Saturday, August 15, 2009
More surgery?
Nikki has just left on a short Florida vacation. Before she left, she told us she has decided its time to start thinking about more reconstructive surgery. She plans to contact her doctors at OSU for a new consultation & then move forward from there. Her doctors had indicated a few years back that her face could probably be improved on quite a bit... it would just require more radical procedures than "simple" skin grafts. Maybe we'll find out for sure soon. I'll keep in touch.
Wednesday, July 8, 2009
Nikki gets her day in court
On July 7th, Nikki went to court for the trial of the man who carjacked and beat her back in March. She was very nervous... I could tell, after she upchucked her breakfast in the parking lot at the court house.
It was a very cut-and-dried affair. The man had a long history of domestic abuse and assault, although all of these cases were dismissed when the victims refused to testify. He wasn't so lucky this time. The prosecutor met us when we arrived & told Nikki that the defense attorney had already brought up a plea bargain request- a sure sign that the defendant had nothing. As usual, both sides wanted to avoid a jury trial, due to the unpredictable nature of juries. Up 'til now, the 23 year old man had only served two minor jail sentences and had never been in state prison.
Over the next two hours, the attorneys jousted in the judge's chambers. The man was facing 2 - 8 years on the assault charge alone, not to mention the two other charges against him, plus probation violation from a previous crime. After conferring with Nikki, the prosecutor insisted on at least 4 years in the state penitentiary. The defense attorney agreed to this, but wanted only 6 months served, with 3-1/2 years on probation. Nikki refused, saying that wasn't enough. Everyone finally agreed to 1 year served and 3 years probation. Probation will include mental health counseling, drug counseling and payment of $1500 to Nikki for damage to her vehicle.
After this agreement was reached, everyone appeared before the judge in open court. Everything was spoken into the record and agreed on by both parties. The judge berated the perpetrator for his crimes, telling him he was lucky that Nikki was more interested in seeing him get treatment than she was in seeing him in prison for up to 8 years. Nikki then got up and spoke, telling the man that she wanted him to get well and hoped that no other woman would have to suffer at his hands. The guy never looked at her. And that was it.
I'm glad that Nikki got pretty much what she wanted, without having to go through the emotional strain of a jury trial. She was dreading having a defense attorney tear her apart on the stand, exposing her private life to all. I really hope this is her only exposure to our legal system.
It was a very cut-and-dried affair. The man had a long history of domestic abuse and assault, although all of these cases were dismissed when the victims refused to testify. He wasn't so lucky this time. The prosecutor met us when we arrived & told Nikki that the defense attorney had already brought up a plea bargain request- a sure sign that the defendant had nothing. As usual, both sides wanted to avoid a jury trial, due to the unpredictable nature of juries. Up 'til now, the 23 year old man had only served two minor jail sentences and had never been in state prison.
Over the next two hours, the attorneys jousted in the judge's chambers. The man was facing 2 - 8 years on the assault charge alone, not to mention the two other charges against him, plus probation violation from a previous crime. After conferring with Nikki, the prosecutor insisted on at least 4 years in the state penitentiary. The defense attorney agreed to this, but wanted only 6 months served, with 3-1/2 years on probation. Nikki refused, saying that wasn't enough. Everyone finally agreed to 1 year served and 3 years probation. Probation will include mental health counseling, drug counseling and payment of $1500 to Nikki for damage to her vehicle.
After this agreement was reached, everyone appeared before the judge in open court. Everything was spoken into the record and agreed on by both parties. The judge berated the perpetrator for his crimes, telling him he was lucky that Nikki was more interested in seeing him get treatment than she was in seeing him in prison for up to 8 years. Nikki then got up and spoke, telling the man that she wanted him to get well and hoped that no other woman would have to suffer at his hands. The guy never looked at her. And that was it.
I'm glad that Nikki got pretty much what she wanted, without having to go through the emotional strain of a jury trial. She was dreading having a defense attorney tear her apart on the stand, exposing her private life to all. I really hope this is her only exposure to our legal system.
Monday, May 11, 2009
A new home for the blog.
I've maintained a read-only blog about my daughter's accident and recovery since her accident in 2004. It's finally gotten much too large & unwieldly to keep in that form. So, I went out and researched the most popular blogging sites on the internet. As a result, today I've completed migrating the blog to Blogger.
Even though the day-to-day excitement of Nikki's recovery has died off, I think there is still a lot of interesting and useful information to be had in reading it. I base that opinion on the many emails that I still get from people all around the world, asking for more on Nikki's recovery and current condition.
You'll see many (several dozen) posts made just today, as I moved over four years of blog over to Blogger. Just like most blogs, this is in reverse chronological order. So, to get the whole story step-by-step, you have to go 'way back in the older posts.
With this easier to use interface, I'm going to make a concerted effort to stay more current on Nikki's progress through life. She still talks often of having more surgeries, especially on her face, and I'll be here to detail those when they happen.
Please leave comments! Every author likes a little feedback on his efforts, and I'm no different. I've been criticised for being too chatty and for being too graphic in some of my descriptions. You can decide that, and more, on your own.
Even though the day-to-day excitement of Nikki's recovery has died off, I think there is still a lot of interesting and useful information to be had in reading it. I base that opinion on the many emails that I still get from people all around the world, asking for more on Nikki's recovery and current condition.
You'll see many (several dozen) posts made just today, as I moved over four years of blog over to Blogger. Just like most blogs, this is in reverse chronological order. So, to get the whole story step-by-step, you have to go 'way back in the older posts.
With this easier to use interface, I'm going to make a concerted effort to stay more current on Nikki's progress through life. She still talks often of having more surgeries, especially on her face, and I'll be here to detail those when they happen.
Please leave comments! Every author likes a little feedback on his efforts, and I'm no different. I've been criticised for being too chatty and for being too graphic in some of my descriptions. You can decide that, and more, on your own.
A New Life: 5/10/2009
I hope that everyone is doing OK. Still no new medical news for Nikki, but there has been some other things going on recently. In early April, Nikki was car-jacked by a young “man” that she had known for several weeks. She was taking this guy somewhere, when he suddenly flipped out and started kicking and beating her windshield. When she intervened, he started beating her. She stopped the car and he drug her out, smacked her around, and then took the car, leaving her stranded in a poor neighborhood at 3am. She called the police right away, and they were there in seconds. They took Nikki & chased down her car… not too hard, since the drug-crazed dufus had hit a curb nearby and blown a tire. It took three officers and some strategically-applied force to get this guy into the police car. The police said he was obviously high on something. After wrecking her car, he flew into a rage and broke the driver’s window, kicked out the sunroof and smashed a headlight and the fender around it. Nikki was scraped and bruised, but otherwise OK. The piece of trash is still in jail & Nikki has promised to pursue any charges possible against him. In a tragedy of justice, it cost Nikki over $300 to get her car out of police impound… and she’s the victim! Plus, she has several hundred dollars of damage that she’ll have to pay for… it’s an older car, with only collision insurance coverage.
For myself, I was laid off in January by my employer of fifteen months. It’s my second layoff ever and the second in six years. As a senior-level manager, my type of job always takes a while to find. In this lousy business climate, it’s much, much worse. When I was laid off in 2003, I was vice president of a mid-sized technology company with a comfortable six-figure salary. Since then, the closest I’ve come to my income level back then is still 50% off. That put a real strain on our finances and led to a 2005 bankruptcy. This time around, it could well cost us our home. Oh, well, there are folks out there a lot worse off than I am.
So,,, no new surgeries for Nikki yet, but still plenty of pain to go around. And how has your spring been going? Stay tuned for more when I have it.
For myself, I was laid off in January by my employer of fifteen months. It’s my second layoff ever and the second in six years. As a senior-level manager, my type of job always takes a while to find. In this lousy business climate, it’s much, much worse. When I was laid off in 2003, I was vice president of a mid-sized technology company with a comfortable six-figure salary. Since then, the closest I’ve come to my income level back then is still 50% off. That put a real strain on our finances and led to a 2005 bankruptcy. This time around, it could well cost us our home. Oh, well, there are folks out there a lot worse off than I am.
So,,, no new surgeries for Nikki yet, but still plenty of pain to go around. And how has your spring been going? Stay tuned for more when I have it.
A New Life: January 2009
Remember- No news is good news… Happy 2009! Yep, it’s been my longest break yet, for the same good reasons- nothing’s going on. That is, nothing stupendous. There’s plenty of good ol’ routine, day-to-day stuff, but it’s mostly stuff that only family would want to read about.
Nikki appears to have reached a comfort zone in her life. She’s about as functional as she’s likely to ever be and she’s comfortable with how she looks. Sure, she talks about further facial reconstruction now and then, but she doesn’t have any urgency. Her life is as stable as it’s ever been now and I think she just wants to enjoy it for a while.
She’s still active in the fledgling OSU burn support group & she also completed her SOAR training through the Phoenix Society. She hasn’t had any consultations as of yet, which is a good thing.
She continues to tend bar at the Cheesecake Factory and lives in her own house with her American bulldog, Reno. She’s tried roommates several times & has decided she likes living on her own.
That’s really all I have. I have received a few emails over the past few months asking why the blog isn’t updated, so I thought I’d better post *something*. Rest assured, I’ll promptly update any burn-related information as quickly as it happens. Thanks to everyone for their continued interest in my little girl.
Nikki appears to have reached a comfort zone in her life. She’s about as functional as she’s likely to ever be and she’s comfortable with how she looks. Sure, she talks about further facial reconstruction now and then, but she doesn’t have any urgency. Her life is as stable as it’s ever been now and I think she just wants to enjoy it for a while.
She’s still active in the fledgling OSU burn support group & she also completed her SOAR training through the Phoenix Society. She hasn’t had any consultations as of yet, which is a good thing.
She continues to tend bar at the Cheesecake Factory and lives in her own house with her American bulldog, Reno. She’s tried roommates several times & has decided she likes living on her own.
That’s really all I have. I have received a few emails over the past few months asking why the blog isn’t updated, so I thought I’d better post *something*. Rest assured, I’ll promptly update any burn-related information as quickly as it happens. Thanks to everyone for their continued interest in my little girl.
A New Life: 2008
5/4/2008
Another long break, for the same old reason- nothing going on. Nikki has been healthy, happy and working. She does have an upcoming doctor’s visit planned, with an eye toward more facial reconstruction surgery later this year. I'll let you know more when I do.
Nikki did apply for membership in SOAR (Survivors Offering Assistance in Recover) and was accepted, after a thorough background check and screening by the Phoenix Society. She completed her training in April 2008 and is now qualified to offer support to burn victims and their families in a hospital environment. She's awaiting her security clearance at OSU Medical Center, after which she'll begin work lending support to patients and families in their burn center.
I'll keep this blog up to date on Nikki's medical plans and on her work in SOAR at OSU. Stay tuned.
Another long break, for the same old reason- nothing going on. Nikki has been healthy, happy and working. She does have an upcoming doctor’s visit planned, with an eye toward more facial reconstruction surgery later this year. I'll let you know more when I do.
Nikki did apply for membership in SOAR (Survivors Offering Assistance in Recover) and was accepted, after a thorough background check and screening by the Phoenix Society. She completed her training in April 2008 and is now qualified to offer support to burn victims and their families in a hospital environment. She's awaiting her security clearance at OSU Medical Center, after which she'll begin work lending support to patients and families in their burn center.
I'll keep this blog up to date on Nikki's medical plans and on her work in SOAR at OSU. Stay tuned.
A New Life: 2007
11/1/07
Yep, it's been a llooonnggg time, I know. Again, silence means generally good news in this situation. I've been going through some work-related issues myself the past few months, leading to a job change... yay! Hopefully I can relax a bit more & spend more time here.
Nikki's been busy & healthy, too. Her collar bone apparently healed well enough on its own, surprising her doctors Nikki moved into full-time serving in late spring, leaving hosting behind. Then, she started picking up bar shifts over the summer. This went slowly, as she hasn't tended bar since her accident in 2004. It took a while to get comfortable handling lots of glass at a high rate of speed. She also had to find shortcuts and work-arounds for some motions, as her fingers on the badly burned hand don't move nearly as well as they used to. After a few months of part-time bar work, she was set. She now has returned to full-time bartending. Finally, she's back to where she left off in July 2004. Some happy times for all, I can tell you.
Nikki did have a big negative recently. She was slated to attend the Phoenix Society's World Burn Congress in Vancouver in early October. She was attending as a delegate of the Ohio State Medical Center's burn support group- all expenses paid. Unfortunately, my daughter is the great procrastinator and she put off getting the passport until it was too late. By the time of her trip, they had stopped accepting proof-of-filing in its place. She couldn't go. Lots of weeping, wailing and gnashing of teeth. Fortunately, the burn support group was very understanding, especially since some money was non-refundable. Maybe next year?
On a positive note, Nikki has been invited by the Phoenix Society to apply for their SOAR (Survivors Offering Assistance in Recovery) program. If accepted, she will be trained professionally to meet with and assist burn survivors and family members in the hospital setting. She's very excited about this, feeling it’s a chance to give some back to those who helped her. Her interview is next week- look for a follow up soon.
Still no surgeries on the horizon. Nikki's committed to getting back into it next year, probably spring time. The focus is still on facial and hand reconstruction. I'll keep you updated.
5/3/07
A brief update to help fill a quiet time. Nikki is doing well, continuing to heal from her broken collar bone. She has continued to work during her recovery as a hostess, which requires no lifting. Although it pays a lot more per hour, she still loses a lot of money due to missing tips. The doctors are reasonably happy with her progress and are thinking that surgery may not be needed, after all. In the past week, Nikki has begun working some serving shifts. She has to be careful & the work makes her arm ache, but she keeps plugging away.
On other fronts, OSU has brought in a new head of plastic surgery, Michael Miller, from Baylor University in Texas. Dr. Miller has done original research in the emerging field of tissue engineering, a multidisciplinary field committed to developing new methods to fabricate tissue for reconstructive surgery by altering existing tissue at the cellular and molecular levels. Nikki has already been referred to him & he has some very aggressive plans for continuing her reconstruction. Nikki has a lot of interest in his plans, but has made it clear that it will be several months before she is financially ready to begin this work.
Nikki has also continued her participation in the fledgling OSU burn support group. She has already been chosen to represent the group to the World Burn Congress meeting in Vancouver in October.
That's all for now... more as it develops. Take care!
3/21/07
Nearly a month since the last posting and I finally have something to report- not very good news, either. Nikki was taking her dog out yesterday, leading him on a leash down the stairs from her apartment. She was wearing high heels, the dog tugged hard on the leash- yep, you guessed it. Nikki lost her footing & fell on the stairs. She went backward, landing on her back & shoulders, right on a riser. She was scraped & very sore, but basically OK- she thought.
The pain was very bad during the night and worse this morning and the impact site was very swollen. She finally gave up toughing it out and went to urgent care today. Prognosis?... a broken collar bone. Not just a simple break, either, but broken in two places. The doctor said she actually has broken a piece out of her collar bone. He also said it might require surgery to secure the piece... great.
Of course, Nikki isn't handling this well. The doctor said she'll need "a month or so" off of work- not an option, says Nikki, since she's not prepared for it. She's off to the Cheesecake Factory tomorrow to see if she can have some adjusted duty & keep working. She can handle anything that doesn't require lifting or carrying things. As a server, she has to carry drink trays and such, but Nikki hopes she can get a work around.
She's off to see her family doctor tomorrow. She also has to notify her plastic surgeon and occupational medicine doctors. I might have more then- stay tuned!
2/28/07
Winter's finally coming to an end and all's well here. Nikki is healthy & happy, and working lot's of hours at the Columbus Cheesecake Factory... be sure to stop in and meet her, if you're in the area.
There's been no talk lately of further medical procedures... again, Nikki hates winter & doesn't like to be out and about in it. Once the weather turns warm, she'll begin to think about "What's next?". then, the blog will once again be busy- and more interesting! Stay tuned for warm weather & more Nikki! Take care...
Yep, it's been a llooonnggg time, I know. Again, silence means generally good news in this situation. I've been going through some work-related issues myself the past few months, leading to a job change... yay! Hopefully I can relax a bit more & spend more time here.
Nikki's been busy & healthy, too. Her collar bone apparently healed well enough on its own, surprising her doctors Nikki moved into full-time serving in late spring, leaving hosting behind. Then, she started picking up bar shifts over the summer. This went slowly, as she hasn't tended bar since her accident in 2004. It took a while to get comfortable handling lots of glass at a high rate of speed. She also had to find shortcuts and work-arounds for some motions, as her fingers on the badly burned hand don't move nearly as well as they used to. After a few months of part-time bar work, she was set. She now has returned to full-time bartending. Finally, she's back to where she left off in July 2004. Some happy times for all, I can tell you.
Nikki did have a big negative recently. She was slated to attend the Phoenix Society's World Burn Congress in Vancouver in early October. She was attending as a delegate of the Ohio State Medical Center's burn support group- all expenses paid. Unfortunately, my daughter is the great procrastinator and she put off getting the passport until it was too late. By the time of her trip, they had stopped accepting proof-of-filing in its place. She couldn't go. Lots of weeping, wailing and gnashing of teeth. Fortunately, the burn support group was very understanding, especially since some money was non-refundable. Maybe next year?
On a positive note, Nikki has been invited by the Phoenix Society to apply for their SOAR (Survivors Offering Assistance in Recovery) program. If accepted, she will be trained professionally to meet with and assist burn survivors and family members in the hospital setting. She's very excited about this, feeling it’s a chance to give some back to those who helped her. Her interview is next week- look for a follow up soon.
Still no surgeries on the horizon. Nikki's committed to getting back into it next year, probably spring time. The focus is still on facial and hand reconstruction. I'll keep you updated.
5/3/07
A brief update to help fill a quiet time. Nikki is doing well, continuing to heal from her broken collar bone. She has continued to work during her recovery as a hostess, which requires no lifting. Although it pays a lot more per hour, she still loses a lot of money due to missing tips. The doctors are reasonably happy with her progress and are thinking that surgery may not be needed, after all. In the past week, Nikki has begun working some serving shifts. She has to be careful & the work makes her arm ache, but she keeps plugging away.
On other fronts, OSU has brought in a new head of plastic surgery, Michael Miller, from Baylor University in Texas. Dr. Miller has done original research in the emerging field of tissue engineering, a multidisciplinary field committed to developing new methods to fabricate tissue for reconstructive surgery by altering existing tissue at the cellular and molecular levels. Nikki has already been referred to him & he has some very aggressive plans for continuing her reconstruction. Nikki has a lot of interest in his plans, but has made it clear that it will be several months before she is financially ready to begin this work.
Nikki has also continued her participation in the fledgling OSU burn support group. She has already been chosen to represent the group to the World Burn Congress meeting in Vancouver in October.
That's all for now... more as it develops. Take care!
3/21/07
Nearly a month since the last posting and I finally have something to report- not very good news, either. Nikki was taking her dog out yesterday, leading him on a leash down the stairs from her apartment. She was wearing high heels, the dog tugged hard on the leash- yep, you guessed it. Nikki lost her footing & fell on the stairs. She went backward, landing on her back & shoulders, right on a riser. She was scraped & very sore, but basically OK- she thought.
The pain was very bad during the night and worse this morning and the impact site was very swollen. She finally gave up toughing it out and went to urgent care today. Prognosis?... a broken collar bone. Not just a simple break, either, but broken in two places. The doctor said she actually has broken a piece out of her collar bone. He also said it might require surgery to secure the piece... great.
Of course, Nikki isn't handling this well. The doctor said she'll need "a month or so" off of work- not an option, says Nikki, since she's not prepared for it. She's off to the Cheesecake Factory tomorrow to see if she can have some adjusted duty & keep working. She can handle anything that doesn't require lifting or carrying things. As a server, she has to carry drink trays and such, but Nikki hopes she can get a work around.
She's off to see her family doctor tomorrow. She also has to notify her plastic surgeon and occupational medicine doctors. I might have more then- stay tuned!
2/28/07
Winter's finally coming to an end and all's well here. Nikki is healthy & happy, and working lot's of hours at the Columbus Cheesecake Factory... be sure to stop in and meet her, if you're in the area.
There's been no talk lately of further medical procedures... again, Nikki hates winter & doesn't like to be out and about in it. Once the weather turns warm, she'll begin to think about "What's next?". then, the blog will once again be busy- and more interesting! Stay tuned for warm weather & more Nikki! Take care...
