Trial By Fire

A Bad Scare

2011-03-02T16:29:00.000-05:00

The new year brought a new scare for Nikki. In mid-January, Nikki came down with a bad cold that she couldn't shake. Stubbornly, she kept putting off going to the doctor, expecting to get better at any time. After about ten days, she had lost 17 pounds and became *very* sick. Finally going to the doctor, she was diagnosed with the flu. She received treatment for the symptoms and was told to drink lots of liquid. Unfortunately, she didn't get better and started to be unable to work. She'd make herself go in to work, only to have to leave a few hours later.

Finally, there came a day in late January when she dragged herself in to work again. Her manager took one look at her and said "Enough". He had an employee who was off-duty take Nikki to the emrgency room at OSU Hospitals. She spent 12 hours in the ER, then was admitted to the hospital. Batteries of tests were conducted, including lots of imaging. The result came back the morning of the 2nd day; acute hepatic failure. Nikki's liver was failing, already operating at a dangerously low level.

The liver is the body's biochemical factory. It produces enzymes that do a great many things for us. It also converts many potentially toxic substances into non-toxic forms. The liver is very resilient, being the only organ that can regenerate; as little as 1/4 of a liver can grow back to normal size in only 6 - 8 weeks. On the flip side, the liver is irreplaceable; there's no mechanical or chemical substitute for it. When it goes, it's gone, and the only recourse is a liver transplant.

With this diagnosis, Nikki was transferred to an intensive care step-down unit & moved to the hepatic (liver) service. She was consulted by the transplant doctors early on- not because she was at that point yet, but because it takes time to be made eligible to receive a transplant and the docs wanted to get a headstart, in case the liver should completely & suddenly fail. By this time, Nikki was beginning to drift mentally, as toxins built up in her body. With the liver already struggling, they couldn't give her medications for this confusion. The staff expected this, but her family was pretty unnerved by it. She was actually having minor hallucinations and lost track of where & when she was. This lasted for a couple of days, and required Nikki to have a sitter with her at all times.

Finally, progress was seen. She was being given medications to help bolster the liver, relieving the stress on it. And the liver started responding, with hepatic function slowly improving. After a second day of improvement, her confusion went away all at once, and she began to feel better. A final diagnosis was still unclear, although the doctors believed that acetaminophen (Tylenol), alcohol and possibly a viral infection all combined in a "perfect storm" to damage the liver. With all of Nikki's surgeries, she's taken a great deal of acetaminophen-containing pain medication over the years. The theory is that this has caused cumulative damage. Add to that social drinking and possibly a nasty virus, and it was too much for her liver.

In the end, Nikki went from possibly needing a liver transplant on Monday, to being discharged to home on Saturday. She has some permanent lifestyle changes to make, though. First, no more acetaminophen... she'll have to use other medications, such as ibuprofen, and always in moderation. Second, no more alcohol... the doctors stressed that her liver is permanently impaired now, even though it may regain near-normal levels of production. It will always be very susceptible to additional damage. As a social drinker, this is a big change from how Nikki is used to hanging out with friends. However, she has a great support network and has adjusted very well so far. And third, she's to get to the doctor faster when sick. Many illnesses put a strain on the liver, and doctors will be looking for that from now on.

As of today, Nikki has regained all of her weight, her energy is back, and she's her old self again. She'll have a lot of regular bloodwork drawn for the next year or so, just to make sure that all stays well. She also has to wait for a while before going through anymore plastic surgeries, since the docs don't want to strain the liver with anesthesia for a while. When the time comes, there are specific drugs that can be used that aren't as toxic to the liver.

And that's it... just another chapter in the life of my little girl. She's never boring.

Business as usual

2010-07-29T12:45:00.000-04:00

Nikki returned to work in late June, 9 days later than she originally planned. The same day that she got the go-ahead from her doctor to start working again, she stopped by Cheescake Factory to see when she could start. The two week bar schedule had just been posted, so she spent the next couple of weeks picking up hostess & serving spots. Other than sore feet, after 1-1/2 months of laying around her house, Nikki had no problems settling back in. She's been back on regular bar shifts for some time now & is doing fine.

Nikki's flap transplant continues to improve in appearance. Almost all of the dark, red lines around the edges of the graft have faded away. The actual suture lines are so small & fine, you have to look closely to see them. One small area, up near her ear, still has a red outline. This was also the slow-to-heal area that delayed her return to work. The graft continues to shrink as it settles in. It's uncertain whether surgical reduction of the flap will be needed.

That's all for now. I'll keep you informed of any updates or changes.

Almost ready for work

2010-06-23T12:21:00.000-04:00

Nikki has healed very well over the past month. The tissue flap has settled onto her neck nicely, and significantly reduced in thickness. The suture lines around the flap are still very prominent, the deep red of a healing cut. Her doctor has said within another 60 days or so, these lines will fade, causing the flap to blend in even better with the rest of her skin. The doctor has been very pleased with how her recovery has gone.

Nikki had hoped to return to work on June 19th, but she had to delay another week, due to a small open sore at the top of her flap. A very small area just under her ear healed very slowly and has only scabbed over in the past few days. She's been fully mobile for most of the past month, but an open sore in food service is a definite no-no.

Nikki would like to try to have more surgical work done by the end of this year. She'll have to juggle her finances, her job and other responsibilities before she can schedule anything, though. I'll keep the blog updated as the year moves onward.

Home From the Hospital

2010-05-24T10:45:00.001-04:00

Nikki was discharged and returned to her home on Sunday 5/23. Her recovery went well, with only minimal discomfort. Immediately after her surgery, her face had a dull ache all of the time, but never any sharp pain. She learned quickly, however, that she had to be careful how she moved her head. Any turning or twisting of the head put stress on the transplant, which hurt. Nikki also had trouble holding a phone in any kind of a comfortable position, so she tended not to talk long. Her leg hasn't bothered her much at all, in spite of the 10 inch incision.

Friday was a little rough for her, as she had a steady stream of visitors all day. The nurses finally told her they were concerned that she was over doing things, reminding her that she had just undergone major surgery. When we visited her that evening, she was tired, sore and grouchy, so the nurses were obviously right. Nikki finally agreed with them & warned off most of her friends for the following day, so that she could rest.

She was discharged around noon on Sunday, and her sister went to get her and take her home. She was home by 2:30pm & resting comfortably. One logistics problem at home- keeping her 90lb. American Bulldog, Reno, from jumping all over her. Reno loves everyone and gets very excited when people stop by.

Nikki won't be able to drive for a while, so she'll need the help of family & friends to make it to the doctor and any shopping needed. She is off work for 4 weeks, which always drives her crazy. Nikki likes her job, likes being active and likes being around people. Staying in her house, quietly, for a month is a real challenge for her.

I'll have more after her next doctor appointment, in a week or so. Stay tuned.

Surgery #24 was a success

2010-05-19T21:51:00.000-04:00

Up at 4:15am this morning, to be at OSU Medical Center by 5:30am... yuck. Nikki actually worked until after midnight last night and didn't get to our house until 1:30am. Of course, she got to take it easy all day ;).

She was checked in and up in pre-op by 6:00am, with surgery scheduled for 7:30am. Only one person could go with her during prep, so my wife sent me along. Nikki's surgery was actually in the James Cancer Hospital- a first. I didn't even know that the James had it's own O/R suites, but they have six of them. Dr. Miller prefers to operate and keep his patients there when possible, since most of his Plastics workload comes from cancer patients.

Nikki was once again a difficult stick- they couldn't get an IV started. Her arms are both covered with grafted skin from her burns, and this is very difficult to work with. The only suitable veins are deep ones, and it's very hard to pick them out through the scar tissue. Two nurses, a nurse anesthetist and an anesthesiologist all had a go at it... the doctor even used an ultrasound machine to pinpoint a good vein, to no avail. They finally decided to use inhalation sedation in the first round to put Nikki under, then dug around and started two IVs while she slept. Her arm is well-bruised from the efforts.

Nikki was taken to the O/R at 7:32am, although the procedure did not start until 9:00am. My wife Bonnie & I spent a long, dreary day in the family waiting area, reading & playing on our laptop. We left for lunch & snacks in the cafeteria, but didn't venture outside, since it rained most of the day.

Surgery was expected to last 7 hours; it lasted exactly 8 hours. Dr, Miller came to us immediately after, saying that all went as planned. He took a piece of tissue about the size of my hand from Nikki's left thigh, one of the few unburned areas on her body. This slab of tissue was about 3/4" thick and contained a portion of a major vein running through her leg. This vein, along with several smaller ones, was microsurgically attached to existing veins in Nikki's neck and face. It's very important that a good blood supply be maintained to this large piece of tissue, or it will fail. That, along with preventing infection, is the main reason that Nikki has to spend 5 days in the hospital. The tissue graft will be checked regularly with a sonic-amplified scope and ultrasound to ensure it's health and circulation.

