Update #150

As long as you promise not to leave angry comments if this happens to change...

[Drum roll please] Dave's discharge date is...next Tuesday, January 6, 2009, exactly seven months after his accident. The date is just a rumor at this point - Dave's psychologist had a spy do a little research for us - but hopefully we will get confirmation tomorrow. Craziness!

PT was at 7:30 this morning - ugh! I hadn't had enough coffee at the point to hold a camera straight to video Dave walking, and honestly, I don't think he would have been very happy if I had been sticking a camera in his face at that hour anyway. But I haven't forgotten about the "walking with crutches" video or the Christmas photos and will get both up online soon.

Dave has a new roommate - Dwayne, his last roommate, got transferred to UC because he was having trouble swallowing and breathing (please be praying for him and his wife, Melissa). As always, the nurses are working to spoil him with his own room again as quickly as possible, which may happen as soon as tomorrow. We are planning to ring in 2009 with a few friends, food, and Guitar Hero World Tour (I can't wait to get my hands on the microphone - I hear there's an Ozzy song I'd be great at), so having his own room again will be wonderful.

As his first official preparation to go home, Dave got fitted for an AFO today, a brace for his left foot that will help him deal with his foot drop. Still no word on another EMG to see if any of the nerve activity has been restored in that foot, so for the moment at least, the brace is necessary. Dave has been practicing walking with a loaner over the past few days and seems to do well with it. Hopefully the custom fit brace will be even better.

PT is later tomorrow, but we'll still be up early to prepare, so it's off to bed. More info as we get it. Keep praying!

Update #149

The long awaited pics from Christmas (the one of me on the phone is "with" my family at Christmas)...

Dave's walking with crutches! I'll get video up soon, but it was pretty amazing. He even managed to walk up and down the stairs with crutches this afternoon! PT is pushing him hard to make as much progress as he can before he gets kicked out...er...released.

Speaking of which, be praying tomorrow morning. The doctors, nurses and therapists will be "conferencing" on Dave to discuss his treatment plan and, hopefully, to tell us how much longer he will be here. According to his new physical therapist, Milan, Dave is ready to go home today, and he would be surprised if Dave is still here at the end of the week. We're hoping that it will be a little longer than that (still have to finish getting the house ready and moving Dave's stuff in), but we'll see. Just be praying for an answer...

Short post, but things are going well. More soon!

Update #148

Thought this might help make your Christmas merrier. Dave walked a whole lot farther than it shows on the video, but at least you can see him with a walker. PT and OT kick off again tomorrow. I'll get Christmas pics up soon.

Special "Merry Christmas" shout-out to the folks at UT - thanks for the comments on the blog! We miss you all and can't wait to walk (both of us) into the SCC to hand-deliver a wedding invite to you. We wouldn't be where we are without you!

Update #147

Merry Christmas (well, in an hour and fifteen minutes) from back at Drake!

After some miscommunications between UC and Drake, Dave arrived back on the Rehab Floor (not the SNF unit) around 3:00 p.m. today - same room, same roommate, same plan for therapy. His room is much more bare, though - in the two day UC interim, he was actually discharged from Drake, so we had to move his stuff to my house (HUGE thank you to the McLaughlins and Todd for taking care of that), and thinking optimistically that Dave won't be here for very long, we've decided not to move back in (we're already missing the mini fridge and coffeemaker though).

Today was a really lazy day of waiting around to be transferred, but thankfully, Dave got some much needed rest last night and this morning while we waited. Tomorrow is a quiet Christmas lunch with his parents and more relaxing before therapy kicks off again on Friday.

In the past few weeks, we have received Christmas cards from all over the country, and it has been so wonderful getting updates from everyone who has been reading ours since Update #1. Dave and I have decided to give ourselves a free pass on real Christmas cards this year - you all aleady know the basic gist of our year anyway - but from both of us to you, Merry Christmas! Time to watch The Christmas Story marathon on TBS. :-)

Update #146

I was just typing a post to say that we were heading back to Drake when Dave's social worker came in to tell us that we are at UC for another night. Supposedly, the Rehab Floor at Drake won't approve Dave to come back because of his new medical issue (the new drainage hole) and Dave's insurance won't approve him to go back to the Wound Care Floor because he doesn't have enough medical issues. Gotta love it. So, tomorrow morning, Dave will be moved to the Skilled Nursing Facility (SNF) at Drake to continue is care. When the idea of a SNF originally came up a few weeks ago, there was never any indication that there was a SNF at Drake, so we were a little confused at the news. From what we understand, though, Drake's SNF is only for short term care (less than 30 days), and the first time it was discussed as a possibility for Dave, there was a good chance he would need to stay longer than that. Now, assuming everything goes as planned, Dave will be at the SNF for the same amount of time that he would have been on the Rehab Floor (two-ish weeks) then will be headed home.

On a different note, Dave's doctor during our short stay at UC, Dr. Pritts, told us that the new hole in his side actually may be a positive thing because the drainage is no longer running over his open wound but is instead running away from the wound. Dave may actually heal faster than he would have, and the dressing changes should be much less complicated.

If we have learned anything over the past few months, we have learned to expect the unexpected. For tonight, we are enjoying being inside on a warm night in a quiet room with no roommate and waiting for the newest plan in the morning. We'll see what tomorrow brings...

Update #145

After seven hours in the ER, Dave's finally in a room. And I gotta say, it was worth the wait. Dave has a private, very nice room with a view of Cinci and plenty of room for him, his parents and me not to be tripping over each other. No word yet on how long we'll be here (Christmas at Drake or UC?) or what the next steps are, but for now, we're enjoying having some quiet time after a long day. More updates coming tomorrow. Thanks again for continuing to pray!

Update #144

No surgery for now, but Dave's being admitted to UC for a day or two so the surgeons can keep an eye on him. His white blood count - I was really hoping we wouldn't ever have to talk about that again after UT - was slightly elevated, so they want to make sure he isn't developing an infection. If everything goes okay, he'll be back at Drake sometime this week to continue therapy. We're waiting in the ER for a regular room - I'll keep you posted if we hear anything else. Thanks for the prayers!

Update #143

Thanks for posting, Dad.

Typing this from UC's cafeteria because unlike UT, this place seems to enforce the "two visitors per patient rule," even for sweet li'l old us. :-) Dave's parents are sitting with him now so I can grab some lunch.

Late last week, Dave mentioned, while I was changing his dressing, some irritation on the skin flap that was rotated to cover his injury back in June. When Wound Team came to check it out, they thought they noticed some swelling as well and decided to order a CT to rule out the possibility of something more serious than skin irritation or aggravation from Dave's increase in exercise.

Just as I was going to post all of this on the blog last Friday, one of the doctors came in and informed us that the CT seemed to be clear, so I decided it wasn't worth the hassle. Silly me thinking people don't need to pray...

Last night, as I was changing Dave's dressing again, I noticed that the irritated area had turned into what looked like a very large blister. Wound Team came this morning to check it out, and when they pulled back the dressing and touched the area, drainage pushed through the skin and poured out.

The fear last week, which was confirmed this morning, was that Dave had either developed another hole in his colon with another drainage tube (fistula) or that his current fistula was trying to find another way to drain in addition to the original hole in his side. From what I understand, the second option is less complicated to fix than the first (still only requires one section of repair in his intestines), but neither option is super surprising.

Within 45 minutes of the discovery of the new opening, Dave and I were in an ambulance on our way to UC. Since then, we have been sitting in the ER waiting for the surgeons to see him. It is likely that we will be here all day, both for the surgeons to evaluate him and for them to run some scans and tests to determine whether the problem is a new fistula or simply a new exit point. From Wound Team's perspective, Dave will likely be back at Drake by tonight to continue with the original plan for surgery in January, but there is a small chance that Dave's surgeon will decide to admit Dave to UC to do the surgery now.

I do have Internet access here, so I will do my best to post again once we hear anything. It may be a while, though, so don't worry if there is no news until late tonight. Until then, be praying. Dave is doing well, feeling fine, and his spirits are still up. That being said, seeing yet another hole in his body this morning was hard for both of us, and it will be nice when we know what is going on for sure. Keep praying...

Update #142

I just received a call from Kendahl (this is her dad) telling me that Dave has been taken by ambulance to University of Cinncinati Medical Center due to a development with the skin covering his wound. If I understand what Kendahl told me, over the past couple days the skin had developed something that looked like a large blister . The nurses were keeping an eye on it, and a CT scan was done to try to find out what is going on. But the CT scan didn't give any answers. When the nurse changed the dressing this morning, the "blister" broke. Speculation now is that the drainage from the hole in Dave's colon was looking for another way out....

Dave was taken to UCin because that is where his trauma surgeon is. He is waiting to see the doctor now. They do not believe that this is a serious issue. Dave is not in any discomfort. The question is whether the surgeon would want to do the surgery on the colon now or wait until its scheduled date in January, in which case Dave would return to Drake. Drake is apparently keeping his room until they know what the doctor is going to do.

Please pray for wisdom for the doctors and for Dave's continued healing. And thank you...again.

Kendahl asked me to post this blog because she doesn't have internet access at UCin. I'm sure that as soon as they have some answers, either she will update the blog, or she'll call someone to do so.

