Treatment

If you plan to have surgery in Warsaw, Poland, this page is for you. Information is from our own and fellow parents’ experiences.

Paley European Institute (PEI) and Medicover Hospital in Warsaw, Poland

The PEI is one of multiple international places (others include Florida and Abu Dhabi..) where Dr. Paley, Dr. Shannon, and their team treat patients. The surgeries are done in the Warsaw Medicover Hospital – a private hospital (part of the Swedish Medicover Group that is present in 12 countries).

The Paley European Institute is located in a business center right next to the hospital; this is where the doctors’ consultations, x-rays, and physical therapy take place. There is a supermarket on the ground floor of the building, which is very helpful if you need food or drinks while waiting. The PEI is very modern, with friendly staff working there to support you. More information can be found here: https://paleyeurope.com/en/home-page/.

Paley European Institute (PEI) in Warsaw

As the PEI welcomes many patients from around the world, the waiting times for the consultation can take a while. Bring something for your kids to play with. You might be asked if you’d like to take a walk and return after half an hour or an hour. It can be very cold in Warsaw in winter, so bring enough appropriate clothing.

There will probably be many families waiting. Dr. Paley and his team usually spend one week in Warsaw, with about two consultation days, the rest being days they perform surgeries. They travel to Warsaw around 3-4 times per year (at the time of this writing, in November 2023).

Remember, everyone wants to have their questions addressed, so be mindful of each others’ time. Before your initial consultation, you might be sent to get x-rays done (they also mention this in the first e-mail). X-rays will be done at the same place, so you do not have to go anywhere else.

Navigating through PEI and Medicover Warsaw

Your first visit to Paley European Institute and Medicover Warsaw might be overwhelming. There is a lot to take care of and keep in mind. This section provides information and support for your first visit.

You will have to consider a few things depending on the reason for your visit.

If you are there for a consultation, you will do everything at the Paley European Institute. The consultation and x-rays will take place there.

It is helpful to book a hotel or an apartment nearby, so in case you have longer waiting periods, you can go back and forth quickly.

If you are there for surgery – please see the section below.

Always ask questions, write them down beforehand so you don’t forget anything. Have the number and e-mail of your medical coordinator from PEI at hand and WhatsApp on your phone. Stay on top of things: always ask what the next steps are, what you need to do and when, what to consider, etc. You need to check if you have been given the correct Medicover number so the hospital knows you are coming from the Paley Institute. Always mention that you are coming from the Paley Institute when discussing appointments with the hospital staff. Be prepared that many kids from the Paley Institute will be waiting for their tests and appointments.

We always tried to confirm appointments, booking only flights we could reschedule and hotels that could be canceled. Sometimes schedules change (yours or theirs), so staying as flexible as possible is good.

Preparing for Surgery

If you have decided to have surgery for your child, here are some things to consider beforehand (not only relevant to the Medicover Hospital).

Once you have decided that you want to have surgery for your child, you need to schedule an appointment with the Paley European Institute. You will get an appointment schedule sent via mail some days or weeks before the surgery. These appointments took place in our case:

consultation with the surgeons (at PEI)
pre-operative physiotherapy consultation (at PEI)
pre-operative anesthesia consultation (at Medicover)
pre-operative laboratory tests (at Medicover): blood draws, urine samples
in some cases, you might be referred to a pediatrician in the hospital to get cleared for surgery (at Medicover)
psychological consultation (at PEI)

Book a hotel or an apartment nearby (see also sections below), as you will be going back and forth between Paley European Institute and the Medicover in preparation for surgery. Sometimes, bridging the period between appointments in a café nearby or at the apartment to rest is helpful. Especially if you are waiting for surgery, you are probably not keen on risking seasonal infections.

Before surgery:

We always asked a lot and wanted to know what the next step is and what to keep in mind, for example:

Blood draws: You will get a blood panel before surgery, so before the blood draw, ask if your child needs to fast or if it is okay to eat or drink before the draw. Also, ask what exactly they are looking for (e.g., CRP levels, thrombocytes, etc.) and what the threshold is for surgery to take place. Your results can be picked up either at the Medicover check-in desk or online if you manage to log in to the Medicover OnLine system (ask at the Medicover check-in desk for access). Online, you will see the results directly when they are ready.
X-rays: make sure that the X-ray is taken from the body part where the surgery will happen (sometimes children have multiple issues, and many X-rays are taken, so it is essential to focus on that part that will be going through surgery).
Anything to consider before the surgery – such as not eating for 12 hours or not drinking for 4-6 hours (starting when and how long exactly) – have in mind that surgery schedules might change (you might be having surgery earlier or later than planned, so keep in touch with the surgeons to check on whether the child can bridge potential waiting periods with water). If your child is very young, ask if you can be scheduled for surgery early in the morning, as fasting is much more difficult for younger kids.
The exact time of the surgery
The exact time you need to be in the hospital before surgery.
The medication schedule after surgery (if you need to buy anything in addition, what to watch out for after surgery)
The physiotherapy schedule after surgery (when to start, how many hours per day, and how long – make sure to have appointments with the physiotherapeutic department)
The duration of the hospital stay, roughly – assuming no complications.
The type of anesthesia and potential pre-general anesthesia medication your surgeons are recommending (e.g., something to calm the child before general anesthesia in the operating room).
Whether transfusions are planned or standard procedure – TAR kids’ platelets need to be monitored closely, a transfusion might be done as a precautionary measure before, during, or after surgery.

