Day #11 in ICU and Surgery #4

8:30 am - She's gone into surgery. They're going to fix her elbow (humerus) and then irrigate and debride her leg and arm wounds again. They expect it to take at least 3 hours.
10:30 am - They've finished her elbow. Starting on flushing and redressing her arm and leg wounds now.
12:05 pm - Surgical nurse says she's doing well. They are finishing up her leg.
12:45 pm - Dr. W said her elbow surgery went well. He's pleased with how they were able to put two screws in and fix it. The surgical nurse said they gave her a bath and washed and dried her hair while she was sedated. Dr. is still incredibly concerned with her leg wound and the potential for infection. He said her arm bones will likely take 10-12 weeks to heal. She's having some issues with her skin in other sites due to the prednisone that has Dr. W concerned.
9:00 pm - She had turkey sandwich for lunch, chicken noodle soup for dinner, and a visit from Kristen and Derrick. Dr. Wade visited and they discussed that she probably has another two - three weeks in the hospital. That was tough news for Meghan to hear. We're going to try to stay focused on one day at a time and celebrate each success.

Meghan had a laugh about the bath with her surgery today. She wonders if it's new special at the hospital - free bath with every 4 surgeries. Or, maybe a new spa offering.

Day #10 in ICU

9:00 am - Will get an update from Meghan about her hyperbaric chamber treatment this afternoon.
12:00 pm - Meg says the HBO (as the nurses call it) is no big deal. She said they woke her up at 5:30 and made her drink her nutrition drink. Then they gave her pain pills as they loaded her into the ambulance for the 30 min ride to the Hyox clinic. The transferred her to a chair and wheeled her into the "cabin". She has to wear a bubble thing over her head that makes her feel like Buzz Lightyear. She got to watch a movie, eat a rice krispie treat and drink some juice. She was awake and cheerful when Mom got to the hospital at 11:30ish. PT will be by at 1:30pm to get her up to walk. She's taking a nap now.
1:45 pm - Dr. K (rheumatologist) visited. He said for the first time since July, the C-ANCA titres for Wegener's are negative. He said normally that indicates remission. He's cautiously optimistic that we may be out of the woods with Wegeners. Dr. W (orthoped surg.) visited to have her sign consent forms for elbow surgery tomorrow. He will also be getting in touch with the plastics guy to see if they want more debridement on her leg and arm wounds. Red blood counts indicate she may need transfusion over the weekend after the elbow surgery. Dr. W also said he's keeping her in ICU due to the higher level of care for her wounds. She's stable and really shouldn't be an ICU patient. Dr. K and mom discussed asking Meghan's hemotologist to visit and check into her blood count concerns. They are considering a long term care facility rather than keeping her in the hospital.
2:45 pm - PT had her up today. They were able to disconnect all of her lines from the machinery and she walked around the bed and to the door. She decided that was far enough and she turned around and walked back to the bed. Awesome progress!

Elbow surgery tomorrow. Not sure what time.

9:30 pm - Mike went to visit tonight. She's very sleepy. All the activity of the morning and the PT in the afternoon must have worn her out.

Day #9 in ICU

9:15 am - The wound care nurses came to change her V.A.C. dressings. It's incredibly painful for Meghan. They stopped in mid process to contact the ortho surgeon for information and to get an order for stronger sedatives. The plastics guy was here too. Meghan said he mostly poked around and didn't say much that she can remember. After getting strong pain meds, they were able to restart changing her dressings. Even with dilauded and ativan it was a painful procedure. She's being so strong. The wound nurse assures me that the procedure will be less painful each time they have to change the dressings.

The ortho. surgeon came by. They have ordered hyperbaric treatment for her leg. She'll have to be transported to another location for the treatment each day. He says it will be an two hours a day 5 days a week for 20 - 60 days. The goal is to save as much of the skin on her leg as possible.

Her white blood cell count is up and her red blood cell counts are drifting down. They will continue to monitor.

Elbow surgery is planned for Friday evening or Saturday morning.

4:45 pm - She's fought the sleepiness all afternoon but the drugs are winning at this point :) She's awake for about two minutes and then she's out cold again. Even with the drowsiness, PT came and got her up to walk. She walked (sleepwalked?) from her bed to the wall twice and did some leg exercises in the bed. We met Dr. K (hyperbaric treatment dr) this afternoon. He gave her an assessment and talked to us about the treatments. She'll be gone from the hospital for about 3 hours every week day to travel by ambulance to the clinic for treatment and then transported back to her ICU room. To eat today she's had a piece of toast, a bite of turkey, and 16 oz of apple juice. She was willing to eat today but, bless her heart, she just couldn't stay awake. She's running a low grade fever this afternoon and she still has IV antibiotics.

This is for the grandparents! Sorry this picture is such poor quality. This is the best we can get right now since they don't allow cameras in the hospital. She was watching tv last night eating dinner. We have her hair in pigtails.

