Update #185

So sorry for the delay...our Internet is still down.

First, the post I typed last Thursday...

"Posting from my Blackberry since the hospital's Internet is being dumb. Hope this goes through...

"The fast is over...at least for the time being. Yesterday, because the drainage from his wound had not increased from the liquids, Dave started "every man's dream diet" (mine too) - actually, it's called the "low-residue diet" - consisting almost entirely of meat and potatoes and almost no veggies. Crazy, huh? After eating only a few days in the past two weeks, I guess he deserves it. :-) Anyway, a low-residue diet is comprised of easily absorbed foods to keep drainage low, and it turns out that meat and potatoes are at the top of the list!

"Even better news, sounds like we may be going home today! After all the steak Dave ate yesterday, drainage levels actually decreased, so we can go home TPN free! The hole is still draining and hasn't closed yet, but the drainage level is going down since last week, and indications that it will close on its own are pretty promising. So that's where we are...and my fingers are tired from typing on this tiny keyboard. More soon!"

Anyway, we are home and doing well...aside from the fact that Dave is craving salad and apples. :-) On the whole, aside from the setback with the new hole opening, he is recovering much better than any of us - doctors included - anticipated. Dave and I were both planning on him being completely down and out for a week at the hospital and pretty homebound for another three or four weeks after. Instead, two days after surgery, Dave was walking the halls at the hospital, and less than two weeks after surgery, he was taking almost no pain meds and getting around nearly as well as he was pre-surgery. The setback was frustrating, but overall, things are good.

Dave goes back for a post-op with Dr. Kitzmiller (Plastics) on Friday and with Dr. Muskat (Trauma) on Monday. Please be praying for good news at both appointments. Kitzmiller should tell us that the incisions around the skin flap that he stretched are healing well and everything looks good. Hopefully, Muskat will tell us that the small amount of continuing drainage is a very good sign and he is hopeful that the hole will close on its own. He may even let Dave have his salad. :-)

We're hoping to get the Internet back up at our house this week. Until then, I'll do my best to post when we are out and about and can find a connection. At the very least, I will post after appointment #1 on Friday.

Update #184

We're home and doing well. Internet was spotty at UC yesterday and down at our house completely when we got home last night, and the long post that I typed on my Blackberry (where I'm posting from now) yesterday disappeared when I tried to save it. I'll fill you in on all the details once we find a connection for Dave's laptop.

Update #183

The fast is over...well, sort of. Sorry for the lack of posts yesterday, but we waited all day just to find out that Dave wouldn't get to start consuming anything orally again until today. Originally, it sounded like today's diet would include real food, or at least the milkshake I mentioned the other day. Unfortunately (although I'm sure it's better for Dave's recovery), he is restricted to a "clear liquid diet," meaning anything you can see through. Basically, his meal tray consists of jello (which Dave doesn't like), broth, tea and some kind of juice. We've also added some Sprite and some mostly clear soup. Not huge, but definitely a step in the right direction. If the drainage doesn't go up as a result, things will increase gradually from here on out, probably to "full liquid diet" (including oatmeal, ice cream, mashed potatoes, pudding, etc.), then to a regular diet.

I stopped fasting when Dave did this morning (mainly because his orange Jello looked very appealing) and will continue to eat as he does. Hopefully, there will be no more setbacks and we'll keep moving forward over the next few days.

One specific prayer request on top of getting to eat and getting to go home: we found out today that Dave is not allowed to leave the floor he is on for any reason. One of the doctors suggested this morning that we take a walk outside, but when we asked the nurses, they said hospital policy doesn't allow it. We're going to ask for a written doctor's order for outdoor privileges in the morning (sound ridiculous, doesn't it?) - be praying that we can get permission.

Update #182

Well, things are getting a little better. Dr. Muskat had been "away" for a family emergency, so aside from a quick pop-in on Thursday when we got back to the hospital (when he quietly informed us that if anybody asked, we had never seen him), we hadn't heard from him at all. Finally, today he had a chance to check in. According to his reading of the CT, there are visible air bubbles coming from Dave's colon, a sign of a hole, but it is very possible that the hole is tiny, meaning more likely to close. The drainage has slowed quite a bit over the past three days (probably due in part to the fact that Dave hasn't been eating or drinking anything); if things continue that way over night, he may be able to start consuming things that are easily digested (Dr. Muskat suggested a milkshake) tomorrow. If the drainage doesn't increase from the addition of small amounts of food, it is a good sign that the hole is closing, and Dave may be off TPN soon!

