Another good day
First off- let me apologize for whatever I did that made the first set of photos disappear... I can't seem to fix it. If you want all of them, let me know and I will email them. (In the end, I will probably print everything as a book with pictures for anyone who wants.) Also sorry about the delay in this post, just had to take last night for rest.
Now, to the real meat of the matter...
Yesterday morning when we went in, Mom seemed to be a bit better. The swelling was definitely down on her face and hands. The bruising is better and worse- as the swelling is down, the colors are changing and Mom now has the cheeky yellow mask of a raccoon (see photo below).
Yesterday morning,we lucked into being in the room when Mom's faculty attending came in for rounds with his students. He is a very nice man named Dr. Doucet and was very helpful to us. He explained that Mom had not failed weaning the vent the previous day because of lung issues but instead because they were concerned that she would tire too much from the pain from her rib fractures. He said they had decided to just let her rest overnight. That morning, while he was rounding the students, they did something called sprinting. Sprinting is where they take away all the ventilator support except a little leftover pressure assist to see how the patient does and if they wear out. Mom did GREAT on her sprints, as anticipated but was on 10 and 5 (for the criticalists reading the post) and they really like them to be at 5 and 5 before they extubate (remove the tube). He said probably not that day but maybe the next.
He also was able to give us some information on the ankle fracture. It is a nasty, complicated intraarticular (involving the joint) fracture called a Pilon fracture. This type of fracture ONLY can occur when severe vertical force drives the ankle bone into the shinbone (Thanks to Sarah for the internet search on the fracture type!). Given the anatomy of the ankle, this suggests that Mom was hit from behind with the force driving her ankle into itself as it sent her flying. Generally it is repaired with multiple plates. This type of fracture commonly leads to arthritis since it involves the joint but it only has about a 10% rate of arthrodesis (joint fusion). It is often an open fracture (bones sticking through the skin) which Mom's is not. Given the information we now know about the fracture, it is reasonable to except that Mom probably won't be able to run but she may be able to bike and will definitely be able to swim. It is something they will address in 'a bit' once she is a candidate for elective surgery. Whew! What a lot of medical talk!
Later in the day, we scored another special gift. Mom has a new critical care doctor, Dr. Brown. This doctor is not responsible for her primary care but is responsible for her critical care. His manner reminds me a little of Sydney Friedman (the psychiatrist from MASH), something Mom can appreciate. He is just wonderful and was a good questioner (What is she receiving through this line? Does she really need this line? Is she still at risk of X and if not, why is she still on this type of bed?). The upshot of this is that yesterday afternoon they pulled her central line (the catheter that is in her jugular vein at the level of her shoulder), replaced an old catheter, moved Mom to a more comfortable bed and sat her up 30 degrees! And he basically said that today (Wednesday) would probably be the day to try her off the vent. He also was able to give us information on the follow-up CT.
Mom seemed to like him as well. He had her open her eyes and track him, give him a thumbs up with each hand (it was weany but better than I expected) and wiggle her toes. She was very compliant- a big deal for Mom.
More to follow but I just realized a lot of you are probably waiting for something to read-
Now, to the real meat of the matter...
Yesterday morning when we went in, Mom seemed to be a bit better. The swelling was definitely down on her face and hands. The bruising is better and worse- as the swelling is down, the colors are changing and Mom now has the cheeky yellow mask of a raccoon (see photo below).
Yesterday morning,we lucked into being in the room when Mom's faculty attending came in for rounds with his students. He is a very nice man named Dr. Doucet and was very helpful to us. He explained that Mom had not failed weaning the vent the previous day because of lung issues but instead because they were concerned that she would tire too much from the pain from her rib fractures. He said they had decided to just let her rest overnight. That morning, while he was rounding the students, they did something called sprinting. Sprinting is where they take away all the ventilator support except a little leftover pressure assist to see how the patient does and if they wear out. Mom did GREAT on her sprints, as anticipated but was on 10 and 5 (for the criticalists reading the post) and they really like them to be at 5 and 5 before they extubate (remove the tube). He said probably not that day but maybe the next.
He also was able to give us some information on the ankle fracture. It is a nasty, complicated intraarticular (involving the joint) fracture called a Pilon fracture. This type of fracture ONLY can occur when severe vertical force drives the ankle bone into the shinbone (Thanks to Sarah for the internet search on the fracture type!). Given the anatomy of the ankle, this suggests that Mom was hit from behind with the force driving her ankle into itself as it sent her flying. Generally it is repaired with multiple plates. This type of fracture commonly leads to arthritis since it involves the joint but it only has about a 10% rate of arthrodesis (joint fusion). It is often an open fracture (bones sticking through the skin) which Mom's is not. Given the information we now know about the fracture, it is reasonable to except that Mom probably won't be able to run but she may be able to bike and will definitely be able to swim. It is something they will address in 'a bit' once she is a candidate for elective surgery. Whew! What a lot of medical talk!
Later in the day, we scored another special gift. Mom has a new critical care doctor, Dr. Brown. This doctor is not responsible for her primary care but is responsible for her critical care. His manner reminds me a little of Sydney Friedman (the psychiatrist from MASH), something Mom can appreciate. He is just wonderful and was a good questioner (What is she receiving through this line? Does she really need this line? Is she still at risk of X and if not, why is she still on this type of bed?). The upshot of this is that yesterday afternoon they pulled her central line (the catheter that is in her jugular vein at the level of her shoulder), replaced an old catheter, moved Mom to a more comfortable bed and sat her up 30 degrees! And he basically said that today (Wednesday) would probably be the day to try her off the vent. He also was able to give us information on the follow-up CT.
Mom seemed to like him as well. He had her open her eyes and track him, give him a thumbs up with each hand (it was weany but better than I expected) and wiggle her toes. She was very compliant- a big deal for Mom.
More to follow but I just realized a lot of you are probably waiting for something to read-
posted by Jacqui at 8:13 AM
4 Comments:
Jacqui, if you want me to do so, I can post the 1st set of pictures on a server at Vanderbilt. Roland or Kelly can get you my email address. Let me know ...
Jacqui, having gone through a number of neuro issues with my husband, I want to tell you that this all sounds VERY GOOD!!! We will continue to pray and send all positive energy westward.
It is so good to see Mr. Schneller smiling and enjoying himself (as best as is possible given the circumstances)!!! We missed him SO much at practice Monday night!! Keep more pictures coming of smiling faces. And I want to see all of these balloons and decorations!! It is such wonderful news to hear that she might get taken off the vent today. As soon as I read that she had breathed in rhythm to the music on the CD (yesterday?), I smiled and thought, "yep, that's my director!!!" She's always big on rhythm with us.
Tell her I love her!!
Charlotte
Dear all,
This is Fouad Boulos. I used to sing with the community chorus until I got too busy at work. I just got an email from Barry about Pam's terrible accident. I don't know what to say except that Pam just knows how to bring people together, most often in songs and laughter, this time in tears and pain, yet always in everlasting hope and neverending love. Pam cannot but sing her way out of the hospital. My love and prayers go to all of you, and my thoughts are and will remain with you always.
Fouad
Post a Comment
<< Home