As always, I want to start with a big THANK YOU. Support from our basset friends keeps coming in strong, and it's a real blessing. The cards and pictures are a real treat, and the messages of support a true comfort. Nikki will soon be well enough to enjoy these for herself, but for now, they're a huge help to Bonnie and me.
Nikki had another surgery on Wednesday, about 7 hours long. Her back (her worst-burnt area) was re-grafted with her own skin, from her buttocks to her shoulders. A layer of donor (cadaver) skin was laid over this, to serve as a kind of living bandage, which will help to fill in the holes on her own grafted skin. They also grafted the back of her left arm, and some of her right arm. This should be the last of the major burn surgeries. At least one more procedure will be done, mostly to touch up small areas of those already-grafted areas that haven't taken well.
Plastic surgery will be consulting later this week to start planning their work. Plastics will actually handle the grafting to her upper-right face and scalp, which is still covered with donor skin. The forehead is a big area of concern, as it's burned to the bone. You'll remember me mentioning that grafted skin won't stick to bone, without all of the supporting layers of tissue normally there. One or more flaps will probably be extended from her scalp down over the forehead, to provide a blood supply and encourage some tissue growth there. Plastics has already rebuilt part of her right lower eyelid, and it looks great.
Nikki is quite conscious now, and is developing a time sense once again. She knows that she was in a serious car accident, but doesn't remember the accident. She knows she's badly burnt, and has seen some of her burns. So far, she has a positive attitude about this, but that doesn't mean she won't need some psychiatric help down the road. Her voice is still very low after three weeks on a respirator, and she still drifts in and out of sleep, due to the morphine. She's still getting 10mg/hour, plus 2mg/hour of a sedative/amnesiac. For comparison, a normal postoperative dose of morphine is 10mg every 4 hours. At one time, she was getting 17mg/hour, so her drowsiness is understandable. We have normal conversations with her, but she tires after an hour or so.
Those of you who know me well know that I spent 10 years working in patient care at OSU Hospitals. While there, I spent some time caring for burn patients, so I have a good understanding of the scenario. I've seen many burns that were much worse than Nikki's- but never on my own child, which changes everything. Today, I watched her dressing changes for the first time. Her burns are certainly very bad, but I was only thinking how much worse they could have been. As a family member, I keep my mouth shut and stay out of the way, as I still remember how so-called "helpful" family is often anything but helpful to the professionals. I've been pleasantly surprised, though, with the way that Metro's nurses actually encourage me to help Nikki in any way that I'm qualified and feel comfortable. I actually got to help rewrap her burns, help with irrigation, help to reposition her, attend to suctioning her, medicating her eyes, and so on. These little things really help me to feel more in control, and Nikki enjoys me helping. I guess it's nice to be able to squeeze Dad's fingers purple when you feel like screaming from bandages taking skin off with them.
Nikki has been running a fever for the past week, and the docs are still trying to pin it down. She has some pseudomonas infections on her grafts, which isn't too unusual for a burn patient. The regular bandage changes and antibiotic irrigations help to control this, as it can cause severe problems. They're also changing her central IV lines today, in case an infection is starting around them. Hopefully, they'll find the cause of the fevers and eliminate it.
I've become convinced that I need to spend more time with Nikki, and all of the help that we've received from the Drool and others is going to help me to do that. I'm going to take a leave from work of 4 - 6 weeks, starting this week, to see her through the worst of her recovery. Unfortunately, I don't qualify for Family Medical Leave under the federal FMLA, since I haven't been with my current company for a year. This means I'll have to take a standard extended medical leave, which offers no job protection; I'm doing it anyway, and hoping for the best. Unpaid leave is tough, but do-able, with the help we've received. My wife and I will both rest easier knowing that I'll be with Nikki all the time.
Again, heartfelt thanks to all of you that have helped and sent cards, letters and emails. Everything is being saved for Nikki's enjoyment, while Bonnie and I get to enjoy them now. All of you are very important to us.
8/8/2004
First, as always, THANK YOU to the (literally) countless people who have emailed, sent cards & letters, and called us. The nurses on Nikki's unitreally enjoy the basset cards that almost cover an entire wall of her room.I'm sure that Nikki will also greatly enjoy reading all of these cards andletters, once she's able to. Thanks to Holly Eveleigh for keeping this groupinformed during the week, when we're not near a computer. Thanks also to everyone who has sent money (we use it for our travel and room/board),services (dog grooming, offers of boarding, etc.) and products (Eva from OBR has donated food for our houndies). All of this greatly helps us to stay focused on Nikki.
My wife and I have just come home for a few days, to attend to our jobs and such. For those who don't know, Nikki is hospitalized in Cleveland, where she was working, while we live in Columbus. It's a 2.5 hour drive each way,which really adds to our stress in trying to maximize time with her. Nikki's accident was on July 23rd, and she continues to improve slowly. For those who've asked, here's her address again:
MetroHealth Medical Center BICU
This week saw only a single surgery, but it was a long & involved one (she had 4 surgeries in her first week, nearly 25 hours total on the operatingtable). Wednesday's surgery was about 6.5 hours, and involved two different services and 8 doctors. First, the burn surgeons attended to some more grafting. Her right forearm had received a natural skin graft the previous week. Unfortunately, it didn't appear to be taking right, so they went in to redo it. Good news- only about half the graft wasn't taking, so they removed the failed part, excised some more damaged tissue on the arm, and re-grafted that part. Nikki also had a porcine (pig) skin graft to the back of her hand, which had taken very well. This meant that her own skin should also do well there, so they removed the porcine skin and grafted her own skin there.A small area on her right breast was also re-grafted, and a couple of small grafts were done on her right leg. Nikki's skin is being taken from her calves, thighs and stomach. This was about 3 hours of work.