If, on the other hand, the drainage increases over night or increases when Dave starts eating, the nurses will train us on operating the pump, administering TPN and cleaning Dave's PICC line, then we are headed home. From there, more watching, waiting and experimenting with small amounts of food for occasional checks on the progress of the hole.

Either way, our spirits are up, and we are finding substantial ways to amuse ourselves without thinking about snacks and meals. Dave's sister and brother-in-law were in town for the weekend - sans children - so we got to spend some quality time with them, and from the sounds of the texts and voicemails we have been getting, Dave will have many more visitors over the course of the week. Hopefully, we will be able to put in requests with our visitors by then for take-out...even if it is just a McD's milkshake. :-)

In other positive news, Dave is off antibiotics -meaning no infection at all from the new hole opening - and the PICC line is saving him from being stuck every day for blood draws and IVs. The nurses and doctors on the ninth floor have been wonderfully compassionate with regard to how disappointing it is to be back so soon, and aside from giving meds and checking in, they have left us on our own with few disturbances, a nice change from the constant in-and-out of the fifth floor last week.

Please keep praying - hopefully tomorrow I will be able to give you the news that the hole seems to be closing and Dave and I are sharing a milkshake and looking forward to going home.

Update #181

[sigh] What a difference a day makes.

Okay, before I even go there, what a difference a year makes. Last year at this time, I was still trying to communicate every new development in Dave's life with some form of sugar coated optimism. However awful my posts may have seemed at the time, when I go back and reread them, all I can think is that what we were actually experiencing was almost always ten times worse. I've said before that I'm naturally an optimist, which was where some of that communication tone was coming from; it also related to the fact that Dave was still in critical condition, he was fighting his way back from a bout of sepsis, and any step forward was a huge celebration. I was also trying not to scare you. :-)

Now, a year later, Dave and I are both still optimistic, but we have also gotten used to having reality slap us in the face a bit. Hope for the best, prepare for the worst, right? And this time, I'm not sure how to sugar coat it.

That long preface was to prepare you for what comes next. Dave is healthy, I'll say that first. But everything happened so quickly that I couldn't give moment by moment updates, and by the time yesterday ended, we were both too overwhelmed to talk to anyone. I'm sorry if I give you that same feeling now. After spending 36 hours at home (we literally spent 30 of them sleeping), Dave woke up yesterday morning with drainage - not post surgery drainage, but pre-surgery drainage - all over his dressing. After a quick call to the Trauma Clinic, we put our still-packed bags back in the car and headed to the ER at UC. Our initial logical fear, that one of Dave's internal sutures had pulled free or that a new fistula had developed, was confirmed after a CT scan late yesterday afternoon. The short of it: the surgery didn't work. In Dr. Muskat's words, "This is really disappointing."

There are some differences between treating this fistula versus treating the last one. First, Dave is much healthier, and his body is much better prepared to heal. Second, the weak tissue where the first hole developed was taken out during surgery, meaning the hole this time is in healthier, less fragile tissue.

That being said, in some ways where we are today very closely resembles where we were a year ago. The hole is in the same spot and draining the same excessive amount of...stuff, which we are having a very difficult time controlling. As of yesterday, Dave was off all food AND drink (aside from small sips of water for his meds) indefinitely to clean out his system. Instead, he is back on TPN (the nutrition that flows straight into his bloodstream) and IV fluids. The central line in his neck last year will be replaced with a PIC line (better than IVs because it won't come out) for both the TPN and the fluids. Octreotide will be replaced with another treatment (I'll include the name once they say it again). And, we are in the hospital for at least another week.

On the positive, all of this comes with a much more likely hope that the hole will close on its own, which is better than waiting six months for yet another surgery. Hopefully, the doctors will be able to determine how likely that is in the next seven days. On the negative...well, you understand.

After anticipating this surgery for so many months, Dave and I are pretty disheartened. We knew that this scenario was possible, but after the surgery went so smoothly...

