Our chat with the Plastic Surgeon

Now that all of our proverbial "ducks" are in a row medically (had the ultrasound which revealed a clot in my right leg;  Had an inferior vena cava filter inserted and was started on temporary high-dose anticoagulants to deal with that clot;  Had an angiogram to give the plastic surgeon an idea of the vascularity in my lower extremities, three incision and drainage procedures, and began a course of prophalactic antibiotics), we are scheduled to go ahead with the reason that we're here at Froedtert.  

The plastic surgeon came by late Friday to discuss the 6-7 hr grafting / tissue transfer surgery that I will have tomorrow.    All the folks here speak of the wonderful work my plastic surgeon does.  He's young though... seriously looks like he could still be in high-school....well, truthfully, LOTS of the medical docs look incredibly young to me.   Guess that means I'm getting old.  ;)

Here's the Scoop :
I learned that, because the tissues surrounding my ankle are incredibly thin (feel them on yourself....there is hardly anything there), and the hardware/bone is directly underneath the skin,  I will be having procedure called a Free Flap.....in which the surgeon will transfer a portion of skin/fat or muscle from my thigh to cover the affected area of my inside lower ankle.  Again, because of the initial high-impact trauma to the soft tissues in my ankle and resultant swelling, this is apparently not that uncommon.  

As I (naturally) inquired about the extent of cosmetic damage and scarring involved with this surgery, Dr. Logiudice did state that it would be a bit bulky and may take several months to a year to look more "normal."   He went on to say that he will do his best to minimize cosmetic scarring (for example, obtaining tissue from as far up the inner thigh as possible, and pointing out that the inner ankle is a less obvious location than the outside of the ankle).  I segwayed a bit and told him about Jade and Kai who are both cleft-affected, and how, with Jade in particular, we are continually reminding her of how beautiful she is despite the keloid scarring on her upper lip.  I admitted that, despite all of my assurance to my child, now it is time for me to embrace this understanding and it is really hard.   

Dr. Logiudice gracefully reminded me that I literally smashed my ankle.   Really.  In his words:  "Chris if you would have had this climbing fall in another country, or even many parts of our own country [where there is no access to trauma center with cutting-edge medical technology], we would not even be having this conversation.  There used to be, and in some places still is no other option other than amputation."   (gulp...)  The term he used I believe was "limb preservation," and yes, we recalled that this is an acceptance thing and regardless of how ugly things may turn out, I really have no choice in the matter.   He smiled and reassured me that I will do fine.    Sigh...

Sometimes to get exercise while I'm here, I will do "laps" in the wheelchair around the 5th floor and through the other units.   Those include neuro, spinal cord injury, and stroke.   Lemma tell ya, when I get back to my room (despite how sore my ankle or sacrum is) I feel really blessed.   Man, some of those folks are lucky if they will ever be able to talk or feed themselves or breathe on their own again....ever.    I don't know how I would deal with that and hope I never have to.

Some people that I see here are always alone.   Every time I pass their room they are sitting in a wheelchair in the corner or laying in bed.  Really, really sad.  I am lucky to have a husband that has stayed with me nearly every night, and parents and a mother-in-law who we trust to take good care of our kids. I have wonderful family and friends who have stood by me every step of the way (excuse me as I wipe a tear while writing this...), salt-of-the-earth teachers at my son's school and staff at Scott's school who are bringing meals,  and even a great hairdresser who squeezed me in for a hilight when I pleaded with her that I want to feel somewhat like a human being as I lay in a hospital bed for a couple of weeks (she went all out on the stylin' then....thought she'd give me some "come hither" curls that Scott would enjoy.   Hee hee....)  

SO...tomorrow is a big day.   Am I scared?   Heck yeah!   One of the internists that drops by my room almost every day to check in said "you'll do some grieving."  I'm kinda preparing for that.  There will be some pain, of course, but that's what good drugs are for.   I'm mostly concerned about needing to continue laying in bed with my ankle elevated for the weeks to come and how my butt will handle that.   (I ain't got no booty and that won't change until I'm up and able to do steps and other things that strengthen the gluteal muscles). There will be a six-week recovery period in which I will need to keep my leg elevated at nearly all times. I also learned today that I will need to refrain from drinking coffee and eating chocolate (seriously) because caffiene constricts blood flow, and we don't want that to happen in an extremity like an ankle. I do think I'm gonna ask the surgeon if red wine is okay though....because I hear it actually helps with blood flow! We'll see.... ;)


Keep those prayers and positive energy comin'!

