What are tonsils and why do they need removing? (What is a tonsillectomy or adenotonsillectomy?)

How inflamed tonsils compare with normal tonsils

How inflamed tonsils compare with normal tonsils

What are tonsils?

Tonsils are soft tissue located at the back of your throat; they are part of the body’s lymphatic system (so are adenoids). When they are working properly, they help to recognise bacteria and viruses entering through the mouth and produce white blood cells to fight off infection.

Tonsils are particularly useful during childhood while the body is still encountering new bacteria and viruses for the first time and building up the immune system. Doctors seem to be of differing opinion as to how useful they are as adults; I’ve some that have called them redundant and unnecessary, I’ve also met other doctors who view removing them as an absolute last resort.

Why do tonsils need removing?

Tonsils may temporarily swell while fighting infection, sometimes they become so swollen that they result in a very sore throat and fever (tonsilitis), they may also partially obstruct the airways and not respond to non-invasive treatmeants.

Surgery may be recommended to help treat:

  • Multiple case of tonsillitis (seven cases of tonsillitis or strep in the last year, or five cases or more over each of the last two years).
  • Breathing problems related to swollen tonsils
  • Frequent and loud snoring
  • Periods in which you stop breathing during sleep (sleep apnea)
  • Bleeding of the tonsils
  • Trouble swallowing chewy foods, especially meats
  • Cancer of the tonsils

Back in the 1980s, having your tonsils out was kind of a childhood rite of passage. It was a very common procedure and often parents had already experienced a tonsillectomy in their own childhood. Medical opinion has now swung in a different direction and there is a more stringent list of criteria that often needs to be met (as well as requiring parent consent / advocacy). For a balanced medical opinion, try this post by Christopher Johnson (a pediatric intensive care physician) .

What is tonsil grading?

Surgery is most likely to be recommended if tonsils are consistently swollen at Grade 3 or Grade 4 coupled with other complications (such as snoring and/or sleep apnea).

What are the 4 grades of swollen tonsils

What are the 4 grades of swollen tonsils?

Basically tonsils are graded based on how much of the airway they block.

  • Grade 0 = tonsils are within the the tonsillar fossa
  • Grade 1 = tonsils obstruct 0-25% of oropharyngeal airway
  • Grade 2 = tonsils obstruct 26-50%
  • Grade 3 = tonsils obstruct 51-75%
  • Grade 4 = tonsils obstruct 75%

What are the possible side effects of swollen tonsils?

  • Fever / temperature. Keep in mind that children can react in their own individual ways – they may keep getting low grade temperatures instead of a fever.
  • Runny nose and congestion (as well as the sore throat).
  • Difficult or painful swallowing.
  • Swollen and tender glands (lymph nodes) on the sides of the neck.
  • Bad breath.
  • Fever and chills.
  • Tiredness and headache.
  • Stomach upset or pain.
  • Mouth breathing, noisy breathing, and/or snoring (due to enlarged tonsils blocking the airways). Obstructive sleep apnea. The swollen tonsils and/or adenoids can intermittently block airflow. It sounds like your child is silent and then there’s a big noisy sucking in of air.
    • In Miss 2 it can be so loud that I can hear it through her closed bedroom door and can sound like something’s fallen off a shelf and hit the floor! It’s a crappy and frightening thing as a parent that can result in just sitting with them in the dark either to check that they are breathing or to give them a gentle nudge to help them breathe again. If you’ve spent time with them hooked up to an oxygen saturation monitor then you’ll be familiar with what a stark difference there is between their oxygen levels when alert and upright versus lying prone to sleep.

  • Fatigue. They might seem like they’re getting enough hours of sleep but in reality the quality of sleep is poor because their body is struggling to get enough oxygen through the night. It’s a bit like starting each day on a half tank of gas.
  • Developmental delays. Sleep is critical for young children. During those early years, they are rapidly growing and learning. They need sleep to focus during the day; to have time for their brain to make connections between all the things they have learned or experienced; and their brain releases a growth hormone while they sleep. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can make it harder for them to stay on track.
  • Behavioural difficulties. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can result in daily misery that they don’t know how to express.