We were allowed to see Nikki in her room around 7:00pm. She looked amazingly good and had no pain at that time. This is also the third time that she's had no post-op nausea. The tissue graft was completely uncovered, allowing us to get a good look at it. It's quite a large bulge of tissue, slightly lighter in color than the rest of her neck & face (her face gets more sun than her thigh). Dr. Miller said that the lump will settle and spread out some on its own as it settles in. If necessary, it can later be surgically spread out some more, or reduced through liposuction, to better fit the contours of her neck and face. The great news is that you can already see the relaxing of the grafted skin on her upper face, where it was pulled down by contractures previously. Her right lip and eye are already in better positions than they were. Her thigh is also in good shape; Dr. Miller simply pulled the lips of the wide, deep incision together and stitched them in a neat line, leaving no deep scoop or imprint behind. Her thigh will quickly replace the missing tissue.

One unusual side effect- the large piece of tissue on her neck will be dead to the touch, since nerves cannot (yet) be surgically reconnected. Over time (years), Nikki will regain some sensation there as nerves from her surrounding neck areas infiltrate the newly transplanted tissue. A small price to pay for a much better look to her face.

And that's it. After 14 hours at the hospital, Bonnie & I didn't linger long. We'll be visiting her during her stay, and I'll report anything that comes up. Thanks for following Nikki's latest adventure.

Pre-Op Report

2010-05-13T11:48:00.001-04:00

Nikki didn't have any unusual problems Tuesday during her pre-op workup. It took five sticks to get her blood sample- not bad for her. Since being burned, Nikki doesn't have any ungrafted sites to use for blood draws. On top of that, it's very hard to find a vein under her heavily textured skin grafts. She was pretty sore by the time they finished, but the mission was successful.

The operating room is booked for eight hours, which would be a record length of surgery for her if used. Dr. Miller is anticipating 6 - 7 hours in the O/R, so we'll see. The actual procedure will be focused on her lower neck, where the constrictures always form from her neck to her chest / shoulder area. By removing these areas of tight skin, Dr. Miller anticipates that her upper neck & facial features will relax and stay relaxed. This might allow conventional skin grafting to do a better job on the upper areas, without fear of constrictures forming. But if necessary, the same radical tissue transplant procedure can be used on the upper neck & face at a later time.

Nikki is pretty well prepared for her extended time off of work & she's anxious to get this done. This will probably be my last update until surgery day, which is next Wednesday. Stay tuned-

Pre-Op Update 05/10/2010

2010-05-10T15:59:00.000-04:00

Nikki goes to the doctor tomorrow for all of her pre-operative blood work and other tests. She's already been notified that we have to be at the hospital next Wednesday at 5:30am! At least she's a first case, which greatly minimizes the chances of her schedule getting screwed up. Even with Nikki staying the night before with us, that still means a 4:00am start time. We should also get a better estimate of how long her surgery will be after tomorrow.

Nikki's been preparing for her month off of work by working every shift she can get, stocking up on food at home & paying as many bills in advance as she can afford. When she has a goal to meet, she can become a real work-a-holic.

More as I have it.

Back to the O/R- 4/28/2010

2010-04-28T22:30:00.005-04:00

Hello?.... Is anybody there? Yep, we're all alive and well. Nikki has been doing very well, continuing to tend bar at The Cheesecake Factory in Columbus, at Easton. I also returned to work in July 2009, finding a new position with a technology company after a 6 month layoff. Finally!... back to the computer field after six years!

Why am I posting after all of this time? Nikki has decided it's time to get back to surgeries, that's why. Surgery #24 has been scheduled for May 19th, with the Director of Plastic Surgery at OSU, Dr. Michael Miller, slated to perform a free flap procedure on her right neck and face. This will be a 5 - 8 hour procedure, following the same general recommendation made by the Cleveland plastic surgeon a couple of years back. A large, deep section of tissue will be removed from Nikki's left thigh and implanted on her neck and lower face. More than just a simple skin graft, the free flap is actually a microsurgical procedure. All layers of skin, along with underlying tissue, veins and arteries, will be transplanted. The veins and arteries will be surgically connected to corresponding blood vessels in her neck. This will allow the blood supply to continue to the transplanted tissue, keeping it alive, soft and viable. This tissue will be unable to contract the way that skin grafts do, preventing contractures from forming. Liposuction will be used as needed to better fit the tissue to the face. The doctor belives that her thigh will be able to replace the missing tissue with little to no scarring.

This will mean five days in the hospital, but offers the best chance to date of a smooth facial reconstruction. After this, Nikki intends to pursue further work on her right eye with Dr. Katz at OSU, as well as some more reconstructive work on her nose. She's very excited that she's finally in a position to continue with her reconstruction. We all have very high hopes that this procedure will be the one that works. I'll have more details for you as they develop.

Stay tuned... we're on the run again!

More surgery?

2009-08-15T15:53:00.002-04:00

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.

Nikki gets her day in court

2009-07-08T22:29:00.003-04:00

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.

A new home for the blog.

2009-05-11T12:29:00.000-04:00

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.

A New Life: 5/10/2009

2009-05-11T12:27:00.000-04:00

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.

A New Life: January 2009

2009-05-11T12:26:00.000-04:00

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.

A New Life: 2008

2009-05-11T12:24:00.000-04:00

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.

A New Life: 2007

2009-05-11T12:19:00.001-04:00

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...

A New Life: October - December 2006

2009-05-11T12:18:00.000-04:00

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.

Reconstruction: July - August 2006

2009-05-11T12:13:00.000-04:00

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!

Reconstruction: May - June 2006

2009-05-11T12:10:00.000-04:00

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.

Reconstruction: March 2006

2009-05-11T12:08:00.000-04:00

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.

Reconstruction: January - February 2006

2009-05-11T12:04:00.000-04:00

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!

Reconstruction: September - December 2005

2009-05-11T12:00:00.000-04:00

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!

Reconstruction: August 2005

2009-05-11T11:57:00.000-04:00

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?

Reconstruction: July 2005

2009-05-11T11:53:00.000-04:00

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!

Reconstruction: May - June 2005

2009-05-11T11:50:00.000-04:00

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!

Reconstruction: March - April 2005

2009-05-11T11:45:00.000-04:00

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.

Reconstruction: February 2005

2009-05-11T11:43:00.000-04:00

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!

Reconstruction: January 2005

2009-05-11T11:38:00.000-04:00

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.

Reconstruction: December 2004

2009-05-11T09:41:00.000-04:00

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-

"... Ready for my closeup, Mr. DeMille."

2009-05-11T09:38:00.000-04:00

11/12/2004
Nikki and I traveled to Cleveland today, to attend the American Red Cross Hero awards. The ceremony was held at the Renaissance Hotel in downtown, a beautiful old hotel. The organizers were wonderful, going out of their way to make sure that Nikki was comfortable. As invited guests, we attended the VIP reception held before the ceremony. Nikki met a steady stream of local dignitaries and personages, all of whom were unfailingly kind and supportive.

Eventually, we were escorted to the banquet hall where the ceremony would be held. It was enormous, with seating for many hundreds of people. We were seated with Mike Melinis, the hero who helped to rescue Nikki back in July, along with his wife. The ceremony moved at a comfortable pace, and was well presented. After the great lunch, a video was shown, featuring each of the 17 recognized heroes and a bit about their stories. Each hero received a copy of this video for their own The heroes also received beautiful American Red Cross plaques, along with signed documents from local congressmen and the mayor of Cleveland. All told, we both had a very pleasant day as guests at the event.

Tonight, Cleveland's NBC 3 TV showed their story of Mike's rescue of Nikki. Mike got some very good footage here, and Nikki also represented herself well. Obie Shelton of channel 3 did a fine job with this feature. I've included links to both stations news stories, at the top of this page. We've been very happy with the news stories done by the Columbus and Cleveland NBC stations.

We were both glad that we were able to witness Mike receiving the reward that he so deserved. Naturally, we'll continue to stay in touch with Mike and his family going forward. I'm sure there'll be more meetings between us in the future, as Nikki continues to recover.

11/09/2004
Just a brief one tonight. This evening, a local NBC news crew came to our home to interview Nikki. This came about in relation to the award ceremony for one of her rescuers, being held in Cleveland on Friday. NBC 4 in Columbus and NBC 3 in Cleveland did a joint story on Nikki and rescuer Mike Melinis. Each station will share it's footage with the other, and both stations will run the feature this evening on their 11pm news. Both stations are usually good about putting their features on their web pages, so take a look there, if you can't see the newscast tonight.