Update #141

Please don't kill me...

I know that it's been a full week with no post, and I feel terrible about it. But it has been a crazy week. No news is good news - and the past week has been full of it.

Dave did get approval from his insurance company late last week to move to the Rehab Floor, the 3rd floor at Drake, and the move happened late Tuesday evening. For anyone who wants to send mail or find him when you come visit, he is now in room 307-1. The -1 is important because sadly, he now has a roommate, although Dwayne, his roommate, and his wife Melissa are wonderful, so we got pretty lucky. Actually, if you think of it, be praying for Dwayne - he had a "cardiac event" (heart attack that is not caused by a problem with the heart, from what I understand), and when he went into cardiac arrest, he fell, hit his head, and broke his neck in two places. The accident happened on December 3rd, and so far, he is completely paralyzed. Be praying for him as he recovers and for his family, who is just starting to get used to the life that we have started to call normal.

Speaking of updates, remember Darlene and Tony? Tony was hit by the drunk driver a few days before Dave's accident? Darlene texted the other day and said that Tony had had a surgery to repair a pretty intense bed sore that was caused by a lack of care at one of the rehab facilities where he was. The surgery went very well, and he is now at another rehab center where things seem to be progressing. One very cool story - because Tony is on Worker's Comp (the accident happened while he was working), his Worker's Comp Insurance will be paying the company where Darlene works as a nurse to hire her to be his in home nurse. So basically, Tony's company is paying Darlene to take care of him! Pretty great situation. :-) Tony is still recovering very slowly - they aren't sure if he will walk, be able to take care of himself, etc. - but he is smiling and interacting and doing so much better than when we last saw Darlene.

Okay, end of sidenotes. Yesterday was a day of new therapists, new doctors, new rooms, new situations...new everything except the building. The Rehab Floor requires three hours of therapy per day, and the nurses weren't kidding when they warned Dave that it would kick his butt. Yesterday, he got dressed and out of bed on his own, then had to wheel himself all the way around the Drake Center in his wheelchair for OT. During PT, he walked 120 feet twice with is walker, then practiced the motions for getting in and out of a car (which we will work on for real tomorrow), then did calf raises and squats with his walker. The day also included another hour of Group Therapy, which involve playing a strategy game and lifting weights between turns. Welcome to rehab!

In addition to the increase in therapy, Dave officially had his last breathing treatment this morning. Although his breathing is still fairly shallow as a result of his diaphragm injury, the Pulmonary Specialist is convinced that Dave no longer needs the medicine that he has been getting for the past three months.

Somehow, in the course of the 36 hours that Dave has been on the Rehab Floor, he has already won his way into the hearts of his new nurses (big surprise). Yesterday afternoon, his nurse Greg came in and offered to set us up a "living room" area in an unused room on the floor where Dave and I can spend some time watching TV and hanging out in the evenings away from the nurses, roommates and the general bustle of the last six months. In his words, "Young people need alone time." He set up the room with a TV, a chair and a table, but no bed, so I'm pretty sure his insinuations in "alone time" were as innocent as our use of the room will be. :-)

Speaking of living rooms - okay, that was a weak transition, but I'll go with it - some info on the next steps of Dave's living situation. Before I go any further, please try to remind yourself over the course of the next few paragraphs that Dave and I are doing the best we can with a very abnormal situation. You'll understand that when I say...

Dave and I have decided to move up our wedding. I mentioned a few weeks ago that I would go into more detail on the definition of "home" later - the reason for the lack of explanation at the time was that he and I, along with his parents, were still figuring out what "home" would look like upon his release. I'll avoid boring you with the details, but the short of it is that "home" for Dave and me is, well, wherever the other person is. Originally, we set our wedding date for June 6th so that Dave would be able to enjoy the ceremony and reception (and hopefully be on his feet for them) without exhausting himself. Although he is still not ready for a large party (and trust me, June 6th still will be - we'll get to that in a minute), after a lot of discussion (and once we do premarital counseling in the next few weeks), we know that we are ready to get married.

For anyone who enjoys a more practical and less sentimental explanation (we took both into account), Dave's apartment lease expired in September. Although his parents have a place to live in Cinci, their home is in Michigan, and at some point, we know that they would like to go back to that home more permanently than just a week every few months. The condo where they are staying is on the market and could sell at any moment, and it also has six or seven stairs to get to it, which could be difficult for Dave when he is released. The house where I live, which is right next door to the church where I work, is a ranch and has only two small steps to get into it. Because of my position with the church, we can live at the house for free for as long as we like, and I will be close by, even when I am at work, if Dave needs anything. As Dave gains more independence (which happens every day), his parents will have the freedom to move back to Michigan, and Dave will be able to maneuver his way around our new home, whether using a wheelchair, a walker, a cane or nothing at all, without much assistance. Most importantly, although we both know that marriage will not be easy, and nothing Dave and I do is ever normal, we will be able to begin our "regular" life together away from a hospital and in our own home.

Because of the short notice, and because the wedding will likely be at Drake (engaged in the ICU, married in rehab - collective "Awww..."), we are having a VERY small ceremony with only immediate family and our wedding party. Trust me, we would love to have everyone at the wedding, but as we started to list off the people we would want to be there, we quickly realized the reason that our June guest list is close to 450 - Dave and I are just too well-liked. :-) Seriously, though, we do want to celebrate with all 450 of you. Because of that, we are doing an intimate ceremony now BUT are still planning a huge celebration for June 6th - bridesmaids, groomsmen, DJ, dinner, and all of you. Two pleas:

1. Don't be upset about the early wedding (it's on January 10th, by the way) or how small it is. We truly want to celebrate with all of you, and if we could invite everyone, we would. But Dave's health, the limited space, and the short notice make a small ceremony much more do-able;

2. PLEASE still come to the wedding/Welcome Home Dave!/reception/celebration/we-don't-really-know-how-to-phrase-it-yet June event. Don't let the fact that we are doing the official stuff in January keep you from coming to celebrate. Remember my disclaimer? Dave and I are doing the best we can with a difficult situation. If we had our way, we would do everything in June. But if we had our way, we wouldn't have spent the past six months in a hospital room either.

When I was living in France, one of the many things I learned about the culture is that French weddings involve two ceremonies: first, a civil ceremony at a government office; second, a religious ceremony at a church. In France, the reason for two ceremonies is the strict separation of church from state, meaning that a religious ceremony is not recognized by the state. For us, the two ceremonies will be a separation of hospital and home? Rehab and recovered? Wheelchair and dancing? However you want to look at it, June 6th is still on, and we still hope you will be there.

Dave is getting ready for a dressing change - his wound continues to improve and get smaller every day, by the way - so I have to run. Thanks, as always, for your support, prayers and constant reminders of love. Love from Cinci...

Update #140

Here's where we are...

As of this morning, Dave was approved to be moved to 3 North, Drake's Rehab Floor, a move that will happen as early as Tuesday. From there, he will have "a few weeks" (probably twoish) of intense therapy (three hours per day) before moving...are you ready?...HOME! The entire process is still pending insurance approval, but it is the under the recommendation of Dr. Weintz, Fran, Maura and the Rehab Floor, so the approval should go through. If that is the case, Dave could be home as early as a few days after Christmas!

Other news: Dave walked up and down six steps today during PT (with the help of railings) and transferred to a normal chair (one without armrests) during OT. So much progress...

That's it for now. More updates as we hear...

Update #139

So there is an Option #3...

As of Friday, it sounded as if the only two options for Dave were heading to a SNF or heading home. Yesterday, Maura (OT) mentioned the possibility of a move to Drake's Rehab Floor. Dave no longer needs the amount of care that the Wound Care Floor offers, which is the reason that his insurance may not allow him to stay. But if he qualifies for the Rehab Floor, he could stay at least in the same building and continue intensive therapy until his surgery. In order to qualify, he must be able to handle three hours of therapy per day (an hour and a half of OT and an hour and a half of PT), and he must be able to do certain things on his own. From Maura's perspective, Dave is right where he needs to be to qualify.

Maura and Fran are both still comfortable with Dave going home, but from their perspective (and it makes sense), Dave might as well continue with as much therapy as possible for as long as possible until he goes for surgery.

Colleen from the Rehab Floor is supposed to be by sometime today or tomorrow to do an evaluation, which she will use to make a recommendation to Sandy, Dave's social worker. Then, tomorrow, Sandy will talk to Dave's insurance again to hopefully try to convince them to continue paying for treatment at Drake. In the end, the decision is still up to Dave's insurance, and again, Dave will be fine no matter where he ends up, but having another option is always good. Please continue to pray for the right decision...

Some positive updates:

1. Dave's pain patch has been cut in half, and he is still dealing fine.

2. He has been sleeping better over the past few nights.

3. He is gaining weight! Up to 168 or so now - thank you solid food!

One other prayer request: Dave's breathing is getting rough again. Ever since Saturday, he has had a really difficult time catching his breath after any amount of activity and has been coughing quite a bit. Dr. Weintz ordered a chest x-ray yesterday - in some ways, we are hoping that it will show bronchitis or something similar so it can actually be treated. If the x-ray comes back normal, we're back to the days of Dave not being able to breathe and not being able to do anything about it.

