Reconstruction: November 2004

11/16/2004
26 years ago today, at 1:04pm, Nikki was born. Being our second child, the delivery was pretty easy for my wife. Getting there was tough, though. My wife had some gynecological problems that made it difficult to become pregnant. It took nearly a year of doctors, treatments, and a minor surgery, before Nikki was conceived. The problems for my wife persisted after Nikki's birth, finally resulting in a total hysterectomy. So Nikki was our last.

I don't intend to get too maudlin here, but obviously this birthday was something special for all of us. We came all too close to not having another one of these with Nikki, so it's that much sweeter this year. We kept it low-key; dinner at a favorite restaurant, and a few small gifts. Lots of old friends called or sent emails, which Nikki enjoyed answering today. Her sister took her shopping for some new clothes- always a favorite activity for Nikki. Even though quiet, it was certainly special to us.

Nikki's also had two doctor's appointments in the past two days. Yesterday was with ophthalmologist Dr. Mauger. He did a very thorough exam of the damaged right eye. There are some corneal scars there, probably from the night of the accident, which affect her sight somewhat. There is also the possibility of some nerve damage in the eye; light isn't as intense in her right eye as it is in the left. The corneal scarring may clear up on it's own; the nerve damage is permanent. Nikki was also examined by Dr. McLaughlin, Assoc. Professor of Clinical Ophthalmology, who fitted her with contacts for her left eye! This is the first time that Nikki has had near-normal vision since her accident. Dr. McLaughlin pronounced the left eye to be "fine and dandy", with no reason not to have contacts in it.

We also found out while there that the surgery scheduled for Dec. 15th was an error; no such procedure is scheduled as of now. Correction of the eye and surrounding areas will wait until the neck graft is not contracting significantly. Nikki has an appointment on Dec. 7th to see Dr. Katz, whose specialties are orbital oculoplastics and neuro-ophthalmology... in other words, the man knows the eyeball, as well as the bone, muscular and neural structures surrounding it. Katz will be the one to eventually tear down Nikki's eye socket, raise and re-secure the eyeball, then rebuild the area around it.

Nikki also saw plastic surgeon Dr. Gordillo today, in a follow up to her surgery last week. Gordillo pronounced all three releases to be in good shape, and told Nikki that she could stop wearing the airplane splint during the day- still has to sleep with it, though. There's another appointment in three weeks, and Gordillo is showing a strong interest in the last two fingers of Nikki's right hand. These fingers have been sharply curled into a claw since Nikki's early surgeries. Therapy and passive restraints don't seem to be straightening them very much, so I believe that Gordillo is contemplating releasing them surgically.

Nikki's back to therapy tomorrow; 3 hours worth, starting at 7:30am. Life as usual for my little girl.

More as it happens... take care.

11/03/2004
Nikki is moving ahead faster than I can keep up. A doctor visit yesterday led to surgery today. This was surgery 11, and she came through fine, finally getting to her room at 6:00pm after a 3 hour procedure. Today, Dr, Gordillo removed the Integra from Nikki's neck. With the Wound VAC's help, the Integra took very well, creating a fine bed for a real skin graft. Gordillo took a large sheet graft from Nikki's left thigh and covered the neck. This non-perforated graft will provide a nice, smooth appearance on the neck, while hopefully reducing contracture.

Gordillo also released Nikki's right shoulder and right elbow. Large patches of contracted skin were removed from her armpit (Ouch!) and the inside of the elbow. Both areas were then covered with skin grafts, harvested from the left thigh. Nikki is now in an airplane splint, named for it's similarity to an airplane's wing. This complicated device holds Nikki's right arm out at a right angle to her body. Her arm is elevated to about 100 degrees, and her elbow is at 175 degrees, meaning the arm is almost perfectly straight for the first time since her accident. The airplane splint wraps around her torso and runs up her right side to a platform, on which her arm is suspended. It then runs down her arm to her wrist, with the arm tightly secured to it. This fun-looking device will remain in place until the grafts are healed enough to sustain physical therapy. Without these releases, no amount of physical therapy would ever have returned the arm to normal range of motion.

Dr. Gordillo also attended to four sizable areas on her forehead that just weren't healing right. Large scabs continually formed there, and when removed, would simply re-form. Gordillo determined that they were hyper-granulating- sort of like the healing process running wild, building up too much tissue and not stopping when it should. She cauterized these areas in an effort to return the healing process to normal. Sort of weird, burning a burn patient to help with healing! Nikki now has a few areas on her forehead that are burned black, which should now heal normally.

Nikki is in a great deal of pain tonight, receiving I.V. Dilaudid every 2 hours, along with oral Dilaudid. She was also getting a Foley urinary catheter as we left tonight, since she cannot raise herself up to use a bed pan. She will be on very limited activity for a few days, so as not to disturb the new grafts. Also, it hurts too darn much to move.

Tomorrow, Nikki will be transported to the ophthalmology clinic at OSU for a thorough exam of her right eye. Past exams have indicated some possible nerve damage there, along with at least some loss of peripheral vision. Hopefully, we'll get a better picture of what's going on tomorrow. Surgery to rebuild the area around this eye, as well as to move the eye back to where it belongs, will have to wait until the neck graft has taken well... probably 5 - 6 weeks from now.

Nikki is in very good spirits this time. She knew this wouldn't be fun, and was ready to be uncomfortable for the sake of regaining more use of her right arm and neck. In the future, Nikki will probably be facing more releases on her right hand and left shoulder. The right shoulder and elbow could also need more work- only time will tell.

I'll try to be more prompt on updates as we learn more about her eye and the success of today's work. More to come!