The whole process went pretty well. The crew was polite and considerate of and interested in Nikki. My only gripe is that TV can't resist looking for a negative side to every story. When the crew first arrived here, they noticed the For Sale in our yard. One of the first questions asked of me was whether the house is being sold due to hardship caused by Nikki's accident (it's not). When the reporter discovered that Nikki's insurance ran out this month, I got questions about how the bills will be paid (Medicaid- I hope). During my interview, the reporter asked "but aren't you pissed?"- at life in general, I guess she meant (I'm not). I hope that the tone of the story is a positive one, but you never know until you see the final edit.

The crew had also asked if they could film Nikki's dressing change, which was going on when they arrived. Nope, I replied, too much like exhibitionism, with no real purpose. I explained that she's completely nude during the change, and that most of her dressings are on or near private places. Nikki did her interview wearing a halter top, though, in order to provide a good look at a lot of her damage. She also demonstrated various exercises that she does, and I think the crew saw more than enough to satisfy themselves.

Nikki did very well, even though she was quite nervous about the camera. She got emotional when speaking of rescuer Mike Melinis and her accident, and still handled herself well. Her energy and enthusiasm came through during her segment, which should make for a positive showing.

In non-TV news today, I saw Nikki's recent surgical sites for the first time. Ouch. The armpit and elbow have large chunks of tissue missing, even when grafted over. I can't see these ever filling in completely. However, Nikki can raise her right arm to 90 degrees unassisted now, even though it hurts, and can extend her arm to nearly 180 degrees- Awesome! She returns to Fiends & Torture- er, Occupational Therapy tomorrow morning, during which these new graft sites will get a real workout.

That'll do for now. Take care-

11/08/2004
Nikki came home today, airplane splint and all. She has to turn sideways to get through doors, and she can't walk really well; but still, she's happy to be home. Her right arm is still very sore, with grafts in her armpit, elbow joint, and along the right side of her neck. Her right thigh is also very painful, where the grafts were taken from. However, the only tears she shed today were tears of joy, when the physical therapist was able to extend her arm upwards over 90 degrees- the furthest possible since her accident in July. This represents a big step in her rehabilitation, hence the tears.

Nikki resumes physical and occupational therapy through outpatient services this week. She's now scheduled 3 days weekly, which is quite a workout. She also still gets home nursing for her dressing changes. Her burn wounds on her back are healing very well, but with such a large area, it's slow going. Nikki had a large reduction along the base of her back / top of her buttocks, where skin and fat burned away, down to the muscle layers, This caused a nearly 3 inch deep fissure, running completely across the back, exposing fatty tissues at the top of the buttocks, making a sort of ledge across the buttocks. This huge area has now almost completely healed itself, and is looking very good. It was thought early on that plastic surgery would be necessary to even out the transition from back to hips. Now, it looks like it probably won't be necessary. Nikki is living proof of how resilient and downright tough the human body is, and watching her healing process has been a rare treat.

Nikki received her next surgery schedule today- December 15th. This will be surgery on and around the eye, with both ophthalmology and plastic surgery involvement. This will be tricky, detailed work, with the payoff being a working right eye and a better-looking face. Nikki is really looking forward to this one, although she has some fear about the eye itself. She's an avid reader, and the thought of permanently impaired vision is a sobering thought. Nevertheless, the eye isn't much good as it is, so she's ready to charge forward.

Nikki and I still plan to attend the American Red Cross Hero awards in Cleveland on Friday. Also, a TV crew is coming to our home this week to film a brief interview with Nikki for Cleveland's TV3 news, in time for the ceremony on Friday. The station there has taken an interest in Nikki's recovery, and I hope they do a good job with her. We're both really looking forward to the ceremony, where Mike Melinis will receive an award for his part in helping to rescue Nikki from her burning car on July 23rd.

That'll do it for now. I'll add more when I have it.

11/05/2005
A little different kind of update today. We've just learned that one of the Good Samaritans that helped to rescue Nikki from her accident in July is receiving some recognition next week.

Michael Melinis, of Parma, is receiving the American Red Cross Hero Award, sponsored by various Cleveland businesses. This award is for everyday citizens, who have performed extraordinary feats of heroism. Apparently, pulling my flaming daughter out of a burning car qualifies! Of course, we're all very excited about this, and very happy that Mike is getting his just recognition.

Local press seems to be making a pretty big deal of this honor (as they should). Mike is a truck driver for Giant Eagle, and the local Teamsters are heavily promoting their own. The local newspaper (the Parma Sun, I think) has interviewed Mike a couple of times. The Sun has also tried to interview Nikki at home, but she's always in the hospital . The Red Cross is doing a lot of promotion, including a video production. Local TV Channel 3 is planning to do a follow-up on the events that led to Mike's heroism, even talking of sending a camera crew to Columbus. Both newspapers and TV are interested in speaking with Nikki and/or me, to which we've agreed. Nikki and I are also planning to be at the ceremony, if she's able to travel by then. I'll go alone, if she's not able, as Nikki wants at least one of us to be there.

The ceremony will be held next Friday, Nov. 12th, at the Renaissance Cleveland Hotel, at noon, in the grand ballroom. I would think anyone living in the Cleveland area at least has a chance of seeing something on their local news, or in the newspapers.

Isn't it nice to see some good news about good people for a change?

Reconstruction: November 2004

2009-05-11T09:33:00.000-04:00

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!

Reconstruction: October 2004

2009-05-11T09:29:00.000-04:00

10/23/2004
Nikki had surgery yesterday, to release contracting skin grafts on the right side of her neck. The surgery went well, with no complications. Nikki did have a long recovery- 2 hours. This was due to a low body temperature (something that plagued her in Cleveland, too), and high levels of pain immediately post-op. Both were eventually controlled, and she came through fine.

There was a change in plans, though. Instead of being able to go home last night, or even this morning, Nikki is in the hospital until Monday. The procedure involved removing a fairly large area of skin grafts- about the size of two hands. Grafts were removed from her right neck, the back of her neck and underneath her chin. The excision was pretty deep, leaving a large wound. Over this, Dr. Gordillo placed Integra, an advanced bandage/skin substitute, often used in burn patients prior to actual skin grafts. The Integra protects the wound much like skin does, promoting healing. It also doesn't contract, the way skin grafts do. Over this, a device called a Wound VAC was placed, too stimulate blood flow in the surgical site..

The Wound VAC was created at North Carolina's Wake Forest University back in 1995, and has been increasing in use, especially in burn patients. We're lucky enough to have a senior member of the wound care team at OSU that actually worked with the development of the VAC, who is overseeing its use on Nikki. In certain cases, the VAC has improved the success rate of skin grafts from 60% to near 95%. Neck grafts are difficult at best, so every advantage is important.
Nikki seems a little depressed to be back in the hospital again, but she's still excited to be working on things that will enhance her appearance. Since she's going to be at OSU through Monday, I'm hoping that her orthopedic surgeon will come see her there, in lieu of her Monday morning appointment. She's also scheduled to continue measuring and fitting of her compression garments on Monday, hopefully while she's still an inpatient. Later next week, Nikki is scheduled to meet with the plastic surgeons that will be doing the repair work on her eye and the surrounding areas.

Nikki's health insurance will expire at the end of this month. After that, we're at the mercy of her pending Medicaid application. Fortunately, OSU and its affiliated doctors and clinics will accept "Medicaid Pending" as a provider. Nikki's burn garments will probably be paid for from the OSU Burn Fund, a charitable fund provided to those who need it. The compression garments are very expensive and even Medicaid has a long and difficult approval process for covering them. The doctors don't want this to be delayed, so they've arranged to tap the fund for her.
Overall, Nikki is progressing well. Her skin grafts, which have been a deep, leathery red color are already lightening up and becoming soft, more skin-like. Her sensitivity has been increasing, to where she can feel almost normally in all of her burn areas. The burn garments will enhance this process.

I'll update again next week, after Nikki's discharge and visits with her other doctors. Stay tuned!

10/19/2004
My first update in a while, since Nikki's discharge in September. We've all been concentrating on getting back to a "normal" life, and enjoying it thoroughly. Nikki is mostly self-sufficient now, able to eat, dress herself and so forth. We're not comfortable leaving her alone, so we usually drag her along with us whenever we leave. I'm back to work now, although not in the same position that I held before. No complaints- I took the chance, did what I thought was right, and wasn't affected financially in the long run.