More pics and videos of Dave's progress coming soon. Keep praying!

Update #138

I did say to take it with a grain of salt...

So Dave still needs surgery. The output from his fistula went up slightly (not back to where it was, but still up), and Dr. Muskat, the surgeon, said that after six months, even if the drainage were to stop, scar tissue has built up on the inside of the fistula, which would prevent it from closing. While he was visiting with Dave, he checked the pliability of the scar tissue on Dave's wound to determine if it is soft enough to do surgery. Although it has improved a lot, Dr. Muskat would like to wait another 30 days (early January) and check on Dave one more time before scheduling surgery.

Please don't take any of this as bad news. Considering the extent of Dave's injuries, the fact that they can even consider doing surgery only seven months after the accident is pretty impressive. Not only that, the decrease in fistula drainage is allowing the area around the fistula, which is still raw (granulation tissue, they call it), to heal much more quickly. The progress that Dave's wound has made in the past week even is incredible!

Because Dave's surgery is now farther off than just a couple of weeks, there is a possibility that he will be moving out of Drake before surgery. The decision on whether he leaves is between Drake, Dave's doctor and his insurance, but the decision on where he goes is his. According to Maura (OT) and Fran (PT), Dave has definitely made enough progress to be cleared to go home if he chooses. He can walk the length of the hallway with a walker (over a hundred feet); he can do most of his personal care on his own; yesterday he even tackled going up one stair (with the help of the parallel bars). If he came home (more info later on where "home" will be since Dave's lease expired on September), whatever care and assistance he still needs will come from me and his parents. The other option is to head to a skilled nursing facility (SNF), another live-in situation where Dave would still have nursing care while he gains more strength.

If Dave comes home, from what we understand, he would continue PT/OT, but twice per week (as opposed to five times) at home for a more extended period of time (two hours a day or more). If he goes to a SNF, he may receive PT/OT every day but for a shorter period of time.

Although no timeline has been set, the overall impression is that this new transition may happen in much the same way that the transfer from UT to Drake did. Now that the ball is rolling, the move may happen very quickly. Obviously, the decision is slightly less critical than the first move was. Dave is much more stable and will do fine in either location. But the decision is still important. If Dave will get better care and more therapy at a SNF, we don't want to compromise his progress out of a selfish desire to get him home. On the flip side, the idea of having him home before Christmas...

Please be praying for this new decision - for Dave as he makes it, and for me and his family as we support him. Hopefully, we'll have more info on Monday.

Update #137

Thanks for the prayers, everyone, as always! The last two days have been much better. As it turns out, Dave's pain patch that he wears on his arm had expired on Sunday and wasn't renewed until Monday afternoon, so it seems that the nausea may have been a reaction to a lack of pain meds in his system for the first time in six months. Once the patch was replaced, the nausea faded, and things have been good since.

Today, Dave walked 80 feet, then 100 feet, then another 80 feet with his walker during PT today! So much progress in only a few days - not that I'm surprised anymore. Also, during OT this morning, he worked on batting a balloon back and forth with me while standing, which meant alternating letting go of the parallel bars with one hand, then the other and putting more weight on his legs.

Be praying tomorrow for our meeting with Dr. Muskat, Dave's surgeon. Although still low, the output of drainage from Dave's fistula was higher today - pray that it was just a fluke. From what Dr. Weintz has said, Dave will likely still need surgery, but it may be much more minor than it would have been if the fistula output had stayed really high. Hopefully tomorrow will bring some clarification and timing on next steps.

Time to go watch a movie. I'll let you know what Dr. Muskat says as soon as possible!

Update #136

Kind of a rough day today - granted, that's "rough" in comparison to the amazing past three weeks we have had...

Dave was sick to his stomach for most of the morning. It started during shower #2 (#1 happened on Saturday evening) in OT this morning and lasted through PT this afternoon. Overall, Dave said he was feeling really tired (the lethargy started over the weekend) and was having a hard time breathing. He seems to be doing better this evening, however, so hopefully, tomorrow will be back to more progress.

On the positive note, still very little drainage from the fistula! The Wound Care Team was astounded today and couldn't wait to take pictures to send to Dave's surgeon, Dr. Muskat, who will be at Drake on Thursday. Be praying that the news that day is, "Maybe he doesn't need surgery after all!"

Short post today... Keep praying!

Update #135

For the first few weeks after Dave's accident, it seemed as if almost every day, there was something new to be praying for - both, on the negative, a new scary situation and, on the positive, a new step forward every time I updated the blog. For as overwhelming as that period of time was, as exhausting and emotional and uncertain, it was also incredible because the progress was obvious and the miracles abounding.

As time went on, I know we all continued to pray, but things slowed. For many of you, that meant fewer updates on Dave's progress to read, simply because there really wasn't much happening. I almost found myself feeling guilty for not having anything exciting to post. For Dave, his parents and me, it meant...well, to be perfectly honest, blah. Melancholy. Monotonous. Almost depressing.

If you walk - or leap (you'll understand that comment in a moment) - away from this post with only one thing today, I hope it will be a reminder to NEVER STOP PRAYING!

After a long spell of...well...blah, the times of almost overwhelming progress are back! For the past two and a half weeks, I have been humbled over and over again at how often I had forgotten to pray through the blah - and how powerfully God reminds us of his presence anyway.

Today, Dave walked with a walker for the first time! Ten steps, five feet or so, but moving forward without the stability of the parallel bars attached to the ground.

Potentially even more exciting, for the first time in almost six months, after hundreds of "bed baths," Dave has been cleared to take a real, hot, running water, so-amazing-I-never-want-to-get-out shower.

Finally...well, before I go here, a small disclaimer: the problem with being a perpetual optimist is that it is easy to drive people nuts with "false hope" that may blow up in their faces afterward. If you lean toward the pessimist or even realist side of things, please take the next paragraphs with the appropriate grain of salt (or pepper, as your taste may be). Please know, by the way, that even as an optimist, I'm pretty flabbergasted.

As most of you know, just after Dave's last abdominal surgery in June, he developed a hole somewhere in his digestive system that was causing secretions to leak from the side of his body. Over time, his body, in order to protect itself from infection, formed a fistula, a tube of scar tissue leading from the hole in his intestines directly out of a hole in the right side of his abdomen. In spite of meds to slow the secretions (remember Octreotide?), TPN (IV feed) to reduce the amount of food being put into his stomach and tube feed to keep the drainage as liquid as possible, the fistula has remained and has contributed to many of the complications with Dave's progress.

The plan was to wait until a minimum of six months after Dave's last surgery (December) for the scar tissue to heal, then to go back into his abdomen to repair the fistula surgically. Until then, it has been wound vacs and tube feeds and annoyances trying to handle the hole.

For a while, my prayer specifically, in spite of what the doctors said, was that the fistula would close on its own and save Dave from another major surgery. After a while, even I started to let that prayer fade, and the biggest good news we could hope for was surgery in December and not March or April.

There's a story in the Old Testament about a widow who comes to Elisha because she has no money to live on - all that she owns is a small amount of oil - and she is about to lose her sons to a creditor of her husbands. Elisha tells her to go out around her neighborhood, collect all of the jars she can find, and bring them back to him. When she comes back, Elisha uses the small amount of oil in her jar to fill all of the other jars, giving her resources to sell in order to pay the debt. The small amount of oil flows and flows to fill every jar to the top, but when the last jar is full, the supply runs out. If the widow had collected hundreds of thousands of jars, the implication is that the oil would have continued to flow until every jar was full. But God worked to match the greatness of her faith and filled only as many jars as she had collected.

Sometimes, like in the story of the widow, God allows himself to be limited to the amount of power we give him and the amount we truly believe he can accomplish. Sometimes, however, God decides to blow us away, reminding us he is a God who is, in fact, "able to do immeasurably more than we can ask or imagine," that his power reaches far beyond the number of jars that we decide to collect.

The reason behind this mini sermon is - how do I say this? - Dave's fistula may be closed. The doctors are not convinced...yet. The nurses are rationally skeptical. Fistulas just don't close after almost six months. But in the past 72 hours, the daily amount of drainage on Dave's dressing has been less than a fourth of what is has been every day over the past six months. Not only that, putting this as delicately as possible, his digestive system seems to be working as normally and "regularly" (think fiber commercials) as yours or mine. So not only is there very little drainage coming from Dave's fistula, in spite of how much more he has been eating, but what Dave is eating is going through his system in the way that is should be.

I wish I could say that this is what I have been praying for all along (I think Dave's sister is the only one who can say that). I wish I could tell you that I had the faith to believe that it might happen. But to be completely honest, I took the "good" news of a December surgery and started placing all of my hopes there. In spite of the limitation that I placed on what God's power could do through Dave's body - kind of funny how it is possible to think that all of the "big miracles" ended in June - God may just be sending a reminder that we should never underestimate what he can do, no matter what science may say.

Dave is a miracle - have I said that recently? - whether his fistula is closed or not. But if things continue the way that they have been going for the past three days, the most recent evidence of his miracularity...miracleness...miraculaneousness (yeah, I know the real word is miraculousness) may be a whole lot closer than it was a few weeks ago. I think God is laughing at, at the very least, my lack of faith. I'm just glad his laughter is serving to heal Dave even more quickly than...well...than I could ask or imagine. :-)

His Spirit, His will, His peace, His glory...