Keep in mind that young children (i.e. toddlers) may not be able to describe their symptoms to you and it may not even occur to them to do so (especially if they chronic health issues). They may also be confused by referred pain; the ears and throat share nerves (as well as being linked by eustachian tubes) so they may say their ear is sore when the infection is actually in their throat. Another possibility is if they keep exhibiting teething type behaviour well after all their teeth are in (i.e. chewing on fingers or a dummy constantly, lots of drool) combined with a temperature and bad breath – the cause may actually be their tonsils!

What does surgery (a tonsillectomy) involve?

Surgery will normally take place at a hospital (probably as an outpatient). The doctor will review medical history in advance and make recommendations about pausing medications. You will normally be advised not to take anti-inflammatory medications within 7 days of surgery. They will also discuss post-operative pain medication.

The day of the surgery will involve a period of fasting; food or water won’t be permitted because they can impact the anesthetic. It’s a good idea to have family support and a game plan of how to distract your child; an older child may understand why they can’t eat but a toddler is likely to just focus on the fact that they are off routine and they are HUNGRY!

During surgery, your child will be under a general anesthetic. The surgeon will enter through the mouth and the tonsils will be removed with an electrical cauterizing unit.  You can watch videos of surgery on YouTube but they can be a bit difficult to stomach; I preferred this video of a digital tonsillectomy surgery.

adenotonsillectomy

Adenoids and tonsils

Often the adenoids will be removed at the same time as the tonsils (if they are also swollen); this is termed an adenotonsillectomy. Click here for information about the adenoids.

What happens after surgery?

Depending on the age of your child, they may keep them in the hospital overnight for monitoring or they may go to a recovery room and then go home the same day. You should be given a pamphlet with information about post-op care (i.e. like this tonsillectomy guide).

Your child may feel quite groggy and tired for the next few days and also have some nausea; vomiting once or twice is normal but contact your doctor if vomiting persists.

A light, cool diet for the next few days is generally recommended (avoid hot liquids or spicy food) but doctors will often recommend that children eat whatever they want – the abrasion from bread or crackers will actually help to clean the area. (That’s not to say there won’t sometimes be screaming pain because a sharp cracker edge has just struck the surgical site).

Some doctors will prescribe antibiotics. They will normally be prescribed painkillers (like Pammol and Tramadol) and anti-inflammatories (like Nurofen); if your child won’t take the fully funded options consider buying over-the-counter replacements (for kids) that have been flavoured.  It is important to keep on top of their medication (including waking them up around the clock for a few nights) as the pain is severe; it will often peak somewhere around around Days 5-9 due to the way the membranes heal and can be excruciating.

It’s important to keep them rested and hydrated – even if this means just getting small regular sips of water, lemonade ice-blocks, or melty ice=cream into them; overall, the fluids are more important than food.

Common side effects will include:

  • Swollen tongue
  • Bad breath (like a hyena!)
  • White coating on the tongue
  • White scabs over the tonsils

Your doctor will talk you through potential complications and when to seek immediate medical care – i.e. if bleeding occurs (it can be life threatening); they may be able to resolve with medication or surgery may be required.

They need lots of rest for two weeks to promote healing and will be off school during this time due to the risk of infection.  They will also generally have several weeks off sports, exercise, and swimming.

Keep in mind that removing tonsils may only be one part of a wider treatment plan. If the chronic inflammation was linked to allergies then you will still need to work with a doctor to create an ongoing allergy treatment plan.

In Splendid Isolation

Autumn wonderland

Autumn wonderland

“He who is certain he knows the ending of things when he is only beginning them is either extremely wise or extremely foolish; no matter which is true, he is certainly an unhappy man, for he has put a knife in the heart of wonder.” Memory, Sorrow, and Thorn

I drafted this a week ago…little did I know that life would throw up complications and we’d be looking at a minimum of fours weeks in isolation.

Today marks the end of two weeks of isolation leading up to Miss 2’s surgery. She spends the night in my bed (she’s refused to sleep in hers since we were rushed to hospital by ambulance for Mother’s Day) and is awake all day with it just the two of us. There is a distinct lack of personal space and it’s challenging for both of us. The only time that I have to myself is an hour or so in the evening, after finishing up cleaning the house, before collapsing into bed beside her.