A New Life: October - December 2006
12/19/06
Yep, you guessed it… still quiet and uneventful here. There's not likely to be any medical action with Nikki until spring. I believe she's still leaning toward going to Cleveland for her next procedure, and that will likely be the much discussed free-flap procedure. She'll definitely wait for warmer weather for this next step, though, so there are several months of peace & quiet yet to come.
In the meantime, the Mize family is enjoying good health by all and is getting ready for Christmas. We all think back to 2004 at every holiday season now, remembering how we came all too close to losing one of our own, and it makes the holidays all the more special to us. We're definitely more thankful for all that we have and tend to be more relaxed than in Christmases past. We enjoy the season more than ever, while letting a lot of the commercialism pass us by. We also have special thoughts for those who helped us so much in those difficult times past, from the medical professionals to the good friends, all equally important to us.
We still haven't gotten back into sending out Christmas cards in a big way yet… maybe next year. In the meantime, please consider this note our "Merry Christmas" to all of you. We hope that this special season means as much to all of you as it does to us. Enjoy the season, enjoy your families, enjoy your friends…
Merry Christmas!
10/12/06
Sorry for the long silence, but there's not a darn thing going on. Nikki's last graft took fine, but she's not very satisfied with how it looks. Odds are good that she will continue to consider the more radical free-flap procedure, hoping for a better outcome. Nothing scheduled at this time, though…
In the meantime, Nikki has been accepted as a bartender at Cheesecake Factory once again, a major coup for her. She's already recertified and is now picking up occasional bar shifts, although she's still serving most of the time. Needless to say, she's very happy as her return to normalcy continues.
That's really it for now. Sure is nice to be boring for a change. We'll keep you informed as things develop.
Yep, you guessed it… still quiet and uneventful here. There's not likely to be any medical action with Nikki until spring. I believe she's still leaning toward going to Cleveland for her next procedure, and that will likely be the much discussed free-flap procedure. She'll definitely wait for warmer weather for this next step, though, so there are several months of peace & quiet yet to come.
In the meantime, the Mize family is enjoying good health by all and is getting ready for Christmas. We all think back to 2004 at every holiday season now, remembering how we came all too close to losing one of our own, and it makes the holidays all the more special to us. We're definitely more thankful for all that we have and tend to be more relaxed than in Christmases past. We enjoy the season more than ever, while letting a lot of the commercialism pass us by. We also have special thoughts for those who helped us so much in those difficult times past, from the medical professionals to the good friends, all equally important to us.
We still haven't gotten back into sending out Christmas cards in a big way yet… maybe next year. In the meantime, please consider this note our "Merry Christmas" to all of you. We hope that this special season means as much to all of you as it does to us. Enjoy the season, enjoy your families, enjoy your friends…
Merry Christmas!
10/12/06
Sorry for the long silence, but there's not a darn thing going on. Nikki's last graft took fine, but she's not very satisfied with how it looks. Odds are good that she will continue to consider the more radical free-flap procedure, hoping for a better outcome. Nothing scheduled at this time, though…
In the meantime, Nikki has been accepted as a bartender at Cheesecake Factory once again, a major coup for her. She's already recertified and is now picking up occasional bar shifts, although she's still serving most of the time. Needless to say, she's very happy as her return to normalcy continues.
That's really it for now. Sure is nice to be boring for a change. We'll keep you informed as things develop.
Reconstruction: July - August 2006
8/20/06
We arrived at OSU Wednesday at 10:30am for the 12:30pm surgery. In her room by 11:00am, where the waiting began. Something was wrong in OR and schedules were shot. As the afternoon dragged on, we tried to stay patient… but no one was telling us anything. At 2pm we finally asked what was going on… the nurses at the desk seemed surprised to see us still there- bad sign. They made some calls and a resident finally rushed up to tell us that all was chaos.. an unscheduled, 6 hour+ case squeezed in ahead of us. The resident thought Nikki would be going down in another hour or so. My book was finished, my Palm Pilot was exhausted and so was I. About 4pm I went out to the nursing station again to see if there was any news. The late shift was on now and one of the nurses that we knew said "Oh, back from surgery?"- Another bad sign.
Nikki finally went down at 5:15pm, hit OR at 6:30pm, finished at 7:15pm, went through a very quick recovery and was back in her room by 8:15pm. Once again, no nausea… I hope they've found the perfect anesthesia for her. At 9:15 she was out and back home by 10:00pm. The small donor patch was taken from her upper thigh this time and grafted onto the neck area that wasn't taking right. Nikki went to the doctor on Friday & the early report is good- the site looks much better than it did with the previous graft.
Nikki has continued to do research on the free-flap procedure proposed by Dr. Kaufman and is becoming more & more convinced that this is the way she wants to go. If so, this will almost certainly happen in Cleveland at MetroHealth. As always, I'll keep you all updated.
8/15/06
Got a call at work today from Nikki… sort of snuffly & depressed. She had what was supposed to be a "quick" checkup today- and ended up being scheduled for surgery #23 tomorrow! About 30% of her graft is failing and Dr. Gordillo wants to quickly repair it and save the rest of the grafted area. She promises a "minimal" procedure.
Aside from being bummed by yet another surgery on her face, Nikki was expecting to return to work this weekend. Now, it'll be two weeks or so before she can work again. No problem with her work- they understand. Nikki's money was carefully budgeted, though, and this blows the budget. She thinks she can stretch things far enough, though, and we'll help what we can.
I'll give a follow up tomorrow when she's done… 12:30pm surgery, so it'll be another late one. Stay tuned!
8/8/06
Sorry for the tardiness this time- we've been pretty busy lately. Of course, Nikki had her 22nd surgery on 8/1 and everything went fine. Only one hitch… The home care nurses had removed Nikki's Woundvac the day before surgery at the doctor's direction, due to a mild infection that had started. Nikki left the machine at home on surgery day, thinking she was done with it… Nope, Dr. Gordillo planned to put it on again after surgery. I was already gone from the hospital on other errands, so Nikki chased down one of her friends to go to her apartment and get the machine. Her friend rushed so much that he was stopped by the police for speeding. The police actually believed his story about rushing to the hospital with critical medical equipment & waived the speeding violation. Unfortunately, her friend's tags had also expired and the officer wouldn't let that one go. So the friend got a ticket for expired tags & an admonishment to get them renewed in 24 hours.
Nikki kept the Woundvac on for a few days and then had it removed. So far, so good… we'll have to wait for the bandages to be removed to see how the graft is going. The doctor seems pleased so far, though. Nikki is already driving again and chafing to get back to work. Tomorrow, we're all going to the state fair, so she's obviously feeling good.
I'll have another update when I have something new to report. Take care for now…
7/19/06
See?... I can make two entries in two days!
Nikki did fine today, as expected. Her 11:30am surgery was pushed back to 1:00pm, she spent 2 hours in OR, 2 hours in recovery, 1 hour in the ambulatory surgery suite and was in her own apartment resting by 7:00pm. Dr. Gordillo excised a lot more contracted skin than originally planned, which made Nikki very happy. From just above her right eyebrow (or where it would be if she had an eyebrow anymore) down onto her shoulder and upper chest was tossed into the trash today. Integra went over this, followed by Acticoat, then the Wound Vac leeched powerfully over the whole mess. Nikki will keep the WoundVac on for two weeks, with thrice-weekly dressing changes- at home! Turns out that Medicaid will cover the home nursing, just not the Vac... go figure.
For the first time that I can remember, Nikki didn't have any postop nausea this time and rested very comfortably after surgery. Gordillo succeeded in raising the area around Nikki's right eye quite a bit, stitching it into place. The face looks much more relaxed now. Nikki also had her chief physical therapist (now a good friend) observing the surgery. The therapist & Gordillo went over Nikki very thoroughly, including looking at the tissue under the skin- much improved in texture with all of the therapy.
On August 1st. Nikki returns to have the actual grafting done, with her left thigh once again serving as a donor site. I'll be back by then with another update, so stay tuned!
07/18/06
Yep, I've let things creep up on us again! Nikki goes to OSU Medical Center tomorrow for surgery #21. I wasn't very clear on this in my last update. After getting the 2nd opinion from Dr. Kaufman on the free flap, Nikki talked it over with her regular surgeon Dr. Gordillo. Gordillo thought that it was a fine idea, but had not offered it to Nikki for three reasons. One, it's much more radical than the relatively simple skin grafting. Two, it's potentially disfiguring to the donor site and also can take several follow-up procedures to make the flap look "right" again. Gordillo knows that Nikki wants to look the best she can at all times and didn't think she would like this route. And three, Gordillo doesn't do this sort of microsurgery herself, so Nikki would probably have to go to Cleveland for it.
After some thought, they reached a compromise… one more grafting attempt. This time, Gordillo wants to use the WoundVac for two weeks, to give the graft its best possible chance of success. One problem- Medicaid won't cover the WoundVac for home use, so Nikki would have to sit in the hospital for two weeks!.. I know, it makes no sense. Workaround- the company that provides the Vac occasionally provides its equipment at no cost for needy people. Dr. Gordillo helped Nikki apply for this use and was accepted, so she gets to bring home a portable Vac for two weeks. No way to do the needed nursing care every 3 days at home, though, so she'll have to go to the doctor's office every 3 days.
Tomorrow, Nikki will have all of the contracted tissue removed from her face again. Along with Gordillo, Dr. Katz (occuloplastics) will be there doing some more work around Nikki's right eye. Then the WoundVac will be put in place on the open tissue and left there for two weeks. Nikki should be able to go home tomorrow evening. Two weeks later (August 1st), she'll return to the hospital for the actual graft, coming from her thigh. She has high hopes that this procedure will work & she can avoid the free flap procedure. I'll provide an update after tomorrow's procedure.
On a technical note… the blog is broke. I wiped & reloaded my computer a couple of weeks ago to solve several annoying issues that piled up over the years. While restoring it, I over-wrote a recent folder (and its backups) with an older one, instantly losing the last year's entries to the blog! I didn't even notice this until last night, when I began working on this update. Yes, I used harsh language. Thank goodness for Google and its web cache entries. I found a recent version of the page stored there, downloaded it and began putting the blog back together. I also lost some image files, which broke the links in the blog. I'm slowly putting things back together… text first, then images, so it'll look funny for a while. I'm doing a little restructuring as I go, putting older stuff on the second page so that the main page will load faster. Just bear with me for a few days.I'll update on Nikki's surgery soon… stay tuned!
We arrived at OSU Wednesday at 10:30am for the 12:30pm surgery. In her room by 11:00am, where the waiting began. Something was wrong in OR and schedules were shot. As the afternoon dragged on, we tried to stay patient… but no one was telling us anything. At 2pm we finally asked what was going on… the nurses at the desk seemed surprised to see us still there- bad sign. They made some calls and a resident finally rushed up to tell us that all was chaos.. an unscheduled, 6 hour+ case squeezed in ahead of us. The resident thought Nikki would be going down in another hour or so. My book was finished, my Palm Pilot was exhausted and so was I. About 4pm I went out to the nursing station again to see if there was any news. The late shift was on now and one of the nurses that we knew said "Oh, back from surgery?"- Another bad sign.
Nikki finally went down at 5:15pm, hit OR at 6:30pm, finished at 7:15pm, went through a very quick recovery and was back in her room by 8:15pm. Once again, no nausea… I hope they've found the perfect anesthesia for her. At 9:15 she was out and back home by 10:00pm. The small donor patch was taken from her upper thigh this time and grafted onto the neck area that wasn't taking right. Nikki went to the doctor on Friday & the early report is good- the site looks much better than it did with the previous graft.
Nikki has continued to do research on the free-flap procedure proposed by Dr. Kaufman and is becoming more & more convinced that this is the way she wants to go. If so, this will almost certainly happen in Cleveland at MetroHealth. As always, I'll keep you all updated.
8/15/06
Got a call at work today from Nikki… sort of snuffly & depressed. She had what was supposed to be a "quick" checkup today- and ended up being scheduled for surgery #23 tomorrow! About 30% of her graft is failing and Dr. Gordillo wants to quickly repair it and save the rest of the grafted area. She promises a "minimal" procedure.
Aside from being bummed by yet another surgery on her face, Nikki was expecting to return to work this weekend. Now, it'll be two weeks or so before she can work again. No problem with her work- they understand. Nikki's money was carefully budgeted, though, and this blows the budget. She thinks she can stretch things far enough, though, and we'll help what we can.
I'll give a follow up tomorrow when she's done… 12:30pm surgery, so it'll be another late one. Stay tuned!
8/8/06
Sorry for the tardiness this time- we've been pretty busy lately. Of course, Nikki had her 22nd surgery on 8/1 and everything went fine. Only one hitch… The home care nurses had removed Nikki's Woundvac the day before surgery at the doctor's direction, due to a mild infection that had started. Nikki left the machine at home on surgery day, thinking she was done with it… Nope, Dr. Gordillo planned to put it on again after surgery. I was already gone from the hospital on other errands, so Nikki chased down one of her friends to go to her apartment and get the machine. Her friend rushed so much that he was stopped by the police for speeding. The police actually believed his story about rushing to the hospital with critical medical equipment & waived the speeding violation. Unfortunately, her friend's tags had also expired and the officer wouldn't let that one go. So the friend got a ticket for expired tags & an admonishment to get them renewed in 24 hours.
Nikki kept the Woundvac on for a few days and then had it removed. So far, so good… we'll have to wait for the bandages to be removed to see how the graft is going. The doctor seems pleased so far, though. Nikki is already driving again and chafing to get back to work. Tomorrow, we're all going to the state fair, so she's obviously feeling good.
I'll have another update when I have something new to report. Take care for now…
7/19/06
See?... I can make two entries in two days!
Nikki did fine today, as expected. Her 11:30am surgery was pushed back to 1:00pm, she spent 2 hours in OR, 2 hours in recovery, 1 hour in the ambulatory surgery suite and was in her own apartment resting by 7:00pm. Dr. Gordillo excised a lot more contracted skin than originally planned, which made Nikki very happy. From just above her right eyebrow (or where it would be if she had an eyebrow anymore) down onto her shoulder and upper chest was tossed into the trash today. Integra went over this, followed by Acticoat, then the Wound Vac leeched powerfully over the whole mess. Nikki will keep the WoundVac on for two weeks, with thrice-weekly dressing changes- at home! Turns out that Medicaid will cover the home nursing, just not the Vac... go figure.
For the first time that I can remember, Nikki didn't have any postop nausea this time and rested very comfortably after surgery. Gordillo succeeded in raising the area around Nikki's right eye quite a bit, stitching it into place. The face looks much more relaxed now. Nikki also had her chief physical therapist (now a good friend) observing the surgery. The therapist & Gordillo went over Nikki very thoroughly, including looking at the tissue under the skin- much improved in texture with all of the therapy.
On August 1st. Nikki returns to have the actual grafting done, with her left thigh once again serving as a donor site. I'll be back by then with another update, so stay tuned!
07/18/06
Yep, I've let things creep up on us again! Nikki goes to OSU Medical Center tomorrow for surgery #21. I wasn't very clear on this in my last update. After getting the 2nd opinion from Dr. Kaufman on the free flap, Nikki talked it over with her regular surgeon Dr. Gordillo. Gordillo thought that it was a fine idea, but had not offered it to Nikki for three reasons. One, it's much more radical than the relatively simple skin grafting. Two, it's potentially disfiguring to the donor site and also can take several follow-up procedures to make the flap look "right" again. Gordillo knows that Nikki wants to look the best she can at all times and didn't think she would like this route. And three, Gordillo doesn't do this sort of microsurgery herself, so Nikki would probably have to go to Cleveland for it.
After some thought, they reached a compromise… one more grafting attempt. This time, Gordillo wants to use the WoundVac for two weeks, to give the graft its best possible chance of success. One problem- Medicaid won't cover the WoundVac for home use, so Nikki would have to sit in the hospital for two weeks!.. I know, it makes no sense. Workaround- the company that provides the Vac occasionally provides its equipment at no cost for needy people. Dr. Gordillo helped Nikki apply for this use and was accepted, so she gets to bring home a portable Vac for two weeks. No way to do the needed nursing care every 3 days at home, though, so she'll have to go to the doctor's office every 3 days.
Tomorrow, Nikki will have all of the contracted tissue removed from her face again. Along with Gordillo, Dr. Katz (occuloplastics) will be there doing some more work around Nikki's right eye. Then the WoundVac will be put in place on the open tissue and left there for two weeks. Nikki should be able to go home tomorrow evening. Two weeks later (August 1st), she'll return to the hospital for the actual graft, coming from her thigh. She has high hopes that this procedure will work & she can avoid the free flap procedure. I'll provide an update after tomorrow's procedure.
On a technical note… the blog is broke. I wiped & reloaded my computer a couple of weeks ago to solve several annoying issues that piled up over the years. While restoring it, I over-wrote a recent folder (and its backups) with an older one, instantly losing the last year's entries to the blog! I didn't even notice this until last night, when I began working on this update. Yes, I used harsh language. Thank goodness for Google and its web cache entries. I found a recent version of the page stored there, downloaded it and began putting the blog back together. I also lost some image files, which broke the links in the blog. I'm slowly putting things back together… text first, then images, so it'll look funny for a while. I'm doing a little restructuring as I go, putting older stuff on the second page so that the main page will load faster. Just bear with me for a few days.I'll update on Nikki's surgery soon… stay tuned!
Reconstruction: May - June 2006
06/29/06
Been a while, I know, but as before, it means good news- no problems. Nikki is tentatively scheduled for another face grafting in late July- more when I have it. In the meantime, though, we have good news from physical therapy- Nikki is reducing to one day per week! Her strength in the badly damaged right arm and hand has grown significantly this past 6 months. In just the last month, she's gained 10lbs of lift with her right arm, and her grip has also increased nicely. This is a major milestone and Nikki is very excited.
We should have more information on upcoming surgeries after the holiday. I hope everybody has a very enjoyable (and safe!) 4th of July.
06/01/06
Nikki & I made the long trip to Cleveland today to obtain a second opinion on her facial reconstruction. Nikki wants to make sure that she has all viable options in front of her, not limited by one doctor's viewpoint. For this "outside" viewpoint, Nikki chose Dr. Bram Kaufman, the MetroHealth plastic surgeon that did the initial (and great!) work on her face, just after her accident.
After clearing up some confusion about seeing a resident, versus the man himself, Dr. Kaufman made it down to see us. Just as pleasant as I remembered from 2004, he listened to Nikki explain her concerns about having three grafting sessions to her face so far, with little improvement to show for them. He examined her face & neck, seeming surprised at just how good her forehead looks (he did the original sheet graft over her burned-to-the-bone forehead in 2004). When told about the unimpressive doctor at OSU that tried to insert an expander under the graft, he just shook his head.
His opinion is that Nikki should consider an anterolateral thigh free flap. As opposed to grafting, this procedure surgically removes a deep section of skin, with all of its supporting tissues, including branches of the femoral artery, from the thigh and implants it into the burned area. Vessels are surgically reattached to provide blood to the transplanted chunk of skin. The procedure is a delicate bit of microsurgery, taking around eight hours in Nikki's case, followed by several days in the hospital. The flap will look like a large, fat piece of skin growing from the side of her face. After a couple of months of healing, liposuction and trimming will reduce the flap to more normal proportions.
The downsides include the hunk of tissue hanging from her face for some months, as well as a possible permanent indentation on her donor thigh. The upside is that the procedure neatly deals with the contracture problems that have affected every graft attempt to Nikki's face so far. With all of its support tissues moved along with it, the skin will stay soft & pliable, immune to contractures.
Dr. Kaufman will be forwarding his opinions to Dr. Gordillo, Nikki's surgeon in Columbus. Nikki & Dr. G will meet to discuss the pros and cons of the procedure, so that Nikki can get a very good idea of what it will really do for her. Then, she'll have to make some decisions…. Do the procedure? If so, which doctor?
In the shorter term, OSU is urging Nikki to come in for surgery on her eye this month. Dr. Katz (ophthalmics, plastics) wants to do some more reshaping around Nikki's eye, in order to get the lids closing better and generally improving the appearance around the eye.