Update #134

Dave stood up without the parallel bars today! Okay, he used them to get himself up, but once he was up, he let go with both hands for about 15 seconds! His legs are definitely getting stronger, and his breathing is not affecting his PT nearly as much. So great to see!

Dr. Kitzmiller, the plastic surgeon, came by again today and said that he is ready to go whenever Dr. Muskat is. December, anyone? We're shooting for an early Christmas present...

Otherwise, pretty chill day. Tomorrow, we'll be enjoying Thanksgiving a la Kroger (easier to keep everything hot than it would be trying to bring it from the condo) with Dave's parents, Jen, Chris and their kids. Happy Thanksgiving to you all! I'll try to get some pics up on Friday.

Update #133

So I realized after I put what I thought was an adorable comment about engagement ring #3 in a recent post that I never told you all the story of engagment rings #1 and #2.

Not too long after Dave proposed in the ICU down at UT, the nurses started giving him a hard time about not getting me a ring. I kept telling them that I didn't even need one, and that I certainly didn't need one while Dave was still in the hospital. But they were relentless.

One morning, Dave's parents and I were hanging out in his room, and Dave and his mom kept looking at each other and smiling in a weird way. Then, his mom reached over, still smiling, and started holding his hand - and he smiled too! Awkward! This is the conversation that ensued:

Me: What are you doing?

Dave: Trying to be smooth.

Me: Smooth? With your mom?!

Dave: You really didn't see what I was doing?

Me: (Confused look)

Dave: (Opening his hand) I thought you might want this.

In his hand was a three carat cubic zirconia silver plated ring with six smaller CZ stones around it. Turns out that while I was at Dave's parents' place taking a shower that morning, his mom had gone down to a $5 jewelry sale that UT was having in the cafeteria, and she had picked out two outrageously large "diamond" rings for Dave to choose from to give to me. Fake ring #1, the one his mom transferred not-so-stealthly to him and he handed me that morning, lasted two and a half months before the large stone fell out. Fake ring #2, a four carat CZ solitaire, is still going strong but has a habit of leaving another kind of ring on my hand - green is my favorite color, but not around my ring finger. Fake ring #3 came today thanks to the gift certificate to the Drake Gift Shop that Dave got from Drake for his birthday - $10 of CZ and silver and well worth the investment.

The shopping trip was just one fun part of a good Monday. More walking during PT, more "normal" tasks during OT, more solid food, more wedding planning. Praying for another good day tomorrow...

Update #132

Just a quick prayer request:

We have loved the new dressing that Dave has (just gauze, tape and a binder) - simpler, not attached to any machines, less painful to change, and most importantly, allows him to eat real food. That being said, last night, Dave had his dressing changed at 10:00 p.m.; it started leaking around 2:00 a.m. and took a half hour to change. Back to sleep for two and a half hours, then it exploded again at 5:00 a.m. Obviously, it made for a long night, especially considering the fact that it had been lasting up to nine hours before last night. Be praying that the long night was a one-time fluke and that tonight, we'll be back to a full night of sleep.

Otherwise, life is good! Four days till Turkey Day! Yum...turkey. :-)

Update #131

Dave walks. 'nuff said. :-)

(Sorry for the sideways video, but I didn't realize that my camera won't let me flip it after the fact. Also, sorry for the "Blair Witch Project" filming quality - a little bouncy.)

Update #130

Happy birthday to Dave! Definitely not the way that he expected to spend it, but at least he can eat cake. :-)

Things continue to progress well, and it should be a great day. Yesterday, during OT, Dave got himself in and out of a regular bed from his wheelchair (a whole lot easier than getting in and out of his air bed), including laying all the way down and getting all the way back up again. This morning, he cut his time getting dressed in half (probably sounds silly, but it's pretty impressive to watch, especially since his bandage prevents him from bending at the waist). Moving forward, Maura wants to work on doing more "normal" tasks in more "normal" ways - standing up while shaving, going through the motions of taking a shower so he'll be prepared once his wound is healed, etc.

During PT yesterday, Dave continued practicing his walking (still incredible to see every single time), and Fran started having him work on his hip strength by raising his legs out to the side between steps. Dave's getting more comfortable having his picture taken now that he is looking more like himself so you may get to see walking pics tomorrow...

As a sidebar, in the same way that Dave worked his way into the hearts of everyone at UT (not to mention even deeper into mine) throughout his stay there, the nurses and staff here at Drake completely adore him as well - there are moments when I think they would do anything to make him smile. Last night, as we were getting ready for bed just before midnight, Sara, one of the nurses we have gotten closest to, popped in with a couple of pieces of chocolate cake that she had made just for us to celebrate Dave's birthday. So sweet. Since I've been typing this post, no fewer than 10 people have stopped by to say "Happy Birthday." Anyone who knows Dave knows how endearing he can be, but it's amazing to me that even with how worn out and beat up he has been, he still manages to win people over just by being him.

The social worker just stopped by with a birthday card and a $10 gift certificate for the gift shop downstairs, so we're off to shop. Maybe if I smile really sweetly, Dave will use half of it to buy me another engagement ring. #2 is starting to turn my finger green. :-)

Update #129

Short post, but I thought you might enjoy some pics from Dave's birthday celebration with his fam over the weekend. For anyone who hasn't had a chance to see Dave at all since his accident, you may not notice any difference - for anyone who has seen him, it's incredible how much he looks like himself again. :-) Enjoy the photos!

Also, more walking today! This time, instead of the small gym with the short parallel bars (six feet long or so), we hit up the long gym with the long parallel bars (12 feet long or so), and once again, Dave tackled them twice without a problem! His breathing was clearly better, his strength lasted longer, and his steps were surer. Incredible!

Update #128

Dave walked! During PT yesterday, Fran asked Dave if he wanted to try taking a step or two while holding onto the parallel bars. So he took one...then another...then walked the whole length of the parallel bars! Then, he did it again! It is impossible to describe...yeah...exciting...Dave is walking! Little at a loss for words... :-)

Dave is also, as of yesterday, tube free (at least during the day)! On Monday, all of the wound vac suction tubes disappeared, leaving only his feeding tube. Yesterday, in order to increase Dave's appetite, Dr. Weintz decided to increase his tube feed and have it on only from 7:00 p.m. to 6:00 a.m. Otherwise, Dave is on his own to eat what he wants during the day without the tube feed (sidenote: if he doesn't have the appetite to eat enough, the nurses will give him bolus feeds to supplement during the day). All of this means that Dave can now maneuver in his wheelchair, get in and out of bed, get dressed, and basically live life unattached (to his tubes - he's still stuck with me)! :-)

This week has been incredible, and we have heard over and over again from nurses, doctors, therapists and aides what amazing progress that Dave has made (not that we didn't know that already). Dave's energy is up, his nausea is down, he's eating more (Carabbas Italian and Graeter's ice cream last night), he's sleeping better, his lungs are clearer, he's smiling more - he's becoming more and more Dave every minute.

I'm sure I don't say it often enough, but on behalf of Dave, myself and his family, thank you to everyone for your continued prayers. Almost every day, I get an email or read a comment from someone that I didn't even know knew about Dave and his accident. In the midst of your own crazy lives, more than five months later, you take the time not only to pray but to let us know that you are doing so. I really wish you all could be here to see the progress and hang out with Dave, but I hope the updates continue to help make you feel like you are here experiencing this with us.

Update #127

Two posts in one day - maybe the first time that has happened for a good reason. :-)

Dave stood up three times today! Normally, he stands twice and ends up exhausted but today, he stood up the first time and marched for the first 30 seconds, then stood for another minute. The second time, he shifted his weight from left to right and let go of the parallel bars with the opposite hand (more weight on his legs) for a few seconds, and stood for a total of 1:15. When Fran asked if he would be up for a third stand, he said, "Maybe," then went for it and stood for another 1:15! So exciting!

Dr. Weintz came in this morning and said Dave's lungs sound "100% clearer than they did two days ago." Dr. Robinson, one of the surgeons who works with Dave's surgeon stopped by as well and told us that his nutrition labs are going up and confirmed that the target for the surgery is sometime around Christmas. Dave got signed off at the highest level for shaving on his own in OT this morning, including gathering the supplies, and although he was slightly nauseated during OT, he was feeling much better than he had been.

Overall, the week continues to be very positive. Thanks for the continued prayers!

Update #126

Monday was defintely the kick start we needed for a good week. There have certainly been some downs - Dave threw up all the solid food he ate on Monday, and his stomach has still really been bothering him; the new dressing set up for his wound leaks a whole lot more than the wound vac did - but this week, the ups seem to be winning.

Getting ready for OT or PT has become a very independent thing, to the point that all we have to do is fetch the necessary supplies, whether it be his clothes or his wheelchair. Although he is still never really hungry, it's easy to see how uplifting and freeing it is for him to know that he can eat if he wants to. During PT yesterday, he needed almost no assistance from Fran getting up to a stand from his chair, and once he was up, he stood on his own (holding the parallel bars) for a minute and a half. He did so well during the first stand that Fran had him start "marching," lifting one foot off the ground, then the other, all in preparation to start walking. Although Dave still has a difficult time breathing, especially during the stands, he does not seem as exhausted during or after and recovers much more quickly each time.