Week 1 was a particularly vicious head cold with rivers of snot that covered her face no matter how often I wiped it away. Her facial dermatitis was miserable, her already swollen airways blocked up, and she’d give up on sleep entirely somewhere between 2am and 4am when the fluid build-up got too much (and she needed to be upright to have it drain away). Being awake around the clock was beyond exhausting, I got sick too, I dragged myself through each day, I was grateful whenever she was willing to listen to audio stories that might give me a break for twenty minutes.

She hit rock bottom after about 7 days and then slowly started to improve. Her doctor advised that with her surgery so close we were best to spend another week away from playgroups, Sunday School, gatherings of kids, and, well, anywhere germy, to try and prevent her from catching a secondary infection. Historically. her compromised immune system has meant a rolling series of viral infections for weeks at a time.

She missed her friends. She missed her rountines. She stomped around the house (literally) telling me, “I’m a grumpy old troll! I’m ANGRY! I want (insert names of friends)”. I’m proud of her emotional recognition and expression; I’m glad that teaching her to stomp (as opposed to kick, hit, bite, or throw) as a healthy way of venting her feelings seems to be helping. It’s exhausting and it sucks for both of us.

It’s been a mental challenge each day trying to work out where we can for the morning that ideally doesn’t cost money, will interest her, doesn’t involve kids, and can’t be an indoor playground / attraction (because let’s face it those things hardly ever get disinfected!). Oh, and it’s winter, cold, and rain keeps threatening on the weather forecast.

Each day I have to try and be cheerful, positive, and zen. Some days I do better than others. Some days I’ve burst into tears in public toilets while she just keeps tantruming and I can’t even have 30 seconds to pee in quiet (not alone, just peacefully). Some days it feels overwhelming that not only do we have to get to the surgery but then we’re still going to need to be careful about post-op infection. Some days the logistics of our upcoming hospital stay, needing to take all our food with us, needing to look after her alone (and just physically carrying everything!) seems overwhelming.

So I’ve tried to find the beauty in each day for us. She delights in the small details – the differing colours and shapes of leaves, throwing seed cones into the ocean and watching them bob like boats, stopping to listen to birds sing.

Autumn dreaming

Autumn dreaming

Autumn explorer

Autumn explorer

We’ve walked through parks of imported oak trees with their beautiful autumn leaves still covering the ground like snow.

We’ve spent hours exploring Botanic Gardens admiring the hidden mazes and the surprise of colourful roses even though it’s winter.

New Zealand beaches in winter

New Zealand beaches in winter

What is New Zealand like in winter?

What is New Zealand like in winter?

We had one morning that saw me teaching her chess in the library while the wind and rain swirled outside, only for it to suddenly be replaced by a little beachside microcosm of warm blue skies and sunshine. We walked on the sand, splashed in the waves, and drew pictures in the sand creating beach art.

Being isolated was anything but splendid (although it makes for a catchier title) but looking for the beauty in each day and seeking a positive focus made it more bearable. We can’t always change our circumstances, we can only change how we choose to view our circumstances and how we react within them.

How to give your toddler a spa bath in winter!

Spa bath in a flexi bucket

I love flexi buckets! I have two: one big pink one and a small yellow one. They can be used for so many things from hanging out laundry, to clothes hampers, packing stuff to visit relatives, toy storage, and winter spa baths!

Miss 2 loves asking for a bucket bath when the temperatures start dropping. Just sit the bucket in your bath, fill it to a nice warm temperature from the taps, add a gentle-on-the-skin bubble bath, and pop in your toddler.

The Goldilocks principle applies when choosing your flexi bucket: not too big, not too small, but just right. You want your toddler to be able to sit upright comfortably and have water up to their armpits (parental supervision is recommended as per any bath). You’ll find that you use much less water than a normal bath and they’re warmer because more of their body is consistently covered.

The great thing is that this also works in a shower! I’ve also seen friends put multiple buckets in one bath (of assorted sizes) so that siblings can spa together (and without fighting).

You can even do this during summer! Put the empty bucket outside on the lawn (water is heavy) and ferry warm water to it. Presto! An outdoor bath in the sun and a happy excited child!

Tip: These are also great to take to a beach so that you can create a mini pool for younger siblings or wash off sandy feet.

Spa bath fun!

How to display your child’s artwork without damaging the walls!

How to display kids art work

How to display kids art work

There are lots of great ideas on how to display your child’s art work. There’s only so many pieces that you can attach to the fridge with magnets, so why not hang some in their rooms where they can admire what they’ve made!

