May 23, 2006

I was told it was time to get Gary some athletic shoes, and he also asked for some long-sleeved T’s, so on Sunday evening I took another shopping trip. Blcchh, this one was not fun. At Target I went through the entire men’s department and scrounged up only two long-sleeved T’s. Fortunately Gary likes the Braves (that’s a baseball team, for my French friend), as the shirts bear their logo. In the shoe department, the sizes were only mostly together. Same with the styles. So I ended up looking through the entire wall-full of shoes, and found only one pair with velcro straps, which is what he needs at the moment. Unfortunately they were not the correct size. The Target salesperson sent me off to another store (I have told you how much I hate driving in traffic, haven’t I? At least Atlanta’s was easier than Birmingham’s). The store was closed. No way was I going to head back in the direction I’d just come from and hack my way through the jungle of Lenox Square Mall searching for shoes. I chalked the trip up as a failed attempt and consoled myself by going to a Publix grocery store and perusing their “organics and natural” section. I got Gary some organic yogurts and smoothies and milk, some definitely nonorganic Hershey’s cocoa, some zukes for me, and also such exciting things as natural toilet bowl cleaner.

Gary had told me that in talking to his mom Saturday night he’d found out that he had a cousin who lived very close to Shepherd, about a mile away (give me a second – this is actually related to the above paragraph). This cousin, Helen, called on Monday. We talked a bit and she asked if there was anything we needed. Not really serious, I said Gary needed tennis shoes (I had been planning to go out to find them a couple of hours hence). She said she was doing errands and would be near the place I had been told might have them, so would check it out and give me a call. She did this, found the place didn’t have velcro shoes either, but found them at a nearby place. She picked them up for us and said she would bring them when she came to visit that evening! We knew it was her when she walked through the curtain shortly after seven. Okay, there were some giveaways: she said she was coming about seven, and she was not dressed like one of the medical personnel. But I could tell she was of Groteleuschen stock because she has the same facial features and coloring as Gary’s mother. She was full of stories, and kept us well-entertained. She brought a beautiful begonia, and the tennies – which she probably has no idea how grateful I am that she got them so I didn’t have to hunt them down.

Okay, to the medical stuff. Gary will have to have the “sacral flap” surgery for his bed sore. The doctor’s opinion is that it wouldn’t easily heal on its own – could take five months to do so – and wouldn’t heal as well with the natural scar tissue as opposed to having a skin flap put over it. The doctor came in the afternoon to take another look at the sore (bellowing “Gary!” as he walked through the curtain, thus destroying the nap of the person in the next area who had recently asked us to turn down our tape recorder because he wanted to take a nap – we had turned it off because if we turned it down Gary wouldn’t have been able to hear it). I immediately liked the guy because he asked if I was Gary’s daughter. (Of course, this could have just been very bad news for Gary, not good news for me.) Anyway, the doctor said the sore was worse than when he’d seen it on Friday and that it was sitting right on the bone.

So on Friday Gary will be wheeled over to Piedmont Hospital, which is connected to Shepherd through a tunnel. He will be put under anesthesia (just the usual general type – he won’t be put on a breathing tube). Then the doc – a plastic surgeon – will debride the area (“debride” sounding so much better than “digging the icky stuff out”). He will also remove Gary’s tailbone (!) because evidently it is more trouble than it is worth for Gary’s condition. Then he will take muscle from Gary’s glutes to fill in, then fold his skin over the area and use staples and sutures on it to close it. Gary will then have to lay flat, or nearly so (no more than a 20 degree angle), for three weeks. If he can tolerate “proning” (laying on his stomach), the success rate of this surgery goes up significantly. During the last of these three weeks he will undergo gentle stretching of the scar tissue until they have increased the stretch of the hips to 110 degrees. Then they will start to gradually sit him up in bed, then get him gradually used to sitting in his wheelchair again – in total, it is a five week healing process. At which time he will be back to where he was about the time he first arrived here. Sigh. The good part about this is his finger should be just about healed then, so he can better take advantage of the rehab.

So a lesson for anyone who reads this: bed sores are a very serious matter, and don’t trust your nurses to be taking the proper preventive care of them.

On the plus side, Gary’s coughing problem seems to have improved (keep your fingers crossed). Those first days here sometimes it was so bad that he was totally exhausted by it. But now they are thinking of reducing his nebulizer treatments to twice a day, then as needed, so with any luck I soon won’t be able to joke “put that in your pipe and smoke it” anymore (he breathes in the medicine through something that looks like a pipe and “smoke” comes out the end of it). (Another phrase we bandy about is “knock on plastic” (there no being any wood around), whenever an improvement seems in the making. It got us to wondering how that phrase had originated. Normally I would immediately go on the internet and track the phrase down, but I haven’t had the time.)