Finally, as an aside, the local NBC news affiliate continued its interest in burn support by profiling a local victim injured some time ago. This woman was burned worse than Nikki, and also lost her husband in the fire. She obviously needs some support in dealing with her personal tragedy and the news article gave information on the fledgling OSU burn support group that Nikki is very involved with. This high-profile publicity is invaluable in helping the new support group to get off to a good start.
I'll update again after Nikki has time to reach some decisions… stay tuned!
05/20/06
Just a quick update… the NBC news crew did a nice job at Nikki's burn support meeting this past Wednesday. I thought that Nikki looked great! There's a lot of publicity within OSU for this new group. Other hospitals in the area are also being drawn into the effort. Of course, burn patients are also being made aware that a new support group just for them & their families is starting up. Such things take time and sustained effort to become self-sufficient… and some kind support from a great local news station doesn't hurt, either! Be sure to check out the new interview link on the blog.
Until next time…
05/17/06
Yep, it's been very quiet and peaceful around here… I like quiet & peaceful. It makes for boring reading on this web log, I know, but its good for the nerves. Nikki is working, driving, socializing- all the things that a normal 27 year old does. Physical therapy continues twice weekly, with slow improvements. Two weeks ago, Nikki played 'Show & Tell' again for a graduate class of physical medicine. Wearing skimpy shorts & halter top, she served as Director of Physical Rehab Bob Vaneko's display for what being a burn survivor really means. Students were invited to ask her questions and even to touch her. This is the second time that she's done this and she really enjoys opening the eyes of advanced students who thought they'd seen it all. For many, concepts such as "grafting" and "permanent disfigurement" were just that- concepts. She brought reality to a good group of kids that hope to help people like her in their medical futures.
As mentioned before, Nikki isn't really satisfied with the progress being made on her facial reconstruction. She's started shopping around for second opinions, including getting in contact with the plastic surgeon who did some of her original work in Cleveland. She hopes to visit there in the near future and hear what he has to say.
Tonight, Nikki is attending one of the first meetings of the newly formed burn support group here at OSU. Our local NBC 4 is also attending the meeting, providing some much-appreciated publicity for the fledgling group. Nikki is very proud to be a driving force in the reformation of this necessary support group.I'll be back with more when I have it. Thanks for staying in touch… I welcome any and all comments, as does Nikki. Don't be shy.
Been a while, I know, but as before, it means good news- no problems. Nikki is tentatively scheduled for another face grafting in late July- more when I have it. In the meantime, though, we have good news from physical therapy- Nikki is reducing to one day per week! Her strength in the badly damaged right arm and hand has grown significantly this past 6 months. In just the last month, she's gained 10lbs of lift with her right arm, and her grip has also increased nicely. This is a major milestone and Nikki is very excited.
We should have more information on upcoming surgeries after the holiday. I hope everybody has a very enjoyable (and safe!) 4th of July.
06/01/06
Nikki & I made the long trip to Cleveland today to obtain a second opinion on her facial reconstruction. Nikki wants to make sure that she has all viable options in front of her, not limited by one doctor's viewpoint. For this "outside" viewpoint, Nikki chose Dr. Bram Kaufman, the MetroHealth plastic surgeon that did the initial (and great!) work on her face, just after her accident.
After clearing up some confusion about seeing a resident, versus the man himself, Dr. Kaufman made it down to see us. Just as pleasant as I remembered from 2004, he listened to Nikki explain her concerns about having three grafting sessions to her face so far, with little improvement to show for them. He examined her face & neck, seeming surprised at just how good her forehead looks (he did the original sheet graft over her burned-to-the-bone forehead in 2004). When told about the unimpressive doctor at OSU that tried to insert an expander under the graft, he just shook his head.
His opinion is that Nikki should consider an anterolateral thigh free flap. As opposed to grafting, this procedure surgically removes a deep section of skin, with all of its supporting tissues, including branches of the femoral artery, from the thigh and implants it into the burned area. Vessels are surgically reattached to provide blood to the transplanted chunk of skin. The procedure is a delicate bit of microsurgery, taking around eight hours in Nikki's case, followed by several days in the hospital. The flap will look like a large, fat piece of skin growing from the side of her face. After a couple of months of healing, liposuction and trimming will reduce the flap to more normal proportions.
The downsides include the hunk of tissue hanging from her face for some months, as well as a possible permanent indentation on her donor thigh. The upside is that the procedure neatly deals with the contracture problems that have affected every graft attempt to Nikki's face so far. With all of its support tissues moved along with it, the skin will stay soft & pliable, immune to contractures.
Dr. Kaufman will be forwarding his opinions to Dr. Gordillo, Nikki's surgeon in Columbus. Nikki & Dr. G will meet to discuss the pros and cons of the procedure, so that Nikki can get a very good idea of what it will really do for her. Then, she'll have to make some decisions…. Do the procedure? If so, which doctor?
In the shorter term, OSU is urging Nikki to come in for surgery on her eye this month. Dr. Katz (ophthalmics, plastics) wants to do some more reshaping around Nikki's eye, in order to get the lids closing better and generally improving the appearance around the eye.
Finally, as an aside, the local NBC news affiliate continued its interest in burn support by profiling a local victim injured some time ago. This woman was burned worse than Nikki, and also lost her husband in the fire. She obviously needs some support in dealing with her personal tragedy and the news article gave information on the fledgling OSU burn support group that Nikki is very involved with. This high-profile publicity is invaluable in helping the new support group to get off to a good start.
I'll update again after Nikki has time to reach some decisions… stay tuned!
05/20/06
Just a quick update… the NBC news crew did a nice job at Nikki's burn support meeting this past Wednesday. I thought that Nikki looked great! There's a lot of publicity within OSU for this new group. Other hospitals in the area are also being drawn into the effort. Of course, burn patients are also being made aware that a new support group just for them & their families is starting up. Such things take time and sustained effort to become self-sufficient… and some kind support from a great local news station doesn't hurt, either! Be sure to check out the new interview link on the blog.
Until next time…
05/17/06
Yep, it's been very quiet and peaceful around here… I like quiet & peaceful. It makes for boring reading on this web log, I know, but its good for the nerves. Nikki is working, driving, socializing- all the things that a normal 27 year old does. Physical therapy continues twice weekly, with slow improvements. Two weeks ago, Nikki played 'Show & Tell' again for a graduate class of physical medicine. Wearing skimpy shorts & halter top, she served as Director of Physical Rehab Bob Vaneko's display for what being a burn survivor really means. Students were invited to ask her questions and even to touch her. This is the second time that she's done this and she really enjoys opening the eyes of advanced students who thought they'd seen it all. For many, concepts such as "grafting" and "permanent disfigurement" were just that- concepts. She brought reality to a good group of kids that hope to help people like her in their medical futures.
As mentioned before, Nikki isn't really satisfied with the progress being made on her facial reconstruction. She's started shopping around for second opinions, including getting in contact with the plastic surgeon who did some of her original work in Cleveland. She hopes to visit there in the near future and hear what he has to say.
Tonight, Nikki is attending one of the first meetings of the newly formed burn support group here at OSU. Our local NBC 4 is also attending the meeting, providing some much-appreciated publicity for the fledgling group. Nikki is very proud to be a driving force in the reformation of this necessary support group.I'll be back with more when I have it. Thanks for staying in touch… I welcome any and all comments, as does Nikki. Don't be shy.
Reconstruction: March 2006
03/31/06
Well, it had to happen sooner or later… Nikki is now (gasp) DRIVING again! Scared?.... you bet. Not her- ME! Nikki has always been a poor driver, because she's so easily distracted. Eating, drinking, cell phone, friends- all take her attention away from the road. Add to that her last accident- well, it'll take some getting used to. Of course, she's thrilled. After being dependent on other people to get around for so long, it's hard for her to believe that she's independent again.
Nikki is also at the end of her medical leave, returning to work this weekend. She's felt well enough to work for weeks, but she had to wait for her facial wound to completely heal. Being in foodservice, seeping wounds are generally a no-no. Now that she has the added expense of a car & insurance, she really needs to get back to work. It's good to see her so excited again.
No surgeries are planned as of yet. Stay tuned, though- they're coming. That's all for now- take care until next time.
03/13/06
Of course, Nikki made it home just fine last Saturday, with little to no discomfort. She went right to her own apartment, and has been hanging out & taking it easy this past week.
The surgical results are still 'iffy'. At least a part of the graft did not take- a small piece back near her ear actually came off. Nikki's used to bits and pieces of her falling off from time to time, but it doesn't make her happy. She's been giving some thought to consulting another plastic surgeon, since she seems to be having a lot of trouble getting the face right. The right eye looks great, though.. the "Z-plasty" really did the trick, leaving Nikki with a perfectly almond-shaped eye.
While Nikki mulls over her next step, she continues to heal. Dressing changes get easier, and the area covered gets smaller. She'll be resuming physical therapy this week, and is looking forward to getting back to work. More when we know what's next.
03/02/06
Yeah, I'm still running behind, but I have good intentions- honest! March 1st was here before I knew it, & yesterday was once again spent at OSU Medical Center. Nikki spent 3 hours in surgery, twice as long as scheduled- an error in the schedule. Time wasn't allotted for Nikki having to be flipped over during the procedure. She started out face down (although she doesn't remember it), so that Dr. Gordillo could remove the first graft from her skull. A 4 x 4 square right at the back of her head was shaved, then the split-thickness graft was harvested. The heavy hair that Nikki has re-grown since her accident will hide this nicely.
Nikki was then flipped over on the table (it takes a lot longer than you'd think), and a sizable chunk of skin was harvested from her left thigh (a favorite donor site, since her right leg was burnt some). Then the Acticoat & Integra was removed from her last surgical site, exposing raw tissues. This area was a little "soupy", probably from mild topical infection, so it was thoroughly cleaned. Then the skin from her skull was grafted onto the upper face, around the right eye. This skin type is almost identical to the skin that grows on the upper face, making for a natural look after grafting. The skin from her thigh was then slightly meshed (tiny holes punched in it to make it cover a wider area), then grafted to the upper neck & shoulder. As of now, the site is very clean looking, with a very snug WoundVac clinging to it like a black jellyfish.
Nikki also had a "Z-plasty" performed on the inner corner of her right eye. This part of her eye has had a squared-off look ever since plastic surgery done in Cleveland just after her accident to rebuild the area. Gordillo made a Z-shaped incision, which seems to prevent tissues from lining up in a manner that enables contractures…. sort of contracture-proof, as it were. Gordillo then reshaped that area around the eye, making it more almond shaped. We can't see this now, as she has a bandage over the eye, but we're all excited to see how it came out.
Gordillo had already decided yesterday morning that she wanted Nikki to stay at the hospital for a few days with a WoundVac, instead of going home as originally planned. She had problems getting a room, as there were no beds on the surgeon's favorite units. Nikki spent 7 hours in recovery, while room was made for her on the desired unit. My wife & I came back to visit her at 7:30pm, running an hour late, and she had just gotten to her room in the last 10 minutes. She was wide awake & feeling alert, although she had her usual post-op nausea. No solid food that night. Nikki will be discharged on Saturday.
Gordillo plans to focus some really aggressive physical therapy on the right side of Nikki's face & neck, in an effort to ward off contractures. The graft was done in two pieces for the same reason, instead of using long, single sheets, which is what has been done in the past. This is the third time that Nikki's face has been re-grafted due to contractures, and we'd all like it to be the last. If successful, this should be the last major procedure on her face.
Future procedures will concentrate on the right arm- elbow and shoulder. It's possible there could be some more surgery on the right hand, but that's far from definite. Nikki is also thinking about trying to do something about the "ledge" that formed at the juncture of her back and hips when all of her soft tissue on the back was burned away in her accident. This left her hips sticking several inches out from her back, like a ledge. Just after the accident, I could lay all 5 fingers of my hand flat on this ledge, and a little still peeked out- all raw tissue on top. As Nikki lost weight in the hospital, this ledge actually healed over and joined back to the back- an amazing thing to watch happen, believe me. But now, Nikki's waist is much smaller than her hips, making fitting clothes difficult. Her back also has no cushion anymore, as all fatty tissue was destroyed. As a result, she's not padded well right where pants & aprons tend to clinch, and it hurts. It also wears skin raw sometimes, which could get infected. Dr. Gordillo is already thinking over the best way to deal with this. One thought is to take fatty tissue from a thigh and surgically place it around the waistline at her back. Nikki wishes she'd just suck some from her ample butt & move it up a bit. In any event, this is low-priority stuff, and may not happen for some time.
Stay tuned, and I promise that I'll update everyone after she comes home Saturday.
Well, it had to happen sooner or later… Nikki is now (gasp) DRIVING again! Scared?.... you bet. Not her- ME! Nikki has always been a poor driver, because she's so easily distracted. Eating, drinking, cell phone, friends- all take her attention away from the road. Add to that her last accident- well, it'll take some getting used to. Of course, she's thrilled. After being dependent on other people to get around for so long, it's hard for her to believe that she's independent again.
Nikki is also at the end of her medical leave, returning to work this weekend. She's felt well enough to work for weeks, but she had to wait for her facial wound to completely heal. Being in foodservice, seeping wounds are generally a no-no. Now that she has the added expense of a car & insurance, she really needs to get back to work. It's good to see her so excited again.
No surgeries are planned as of yet. Stay tuned, though- they're coming. That's all for now- take care until next time.
03/13/06
Of course, Nikki made it home just fine last Saturday, with little to no discomfort. She went right to her own apartment, and has been hanging out & taking it easy this past week.
The surgical results are still 'iffy'. At least a part of the graft did not take- a small piece back near her ear actually came off. Nikki's used to bits and pieces of her falling off from time to time, but it doesn't make her happy. She's been giving some thought to consulting another plastic surgeon, since she seems to be having a lot of trouble getting the face right. The right eye looks great, though.. the "Z-plasty" really did the trick, leaving Nikki with a perfectly almond-shaped eye.
While Nikki mulls over her next step, she continues to heal. Dressing changes get easier, and the area covered gets smaller. She'll be resuming physical therapy this week, and is looking forward to getting back to work. More when we know what's next.
03/02/06
Yeah, I'm still running behind, but I have good intentions- honest! March 1st was here before I knew it, & yesterday was once again spent at OSU Medical Center. Nikki spent 3 hours in surgery, twice as long as scheduled- an error in the schedule. Time wasn't allotted for Nikki having to be flipped over during the procedure. She started out face down (although she doesn't remember it), so that Dr. Gordillo could remove the first graft from her skull. A 4 x 4 square right at the back of her head was shaved, then the split-thickness graft was harvested. The heavy hair that Nikki has re-grown since her accident will hide this nicely.
Nikki was then flipped over on the table (it takes a lot longer than you'd think), and a sizable chunk of skin was harvested from her left thigh (a favorite donor site, since her right leg was burnt some). Then the Acticoat & Integra was removed from her last surgical site, exposing raw tissues. This area was a little "soupy", probably from mild topical infection, so it was thoroughly cleaned. Then the skin from her skull was grafted onto the upper face, around the right eye. This skin type is almost identical to the skin that grows on the upper face, making for a natural look after grafting. The skin from her thigh was then slightly meshed (tiny holes punched in it to make it cover a wider area), then grafted to the upper neck & shoulder. As of now, the site is very clean looking, with a very snug WoundVac clinging to it like a black jellyfish.
Nikki also had a "Z-plasty" performed on the inner corner of her right eye. This part of her eye has had a squared-off look ever since plastic surgery done in Cleveland just after her accident to rebuild the area. Gordillo made a Z-shaped incision, which seems to prevent tissues from lining up in a manner that enables contractures…. sort of contracture-proof, as it were. Gordillo then reshaped that area around the eye, making it more almond shaped. We can't see this now, as she has a bandage over the eye, but we're all excited to see how it came out.
Gordillo had already decided yesterday morning that she wanted Nikki to stay at the hospital for a few days with a WoundVac, instead of going home as originally planned. She had problems getting a room, as there were no beds on the surgeon's favorite units. Nikki spent 7 hours in recovery, while room was made for her on the desired unit. My wife & I came back to visit her at 7:30pm, running an hour late, and she had just gotten to her room in the last 10 minutes. She was wide awake & feeling alert, although she had her usual post-op nausea. No solid food that night. Nikki will be discharged on Saturday.
Gordillo plans to focus some really aggressive physical therapy on the right side of Nikki's face & neck, in an effort to ward off contractures. The graft was done in two pieces for the same reason, instead of using long, single sheets, which is what has been done in the past. This is the third time that Nikki's face has been re-grafted due to contractures, and we'd all like it to be the last. If successful, this should be the last major procedure on her face.
Future procedures will concentrate on the right arm- elbow and shoulder. It's possible there could be some more surgery on the right hand, but that's far from definite. Nikki is also thinking about trying to do something about the "ledge" that formed at the juncture of her back and hips when all of her soft tissue on the back was burned away in her accident. This left her hips sticking several inches out from her back, like a ledge. Just after the accident, I could lay all 5 fingers of my hand flat on this ledge, and a little still peeked out- all raw tissue on top. As Nikki lost weight in the hospital, this ledge actually healed over and joined back to the back- an amazing thing to watch happen, believe me. But now, Nikki's waist is much smaller than her hips, making fitting clothes difficult. Her back also has no cushion anymore, as all fatty tissue was destroyed. As a result, she's not padded well right where pants & aprons tend to clinch, and it hurts. It also wears skin raw sometimes, which could get infected. Dr. Gordillo is already thinking over the best way to deal with this. One thought is to take fatty tissue from a thigh and surgically place it around the waistline at her back. Nikki wishes she'd just suck some from her ample butt & move it up a bit. In any event, this is low-priority stuff, and may not happen for some time.
Stay tuned, and I promise that I'll update everyone after she comes home Saturday.
Reconstruction: January - February 2006
02/17/06
Surgery Wednesday was a success, with no complications. A little over two hours in the O.R. and Nikki came out with no skin from her right eyebrow, back to her ear and down to the top of her shoulder. Her largest WoundVac to date is sitting snugly over this huge site, encouraging circulation in the area & preparing it for the skin graft in a couple of weeks.
Nikki was a little upset when she first woke up & found more skin gone from her face than she expected. Dr. Gordillo explained that even though part of her last skin graft looked good to the eye, it was actually contracted tight as a snare drum. When Gordillo removed all of this, the skin around Nikki's right eye lifted almost an inch, and the right corner of her mouth literally snapped back up where it belonged. Even under the WoundVac & Integra, Nikki can tell that the constricted skin is gone.
Nikki is expecting to be discharged early Saturday morning. She'll be sent home with a tightly wrapped bandage pack that will need no care for several days, until she returns for a checkup. On March 1st, she returns to OSU for the actual skin graft. This will be done in two pieces. One smaller piece will be removed from her scalp (yep, there goes some hair again) and grafted around the eye and upper face. Skin from the scalp is most similar to that around the upper face. A much larger area will be harvested from her left thigh & used to cover the lower face, neck and shoulder top. This will be a split-thickness graft, not involving any but the topmost layers of skin. Think of falling off a motorcycle onto pavement, wearing shorts, and you'll get a good idea what her thigh will look (and feel) like afterwards.
While Nikki was recovering from surgery Wednesday, the fledgling burn support group that she is helping to start had its first real meeting. This was to lay the groundwork for electing officers, discussing group structure, etc. She was really bummed to miss it, after waiting so long.
More updates during the coming week... stay tuned!
02/14/06
Happy Valentine’s Day! And yes, I've been bad…. My updates this year have been spotty and infrequent. I plead forgiveness… it's been a busy time at work this year, while Nikki's life has been quiet and uneventful for a few months. Rest time's over, though, and its back to the surgery table for Nicole. Surgery 19 is tomorrow (Wednesday), around 12 noon.
Dr. Gordillo is concentrating on the right side of the face and neck again, an area that's been grafted several times. There's a continuous problem with contractures here, resulting in several grafts not coming out as good as expected. It's more of the same this time…. the plan for tomorrow is to remove hardened skin from the right face and neck. Afterwards, Nikki will spend 3 days in the hospital with a WoundVac latched to her face like a leech, stimulating blood flow into the tissue that will form the bed for the new graft. Then Nikki will leave the hospital until March 1st, when she will return for the actual skin graft, to be taken from her thigh again. Depending on how things go, this could be a same-day surgery, or a night or two.
This year should also see more surgeries on the right eye and right arm, from hand to shoulder. Nikki is still working on getting the burn support group off the ground. This effort paused during the holidays, due to everyone's schedule. She's also making some noise about going back to school, while working full time. Can't hold her down.