9:00 pm - she's bright eyed and bushy haired tonight at least she was until Mom brushed her hair out. Mom's now in trouble for posting this picture from last night (Meghan DID NOT appreciate it). She and Caitlin have had a lively evening of conversation and jokey jokey.

Day #8 in ICU

9:00 am - She had a relatively good night. Her bed is in the "lazy boy" position and she's trying to enjoy pancakes. There's talk of her getting out of ICU today and going to the orthopedic floor but no official orders yet. No doctors have visited this morning. Had to switch to Fruit Loops for her to munch on. She has NO appetite.
2:30 pm - Busy afternoon for Meg. The PT guy came at 11:30 and whisked her out of bed. He had her stand for a while and then rock back and forth raising her heals. Then she had to do toe raises. Her heart rate was a little high but he stayed right there with her and she never felt faint. She has a sling for her arm and said her right leg feels "heavy". They brought the chair over and sat her up and propped her right leg in another chair. Nurse J and I washed and dried her hair and got her all cleaned up. She just got back into bed a few minutes ago and is trying to munch on her turkey sandwich. She said her pain was a 4 out of 10 while she was sitting in the chair and its mostly her arm that's bothering her.

5:00 pm - Napped all afternoon after eating some grapes, half a banana and two bites of her turkey sandwich.
9:10 pm - Dr. W (ortho surgeon) visited this evening. He plans to do the elbow surgery late Friday or Saturday depending on the swelling. The wound nurse came by in the afternoon. They will change her V.A.C. dressings Thursday or Friday with out taking her to surgery (yay). Grilled cheese for dinner was hardly touched but she ate all of her green beans :). We sat her up in the bed that transforms into a reclining lazyboy.

Unfortunately, the doctor didn't mention moving her out of ICU today. But, we're ok with it - she is getting such great care from these nurses.

Summary of her injuries (cliff notes)

Here is the cliff notes version of what Meghan's dealing with. We continue to be incredibly grateful that she didn't have the injuries that could have happened.

Prior to the accident, Meghan has been undergoing treatment for Wegener's Granulomatosis, a life-threatening auto-immune illness. She had completed about 5 months of daily doses of Prednisone and weekly doses of Methotrexate. Prednisone makes the skin very thin and easily injured. Methotrexate is an immune suppresant drug. Normal protocal for treatment is 18 months.

In the 11/24 accident, she

• shattered both bones in her left forearm.
• fractured her left wrist.
• broke her left humerous (elbow).
• experienced internal trauma to the soft tissues in her left arm.
• needed 12 stitches to close lacerations in her right forearm.
• had multiple minor lacerations on her right forearm.
• had a serious laceration on her upper right leg from femoral artery to hip across her lap.
• experienced serious internal injuries to the soft tissues of her right thigh.
• had a complete rupture of her right quad muscles.

To repair her injuries, she has had and will have numerous surgeries to:

• plate the bones in her arm. (done)
  
• pin her wrist. (done)
  
• apply V.A.C. therapy to her internal injuries on her arm and thigh. (multiple done not sure if she'll need to go under for future dressing changes)
  
• close as much of the wound as possible in her leg laceration. (done)
  
• place screws or pins in her elbow. (to be done this week when the swelling goes down)
  
• skin grafts for her arm and thigh. (hopefully within two weeks)
  

She also has to wear a knee brace to keep her right leg from bending at the knee.

The doctors have stopped her treatment for Wegeners to allow her immune system to fight off infection and help heal the wounds as quickly as possible. We are racing against time to heal her as quickly as we can and hope that Wegener's is in remission.

Day #7 in ICU

9:00 am - She had a rough night but is in very good spirits this morning. Today's goal will be to work with PT and OT on getting her moving. She wasn't interested in eating breakfast.
12:00 pm - She's nauseous. Interested in eating but not willing to try. PT came by and said orders are to get her up and into a chair. Will try after nausea meds. Wound treatment therapists came by and checked the VACs on her arm and leg.
2:30 pm - SHE WALKED!!!!! Unbelievable!! The PT and OT came at 1:00 and showed her how to sit up and get out of bed. She sat up for a few minutes while they checked her blood pressure and fashioned a splint for her left arm. It was quite an ordeal to position all the tubes and equipment. Then they had her stand for a few minutes and sit back down. Then they stood her up and walked her 6-7 steps to the wall next to the window. Stand there, and then walk backwards to the bed. The OT positioned the bed into a reclining chair position and then they talked about how she would be able to dress herself, eat, bath herself, use the restroom, etc in no time. They're going to get a cane to help her with her right leg - she won't be able to bend it at the knee until her ruptured quad heals. The OT is VERY impressed with her effort today. She said the pain was about a 6 out of 10 and she's still in ICU at this point. Seems to have worn her out. She's asked for a protein drink instead of food.
5:00 pm - sleepy afternoon. The PT wore her out.
9:00 pm - Dr. K (rheumatologist) visited. All is well with Wegener's so far. Ate some of her pasta dinner.

