Day 4: Scott's in surgery March 17, 2012

Quick little post while Scott is in surgery.

The trach and PEG (feeding tube) have been inserted successfully and the plastic surgeon is now doing his job stabilizing his mandibular fracture.  We are anticipating him to be done about 2 pm AZ time.  We are glad to have this final surgery (we hope) done, so they can move forward more aggressively in weaning him from artificial ventilation.  They have had to put plans on hold until after his surgeries were done.  He will have one-two more surgeries to remove the PEG and trach, but.... those don't count?!?

We have been comparing different LTAC (long term acute care facilities) to transfer Scott to in Phoenix.  Basic run down of the potential transitions ahead:
1.  Currently in ICU for emergency procedures and to get him medically stable.
2.  LTAC to wean from the artificial ventilation.  It is highly unlikely he will be weaned from ventilation before leaving the ICU.
3.  SNF - Once he is weaned from ventilation, we may need to transition to a SNF, depending on his consciousness status.  If he is awake and strong enough to tolerate therapy 3 hours per day, we will transition to an acute neurological rehab unit.  If he is still unconscious, then he will need to transition to a Skilled Nursing Facility (SNF) first.
4.  Acute Neurological Rehab Unit - Once he is awake and ready to start his rehab to return his function, he will go here. Phoenix has several good neurological rehab centers, but they also have Barrows, which is world renown.  Scott has even introduced Ashley to it in the past (physically took her to it and introduced her to it...for no tangible reason.).  Crazy, huh?  Most of the other local rehab centers have been trained by the personnel at Barrows, so we think it best to go to the teacher rather than the student.  Plus, interesting coincidence... Scott's neurosurgeon here was on loan from Barrows, and we have been so incredibly impressed with him.  Even has some bedside manner....A neurosurgeon with bedside manner, really.... no lie!  In addition, everyone we have asked here has said that Barrows is the place to go.  Soooo.... we do know where we want to go for this step, Barrows.

We are still deciding on the LTAC facility.  It is nice to have this week or two to research them and make an informed decision.

One thing I thought of in the middle of the night.... on my final post last night I referenced the Korean Neurosurgery article, and said that Scott does not have Hypoxia or Hypotension.  I kind of misspoke.... Scott is on assisted ventilation and thus his SPO2 (oxygen saturation measurements) have not dropped below 97%.  They are consistently at 100%.  I do not know how they are measuring the hypoxia statistics cited.  Are they referring to SPO2 measurements, regardless of ventilation? or are they referring to independent, unassisted breathing SPO2 measurements? (Which we don't have measurements for unassisted breathing on Scott.)

Scott was quite fidgety last night, moving around a lot, trying to slide out of the bed and kicking things off that are attached to his bed, pulling at his ventilation tube and his chest tube, etc.... I was hoping that this sign of increased activity was a sign that his brain may be waking up soon, but the neurosurgeon said that there was no link.  Dang it!  Looking for any ray of hope!  They did increase his sedation as a result....

We do continue to see daily changes in the external things we can see easily with our eyes.  I love it, too, that each time we have a shift change, the new nurse comments on how much the swelling has decreased since their last shift 12 hours ago.  We hope and are choosing to presume that the internal healing is occurring at the same rate.  We see daily victories with everything, except the consciousness.  We know we have to "wait and see", we have to be patient (not my strong suit as many of you already know!)....  we have had thoughts that even though it is tough on us to have another day pass without regaining consciousness, we also know that the rest he is getting is extremely critical for the brain healing process.  We are happy to accept the discomfort of waiting if it means his brain is healing and getting stronger.  So... we are trying to remain positive and hopeful.  Trying to keep our spirits and our strength up.  That is where all of you are helping so tremendously...more than you could possibly know.  The outpouring of love and support has definitely lifted our spirits. And we know that it has been so hard for many of you who want to tangibly help in some way....but be reassured you are truly helping.  And... as Scott progresses through the various stages and regains consciousness, that is when more tangible help will be needed.  There will be an opportunity and a true need down the road..... And I know that he will be buoyed to feel the outpouring of love that has been showered upon him this week.  It will help to keep his spirits high in order to push through the arduous rehab process.

Oh... cute little things I noticed during the night...  He was doing fine motor movements.  Grabbing the end of his hospital gown with a pinch like grasp using two fingers to  pull his gown down.... and picking at little things on his face.  It was just kinda' cute to watch....

The surgeon just entered the room.  Scott is done with surgery.  The surgery took much less time than anticipated.  The MD said it went well, it was uncomplicated and it is rock solid.  So... 3 weeks of a soft diet (Which for now is all done through a feeding tube anyway), then he can return to normal foods gradually.  Good news!  They are just now wheeling him into the room, so I need to sign off.  I will log on again later.... Sounds like a successful day.

Oh... I keep forgetting to mention... if anyone has questions they would like answers to, feel free to ask them in the comments section or my email (pjdn150@gmail.com).  I am now accessing my email once a day.  I will be happy to answer what I can and find answers to those I can't.

We love you all!
Patti