Setbacks and Stamina...

This morning Scott and I recalled that we have been going through this recovering thing since November 30th.   In a way, I had to take a step back and marvel at how really awful this whole accident experience has been and how far I have actually come (I tend to minimize things...for coping I guess).   Seriously.   An ambulance ride to the ER....where they cut off my clothing and climbing harness, hooked me up to a drip of dilaudid, and proceeded to put me through lots of uncomfortable tests and such.   I felt like, well....a marionette.   Intuitively, I knew that my pelvis was in bad shape because it wasn't connecting.  Luckily the medical folks knew what they were doing and they kept me pretty doped up.  

After all of the x-rays and CT scans, the verdict seemed a tad dire.... expressing that I should expect an 8-10 month recovery period, the resident orthopedic doc assured us of the competency of the orthopedic team and the brilliance of the orthopedic surgeon who would do my surgeries.   However, he emphasized what a horrible break my ankle / leg was......and in my medicated state, I don't know if I fully caught the magnitude of what he was saying.  (Scott did, because that was about when he passed out.   [BTW, we did get a $398 bill for that from Froedtert.])  From what I remember, the doc mentioned that I'd suffered a vertical shear type of pelvic fracture, including two fractured pubic rami and fractured sacrum which would require surgery, and may or may not result in neurological complications.   Then he went on to discuss the severity of my pilon ankle fracture and the potential related complications including:  loss of range of motion, osteoarthritis, deformity, implant-related problems, soft-tissue complications including infection and nerve damage, and amputation.   Naturally, that last potential complication raised my ire a bit, but I figured that it is the good doctor's job to spell out all worst-case scenarios to put them "on the table."  

I seem to have been very lucky in the sense that my sacrum "fit" back together well and there appears to be no evident nerve damage.   In addition, the doc was surgically able to retain the integrity of the "architecture" of my ankle .   It seems pretty miraculous that he was able to pull together remnants of bone to re-create the ankle structure.   With everything appearing to be going well, I did not anticipate a major setback.

Well....apparently the intense trauma of my fall created a great deal of swelling, which, while minimized by the staging of the ankle surgeries (3 weeks apart), continued nonetheless to create problems with the outer soft tissue healing...which is an issue because the bone will not heal unless the soft tissues surrounding it are healthy.   SO...we were surprised last week to see a few patches of necrotic (dead) tissue along the suture line which unfortunately have spread.   It was really gross (and scary) to see, and even scarier to talk about with the surgeon and physician assistant. 

The upshot is the need for further surgery (Monday)......to remove the affected soft-tissues in the hope of regenerating healthy tissue.   The good news is that there is good, vascular healthy tissue underneath.    Best case scenario:   The bad stuff is removed by a process called debridement, the area is washed and a vac is temporarily inserted to keep the area clean, and eventually skin is pulled up and stitched in place over the affected area.    Next best case scenario:   A skin graft would happen, in which a vascular tissue sample would be surgically removed from one bodily area (usually side or thigh) and is grafted over the affected tissue above the tibia.   This would be a longer procedure, lasting 10-14 days.  (It is important to clear the tissues of anything that might do damage to the tendons or the plating on the bone.)  The truth of the matter is that, well, we need to do whatever we have to do....no matter how much it sucks. 

I've always considered my legs to be one of my greatest assets.   This experience is leading me to re-define that.   It is leading me to re-define and re-think a lot. 

So, how are the kids holding up?   Today both of the kiddos had some challenging behaviors....lots of irritability and poor frustration tolerance.   This morning Jade broke down crying, looking at me intently while muttering "I don't want you to go in the hospital again."   I held her close and we cried together briefly....  I reassured her that I will be okay and that I will always be here for her, even if there are moments that I need to focus on my healing.    I also told her how much I miss running and playing with her and Kai.  (Boy was it hard not to let the dam open, but I managed to do okay).