Nikki continues to do well. She has occupational therapy twice weekly, about 90 minutes each time. Work is focusing on her right hand, both elbows and shoulders, and on her neck. Two fingers on her right hand were originally curled into a claw position, due to contracting skin grafts. Through the use of splints and casts, these fingers are nearly straightened now. Range of motion in her left elbow and shoulder has greatly improved, while the right arm is going much more slowly. The right side of her neck is also contracting steadily, pulling down the right side of her face and her damaged right eye. The OT clinic is also handling the measurement for and fitting of pressure garments for all of her grafted areas. This is a slow process, as the garments are custom-made.

Home health care continues to visit and do her dressing changes. These become simpler as time passes and the wounds heal. Now, Nikki only needs the wounds at the base of her back / top of her buttocks wrapped. It's a challenge to keep this area wrapped, as Nikki is pretty active, constantly working the dressings lose. She's always going shopping, or out to eat with friends or family. Last weekend, she even went to a Cleveland Browns game with her boyfriend, a long up-and-back trip on Sunday. People have been very considerate to her, engaging her in conversation and such, without a lot of staring. She had one embarrassing moment a week ago, while in a Halloween costume store for her niece. A young girl thought that Nikki was working at the store, in costume. Nikki tried to explain, but discovered that the girl was handicapped and didn't understand. The girl's mother apologized to Nikki, and explained the situation to her daughter. Nikki resolved to stay away from costume stores for a while.

Things are starting to move along with Nikki's reconstructive work. Her appointment today with Dr. Gordillo, a plastic surgeon, has resulted in surgery being scheduled for this Friday at OSU. Gordillo is going to perform a release on the right side of Nikki's face & neck. A pretty large area of grafted skin will be removed from this area and replaced with Integra, a substitute skin material. This will relieve the pulling that's occurring all along her face, eye and neck. The Integra will be in place for a few weeks, and then will be replaced by another skin graft, probably taken from the thigh. Nikki will stay overnight after this procedure.

Next week, Nikki has an appointment with Dr. Rosenberg, a cranio-facial plastic surgeon. He, along with an ocular plastic surgeon, will begin plotting the reconstruction and relocation of Nikki's right eye. As mentioned before, her eyeball is out of place on her face, due to the fractured socket and damaged supporting tissue. Rosenberg's specialty involves breaking the bones in her face, including the eye socket, and rebuilding as needed, while the ocular PS specializes in physically re-securing the eyeball and ensuring that it's functional. They also need to continue rebuilding the lower eyelid. It's delicate work, demanding a lot of attention to detail. The payoff will be an eye that works and looks a lot better. Without this correction, the eye won't be very useful to Nikki.

Another appointment coming up will be with Dr. Bos, Director of Orthopedics at OSU. Bos will be evaluating the heterotopic ossification in Nikki's elbows and right shoulder. This abnormal bone growth causes a lot of pain in the afflicted joints, and also restricts movement. The likely outcome here is surgery to remove the offending growths.So, after three fairly quiet weeks, it's time to get going again. Nikki is excited about the upcoming work, knowing that it's the beginning of improving her appearance, as well as enhancing her functionality. I'll probably have more frequent updates, now that stuff is starting to happen again. We still receive a fair quantity of emails, so I know that people are still interested in Nikki. Stay tuned!

Home at Last! September 30th, 2004

2009-05-11T07:44:00.000-04:00

Today is the day- Nikki came home, for the first time since her accident on 7/23/04! As you can imagine, we're all excited by this, especially Nikki. Once again, we had to say goodbye to some wonderfully caring people. At least there wasn't 8 weeks of attachment here, like in Cleveland, so the goodbyes were a little easier. Nikki keeps saying that she still can't believe that she's out of the hospital.

She had a pretty busy day before finally being discharged at 3pm. We started with another dressing change in the burn unit. This gave me a chance to practice my dressing skills, and also gave Bob, the Director of Rehabilitation Services, a chance to go over Nikki completely. Bob has over 20 years experience in burn rehab, and his insights are very important to Nikki's future care. Nikki's open wounds have shrunk to mere sore spots now, with no openly bleeding wounds. Since her grafted skin can't handle tape, though, wounds must be wrapped in bandages and Ace wrap, which covers her torso and shoulders completely.

Nikki has the beginnings of heterotopic ossification in both elbows and right shoulder. This is a condition where bone material starts to sprout off into surrounding muscle. It isn't uncommon in burn and other trauma patients, and can be crippling. Physical therapy and anti-inflammatory drugs are used to combat it. Surgery could be needed to shave the bone growths, so we'll be following this closely.

After dressing changes, we had some instructional physical and occupational therapy. I was tested on my ability to help Nikki with the numerous exercises that she will have to do on her own, in addition to outpatient therapy. Nikki will be going to outpatient therapy at least 3 times weekly for a while. The clinic she will be attending has a strong specialty in hand and burn therapies. We're lucky to have such a specialty unit close to us here in Columbus.

The outpatient clinic will also handle the fitting of Nikki's pressure garments, an important part of her recovery. These custom-made garments exert smooth, even pressure to her grafted skin. This pressure helps to smooth wrinkles, folds and scar tissue on her grafts. They also improve circulation (promoting healing) and help reduce itching. It's these garments that will help her grafts to return to a nice, smooth texture, with a healthy look, and greatly reduced scarring. Both MetroHealth and OSU are strong believers in pressure garments. Wearing them is an exercise in dedication- requiring 23 hours each day, for 12 - 18 months. This includes facial garments, which are usually a full-cover mask.

After we got home this afternoon, Nikki went out with me to get her prescriptions and some other items that she needed. We went to 2 businesses, and she seemed very comfortable out in public for the first time. Other than a few staring children, everyone took her in stride. One of her medications was to have been Vioxx, which was just pulled from the market today due to adverse effects. This became Celebrex, which Nikki's insurance requires special prequalification to cover. So for now, its ibuprofen, to help reduce the effects of ossification in her elbows and shoulder.

Nikki still has several surgeries coming up. The right eye still needs a lot of work, and plastics is actively discussing their strategy. There was some talk of operating as early as next week, but that's not confirmed yet. In addition to the eyelid repair, it was found that Nikki's right eye is actually out of place. It's quite a bit lower than it should be, and a little to one side. So the eyeball will actually be moved and secured as part of the reconstruction. This may also involve maxillofacial surgery, to rebuild the right socket. In the future, they'll also rebuild the other socket and sinus cavities, and straighten her nose. Even though the hospital stay is finally over, it's obvious that there's a lot of work yet to be done. Aside from outpatient care, Nikki will be in and out of the hospital several times in the coming years for more surgery.

Lots of thanks and sincere gratitude to those who have helped to support us throughout this difficult time. All of the cards, letters, emails and other contributions have been a huge help to us, in many ways. I'll continue to keep everybody updated on Nikki's progress, as long as people seem to be interested. I'll also keep the web page updated, so that the full history will always be available to those that are interested.

Stay tuned!

Physical Rehab: September 22nd - 26th, 2004

2009-05-11T07:41:00.000-04:00

09/26/04
Nikki continues to do well in rehab. 3+ hours per day (except Sundays) of physical and occupational therapy, plus daily Average Daily Life skills. Due to her very good mobility, there's some talk of discharging her within a week, to continue her occupational therapy as an outpatient. She would also need outpatient care for her skin grafts, although Dad will probably handle the routine wraps and bandages at home (with some training).

Nikki's appetite is doing very well, and she's really scarfing down the food that we bring in to her. She is also enjoying a LOT of visitors; so many, that she has to schedule them, in order to keep from filling up the room. The nurses are very supportive of visitors, and don't enforce any kind of quantity or time limits. She spends a lot of time on her phone, sometimes using the speakerphone, but increasingly using the handset.

I've got the ball rolling for Social Security Disability and Medicaid Disability for her. I have a Medicaid interview Tuesday, and then Social Security does a phone interview with her on Wednesday. As Nikki's insurance runs out next month, these are very important for her future care. Remember, she still faces several plastic surgeries. There's a good chance she'll have a surgery on her eyelid before discharge.

I was expecting to start back to work at Sears on Monday, but there's been a snag. My district manager was pleased when I told him two weeks ago that I was ready to come back, a week earlier than my leave called for. He visited my store on Friday morning, and was making plans with my assistant manager for my return. Then on Friday afternoon, I got a call from him, telling me that I would have to interview for my job again! This apparently comes from the V.P. of sales, and I think it caught my DM by surprise as much as it did me. I have to interview with both the DM and the V.P., which is unusual. This had never been mentioned anywhere during my leave process, and I'm concerned about it popping up now. There have been a lot of organizational changes in my division this past year, and I hope that someone isn't looking for an excuse to make a change at my store. This also hurts us financially, as I need to get some income going pretty quickly, and this will cost me at least another week- if not more. I have little choice but to go along with it, though.

