Sorry this post is so late but I wanted to talk to the surgeon before posting about the surgery. Luke did have surgery on his leg this morning but it didn't go as planned and as I posted yesterday. The damage to his upper leg was more extensive than originally thought and when they opened it up they found two areas of concern. First the muscle tissue on the inside of the leg had more dead tissue so they removed that and cleaned up that area. Second, they found the section of the femur from the fracture down also was dead and they had to remove it as well. The end of the bone at the fracture was viable so there shouldn't be any more problems there. After cleaning the leg up they put a vacuum bandage on it, but didn't close.
They will do another surgery, probably Sunday, to move the bone to the center of the muscle tissue and bring the muscle tissue together at the end. Somewhere down the road there will be another surgery to shape the end of the bone to make it receptive for a prosthesis.
So, today was another unexpected turn in the road for us, but we are assured that God is in control and His timing is the only timing that counts.
They removed the staples from the incision from his spleen removal and that looks good.
After the surgery they put in a pick line. This is a long term IV line that goes in the arm above the elbow and runs up and into the upper chest. That process went fine and later on in the day they removed the other IV line in his neck.
When we went in to see Luke around noon all his vitals were really good, but his temperature did rise through the afternoon.
They continue to work on him with the respirator. His lungs seem to be getting a little better each day. The last culture on his blood didn't show any infection, but he did get a positive on his sputum culture. His Kidneys continue to improve as well.
---Bill
Thursday, November 13, 2008
Wednesday, November 12, 2008
Day 16 - Doing Better
After Luke's blood pressure took another dive during the night last night, he had a much better day today. His lungs are sounding better and his blood pressure has been good all day along with his heart rate and oxygen concentration.
The physical therapist stopped in this morning and worked him through a series of exercises. This was his second session with her and Monday he was more responsive than he was today but she still put him through the paces.
I was able to find out why Luke needs to go back for another surgery on his left leg tomorrow. When they did the last surgery, they put a plate over the fracture of the femur. They left as much bone as they could and still have the minimum three screws below the fracture. Their hope was that they would be able to preserve enough muscle tissue to cover the bone. It turns out because of the extensive tissue damage there wasn't enough. One option would be to have plastic surgery work with it but it would require several surgeries and probably would have problems down the road. The better solution is to go back in, remove the current plate and replace it with two shorter plates, one on each side of the bone with two screws on each side below the fracture. This will give them the minimum number of screws to keep the plate secure. They can then take a little more of the bone off and use his muscle tissue to cover the end. I don't know the time he will be going to surgery as it will depend on how many emergencies come in during the night.
We found out today that Luke was approved to receive leave time that can be donated from any Department of Homeland Security employee. Already from the Imperial Beach station there has been two months donated. Their goal is to have two years donated to Luke. What a tremendous blessing!! We thank all who have, and who will give their hard earned leave, so Luke will have one less thing to worry about.
---Bill
The physical therapist stopped in this morning and worked him through a series of exercises. This was his second session with her and Monday he was more responsive than he was today but she still put him through the paces.
I was able to find out why Luke needs to go back for another surgery on his left leg tomorrow. When they did the last surgery, they put a plate over the fracture of the femur. They left as much bone as they could and still have the minimum three screws below the fracture. Their hope was that they would be able to preserve enough muscle tissue to cover the bone. It turns out because of the extensive tissue damage there wasn't enough. One option would be to have plastic surgery work with it but it would require several surgeries and probably would have problems down the road. The better solution is to go back in, remove the current plate and replace it with two shorter plates, one on each side of the bone with two screws on each side below the fracture. This will give them the minimum number of screws to keep the plate secure. They can then take a little more of the bone off and use his muscle tissue to cover the end. I don't know the time he will be going to surgery as it will depend on how many emergencies come in during the night.
We found out today that Luke was approved to receive leave time that can be donated from any Department of Homeland Security employee. Already from the Imperial Beach station there has been two months donated. Their goal is to have two years donated to Luke. What a tremendous blessing!! We thank all who have, and who will give their hard earned leave, so Luke will have one less thing to worry about.
---Bill
Tuesday, November 11, 2008
Day 15 - Some Good, Some Not So Good
Late addendum: Further detail on Luke's "respiratory condition" - Monday evening the oxygen concentration in the blood, which optimally is 100, had dropped a little. I noticed when we left him it was down to 93. It continued to drop through the night, so the oxygen percentage in the ventilator was increased. That is what led to the x-ray and brachioscope done today. They were able to decrease the oxygen percentage through the day and when we left this evening it was at 65%.