I'll post tomorrow or the following day with an update on her surgery. Thoughts and prayers appreciated.
01/05/06
Happy New Year to everyone who continues to follow Nikki through her recovery! This is just another very brief update, as there's nothing new to report as yet. However, I received a couple of emails asking if I'd given up on the blog- not at all. It's just that the last few months have been surgery-free and uneventful for Nikki. She continues improving physically through her continuous therapy. She also works nearly full-time, which keeps her quite busy.
The month of December was extremely busy for all of us, and I just never got another update done- very sorry. I hope that everyone had a great holiday season, From Thanksgiving right through New Years. We all had a great Christmas here and are looking forward to a great 2006.
Today, Nikki scheduled her next doctor's appointment for next week, and this should signal the start of another year of surgery. Nikki still needs a lot of work on her right face, right eye, right arm and maybe the right hand. I'll provide updates on upcoming surgeries as soon as I have them.Thanks again for everyone's support. I really enjoy the emails that I receive through this site, and I hope to hear from many more of you during the year. Stay tuned!
Surgery Wednesday was a success, with no complications. A little over two hours in the O.R. and Nikki came out with no skin from her right eyebrow, back to her ear and down to the top of her shoulder. Her largest WoundVac to date is sitting snugly over this huge site, encouraging circulation in the area & preparing it for the skin graft in a couple of weeks.
Nikki was a little upset when she first woke up & found more skin gone from her face than she expected. Dr. Gordillo explained that even though part of her last skin graft looked good to the eye, it was actually contracted tight as a snare drum. When Gordillo removed all of this, the skin around Nikki's right eye lifted almost an inch, and the right corner of her mouth literally snapped back up where it belonged. Even under the WoundVac & Integra, Nikki can tell that the constricted skin is gone.
Nikki is expecting to be discharged early Saturday morning. She'll be sent home with a tightly wrapped bandage pack that will need no care for several days, until she returns for a checkup. On March 1st, she returns to OSU for the actual skin graft. This will be done in two pieces. One smaller piece will be removed from her scalp (yep, there goes some hair again) and grafted around the eye and upper face. Skin from the scalp is most similar to that around the upper face. A much larger area will be harvested from her left thigh & used to cover the lower face, neck and shoulder top. This will be a split-thickness graft, not involving any but the topmost layers of skin. Think of falling off a motorcycle onto pavement, wearing shorts, and you'll get a good idea what her thigh will look (and feel) like afterwards.
While Nikki was recovering from surgery Wednesday, the fledgling burn support group that she is helping to start had its first real meeting. This was to lay the groundwork for electing officers, discussing group structure, etc. She was really bummed to miss it, after waiting so long.
More updates during the coming week... stay tuned!
02/14/06
Happy Valentine’s Day! And yes, I've been bad…. My updates this year have been spotty and infrequent. I plead forgiveness… it's been a busy time at work this year, while Nikki's life has been quiet and uneventful for a few months. Rest time's over, though, and its back to the surgery table for Nicole. Surgery 19 is tomorrow (Wednesday), around 12 noon.
Dr. Gordillo is concentrating on the right side of the face and neck again, an area that's been grafted several times. There's a continuous problem with contractures here, resulting in several grafts not coming out as good as expected. It's more of the same this time…. the plan for tomorrow is to remove hardened skin from the right face and neck. Afterwards, Nikki will spend 3 days in the hospital with a WoundVac latched to her face like a leech, stimulating blood flow into the tissue that will form the bed for the new graft. Then Nikki will leave the hospital until March 1st, when she will return for the actual skin graft, to be taken from her thigh again. Depending on how things go, this could be a same-day surgery, or a night or two.
This year should also see more surgeries on the right eye and right arm, from hand to shoulder. Nikki is still working on getting the burn support group off the ground. This effort paused during the holidays, due to everyone's schedule. She's also making some noise about going back to school, while working full time. Can't hold her down.
I'll post tomorrow or the following day with an update on her surgery. Thoughts and prayers appreciated.
01/05/06
Happy New Year to everyone who continues to follow Nikki through her recovery! This is just another very brief update, as there's nothing new to report as yet. However, I received a couple of emails asking if I'd given up on the blog- not at all. It's just that the last few months have been surgery-free and uneventful for Nikki. She continues improving physically through her continuous therapy. She also works nearly full-time, which keeps her quite busy.
The month of December was extremely busy for all of us, and I just never got another update done- very sorry. I hope that everyone had a great holiday season, From Thanksgiving right through New Years. We all had a great Christmas here and are looking forward to a great 2006.
Today, Nikki scheduled her next doctor's appointment for next week, and this should signal the start of another year of surgery. Nikki still needs a lot of work on her right face, right eye, right arm and maybe the right hand. I'll provide updates on upcoming surgeries as soon as I have them.Thanks again for everyone's support. I really enjoy the emails that I receive through this site, and I hope to hear from many more of you during the year. Stay tuned!
Reconstruction: September - December 2005
11/22/05
Just a very brief update for you folks, as there's really nothing happening right now. The doctors have decided that there'll be no more surgeries until after the holidays. Nikki isn't really satisfied with that, as she's impatient to keep moving along in her recovery.
While the last surgery was a success, she has already developed some new contractures along her face and neck. These are once again dragging down the right side of Nikki's face, and making her uncomfortable. This will mean more excising and grafting along the right neck & cheek. There's also still work to the done on the right shoulder and upper arm, and more work is needed on the right eye. 2006 will be another busy year for Nikki.
Things continue to progress with the new burn support group- just a lot more slowly than everyone would like. The interest and support is definitely there, and Nikki is already making contacts with web page designers, local fire stations, and so on.
Work is also going well for her. She's carrying a full schedule now as a server, and patiently (sort of) waiting to break back into bartending. Bartending is fast paced, requires mental & physical skill and is also more financially rewarding… plus, she's really good at it.
That'll do for now. I promise at least one more update by Christmas. In the meantime, we hope that everyone has a blessed Thanksgiving. All of you have things to be thankful for, and this is that special time of year to reflect on how lucky we all are. I know our family does.
Happy Thanksgiving!
10/26/05
It's been nearly a month since Nikki's last surgery- and my last update. Things are going well for Nikki, and there hasn't been much to report.
As anticipated, Nikki did leave the hospital the day after her surgery. She was very sore for a couple of days, and had to miss a wedding that she planned to attend. As usual, though, she healed quickly. The graft took very well this time, and the area around the eye also healed well. The donor site on the back of her head is already growing back in nicely. The bone harvest site over her right ear never did give her any problems.
Nikki returned to work last week, this time as a server.... no more hosting for her! Her manager has also made arrangements for her to begin picking up shifts as a bartender. Of course, her ultimate goal is to return to bartending full-time, and it looks like she's well on her way to that.
In another important step toward regaining her independence, Nikki moved into her own apartment this week. Just 15 minutes from here, and only 5 minutes from her work, this nice apartment is also close to a couple of her friends, and very inexpensive. There is a shuttle service that runs from the Easton Towne Center (where she works) to all of the apartment complexes in this area, which gives her an easy (and free!) ride to and from work- very important, since Nikki can't drive yet. It seems strange not to have her in the house for the first time in 13 months.
Returning to work has its problems. Her Medicaid health benefits will continue for nine months, but at a sharply increased deductible, or "spend-down". She still receives a $750 monthly stipend from Social Security, but $650 of it now goes to Medicaid. No complaints, though, since just her monthly medications cost more than $700. Nikki can't get insurance through her work until she's been there for six months.
The doctors were talking about one more surgery this year, but nothing is finalized as yet. I'll keep everyone up to date as things develop. Take care for now.
9/28/05
Surgery #18 was today, and Nikki's fine & resting comfortably in the hospital tonight. There were some minor issues, though.
Nikki was scheduled as a 2nd case, starting at 9:00am, so we were at the hospital at 7:00am. Everything went smoothly; so smoothly, she actually started surgery at 8:55am, her case slated for 3.5 hours. By 1:00pm, I'm wondering what's happening. Surgical schedules are always over-estimated, and Nikki has almost always finished early. The rare time or two that she's run over, a doctor has called the waiting area to tell me. Today, nothing. By 1:30, my wife is burning up my cell phone. Come 2:00pm, we're both driving each other crazy, and Bonnie is getting ill. I finally went to the attendant's desk in the waiting area and asked her to check on my daughter. She frowned when she saw how late we were running & got right on it. A few minutes later, she reported that the next case had been called for in Nikki's O.R., meaning they were finishing up. At 2:40, Dr. Gordillo finally appeared, looking exhausted.
She quickly told me that Nikki was fine, awake & talking. She apologized for the lateness, and explained that she and Dr. Katz had some problems with Nikki's right eye. The plan was to reshape the outside and inside corners around the eye. Dr. Katz did the outside first, trimming and pulling the skin out to the right a bit. Unfortunately, this put more tension than anticipated on the inside corner, by the nose that Gordillo was rebuilding. The two spent a lot of time moving things around, and also drawing plans all around Nikki's eye and nose. It was finally decided to forget doing any further work on the inside corner by the nose. This is a fairly minor procedure that Gordillo feels can be done on an outpatient basis later.
When Katz was done, Gordillo flipped Nikki over onto her stomach and harvested a 2" by 5" strip of skin from the back of Nikki's skull. She then removed the dark scar tissue from the last failed graft on Nikki's right cheek, then grafted the new skin there. This was originally envisioned as a two part process, but Gordillo like the quality of graft material that she was getting, and decided to do it all at once- something that Nikki had wanted. The harvest site was covered in Xeroform, then stapled. Interestingly, while stitches can kill hair follicles and leave a hairless line, staples don't.
Then the tricky part. Gordillo went to the right side of Nikki's skull, above the ear. A 2" incision was made, and a long, slender piece of bone was dug out of her skull. This is a somewhat delicate procedure, as it's easy to screw up the bone fragment and have to harvest another. When it was free, Gordillo then made an extremely small incision on Nikki's nose, just inside one nostril, in the septum dividing the two nostrils. She then slid the bone fragment carefully through the incision, just underneath the skin on top of the nose, all the way to the top of the bridge. A couple of small stitches closes this, and Nikki now has a defined ridge to her nose, instead of the flattened look that she's had since her accident. The bone harvest site, a very shallow thing, is also stapled over.
And that was it... 5.5 hours of surgery, and 3 of 4 planned objectives met. Nikki has a large bolster bandage stitched over the graft on her right cheek and the outside corner of her eye (take a washcloth, roll it loosely- that's a bolster). She has a 6" Ace bandage wrapped completely around her head, with hair sticking out of the top and bottom. Her right eye is swollen nearly shut, and looks like it'll be black & blue by morning. Her cheek and nose are also swollen. Yep, she looks like hell.
When I knew she was safe in recovery, I left for a few hours, returning later with Bonnie. Nikki was pretty sore and a little down- she had been told that all of the planned work on her eye wasn't done. I went over everything that was done in detail, including the problems the doctors had. She finally understood that a lot of good stuff had been completed, and lightened up. While we visited this evening, her IV infiltrated, causing a lot of discomfort. When we left at 8:00pm, the unit nurses had tried twice to restart the IV, with no luck. Nikki has been a very difficult stick since her accident, what with all of the skin grafts and scar tissue covering all of the usual spots. They called for a special IV team as we left.
Gordillo had said that Nikki could go home Thursday, if she felt up to it. She probably will, no matter how she feels, since she says that she always feels better at home. She goes back to the doctor Tuesday to have the bolster removed & everything checked over. I'll update again after that checkup. Stay tuned!
09/09/05
Just a very brief update tonight. Nikki's 18th surgery has been scheduled for Sept. 28th, and will be as described in my last post. She'll have a couple of days in the hospital for this one, and her work is ready for it.
Nikki worked her first shifts as server this week, which has really excited her. Serving (food or drinks) is really what she loves to do, and she's good at it. She feels like she's really come home now, especially since she's been able to handle the demanding work with no problems. Tips are also great... I suggested that she keep her bandages on from her upcoming surgery as long as possible .
On a basset note, the family just got back from Ohio Basset Rescue's Meet & Greet pizza party for the waddle this weekend. It was great to see many of our old friends and spend a few hours chatting, while the hounds also visited and stole pizza from the tables. Turn out was good, with many new faces in attendance. I hope to see many more at tomorrow's OBR Big Drool Carnival at Paws Park, here in southeastern Columbus. This large off-lead park (7 acres!!) should be a lot of fun for hounds and people. Several concessions & eating areas are available- just a perfect place for a picnic and dog carnival.
Ohio Basset Rescue and its members were a huge help to us during Nikki's worst times. Eva DeVaughn, the head of OBR, fed our dogs for more than half a year, and also donated medicines and other helpful things. Several members also pitched in with cash and other useful items, all very important to us. It was help like this that enabled us to concentrate on Nikki when she needed it the most. It's impossible to ever repay that sort of help. Nikki really enjoyed meeting many of these people for the first time tonight.
I'll have more basset stuff soon... Stay tuned!
Just a very brief update for you folks, as there's really nothing happening right now. The doctors have decided that there'll be no more surgeries until after the holidays. Nikki isn't really satisfied with that, as she's impatient to keep moving along in her recovery.
While the last surgery was a success, she has already developed some new contractures along her face and neck. These are once again dragging down the right side of Nikki's face, and making her uncomfortable. This will mean more excising and grafting along the right neck & cheek. There's also still work to the done on the right shoulder and upper arm, and more work is needed on the right eye. 2006 will be another busy year for Nikki.
Things continue to progress with the new burn support group- just a lot more slowly than everyone would like. The interest and support is definitely there, and Nikki is already making contacts with web page designers, local fire stations, and so on.
Work is also going well for her. She's carrying a full schedule now as a server, and patiently (sort of) waiting to break back into bartending. Bartending is fast paced, requires mental & physical skill and is also more financially rewarding… plus, she's really good at it.
That'll do for now. I promise at least one more update by Christmas. In the meantime, we hope that everyone has a blessed Thanksgiving. All of you have things to be thankful for, and this is that special time of year to reflect on how lucky we all are. I know our family does.
Happy Thanksgiving!
10/26/05
It's been nearly a month since Nikki's last surgery- and my last update. Things are going well for Nikki, and there hasn't been much to report.
As anticipated, Nikki did leave the hospital the day after her surgery. She was very sore for a couple of days, and had to miss a wedding that she planned to attend. As usual, though, she healed quickly. The graft took very well this time, and the area around the eye also healed well. The donor site on the back of her head is already growing back in nicely. The bone harvest site over her right ear never did give her any problems.
Nikki returned to work last week, this time as a server.... no more hosting for her! Her manager has also made arrangements for her to begin picking up shifts as a bartender. Of course, her ultimate goal is to return to bartending full-time, and it looks like she's well on her way to that.
In another important step toward regaining her independence, Nikki moved into her own apartment this week. Just 15 minutes from here, and only 5 minutes from her work, this nice apartment is also close to a couple of her friends, and very inexpensive. There is a shuttle service that runs from the Easton Towne Center (where she works) to all of the apartment complexes in this area, which gives her an easy (and free!) ride to and from work- very important, since Nikki can't drive yet. It seems strange not to have her in the house for the first time in 13 months.
Returning to work has its problems. Her Medicaid health benefits will continue for nine months, but at a sharply increased deductible, or "spend-down". She still receives a $750 monthly stipend from Social Security, but $650 of it now goes to Medicaid. No complaints, though, since just her monthly medications cost more than $700. Nikki can't get insurance through her work until she's been there for six months.
The doctors were talking about one more surgery this year, but nothing is finalized as yet. I'll keep everyone up to date as things develop. Take care for now.
9/28/05
Surgery #18 was today, and Nikki's fine & resting comfortably in the hospital tonight. There were some minor issues, though.
Nikki was scheduled as a 2nd case, starting at 9:00am, so we were at the hospital at 7:00am. Everything went smoothly; so smoothly, she actually started surgery at 8:55am, her case slated for 3.5 hours. By 1:00pm, I'm wondering what's happening. Surgical schedules are always over-estimated, and Nikki has almost always finished early. The rare time or two that she's run over, a doctor has called the waiting area to tell me. Today, nothing. By 1:30, my wife is burning up my cell phone. Come 2:00pm, we're both driving each other crazy, and Bonnie is getting ill. I finally went to the attendant's desk in the waiting area and asked her to check on my daughter. She frowned when she saw how late we were running & got right on it. A few minutes later, she reported that the next case had been called for in Nikki's O.R., meaning they were finishing up. At 2:40, Dr. Gordillo finally appeared, looking exhausted.
She quickly told me that Nikki was fine, awake & talking. She apologized for the lateness, and explained that she and Dr. Katz had some problems with Nikki's right eye. The plan was to reshape the outside and inside corners around the eye. Dr. Katz did the outside first, trimming and pulling the skin out to the right a bit. Unfortunately, this put more tension than anticipated on the inside corner, by the nose that Gordillo was rebuilding. The two spent a lot of time moving things around, and also drawing plans all around Nikki's eye and nose. It was finally decided to forget doing any further work on the inside corner by the nose. This is a fairly minor procedure that Gordillo feels can be done on an outpatient basis later.
When Katz was done, Gordillo flipped Nikki over onto her stomach and harvested a 2" by 5" strip of skin from the back of Nikki's skull. She then removed the dark scar tissue from the last failed graft on Nikki's right cheek, then grafted the new skin there. This was originally envisioned as a two part process, but Gordillo like the quality of graft material that she was getting, and decided to do it all at once- something that Nikki had wanted. The harvest site was covered in Xeroform, then stapled. Interestingly, while stitches can kill hair follicles and leave a hairless line, staples don't.
Then the tricky part. Gordillo went to the right side of Nikki's skull, above the ear. A 2" incision was made, and a long, slender piece of bone was dug out of her skull. This is a somewhat delicate procedure, as it's easy to screw up the bone fragment and have to harvest another. When it was free, Gordillo then made an extremely small incision on Nikki's nose, just inside one nostril, in the septum dividing the two nostrils. She then slid the bone fragment carefully through the incision, just underneath the skin on top of the nose, all the way to the top of the bridge. A couple of small stitches closes this, and Nikki now has a defined ridge to her nose, instead of the flattened look that she's had since her accident. The bone harvest site, a very shallow thing, is also stapled over.
And that was it... 5.5 hours of surgery, and 3 of 4 planned objectives met. Nikki has a large bolster bandage stitched over the graft on her right cheek and the outside corner of her eye (take a washcloth, roll it loosely- that's a bolster). She has a 6" Ace bandage wrapped completely around her head, with hair sticking out of the top and bottom. Her right eye is swollen nearly shut, and looks like it'll be black & blue by morning. Her cheek and nose are also swollen. Yep, she looks like hell.
When I knew she was safe in recovery, I left for a few hours, returning later with Bonnie. Nikki was pretty sore and a little down- she had been told that all of the planned work on her eye wasn't done. I went over everything that was done in detail, including the problems the doctors had. She finally understood that a lot of good stuff had been completed, and lightened up. While we visited this evening, her IV infiltrated, causing a lot of discomfort. When we left at 8:00pm, the unit nurses had tried twice to restart the IV, with no luck. Nikki has been a very difficult stick since her accident, what with all of the skin grafts and scar tissue covering all of the usual spots. They called for a special IV team as we left.
Gordillo had said that Nikki could go home Thursday, if she felt up to it. She probably will, no matter how she feels, since she says that she always feels better at home. She goes back to the doctor Tuesday to have the bolster removed & everything checked over. I'll update again after that checkup. Stay tuned!
09/09/05
Just a very brief update tonight. Nikki's 18th surgery has been scheduled for Sept. 28th, and will be as described in my last post. She'll have a couple of days in the hospital for this one, and her work is ready for it.
Nikki worked her first shifts as server this week, which has really excited her. Serving (food or drinks) is really what she loves to do, and she's good at it. She feels like she's really come home now, especially since she's been able to handle the demanding work with no problems. Tips are also great... I suggested that she keep her bandages on from her upcoming surgery as long as possible .
On a basset note, the family just got back from Ohio Basset Rescue's Meet & Greet pizza party for the waddle this weekend. It was great to see many of our old friends and spend a few hours chatting, while the hounds also visited and stole pizza from the tables. Turn out was good, with many new faces in attendance. I hope to see many more at tomorrow's OBR Big Drool Carnival at Paws Park, here in southeastern Columbus. This large off-lead park (7 acres!!) should be a lot of fun for hounds and people. Several concessions & eating areas are available- just a perfect place for a picnic and dog carnival.