In the midst of this new development, here is my challenge to you: fast and pray. Dave is, in essence, fasting for at least the next week. All throughout the New Testament, we see prayer and fasting partnered; yet while we focus so much on prayer, we very rarely honor the other command. In the next week, do be praying earnestly that the hole will show signs of closing. But partner that with fasting something. Fasting all food completely may not be possible, but maybe give up one meal a day. Don't play video games. Go without coffee. And use the time - and every time you remember how much you miss whatever you have given up - to pray for Dave. Pray for his strength, his spirits, his energy, his patience, and always, his healing.

We'll keep you posted.

Update #180

Well, we finally made it home just before 11:00 last night. Once the doctors told us that we were headed home, it almost seemed like they were pushing us out the door - gathering discharge paperwork, encouraging us to pack up, even seeming slightly frustrated when Dave said he wanted to take a shower (the first he was allowed since surgery because of the epidural). In the midst of the chaos, however, Dave started bleeding from one of his incisions, which caused Dr. Muskat and his partners to order blood work to make sure that there was no sign of infection or other problem.

Now, don't get me wrong - we appreciated the caution and concern, and we would always rather be absolutely certain that Dave is as healthy as possible before leaving the hospital. That being said, three hours after Dave stared bleeding, the lab finally sent someone to draw blood. And three hours after that, around 8:00 last night, we were still waiting for results. We paged Dave's nurse to see if she could check with the lab, and two minutes later, the lab tech walked back into our room. Somehow, the lab managed to lose the first blood draw, and they needed another sample. As I mentioned before, Dave's veins are impossible for needles to find, and sure enough, the tech and three nurses (including a nurse paged from the burn unit who can find veins through charred skin) each tried unsuccessfully to find a new vein for the sample.

At that point, we were starting to believe that we would not being going home - not that big of a deal except for the fact that we had already sent most of our stuff back to the house with Dave's parents and had already cancelled our dogsitter for the night. We asked the nurse to see if Dr. Muskat and his partners would let us go home then head to a local lab in the morning to get another sample; wonder of all wonders, the lab suddenly found the original blood sample again. Sometime just before 10:00 p.m., the lab work came back fine, and we were finally discharged.

End of story, right? Not quite. Earlier in the afternoon, I had called our normal pharmacy to confirm that they had Oxycodone - Dave's new oral pain med to replace the dilaudid and the epidural - in stock since we have had problems getting it before. As it got later and later while we waited at the hospital, I called a 24 hour pharmacy to ask the same question since ours had already closed. Both locations confirmed that getting Oxy would not be a problem. After dropping Dave at home around 11:00 p.m., I headed to the 24 hour pharmacy to fill his prescriptions and quickly found out that not only did they not have the normal dose of Oxy pills in stock (5 milligram pills); the pill that the doctors had precribed (and the pharmacy assured me they had), 20 milligrams, does not even exist. And, because Oxy is a narcotic, the pharmacist couldn't substitute anything in the place of the pill without a new written prescription from Dave's doctor.

The pharmacist called UC, where all of Dave's doctors were in the midst of a trauma, to find out alternatives to get us through the night, while I headed home to wait for an answer. Finally, at 12:30 a.m., the pharmacy called to say that the doctor had allowed her to switch from Oxy in pill form to Oxy in liquid form, of which she had enough to get us through three days. Back to the pharmacy, then home just in time to give Dave his next dose of pain meds at 1:00 a.m. Dave and I both slept till noon today (aside from two more doses of Oxy at 5:00 a.m. and 9:00 a.m.), and now we too are navigating the art form that is pain control. Too much Oxy means dizziness and sleeping; too little, and we get behind on controlling Dave's pain, which will almost certainly end us up back in the hospital.

On the positive side of this whole charade, we are home, and it is wonderful. Dave's sleeping in the hospital bed again for a while, but fortunately for him, I am the only person he has to worry about waking him up, which I won't do aside from pain meds. And I am back sleeping in our bed instead of a recliner, so happy that on the whole, Dave is recovering well and we are once step closer to the end of this story.

Thanks again for praying and for continuing to partcipate in this saga with us. We are getting close to the end, and we would not have made it this far without all of you and your support. For those of you outside of Cincinnati, keep praying as we walk through recovery. And for anyone around town, we're homebound for a while (the car's seatbelt sits right along one of Dave's incisions) but always up for visitors - well, except for tonight. Tonight, we are eating the Outback take-out that Sarah dropped off for dinner last night, then heading to bed to sleep off the rest of the hospital hangover. More soon...

