Day 3: Evening of March 16, 2012..

Hi folks,...  sorry not as many posts today.  Actually took time to eat lunch and to take a shower today instead of getting the extra posts in.  The other people in the room were pretty glad I made that decision!  My first shower since arriving here.  It's a small room, no where to avoid the inevitable stink!

We have been so uplifted by all of the comments, emails, phone messages, facebook posts (everyone knows I don't use my facebook, but Ashley does, so she gets them!  Thanks!), and prayers.  There are not words to describe the level of appreciation we have for all of the many efforts in Scott's behalf.  His name has been placed in numerous temples throughout the world (yes, I said world), he is on many many prayer rolls in numerous different religions, prayers are occurring frequently and fervently.... So many people have been touched by Scott in their lives and are reaching back. It is very comforting and uplifting.  We are saving all of the messages to show Scott when he wakes up.  We know that he will be so very touched by the outpouring of love and support!  Again, we are so eternally grateful for the amazing show of love that we have been showered with.

I finally was able to read the article that Bree sent (that I linked in a previous email).  It did provide some insight re: expectations in this small sample.  It is important to note that it was a very small sample of patients, and that Scott would not meet the criteria for this group because he also has an additional hematoma and a craniotomy, ...sooo... we are not comparing apples to apples, but... there are still some food for thought regarding prognosis and expectations.

For comparison sake,... here is a paragraph from the article.....
Hypoxia and hypotension ( Scott has neither of these conditions) have been known to be among the most important associated medical conditions with regard to outcome in severely injured patients^3,12,13,18). Initial GCS in patients with head injuries strongly correlates with outcome, especially a GCS score below 5, which is associated with a poorer outcome^6-8,12,16). (Scott's initial GCS score was 7 and is currently still a 7) Pupillary abnormalities such as anisocoria or bilateral pupil dilatation due to herniation have also been reported to correlate with poor prognosis^11,14). (Scott has no pupil changes) The duration of loss of consciousness has been shown to be strongly related with the outcome in some reports^16,18). (Scott is at 4 days and counting.) The correlation between outcome and MRI findings has been studied in several reports^9,10,15,16). Kim et al.⁹⁾reported an association between higher MRI grade and longer duration of loss of consciousness, but not statistically significant difference between MRI grade and outcome or clinical severity. Oh et al.¹⁵⁾ reported worse outcomes in patients with brain stem lesions shown on MRI but sizes of lesions were not consistent with outcomes. Kim et al.¹⁰⁾ reported more lesions on corpus callosum and brain stem in worse outcome in patients. And Park et al.¹⁶⁾ reported that 14.3% of patients with cerebral white matter lesions did not recover their consciousness and 50% of patients with corpus callosum lesions, 51.6% of patients with brain stem lesion did not recover their consciousness.  (Scott is a grade II lesion, diffuse cerebral white matter  in the upper hemispheres and corpus callosum lesion, no brainstem lesion, thank heavens!)

Again remember the limitations of this study, but it may help some of you to wrap your mind around it.  Oh...also.... Nate Larson, one of Scott and Ashley's good medical school friends, mentioned that the average range of time before awakening in the grade II group was 2 weeks, but there was a fairly wide range within that group.  The longest was 30 days, it was a 26 year old male.

New news this afternoon.... He had a 109 degree fever for a very short time.  It has been completely normal since, but yes, we did panic a bit.  Surgery is scheduled for 9:15 am tomorrow. They will insert the trach (which we are growing more grateful for each day.  As they are lessening the sedation, he is almost constantly pulling at his chest tube and his ventilator tube.  He will be a lot more comfortable with the trach inserted.)  and the PEG (peripheral endogastric) tube first, then they will perform the jaw surgery.

That should be the last surgery, barring anything unforeseen.  ...Well...other than removing the trach and the PEG tubes......  After that they will focus on stabilizing him, weaning him from ventilation, and creating a discharge plan.  They will transfer him via "air ambulance" (land ambulances do not have the ventilation capacity needed) to a Long Term Care facility in Phoenix.  The focus there will be to wean him off of assisted ventilation and get him strong enough to tolerate therapy 3x/day.  When he is strong enough, he will be transferred to an acute neurological rehab facility.

I'll sign off for tonight...and we'll "talk" again after his surgery in the morning.

Love you all!
Patti