How to display children's art work

How to display children’s art work

Some ideas include using curtain rails but those (although sturdy) require drilling holes into the wall which isn’t a great idea if you’re renting.

How to display kids art without damaging the walls

How to display kids art without damaging the walls

The solution is to use hooks with a removable, damage free, adhesive backing. Tie some pretty coloured wool between the hooks and peg up your child’s beautiful creations!

Decorative clips for hanging art work

Decorative clips for hanging art work

Also check out these totally adorable decorative clips on AliExpress for US$3 and free international shipping!

What are the benefits of chemical free soaps?

It’s funny how invisible ingredient labels have become in our modern lifestyle. We take for granted that there are lots of words, chemicals, compounds, and numbers that we don’t recognize. The dynamic journey that I’m on with my daughter means delving into those labels to find out more.

I posted recently about glycerin and how it’s found in many body and beauty products. The difficulty for me is that it’s often soy derived (and Miss 2 is allergic to soy). My options are to either exhaustively ring manufacturers every time I buy a product (to check if they know their source / that their source hasn’t changed) or aim to eliminate glycerin from our home so that the risk simply doesn’t exist.

Looking into bathroom & beauty products also found me reading articles about other commonly used additives. Wider scientific debates aside, some people are sensitive to parabens and/or sulfates (SLS = Sodium Lauryl Sulfate and Sodium Laureth Sulfate). If you have a child with sensitive skin or eczema then it’s worth considering a natural soap.

So I set off on a search to see if I could find a soap that was free of glycerin, parabens, and sulfates. This pretty much excludes anything made on a large commercial scale, it means that you’re looking for small batch soaps (although that doesn’t preclude them being sold in stores).

This turned out to be more of a challenge than I thought it would be!

The two companies that I narrowed my search down to were Blue Earth (based in Ashburton, NZ) and Natural Us (based in Christchurch, NZ).  Both have a great range of products! My decision to go with Blue Earth is that they are available in over 65 stores throughout New Zealand so I was able to avoid paying for shipping. I still have products that I’d like to order from Natural Us – like their Goats Milk soap and their natural tooth powder! For international readers,  both companies ship internationally!

The first soap we’re trying is Blue Earth’s Carrot and Orange Cake.

Ingredients: Olive, coconut and rice bran oils, cocoa butter, rain water, soda lye, and carrot, sweet almond, hempseed and wheat germ oils, benzoin tree resin and essential oils of orange and cinnamon leaf.

It smells delicious and Miss 2 thinks it’s so awesome that she now actively asks to wash her hands!

What is glycerin and is it good for me?

Glyercin in bathroom products

Glyercin in bathroom products

It’s funny how invisible ingredient labels have become in our modern lifestyle. We take for granted that there are lots of words, chemicals, compounds, and numbers that we don’t recognize. The dynamic journey that I’m on with my daughter means delving into those labels to find out more.

What is glycerin?

Glycerin, also known as glycerol, is an organic compound that is commonly made of animal fat or vegetable oil. It’s clear, odourless, and has a sweet taste.

If you’re interested in it’s molecular formula, check out this post by Allan Robinson.

What is glycerin used for?

We can safely ignore some of its more explosive uses, like being used to make nitroglycerin (an active part of dynamite); we’re most likely to encounter it in food products or beauty products. It’s widely used because products often dissolve more easily into it (than water or alcohol) and because it’s believed to help moisturise skin.

Go have a look in your bathroom and you will find glycerin in many of your products including:

  • Toothpaste
  • Soap
  • Shampoo & Conditioner
  • Skincare products.

In the kitchen, you can find it in foods but not as frequently. It’s often used in diet / low sugar products or as a base for things like ‘Peppermint Essence’.

Should I be concerned?

For most people, the answer is no. Glycerin is widely considered to have all kinds of benefits for skincare.

For some people, like those with eczema, glycerin is often an important component in moisturising treatments.

For some, for instance vegans, the source of glycerin may conflict with personal beliefs.

What is vegetable glycerin made from?

The main cause for concern about vegetable glycerin is if you have a soy allergy.

Vegetable glycerin is commonly made from soybean oil, palm oil, or coconut oil. If you’ve read my post about soybean oil then you’ll know it’s cheap, readily available, and widely used internationally in a variety of commercial products – which is a problem if you’re allergic.