Ohio Basset Rescue and its members were a huge help to us during Nikki's worst times. Eva DeVaughn, the head of OBR, fed our dogs for more than half a year, and also donated medicines and other helpful things. Several members also pitched in with cash and other useful items, all very important to us. It was help like this that enabled us to concentrate on Nikki when she needed it the most. It's impossible to ever repay that sort of help. Nikki really enjoyed meeting many of these people for the first time tonight.
I'll have more basset stuff soon... Stay tuned!
Reconstruction: August 2005
8/31/05
On Monday 8/29, Nikki was visited again by our local NBC television affiliate. They were doing a follow up on Nikki, to see how she had progressed since their last visit in November 2004.
The day got off to a rough start. The news crew had wanted to be with Nikki during her physical therapy at OSU early that morning. They contacted Nikki the night before, and she agreed to this. Unfortunately, when the crew arrived at the clinic Monday morning, no one was expecting them, and the staff on duty wasn't sure how to handle them. In the end, the crew was finally refused admittance, in the interest of patient confidentiality (several patients are there at once). As it turned out later, a simple five minute call to the Communications office would have cleared the visit. Live and learn.
The crew then regrouped, and arranged to interview Nikki at home. My wife and I got a 20 minute warning to get ready for them. As my wife does childcare in the home, she had to do something with six noisy little kids, while she straightened up the house. When the crew arrived, she retreated to our large bedroom with the kids, leaving me to deal with the crew.
It was the same anchor person as before, so we knew each other. They quickly set up, and began chatting with Nikki. Very low-key, very pleasant. The news anchor, Monique, was amazed at the differences in Nikki in just nine months. Nikki also managed to work in her interest in starting a burn support group in central Ohio, just to plant the seed. NBC was quick to pounce on that as a point to follow up on later. Nikki had me help her with a few simple exercises for the camera, to help make up for the botched therapy session. The segment aired on Columbus TV 4 at 5pm & 11pm, and was well done. As of today, I haven't seen the film posted on the website yet. There is a brief article, though, with a small slide show, at this address:
http://www.nbc4i.com/news/4911530/detail.html
On the medical side, Nikki has another surgery coming up very shortly. This will focus on her nose and the outside corner of her right eye. A small patch will be shaved on the back of her head, and a small sheet graft harvested from there. Then a small piece of bone will be taken from the skull by Dr. Gordillo, to be used in rebuilding the bridge of Nikki's nose (it's very flat right now). After that, Dr. Katz will begin reworking the outer corner of her eye, in an effort to make it look more natural. When he's done with that, the graft from the back of her head will be placed by the eye, down the side of the upper cheek. Nikki will be hospitalized for a couple of days after this one.
Nikki continues to enjoy working, having several shifts per week. She's requalified for serving now, and hopes to begin picking up some server shifts this week. She's also scheduled her first real meeting with hospital staff concerning a burn support group, which she's very excited about.
I'll have more shortly... take care.
8/15/05
Mostly some housekeeping chores for the web page today. The darn thing's gotten so large that people with dialup connections really suffer through some long download times. Therefore, I've split the page into two parts, putting older items on the second page, which is accessible by clicking links from the main page.
Also today, Nikki wanted to put up a couple of pictures taken since the many surgeries that she's had. Unfortunately, these are "pictures of pictures", and not very good quality, so they'll be replaced soon with better ones. They've been included at the top of this page for now. We're also working on putting up many more pictures of Nikki on a separate photo web site, the link to which we'll make available when it's ready.
Nothing new medically as of today. Nikki has three doctor appointments this week, and I might have something new afterwards. She continues to work, getting used to being on her feet for long periods again. She's having a blast so far. More when I have it....
08/06/05
Yep, it's another milestone for Nikki today- she returned to work! True, it's only 2 or 3 shifts a week, and it's hosting, not bartending... but it's an important step toward self-sufficiency!
Nikki spent the past week getting the blessings of her doctors, therapists, Social Security, Medicaid, and her old workplace, The Cheesecake Factory, here in Columbus. Everything came together nicely, and she started today with a five hour shift.
There was never any doubt that Nikki would be returning to The Cheesecake Factory. She helped to open the one in Columbus, which is the first in Ohio. She had a lot of upscale serving experience when hired there, and worked as a server for four years. She became interested in bartending due to the complexity and potential earnings, was allowed to test for it, and then bartended for a year. She was good enough to be invited to the new Cleveland location (along with her manager at Columbus) to be their senior bartender, responsible for scheduling and inventory of the bar. She was still working there when she had her accident, although she had already decided to return to Columbus, where a position with her original Cheesecake awaited her.
Nikki's goal is to host for a while on a light schedule, to get used to working & the very rapid pace of Cheesecake once again. When she's comfortable, she'll begin to pick up shifts as a server. She's already been told that her server certification is still good (yes, you have to test & be certified for both serving and bartending there). She'll eventually work into full time serving again, as her limitations allow. She still doesn't have the range of motion necessary for bartending as of yet.... too much reaching, stretching, fast motions, etc. When physically able, though, they'll put her on the list for promotion for bartending again, as an experienced bartender.
Cheesecake is well aware of the many surgeries still ahead of her, and are ready to work around prolonged absences, work restrictions, etc. The management of this fine establishment is a great group of people, and a good representation of the quality of people that The Cheesecake Factory has working for them. Nikki's been given the opportunity to write her own schedule, along with any restrictions she feels necessary. How many places would do that for a young employee? Anyone that lives near a Cheesecake Factory should visit often, and look with favor on this great company.
Social Security & Medicaid have proven easy to work with. Maybe because they're so sick & tired of fighting malingerers and other abusers, a young lady itching to return to work is a breath of fresh air. Ohio provides a nine month transitional program for people like Nikki, allowing her to work as she's able, without sacrificing benefits. She does have to pay more for her medical benefits as her income increases, which is to be expected. It'll be 90 days before she qualifies for medical again at Cheesecake. I'm sure their insurer is dying to have her back, after paying nearly $400,000 for her last year. Medicaid's paid another $200,000 or so here in Columbus.
Nikki's first shift has just ended as I'm typing this, and I'm waiting for her call to go & get her. It's been exactly one year & 8 days since her last shift at the Cleveland location.... wonder what she'll have to talk about?
On Monday 8/29, Nikki was visited again by our local NBC television affiliate. They were doing a follow up on Nikki, to see how she had progressed since their last visit in November 2004.
The day got off to a rough start. The news crew had wanted to be with Nikki during her physical therapy at OSU early that morning. They contacted Nikki the night before, and she agreed to this. Unfortunately, when the crew arrived at the clinic Monday morning, no one was expecting them, and the staff on duty wasn't sure how to handle them. In the end, the crew was finally refused admittance, in the interest of patient confidentiality (several patients are there at once). As it turned out later, a simple five minute call to the Communications office would have cleared the visit. Live and learn.
The crew then regrouped, and arranged to interview Nikki at home. My wife and I got a 20 minute warning to get ready for them. As my wife does childcare in the home, she had to do something with six noisy little kids, while she straightened up the house. When the crew arrived, she retreated to our large bedroom with the kids, leaving me to deal with the crew.
It was the same anchor person as before, so we knew each other. They quickly set up, and began chatting with Nikki. Very low-key, very pleasant. The news anchor, Monique, was amazed at the differences in Nikki in just nine months. Nikki also managed to work in her interest in starting a burn support group in central Ohio, just to plant the seed. NBC was quick to pounce on that as a point to follow up on later. Nikki had me help her with a few simple exercises for the camera, to help make up for the botched therapy session. The segment aired on Columbus TV 4 at 5pm & 11pm, and was well done. As of today, I haven't seen the film posted on the website yet. There is a brief article, though, with a small slide show, at this address:
http://www.nbc4i.com/news/4911530/detail.html
On the medical side, Nikki has another surgery coming up very shortly. This will focus on her nose and the outside corner of her right eye. A small patch will be shaved on the back of her head, and a small sheet graft harvested from there. Then a small piece of bone will be taken from the skull by Dr. Gordillo, to be used in rebuilding the bridge of Nikki's nose (it's very flat right now). After that, Dr. Katz will begin reworking the outer corner of her eye, in an effort to make it look more natural. When he's done with that, the graft from the back of her head will be placed by the eye, down the side of the upper cheek. Nikki will be hospitalized for a couple of days after this one.
Nikki continues to enjoy working, having several shifts per week. She's requalified for serving now, and hopes to begin picking up some server shifts this week. She's also scheduled her first real meeting with hospital staff concerning a burn support group, which she's very excited about.
I'll have more shortly... take care.
8/15/05
Mostly some housekeeping chores for the web page today. The darn thing's gotten so large that people with dialup connections really suffer through some long download times. Therefore, I've split the page into two parts, putting older items on the second page, which is accessible by clicking links from the main page.
Also today, Nikki wanted to put up a couple of pictures taken since the many surgeries that she's had. Unfortunately, these are "pictures of pictures", and not very good quality, so they'll be replaced soon with better ones. They've been included at the top of this page for now. We're also working on putting up many more pictures of Nikki on a separate photo web site, the link to which we'll make available when it's ready.
Nothing new medically as of today. Nikki has three doctor appointments this week, and I might have something new afterwards. She continues to work, getting used to being on her feet for long periods again. She's having a blast so far. More when I have it....
08/06/05
Yep, it's another milestone for Nikki today- she returned to work! True, it's only 2 or 3 shifts a week, and it's hosting, not bartending... but it's an important step toward self-sufficiency!
Nikki spent the past week getting the blessings of her doctors, therapists, Social Security, Medicaid, and her old workplace, The Cheesecake Factory, here in Columbus. Everything came together nicely, and she started today with a five hour shift.
There was never any doubt that Nikki would be returning to The Cheesecake Factory. She helped to open the one in Columbus, which is the first in Ohio. She had a lot of upscale serving experience when hired there, and worked as a server for four years. She became interested in bartending due to the complexity and potential earnings, was allowed to test for it, and then bartended for a year. She was good enough to be invited to the new Cleveland location (along with her manager at Columbus) to be their senior bartender, responsible for scheduling and inventory of the bar. She was still working there when she had her accident, although she had already decided to return to Columbus, where a position with her original Cheesecake awaited her.
Nikki's goal is to host for a while on a light schedule, to get used to working & the very rapid pace of Cheesecake once again. When she's comfortable, she'll begin to pick up shifts as a server. She's already been told that her server certification is still good (yes, you have to test & be certified for both serving and bartending there). She'll eventually work into full time serving again, as her limitations allow. She still doesn't have the range of motion necessary for bartending as of yet.... too much reaching, stretching, fast motions, etc. When physically able, though, they'll put her on the list for promotion for bartending again, as an experienced bartender.
Cheesecake is well aware of the many surgeries still ahead of her, and are ready to work around prolonged absences, work restrictions, etc. The management of this fine establishment is a great group of people, and a good representation of the quality of people that The Cheesecake Factory has working for them. Nikki's been given the opportunity to write her own schedule, along with any restrictions she feels necessary. How many places would do that for a young employee? Anyone that lives near a Cheesecake Factory should visit often, and look with favor on this great company.
Social Security & Medicaid have proven easy to work with. Maybe because they're so sick & tired of fighting malingerers and other abusers, a young lady itching to return to work is a breath of fresh air. Ohio provides a nine month transitional program for people like Nikki, allowing her to work as she's able, without sacrificing benefits. She does have to pay more for her medical benefits as her income increases, which is to be expected. It'll be 90 days before she qualifies for medical again at Cheesecake. I'm sure their insurer is dying to have her back, after paying nearly $400,000 for her last year. Medicaid's paid another $200,000 or so here in Columbus.
Nikki's first shift has just ended as I'm typing this, and I'm waiting for her call to go & get her. It's been exactly one year & 8 days since her last shift at the Cleveland location.... wonder what she'll have to talk about?
Reconstruction: July 2005
07/21/05
A fairly brief update today. Nicole came through surgery 17 yesterday with flying colors. We left for the hospital at 9:30am (she was 3rd case), she went to pre-op at 11:15am, surgery at 12:31am, post-op at 1:45pm, and discharged at 4:30pm- a new record for quick surgeries! A 2" x 12" strip of skin was taken from the top of her left thigh (her most undamaged one, with the most healthy skin) and cut to fit the skinless area of her upper right shoulder and lower right neck. This area was in great shape, after playing host to Integra (an artificial skin substitute) the last two weeks, and the graft bed was perfect. This graft was not perforated to increase the coverage area, leaving the skin looking smooth and natural. Therefore, in technical terms, Nikki had a "split-thickness sheet graft". She was quite comfortable afterwards, with only a little nausea from the post-op morphine. Usually, her harvested areas hurt worse than her graft sites… after all, it's like taking a razor and cutting off the top layers of skin, leaving a very bloody "raspberry" behind, full of screaming nerves. However, this small graft doesn't seem to bother her at all, and she's been quite active.
Late August is the next tentative date for surgery. Probably a joint effort between Dr. Gordillo (general plastics) and Dr. Katz (Occuloplatics), involving more reshaping of the right eye and upper right face. Gordillo may also get into Nikki's nose repair, using a combination of artificial materials and harvested bone to reshape the bridge of her nose. Soon after that, some major releases are needed on Nikki's right shoulder and elbow, to provide some much-needed range-of-motion improvement.
Closer at hand, and more fun to think about, is Nikki's 1st Survival Anniversary! One year ago this Saturday, at 2:00am, Nikki came very close to leaving us forever. The unbelievable support of a number of great people, plus the determination and incredibly positive attitude of a very special lady, have turned a near-death experience into a life-altering event. All of you are sharing that experience with Nikki, through the imperfect window of my writing. A better writer would do the story more justice, as I feel that it's a powerful tale. Nevertheless, we'll continue to plod along together, you and I, peeking into a remarkable young lady's life as she continues to triumph over situations that would break many others.
Stay tuned for another update after this coming Anniversary!
07/09/05
Surgery 16 was successful on Wednesday 7/6/05… as a matter of fact, it went so well, that Nikki was discharged yesterday!
Nikki spent about 90 minutes in surgery, her fastest surgery to date. As planned, an area of hard, constricted skin was excised from her lower neck and the top of her right shoulder. As soon as this toughened skin was removed, Nikki's face, mouth and eyelid all lifted noticeably- just what we wanted. The results were so good that Dr. Gordillo didn't remove any skin from her face, preferring to minimize the trauma. Integra was laid over the now-skinless area, and the WoundVac (described below) was applied over that. Nikki was very comfortable after returning to her room around 11:30am. I got her some French fries from Wendy's, and left her happily munching on them. Later that evening, my wife and I brought her Chinese food, and she ate a lot of that.
We learned from Dr. Gordillo that Nikki's last CAT scan had shown some polyp growth in her right sinus cavity. You'll remember that both of Nikki's sinuses were crushed in her accident, along with her nose being smashed flat against her face & burned. The E.R. docs reshaped the nose very well, although it still has a flattened look to it. Since the skin and underlying material was seriously damaged, Dr. Gordillo is planning to use artificial materials to reshape her nose, building the bridge back up again. Gordillo also consulted with ENT (Ears, Nose, Throat) on the polyps, but ENT isn't very concerned. Nikki breathes properly and doesn't have any discomfort there, so the docs decided to try antibiotics for a while and see if they affect the polyps.
On Thursday, Dr. Litts, the hand Plastics doc, paid Nikki a visit to check out her right pinkie. This finger has never healed properly since pins were inserted into it a few months back. You could even see one of the pins peeking through her skin. So, Litts removed it…. He grabbed it with a pair of pliers and just pulled it out! You'd think this would hurt like hell, but Nikki said it wasn't bad. But then, Litts pointed out another pin- a figure-8 piece of wire wrapped around the knuckle. He said that this needed to come out, too. This time, he used some Novocain to numb the area, then worked the wire out. More painful, and pretty gross-looking, too. It was effective, though. By that evening, Nikki's swollen knuckle had reduced to normal size, and the open wound was looking much better.
On Friday, Nikki called to let us know that they were thinking of discharging her today, a day early. It was decided not to send the WoundVac home with her, since it's very difficult to get Medicaid to cover home nursing- a necessity with the WoundVac. Instead, Nikki will visit the doctor every three days at first to have the dressing on her neck changed. Then, on July 20th, surgery again to graft skin from her thigh onto her neck.
Nikki is home and feeling fine. We went to dinner last night, and she's up and active. Her right arm is in a special type of sling, keeping the arm elevated so that it doesn't drag down on the surgical site on top of her shoulder. She's already looking forward to the next surgery, and having some good-looking skin over her lower neck.
07/04/05
Rest time is over for Nikki, and it's surgery time again. On Wednesday 7/6/2005, Nikki will have another major release to the right side of her face and neck. Skin that has stiffened and hardened to a plastic-like texture will be excised- an area about the size of both palms put together. A layer of Integra, a man-made material used as a temporary skin replacement, will be laid over the now-skinless area. A WoundVac will be attached over the Integra. This looks like a small jellyfish with a hose running from it to a powerful vacuum pump. It looks like a piece of pebbled tar paper, very pliable. When activated, though, the WoundVac will seal tightly over the wound, becoming rock-hard. The WoundVac stimulates blood flow into the skinless area, including into the Integra, greatly speeding up healing in the area. In a couple of weeks, Nikki will return to surgery to have the WoundVac and Integra removed. At the same time, skin will be harvested from her thighs and grafted onto her face and neck. With the healthy tissue bed provided by the WoundVac and Integra, it’s hoped that the new grafts will take really well.
Nikki's looking forward to this one, as she really wants to get her face back together. I'll post after the surgery Wednesday and let everyone know how this one went. The last time she had this type of procedure done, it cost Nikki 3 days in the hospital. More coming up soon!
A fairly brief update today. Nicole came through surgery 17 yesterday with flying colors. We left for the hospital at 9:30am (she was 3rd case), she went to pre-op at 11:15am, surgery at 12:31am, post-op at 1:45pm, and discharged at 4:30pm- a new record for quick surgeries! A 2" x 12" strip of skin was taken from the top of her left thigh (her most undamaged one, with the most healthy skin) and cut to fit the skinless area of her upper right shoulder and lower right neck. This area was in great shape, after playing host to Integra (an artificial skin substitute) the last two weeks, and the graft bed was perfect. This graft was not perforated to increase the coverage area, leaving the skin looking smooth and natural. Therefore, in technical terms, Nikki had a "split-thickness sheet graft". She was quite comfortable afterwards, with only a little nausea from the post-op morphine. Usually, her harvested areas hurt worse than her graft sites… after all, it's like taking a razor and cutting off the top layers of skin, leaving a very bloody "raspberry" behind, full of screaming nerves. However, this small graft doesn't seem to bother her at all, and she's been quite active.
Late August is the next tentative date for surgery. Probably a joint effort between Dr. Gordillo (general plastics) and Dr. Katz (Occuloplatics), involving more reshaping of the right eye and upper right face. Gordillo may also get into Nikki's nose repair, using a combination of artificial materials and harvested bone to reshape the bridge of her nose. Soon after that, some major releases are needed on Nikki's right shoulder and elbow, to provide some much-needed range-of-motion improvement.
Closer at hand, and more fun to think about, is Nikki's 1st Survival Anniversary! One year ago this Saturday, at 2:00am, Nikki came very close to leaving us forever. The unbelievable support of a number of great people, plus the determination and incredibly positive attitude of a very special lady, have turned a near-death experience into a life-altering event. All of you are sharing that experience with Nikki, through the imperfect window of my writing. A better writer would do the story more justice, as I feel that it's a powerful tale. Nevertheless, we'll continue to plod along together, you and I, peeking into a remarkable young lady's life as she continues to triumph over situations that would break many others.
Stay tuned for another update after this coming Anniversary!
07/09/05
Surgery 16 was successful on Wednesday 7/6/05… as a matter of fact, it went so well, that Nikki was discharged yesterday!