Then the plastic surgeons came in. Bear in mind that "plastic surgery" being done now isn't for looks, but for functionality. Surgery "for looks" will only come well after she's out of danger, months down the road. Plastics was focusing on her right lower eyelid, which had taken some kind of blunt trauma in the accident. Unfortunately, the plastics guys found a lot more damage in that area than they expected. The lower eyelid was mostly gone; more importantly, a lot of the muscles, ligaments and tissue behind the lid were also gone. They did the planned procedure, called a 'flap', where a small piece of the inside of the upper eyelid was cut free, then stitched into the damaged lower lid. This flap, which contains blood vessels, restored the blood supply to the lower lid. In time, the flap will grow into place onthe lower lid, and promote growth there. After a few weeks, the lids will be separated, leaving 2 separate lids again. Due to the extensive damage there, a small piece of tissue was also taken from her neck to help build up the area around the lower lid. Problem is, with no muscles or ligaments, there's nothing to support the lid & make it work. Left alone, the lower lid would sag down onto her cheek, causing problems with covering the eyeball (not to mention looking bad). Normally, the amazing plastics folks would re-route muscles and ligaments from the upper lid to fill this need.Unfortunately, Nikki's upper lid is badly burned, making this impossible. 2nd choice would be to borrow some material from her cheek around the eyelid; again, this area is badly burned, too. Eventually, a small piece of ligature will probably be taken from elsewhere on the body and placed behindthe lid for support, holding it up. It will never work like her original lid, though, always staying in one place.
The plastics guys also examined her forehead, which is badly burned. One area is burned to the bone, meaning that all of the many layers of fat and supporting tissue for the skin is gone. Repair here will probably involve larger flaps being run from back on her scalp across this area. With a blood supply to the area, they hope to encourage some of the surrounding tissue to grow over this area, which could then be grafted. It's iffy, though, and the outcome is uncertain. This area could take several surgeries to get to a satisfactory point.
On a more cheerful note, Nikki was taken off of the ventilator on Friday,and is now breathing entirely on her own. The real benefit of this is to reduce the chance of pneumonia. The other benefit is psychological- Nikki can now talk. The nurses make her cough a lot, which hurts, but keeps her lungs clear. As for talking- well, she's still heavily medicated, so talk is very jumbled and disjointed, as she's still in a dream state. Also, her larynx is swollen and sore from the intubation tube, so it's more of a whisper for now. Nevertheless, when we told her Saturday night that we loved her, she answered "I love you, too"... talk about feeling good! She also had her left eye open quite a bit last night, responding (with head shakes) that she could see us. Ophthalmology still isn't sure what condition her eyes are in, but at least the left is working somewhat. This morning, during a dressing change (which *really* hurts), she was telling the nurses "NO" and"STOP". Afterwards, she told them repeatedly that she had to go to work, and she had to go home. She also informed everyone that she had gotten married; asked when, she replied "Today- I have pictures, too". No doubt, she's going to be a handful!
This coming week should have no surgeries, which is why Bonnie & I plan to stay in Columbus and work on keeping our jobs, until Friday. They're leaving her alone, so that she can grow more skin- a *lot* of it. The next grafts will be to her back (the worst burned area), which is now covered with donor (cadaver) skin. That will be rejecting in a couple of weeks, and must be covered. The head and upper right face also has donor skin that must be replaced, and some other smaller areas over her body will probably need grafting. The burn service figures 2, maybe 3 more surgeries, and their work will be done- she'll be completely covered with her own skin, and much less susceptible to infection. At this time, she is still considered critical & stable.
We hope everyone understands that we just can't personally thank everyone who has offered support to us- this group gives us the best way to do that. As long as people are interested, we'll keep updating. Thank you again for all that you've done for us.
7/31/2004
I'm making a brief pass through home today, while Bonnie stays with Nikki in Cleveland, and I wanted to update the many, many concerned and caring people here.
We've been buried in emails and phone calls from many of you- and they help a lot. Cards have started coming into the hospital in Cleveland, and we're trying to put all of them up for Nikki to enjoy later. Many have even sent money, which we've swallowed our pride & accepted gratefully. Travel back and forth and missed work adds up quickly, and we appreciate the help that many of you have sent.
Nikki's surgery plans changed some this week. She had major grafting done on Monday and Wednesday, with a combination of donor skin (much like a donated organ), porcine (pig) skin and her own skin. She's now a mass of bandages, all of which quickly become soaked with seepage, including blood. This is normal, but it almost makes her look worse than before the surgeries started. On Wednesday, they found that Nikki's right arm and hand were burnt worse than first suspected. The back of the hand is bad, and is now covered in porcine skin. Eventually, all of the donor and porcine skin will be removed & her own skin grafted. She'll have to grow some more skin before this can happen.
Thursday was originally to be facial repair day, with the numerous broken and pulverized bones in her face being fixed. Wednesday's session convinced the doctors that her head was also burnt worse than originally suspected. Both the burn service & maxillofacial service agreed that the burns better be attended to first, as the bones are not life-threatening. So on Thursday, a lot of burnt tissue was excised from Nikki's right scalp, forehead and upper right face. These areas were covered with donor skin for now. Her right lower eyelid was also destroyed in the fire, leaving the eye exposed. Thank God the lid did its job, though, and saved the eye itself. The lid will have to be reconstructed by the plastic surgeons. A lot of plastics will also be needed on the head and upper facial area.
I haven't got the schedule for next week yet, although more surgeries are planned. I'll keep the group updated, as I can't possibly answer each email and call. Again, we read and listen to every message, sometimes with tears, and they all help to make us feel better. All of the concern and support is very touching, and much appreciated. Thank you all.
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