Day #6 in ICU and Surgery #3

I'm new to keeping a blog, so forgive the issues with the font sizes. Also, I'm posting a new picture of Meghan every day. If you have a picture of her you'd like me to use, feel free to send it to laura_lambert@bellsouth.net. I told her I'd start with the good ones and eventually have to use the bad ones...to give her incentive to get better faster. Thanks for reading. The comments cheer her up a lot. - Mom

8:45 am - She's sleeping soundly and appears to be dreaming. I'm waiting to ask the nurse how her night was.

9:15 am - Dr. W (orthopedic surgeon) came in at 8:00 and had her sign consent and explained her surgery today. For some reason, he tore apart her splint/cast on her arm so now she's really uncomfortable and feels like she can't move without injuring her arm. Her heart rate is down in the low 100s today - an improvement over yesterday. But it looks like her blood pressure may be up. Occupational therapist came to see her about her arm. Given the condition of her cast and the ambiguity of the dr's orders, she called him for clarification. He confirmed there's to be no OT until the elbow is fixed and he wants her doing weight bearing PT on the rest of her limbs. Mom will clarify this when she speaks to him after the surgery. We can't figure out how she'll do anything with her right leg at this point. Meghan's feeling anxious, grumpy and itchy. We've had yet another visit from the vascular team to remind us that Meghan's IVC filter needs to come out. We think that is the 5th person from that group to come tell us that. I think we got the message ;-).

The OT confused Meghan when she asked about the wound on her arm. Meghan realized that she didn't have a wound when she came into the hospital. Mom asked her if she wanted more details about what happened and she did. Mom explained that it was similar to hearing about people having internal injuries in an accident....the force of the wreck caused internal injury to her arm and leg and all of that injured tissue has to come off and heal.

11:40 am - The did the echo cardiogram/ultrasound of her heart. Her blood pressure is fine. The cuff was in the wrong place on her leg.

2:45 pm - still waiting to go to surgery. She's slept fitfully most of the day so far. She's sitting up checking her Facebook and email to pass the time. We found that she can move her right leg back and forth with minimal pain when we noticed her leg looked like it was about to slide off the side of the bed.

5:45 pm - Meghan just went to pre-op. Mom is waiting in surgical waiting. Will post updates as they come. Her surgery will be to irrigate and debride her leg and arm wound. The plastic surgeon will also be there to assess her need for skin grafts. They will also re-splint her arm.

Before they wheeled her down, Meghan was playing with the finger sensor and the mobile monitor. If she raised her finger, it beeped faster. If she lowered it, it beeped slower. We found that pretty funny. And, the guy transporting her had trouble with the cables and tubes and had to keep leaving the room to get stuff. I told her they were really testing our patience and then we realized that was a really good pun and had a good laugh. She was SO ready to get the show on the road.

6:45 pm - The surgical nurse called to say that Meg's surgery has finally gotten under way.

9:00 pm - Surgery complete. Dr. W said things are looking very positive. She will need skin grafts and the plastic surgeon was there to get a good assessment of how things are healing after just a week. Dr. W plans to fix her elbow in two-three days (one more surgery). He is waiting for more of the swelling to go down. The plastic surgeon will take over treating her leg and arm wounds. Dr. W doesn't think she will have to have general anesthesia for the wound treatments going forward -- which means she may not need surgery on the wounds again. Her blood counts have been stable over the weekend. They will monitor things to see if she needs another blood transfusion this week. She will be in the hospital at least another two to three weeks and still has a long road ahead of her but, things do sound positive. Dr. W wants her to start getting up (bed to chair) and eventually walking with a knee brace. She will not be allowed to bend her right leg until the quad heals (up to 6 months). Mike and Mom are waiting in the ICU waiting room for her to return to her room so they can say good night to her.

Day #5 in ICU

9:00 am

Mike is visiting with her this morning. She's had an EKG to check out why her pulse is racing occasionally. She had a good night and is in good spirits this morning. French toast for breakfast. Mike's parents came to visit.
1:00 pm
She's been awake most of the day with a short nap before Mom and Caitlin arrived. Dr. L (cardiologist) came to visit Meghan to discuss her heart arrhythmia during the night. They are going to do an echo/ultrasound of her heart just to rule out any issues but they think it's just a normal reaction to the stress, trauma and surgeries. She's now able to move her left leg so we're working on easing her into repositioning herself by using her left foot. Her arm is hurting - she feels like something is poking the outside of her arm and we think it's the incision from where they fixed that bone on the outside of her arm.
3:00pm
Physical Therapist visited and gave Meghan new exercises for her left leg. She can't let her heart rate get above 120 so she has to take breaks to let it drop back down. She really enjoyed her visits from Jena and Sarah.

5:00 pm

The day got the most of her and Meghan took a good nap after visiting with Lauren and Dr. K.
9:00 pm
Mike and Mom went back to visit Meghan at the 8:30 visitation. We did her physical therapy for her left leg and fingers. She also did her respiratory therapy. She had grilled cheese for dinner. She has to drink what she describes as a really nasty kool aid drink twice a day. We brought her laptop and she's on line for the first time in a week.