What I was not prepared for:

Bringing my daughter into anesthesia – it was very tough to give her the medication in the room to calm her down (it is like sweet purple juice), and it was even harder to put the mask on her face and make sure she inhaled the medication in the operating room. Be prepared for challenging moments, such as convincing the child (depending on age) and entering and leaving the operating room before surgery.

After surgery:

The number of things to consider before surgery is vast. However, everything «freezes» until your child wakes up from anesthesia, and the surgery seems to last forever.

There were many, many cables attached to her little body (heart monitoring, blood pressure management, catheter, anesthesia / central line ports, etc.). I found this to be the most challenging part of the entire process. But you toughen up, and you get through it.
When your child wakes up, have water and some easy-to-eat food ready for when they realize how thirsty and hungry they are. This will get them into a better mood. They will be groggy with all the pain medication, but it will get better.
Hold their head – they might seem awake again, but they are still very fragile due to the anesthesia and might not have complete control over their head to hold it tight up themselves.
Do not hesitate to ask for pain medication immediately if you feel that your child is in pain. The anesthesiologist and nurses are very attentive and will ensure your child is as comfortable as possible.
Make sure to keep hands (depending on surgery) elevated as much as possible – ask if you need to watch out for anything else regarding positioning.
Don’t panic when they get a fever – apparently, many children get a fever after major surgeries.
You will spend a few hours in the recovery room after surgery; there will probably be other patients there with you. After clearance from the anesthesiologist, you will be sent to your room. Nurses will come by to administer medication, and you will spend a few nights there. The food in the hospital was excellent, by the way.
Be amazed about how quick recovery is for little children (of course, every patient is different). They are so resilient and really want to start moving and getting out of bed soon.
Have all the prescribed medication available, so you don’t need to think about it when going home.

Leaving the Hospital

Wound Healing and Positioning of the Arms

After around five days, we were able to leave the hospital. It could have been earlier, but our daughter had a minor infection (not of the arms but the lungs), and the doctors wanted to monitor her.

To avoid unnecessary swelling, keeping the arms elevated was essential; the hospital staff created custom pillows for us that we put under her arms at all times — post-anesthesia, sitting in the stroller, at night, etc.

The first comprehensive check on her arms happened two weeks after the surgery, so we stayed in Warsaw until that check and drove back home afterward.

I was surprised to see that the wounds were still “wet,” but it made sense considering that they had been under a cast-like splint. It was the first time I saw her hands after surgery in a straight position, hands and arms still swollen.

After the first major check-up (x-rays, wound dressing) we left Warsaw and returned for the next check and splint change six weeks later.

Antibiotics and Pain Medication

To avoid infections and pain, doctors start administering intravenous antibiotics and pain medication during and immediately after surgery.

Ask what kind of medication your kid needs get and how often. On the first days, you will probably see some alternation of pain medications – e.g. Paracetamol, Ibuprofen, and additional stronger medication.

After you leave the hospital, you will probably need to administer pain medication and antibiotics orally. For us, this was a significant challenge. Our daughter was fighting hard to avoid taking the medication. Thankfully, she did not need any further pain medication after her discharge from the hospital. However, we still needed to go through the entire antibiotic treatment (generally, you should not abruptly stop taking antibiotics).

Advoid Falling on Arms

It was incredible to see how fast her recovery was. After the first three nights in the hospital, everything got smoother. Leaving the hospital and ending the medication some days later was the first big step. Our daughter was very mobile, already using her fingers and moving her arms and shoulders. The challenge was to keep her from running and the potentially ensuing falls. We walked near her for six weeks and bought a harness typically used for kids learning to walk, so we could hold her in case she stumbled.

Scar Treatment

We started with scar treatment a few weeks after the wounds were closed. The physical therapists in Warsaw showed us how to massage the scar tissue to make it mobile (to help with wrist movement / to avoid the hardening of scars and tissue and subsequently impeding movement).

We also used a scar cream (Bepanthen Scar Gel with a roller on top) that had proven effective in prior, unrelated surgeries within the family. We used it twice per day and ensured the scars were not exposed to the sun for at least a year (advice we had received after other surgeries). Since our daughter’s surgeries were in autumn and winter in Poland, there was not much sun we needed to be afraid of.

Your Stay in Poland

Traveling to a different country for surgery can be exhausting. Be prepared for communication problems and other challenges. But also try to enjoy the beautiful aspects of getting to know a new place.

Warsaw is a good place to spend some time. OK, in winter, it can be freezing, but you will get to enjoy beautiful lighting around the Polish capital. The Paley European Institute is located in Wilanow, a lovely area with a beautiful palace and a park. Close by, there are many (kids’) cafés, great playgrounds, restaurants, apartments for long-term rent, grocery shopping stores, and other shopping opportunities.

If you travel downtown by bus, train, car, or Uber, you can enjoy lovely museums (tech, science), a zoo, great architecture, tons of shopping malls, and delicious food. Getting around is easy, the food is good, and there is enough entertainment for kids in Warsaw for several months. We highly recommend booking a nearby apartment, especially if you are doing daily PT. There are many offerings for PEI patients (although no discounts or similar) available, and if you book early, you have good chances of managing everything within walking distance (Paley European Institute, Medicover, groceries, etc.).

Relevant Links

Paley European Institute in Warsaw, contact, information and price lists.

Main information source for Paley's patients, patient success stories and description of treatment methods.

Info about activities and things to do for kids in Warsaw.

Longer walking distance away from Paley Institute but ideal for spending an afternoon without aditional needs for transport.