Update #179

The weekend was full of the "art form" of pain control. Saturday morning, Dave was miserable again. Pain was at an eight on a scale of one to ten, and the Pain Management "Team" consisted of one resident trying desperately to figure out how to at least relieve the worst of Dave's pain. Up with the dilaudid - both a bolus (one time larger dose boost) and an increase in Dave's PCA (personal control button) - and by 6:00 p.m. he was out of bed for the first time and in a chair.

Sunday morning, more pain. For some reason, it took us all that long to figure out that because the majority of Dave's dilaudid was coming from his PCA, and because most people are not capable of pushing a button every six minutes in their sleep, Dave was waking up with almost none of the most effective pain meds in his system. Another bolus, plus the addition of small continuous amount of dilaudid in addition to the PCA and the epidural (which never seemed to do much), and Dave was up and walking the halls, dragging a pole full of pumps and meds, Sunday afternoon.

Throughout this entire process, Dave was also dealing with the constant joy of an IV that just wouldn't stay put. One thing we've learned over the past year is that Dave's veins are almost impossible to stick. On Wednesday during the surgery, he had an IV in both wrists, one to receive meds, etc. and one as a backup. On Friday, the first IV started leaking, so the nurses switched the line to his other wrist. Fortunately no needle stick that time. Saturday night, Dave's left hand started swelling, a sign that the IV fluids were not going into his vein, so the IV was moved to his right elbow - according to one of Dave's nurses, the "lazy man's IV" because the vein is easy to hit, but the placement of the IV is extremely annoying the patient. Sure enough, less than 24 hours later, the needle in the IV was bent because of the movement of Dave's arm, and off to the right forearm we go. 12 hours later, Dave's hand was no longer swollen, but his left forearm made him look like Popeye - another missed vein, another removed IV. This time, however, there were no veins left. After three different nurses tried four different sticks, Dave told them to leave him alone (very politely, of course) and find another way to give him his meds.

So today, he's back on Oxycodone pills, off his IV, and as of 10:00 this morning, epidural free! The best news - assuming he doesn't experience withdrawal from the epidural meds, we should be heading home late this afternoon or early this evening! Like Dr. Muskat and Dr. Kitzmiller predicted, one week, and Dave is doing even better than they could have hoped. His incisions are healing nicely, his pain is almost under control, and unlike with his femur surgery, he is walking fairly long distances with very little problem.

Thanks again for all the prayers, emails, texts, phone calls and general support. On the whole, this has gone about as well as any major abdominal surgery could go. Continue praying that Dave's pain will remain under control as we go home and that the recovery goes quickly and smoothly from here on out.

Update #178

So sorry for not posting yesterday. Dead laptops, lots of doctors, Dave not feeling well, and just general laziness on my part - but the excuses are gone now, and we're back.

Wednesday night after the surgery was rough. Dave spent five hours in the post-op area waiting for a room on the floor (you'd think that scheduling a surgery two months in advance would guarantee you a room), and when he finally got moved, the only room available was a double. Read: I couldn't spend the night. In spite of the epidural and an additional PCA pain med (a pump that he controls in small doses every six minutes as needed), Dave was in a signifcant amount of pain, so it was pretty rough leaving him. Dr. Muskat also told him that he could not eat or drink anything but ice chips for 24 hours (we're at 48 and going strong right now with no word on when food may be allowed) to allow his digestive system to heal. After I tore myself away from the hospital at 9:00 p.m. - the end of visiting hours - Dave texted to tell me that he had just found out that he could not have any sleeping meds either. Great surgeries, but not a great start to the hospital stay.

Yesterday was a day of finding the right balance of pain meds, a process that is still ongoing in part. Fortunately for us, this stay at UC, unlike the stay after Dave's femur surgery, includes consults with a Pain Management Team multiple times per day, and the team truly has been working hard to make Dave comfortable. First, they upped the PCA meds and changed the type of medicine in the epidural, then upped the dose there as well. A few hours later was the first time I saw Dave stop wincing since surgery. The new meds worked for most of the day, but around 7:00 p.m. last night, Dave said he was "feeling floaty" and that his left arm was completely numb. With his head rolling around the pillow and his left arm flopped at a strange angle across his body, slightly with a lisp: "I sthink, my pain medsth are too sthrong." You think? :-) Back down on the dose of the epidural we go.