Breathing is actually going well enough that Dr. Weintz DC'd (discontinued - don't you love my use of medical terminology? Our friend Jennifer would be so proud) the midnight treatment, so Dave is down to four times per day. Each respiratory therapist who comes for the treatment mentions how much better Dave's lungs are sounding and how impressed they are with his improvement.

After the big switch on wound care on Monday, Dave and I got to see pictures of the progression of his wound size since he's been at Drake. In the past two months, the total area of his wound has been reduced by 56% and the volume (length times width times depth, for anyone who doesn't remember their high school geometry) by 98% (his wound is only .1 centimeters deep in any place now). Although I realized how much it had changed just from my memories of being at UT, it was incredible to see it in pictures.

Be praying for continued improvement and strength, and that the nausea will go away completely. Also be praying that the dressing will stop leaking so much, as it has caused Dave to miss PT at least once this week.

More soon!

Update #125

Would you like fries with that?

Yes, folks, for the first time in over five months, Dave has permission (real permission, not just mine) to eat solid food! Dave's surgeon, Dr. Muskat, came by this morning to check on his wound and (we hoped) give us some idea when the next surgery would be. In the course of Dr. Muskat's ten minute visit, Dave permanently lost the wound vac (just gauze, tape and a binder for dressings now), got permission to eat whatever he wants and found out that he may be done with his next surgery before Christmas! December was the earliest possible timeframe for the surgeons to fix the hole in Dave's colon, and it was beginning to sound like it would be closer to March or April, but after examining Dave and seeing all of his progress, Dr. Muskat was very optimistic about getting things closed up quickly.

In other, even more impressive news, Dave now puts his pants on one leg at a time just like everyone else. :-) Late last week, we found out that Dave is progressing so well with therapy that his OT and PT would be split starting this morning. So today, with Maura (OT - which, by the way, focuses on fine motor skills and completing everyday tasks like washing, shaving, etc., versus PT, which focuses on gross motor skills and large movements like walking), Dave got dressed all by himself (well, with the aid of his gripper), including pants, socks and shoes, and he managed to move his legs off the edge of the bed and sit up on the side with no assistance (which required a tremendous amount of improvement in his leg, arm and abdomen strength). He moved himself to the wheelchair on his own and got to wash his face, shave, and brush his teeth in the bathroom instead of in bed.

After a very successful OT session, Dave and I got to enjoy a real meal together, sitting at a table, with the full permission and blessing of Drake's staff. Because of a mix up in the ordering, Dave got not only a burger and potatoes but also chicken, rice and a salad, and although he doesn't have much of an appetite (he's still getting a full 2,000 calories of tube feed), he did manage to sample everything and help me finish my cherry pie. I get the feeling I may be making a surf 'n turf run for dinner. :-)

Overall, an incredible Monday, and after such a long week last week, just what we needed to remind ourselves that things are moving forward. Continue praying:

1. for the waves of nausea that are still hitting fairly frequently;

2. for the new dressing which doesn't control the drainage as well as the wound vac and has already stained a few sets of scrubs;

3. for Dave's breathing, which seems to be improving but still causes him problems;

4. that the wound will continue to heal quickly so the surgery can be done before Christmas.

Also, just a head's up, Dave's 27th birthday is November 19th (a week from Wednesday). I'm sure it will stink to be spending it in the hospital (although at least now we can celebrate with cake), so if you want to send a card...

More positive news comin' at ya tomorrow...

Update #124

Dave's dressing is on Day #3 and holding, the best we've done in a while. Unfortunately, whether it is the pressure from the wound vac or something else, the right side of Dave's stomach has really been bothering him over the past few days. The pain seems to go in waves and hits so badly sometimes that he can't move (he's in that place right now). Dr. Weintz is "almost tempted" to switch his tube feed from continuous to bolus to see if that helps, but not quite yet. Be praying that the pain will subside.

PT/OT continues to go well. When he stood on Tuesday, Fran (PT) and Maura (OT) did almost nothing to help, and for the first time, Dave said that although his arms hurt, his breathing didn't bother him much. Yesterday, he got some cool new toys - okay, that might be a slight overstatement - some gadgets to help him put on his socks and shoes without help and a gripper to grab things that are out of his reach, which he has been using to torment me ever since. :-) Getting in and out of his wheelchair gets easier and easier, and there is some visible definition in to his leg muscles for the first time since June.

Ann from Cardio-Pulmonary discontinued Dave from their services - I guess we were right when we thought it wasn't doing anything for him - but left some information on breathing that is supposed to help during exercise. Dave has tried the techniques a few times and doesn't seem sold, but we haven't given up yet.

One of the trauma surgeons (potentially even Dr. Muskat, Dave's surgeon) is supposed to be by this afternoon to check on Dave's wound, and we are hoping to get some information on how they will know when he is ready for surgery (this whole "sometime between December and April" thing isn't working for either of us). From what we understand, the scar tissue in Dave's abdomen needs to heal and soften quite a bit before they can operate again (hence the six month time frame we heard originally), but we have no idea if there is some indicator for which they will be watching to know when he is ready. In the meantime, the wound vac (when it holds) is doing a great job of helping Dave's body to create new skin and shrink the wound, a visible indication of progress every week.

There are so many moments when this process seems interminably long and almost unbearable. Dave is consistently positive (or as positive as one can be when one can't breathe), but there are definitely times when the frustration is written all over his face. At the same time, as we crossed the two month mark at Drake yesterday and sit at the five month mark since Dave's accident today, it is once again amazing to think back on how far he has come, and it is encouraging to know that one day, this will all be over. In the meantime, we enjoy the soup, endure the dressing changes, and anticipate the celebration on June 6, 2009.

Update #123

Dressing change #4 in eight days. This isn't going well. Saturday's dressing started leaking not too long after they changed it, then was fine for most of yesterday, then basically exploded last night. We managed to get the vacuum to hold through the night, but this afternoon, in place of PT/OT, Dave got yet another wound vac. Made for a pretty rough day.

Anne from Cardio-Pulmonary also came by today to do some more pulmonary rehab with Dave. So far, neither Dave nor I is sure that it is accomplishing much, but he's trying. Lots of "breathe in through the nose, out through the mouth" and diaphragmatic breathing (stomach breathing as opposed to chest breathing) to try to help him feel less out of breath. He coughed through most of the process, which made it really difficult to accomplish anything, but Anne said she would be back on Wednesday to try again.

Otherwise, pretty blah kind of Monday. Hopefully, the post tomorrow will be a little perkier. Till then...

Update #122

Quick and very non-eloquent post because I just realized I haven't written in a while...

Dave's back continues to bother him, but a CT scan came back clear. Dr. Weintz seems to think it is all muscular from being in bed so long, but that doesn't change how much it has been hurting. Dave did get his pain meds increased in order to help control the pain, which seems to be helping, but we're still working to figure out a more long-term fix.

On Thursday, Dave started pulmonary rehab, which seems to involve different breathing exercises with both his stomach and his chest. Still not sure what will happen, but at least it's a step in the right direction.

Dave had his dressing changed three times this week (Monday, Wednesday and Saturday) because his wound vac kept leaking even when he wasn't eating any contraband solids. Praying that this one will hold because it's been a pretty miserable week on that end of things.

Still moving in the direction of one more major surgery to fix Dave's intestinal system, but the doctors won't give us a definite answer on when the surgery will take place. At the moment, I think we're praying for December (the earliest it could happen) but expecting March or April.

Sorry for the short, clipped sentences, but it's almost time for youth group. More updates this week, I promise. Be praying for Dave's parents - this week is the first time that they will both be back up in Michigan since the accident.

Love you all...

Update #121

Dave's having a rough day today. His wound vac started leaking last night (still Day 1), and he got in trouble this morning when the Wound Care Team came to fix it because he may or may not be eating solid food that we may or may not be sneaking to him, which clogged his drainage tubes.

Speaking of clogging, Dave's feeding tube also clogged again this morning. The clog was bad enough that it had to be changed (for the third time in six weeks), a very painful process, and he is waiting on an X-ray to confirm that it is properly placed before he can eat again.

More upsetting than anything, and possibly as a result of the dressing and feeding tube issues, Dave's back pain was so bad this afternoon that he missed PT/OT.

I know Dave is making some amazing progress, but these small setbacks are reminders to continue praying. Also, the encouraging cards and emails are hugely helpful and reminders to Dave that you are thinking of and praying for him, so if you get a chance...