This afternoon his blood pressure took a dive and they stopped his ativan (sedative) and fentenyl (pain medication) and increased the IV saline solution. He responded and by this evening it was back up to around 100/65. He was resting comfortably during our visit.
Luke begins week three with another trip to the O.R. but it was a brief one and not a lot was accomplished. The doctor said that his respiratory condition wasn't good enough to fix everything on his hand, but they did put pins in his thumb to keep those bones straight.
They took x-rays of his chest and his lungs appeared cloudy so they did another brachioscope and found some lesions in his right lung. These are probably from an infection so he'll be getting more antibiotics to clean that up. The scope also showed some plugs and they removed those.
The kidney doctor stopped in this afternoon and told us that his kidneys are doing better.
Luke will be going back to surgery on Thursday for his left leg. The muscle tissue must have retracted more than expected and they are going to have to remove a little more of the bone in order to be able to get a good covering of muscle over the end.
They keep fine tuning his pain medication and sedative up and down to meet his needs at the time. He remains pretty much sedated with some movement and responding to voices and occasionally partially opens his eyes, but not enough to focus or make eye contact.
After two weeks he has come a long way and of course we would like to see giant leaps forward every day. However, some minor steps backwards must be expected and the Lord is giving us a good exercise in patience as we wait for the next forward leap.
---Bill
This afternoon his blood pressure took a dive and they stopped his ativan (sedative) and fentenyl (pain medication) and increased the IV saline solution. He responded and by this evening it was back up to around 100/65. He was resting comfortably during our visit.
Luke begins week three with another trip to the O.R. but it was a brief one and not a lot was accomplished. The doctor said that his respiratory condition wasn't good enough to fix everything on his hand, but they did put pins in his thumb to keep those bones straight.
They took x-rays of his chest and his lungs appeared cloudy so they did another brachioscope and found some lesions in his right lung. These are probably from an infection so he'll be getting more antibiotics to clean that up. The scope also showed some plugs and they removed those.
The kidney doctor stopped in this afternoon and told us that his kidneys are doing better.
Luke will be going back to surgery on Thursday for his left leg. The muscle tissue must have retracted more than expected and they are going to have to remove a little more of the bone in order to be able to get a good covering of muscle over the end.
They keep fine tuning his pain medication and sedative up and down to meet his needs at the time. He remains pretty much sedated with some movement and responding to voices and occasionally partially opens his eyes, but not enough to focus or make eye contact.
After two weeks he has come a long way and of course we would like to see giant leaps forward every day. However, some minor steps backwards must be expected and the Lord is giving us a good exercise in patience as we wait for the next forward leap.
---Bill
Monday, November 10, 2008
Day 14 - R & R
Luke had a day of rest and recuperation today. His biggest activity was a breathing exercise this morning. Paula was there to talk him through it, encouraging him to take deep, slow breaths. He will have another one later this evening.
He will be going in for surgery tomorrow morning to repair the broken bones in his left hand. He also needs some more work on his leg to have more muscle covering the end of the bone. They may do that while they have him in the O.R.
Today he followed the same cycle that he has the past couple of days. His temperature is down in the morning but through the course of the day gets up to over 101°. They took more cultures today of his blood, urine and sputum.
He does respond to some voice commands, but stays in a sleepy state. Continue to pray for the infection and his surgery(ies) tomorrow.
---Bill
He will be going in for surgery tomorrow morning to repair the broken bones in his left hand. He also needs some more work on his leg to have more muscle covering the end of the bone. They may do that while they have him in the O.R.
Today he followed the same cycle that he has the past couple of days. His temperature is down in the morning but through the course of the day gets up to over 101°. They took more cultures today of his blood, urine and sputum.
He does respond to some voice commands, but stays in a sleepy state. Continue to pray for the infection and his surgery(ies) tomorrow.
---Bill
Sunday, November 9, 2008
Day 13 - Looking Better!
Luke had the tracheostomy this morning. He looks so much better! No more tubes in his mouth with his lips swelled and chapped. He does have his small feeding tube going in through his nose to his stomach.
He is being kept sedated today and tomorrow until he goes in to surgery again on Tuesday to do repairs on his hand. They plan to bring him out of sedation early tomorrow morning for a brief time to get it out of his system. If they keep him in constant sedation the sedative will build up in his tissues and it will prolong bringing him out when he is ready. For now he is resting comfortably. His temperature was down this morning but went back up this afternoon. He is still probably fighting the bacterial infection. Continue to pray for that.