Jade did mention that she has talked with the school guidance counselor twice since my accident.   The last time she said that she told Mrs. B that she was afraid that I would go in the hospital and never come back.   I reassured her again....(those old abandonment issues are always there) and she remarked that the best gift she can give is to do her best in school and not worry.  (I put a little love note in her lunchbox for tomorrow.  Shhhh ;) 

Kai....well, quite honestly I have felt lucky to have the help of family (Scott, my folks and Scott's mom) and his ABA therapists to deal with him because frankly, my reserve is quite low.   Folks have kindly suggested all along that I "let go" of feeling the need to constantly be there for his issues.   I guess this has been my "shot in the arm" to do just that.   

SO....tomorrow is a new day with lots of unknowns.   I am thankful for all of the healing that has taken place and the support, prayers and positive energy folks have sent my way!   This is a journey that I couldn't do alone.   I just keep pluggin' away and have a sense of trust that things will be as they are meant to be.

Breathe....

Thoughts on "Trauma"

I have been seeing the word trauma quite a bit lately.   Having ridden in an ambulance and ushered through the "trauma" departments of sorts....staying on the "trauma" unit,  hearing my doctors talk of the "trauma" to my ankle and body, etc.   Somehow my mind segways and I begin to think about psychological trauma....such as that which our son endured in his early years.   

I mentioned to the spine doctor yesterday that, despite the normal x-rays and CT scans,  my spine feels "different." For example,  I can turn my head and hear a slight crunch in my neck (which is normal, BTW).   Despite injuries becoming "fixed" or "healed" most folks say that things are still different.    That's just the way things are.  

This morning as I contemplate some of the quirks that Kai continues to have, I realize that these quirks are probably the result of his own trauma.    While we would like to gloss over or forget about the hunger, neglect, and deprivation of his early years, it will never be completely eradicated from his psyche.   He will probably always have "food issues" to some extent.   He may always be tiny.   He may always have problems with trust (although we certainly hope not.)   These things are the result of early trauma which can be helped through therapy, good nutrition and positive parenting, though not eradicated completely.     As I talk to other adoptive parents, this tends to be a common realization at some point.

With these things in mind, I realize that there are degrees of healing....We are always hoping for the degree that ends on the "cured" side.   Our resounding hope is that we have the great doctors and professionals to get us there, the nurturing to sustain us, and the internal strength and determination to carry-on.  

Patience...

I've come to the realization that I am not a good patient.   I am not a patient patient either.   Even my surgeon's and his tech said so.      First of all, every time I see the doc I have lots of questions.  (Apparently I'm supposed to just trust the doc and the healing process).   Granted, my surgeon is the "go to" guy for trauma surgery and is the best in the area.   He's got 25 years of experience, is the chief orthopedic surgeon and Vice Chair of orthopedics at the Medical College of WI.    But here's the thing.....I want to have a clear understanding of what is going on in regard to my injuries.   Vagueness doesn't help much, and my asking for clarifications should be welcomed and viewed as patient empowerment.   

Recovery is scary, painful and very uncomfortable....riddled with lots of unknowns.   I get that.   Perhaps I'm looking for reassurance, along with the thousands of other patients my surgeon has dealt with, and that gets old.   Perhaps it is a "personality thing"  and my doc doesn't have that "bedside manner".   Maybe he is not able to provide reassurance at this time because there are too many unknowns.   Truth be told, if given the choice, I would much rather have a top-notch surgeon than a "good enough" surgeon with a great bedisde manner.   So I should quit my belly-achin' right?

Here are images of the injuries.   The top is the back of a 3-D pic of my tibia fracture.   Yeah, it's pretty nasty (amazing how they can get such a great image though.). They call this a pilon, or tibial plafond fracture because of the crushing nature of the injury (literally translates into "mortar and pestle")    The bottom is a pic of my pelvic injury with repaired sacrum.






 

Pelvic injury to superior and inferior pubic ramus (on bottom left). 
Repaired sacrum (screws inserted).    X-ray taken while external
fixator was in place (since removed)

 They're anticipating that my pelvic injuries will heal on their own, while I continue on general bed-rest with minimal movement.    I'm able to sit up for 30-40 minutes at a time, but otherwise, need to be mostly horizontal with my leg elevated.  

Speaking of leg, here's an x-ray of my repaired ankle.   It is pretty impressive eh?

 

 

The doc mentioned swimming as a potential part of my rehab, and I questioned whether or not I will even be able to float, given all of that metal.  ;)

The thought is that it seems I am doing quite well, according to the nurse who comes to our home.   She also encourages me not to worry, and mentions that my lack of patience is a good sign that my body is healing.   Well......my fingers are crossed!