Update #120

Yesterday, Dave's nurse (one he has only had a few times) asked if he was ready to get out of here. When he said that he was, she said, "That's good, because I've noticed that when patients get to that point, they are motivated to work that much harder and do whatever it takes to be released as quickly as possible." Dave was nice enough to smile and say only, "I've been ready for a while," but all I could think was, "Get to that point? He's been there since he woke up!" and "Why would anyone NOT be ready to get out of here?" and "Does she really think he hasn't been motivated and working hard up until now?" It was almost as if she was implying that until yesterday, he had just been sitting around, enjoying the mechanical bed and incredible (gag!) cuisine. I wanted to remind her of everything he has come through, every huge improvement he has made, every struggle he has fought through, and (in spite of the difficulties) every smile and joke and piece of positive attitude that he still manages in the midst of it all. I wanted to tell her about his injuries, the difficulties he has just taking a breath, the new pains that seem to show up on a daily basis almost as if as his body heals, it is finding new things that it hasn't even been able to notice up until this point. Basically, I wanted to print her a copy of the blog and force her to sit down and read it top to bottom (or bottom to top, I guess) so she would know just how ready he is and just how much work he has already done. She was just trying to be encouraging, of course, and I'm sure my reaction is attributable to the stress of a long weekend, but grr... Unless you know the whole story, don't try to tell me that Dave needs to be motivated (I'm a little protective, can you tell?). Makes me want to go Fighting Irish on her butt... :-)

That being said, when there is more than a day or two with no major updates, there are moments when I feel like I need to go back and reread the blog as well, to remind myself of everything that I felt like screaming at the nurse yesterday. Dave is doing well, and the lack of huge steps forward every single day only means that he is so far past the traumatic level of injury that progress is much slower and often more painful. Unfortunately, that doesn't make it any easier, for him or for us, to hurry up and wait.

Thankfully today, there are a few marks of progress worth mentioning:

1. Den has been doing some research and broached the idea of pulmonary rehab with the Respiratory Therapist yesterday. From the little I've read, pulmonary rehab is used primarily for patients with COPD (a chronic breathing disorder) and includes education on lungs and breathing and a specific exercise program designed to decrease the feeling of shortness of breath. Thanks to Den's research, the person in charge of pulmonary rehab will be by today at some point to determine if Dave qualifies for rehab based on whether a specific nerve is intact in his chest or not. Dave's breathing is affecting everything about his recovery, so be praying that the nerve is intact and that the rehab can start quickly.

2. In the midst of so many small steps of change, it's incredible to have an area in which improvement is actually visible and measurable every week. Dave had his dressing changed again yesterday morning, and his wound continues to get noticeably smaller, close to half the size it was when we arrived at Drake. New skin is growing all over his abdomen, and even the area where he is missing two ribs has filled in with scar tissue.

3. The final remnants of the blood clot in Dave's left hip are disappearing. When the clot was at its worst, Dave's leg swelled so badly that he had enormous blisters on his foot and hard tissue on the outside of his thigh (the swelling may be one of the causes of the nerve damage in his left leg that prevents him from flexing his foot). Both the blisters and the hard skin are getting progressively smaller and are looking better every day.

Also on the positive side, Dave's sleep meds were changed yesterday, and since I am sitting next to his bed as I type this, I can tell you that the Ambien seems to be working. So nice to see him peaceful...

As I mentioned above, Dave's body almost seems to be reprioritizing every day, choosing what new things can hurt as it heals other areas. Most recently, it has been his back, on the left side just above his hip, and unfortunately, because an X-ray late last week came back clear of fractures, Dr. Weintz doesn't see anything that can be done aside from relieving the pain with pain meds. Be praying that whatever is causing the pain - likely a muscle strain from PT/OT - will be resolved quickly.

One more prayer request: Cherie decided to head back up to Michigan with Jen on Sunday, and this coming Monday, Den will be joining her so they can both vote in the election. Next week will be the first time that both of Dave's parents have left at the same time, and I know it will be rough for them. Be praying that they will be able to relax and enjoy some much needed time off, and be praying for Dave and me since we will be on our own for the first time since his accident as well.

Hopefully, I'll have more updates after the meeting with pulmonary rehab today.

Update #119

On Friday night around 11:00 p.m., I got a message that one of my girls was on her way to the ER with a bloody nose and high fever. At 4:30 on Saturday morning, she was diagnosed with leukemia. It was frighteningly amazing how that turn of events brought rushing back every single feeling of those first few hours and days after Dave's accident and how much empathy and compassion I was able to have for her and her family as a result (try 2 Corinthians 1). At the same time, in the midst of a new trauma, it was incredible to be able to look at Dave and remember how far he has come since that first night. Trying to see the sunshine through the shadows...

Dave has had a good weekend. Jen was in town (sans family this time), so the four Heckels got to spend quite a bit of time together, including some quality time on the Wii. Although he has not been sleeping great (we found out last week that his sleeping med had been switched when he got to Drake and nobody ever mentioned it to us), he seems to be energetic and in good spirits. His wound vac started leaking this afternoon, so it will be changed tomorrow, but it still managed a full five days between changes.

Overall, more steps in the right direction. Continue praying for his back - it is still causing him quite a bit of pain - and his breathing, which is still preventing him from making more substantial progress in PT/OT. Also, if you think of it, please pray for my girl Liz and her family as they get ready to begin the long road of cancer treatment (for updates on Liz, go to http://glittergirlliz.blogspot.com/).

His Spirit, His will, His peace, His glory...

Update #118

No trach surgery!

The scope yesterday afternoon was miserable, I won't lie. Dave was asking Dr. Bauer to take the camera out of his throat the whole time, and I one point, I was tempted to reach over and yank it out myself because it was making him cough so much. But within 10 minutes, it was over, and the results were good...in a way.

On the positive side, Dave will not need a new trach, a stint or a massive throat surgery. Although there is scar tissue built up in small amounts around his trach site, the tissue is not blocking his airway, even when he coughs. Such a relief!

On the negative side, however, that means there is nothing he, we or the doctors can do to make his breathing easier aside from wait. Because his shortness of breath is not coming from scar tissue, it can only be coming from the damage to his diaphram. Unfortunately, the body's next choice for breathing assistance is the abdominal wall and muscles, which Dave also does not have. As a result, the muscles in his neck and shoulders have to compensate for the lack of strength and support in his abdomen, and building up those muscles is a matter of time and patience. In the future, there are plans to reinforce Dave's abdomen and reconstruct his injury site, but the five-year reconstruction process won't do him a whole lot of good when he is struggling to breathe during PT/OT this afternoon.

That being said, Dave's body will compensate, at least in part, without additional procedures or surgery, and that is completely an answer to prayer. Thank you all so much for continuing to be so faithful in your prayers. They are working!

One more really cool piece of news: Dave and I set the date for our wedding! Save the date - June 6, 2009, the one-year anniversary of his accident (collective "Awwww..."). :-) Now we're just praying that he'll be up and about and energetic enough to enjoy the ceremony and reception without being too worn out...

More later...

Update #117

Quick prayer request tonight: tomorrow afternoon, Dave will be having the scope to see if he has damage to his trachea from the trach tube. Although not as painful as a full bronchial scope, the procedure (can't remember the name) involves putting a small camera up his nose and down his throat and will still be fairly uncomfortable. Dave will be receiving some anxiety meds before the scope, but he cannot have a sedative because he must be conscious enough to respond to some commands to swallow, etc. Be praying for his anxiety before the scope and his pain level during.

Also, Dave has had some pretty extreme pain on the left side of his lower back, to the point that it prevented him from doing much during PT/OT today. Be praying that the doctors can figure out what is causing the pain and can resolve it quickly.

I'll update tomorrow after the scope. Thanks!

Update #116

Although I have not been as good about updating recently, I hope this blog is still useful to the many of you who are too far away to come see how incredible Dave looks for yourself.

New prayer request today: out of nowhere this morning, Dave started experiencing chest pain, a tightness that started around his heart and spread gradually toward the right side of his chest. Considering his two past cardiac episodes, needless to say, the issue was a little concerning. Dr. Weintz ran an EKG, which came back normal, and eventually the pain subsided, but please be praying that the pain was just a fluke (extreme heartburn or something equally minor) and not evidence of a larger problem.

Otherwise, things are going well. We continue to wait to hear from Dr. Bauer, the Pulmonary Specialist, regarding Dave's bronchial scope, but while we wait, Dave's breathing is making progress. Currently, in addition to his IPV breathing treatments that he gets five times per day (pump oxygen and Albuterol into his lungs to loosen the congestion and make him cough), Dave also has two different breathing mechanisms that he uses to help improve his lungs, both of which he has been using since he was at UT. The first, his Acapella (a.k.a. Flutter Valve, a.k.a. Pickle), also works to break up the congestion in his chest (don't really understand how, but that's why I'm marrying an engineer - I'm sure Dave could explain it without a problem). The second, the incentive spirometer, measures the volume of oxygen that he is getting on each inhale. For the incentive spirometer, Dave has been running around 750 and occasionally hitting 1,000 per inhale (a normal 26-year-old non-smoker should be around 2,000). Last night, he was consistently at 1,000 and even hit 1,250 once. His cough is getting stronger, and his lungs are sounding okay. Hopefully, whenever he finally has the bronchial scope, it will show no scar tissue in his throat but only that the muscles he uses to breathe need to get stronger to compensate for his injured diaphram.

PT/OT continues to go well. Although the length of time that Dave is standing is not increasing (still about a minute and a half twice per day with the parallel bars), the ease with which he gets up certainly is. Transfers between his bed and his chair are getting progressively easier, and Dave is gaining strength in both arms and both legs every day. The EMG has even strengthened his right leg to the point that he can now flex his whole right foot! Still praying that the nerves in his left leg will regenerate...