That's all for now- more later.

09/22/2004
The first days of rehab for Nikki have been busy ones. She has physical therapy and occupational therapy scheduled throughout the day. The sessions take place in one of Dodd Hall's 4 gyms. In between sessions, she has appointments with her various doctors and support staff. So far, she's been visited by the burn team, oral & maxillofacial, nutrition, physical medicine, general plastic surgery, ocular plastic surgery (specializing in eye repair), rehab psychology and a burn rehab specialist... all in her first two days!

Nikki is a little overwhelmed by all the attention. This is a busy place, and there's a lot of work to be done, so they cram a lot of activity into a small amount of time. From 8:30am until around 4:00pm, it's hard to find her. All of the physical work is on the first floor, while many specialists have offices on the second. Thank goodness her daily schedule is posted on the unit for anyone to find her by.

Today, Nikki had a very thorough review by a physiatrist specializing in burn rehab for more than 20 years. He dictated an amazing amount of observations and treatment recommendations during her 30 minute exam. Her skin grafts are starting to constrict, and this has a marked effect on her mobility and appearance. Her arms and right hand have limited mobility at all of the joints, requiring a lot of focused exercise to relax. Some areas may require surgical releases to enable the desired range of motion. Pressure garments are already in the works, to help reduce future scarring. Custom made for the patient by in-house specialists, these garments can be designed to cover every body area that has skin grafts. They exert pressure evenly over the grafts, preventing the skin from bubbling and wrinkling. Using these garments early and often can make a huge difference in long-term appearance. The grafts on Nikki's right neck and face are also constricting, causing her to lean her head to the right and pulling down her right eyelid and right side of her mouth. A special neck and head support is being made that will hold her head in the proper (neutral) position. She's been warned that it's not real comfortable, but is crucial for future mobility and appearance. Nikki was a little down during this session, as the amount of information being presented to her was overwhelming, as well as a little scary. Hearing about so many things that need correcting on your body can be depressing. We had a brief crying session afterwards, followed by a conveniently scheduled appointment with the rehab psychiatrist. She felt a lot better afterwards, and so did I. No signs of clinical depression or post traumatic stress syndrome, and a good overall attitude about getting better.

Ophthalmology and the ocular plastic surgeon visited Nikki today. The plastics guy liked the work done on her bottom right eyelid. However, the graft constrictures are pulling the lid down enough to keep the eyeball exposed all of the time. She wears a moisture barrier to maintain proper lubrication, but that's a short term solution. Plastics wants to work on her eyelid soon, releasing the constricture & also raising the eyelid to provide better coverage. They feel that the integrity of the eyeball is at risk, and they want to move pretty quickly on this- probably within a week.

Nutrition is also a concern for a burn patient. Lots of protein is the key, and it can be a chore getting enough into her. Nikki is a picky eater, and doesn't care for much hospital food. We bring a lot of food in for her, and her unit also offers some favorites, such as canned pastas and the like. She loves this stuff, and can just help herself any time she wants. They are also working on finding an oral nutritional supplement that she likes.... good luck!

Small advances are already being made. Nikki can now brush her teeth on her own, as well as feed herself and get a drink. The staff equipped her room with a speakerphone, so she can answer and make calls on her own- a HUGE morale booster. She's now wearing several nice athletic suits during the day, which I'm sure make her feel more normal. She handles her own laundry in the unit's laundry room. Whenever she wants a snack, she just wanders down to the pantry and helps herself to an amazingly large stock of convenience foods, adding to her feeling of independence. She also has a menu for local restaurants that will deliver food to her.

Things are going well, if hectic. I'll try to keep everyone up to date as things develop. If you'd like to send a card to Nikki, here's her temporary address:

OSU Medical Center
Dodd Hall, 4th Floor

The staff at Dodd Hall is amazed at the amount of cards, posters and stuffed animals that are in Nikki's room after only two days.

Thanks for your interest in Nikki's progress- more later!

Back to Columbus: September 21st, 2004

2009-05-11T07:37:00.000-04:00

Yesterday, Nikki transferred to OSU Medical Center, to the Dodd Hall rehabilitation center. This was a major step in her recovery, being the end of more than 8 weeks of critical care! It was also a very sad day, since we said goodbye to many of the wonderful people who helped to save Nikki's life. We spent the weekend taking lots of pictures of the wonderful staff at MetroHealth, many of them with Nikki. Needless to say, we'll be back in the future to visit these folks.

We transported Nikki ourselves, since she is well enough to sit in a chair for several hours. Getting her into the Jeep was easy; the hard part was taking everything out of her room. There were a couple of hundred cards, many stuffed animals, deflated balloons, and several odds and ends. It added up to several bags and boxes- quite a load. The trip itself was uneventful, and she was comfortable for the entire trip. We even stopped at McDonalds for some take out. Nikki really enjoyed being outside, and it was a beautiful day to drive.

OSU's Dodd Hall was ready and waiting when we got there. Nikki was taken right to her room, which is very nice. It's a double-bed room, but she has it to herself. Being a burn patient, they won't have anyone else rooming with her. Every patient room in Dodd Hall has a full-wall window, offering a great view and lots of sunshine. While it's still early, the staff seems to be just as caring and professional as the folks at MetroHealth. Nikki's still a little nervous, being exposed to all new staff and procedures, but she's becoming more comfortable. She had her first dressing change today, and it went well. The procedures are a little different, but nothing unpleasant.

At OSU, Plastic Surgery runs the burn service, so plastics is closely involved with her from the start. That's a good thing, since most of Nikki's future surgeries will be by plastics. She was seen by the burn staff today, and they had good opinions of the work that Nikki has received so far. She will also be consulted by ophthalmology and maxillofacial services. Of course, physical medicine is her primary service here, the science of rehabilitation, and Dodd Hall is one of the country's best. Take a look at U.S. News & World Report's "Best Hospitals" list for 2004 for more info... http://www.usnews.com/usnews/health/hosptl/tophosp.htm

With Nikki just 20 minutes away now, instead of 2 ½ hours, it's time for me to go back to work. Fortunately, I seem to still have a job to go back to, so that's one less worry. Bonnie will be able to spend more time with Nikki now, so we'll still be there a lot for her. It'll seem strange, getting back to a more normal life.

Many thanks to those who have helped us through cards, letters and more. While Nikki still has a lot to be done over the next couple of years, things are definitely getting better. Everyone's support has meant an awful lot to us. More later!

Intensive Care: September 2nd - 16th, 2004

2009-05-11T07:34:00.000-04:00

09/16/2004
An uneventful week so far... it's nice to be able to say that! Nikki continues to improve. She's eating better this week, and has had her tube feedings reduced to 6 hours daily. The docs really want to remove the tube before her discharge, but she must be taking in at least 75% of her total nutrition needs orally before they'll do that.

Dressing changes continue every morning, and are still somewhat painful. She still receives 8mg morphine I.V. just before each change. Some bandages still stick in places, and the wash downs still hurt sensitive areas. Nikki still has some small open wounds scattered around her back and shoulders, and on the sole of her left foot. Everything is healing, though.

Great news today... Nikki is expected to transfer to OSU Hospitals on Monday, Sept. 20th! That's about 2 weeks earlier than first expected, and 5 days earlier than we thought just last week. Good attitude and rapid healing are the reasons. Bonnie and I plan to return to MetroHealth on Friday evening, and return on Monday with Nikki, taking her directly to OSU Hospital's Dodd Hall. She's expected to remain there for 4 weeks, and then come home.

Nikki gets to go outside the hospital today, for the first time in 8 weeks. She was very excited about this when I left her this morning, and we're looking forward to going outside with her this weekend. The staff at MetroHealth is already getting sad about saying goodbye to her. I'm sure there'll be some tears all around this weekend about that.

We'll be taking all of her cards and letters to Dodd Hall with her, to put up on her new walls for the next month. There's well over 100 cards taped to her walls, so this won't be an easy task. There are also a couple of large plastic bags full of stuffed animals making the trip. Most of the cards and several of the animals are all courtesy of you wonderful folks, and they really brighten up a place. I would suggest that anyone still wishing to send cards or other items to Nikki wait until I have her new room address at OSU next week.