Nikki spent about 90 minutes in surgery, her fastest surgery to date. As planned, an area of hard, constricted skin was excised from her lower neck and the top of her right shoulder. As soon as this toughened skin was removed, Nikki's face, mouth and eyelid all lifted noticeably- just what we wanted. The results were so good that Dr. Gordillo didn't remove any skin from her face, preferring to minimize the trauma. Integra was laid over the now-skinless area, and the WoundVac (described below) was applied over that. Nikki was very comfortable after returning to her room around 11:30am. I got her some French fries from Wendy's, and left her happily munching on them. Later that evening, my wife and I brought her Chinese food, and she ate a lot of that.
We learned from Dr. Gordillo that Nikki's last CAT scan had shown some polyp growth in her right sinus cavity. You'll remember that both of Nikki's sinuses were crushed in her accident, along with her nose being smashed flat against her face & burned. The E.R. docs reshaped the nose very well, although it still has a flattened look to it. Since the skin and underlying material was seriously damaged, Dr. Gordillo is planning to use artificial materials to reshape her nose, building the bridge back up again. Gordillo also consulted with ENT (Ears, Nose, Throat) on the polyps, but ENT isn't very concerned. Nikki breathes properly and doesn't have any discomfort there, so the docs decided to try antibiotics for a while and see if they affect the polyps.
On Thursday, Dr. Litts, the hand Plastics doc, paid Nikki a visit to check out her right pinkie. This finger has never healed properly since pins were inserted into it a few months back. You could even see one of the pins peeking through her skin. So, Litts removed it…. He grabbed it with a pair of pliers and just pulled it out! You'd think this would hurt like hell, but Nikki said it wasn't bad. But then, Litts pointed out another pin- a figure-8 piece of wire wrapped around the knuckle. He said that this needed to come out, too. This time, he used some Novocain to numb the area, then worked the wire out. More painful, and pretty gross-looking, too. It was effective, though. By that evening, Nikki's swollen knuckle had reduced to normal size, and the open wound was looking much better.
On Friday, Nikki called to let us know that they were thinking of discharging her today, a day early. It was decided not to send the WoundVac home with her, since it's very difficult to get Medicaid to cover home nursing- a necessity with the WoundVac. Instead, Nikki will visit the doctor every three days at first to have the dressing on her neck changed. Then, on July 20th, surgery again to graft skin from her thigh onto her neck.
Nikki is home and feeling fine. We went to dinner last night, and she's up and active. Her right arm is in a special type of sling, keeping the arm elevated so that it doesn't drag down on the surgical site on top of her shoulder. She's already looking forward to the next surgery, and having some good-looking skin over her lower neck.
07/04/05
Rest time is over for Nikki, and it's surgery time again. On Wednesday 7/6/2005, Nikki will have another major release to the right side of her face and neck. Skin that has stiffened and hardened to a plastic-like texture will be excised- an area about the size of both palms put together. A layer of Integra, a man-made material used as a temporary skin replacement, will be laid over the now-skinless area. A WoundVac will be attached over the Integra. This looks like a small jellyfish with a hose running from it to a powerful vacuum pump. It looks like a piece of pebbled tar paper, very pliable. When activated, though, the WoundVac will seal tightly over the wound, becoming rock-hard. The WoundVac stimulates blood flow into the skinless area, including into the Integra, greatly speeding up healing in the area. In a couple of weeks, Nikki will return to surgery to have the WoundVac and Integra removed. At the same time, skin will be harvested from her thighs and grafted onto her face and neck. With the healthy tissue bed provided by the WoundVac and Integra, it’s hoped that the new grafts will take really well.
Nikki's looking forward to this one, as she really wants to get her face back together. I'll post after the surgery Wednesday and let everyone know how this one went. The last time she had this type of procedure done, it cost Nikki 3 days in the hospital. More coming up soon!
Reconstruction: May - June 2005
06/16/05
Over a month since my last update, and again, no news is good news. Nothing is happening, and everything is good. Nikki has been left alone to heal, although there is a surgery coming up in the next few weeks. This will be another release to the right side of her neck and face. Skin will be grafted from her thighs, and the dreaded vacuum pack will be used again to speed the healing of the graft. This hasn't been scheduled yet, but will probably be just after July 4th. Later this summer, a more major release to the right arm and elbow is planned. Airplane splint time again....
Nikki has been very active, and is feeling fine. Sun is a problem; even small amounts cause her grafted skin problems. A life-long problem for this former sun-worshipper, I'm afraid. She's been using 45 sunblock for even quick exposures, and has her eye on some 70 block. Lots of lotion, too.
Therapy continues, and range of motion continues to improve. Nikki's getting restless around the house as she gets better. She's mumbling about going to work, but the doctors won't hear of that for quite some time yet. She's still easily injured, and has enough restricted motion that she can't drive or do many delicate tasks.
She just got back from Cleveland tonight as I'm writing this. She went to visit friends and to see Dave Matthews for the 3rd time in a month. She also dropped in to MetroHealth to visit the staff. I don't know who she caught on duty yet, so I'm going to wrap this up and go find out. I'll be writing again soon with details of the upcoming surgery, so stay tuned.
05/10/05
A long time without an update is usually a good thing- no surgeries, no misery, etc., and this is no exception. Things are going well for Nikki, with just the routine of physical therapy and doctor appointments. Her hand has healed nicely, with only the pinkie still looking kind of rough. The metal pin will be pulled from her ring finger in another couple of weeks. It's hoped that the finger will not curl back into its pre-op shape, and aggressive therapy will start on it immediately after the pin is removed. There's been no serious planning for the next surgery as of yet. It will probably involve releases on the elbow, shoulder and armpit of the right arm- again. This will mean another airplane splint, which thrills Nikki to no end.
Today was the day that Nikki assisted Director of Rehabilitation Bob Vaneko with a lecture to OSU physical medicine grad students. Nikki had agreed to be Bob's model for his lecture on the rehabilitation needs of burn patients. I urged her to do this, in order to become even more comfortable in displaying her burns. Summer's almost here, and Nikki is a minimalist dresser in warm weather. I've noticed a tendency for her to wear more concealing clothing than usual for her, and I didn't want her to fall into an unnatural routine. This also served as good exposure (pun intended) for her upcoming work in getting the OSU burn support effort off the ground.
I wasn't able to go with Nikki today, but her account was a very good one. She was nervous only at first, when she walked to the center of a ring of 50 grad students. Since they were only a little younger than her, though, communication was good, vibes were flowing, karma was high- whatever, she felt comfortable right away. Bob led her through a discussion of her injury and subsequent recovery. Several types of grafting were illustrated on Nikki's body, along with contractures and the work required to prevent them and to correct them. The kids learned about sheet grafts, split thickness grafts, full thickness grafts and so on. They learned that Nikki doesn't have sweat glands anymore in her burned areas, and that she sweats like a pig in the remaining areas as compensation. They saw where her right eyelid had been destroyed and then restored- a work in progress. They learned that after 9 months and 15 surgeries, she still has years of work ahead of her. The students learned that, unlike many common physical injuries, burn patients required a much longer period of intense physical therapy, often measured in years.
The grad students also learned about more than just the physical injuries. They learned that Nikki was somewhat unusual in her very positive attitude and outlook, graphically illustrated by her coming to the lecture today & displaying herself to total strangers. They learned that many victims have a lot of trouble getting past the appearance of their injuries, sometimes becoming depressed to the point that it hampers their recovery. In Nikki, they saw that good humor and optimism were healing tools, fostering better compliance to therapy and other treatments and leading to healthy and more rapid healing. Bob pointed out that Nikki is well above average in the speed, degree and quality of her healing. He also credited the expert care that Nikki received at MetroHealth in Cleveland.
Nikki then played anatomical dummy, and invited the class to come and touch her burns and injuries. Bob gave a running discussion on the various things that a physical medicine specialist needs to look for, and how to deal with them. Many students were surprised at how alive her skin felt, even where it looks pretty rough. They felt first hand how restrictive contractures are, and learned why they must be released. Nikki's face was especially interesting, as it displays a sheet graft, split thickness graft, full thickness graft, and a failed graft site. They noticed how Nikki's new eyelid doesn't stop tears from leaking down her face, and she explained that while that could be improved somewhat, it will be a problem for the rest of her life.
After nearly 3 hours, class was over. Many of the students collected Nikki's address, email and phone. All were at least a little touched at how brave someone would have to be to do what Nikki had done today, and very appreciative that she had chosen to share with them, at least a little, of what it's like to be a burn survivor. I think it helped Nikki some, as well. She was very excited at how the lecture went, and is still talking about it. We went to dinner tonight, with Nikki wearing a flimsy tank top and short skirt, and listened to her bubble with enthusiasm. She has agreed to help Bob with other such lectures, at least one every quarter, and she's really super-charged over getting more involved in the burn support effort.All in all, a day well spent, I think. Stay tuned for more!
Over a month since my last update, and again, no news is good news. Nothing is happening, and everything is good. Nikki has been left alone to heal, although there is a surgery coming up in the next few weeks. This will be another release to the right side of her neck and face. Skin will be grafted from her thighs, and the dreaded vacuum pack will be used again to speed the healing of the graft. This hasn't been scheduled yet, but will probably be just after July 4th. Later this summer, a more major release to the right arm and elbow is planned. Airplane splint time again....
Nikki has been very active, and is feeling fine. Sun is a problem; even small amounts cause her grafted skin problems. A life-long problem for this former sun-worshipper, I'm afraid. She's been using 45 sunblock for even quick exposures, and has her eye on some 70 block. Lots of lotion, too.
Therapy continues, and range of motion continues to improve. Nikki's getting restless around the house as she gets better. She's mumbling about going to work, but the doctors won't hear of that for quite some time yet. She's still easily injured, and has enough restricted motion that she can't drive or do many delicate tasks.
She just got back from Cleveland tonight as I'm writing this. She went to visit friends and to see Dave Matthews for the 3rd time in a month. She also dropped in to MetroHealth to visit the staff. I don't know who she caught on duty yet, so I'm going to wrap this up and go find out. I'll be writing again soon with details of the upcoming surgery, so stay tuned.
05/10/05
A long time without an update is usually a good thing- no surgeries, no misery, etc., and this is no exception. Things are going well for Nikki, with just the routine of physical therapy and doctor appointments. Her hand has healed nicely, with only the pinkie still looking kind of rough. The metal pin will be pulled from her ring finger in another couple of weeks. It's hoped that the finger will not curl back into its pre-op shape, and aggressive therapy will start on it immediately after the pin is removed. There's been no serious planning for the next surgery as of yet. It will probably involve releases on the elbow, shoulder and armpit of the right arm- again. This will mean another airplane splint, which thrills Nikki to no end.
Today was the day that Nikki assisted Director of Rehabilitation Bob Vaneko with a lecture to OSU physical medicine grad students. Nikki had agreed to be Bob's model for his lecture on the rehabilitation needs of burn patients. I urged her to do this, in order to become even more comfortable in displaying her burns. Summer's almost here, and Nikki is a minimalist dresser in warm weather. I've noticed a tendency for her to wear more concealing clothing than usual for her, and I didn't want her to fall into an unnatural routine. This also served as good exposure (pun intended) for her upcoming work in getting the OSU burn support effort off the ground.
I wasn't able to go with Nikki today, but her account was a very good one. She was nervous only at first, when she walked to the center of a ring of 50 grad students. Since they were only a little younger than her, though, communication was good, vibes were flowing, karma was high- whatever, she felt comfortable right away. Bob led her through a discussion of her injury and subsequent recovery. Several types of grafting were illustrated on Nikki's body, along with contractures and the work required to prevent them and to correct them. The kids learned about sheet grafts, split thickness grafts, full thickness grafts and so on. They learned that Nikki doesn't have sweat glands anymore in her burned areas, and that she sweats like a pig in the remaining areas as compensation. They saw where her right eyelid had been destroyed and then restored- a work in progress. They learned that after 9 months and 15 surgeries, she still has years of work ahead of her. The students learned that, unlike many common physical injuries, burn patients required a much longer period of intense physical therapy, often measured in years.
The grad students also learned about more than just the physical injuries. They learned that Nikki was somewhat unusual in her very positive attitude and outlook, graphically illustrated by her coming to the lecture today & displaying herself to total strangers. They learned that many victims have a lot of trouble getting past the appearance of their injuries, sometimes becoming depressed to the point that it hampers their recovery. In Nikki, they saw that good humor and optimism were healing tools, fostering better compliance to therapy and other treatments and leading to healthy and more rapid healing. Bob pointed out that Nikki is well above average in the speed, degree and quality of her healing. He also credited the expert care that Nikki received at MetroHealth in Cleveland.
Nikki then played anatomical dummy, and invited the class to come and touch her burns and injuries. Bob gave a running discussion on the various things that a physical medicine specialist needs to look for, and how to deal with them. Many students were surprised at how alive her skin felt, even where it looks pretty rough. They felt first hand how restrictive contractures are, and learned why they must be released. Nikki's face was especially interesting, as it displays a sheet graft, split thickness graft, full thickness graft, and a failed graft site. They noticed how Nikki's new eyelid doesn't stop tears from leaking down her face, and she explained that while that could be improved somewhat, it will be a problem for the rest of her life.
After nearly 3 hours, class was over. Many of the students collected Nikki's address, email and phone. All were at least a little touched at how brave someone would have to be to do what Nikki had done today, and very appreciative that she had chosen to share with them, at least a little, of what it's like to be a burn survivor. I think it helped Nikki some, as well. She was very excited at how the lecture went, and is still talking about it. We went to dinner tonight, with Nikki wearing a flimsy tank top and short skirt, and listened to her bubble with enthusiasm. She has agreed to help Bob with other such lectures, at least one every quarter, and she's really super-charged over getting more involved in the burn support effort.All in all, a day well spent, I think. Stay tuned for more!
Reconstruction: March - April 2005
04/20/05
Nikki returned to Dr. Litts today for her second checkup since the last surgery, 2 weeks ago. Her first checkup, a week ago, showed the little finger looking a lot like hamburger. Even Professor Litts had expected more healing than what he found. When the Director of Orthopedics, Hand & Upper Extremities is surprised, so am I.
Today, the pinkie was obviously healing up, and was in better shape than last week. The ring finger was looking really good, with almost no sign of trauma- except for the metal pin sticking out of her knuckle. Her permanent dressings were removed, the fingers cleaned with peroxide, and light dressings were applied. Now we change the dressings twice daily, washing with soap, water & peroxide each time. The light gauze will adhere to the wound, providing some debriding (removing dead tissue) each time it's removed. This will greatly speed up the healing process, and help with scarring. Nikki was also fitted with a plastic splint along her forearm and last two fingers, to shape and protect the fingers. This splint will be gradually adjusted to increase the curl of her fingers as they heal.
A funny thing happened during the 2-1/2 hour appointment today. Nikki needed a new prescription for pain medicine- especially after they finished scrubbing and bending the poor, raw-looking pinkie. Since it would take a bit to get to Dr. Litts, we went down the hall to have her splint made. While we were there, the doctor sent some young medical assistant down to the hand clinic with Nikki's prescription. The young thing saw a bunch of people in the area, and not knowing Nikki, called her name. Some elderly woman answered that she was her, and the assistant gave her the prescription. We found this out when we went back to the doctor's office to get it. By then, the woman was gone. Much embarrassment, to be sure. They figured out who the woman was, and were planning to call her.
In other news, Nikki has been approached a few times by the nurse practitioner of the burn unit about helping OSU start up its burn support group again. When I worked at OSU in the 70's and 80's, the burn program was very robust, with a very active support group. Sometime in the years since, the program diminished, becoming a part of S.I.C.U., and the OSU support group went away entirely. The nurse practitioner was quick to notice Nikki's great, outgoing personality, and also the fact that she's handling her situation very well. The nurse has been trying to jump-start the support group for some time, and thinks that Nikki will be a huge help. Nikki is very interested, and is going to pursue this further.
Also today, Nikki ran into the Director of Physical Rehab for OSU, the guy that runs the nuts-and-bolts side of physical medicine. Bob has a strong interest in burn therapy, and has been instrumental in designing Nikki's rehab program. Bob has a series of in-house lectures coming up about the needs of burn patients next month, and wants Nikki to join him. As he said, he can speak about burns and special needs until he's blue in the face, but coming from Nikki, the words will have a real impact. She will also serve as an example that being burned doesn't have to ruin your life, as long as you don't let it. Nikki agreed to help, and will be working with Bob in the near future. Of course, I'm very proud of her involvement in all of this, and will keep everyone informed. Nikki and I agree that she should take advantage of her time away from work and other commitments to get as involved in burn support as she can.
Nikki's back to Dr. Litts next week, and I'll follow up then. Take care-
04/07/05
Nikki's 15th surgery went off without a hitch today. This surgery was performed by Dr. Litts, an orthopedic plastic surgeon specializing in the hand. Today's surgery was performed at OSU Hospital East, a smaller hospital just east of downtown Columbus. Working with the smaller hospital proved to be quite nice. For starters, there was plenty of free parking (parking at the main OSU hospital is expensive!), close to the entrance. The smaller facility is a lot more relaxed than the hustle & bustle of the 1000+ bed, 50+ O.R. suite main hospital. We arrived at 11:00am as scheduled, and Nikki was taken right in to admissions. 10 minutes later, we were taken to the surgical floor- where Nikki went straight to pre-op! There's usually long wait for this part, especially when you're not the first case. Nikki started surgery at 12:45, and went to recovery at 2:30- just 15 minutes past the scheduled time. We left the hospital at 4:30- a record for quick in and out. I'd like to have more procedures done here.
No real surprises in surgery. Nikki's little finger was a mess, as anticipated. At least two serious infections had completely destroyed the middle joint, as well as part of the bone joining the finger to the hand. Litts cleaned the remnants of the joint and diseased bone from out of the finger. He then placed two metal pins and a piece of wire into the finger, to hold it together. The finger was shaped into a relaxed, natural curl- where it will remain for the rest of her life. She will be able to flex the entire finger from the hand, but will not be able to bend or straighten the finger. This beats the heck out a permanently straight finger, or an amputated finger, so Nikki is pretty pleased. Her main physical medicine doctor, Professor Pease, has the same condition on one of his pinkies, from where he trashed it playing football as a kid. You'd never notice it, if he didn't point it out to you. The hardware can remain with her permanently, as long as it doesn't bother her, or could be removed after several months.
The ring finger is in better shape. Litts performed releases on skin and tendons, making the finger straight for the first time since her accident. A metal pin was placed in the finger, to keep it straight, and will be removed after six weeks or so. Physical therapy will then begin on the finger, in an attempt to restore normal range of motion. It's not sure yet how much motion will be regained. One complication- after straightening the finger, there wasn't enough skin to re-seal the finger. After being curled for 8 months, the skin had contracted so much that it wouldn't cover the straightened digit. So Dr. Litts took a small piece of tissue from the outer edge of her hand to graft over the finger.
Nikki is home and very comfortable tonight. She has a huge bandage over her entire hand and an ice pack over that. This will all come off next week. Her arm is still numb, so she's carrying it in a sling, to keep from banging it into things.
So- all's well, and Nikki's happy. Her next procedures will probably be more releases on the right arm and shoulder, which means the oh-so-fun airplane splint again. She's *not* looking forward to that thing again. Nikki is also considering returning to Cleveland to consult with the plastic surgeon there that did some great early work on her face and forehead. She's been in touch with him, and Cleveland is eager to see her again.
More later- thanks for reading.
04/05/05
So sorry about the long delay between updates. March was a busy month for us in general, although not so much for Nikki. My wife & I went to Florida with granddaughter Erika for a national cheerleading competition at the end of the month, and we spent a good deal of time preparing for that. Nikki didn't make that trip with us, not really feeling up to a long time away from home, and also cautious about the sun. One of the biggest lifestyle impacts to Nikki is having to avoid the sun for the rest of her life. She's always been a big sun-worshipper, sporting a deep tan every summer. Unfortunately, her grafted skin can't handle this anymore, so she has to be well-protected to venture into the sun. Her paper-thin skin will crisp in an instant, and it can actually damage the grafts.
Some bad news shortly after my last update. Nikki's last skin graft to her face, which looked good at her first postop checkup, did not take. It turned into a thick, black scab & flaked off of her face. She was very disappointed about this, until I pointed out that this was the first procedure in 14 to not work properly. Of course, this is a risk with every grafting procedure, but it's still disappointing when it happens. This was also a full-thickness graft, instead of the very thin split-thickness grafts that are commonly used. Instead of shaving off just the outer layer of skin for transplant, the surgeon digs down deep, removing all layers of skin at the site. This is a more traumatic procedure, leaving a standard surgical incision in it's place. These grafts tend to look better, due to all of the supporting layers of tissue being moved along with the outer dermis. They don't contract as easily, and they also present a smooth, sheet-like appearance after grafting.
