

I would strongly suggest looking at Gillette. There are doctors at

Gillette who are on the Ponseti list, and if you are interested I'm

sure they would be happy to talk to you. We see Dr. Quanbeck. She

has been absolutely wonderful for us so far.

Feel free to send me an e-mail if you have any questions (kannhoudek

@ yahoo.com)

Aleksander, 11/24/04 bcf

Hi,

> > My son was born with bilateral clubfeet in Feb. His tenotomy is

> > scheduled to happen in a couple weeks. The doctor wants to do a

> > general anesthesia instead of local anesthesia and have my son

in the

> > hospital overnight for observation. Is this normal? Shouldn't it

be a

> > out patient surgery?

> > Thanks in advance

> > Veekay

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