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...

Update #107

In the midst of all of the uncertainty surrounding Dave's breathing on Sunday and Monday, I forgot two very important positive updates. First, for the first time since his accident, Dave is off of insulin completely, meaning his blood sugar is regulating itself again! Second, on Monday, Dave moved himself completely between the wheelchair and his bed on his own. Supposedly his weight is up to 162 (he had been down as low as 145), and I would guess that most of those extra pounds are in his arms, which have gained a considerable amount of strength since we got to Drake.

Just small reminders that in the process of Dave's recovery, the positive has always outweighed the negative. I think I lost sight of that at the beginning of the week.

As for the pneumonia, unfortunately the culture that they tested the other day (basically a spit sample) did not provide the doctors with whatever they needed to determine what caused Dave's fever on Sunday afternoon. They took another sample yesterday - we'll see what it shows - but Dave has been on antibiotics since Sunday, so hopefully whatever it is is already on its way out. We've actually seen some pretty great signs in that regard - the fever is completely gone, and according to Dr. Weintz, Dave's lungs are sounding clearer again. The new breathing treatment that the pulmonary specialist recommended on Monday seems to be helping at least a little bit - although the cough is still there, it actually seems to be looser and strong enough to get at least some of the fluid up out of his lungs completely.

The e-stim on Dave's right leg is going well, and he actually was able to flex the three smallest toes on his right foot on Monday (at one point when we first got to Drake, the foot wasn't moving at all). The process is fairly painful, but it is nice to be able to see some of the benefit.

On a much more fun note, Dave is getting his first haircut in four months as we speak, just one more step closer to having a "normal" life. Also, thanks to some gift cards from some coworkers at GE as well as a Best Buy voucher that I had, we now have a Nintendo Wii, complete with Wii Sports and Mario Kart, which we enjoyed with our friends Justin and Sara last night. We're calling it Wii-habilitation (okay, I'd like to take credit for the name, but I actually saw it in a newspaper article posted outside of Drake's library). :-) If anyone has suggestions on good games to get, especially games that would help improve Dave's strength and range of motion, we'd love to hear about them!

Dave's dad is scheduled to come back from Michigan today, and his sister and her family will be heading down to Cinci this weekend (assuming nobody gets sick before then). Be praying for safe travels!

Looking forward to a great Wednesday...