The floaty feeling disappeared around 8:30 p.m., and Dave finally got sleep meds around 9:00 p.m. last night, a huge relief. Still no private room available at that point, but he slept through the night and most of the morning. Dressing change (so minor compared to pre-surgery!), lots of doctor visits, nurses in and out, blood draws - the hospital norm.

Now, at 6:45 p.m. on Friday night, we are sitting in the last private room left in the hospital, comandeered by the charge nurse for "her newlyweds," drinking ginger ale and getting ready to watch a movie. Dave is much more alert, his pain is under control except when he coughs or moves (okay, those are both fairly major parts of his life right now, but at least it's getting better), and I get to spend the night. Not bad for Day 3. Still no food, but that should be coming tomorrow. And hopefully, we'll be home long before this time next week.

Thanks for all of your prayers - each day is getting better and better. Oh, and a huge praise (since the laptop was down, I couldn't post the prayer request this morning), our friends Mike and Kaylie had to take their baby Josiah in for surgery today (could we possible have any more people in the hospital?), and I got to sneak down to Children's Hospital (three blocks away) to sit with them until they heard that everything went fine and they could take him home tonight. Thank God for healing, in Cincinnati and beyond.

More coming soon!

Update #177

No more dressing changes!

The second part of Dave's surgery is done, and Dr. Kitzmiller was very pleased. After Dr. Muskat finished taking down the fistula, Dr. Kitzmiller took the skin flap that has been the bulge on the right side of Dave's body for so many months and cut its thickness in half, separating the muscle from the skin. He managed to stretch the muscle across most of the right side of Dave's abdomen to replace the muscles and supportive tissue he lost when he hit the guardrail. He then used the skin layer cover the area, leaving only a small space between his breastbone and his bellybutton without supportive structure. The stitches and staples will be in for ten to fourteen days and will require some minor care, but after that, NO MORE DRESSING CHANGES! No more drainage leaking everywhere, no more tape tearing off Dave's skin, no more Baza cream making him smell like a medicine cabinet. Yeah!

After at least three months of recovery, we will begin to talk about continuing the reconstruction by covering the last small unprotected layer and beginning to smooth out the mountains and valleys that make up Dave's abdomen. For now, we're just enjoying the fact that surgery is over and Dave is doing very well.

One more thing, total sidenote: my girl Liz's bone marrow came back clear of any new leukemia cells, her blood counts are back to normal, and she is back on track with chemo...in fact, she is walking distance from us right now for a one night stay at Children's Hospital! Thanks for praying for her too.

It will probably be another hour before we get to see Dave, so I'll post more later. Thank you all for your prayers!

Update #176

First part of the surgery is complete. They found the source of the fistula where they expected it to be - in between his colon and his small intestine, the site of a previous repair at the very beginning - and reclosed it. They also discovered another small hole that seems to be coming from his liver (his liver is under his rib cage because of the diaphragm being reattached, so they can't see it clearly), a hole that has been draining a small amount as well. Dr. Muskat cauterized the hole and said it should close on its own but has minimally invasive ideas for how to fix it later if it continues to drain.

Dr. Kitzmiller is working on reconstruction now...more when we hear...

Update #175

Dave just went back for surgery. After talking to Dr. Muskat and Dr. Kitzmiller this morning, it will be approximately three hours for the first part of the surgery to close the fistula and two hours for the second part, which only includes closing Dave back up and readhering the skin flap (the beginning of the major reconstruction, including inserting supportive tissue to replace his abdominal wall, will be in a few months). I'll post as we hear...

Update #174

Today is the big day! Just a reminder to be praying today as Dave undergoes what we hope will be his last major surgery. The procedure starts at 9:30 a.m. at University Hospital here in Cincinnati and will last between four and six hours - two hours for the "trauma" surgery to close the fistula (hole in his digestive track) and an additional two to four hours to begin to reconstruct his abdominal wall, including inserting something to replace his ab muscles and two ribs on the right side that he lost during the accident (the length of the second part of the surgery is dependent on how smoothly the first part goes). Recovery is seven to ten days in the hospital and an additional three to four weeks at home. Be praying for peace for Dave, his parents and me during what will be a very long day today, and for wisdom and skill for Dr. Muskat and Dr. Kitzmiller to complete the procedure without incident.

I'll be posting updates as things happen today, so keep your eyes here!

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