I'll continue to post weekly updates on Nikki's rehab, as well as keeping everyone informed on future surgical procedures. Thank goodness the critical phase is past, but there's still plenty of misery ahead of her. She'll need more procedures on her face, and more on her back. If that newly grafted skin around her armpits and elbows can't be loosened enough with therapy, it'll also be necessary to surgically release it around the joints. But, one thing at a time. For now, we'll all enjoy the successes.

Thanks to everyone who keeps asking about Nikki, and I'll have more later.

09/11/2004
A brief one today. Nikki is back to her usual good-natured self now. She's up walking again after last Friday's surgery, although she's still a little cautious. The grafts to her back seem to be taking well, and her thighs are healing quickly. She's eating pretty well again, probably better than before the surgery. Pain is well controlled by oral medications.

Spoke to a case manager this past Wednesday, to begin planning- DISCHARGE! It’s coming, folks, in 10 - 14 days. We're all very excited, and I'm digging into the necessary arrangements. We're setting Nikki up for transfer to Ohio State University Hospitals, here in Columbus... 15 minutes from home. Nikki will stay in Dodd Hall, the rehabilitation center at OSU, for 4 weeks or so. This will involve at least 3 hours of intense physical and occupational therapy every day. Also, wound care will be provided while she's there. She was very disappointed to learn that she couldn't go straight home, even though I knew that she couldn't. She's accepting it now, though, and I've tried to give her a good idea of what's coming. Rehab patients typically stay in rooms that are more like pleasant hotel rooms. The patients usually just wear street clothes, conditions permitting, and have free reign of the center. Dodd Hall has a library, several recreation areas, community eating, community activities, etc. There's even a pool. I'm digging into all of the details, including Social Security Disability, Medicaid and so on- lots of complicated stuff. MetroHealth is being a big help here, coordinating the transfer.

Nikki had another minor surgery yesterday (Friday), probably her last at Metro. They separated the flap on her right eyelids, and her eye is now open. Its working, but blurry... still lots of medications going into it. The eyelid will take some time before it works properly. The plastics doc also cleaned her damaged right ear very thoroughly, and around the right eye. I had to leave before she came back yesterday, but I'm told that all of those areas look much better. She had little pain afterwards, and ate dinner & visited with friends last night.

We'll be visiting Ohio Basset Rescue's Waddle picnic for a few hours today, then heading back to Cleveland. We attended the pizza gathering last night, which was very enjoyable. I'm afraid that I was pretty tired, and wasn't the life of the party. I think that everyone understood, though, and I'll make up for it today at the picnic. Another milestone- our 11 year old granddaughter Erika (who lives with us) is going to Cleveland tonight to see Nikki for the first time. We thought it was important for her to see Nikki before she came home to us and both Nikki & Erika are very close.

That's it for now. Needless to say, cards and letters are *still* coming in, and Nikki really enjoys them. She hopes to correspond with some of her wonderful supporters when she gets home and back on the computer. Financial aid also continues, which we deeply appreciate. We've been able to make ends meet, which is really all that we can hope for during this time. Many, many thanks to our supporters for their generosity.

More later.......

09/06/2004
Back from spending the holiday weekend with Nikki. Several more cards, letters and other contributions arrived this week. THANK YOU to all of you who continue to support Nikki and us during this time. It all means so much to all of us.

Nikki had surgery on Friday... hopefully, her last burn surgery! It was her shortest procedure to date- about two hours. Skin was harvested from her thighs, and grafted to her upper back, shoulders and backs of her arms. The burn director, Dr. Yowler (a great name for dog lovers!) examined the grafts for the first time today & pronounced them good. He even put a little skin on her right ear, unplanned, because he had some skin left over & didn't want to waste it. To you and me, the grafts look like hell, but to a surgeon, it's a great piece of work.

Nikki was a little down Friday and Saturday. Remember, she's had almost two weeks of feeling pretty good, including eating real food and walking a lot. After surgery, she was on bed rest for three days, her thighs hurt a LOT, and she was on around-the-clock tube feedings. I suppose this seems like a step backwards for her, even though it's really a huge step forward. We just worked hard to be supportive and loving, trying to cheer her up. She had a lousy night last night, mostly due (we think) to fear of her first post-op dressing change this morning. As she was told, though, it was really pretty easy. They didn't touch her thighs, and only lightly washed the graft areas, before wrapping them back up again. Afterwards, she had some anxiety, causing some gagging around her feeding tube. After getting her suctioned and medicated, she slept for a few hours, and then woke up feeling much more herself. Her thighs were feeling better (just don't TOUCH ME!) and she ate a little. When we left this afternoon, she was in good spirits again, and had her best girlfriend with her, with her boyfriend coming soon.

We'll have her back up again in a few days, and will continue to work on getting her to eat more & eventually lose the tube. There will be more concentration on her physical and occupational therapy over the next few weeks, to get her in the best shape possible before discharge. She will still need one more surgery, to separate the flap between her right eyelids, sometime in the next couple of weeks.

Nikki's really looking forward to getting out of the hospital (of course!), and is starting to talk about what she will wear. Her old roommates in Cleveland have already packed all of her belongings for her, and they're in a van on the way to our house right now. I still need to know if she can be upstairs when here, or if I must arrange something downstairs for her- minor stuff, to be sure, and a pleasure to deal with.

I'm back to Cleveland tomorrow, and I'll be there until I come home for the Ohio Basset Waddle this Friday. Bonnie and I are looking forward to meeting many old AND NEW friends during our brief visit to the waddle this weekend. I'll also find time for another update then.... thank goodness, they're getting shorter!

Thanks to all of you again, and take care.

9/2/2004
Home for a night, to catch up on some business and much-needed work around the house. The cards continue to come in very steadily, with Nikki reading each one with delight. I'm going to take a picture of her hospital walls, so everyone can see the outpouring of concern over Nikki. I firmly believe that all of this helps Nikki to maintain a positive attitude, which in turn helps to speed her recovery. Sincere thanks to everyone for their help.

Nikki continues to do well, exceeding expectations. She has another surgery scheduled for Friday 9/3, and this should be her last burn procedure. This will be a "touch up" surgery, with skin from Nikki's thighs being used to graft several small spots where previous grafts didn't completely take. Most of the grafting will be on her back & shoulders. The director of burn and trauma, who does all of her surgeries, told Nikki on Monday that as long as this surgery goes well, she can expect to leave MetroHealth in 2 or 3 weeks! Friday is her 6th week there, and she's chomping at the bit to get out of there.

Maxillofacial was in to see her early this week. Their opinion now is that the facial fracture repairs will be largely up to Nikki. Of course, the broken bones have healed now, in whatever haphazard way they were laying. The facial docs say that as long as the healed bones don't interfere with her eyes, nose or sinuses, it's probably OK to leave them that way. The doc commented that her right cheek looks a little off to him, as does her nose. However, neither she nor I could see a problem. The doc pointed out that any such work could be done at any time, so there was no rush. Quite a change from our initial report!

We're still unsure as to what happens next. We were originally told that she would probably be transferred to a rehabilitation facility for a time after discharge. However, she's very mobile, and has some use of her hands and arms, so now the physical & occupational therapists are saying that she might be discharged to home. She would need to visit a local burn clinic almost daily for ongoing wound care for a while, and could possibly handle rehabilitation as an outpatient. Needless to say, this has her (and us) very excited.

Yesterday (Wednesday), Nikki was given a mirror for the first time. This was done in front of an audience, consisting of a priest, social worker, physical therapist, 2 nurses and a burn doctor. It was pretty anti-climactic. As I mentioned in the last note, Nikki had already had a pretty good look at her face in the reflection of a dark painting in the hallway. The mirror just added color & a bit more detail. She didn't shed a tear or act afraid, but asked a few questions concerning healing and future work. Her only comments were "I'll look pretty good in a year" and "I sure have a funky hair-line going there, don't I?" I was so proud I could bust. When everyone continued to tell her how brave, how strong & how positive she was, she was so embarrassed that she teared up a little. She said she doesn't do well to an audience, and everyone laughed- which made her feel better. Now, Nikki still hasn't seen her back, which is her worst burn area, but that will wait for a while.

Once again, Bonnie & I offer our sincere gratitude for all of the support and aid that we've received. Without the help of many caring people, we couldn't devote 100% of our time to helping Nikki recover. My job is still up in the air after all of this is over, and I'm trying to plan accordingly. We're also starting to deal with what we need to do to our house in order to accommodate Nikki's needs. I might temporarily convert our dining room into a bed room, since her bedroom is upstairs.

Stay tuned for more good news as it occurs. It's now a pleasure to talk about this stuff, rather than a painful purging of emotions. Hopefully, good news will be all that I have to report as Nikki finally nears the end of her hospital stay.

