Monday, November 23, 2009

Monday, November 23

Bill's sedative is starting to wear off so he woke up some today.  I put it that way because I think he is still foggy from the sedative and will continue to be for a few days.  He would wake up for awhile and then fall back asleep.  He would open his eyes and would answer yes or no questions, although not always in a way that made sense.  The pain medicine has also been greatly reduced and they tell us that is to determine if he has any lung function.  So far we don't see any evidence of that, but these things take time.

I want to state that again- this recovery is going to take a long, long, long time.  We won't know anything about the extent of permanent damage for a long, long, long time.

He had a couple of episodes today where his heart rate dropped and he started gasping.  This was quickly remedied with dopamine (I think) and when I left him tonight he was fine.  There is still (and will continue to be for a couple of weeks) a lot of swelling in his spinal cord in the areas that control his heart.  He is getting better, but this is a long process.  We won't know for some time whether or not he will always need medication or even a pacemaker to control his heart.  That is a possibility, but we don't know yet.

Tomorrow he will have the tracheostomy surgery.  This involves cutting a hole in his throat, through his windpipe, and putting the ventilator tube there rather than in his mouth.  We knew this was coming and he will definitely be more comfortable with this set-up.  This also gives his doctors more flexibility to wean him off the ventilator, which we hope will be the case.  Please remember that until the swelling in his spinal cord goes down we won't know if he will need a ventilator for the rest of his life or not.  They will also move his feeding tube tomorrow so that it goes directly into his stomach rather than through his mouth.  Also, this will be much more comfortable for him.

We talked to a couple different surgeons last night and tonight about his initial injuries.  Cervical vertebrae 1-7 were displaced (meaning that they no longer are neatly and evenly stacked one on the other) and there are major fractures in the facets of the spinous processes of C5 and C6.  There is a transection in the spinal cord at C5 and bruising all the way up to C2 or C3.  The surgeons fused C4 and C6 together with a plate, some rods, and lots of screws.  There is nothing that can be done for the spinal cord except stabilizing the cervical vertebrae and waiting.  This is all a bit ominous.  He was administered methylprednisolone approximately 8 hrs and 48 hrs following the initial injury.  This is a steroid that may or may not reduce damage to nerve cells and decrease inflammation near the site of the injury.  That is as far as I've gone in regards to researching this kind of injury.  You are more than welcome to Google away, but I don't really want to hear about what you've learned.  At least not yet.  The only thing we know for sure about this type of injury is that it takes a lot of time before we will know anything for sure.

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