Nikki's surgeon, Dr. Gordillo, will be waiting for several weeks before attempting this graft again. It will probably be a split-thickness graft next time, without the perforations usually used to increase the surface area. Right now, Nikki's face looks like she had a major trauma to the right side- which she did, of course. She's not very shy about it, even though she attracts a lot of attention when she goes out. The next face procedure will probably include her nose, as well. since they couldn't get to it last time. The bridge needs to be narrowed some, and the nose needs to be shifted over a little bit.
Before then, though, Nikki will be having surgery on her right hand- finally!- this Thursday. You'll remember that the last two fingers on this hand have been curled into a claw since her accident, and are almost useless. Nikki went to a hand specialist yesterday, who works with Dr. Gordillo. This guy's been wanting to get hold of Nikki for some time, and we all wish he had done so a little earlier now. After X-rays yesterday, he determined that Nikki's pinky is in really bad shape. Nikki has had at least two infections in this finger over the last 3 months, and it looks like they were in the joint itself, rather than in the soft tissues around it. Result?... the joint seems to be destroyed, and almost certainly can't be made whole again. The doctor (I can't remember his name) will open the joint, clean it out, release contracted skin and muscle on the finger, then insert a large metal pin to hold the finger straight. After 6 - 8 weeks, the pin can probably be removed. The goal is to get Nikki's finger straight again. However, it almost certainly will never be really functional.
The ring finger isn't in as bad a shape, although the muscle has atrophied significantly from being permanently curled for 8 months now. The doctor will perform several small releases on this finger, as well, and also attempt to stretch and re-attach muscle tissue where he can. He'll then start Nikki on a robust therapy regime for the hand, to force the muscle to grow & strengthen. He expects to get this finger at least partially functional, although more surgeries may be needed.
Other than these items, the last month has been uneventful. Nikki continues to socialize heavily, always on the go with friends. I think that her mental health is excellent, and her attitude very good. As I mentioned, hand surgery is this Thursday, and I'll be updating everyone afterwards. This one will probably be outpatient, with Nikki awake through the whole thing. She's nervous about this, but I've explained that she won't feel a thing, and doesn't have to watch.
More later!
03/09/05
Just a brief update tonight. Nikki has visited both Dr. Gordillo (general plastics) and Dr. Katz (oculoplastics) over the past few days. Good news from both- everything looks good. Gordillo removed about 100 stitches from Nikki's face (over an hour's work!), and it's looking good. Her grafts are still a very deep red, but are starting to lighten- a sign that they are taking. Katz removed a few stitches from right around Nikki's eye, and his work there is looking *very* good. He made it clear, though, that there's more to do, and Nikki seems ready for it.
One problem that she has is a leaky right eye; the bottom lid doesn't trap tears effectively, and they just run down her face. This may be a life-long problem for that eye, although Katz thinks that a little re-designing can mitigate some of it. We also still don't know how well Nikki's eye is working. She doesn't have any peripheral vision, and her vision in that eye seems dim and blurry. Katz said it'll be a while before we get into that, as we have to get the tissues around the eye in better shape first.
More surgeries yet to come in the not-too-distant future, and I'll keep everyone up to date. There's a couple of new pictures on Nikki's blog, of Nikki and friends. Nikki is also considering allowing some pictures of her injuries and repair work to go up there, but she's concerned about grossing-out some folks.That's all for now- more later.
Nikki returned to Dr. Litts today for her second checkup since the last surgery, 2 weeks ago. Her first checkup, a week ago, showed the little finger looking a lot like hamburger. Even Professor Litts had expected more healing than what he found. When the Director of Orthopedics, Hand & Upper Extremities is surprised, so am I.
Today, the pinkie was obviously healing up, and was in better shape than last week. The ring finger was looking really good, with almost no sign of trauma- except for the metal pin sticking out of her knuckle. Her permanent dressings were removed, the fingers cleaned with peroxide, and light dressings were applied. Now we change the dressings twice daily, washing with soap, water & peroxide each time. The light gauze will adhere to the wound, providing some debriding (removing dead tissue) each time it's removed. This will greatly speed up the healing process, and help with scarring. Nikki was also fitted with a plastic splint along her forearm and last two fingers, to shape and protect the fingers. This splint will be gradually adjusted to increase the curl of her fingers as they heal.
A funny thing happened during the 2-1/2 hour appointment today. Nikki needed a new prescription for pain medicine- especially after they finished scrubbing and bending the poor, raw-looking pinkie. Since it would take a bit to get to Dr. Litts, we went down the hall to have her splint made. While we were there, the doctor sent some young medical assistant down to the hand clinic with Nikki's prescription. The young thing saw a bunch of people in the area, and not knowing Nikki, called her name. Some elderly woman answered that she was her, and the assistant gave her the prescription. We found this out when we went back to the doctor's office to get it. By then, the woman was gone. Much embarrassment, to be sure. They figured out who the woman was, and were planning to call her.
In other news, Nikki has been approached a few times by the nurse practitioner of the burn unit about helping OSU start up its burn support group again. When I worked at OSU in the 70's and 80's, the burn program was very robust, with a very active support group. Sometime in the years since, the program diminished, becoming a part of S.I.C.U., and the OSU support group went away entirely. The nurse practitioner was quick to notice Nikki's great, outgoing personality, and also the fact that she's handling her situation very well. The nurse has been trying to jump-start the support group for some time, and thinks that Nikki will be a huge help. Nikki is very interested, and is going to pursue this further.
Also today, Nikki ran into the Director of Physical Rehab for OSU, the guy that runs the nuts-and-bolts side of physical medicine. Bob has a strong interest in burn therapy, and has been instrumental in designing Nikki's rehab program. Bob has a series of in-house lectures coming up about the needs of burn patients next month, and wants Nikki to join him. As he said, he can speak about burns and special needs until he's blue in the face, but coming from Nikki, the words will have a real impact. She will also serve as an example that being burned doesn't have to ruin your life, as long as you don't let it. Nikki agreed to help, and will be working with Bob in the near future. Of course, I'm very proud of her involvement in all of this, and will keep everyone informed. Nikki and I agree that she should take advantage of her time away from work and other commitments to get as involved in burn support as she can.
Nikki's back to Dr. Litts next week, and I'll follow up then. Take care-
04/07/05
Nikki's 15th surgery went off without a hitch today. This surgery was performed by Dr. Litts, an orthopedic plastic surgeon specializing in the hand. Today's surgery was performed at OSU Hospital East, a smaller hospital just east of downtown Columbus. Working with the smaller hospital proved to be quite nice. For starters, there was plenty of free parking (parking at the main OSU hospital is expensive!), close to the entrance. The smaller facility is a lot more relaxed than the hustle & bustle of the 1000+ bed, 50+ O.R. suite main hospital. We arrived at 11:00am as scheduled, and Nikki was taken right in to admissions. 10 minutes later, we were taken to the surgical floor- where Nikki went straight to pre-op! There's usually long wait for this part, especially when you're not the first case. Nikki started surgery at 12:45, and went to recovery at 2:30- just 15 minutes past the scheduled time. We left the hospital at 4:30- a record for quick in and out. I'd like to have more procedures done here.
No real surprises in surgery. Nikki's little finger was a mess, as anticipated. At least two serious infections had completely destroyed the middle joint, as well as part of the bone joining the finger to the hand. Litts cleaned the remnants of the joint and diseased bone from out of the finger. He then placed two metal pins and a piece of wire into the finger, to hold it together. The finger was shaped into a relaxed, natural curl- where it will remain for the rest of her life. She will be able to flex the entire finger from the hand, but will not be able to bend or straighten the finger. This beats the heck out a permanently straight finger, or an amputated finger, so Nikki is pretty pleased. Her main physical medicine doctor, Professor Pease, has the same condition on one of his pinkies, from where he trashed it playing football as a kid. You'd never notice it, if he didn't point it out to you. The hardware can remain with her permanently, as long as it doesn't bother her, or could be removed after several months.
The ring finger is in better shape. Litts performed releases on skin and tendons, making the finger straight for the first time since her accident. A metal pin was placed in the finger, to keep it straight, and will be removed after six weeks or so. Physical therapy will then begin on the finger, in an attempt to restore normal range of motion. It's not sure yet how much motion will be regained. One complication- after straightening the finger, there wasn't enough skin to re-seal the finger. After being curled for 8 months, the skin had contracted so much that it wouldn't cover the straightened digit. So Dr. Litts took a small piece of tissue from the outer edge of her hand to graft over the finger.
Nikki is home and very comfortable tonight. She has a huge bandage over her entire hand and an ice pack over that. This will all come off next week. Her arm is still numb, so she's carrying it in a sling, to keep from banging it into things.
So- all's well, and Nikki's happy. Her next procedures will probably be more releases on the right arm and shoulder, which means the oh-so-fun airplane splint again. She's *not* looking forward to that thing again. Nikki is also considering returning to Cleveland to consult with the plastic surgeon there that did some great early work on her face and forehead. She's been in touch with him, and Cleveland is eager to see her again.
More later- thanks for reading.
04/05/05
So sorry about the long delay between updates. March was a busy month for us in general, although not so much for Nikki. My wife & I went to Florida with granddaughter Erika for a national cheerleading competition at the end of the month, and we spent a good deal of time preparing for that. Nikki didn't make that trip with us, not really feeling up to a long time away from home, and also cautious about the sun. One of the biggest lifestyle impacts to Nikki is having to avoid the sun for the rest of her life. She's always been a big sun-worshipper, sporting a deep tan every summer. Unfortunately, her grafted skin can't handle this anymore, so she has to be well-protected to venture into the sun. Her paper-thin skin will crisp in an instant, and it can actually damage the grafts.
Some bad news shortly after my last update. Nikki's last skin graft to her face, which looked good at her first postop checkup, did not take. It turned into a thick, black scab & flaked off of her face. She was very disappointed about this, until I pointed out that this was the first procedure in 14 to not work properly. Of course, this is a risk with every grafting procedure, but it's still disappointing when it happens. This was also a full-thickness graft, instead of the very thin split-thickness grafts that are commonly used. Instead of shaving off just the outer layer of skin for transplant, the surgeon digs down deep, removing all layers of skin at the site. This is a more traumatic procedure, leaving a standard surgical incision in it's place. These grafts tend to look better, due to all of the supporting layers of tissue being moved along with the outer dermis. They don't contract as easily, and they also present a smooth, sheet-like appearance after grafting.
Nikki's surgeon, Dr. Gordillo, will be waiting for several weeks before attempting this graft again. It will probably be a split-thickness graft next time, without the perforations usually used to increase the surface area. Right now, Nikki's face looks like she had a major trauma to the right side- which she did, of course. She's not very shy about it, even though she attracts a lot of attention when she goes out. The next face procedure will probably include her nose, as well. since they couldn't get to it last time. The bridge needs to be narrowed some, and the nose needs to be shifted over a little bit.
Before then, though, Nikki will be having surgery on her right hand- finally!- this Thursday. You'll remember that the last two fingers on this hand have been curled into a claw since her accident, and are almost useless. Nikki went to a hand specialist yesterday, who works with Dr. Gordillo. This guy's been wanting to get hold of Nikki for some time, and we all wish he had done so a little earlier now. After X-rays yesterday, he determined that Nikki's pinky is in really bad shape. Nikki has had at least two infections in this finger over the last 3 months, and it looks like they were in the joint itself, rather than in the soft tissues around it. Result?... the joint seems to be destroyed, and almost certainly can't be made whole again. The doctor (I can't remember his name) will open the joint, clean it out, release contracted skin and muscle on the finger, then insert a large metal pin to hold the finger straight. After 6 - 8 weeks, the pin can probably be removed. The goal is to get Nikki's finger straight again. However, it almost certainly will never be really functional.
The ring finger isn't in as bad a shape, although the muscle has atrophied significantly from being permanently curled for 8 months now. The doctor will perform several small releases on this finger, as well, and also attempt to stretch and re-attach muscle tissue where he can. He'll then start Nikki on a robust therapy regime for the hand, to force the muscle to grow & strengthen. He expects to get this finger at least partially functional, although more surgeries may be needed.
Other than these items, the last month has been uneventful. Nikki continues to socialize heavily, always on the go with friends. I think that her mental health is excellent, and her attitude very good. As I mentioned, hand surgery is this Thursday, and I'll be updating everyone afterwards. This one will probably be outpatient, with Nikki awake through the whole thing. She's nervous about this, but I've explained that she won't feel a thing, and doesn't have to watch.
More later!
03/09/05
Just a brief update tonight. Nikki has visited both Dr. Gordillo (general plastics) and Dr. Katz (oculoplastics) over the past few days. Good news from both- everything looks good. Gordillo removed about 100 stitches from Nikki's face (over an hour's work!), and it's looking good. Her grafts are still a very deep red, but are starting to lighten- a sign that they are taking. Katz removed a few stitches from right around Nikki's eye, and his work there is looking *very* good. He made it clear, though, that there's more to do, and Nikki seems ready for it.
One problem that she has is a leaky right eye; the bottom lid doesn't trap tears effectively, and they just run down her face. This may be a life-long problem for that eye, although Katz thinks that a little re-designing can mitigate some of it. We also still don't know how well Nikki's eye is working. She doesn't have any peripheral vision, and her vision in that eye seems dim and blurry. Katz said it'll be a while before we get into that, as we have to get the tissues around the eye in better shape first.
More surgeries yet to come in the not-too-distant future, and I'll keep everyone up to date. There's a couple of new pictures on Nikki's blog, of Nikki and friends. Nikki is also considering allowing some pictures of her injuries and repair work to go up there, but she's concerned about grossing-out some folks.That's all for now- more later.
Reconstruction: February 2005
02/26/05
Surgery 14 on Friday 2/25/05 was a success, although not everything that was planned was completed. We got to the hospital at 5:30am, for a 7:30am surgery. Then she was bumped 1-1/2 hours due to an emergency case for Dr. Katz. She finally started at 8:45am, and was in surgery for exactly 6 hours, with two plastic surgeons working on her in tandem. She then spent 2 1/2 hours in recovery, having some problems with low blood oxygen. They finally got that stabilized, and she got to her room at 5:30pm. She was in a great deal of pain last night, but was feeling much better today... *so* much better, that she wanted to come home! The doctors agreed, and Nikki got home at 4:00pm today. As soon as she got here, she threw up- the car ride usually bothers her after surgery. She's now laying on the couch reading & watching TV. She has pain in her face, of course, but it's manageable. She also has pain on her stomach, where the donor site is.
Dr. Gordillo, the general surgeon, did a *lot* of work on the skin on the right side of Nikki's face and neck, Several releases (removal of hard, contracted pieces of skin) were performed on the right cheek, neck, nose and underneath the right eye. These were then grafted with skin from Nikki's left neck, behind the left ear, and from the abdomen. These were full-thickness, sheet grafts- fairly thick, with no perforations. This type of grafting, although not an economical use of skin, provides the smoothest look afterwards- just what you want for the face. After repairing that, Dr. Gordillo basically grabbed the right side of Nikki's face and pulled it upwards, stitching it in place (she made it sound like lacing up a pair of boots). This relieved the drag of the skin around the right eye and nose. Stitching followed the jaw line, just underneath it, in order to be nearly invisible after healing. Stitching also had to be done inside of Nikki's mouth, through the cheek, in order to keep everything in place.
Dr. Katz, the oculoplastic surgeon (an ophthalmologist with a residency in plastics) led the repair work around Nikki's eye. First, it was determined that there was more tissue available around Nikki's lower eyelid than suspected. Katz didn't need to transplant a piece of cartilage there for support, as originally planned. Apparently, the great plastic surgeon in Cleveland had already laid the groundwork for this procedure, 'way back in September. Katz spent a lot of time reshaping the tissues around the outside of Nikki's eye, for a more pleasing appearance, and better function for the lids. The outer corner of Nikki's eye has been squared-off since her accident, instead of meeting in a corner, as is normal. He also decided the bones around the eye didn't need any work for now. Although they've healed in a jumble of pieces, they're functional, solid and not causing any problems. They also look OK on the face. Instead, Dr. Katz worked with the tissues that support the eyeball, delicately moving them around, and therefore, moving the eye slightly. He got the eye close enough to where he wanted it, without major trauma to the face, and was very happy with the results. His attitude is that "good enough is good enough", and he can always go back in later with a hammer & chisel if needed (shudder). We can't see *any* of her eye now, due to the bolsters (rolled bandages, sewn directly into the surgical area) attached to it. One long suture goes from the lower eyelid up to her forehead, pulling the eyelid up with it. All of this will be removed on Tuesday, four days after surgery.
The nose did not get done, other than to have a release done to contracting skin on it's side. Both doctors were exhausted after 6 straight hours of very detailed work (Gordillo looked like she had run a marathon- sweating, disheveled), and the nose would have meant another 2 hours of work for her, and 2 more hours of anesthesia for Nikki- neither of which was desirable. Gordillo plans to do the nose in 2 months or so. Nikki will also need releases done to the right armpit again, probably in conjunction with her right finger work. She'll also need a release on the left armpit. That's at least 3 more surgeries in the foreseeable future. Nikki's hoping she can reach 20 surgeries by late July, one year from her accident. What the heck, everyone needs goals....
Back to see Dr. Gordillo on Tuesday and have the bandages removed. She'll also see Dr. Katz sometime next week, and get the preliminary results on all of this work. I'll follow up with everyone then. Thanks for all of the supportive messages that we've received. Nikki reads all of them, and they mean a lot to her. Take care for now.
2/22/2005
Nikki made a trip to the doctor a day early yesterday, when one of the two deformed fingers on her right hand suddenly swelled up and burst open at the middle knuckle. As you might guess, this hurt A LOT & scared hell out of Nikki. The doctor calmed her, telling her she just had a general infection in the soft tissues there, and that antibiotics would clear it right up. Nikki was afraid that this might interfere with the surgery scheduled for Friday, but no problem there. The doctor went ahead with her pre-surgery meeting, since everyone was there.
We've got some specific goals now for Friday's surgery. This one will focus a lot on looks, not just functionality, making it really important to Nikki. Dr. Gordillo will perform some tissue releases on the right side of Nikki's face, just behind the eye and down on her lower cheek, and also on her right neck. Skin will be taken from the left neck to fill the releases on the right. They may also shave behind the right ear and take skin from there, since skin from these areas is the best match for her facial work. Next, her nose will finally be fixed. Nikki's nose was smashed flat against her face in her accident. It was given basic (but very good) repairs while in the emergency room, so that she could breathe through it later. However, it's a little misshapen, and always sort of pulled to the right side since her accident, and she'd like to get it back where it belongs. The bridge is also still flattened out, and needs to be brought up to more of a defined ridge. There'll be some grafting here, too.
While the nose is being fixed, a piece of cartilage will be removed and used to rebuild the lower right eyelid. There's only two types of cartilage in the body suitable for contact with the eyeball itself, and the nose has one of them. This will be attached to the muscles that control the bottom eyelid, giving the eyelid support & muscle control once again. This will enable her right eye to close completely for the first time since her accident.
Finally, Dr. Katz (oculoplastics) will do the eye work. He hopes to use existing tissue to relocate the eyeball to it's proper place. Any bone repair around the eye will be kept to a minimum. The orbital may be healed in pieces, but if it's working, he's going to leave it alone. The eyelid and eyeball work is extremely delicate, and will take a goodly part of the 6 - 8 hours planned for the surgery. It involves precise measurements of the eye's location (in millimeters), including in relation to the other eye. The eye and optic nerve will also get a good exam, to confirm the amount of permanent impairment to her vision.
No work will be done on Nikki's hand at this time. There's a hand specialist in Dr. Gordillo's practice that's itching to get hold of her hand, but that'll have to wait for another time. As of now, Nikki still can't use the last two fingers of her right hand (and she's right-handed). There may also be more work needed on Nikki's right cheek in the future, both skin and underlying bone structure. The bones there were crushed, but healed pretty well.