Intensive Care: August 22nd - 29th, 2004

2009-05-11T07:16:00.000-04:00

8/29/2004
I've just returned home with Bonnie from an enjoyable weekend with Nikki. Nikki is experiencing rapid changes now, healing very well. Her I.V. pain medications were entirely discontinued on Thursday. She now takes oral pain meds only (Oxycontin & Percocet), and has little to no ongoing pain. She was receiving a small I.V. bolus of morphine for dressing changes, but now doesn't even take that. Her rapid healing means less wrappings, and a faster dressing change- about 1½ hours now. Some grimaces and hand-squeezing are about her only response now. She now stays awake almost the entire day, with a short afternoon nap, and is sleeping better at night. She no longer has the nightmares that she was experiencing while on I.V. pain meds.

Nikki's appetite is improving, but slowly. Tube feedings still continue, but only from 6pm to 6am, allowing her appetite to improve. Last night, she ate half of a Wendy's Spicy Chicken sandwich & 3 chicken nuggets- very good for her. On Friday, she ate some spicy Chinese food, although she filled up quickly. She really doesn't like much of the hospital food, even when she does feel like eating. She drinks a lot, although not as much as she would like. She's restricted to 2 liters daily, and only milk, Gatorade or Boost (dietary supplement) - no water, which is what she really wants. The nurses hope to get the volume restriction dropped, as her intake & output are nicely balanced.

Nikki now walks a lot- whenever she wants, and mostly on her own. Her Foley catheter was pulled Thursday, making her much more mobile, and she no longer has to drag an I.V. pole with her. She's still restricted to the sterile hall of BICU, though, which she finds boring. The walks also led to an interesting event today- Nikki saw her face for the first time, in the reflection of a large picture in the hallway. This was especially interesting, as the nurses and I had just discussed the night before that it was time to let her see her face & help her to cope with it. This was supposed to be a topic of discussion for the doctors on Monday.

There are no mirrors on BICU, for obvious reasons, and we haven't offered her one up to now. I was with her on this walk, and I just started pointing out and explaining the work done to her face, neck and head. Now, her face really doesn't look bad, especially considering how it *did* look. However, she does have several suture lines, which look pretty icky with the black suture and blood dried on them. Also, the grafts still look a bit different from the rest of her skin, and really stand out. I explained how the joins between graft and ungrafted skin will virtually disappear when the sutures are removed, and the incisions cleaned. I also pointed out how her skin looks more "pink" every day, as blood vessels continue to grow in to the grafted skin. I admitted her right eye looks like hell, but pointed out the new lower lid & grafted upper lid- which both look great. She noticed that her right ear is only about half its original size, but commented that it still looks like an ear, and besides, she always wears her hair long & over the ears, anyway. Bottom line- she didn't seem unduly bothered, so I hope this attitude continues.

The nurses (and a few docs) have commented all along that Nikki seems unusually strong and resilient during her recovery from a truly traumatic injury. She almost always does more than is asked of her, and likes to do things on her own. The staff isn't just being supportive- they mean it. There's no doubt that she's progressing ahead of schedule, partly due to youth, a strong will and a good attitude. Of course, she has a few down moments… the other night, right after I helped her use the potty and get back to bed, she started crying quietly. When asked what's wrong, she sobbed "I can't feed myself, get a drink, or wipe my butt". I dried her tears, hugged her carefully and told her "I'd much rather feed you & wipe your butt ten times daily, than put a wreath on your grave even once." She smiled at that, and was better. Nikki is slowly understanding that she's very lucky to be alive after that terrible accident, and I hope that helps her to put everything else in perspective. I know from past patient care (and from being a parent) that you don't lie to a patient or child, but instead explain and clarify the situation.

No plans for this coming week that I know of. In another week or so, Plastics will be ready to separate her right eyelids. They'd like to do this in conjunction with some other surgery, to avoid anesthesia just for a relatively minor procedure. I'll find out more tomorrow, when I return to Cleveland.

Nikki has pretty well caught up on all of her cards and letters. She's still amazed at the volume, and of course, more come in every week. She's looking forward to getting back on a computer & chatting with some of the wonderful folks who have helped to support her (and us!) during her difficult times.

From Nikki, as well as Bonnie & me, another big Thank You to all of you.

8/26/2004
Almost daily, we get messages from people who have just found out about Nikki & want to know the whole story. Since not everyone has the time or knowledge to dig through the Daily Drool archives, I've decided to post all of my update messages to a web blog. The page also prominently displays the much-requested addresses to the hospital & our home. Hopefully, this will help the folks that only have part of the story so far. I'll add every new posting to this page as they occur.Thank you to everyone who has expressed interest in following Nikki's progress.

8/25/2004
Just a quick stop by home for a couple of real estate showings over the next two days. Yes, we're trying to sell our home, on top of dealing with Nikki. Back when our life was quiet and uneventful, we couldn't get a showing to save our lives. Now that we don't have time, we've had to turn down several. This week, we bit the bullet and scheduled two showings that we could make. Right after the last one tomorrow, Bonnie & I are back to Cleveland.

Many heart-felt thanks to everyone who has sent cards, letters and assistance in support of Nikki. She's really enjoying the cards, and we show her & read to her every card that she gets. She could read them herself, but her arms and right hand are wrapped & don't bend too well. She's amazed that so many people really care about her, without really knowing her. I've also had several requests for addresses again, as new folks become aware of Nikki's situation. Cards and letters can be sent directly to the hospital, as can appropriate gifts (stuffed animals, artificial flowers, etc). Other items should be sent to our home address.

For a change, Nikki should have an uneventful week, with no surgeries scheduled. This is healing time, both for her grafts and donor sites. She needs to grow some more skin to use in at least one more grafting surgery, where several small spots will need to be re-grafted. Plastic surgery was in today and removed the bolsters (large bandages stitched directly to an area) from her upper eyelid and back of her neck. These areas were grafted on Friday, and her doctors are very pleased with the results. They just want her to have "quiet time" for a while, to allow the grafts to stick & grow. Maxillofacial has also looked her over, laying some long-range plans for her facial repair in the future. The facial docs will attempt to use the suture lines already in place from plastics, minimizing scarring.

Nikki is now walking some, making a couple of trips between her room and the treatment room for her dressing changes (50 - 60 feet) over the last two days. Her changes occur once daily, take about three hours, and hurt a lot. I go through these with her, which really seems to help her. As planned, I have taken a personal leave from work in order to be with Nikki. I didn't qualify for FMLA (not employed long enough), so I'm taking a chance, as there's no position guarantee for me at the end of the leave. Things will work out there, though, and Nikki is more important to us.

Nikki also sits in a standard chair for up to 3 hours at a time. She's on a regular diet, although not eating much yet. She did eat a decent helping of mashed potatoes, mixed veggies & apple sauce today. She also gets a tube feeding during the night, which helps to kill her appetite. Her pain medication has been cut to 5mg/hr, and the sedative has been discontinued. She receives extra doses for her dressing changes, although she doesn't want much- it makes her sleep too long, she says.

We're back to the hospital tomorrow night, and will return home again on Sunday night. I'll give another update then, as there still seems to be a lot of interest from this group. Again, thanks to all of you for providing many shoulders for us to cry on, and to lean on.

8/22/04
Cards & letters keep coming in from Droolers and Cavalier people all over the world. When Nikki has to change rooms, it's going to be a really enjoyable pain in the butt to take down all of her cards to move them. It's starting to look like a basset and Cavalier paint job in there.

Nikki continues to do well, progressing as expected. She remains critical, as she still has some open burned areas & is at great risk of infection. She has been on strict isolation since admission, requiring full gowns and gloves during visits. During dressing changes, I also wear a hairnet and full face shield. She is fully conscious now, with a normal sense of time and a sense of herself. She's awake more than asleep, but still dozes around the clock, as do many hospital patients. She continues to get 8mg/hr of morphine and 1mg/hr of Versed for pain control- still a pretty hefty dose. The infected areas of her grafts have cleared up nicely, due to aggressive antibiotics and dressing care. No temps now for a few days.

On Friday, plastic surgery worked on Nikki from 10:15am to 6:30pm. During this session, they grafted her forehead, upper-right face, upper-right eyelid and the front & back of her neck. All of this skin came from her scalp, which was largely untouched in the accident. It's amazing how much skin they got from there. These were "full sheet" grafts, where the skin was transferred in large, single pieces to the desired area. This gives the best looks after healing, but is an uneconomical use of skin. Most grafting is done by punching small holes in the skin, allowing it to be stretched over a wider area. These holes are typically on a 2-to-1, or even 3-to-1 basis, greatly increasing the coverage of a piece of skin. Problem is, it looks a little like a tire tread mark when it heals- not bad, but not entirely natural. When grafting to highly visible, "look conscious" areas (face, neck), single sheet grafting is preferred, leaving no 'tread marks'. Stitches, rather than staples, are used for this detail work. She has hundreds of finely spaced stitches running around her scalp. Scarring from these will be minimal, with stitch lines following existing wrinkles and areas of skin shading. These guys really know their stuff!