I’ve spent a lot of time trying to find out if sufficient soy protein can transmit through the manufacturing process to remain present in the end product (glycerin). The reality is that I don’t know – I’m also not certain if it’s been particularly well studied. Soy lecithin and soybean oil are not FDA regulated because they are considered to be ‘generally safe’ – unless you’re allergic to them (like my daughter).

It’s certainly something to be aware of if you (or a family member) is allergic to soy and has symptoms that don’t seem to be going away. If you’ve eliminated all other sources of soy then try reconsidering your bathroom. It’s also possible that exposure through other means may be cumulative over time or result in a low grade reaction; you know your allergy symptoms best. It’s certainly food for thought!

Highlights for May (collected recipes & posts)

ALLERGY FRIENDLY COOKING

BAKING & DESSERTS

MEALS

PARENTING

PLAY

HEALTH

Why should I be worried about natural colour annatto?

Annatto Seeds

Annatto Seeds

I was surprised recently to discover that a popular brand of frozen fries uses food colouring – natural colour annatto. There’s something wonderfully reassuring about ‘natural’ when it’s marketing products despite how ambiguous it is; nature is full of things, from lions to mushrooms, that will kill us with ease.

What is annatto?

Pungent red seeds from the annatto tree are used to provide a golden colour and tangy flavour in many processed foods; it can also be used as a colouring agent in cosmetics. This colouring is often referred to as natural colour (annatto), annatto extract, or colour E160b.

They are also used in Mexican, Latin, and Carribbean cooking as a culinary spice, to make achiote oil, and to make adobe paste.

What are its benefits?

The seeds have been used for medicinal purposes for thousands of years in Caribbean and Latin American cultures. It’s believed that they can have a number of benefits including helping digestion, eye health, bone health, and aging.

Why should I be concerned?

Annatto as a colouring agent can have just as much of an adverse effect on children as artificial food colours. As a parent you might keep a watchful eye to see if artificial red colouring will make your child hyperactive but most of us won’t be aware that a natural colour, that can be found in everything from butter spreads to fries, can cause just as strong an adverse reaction (across the spectrum from neurotypical to autistic). It can also be tricky to become aware of the link between food and behaviour because there can be a time delay, of a few hours to next day, before a normally bright, bubbly, sociable child becomes a  screaming, angry, yelling, defiant and hysterical one. It’s particularly useful to be aware of if you have an atopic family where food sensitivities, allergies, and eczema are a issue.

Families with children sensitive to annatto have reported side effects such as:

  • Irritability
  • Grumpiness
  • Headaches
  • Headbanging
  • Hyperactivity
  • Oppositional behaviour
  • Extreme mood swings (that are out of character)
  • Irritable bowel symptoms
  • Hives / Rashes
  • Asthma
  • Severe allergic reactions

 

Where can I find more information?

I started looking into annatto while reading Sue Dengate’s Fed Up; the most useful online source that I found was a Fact Sheet from the Food Intolerance Network which includes references to scientific studies and personal experiences from a number of affected families.

Home Remedy Porridge for sore throats and enflamed guts

Home Remedy Porridge

Home Remedy Porridge with Slippery Elm

I’ve just been posting about how Miss 2 and I were rushed to hospital by ambulance – her with croup and me with gastro. This is a great recipe for helping your toddler (or adult) to eat when they’ve been vomiting, had diarrhoea,  have a sore throat, have food allergies, or have reflux. It’s also a useful recipe to try after surgery, i.e. for removing adenoids or tonsils. It also pairs well with the rehydration tonic.

Slippery elm can  help relieve inflammatory bowel conditions so it’s also useful for

  • Crohn’s disease, ulcerative colitis, and irritable bowel syndrome (IBS).

You may also want to try this as a baby food if your baby or toddler needs to be gluten free.

Ingredients

  • 1 1/2 Tbsp Quinoa Flour
  • 1 1/2 Tbsp Brown Rice Flour
  • 1 cup Rice Milk
  • Optional: 1 tsp Slippery Elm
  • Optional: boiling water
  • Optional: Maple Syrup

Allergies: gluten free, dairy free, soy free, egg free, nut free.

