Saturday, August 6, 2011

Medical Update

What a week.  Trying to acclimate to hospital life has not been easy.  Every one at National Naval Medical Center has been wonderful, though.  It's just too much information to process at a time.  And in a few weeks NNMC will become Walter Reed National Military Medical Center Bethesda.  What.A.Mouthful.  The new Walter Reed is good enough for me.  Or Dr. West said we can call it Walter Reed Bethesda.
So the last few days.  We are on the rollar coaster ride of our lives and I want to get off.  We take a few steps forward, then a step backward, then a leap forward, then a few steps backward.  Cha cha, anyone?
Since the last update, he had surgery on Monday, Wednesday and Friday.  During all three procedures they did a wash out of his wounds.  The infections are still present.  He has e-coli, mrsa, pseumonas and abacter to name four.  There are a lot of fungi and infectious sources in the soil in Afghanistan.  When the soldiers are wounded, the soil gets inbedded in the wounds.  This is why they perform so many wash outs of the wounds.

One of Derek's wounds was to his abdomen.  He had internal bleeding, and because of all of the infections and the swelling of his wounds, they had not closed the abdomen.  Each surgery this week, they were able to close a little more, and today, Friday the 5th, the abdomen was finally closed.

Derek's right leg was amputated high above the knee.  I was told that they did not believe that there was enough skin to close the wound.  Guess what?  Today they closed it!  There is still a wound vac (which is a machine that washs the wounds with a bleach solution and sucks out the icky stuff - yeah, real medical term) attached to the bottom, but they got it closed!

On the left, Derek's amp is high, right up to the hip joint being removed.  They have not closed that wound due to the presence of fungus, BUT they have not had to remove any additional bone or tissue!  Yes!  We were very concerned after Monday's surgery that he would have to lose part of the pelvic bone.

The right arm is fractured and has a "shark bite" out of it.  They fixed the fracture with pins and a stabilizer, and they closed the wound on the outer part of the arm.  The inside of the arm is a completely different story.  That will require a graft of tissue and skin.

Derek's jaw is broken at the TMJ.  One side is sideways at the joint and the other side is fractured just below.  He also has a fracture by his chin and he lost several of his front teeth.  There was a little difficulty with the information coming from the general surgeon and the maxiofacial team.  The max team wanted to wire his jaw shut on Thursday to assist with the healing of his jaw, but the trauma team wanted to wait.  They wanted to wait because if the infection is not under control, it could attach to the hardward and have to be removed, cause the infection to travel to the jaw, or worse.... cause the infection to enter the bloodstream which could kill him.  But the max team said they would monitor it closely, and that if it was not installed, the jaw could set and have to be rebroken which would be horrible and painful for him.  I told them they better get it together because I needed them on the same page!  I also told them no hardware if there was ANY chance of the infection traveling to the appliance in his jaw.
The appliance will be installed in Derek's jaw next week, when they expect the infection will be under control.

They finally got the C-collar off on Tuesday and the dialysis catheter was moved because the one that was set in Germany malfunctioned.  In Germany, Derek was in acute renal failure.  His number was 14, and it is supposed to be 60.  Today it was up to 44!  Go, Derek!

Derek also has a lot of burns to his pelvic area that the doctors are confident will heal 100% after further treatment and skin grafts.  The biggest problem is that damn wound keeps leaking!  It cannot work properly if it keeps leaking!  This morning they reset it in the OR, but it didn't work.  The doctor came by and reset it in the room, and it worked for 15 minutes.  Then Super Nurse Tommy got it working!  At least it was working when we left.  Let's hope it holds.

Then the most disappointing was the extubation that didn't take.  Derek was extubated on August 3rd at 7:30 p.m.  He got to talk to us a little, and it was a little easier on him.  I will report on what happened when he was talking in the personal entry.  Unfortunately, he had difficulty breathing and coughing up the junk in his lungs.  At around 4 a.m. on the 4th, he was intubated again.  They told me that they would attempt to extubate him after the surgery Friday, or Saturday when he woke up.  No go.  The max team has decided that this could further injure his jaw.  If he had to be intubated again, and when he goes to Monday, he will be, they are taking a big chance on causing more harm to his broken jaw.  So, on Monday, they will install a trac, which is a tube in the neck at which they can attach a vent to help him breath.  He will also have a box hooked up that will help him talk easier when his jaw is wired shut.

I love the nurses on CCU.  LTJG Tommy McGuire is great.  He takes such good care of Derek.  RN Trista Blyther and Tommy are my favorites, so far, but they are all really good.  In the CCU each patient has his/her own nurse, so the patient gets the best, most attentive care possible.  So far our awesome nurses have been LTJG Cassandra Aeberseld, LTJG Priscilla Fehrer, LT Leonard, MAJ Dallas Weills, and then Jennifer, Penny and Lindsay, whose last names I forgot to write down.  Penny I named nurse nazi - she runs a tight ship and cracks her whip.  I don't mind because I know she is just considering Derek and his care.

The doctors have been great.  The only complaint so far has been the wound vac leaking constantly and the max team and trauma team taking a while to get together on whether or not to install the appliance.
Krystina and I spent the night in the room with him on Tuesday night.  I stayed on Wednesday, and my sister came to visit on Thursday and kicked me out!  She insisted that I rest and she spend the night, so Thursday and Friday nights, she spent the night.,

So, that's the medical update.  Since it is long, I am going to vent on the personal crap tomorrow in a separate entry.

Thank you for the continued support and prayers.  It really means so much.

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