Her forehead looks great. The area where doctors first thought she was burned to the bone actually had one last layer of tissue covering the skull, and they have high hopes that the graft will stick. It's already turning pink today, which means a blood supply is growing into the new skin. The neck areas are iffier, since every little head movement stresses them some. There will probably be partial success there, but we'll have to wait and see.

Nikki woke up quickly from this one, with no intubation needed after surgery. The plastics surgeon had a nice conversation with her on the operating table, immediately after finishing her. He really loved her personality & sense of humor, especially considering her surroundings. When Bonnie & I got to her room at 7pm, Nikki woke right up for us. Her greeting? "Dad, this sucks.... my head really hurts. Can we go home now?" The next day, she felt much better, and the three of us watched quite a bit of the Olympics over the weekend.

Nikki is on a regular diet now, but not eating much. She still gets a tube feeding, and isn't very hungry. Also, after 4 weeks of not eating, her stomach has shrunk a lot. I got a couple of bites of a noodles & cheese dish down her yesterday, along with a decent helping of peaches and a bite of green beans. She isn't allowed water; only electrolyte-replacement drinks like Gatorade, Boost and milk. Some of her 'lytes are low, and the docs prefer oral replacement to I.V.

This should be a week off for Nikki, a time for us to concentrate on her dressing changes and wound care. This is a daily ritual, hated by any and all burn patients. Simply put, it hurts- a LOT. Dressings stick to open burns, and when they're pulled off... well, you can imagine. Tears for most folks, screaming, cursing and thrashing for a few. I go through every dressing change with her, helping her to relax and concentrate on other things. We get a few tears and some grinding teeth, but that's it. This takes about three hours each time. It's not pretty, and it's not easy to watch, but I can take it as long as she can.

At least one more burn surgery is needed, to cover a few small areas. Maxillofacial surgery also still waits, to repair her broken face... one long, or two shorter procedures, along with lots of plastic and scrap metal. Several plastic surgeries are likely, some in the near future, others over a period of years. At the end of all this, a period spent in a rehabilitation center- in Columbus this time. Then, home to live with us until she can get out on her own again.

Thank you to everyone for the support and help you've given. Nikki is starting to look at her cards (with our help) and she's really enjoying them. She's amazed at the number she's gotten, and the locations they've come from. Your good wishes perk up all of us, and we gratefully appreciate all of you.

Intensive Care: July 30th - August 15th, 2004

2009-05-11T06:44:00.000-04:00

8/15/2004
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.

The Revelation: July 27th, 2004

2009-05-11T06:41:00.002-04:00

7/27/2004
We're home to Columbus for a few hours to get more clothes & things, then I'm back to Cleveland, while Bonnie stays behind to keep her business and our house going. Many, many thanks for the several dozen messages that I found waiting from Daily Drool friends, both old and new. The messages mean a lot to Bonnie and me. A quick update on our daughter Nicole...

Nikki is our youngest daughter (age 25), and has been working in Cleveland since October to help open the new Cheesecake Factory there as the head bartender. Friday morning at 2am, while driving home, Nikki somehow hit the back of a tractor trailer in her 2002 Dodge Neon. Her car exploded on impact, sliding under the trailer and becoming lodged there. She was dragged for some distance before the trailer could pull over. Several people stopped to help remove Nikki from the burning car, pinned underneath the trailer. She was life-flighted to Cleveland's MetroHealth Medical Center, a Level 1 Trauma Center.

The bad news.... Nikki has uncounted broken bones in her face. From the upper lip to her eyebrows is broken. She had a couple of large lacerations there, which were stitched. She has 1st & 2nd degree burns around her face and scalp, which don't appear to be disfiguring, although she has a good chance of losing her right ear. Most serious are her 3rd degree burns, covering 45% of her body, mostly on her back and the backs of her arms and legs. The best guess is that her car seat was burning, with her trapped in it. Nikki is relying on a respirator to help her to breathe. She is not comatose, but is very fuzzy, due to high levels of pain medication and relaxants. She is in critical, but stable condition.

The good news.... Nikki has been alive for four days now. Internally, she's fine... heart, lungs, kidneys and liver are functioning normally. Her brain has checked out fine through two CT scans. Her spine and neck appear OK, and she has no broken bones, other than the face. She started reconstructive surgery today, with a 5 hour grafting procedure on her back. Burned, dead tissue was excised down to the living tissue- which happened to be muscle, meaning that all layers of skin were destroyed. Cadaver / donor skin was placed over these areas, which were very large. This donor skin will be rejected in 2 - 3 weeks, but should give her tissues some protection and prepare the area for proper skin grafting later.

On Wednesday, traditional grafting will be done on her arms, right upper chest and legs. Tissue from the front of her legs and her abdomen will be grafted onto the newly-excised burn areas. If she tolerates this well, on Thursday the facial surgeons will peel her face down below her nostrils & attempt to repair all of the damage there in one large procedure. On Friday, yet more grafting is planned. Then, a week or so of recuperating and re-evaluating. Afterwards, more surgeries, for some time to come. Each of the surgeries this week will involve a great deal of blood loss- up to 10 units of blood will be available for each procedure.

You can see that Nikki has a rough time ahead of her. In her case, 'Critical' certainly means near-death, and she's not out of the woods. She will be hospitalized in Cleveland for at least 2 months, then transferred to a rehab center here in Columbus. After that, she'll be living with us, until she's able to be on her own again.Many thanks again for the kind thoughts and many messages. We'll be keeping all of these to share with Nikki at a later time. Your caring makes a big difference to us.

The Accident- July 23rd, 2004

2009-05-11T06:31:00.000-04:00

At 10:00 this morning, I was at the grocery store doing some shopping for my wife. I received a phone call from my oldest daughter Jessica, crying, saying that I had to get home now. Something had happened to Nicole, my youngest daughter, currently living and working in Cleveland. I abandoned my grocery cart and raced home, only 5 minutes away. When I arrived, my daughter was on our deck with a police officer. My wife, who does childcare in our home, was sitting with her small kids, crying.

The officer told me that Nikki had been in an extremely critical accident. She was badly burned, had numerous broken bones, and they didn't know if she would live. Her car, which was in my name, was destroyed. The accident happened at 2:00am this morning. It had taken this long to trace the vehicle back to us here in Columbus. The police did not know Nikki's name or address, as all of her ID had burned in the accident. She had been flown to Cleveland's MetroHealth Medical Center and admitted as "White Female, Unknown".

Nikki was driving home from work in her 2002 Dodge Neon. While heading westbound on Cleveland's I-480 bypass, near Lee Highway, she somehow hit the back of a tractor trailer at freeway speeds. Her small car exploded into flames on impact, becoming lodged underneath the trailer. The driver didn't notice at first, going another quarter mile or so before pulling over. The car was fully engulfed in flames by now. Several people had stopped to help. Three men finally succeeded in getting Nikki out of her seat, through the back door. Her car seat was burning, and her seat belt was stuck, making extraction difficult. The men reported seeing Nikki thrashing around inside the car, conscious and on fire. Without these good Samaritans, Nikki would almost certainly have died.

By now, Cleveland Police knew who Nikki was and who we were. Shortly after the officer left, I received a call from Dr. Charles Yowler, Director of Trauma at MetroHealth. He was a pleasant, no-nonsense man, who didn't sugar-coat the situation. Nikki was burned over 45% of her body. Most of the bones in her face, especially around the nose and eyes, were broken. CAT scans did not show any brain damage or internal injuries. They had worked until this moment to get Nikki stable. She was critical, but in stable condition. Her outcome was uncertain, and death was still a distinct possibility.

I stumbled and stuttered through his conversation, saying we would be up soon. Dr. Yowler stressed several times to take our time, get our affairs in order, and then drive calmly to Cleveland. He asked if someone could drive us there, but I insisted I'd be OK to drive after I settled down. In any event, it would take us a few hours for my wife to call parents and for us to make arrangements for our house and pets.It was nearly 3:00pm before we could leave. The 2 ½ hour drive took an eternity, and Bonnie and I were nervous wrecks the whole way. We'll update everyone after we find out what's going on.