The biggest piece of news from my perspective is that when the Wound Care Team changed his dressing on Thursday of last week, his wound was noticeably smaller, probably only two-thirds the size it was when we arrived at Drake! Being by his side every day makes it difficult to notice progress, so it was incredible to see just how much his abdomen is healing. Dave's body is generating new skin all over the wound area, so the dressing change is getting easier and easier, and we are moving continually toward the next step of ditching the wound vac and moving to something much smaller and much less complicated.

Overall, Dave is still moving forward. Be praying for his lungs, his vision and his left foot. More soon...

Update #115

I am a perpetual optimist. Unfortunately, even my level of optimism can't change the prognosis we received from the neuro-opthamologist yesterday. The short and not-so-sweet of it:

1. The optic nerve in Dave's right eye is damaged beyond repair, so the blindness is permanent;

2. There is no definite indication on what is causing the sun spots in his left eye.

On the positive (remember, perpetual optimist), there is no damage to the retina or optic nerve in Dave's left eye, so there is a chance (maybe even a good chance) that the spots will go away. There is one other test that they can do to check on his left eye, but he has to be sitting up in order to do it (he was transported on a stretcher yesterday), so he has another appointment in December for a follow up.

One of the things that I love most about Dave is that in the midst of everything he has gone through and in the face of the news yesterday, he is also a perpetual optimist, and his extremely appropriate response to the fact that he will not regain sight in his right eye was, "Hmm...I wonder where I can get a really cool eye patch." Overall, he seems to be handling the news well.

Sorry for the short post, but I just realized that I hadn't updated since the appointment. More later...

Update #114

Dave has a new roommate. :-( So sad. He's actually a really nice guy and seems to be fairly quiet, but the addition means less space, less privacy, fewer chairs and (worst from my perspective) me getting kicked out at 10:00 p.m. Dave is fine overnight by himself, but I think it has given us a peace of mind when I can spend the night or at least stay until he falls asleep. It's nice to be around to silence alarms, get him a drink or just be there if he wakes up in the middle of the night. Drake seems to be getting progressively busier, especially the Wound Care Floor where Dave is, but hopefully, the new living situation won't last too long.

Aside from the roommate, things are going well. Dave's dressing is still holding well, although it was losing suction a little bit from time to time, so it sounds like the nurses will change it today (Day 6) to be safe. During PT/OT yesterday, Dave upped his weights from 30 pounds to 40 pounds for both of his arm exercises and seemed to tolerate the additional weight well. Today is a full hour of PT/OT - be praying that it doesn't go the way Hump Day last week went.

Also, please be praying tomorrow for Dave's appointment with the neuro-opthamologist. The appointment requires transport again, and we've heard rumors that Dave needs to be in a wheelchair the whole time. The appointment could last two hours or longer, and the longest he has ever been in the chair at one time is two and a half. With transport time and waiting time, it could be as long as four hours, and Dave is a little apprehensive. Be praying for the transport, for Dave's back (which has been hurting quite a bit, probably from too much time in bed) and for the appointment itself. Hopefully, we will come away with an optimistic prognosis for both eyes.

One other thing: after much anticipation and a little nervousness (or maybe much nervousness and a little anticipation), Dave finally asked my father if he could marry me. He called last night, and my dad actually left a school district meeting (he's the Chairman of the school board) to talk to him. Okay, so we called from my phone, and he thought it was me, so he really left to talk to his daughter, but he didn't hang up when he heard it was Dave, so it's all good. My dad said yes, by the way, so I guess that means I can change the password on the blog back and allow my him to start updating for me again. :-) Dave and I have been working on the guest list for the wedding (can I tell you how much of a pain in the butt it is?), and my mom and sister are coming to town this weekend to shop for dresses, so we figured with all of the wedding planning, we should probably be sure that my dad wouldn't show up on the big day with a shotgun. :-) Unfortunately for Dave, my dad is the easiest of the four men in my family to win over - Cory, Christian and Camden, if you are reading this, please be kind...

Off to get ready for PT/OT. More later...

Update #113

It may be hard to believe, but there are days when it is nice that there are no updates because that means that things just are. Saturday, Sunday and even today were all that kind of day. Dave is doing well and making progress, and it's been three days with no major ups or downs. The wound vac is finishing Day 4 and holding well. Dave is getting himself in and out of the wheelchair easily. His breathing is still making PT/OT difficult, but he continues to make progress, and it was very clear today that he did most of the work getting himself up to a stand with the parallel bars. His feeding tube has not clogged in three days, and he is sleeping well. Right now, we are drinking tea and watching the History Channel, and aside from the hum of the machines and the fact that he can't get out of bed, it is almost possible to forget for a moment that we are still sitting in a hospital four months and and one week after his accident. That amount of time really helps you appreciate the little things - solid food, walking, breathing...and quiet evenings with the person you love. Off to enjoy that last one for a bit. :-) More tomorrow...

Update #112

Hump Day did in fact pass. Sorry for leaving you in suspense. Thursday and Friday were much more positive, and Dave continues to make progress. His energy level was back up on both days, he is sleeping better, and he is seeming more like himself.

After Dave tolerated three dressing changes in one week, the current wound vac seems to be holding well (even with small amounts of less-than-liquid food). He also received a new feeding tube on Thursday, and so far, no clogs!

PT/OT are progressing well. On Thursday, Dave stood twice for a minute and a half each time, and he even let go of the parallel bars with one hand to put more weight on his legs! Yesterday, a minute and forty seconds and a minute. Also, his progress on strengthening his arms earned him (and us) the right to transfer himself to and from his wheelchair without a nurse's or therapist's assistance!

After another long week, we're looking forward to a mellow weekend. Dave's uncle and aunt (Den's brother and sister-in-law) are in town for the day, which should make for a nice Saturday, and hopefully, Dave will get a lot of rest in preparation for another week.

One other note: One of Dave's friends from high school started a group on Facebook for Dave. If anyone is interested in joining, search for Team Dave on Facebook Groups.

More soon...

Update #111

For anyone who buys into the "Wednesday equals Hump Day" mentality, yesterday would have confirmed your line of thinking. It's hard to describe why this particular Wednesday was so rough, but the look on Dave's face during PT/OT would have convinced you. Blame it on the weather in Cincinnati, blame it on Dave's feeding tube and wound vac continually getting clogged in the middle of the night and keeping him awake, blame it on passing the four-month mark. Whatever it was, even Maura (OT) and Fran (PT) could see that pushing Dave yesterday during therapy wasn't a good idea. He did manage some weights and a few other exercises, but the one-hour scheduled session pretty quickly became less than 30 minutes, and even that was more than Dave really wanted to do.

A rough day of therapy transitioned into an impromptu meeting in Dave's room between the Wound Care Team, Dr. Sway (one of the surgeons - pretty sure I'm not spelling her name correctly), Dr. Weintz, Dave, his dad, me and a few of the nurses. The long and the short of the meeting: stay the course with the same wound dressing and no solid food. Supposedly, when Dr. Johannigman cleared Dave to eat last week, he wasn't aware that Dave hadn't been eating up until that point and that the solid food would have an impact on the thickness of the drainage coming from the fistula. If the drainage is thick, the wound vac has to be replaced more often, painful both for Dave and for the Wound Care Team. Until Dave's wound heals quite a bit more and becomes a whole lot smaller, he is stuck with the current dressing and unfortunately without real food.

On the positive side, Dr. Weintz confirmed that Dave has an appointment with a neuro-opthamologist next Thursday for the first in-depth look at the problem with his eyes. Hopefully, at the very least, the neuro-opthamologist will be able to explain and even treat the sun spots in Dave's left eye to make sight on that side clearer.

We also got a quick explanation of what it will take to get Dave out of the hospital, four specific problems and therefore four specific prayer requests:

1. Lungs - The new breathing treatments are helping, and Dave has been able to clear more of the fluid from his lungs as a result - the most recent chest X-ray even suggests that his right lung is improving! At the same time, however, his breathing is still affecting every aspect of his treatment, including therapy, and making it very difficult to make progress. No word on scheduling the bronchial scope, but hopefully Dr. Bauer will be back to discuss that procedure soon.

2. Therapy - The most obvious issue is weakness, which PT and OT are working very hard to treat. Hopefully, we'll get a chance to ask today what condition Dave will be in when he is released from Drake and moved to an outpatient treatment plan, strictly from a PT/OT standpoint (walking normally, in a wheelchair but walking occasionally, etc.).

3. Nutrition - Dave is getting all of the calories and nutrition that he needs through his feeding tube. At the same time, being on a feeding tube is certainly not ideal, and it is still difficult to tell what percentage of the nutrition being put into his body is actually be processed and used before it becomes drainage.

4. Wound - Okay, so maybe therapy wasn't the most obvious. Dave still has a very large wound on the side of his body, and the only way to control it, keep it protected and hopefully move toward healing it is through a very complex system of plastic, tape and paste. Anne, one of the Wound Care nurses, said she always tells her children that she uses the same tools to do her job as a kindergarten teacher. No matter how simple the tools, the dressing is very complicated, requiring powerful suction and weekly changes (or more than weekly - today will be the third time in less than a week), all of which would be difficult from anywhere but a hospital.