May 24, 2006 (12:47pm)

Much of what I’m going to say here about Gary’s injuries I already said at the beginning of this blog or in the emails sent out, but for those who’ve jumped in recently, here it is again – we had it recently reviewed for us in a conference with Gary’s doctor, Dr. Lin, on Monday. First Gary’s orthopedic injuries were reviewed, complete with newly-taken x-rays: fractures in the spine, the pelvis (two such fractures), and the finger. The doctor explained how the spinal column has a two-fold function. It acts as scaffolding for the head, neck, and shoulders, giving rigidity to support their weight and flexibility for bending. Secondly, it gives protection for the spinal cord, which functions like wiring to the body, allowing our movement, perception of sensation, sense of orientation; it also is responsible for bowel and bladder functioning, ability to breathe, heart rate, temperature control. The top part of the spine, the neck area, is the C spine (cervical), then comes the T spine (thoracic = chest), then the lower lumbar L spine. The cord is like a garden hose, says the doctor. Pinch it somewhere, and the messages have a harder time getting through. Pinching it closed or severing it makes it very difficult for signals to get through (doctor’s words). The spinal cord, like the brain, doesn’t really get better after being bruised (the doctor likened it to a bruised banana); it doesn’t heal well at all. Gary’s injury was at T4, nipple level. When he had his first MRI in the emergency room, the docs saw a hematoma choking the cord. They went in to try to relieve the pressure. When they did that, they saw the spinal cord had been severed, separated, disconnected – take your pick of words, they all mean the same thing. They took the pressure off the spine, and in a later operation stabilized the spine with rods and pins. We saw the x-rays of this. The doctor pointed out how they had removed some of the bone to take off the pressure (they removed 5 of the bony ridges that you could see if you look at the back a skeleton model of the body), then later put in the rods as “replacement.”

His pelvis has two breaks. They heal by not putting pressure on them, which with all the bed rest he’s been getting satisfies that requirement.

The doctor said that perhaps down the line stem cell research could possibly help restore some functioning, though with the political climate of today who knows when such breathroughs might happen. He also mentioned China was better able to do the research, having an abundance of fetal tissue, but that they were so disorganized over there that no useful data was coming out. He mentioned them having some success in Portugal . . . But anyway, for practical purposes this is still very much in the future.

The doctor’s own spinal cord was severed at T1, by the way – armpit level – giving him less functionality than Gary. That surprised us greatly, given the way he moved in his chair.

Medically Gary has no great issues, according to the doctor. But there are four reasons why he is in such a place as Shepherd.

First is for medical stabilization. The trachea hole, broken bones, skin sore, need healing. The breathing issues. Etc.

Second is mobility issues. Learning first how to get from bed to wheelchair, later such things as participating as fully as possible in the community – driving a car, etc. A paraplegic with Gary’s level of injury is expected to be fully independent (though he probably won’t be cleaning gutters, the doctor demurred). Shepherd consistently rates as number one or two as a Model Spinal Cord Injury Center in the nation, meaning this is a very good place to go for this purpose.

The third reason is body acclimatization. Checking the skin frequently for pressure sores (the doctor warned that once a person has had a problem with them, things never get completely better – like trying to smooth a crumpled paper back to its original look), checking the legs for blood clots. Learning the bowel and bladder routines – neither operate as they normal would, so Gary has to learn catheterization for urine removal and rectal clearing (sphincter stimulation) for bowel evacuation. The doctor says it takes about six months for a paraplegic to learn his body well enough to have these routines down.

In addition, the digestive system in general is slowed down and doesn’t operate as well. I mentioned I though Gary’s belly looked swollen and wondered if that was a part of it, but the doctor said that Gary no longer has control of the abdominal muscles, so they go slack and result in the “beer belly look.” That had confused me because Gary hadn’t looked like he had lost weight around his middle, but I noticed his legs were definitely skinnier, and maybe even his arms. I thought it may be due to atrophy, but it turns out that in addition to that, he really has lost weight – he’s dropped 13 pounds since the accident.

The fourth reason for Gary being here is OT (occupational therapy): learning to dress, wash, shower.

And after he’s done with the program here, Gary’s work is, of course, not done. He will still want to work at increasing his fitness, strength, stamina.

Since I’m behind in posting stuff, I’ll get this off now.