Reconstruction: December 2004

12/29/2004
Nothing much today. Nikki had her follow-up doctor appointment this afternoon. Her expander implant is fine, and the incision healed well. Stitches will come out next week. Nikki did receive some disappointing news, though. Her forehead skin, being a graft itself, is a little less durable and less elastic than her original skin would have been. This means that the expander will take a longer time to stretch the forehead as desired. Instead of two months, Nikki is probably looking at six months to achieve the necessary growth, without damaging the skin. This caused some tears, as she isn't too keen on walking around with a large lump on her forehead for six months. This also delays the rebuilding of her right eye socket. Nikki still hopes to convince her primary surgeon to go ahead with the planned neck and finger releases now, so that she doesn't have everything racked up at once later this year.

Christmas went very well... quiet, peaceful. Less lavish than usual, it was still a rewarding time. There was a huge winter storm in central Ohio last Thursday that had 300,000 people without power in zero degree temperatures. Fortunately, we never lost power. As of today (a week later), 46,000 people are still without power. The thaw finally started today, though.

The only down side we've seen this week occurred last night. While on the way home from work, I was stopped by the police in a small township that I drive through. Seems that in the confusion of dealing with Nikki back in early October, I forgot to renew my vehicle registration. I was shocked; I had leased vehicles for the past ten years, and those always renew in March in Ohio. I own this vehicle, though, so it renews on my birthday. I resigned myself to a $100+ ticket, but the over-zealous young officer didn't stop there- he also impounded my jeep! No amount of cajoling or pleading would sway this young zealot from his righteous duty. So, I was dropped off at a McDonald's, 15 miles from home. I finally reached my oldest daughter by cell phone and was home two hours later. Another $120 to reclaim my vehicle today, and me with no traffic violations in over ten years. You'd think I was a hardened road criminal, instead of a local businessman with too much on his mind in October. I'm going to court next month, rather than just paying up, just to speak my mind.

Nikki's next appointment is next week, and I'll follow up then. Take care and a Happy New Year to all of you!

12/22/2004
Surgery went well today, and Nikki came home tonight. The surgery ended up being very simple- only the skin expander in the forehead was done. It was decided to wait a few more weeks for the releases to the neck and hand that were originally planned.

Nikki is in some pain, but nothing serious. She's sitting on the couch doing cross-stitch as I write this. The expander has put a large bulge in the center of her forehead, and on the top of the forehead. It's slightly bruised, and looks for all the world like someone hit her in the head with a large rock.

The expander has a small port, or nozzle, under the skin at on end. The doctor can locate this during an office visit, and then use a syringe to inflate it slightly. The goal is to keep the skin tight, so that it will grow & stretch to accommodate the expander. When it's removed in several weeks, the doctor will have a nice patch of skin to drag down onto Nikki's face. This will be used to graft over the area around her eye after the surgical repair is done there.

The doctor and I also looked over Nikki's CAT scans and facial X-rays, while he explained the upcoming eye repair to me. Nikki's accident broke the orbits around both eyes, and also crushed her sinuses and broke her nose. The left orbit and left sinus actually healed pretty well. The right orbit looks like 25% is just missing; it's actually separated and pulled apart at the bottom, causing the eye to drop about 7mm. Her right sinus looks almost closed on the X-ray. The doctor said this could cause her some problems later on, and that some surgery might have to be done to open and rebuild the sinus cavity somewhat.

The eye repair sounds complicated and scary, but the doctor is confident that it will go well. To get to the shattered right orbit, an incision will be made about the hairline (ear to ear), and the face pulled down below the eyes. Another very small incision will be made just under the right eye, in an attempt to release some contractures there, allowing the lower eyelid to be moved upwards with the eye. Finally, an incision will be made in the roof of the mouth, allowing access to the orbit from behind. A mixture of plastic, metal plates and screws will be used to reconstruct the orbit, thereby anchoring the eye in its proper place. Can you say "Ouch!"?.... When this is completed, Nikki's nice new forehead flap, along with some underlying tissue, will be drug down onto the face, around the eye and upper cheek. This flap will remain in place for some time, until a good blood supply is established in the local area. Then some separation will be done, and Nikki's right cheek and eye should look very good once again.

That's it for now. I hope that everyone reading this will have a very Merry Christmas and a Happy New Year. Thanks to everyone who has followed Nikki's story throughout the year. Hopefully the good news will continue throughout 2005, and all of you will come along for the ride. Take care-

12/18/2004
I screwed up.... Nikki *will* have surgery on Wednesday, but not the surgery that I described. Several options were discussed with doctors last week, and they've chosen a different set for surgery.

Nikki will have the small releases done to her neck and fingers, as described, but there will be no work done on the eye as of yet. Instead, a small, inflatable bladder will be inserted underneath the skin on her forehead. Over the next several weeks, this bladder will be inflated, causing the skin on her forehead to grow over it. When the desired size is reached, the bladder will be removed, leaving a nice fold of overgrown skin. This skin can then be pulled down around the right eye and upper right cheek, providing a nice-looking skin graft for that area. Reconstruction of the eye will probably occur first, with the newly-grown skin being available to cover the surgical sites.

Nikki's not real crazy about this procedure, since she's going to have a hell of a funny-looking bump on her forehead for eight weeks or more. I told her that we could have some fun with it.... make her up like a Klingon, or paint a third eye on the lump. She didn't seem to think that was funny. She's also concerned about the fact that her forehead itself is a skin graft. She was originally burned to the bone there, and a really beautiful graft was done while in Cleveland. The plastic surgeons said it was fine, though, and that the graft took so well that it is just as good as the original skin for their purposes.