According to Dr. Weintz, Dave could easily go home with any one of the four issues that he has. The combination of all four, however, means that Drake is his home for the time being. Ever the optimist (one of the reasons that I like him), Dr. Weintz did tell us that aside from Dave's eyes, everything is making progress and moving in the right direction. He even said that the EMG (the test on the nerves in Dave's legs) indicated a good prognosis for the nerves in Dave's left leg, something we had not heard before. One other small update on that front: Dave can now flex his entire right foot, and his progress through e-stim has been so great that Fran (PT) began stimulating a new set of muscles yesterday.

The beauty of a Hump Day is that things are supposed to get easier on the other side. Dave was doing better last night - more energy, better spirits - and he even managed to sleep through a good amount of the poking and prodding that his nurse Sarah had to do last night to keep his wound vac from exploding and his tube feed from clogging. Thursday is another day, a sunny day, and hopefully a day for moving Dave one step closer to home.

His Spirit, His will, His peace, His glory...

Update #110

Sorry for the lack of updates, but the past few days have been fairly uneventful. Saturday and Sunday, Dave spent most of the day relaxing with his family and most of the evening relaxing with friends, and Monday was a fairly standard start to the week.

The only big (and unfortunately negative) update from yesterday is that Dr. Weintz and the Wound Care Team decided against allowing Dave to eat solid food. Although Dr. Johannigman believes that the hole in Dave's digestive system is far enough along that he is able to process the food, the discussion yesterday revolved around the fact that solid food will make the drainage coming from Dave's side thicker, which in turn will cause him to run the risk leaking far more often. More leaking equals more dressing changes, and more dressing changes equal more pain.

The argument is understandable, and even I have to admit that the drainage tubes were not working nearly as well last night after a test run weekend of solid food. The question and huge concern is that if Dave's next surgery isn't until March or April, will he be stuck on a feeding tube alone for the next six months? I can't even imagine...

More updates later...

Update #109

Every time I think we've gotten the craziest, busiest days out of the way, a day like yesterday happens. A brief synopsis of the downs and ups (might as well end on a high...):

Down #1
We met with Dr. Bauer, the pulmonary specialist, again yesterday afternoon. Apparently the breathing test that Dave did on Monday showed that his difficulty with breathing may be coming from more than just the damage to his diaphram - the most likely possibility is scar tissue built up in his throat from when he had the trach tube, damage that makes it difficult for Dave to get a full inhale on each breath. Dr. Bauer wants to do a scope to determine if the damage is actually there and how severe it is. If the damage is there and substantial enough, Dave has one of three options:

1. The doctors reinsert his trach tube in order to be able to suction him when his cough is too weak to cough up the congestion in his lungs. The tube would be capped, so Dave would be able to talk and breath normally, but it would be visible and fairly permanent.

2. The "fairly permanent" relates to options #2 and #3, both of which require surgery (from the sounds of it. the trach tube would be the first step until Dave is more recovered, then surgery would be considered). If Dave does not want to leave the trach tube in permanently, the doctors can do a surgery to insert a stint, basically a tube like a trach tube that is made of metal and is completely internal (wouldn't be visible from the outside like the trach tube would be). Dr. Bauer mentioned that the surgeons at University of Cincinnati (where Dave would have the procedure) tend to avoid stints if possible.

3. As a third alternative to a permanent trach tube or a stint, Dave also could have surgery to remove the affected part of his throat, a major procedure that requires a long recovery time that even includes tying his head to his chest for a few weeks so he couldn't move his neck and risk undoing the surgery.

Obviously, none of these options is overly appealing. Unfortunately, if Dave does have damage to his throat from the trach tube, a minimum of one of the options is necessary in order to protect him from ongoing respiratory infections (including pneumonia) throughout his life and from serious breathing problems when he is under anesthesia during future surgeries. Dr. Bauer did a great job of explaining each procedure and answering our questions, but that didn't make the news any easier to hear.

The next step is the scope to see if the damage even exists, a process that can be fairly uncomfortable on its own. Please be praying that the scope goes smoothly and that it shows a clear airway so that none of the above options will be necessary. Dave's breathing and the strength of his cough both seem to be improving with the new treatment, but the only way to tell what has been causing him so many problem is by using the scope.

Down #2
Yesterday afternoon, we also got to meet with Dr. Johannigman, the Trauma Chief at UC. He, Dr. Muskat (the first surgeon that we met) and Dr. Kitzmiller (the plastic surgeon) are working together to develop a course of action for the reconstruction of Dave's abdomen (including closing the fistula, skin grafts and future reconstruction). According to Dr. Johannigman, the six month window before Dave's next surgery is not six months from his last abdominal surgery (i.e. December) but more likely six months from now (i.e. March or April). Because there is still such a large unhealed area on Dave's abdomen, the scar tissue that has built up from previous surgeries will not be soft enough to tolerate another surgery until the area is closer to healing. There is a section of the wound that the surgeons are talking about covering with skin grafts (about a 12" high, 3" wide section from Dave's rib cage to just below his belly button) in order to assist in the healing, but no definite decision on that yet. No matter what, it sounds like the earliest that Dave will be done with surgery is sometime next spring (and that doesn't include future reconstruction that will probably happen a few years from now).

Up #1
On the positive side, although Dave may not be able to have his colon fixed until March, he could be out of Drake and living a relatively normal life long before then. According to Dr. Johannigman, if Dave progresses through PT and OT, he can be equipped with a portable suction unit that will continue to take care of the drainage outside of the hospital until he can have surgery. So, at the moment, the only thing keeping Dave at Drake is weakness (which he is working quickly to eliminate).

Up #2
Dave's central line (his IV) is gone! One less tube coming out of his body - now, he is down to just the drainage tubes and his feeding tube.

Up #3
Although we are still waiting on the official order, Dave has been cleared to have real food! According to Dr. Johannigman, the hole in Dave's digestive system is far enough along that he is, in fact, getting nutrition from the food going into his stomach. This also means that Dave is capable of digesting (and getting the benefit of) real food! There will be some restrictions on things that our bodies don't digest (black beans, for example - we found that one out the hard way after a run-in with some contraband black bean soup clogged Dave's drainage tubes for three days), but if he so desires, he can finally have his surf 'n turf (crab legs and prime rib), which our friends Ben and Pat have informed us they are more than happy to prepare.

Yesterday concluded a long week filled with ups and downs. Please be praying for Dave, his family and me as we process all of the new information and try to ride the waves of recovery.

Update #108

This week has gotten progressively better. The new breathing treatment continues to help Dave clear his lungs (thankfully, the respiratory therapists have decided to skip the 4:00 a.m. treatment to let him get some rest), and because he has not had a fever in a few days and his white blood cell count isn't too elevated, he is no longer on antibiotics either! Whatever was happening on Sunday, pneumonia or otherwise, is definitely well on its way out.

PT and OT are progressing really well, and Dave has been bumped up from a 30 minute PT/OT co-treat per day to a full hour. He stood twice yesterday, the first time for a minute and thirty seconds, the second time for a minute, and during the stands, Fran (PT) had him start bending his knees and shifting his weight from one foot to the other, the first step in preparing to walk - yeah! As always, although Dave's arms and legs tire quickly from the effort, it is his breathing and low lung capacity that force him to sit down. Please be praying that his lungs will continue to clear quickly and that the muscles that control his breathing will get stronger to compensate for his damaged diaphram so his breathing doesn't hinder his progress anymore.

As for OT, Maura is really working to strenthen Dave's arms (his progress is evident in how quickly he is getting from his bed to his wheelchair recently). Yesterday, his exercises included the hand bike, lateral pull-downs and a tricep exercise. Today, we play Wii! I guess we weren't kidding about Wii-habilitation. :-)

Dave's wound care continues to go fairly well, and each dressing change is lasting about a week. We are meeting with another surgeon this afternoon (a different surgeon comes every week, but Dr. Muskat will be Dave's surgeon for his fistula) to get an update on plans for his wound, but at the moment, it looks like it is "stay the course" with the current wound vac dressing, tube feed (no TPN - yeah!) and PT/OT until his body is ready for another surgery in December.

One of the wonderful things about being in a rehab hospital is being able to move more and more toward a "normal" life (although I have to admit, it's scary how "normal" the ICU at UT had begun to feel after 11 weeks). Last night, for the first time in almost four months, Dave got to participate in the Bible study that has been such an important part of our lives and such a huge support through this whole situation. We sang, we prayed, we discussed relying on God as our Source - and although Dave was tired after a long day of rehab, we both definitely appreciated being a part of the study again.

One of the passages that came up in study last night was the "Do Not Worry" section of the Sermon on the Mount in Matthew 6. After a week that started out so overwhelmingly and is moving toward such an amazing end, the passage seems particularly applicable. Dave's recovery is a day-by-day process, and sometimes the two steps forward really are accompanied by a step back. But God continues to be faithful, and I'm working to use the occasional steps back not to worry but to remind myself to pray without ceasing, knowing that we never walk alone, and tomorrow is under control.

His Spirit, His will, His peace, His glory...