They didn't do a sprint this morning since he was going for the tracheostomy. They won't do one tonight either, so he can rest. The respiratory therapist was in this afternoon and did a suction on his lungs and got virtually nothing! Thank you, Lord -- prayers answered again!
---Bill
He is being kept sedated today and tomorrow until he goes in to surgery again on Tuesday to do repairs on his hand. They plan to bring him out of sedation early tomorrow morning for a brief time to get it out of his system. If they keep him in constant sedation the sedative will build up in his tissues and it will prolong bringing him out when he is ready. For now he is resting comfortably. His temperature was down this morning but went back up this afternoon. He is still probably fighting the bacterial infection. Continue to pray for that.
They didn't do a sprint this morning since he was going for the tracheostomy. They won't do one tonight either, so he can rest. The respiratory therapist was in this afternoon and did a suction on his lungs and got virtually nothing! Thank you, Lord -- prayers answered again!
---Bill
Saturday, November 8, 2008
Day 12 - Slow But Steady
Luke is holding steady today with slight improvement in a few areas. His urine output remains good and his creatinine levels continue to drop so his kidneys are doing better.
This morning he lasted an hour on his sprint. His lungs are also holding steady but he's not breathing strong enough yet to be off the ventilator. He has about reached his limit for having the breathing tubes going in through his mouth so they are going to do the tracheostomy at 9:00 PST tomorrow. He will be alot more comfortable with that. They have not yet removed the last chest tube.
The orthopaedic doctors rewrapped his left leg this morning. They may have the plastic surgeons check the leg as the skin graft may not completely cover the area.
Luke was also at his limit for the IV lines going into his right hand and arm, so they put a central line into a vein in his neck to give him his medications.
He still has the bacterial infection so today they moved him back to a single room and we have to put the gowns on to go in. Pray for Luke to get over this infection so his temperature will go down.
Luke was restless today and tried to sit up. But he was having a lot of pain so they increased his pain medication and sedative. He was resting better this afternoon.
---Bill
This morning he lasted an hour on his sprint. His lungs are also holding steady but he's not breathing strong enough yet to be off the ventilator. He has about reached his limit for having the breathing tubes going in through his mouth so they are going to do the tracheostomy at 9:00 PST tomorrow. He will be alot more comfortable with that. They have not yet removed the last chest tube.
The orthopaedic doctors rewrapped his left leg this morning. They may have the plastic surgeons check the leg as the skin graft may not completely cover the area.
Luke was also at his limit for the IV lines going into his right hand and arm, so they put a central line into a vein in his neck to give him his medications.
He still has the bacterial infection so today they moved him back to a single room and we have to put the gowns on to go in. Pray for Luke to get over this infection so his temperature will go down.
Luke was restless today and tried to sit up. But he was having a lot of pain so they increased his pain medication and sedative. He was resting better this afternoon.
---Bill
Friday, November 7, 2008
Day 11 - More watching and waiting
Late night notes: Luke had another sprint tonight, which is what they call his breathing exercises. He is steadily improving by taking slower and deeper breathes. His blood sugar level is better and they reduced his dosage of insulin and they may stop it tomorrow. His drain from the spleen surgery is gone. The left chest tube remains but the suction has been shut off. This will most likely be removed tomorrow.
Things are pretty much the same for Luke today. When we got in to see him this morning, they had stopped the sedative for a while. He was moving quite a bit and would react to our voices but still no eye contact. He is receiving insulin today to get his blood sugar back to a normal range. He's still fighting a temperature and it did drop while we were visiting with him. His temperature, in addition to his blood pressure and heart rate all seem to be riding a roller coaster.
They are planning on removing his other chest tube and the drain from his spleen removal surgery today. It appears the hole in his left lung has now healed. They will take an x-ray later today to check it and if confirmed they will remove the chest tube.
They have postponed the tracheostomy until Sunday. There is still the possibility that his lungs will recover enough in the next two days that it won't be necessary. That is our hope.
---Bill
Things are pretty much the same for Luke today. When we got in to see him this morning, they had stopped the sedative for a while. He was moving quite a bit and would react to our voices but still no eye contact. He is receiving insulin today to get his blood sugar back to a normal range. He's still fighting a temperature and it did drop while we were visiting with him. His temperature, in addition to his blood pressure and heart rate all seem to be riding a roller coaster.
They are planning on removing his other chest tube and the drain from his spleen removal surgery today. It appears the hole in his left lung has now healed. They will take an x-ray later today to check it and if confirmed they will remove the chest tube.
They have postponed the tracheostomy until Sunday. There is still the possibility that his lungs will recover enough in the next two days that it won't be necessary. That is our hope.
---Bill
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