Other parts of Nikki's life continue to go well. Physical therapy continues to make good improvements to her functionality. Her Social Security Disability has kicked in, with a fairly large monthly payment, along with a large back payment of benefits. Medicaid's disability supplement is now discontinued- indeed, she had to repay all such benefits that she has received to date, out of her social security. Unfortunately, Nikki now has to pay for her Medicaid medical coverage out of her monthly disability check- about 1/3 of it. That's pretty steep, but she will need that coverage for some time to come.
We have to be at the hospital at 6:00am Friday, as she's first case. I'll get an update out sometime during the weekend. Stay tuned!
2/2/2005
Nikki has been scheduled for a major surgery on the 25th of February. The final details aren't nailed down yet, but it's anticipated that this will be her big facial repair. Involving her general plastic surgeon (Dr. Gordillo) and an oculoplastic surgeon (Dr. Katz), the general goal is too repair all of the facial fractures, including both orbital sockets. Attention will also be given to improving the structure of her right eyelid, with the goal of getting it to close completely & losing the plastic moisture barrier that she's worn since her accident. Rough estimates are 6 - 8 hours in surgery, involving both surgeons the entire time.
Rather than peeling her face down below the fractures, as originally envisioned, multiple fine-line incisions will be made above and below the damaged areas. It may also be necessary to go through the roof of the mouth for the right eye socket repair and re-positioning. Doesn't that sound like fun? Nikki is *very* gung-ho about this, and seems to have no fear at all. She's been pushing to get this done for some time, and is happy to finally have it scheduled.
Nikki went through a lot of disappointment over the failed tissue expander & the damage that it caused to her forehead. That failure, along with some personality issues with the surgeon that performed the procedure, led to her leaving that surgeon's care. Her regular surgeon, Dr. Gordillo, has been very supportive of Nikki, and agreed to do her facial work herself, with Dr. Katz doing the eye work. Nikki loves Gordillo, and has met & liked Katz, so she's very happy with the way things are progressing now.She has a couple of planning sessions with doctors before the big day, and I'll keep all of you informed as the procedure is better defined. More later!
Surgery 14 on Friday 2/25/05 was a success, although not everything that was planned was completed. We got to the hospital at 5:30am, for a 7:30am surgery. Then she was bumped 1-1/2 hours due to an emergency case for Dr. Katz. She finally started at 8:45am, and was in surgery for exactly 6 hours, with two plastic surgeons working on her in tandem. She then spent 2 1/2 hours in recovery, having some problems with low blood oxygen. They finally got that stabilized, and she got to her room at 5:30pm. She was in a great deal of pain last night, but was feeling much better today... *so* much better, that she wanted to come home! The doctors agreed, and Nikki got home at 4:00pm today. As soon as she got here, she threw up- the car ride usually bothers her after surgery. She's now laying on the couch reading & watching TV. She has pain in her face, of course, but it's manageable. She also has pain on her stomach, where the donor site is.
Dr. Gordillo, the general surgeon, did a *lot* of work on the skin on the right side of Nikki's face and neck, Several releases (removal of hard, contracted pieces of skin) were performed on the right cheek, neck, nose and underneath the right eye. These were then grafted with skin from Nikki's left neck, behind the left ear, and from the abdomen. These were full-thickness, sheet grafts- fairly thick, with no perforations. This type of grafting, although not an economical use of skin, provides the smoothest look afterwards- just what you want for the face. After repairing that, Dr. Gordillo basically grabbed the right side of Nikki's face and pulled it upwards, stitching it in place (she made it sound like lacing up a pair of boots). This relieved the drag of the skin around the right eye and nose. Stitching followed the jaw line, just underneath it, in order to be nearly invisible after healing. Stitching also had to be done inside of Nikki's mouth, through the cheek, in order to keep everything in place.
Dr. Katz, the oculoplastic surgeon (an ophthalmologist with a residency in plastics) led the repair work around Nikki's eye. First, it was determined that there was more tissue available around Nikki's lower eyelid than suspected. Katz didn't need to transplant a piece of cartilage there for support, as originally planned. Apparently, the great plastic surgeon in Cleveland had already laid the groundwork for this procedure, 'way back in September. Katz spent a lot of time reshaping the tissues around the outside of Nikki's eye, for a more pleasing appearance, and better function for the lids. The outer corner of Nikki's eye has been squared-off since her accident, instead of meeting in a corner, as is normal. He also decided the bones around the eye didn't need any work for now. Although they've healed in a jumble of pieces, they're functional, solid and not causing any problems. They also look OK on the face. Instead, Dr. Katz worked with the tissues that support the eyeball, delicately moving them around, and therefore, moving the eye slightly. He got the eye close enough to where he wanted it, without major trauma to the face, and was very happy with the results. His attitude is that "good enough is good enough", and he can always go back in later with a hammer & chisel if needed (shudder). We can't see *any* of her eye now, due to the bolsters (rolled bandages, sewn directly into the surgical area) attached to it. One long suture goes from the lower eyelid up to her forehead, pulling the eyelid up with it. All of this will be removed on Tuesday, four days after surgery.
The nose did not get done, other than to have a release done to contracting skin on it's side. Both doctors were exhausted after 6 straight hours of very detailed work (Gordillo looked like she had run a marathon- sweating, disheveled), and the nose would have meant another 2 hours of work for her, and 2 more hours of anesthesia for Nikki- neither of which was desirable. Gordillo plans to do the nose in 2 months or so. Nikki will also need releases done to the right armpit again, probably in conjunction with her right finger work. She'll also need a release on the left armpit. That's at least 3 more surgeries in the foreseeable future. Nikki's hoping she can reach 20 surgeries by late July, one year from her accident. What the heck, everyone needs goals....
Back to see Dr. Gordillo on Tuesday and have the bandages removed. She'll also see Dr. Katz sometime next week, and get the preliminary results on all of this work. I'll follow up with everyone then. Thanks for all of the supportive messages that we've received. Nikki reads all of them, and they mean a lot to her. Take care for now.
2/22/2005
Nikki made a trip to the doctor a day early yesterday, when one of the two deformed fingers on her right hand suddenly swelled up and burst open at the middle knuckle. As you might guess, this hurt A LOT & scared hell out of Nikki. The doctor calmed her, telling her she just had a general infection in the soft tissues there, and that antibiotics would clear it right up. Nikki was afraid that this might interfere with the surgery scheduled for Friday, but no problem there. The doctor went ahead with her pre-surgery meeting, since everyone was there.
We've got some specific goals now for Friday's surgery. This one will focus a lot on looks, not just functionality, making it really important to Nikki. Dr. Gordillo will perform some tissue releases on the right side of Nikki's face, just behind the eye and down on her lower cheek, and also on her right neck. Skin will be taken from the left neck to fill the releases on the right. They may also shave behind the right ear and take skin from there, since skin from these areas is the best match for her facial work. Next, her nose will finally be fixed. Nikki's nose was smashed flat against her face in her accident. It was given basic (but very good) repairs while in the emergency room, so that she could breathe through it later. However, it's a little misshapen, and always sort of pulled to the right side since her accident, and she'd like to get it back where it belongs. The bridge is also still flattened out, and needs to be brought up to more of a defined ridge. There'll be some grafting here, too.
While the nose is being fixed, a piece of cartilage will be removed and used to rebuild the lower right eyelid. There's only two types of cartilage in the body suitable for contact with the eyeball itself, and the nose has one of them. This will be attached to the muscles that control the bottom eyelid, giving the eyelid support & muscle control once again. This will enable her right eye to close completely for the first time since her accident.
Finally, Dr. Katz (oculoplastics) will do the eye work. He hopes to use existing tissue to relocate the eyeball to it's proper place. Any bone repair around the eye will be kept to a minimum. The orbital may be healed in pieces, but if it's working, he's going to leave it alone. The eyelid and eyeball work is extremely delicate, and will take a goodly part of the 6 - 8 hours planned for the surgery. It involves precise measurements of the eye's location (in millimeters), including in relation to the other eye. The eye and optic nerve will also get a good exam, to confirm the amount of permanent impairment to her vision.
No work will be done on Nikki's hand at this time. There's a hand specialist in Dr. Gordillo's practice that's itching to get hold of her hand, but that'll have to wait for another time. As of now, Nikki still can't use the last two fingers of her right hand (and she's right-handed). There may also be more work needed on Nikki's right cheek in the future, both skin and underlying bone structure. The bones there were crushed, but healed pretty well.
Other parts of Nikki's life continue to go well. Physical therapy continues to make good improvements to her functionality. Her Social Security Disability has kicked in, with a fairly large monthly payment, along with a large back payment of benefits. Medicaid's disability supplement is now discontinued- indeed, she had to repay all such benefits that she has received to date, out of her social security. Unfortunately, Nikki now has to pay for her Medicaid medical coverage out of her monthly disability check- about 1/3 of it. That's pretty steep, but she will need that coverage for some time to come.
We have to be at the hospital at 6:00am Friday, as she's first case. I'll get an update out sometime during the weekend. Stay tuned!
2/2/2005
Nikki has been scheduled for a major surgery on the 25th of February. The final details aren't nailed down yet, but it's anticipated that this will be her big facial repair. Involving her general plastic surgeon (Dr. Gordillo) and an oculoplastic surgeon (Dr. Katz), the general goal is too repair all of the facial fractures, including both orbital sockets. Attention will also be given to improving the structure of her right eyelid, with the goal of getting it to close completely & losing the plastic moisture barrier that she's worn since her accident. Rough estimates are 6 - 8 hours in surgery, involving both surgeons the entire time.
Rather than peeling her face down below the fractures, as originally envisioned, multiple fine-line incisions will be made above and below the damaged areas. It may also be necessary to go through the roof of the mouth for the right eye socket repair and re-positioning. Doesn't that sound like fun? Nikki is *very* gung-ho about this, and seems to have no fear at all. She's been pushing to get this done for some time, and is happy to finally have it scheduled.
Nikki went through a lot of disappointment over the failed tissue expander & the damage that it caused to her forehead. That failure, along with some personality issues with the surgeon that performed the procedure, led to her leaving that surgeon's care. Her regular surgeon, Dr. Gordillo, has been very supportive of Nikki, and agreed to do her facial work herself, with Dr. Katz doing the eye work. Nikki loves Gordillo, and has met & liked Katz, so she's very happy with the way things are progressing now.She has a couple of planning sessions with doctors before the big day, and I'll keep all of you informed as the procedure is better defined. More later!
Reconstruction: January 2005
1/28/2005
Nikki has recovered fine from last week's surgery, her 13th since the accident. She visited her surgeon the day after surgery, to examine the surgical site and the drain. The site was already looking better, with no real drainage, so he removed the drain that day. Nikki's forehead has already returned to normal, with all swelling gone. The eruption in the center of her head is also healing nicely.
On Monday, Nikki completed fitting for her compression garments. She's now wearing the complete set- torso, arms, hands and legs. Boy, these things are a *pain* to put on and take off. They're like very heavy stockings; thick, but very elastic. They're also very tight, and it takes a combination of rolling and tugging to get them on (or off). The torso is easiest, since it zips up in the back. These garments are to be worn 23 hours per day, every day, for 18 - 24 months. She is supposed to take them off only for baths and physical therapy.
Nikki received word yesterday that her Social Security Disability had been approved, retroactive to October 2004. Since we had been told to expect a six month wait, this was a pretty good turnaround. This will give her some source of income, until she's able to return to work.
No word yet on upcoming surgery. We'll keep you informed as things develop. More later-
1/19/2005
Nikki came through surgery fine today. We arrived at the hospital at 9:30am, after a miserable 60 minute drive (normally 20) through a snow storm. It only took about 45 minutes to remove the tissue expander, clean the incision and forehead wound, suture both, and install a vacuum drain into the head incision. Nikki does have an infection where the expander was, which will be treated by oral antibiotics and the drain. We returned home by 6:30pm tonight- a long day for both of us.
I get to empty and measure the contents of the vacuum drain every 6 hours- a real treat. I won't describe what comes out of the drain- suffice to say, it's yucky. Nikki returns to the doctor tomorrow, to make sure the drain is functioning normally. We weren't told how long it will remain in place. Her head incision and forehead wounds also need to be cleaned and medicated every 6 hours. The doctor believes that the forehead graft will heal fine, just slower than normal skin.
After the forehead has healed, the next step will be to perform another release on Nikki's right neck. There is another contracture there, although not as bad as the last time. The surgeon will also release the last two fingers on Nikki's right hand at the same time. The facial surgeon is also waiting for Nikki's skin to continue softening, becoming more pliable. When it's right, he'll proceed with the eye repair, teaming with the ocular plastic surgeon. If needed, skin will be grafted from other areas to complete the eye repair.
Nikki's in good spirits today, with only a "bad headache" from her procedure. She sends her thanks to all of you who wrote in her support. Stay tuned for more!
1/18/2005
Nikki got word late today that she has an unplanned surgery tomorrow morning. The expander in her forehead is going to be removed, due to complications. The skin there has never healed properly from the surgery in early December. Yesterday, a hole actually formed in the center of the forehead, oozing unpleasant things. The surgeon is concerned about the integrity of the forehead graft, and is going to remove the expander before more damage is done.
As you can imagine, Nikki is very disappointed about this. This method offered the best hope for a really good looking graft after her right eye socket is repaired later this year. Other options will be discussed with Nikki after this current problem is resolved.
I'll follow up after the surgery tomorrow. Nikki *should* be coming home later in the day. Stay tuned!
01/09/2005
Things continue to be quiet here- thank goodness! Nikki continues to heal, go through therapy, and plan future surgeries. She *is* having some difficulty with the expander in her forehead, though. It doesn't appear to be taking too well, with the skin over it still bruised and battered. The surgeon is concerned that the grafted skin may not be as elastic as anticipated, meaning the stretching may not work. If the skin hasn't healed up in the next few weeks, the expander will probably be removed. This will mean that secondary sources of skin will have to be used to cover Nikki's eye repair later this year. This is very disappointing for Nikki, and she will be seeking a second opinion on this. She definitely wants the area around her right eye and cheek to look as good as possible when this is all done, so she's exploring all options.
The home health care nurse paid a visit right after Christmas, just to check on Nikki. She liked what she saw, as Nikki has continued to heal very well. Of course, Nikki no longer has any bandages or dressings, except for a moisture barrier over her right eye, which doesn't close all of the way. This barrier (simply Glad Wrap, with a lubricant under it) will remain until her eye is repaired and she has a working eyelid.
Medicaid has been a blessing, covering all of Nikki's drugs and procedures. They even transport her to and from therapy, allowing me to resume a regular work schedule. It's a shame that the Medicaid program is so widely abused, depleting the level of care available for those that really need it. I know that we all greatly appreciate it. I'm fortunate to live in a rural county, with relatively small government offices, staffed with people that still enjoy their jobs. I know that more metropolitan offices aren't always as caring or friendly to their charges.
I did go to court last week over my ticketing and vehicle impoundment for an expired registration. It was a waste of time. I was told that the officer followed the law correctly, and was well within his rights to both ticket & impound my vehicle, excellent driving record notwithstanding. My good record resulted in the lowest fine possible, but it was still over a hundred dollars, on top of the $120 to reclaim my vehicle. I guess that justice isn't always just.
Nikki has more doctors appointments this week & next, and I'll update everyone as I have something to report. Nikki's web log (or blog, as its known) recorded its 5,000th visitor today, as counted since early October. That's a lot of interested people, and I thank everyone who's still following her story. Stay tuned for more.
Nikki has recovered fine from last week's surgery, her 13th since the accident. She visited her surgeon the day after surgery, to examine the surgical site and the drain. The site was already looking better, with no real drainage, so he removed the drain that day. Nikki's forehead has already returned to normal, with all swelling gone. The eruption in the center of her head is also healing nicely.
On Monday, Nikki completed fitting for her compression garments. She's now wearing the complete set- torso, arms, hands and legs. Boy, these things are a *pain* to put on and take off. They're like very heavy stockings; thick, but very elastic. They're also very tight, and it takes a combination of rolling and tugging to get them on (or off). The torso is easiest, since it zips up in the back. These garments are to be worn 23 hours per day, every day, for 18 - 24 months. She is supposed to take them off only for baths and physical therapy.
Nikki received word yesterday that her Social Security Disability had been approved, retroactive to October 2004. Since we had been told to expect a six month wait, this was a pretty good turnaround. This will give her some source of income, until she's able to return to work.
No word yet on upcoming surgery. We'll keep you informed as things develop. More later-
1/19/2005
Nikki came through surgery fine today. We arrived at the hospital at 9:30am, after a miserable 60 minute drive (normally 20) through a snow storm. It only took about 45 minutes to remove the tissue expander, clean the incision and forehead wound, suture both, and install a vacuum drain into the head incision. Nikki does have an infection where the expander was, which will be treated by oral antibiotics and the drain. We returned home by 6:30pm tonight- a long day for both of us.
I get to empty and measure the contents of the vacuum drain every 6 hours- a real treat. I won't describe what comes out of the drain- suffice to say, it's yucky. Nikki returns to the doctor tomorrow, to make sure the drain is functioning normally. We weren't told how long it will remain in place. Her head incision and forehead wounds also need to be cleaned and medicated every 6 hours. The doctor believes that the forehead graft will heal fine, just slower than normal skin.
After the forehead has healed, the next step will be to perform another release on Nikki's right neck. There is another contracture there, although not as bad as the last time. The surgeon will also release the last two fingers on Nikki's right hand at the same time. The facial surgeon is also waiting for Nikki's skin to continue softening, becoming more pliable. When it's right, he'll proceed with the eye repair, teaming with the ocular plastic surgeon. If needed, skin will be grafted from other areas to complete the eye repair.
Nikki's in good spirits today, with only a "bad headache" from her procedure. She sends her thanks to all of you who wrote in her support. Stay tuned for more!
1/18/2005
Nikki got word late today that she has an unplanned surgery tomorrow morning. The expander in her forehead is going to be removed, due to complications. The skin there has never healed properly from the surgery in early December. Yesterday, a hole actually formed in the center of the forehead, oozing unpleasant things. The surgeon is concerned about the integrity of the forehead graft, and is going to remove the expander before more damage is done.
As you can imagine, Nikki is very disappointed about this. This method offered the best hope for a really good looking graft after her right eye socket is repaired later this year. Other options will be discussed with Nikki after this current problem is resolved.
I'll follow up after the surgery tomorrow. Nikki *should* be coming home later in the day. Stay tuned!
01/09/2005
Things continue to be quiet here- thank goodness! Nikki continues to heal, go through therapy, and plan future surgeries. She *is* having some difficulty with the expander in her forehead, though. It doesn't appear to be taking too well, with the skin over it still bruised and battered. The surgeon is concerned that the grafted skin may not be as elastic as anticipated, meaning the stretching may not work. If the skin hasn't healed up in the next few weeks, the expander will probably be removed. This will mean that secondary sources of skin will have to be used to cover Nikki's eye repair later this year. This is very disappointing for Nikki, and she will be seeking a second opinion on this. She definitely wants the area around her right eye and cheek to look as good as possible when this is all done, so she's exploring all options.
The home health care nurse paid a visit right after Christmas, just to check on Nikki. She liked what she saw, as Nikki has continued to heal very well. Of course, Nikki no longer has any bandages or dressings, except for a moisture barrier over her right eye, which doesn't close all of the way. This barrier (simply Glad Wrap, with a lubricant under it) will remain until her eye is repaired and she has a working eyelid.
Medicaid has been a blessing, covering all of Nikki's drugs and procedures. They even transport her to and from therapy, allowing me to resume a regular work schedule. It's a shame that the Medicaid program is so widely abused, depleting the level of care available for those that really need it. I know that we all greatly appreciate it. I'm fortunate to live in a rural county, with relatively small government offices, staffed with people that still enjoy their jobs. I know that more metropolitan offices aren't always as caring or friendly to their charges.
I did go to court last week over my ticketing and vehicle impoundment for an expired registration. It was a waste of time. I was told that the officer followed the law correctly, and was well within his rights to both ticket & impound my vehicle, excellent driving record notwithstanding. My good record resulted in the lowest fine possible, but it was still over a hundred dollars, on top of the $120 to reclaim my vehicle. I guess that justice isn't always just.
Nikki has more doctors appointments this week & next, and I'll update everyone as I have something to report. Nikki's web log (or blog, as its known) recorded its 5,000th visitor today, as counted since early October. That's a lot of interested people, and I thank everyone who's still following her story. Stay tuned for more.
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