Directions

  1. Mix everything in a pot and cook over high heat (stir regularly).
  2. Bring it to a boil and then turn down low. Keep stirring regularly and add more liquid (either rice milk or boiling water) to keep a good consistency.
    • If you have an upset gut then it’s best to include the slippery elm. The slippery elm absorbs water so you will need to slowly add liquid while the porridge is cooking.
  3. Cook for approximately 5 minutes.
  4. Serve plain or as you generally like your porridge. I like this with a little maple syrup stirred in.

What a nightmare! Getting hospitalised for Mother’s Day at the same time as my toddler!

Hospitalised for gastroenteritis

Hospitalised for gastro

Being a solo mother for a medically fragile child with chronic health issues (including multiple food and airborne allergies) poses a heap of challenges at the best of times. Having us both hospitalised at the same time was incredibly difficult and it frightens me to think what would have happened if my family hadn’t been willing to spend an hour driving in to us and forgoing sleep for about 40 hours.

We actually had quite a pleasant Mother’s Day to begin with. We went to a playgroup for a short time and then went on to a wonderful Solo Mother’s event that was being held.

I’d spent Saturday cleaning like mad (which takes hours because of her dust mite allergies) and then feeling unwell with a nose running like a faucet. I still wasn’t feeling well on Sunday and figured I might have a mild cold.

Things all went downhill at 1am (so, I try to tell myself in an upbeat way that really Mother’s Day had finished) when a loud barking noise coming from my daughter’s room woke me and I found her struggling to breathe. Her story is here.

When the ambulance crew arrived at 1.30am, I was deperately trying to keep my daughter upright (who was determined that she wanted to be alone, prone, and asleep), trying to wake her up to full consciousness, and trying not to throw up.  There’s no time to be sick when your a solo parent with a sick child – I also had a sufficiently high embarassment reflex not to want to hurl in front of the three lovely (male) paramedics; there’s something that’s just easier about vomiting in private.

I spent the ambulance ride sucking on a home-made coconut milk ice-block trying to convince myself not to vomit and looking after Miss 2.

I’m so grateful for all of the lovely staff that helped us at the hospital. A nurse read Miss 2 picture books while I was busy vomiting in the hospital bathroom.  My embarrassment reflex declined as I got sicker; I ended up just drawing the curtain for her room and being grateful for the many vomit buckets the hospital stocks.

My parents spent an hour driving in to us and while Nana stayed with Miss 2, Poppa drove me (in the opposite direction) to collect the car seat and various things from home. This took a long time as the vomiting and diarrhoea kept me in the bathroom a lot and the pain often felt like a thousand glass daggers writhing through my intestines. At times I was crawling through my home on my hands and knees on gritted teeth determined to pack. Poor Poppa! he so wanted to help but couldn’t do more than watch quietly as I assembled everything we needed; it can’t have been easy either having me dry wretch all the way back to the hospital.

We finally got back to the Children’s Hospital and the nurses transferred me to the adult hospital’s Emergency Department. Nana and Poppa stayed with Miss 2 while I got admitted. I was so wracked with constant vomiting that I couldn’t even speak to the doctor unless it was in-between the waves of pain (and more importantly once the anti-emetic had kicked in). They did various tests for infection, a chest x-ray, and were monitoring me in case my appendix burst or my gallbladder (squeezed dry by that point) did anything gnarly. Apparently I was horribly pale, shivering uncontrollably (bless the nurses that brought heated blankets!), and looking pretty crap (aside from the vomiting and hobbling to the adjacent toilet), I went through two IV bags of fluids and a bunch of drugs before I was stabilised enough to sip water. As really awkward timing, Miss 2 got discharged almost 6 hours before me! Thank god Nana + Poppa were with her as I’m not sure what would have happened otherwise – it certainly would have been a far more traumatic experience for both of us!

Overall, they thought I had a severe case of viral gastroenteritis with severe pain from the inflammation + a cold/flu virus, and possibly Miss 2’s croup as well. I was unwell enough that they were considering admitting me into of the other wards but Miss 2 needed me so I got discharged to family care and monitoring instead (as there’s still a risk the appendix could progressively worsen). I’m so grateful that this has happened at a time when my family can help care for us as I can’t walk much without the pain starting and am pretty much living on mum’s Fail-safe Porridge and Rehydration Therapeutic Tonic.