Nikki might get to come home the day of the surgery in this case, depending on her recovery. In any case, she should be in pretty good shape for Christmas.

As always, stay tuned! I'll keep everyone updated.

12/16/2004
We just confirmed today that Nikki undergoes her 12th surgery on Wednesday, December 22nd. This will involve two, and possibly three, surgeons. The work will involve reconstruction of her right eye socket, with relocation of the eyeball itself. The eye must be shifted 7mm back to its proper place. Several bones in the orbital area will be re-broken, with artificial material being used to rebuild the socket. At the same time, two minor releases will be done to the right neck, and the last two fingers of the right hand will be released, involving four knuckles. Some delicate, scary and very important work, all packed into a long day.

Nikki is ready for this, and has been impatient to get going with her facial reconstruction. My pretty girl wants to look the best that she can, and this is where that starts. We don't know how many surgeries will be needed to complete all the facial work. She also faces the probability of further surgeries on other areas of her body in months to come.

Her healing is progressing well. She spent three days in Cleveland this week, visiting the Cheesecake Factory where she worked, along with several friends. Her wounds have healed very well now, and going two days without a dressing change was no problem. As a matter of fact, her home nurses have decided that no further wrappings are needed, and they are putting her on "hold" until after surgery. Physical therapy continues, of course, and will do so for some time.

We're all getting ready for Christmas here, and we expect a good one. Our whole family will be together, along with assorted friends, so how could it not be good? On top of that, Christmas Eve is the 26th anniversary of the wedding of my wife and I... Yep, I picked a day that I wasn't likely to forget! Christmas has always been a time of many blessings for us, and this one will be no different.

I'll update everyone after the surgery next Wednesday. Merry Christmas to all!

12/09/04
Three doctor visits in three days have identified several needed actions, but no definite time yet. Nikki has visited her general plastic surgeon, ocular plastic surgeon and facial plastic surgeon. These three are discussing what could become a fairly large procedure, with all three working together.

Dr. Gordillo (general P.S.) wants to perform a release on the last two fingers of Nikki's right hand. These fingers have been curled and fairly useless since her accident. The release will involve the middle knuckles of both fingers, as well as the first knuckles (at the hand). At the same time, the doctor wants to perform two small releases on the right neck, which was just released a little over a month ago in a large procedure. The neck is in generally good shape, but has developed two small contractures that she wants to deal with. At the same time, Dr's Rosenburg (facial) and Katz (ocular) want to work on the eye and the area around it. Nikki's right eye is 7mm displaced from optimum, and must be moved and re-secured. This will be done by breaking several bones in the orbital area, and replacing pieces of them with artificial materials.

Scheduling still hasn't been determined. A tentative date is Dec. 22nd, but it's hard to coordinate surgeries involving three busy surgeons. The surgery would likely be fairly long.

In the meantime, Nikki continues with her therapy sessions twice weekly, about six hours total. Medicaid is now helping some by transporting Nikki to and from these sessions, which is a huge load off of me. It's been difficult juggling work around all of this. In addition, all of Nikki's pressure garments should be ready within the next two weeks. Nikki isn't looking forward to 18 months of wearing these, but she knows they're necessary, and she's ready to use them.

Finally, thank you to everyone who's been sending Christmas cards to our home. It's obvious that we've been put on some lists out there, as the cards are really pouring in. We greatly appreciate all of these, and they're being posted all around our house after we read them. Due to time and money constraints, we aren't able to participate in the card exchanges as we have in the past, and we're definitely touched by all of the cards.

I'll update again, when scheduling is more definite. Take care-

12/3/2004
Just a brief update of a very quiet period. No doctor's visits during the past two weeks, although therapy continues. Physical and occupational therapy continues on Nikki's right arm and hand, left shoulder, neck and back. Healing continues, although there are still some small open wounds on the back and upper chest. Nikki still wears a variety of braces, splints and casts, all designed to straighten limbs and prevent skin contractures. Most of the serious hardware is worn only at night, leaving her unencumbered during the day.

Three doctors appointments this week, two of them in one day, all with various plastic surgeons. All of these people will be involved in Nikki's eye and facial reconstruction, which we think might begin before Christmas. I know that Nikki is impatient for it to get started.

We got great news a few days ago- Nikki was approved for Medicaid, just as her private health insurance expired. This had been a big concern, as neither Nikki nor we could afford to maintain her insurance under COBRA. It took about 2 ½ months for the approval- a little better than average. We're still waiting on her Social Security Disability approval.

Thanksgiving was just that- a day of giving thanks for all that we've accomplished, and a quiet day of stuffing ourselves. Nikki went to Cleveland with her boyfriend on Wednesday night, and had dinner with his family on Thanksgiving Day. This went very well, and Nikki enjoyed herself thoroughly. She then came home & had dinner again… nothing wrong with her appetite!

Nikki continues to go out frequently with her sister and friends, refusing to be a recluse. She's done quite a bit of clothes shopping, and has a good collection of comfortable clothing to wear for all occasions.

We've done a lot of Christmas decorating this week, something that Nikki enjoys. She's mostly a spectator, of course, although she'll help to decorate the tree. Christmas won't be as lavish this year as it has in years past, but that's not all bad. Backing off on the commercial aspect might make us all take a closer look at the real meaning of the holiday for a change.

I'll update again later this week, after her various doctor's appointments. Hopefully, I'll have more news to share then. More later-