Meghan's recovery

The final procedure for recovery

2009-06-15T22:34:00.002-04:00

Within a week of the wreck, the vascular doctors inserted a filter into Meg's inferior vena cava to protect her from blood clots. They attempted to remove the filter Christmas Eve but found a blood clot in the filter during the procedure. Meg was put on blood thinners to dissolve the clot and prevent another one. Being on blood thinners is a BIG drag. Aside from the daily doses of an additional medication, blood thinner patients are required to go in weekly or bi-weekly to have their levels checked. If it's too high or too low, the meds are adjusted to try to keep things in the right zone. Unfortunately, Meg's Wegener's Granulomatosis meds interfered with the Coumadin causing her levels to be all over the place. And then there was a nose bleed that required a trip to the ER in June.

They attempted to remove the filter on Wednesday in an in office procedure but weren't successful. Today, Meg went under anesthesia in an outpatient hospital surgery to try again....and they got it out.

Almost 7 months later, Meg is back to the point she was at when she had the wreck...with a little extra hardware, a few scars, and a completely different perspective on life. She continues to fight Wegener's Granulomatosis and currently seems to be winning that battle as well.

Week 15

2009-03-09T09:34:00.002-04:00

Meghan had another follow up with the orthopedic today. Her elbow and ulna are healing well and she has good range of motion. Her radius (the thumb side), unfortunately, is still not healing but given the amount of damage it sustained, it isn't unexpected at this point. The plate holding it together is doing it's job well.

The skin graft on her leg is looking quite awesome as far as skin grafts go. There are still some spots that are over granulated (healing above skin level) and the entire thing still needs to be protected by bandages for some time. Her donor sight looks like a sunburn and is healing just great.

Week 13

2009-02-23T16:34:00.002-05:00

Meghan's been given clearance to do anything except play contact sports and run. The wound on her arm is completely healed and she is adjusting to seeing the scarring now that she doesn't need a bandage.

The bandages on her legs are quite large but only need once per week changing. She'll continue to have bandages over the skin grafting site until it's completely healed and no longer needs protection.

Week 12

2009-02-16T16:38:00.001-05:00

Dr. F says that 98% of Meghan's skin graft is successful! Way to go Meghan!!!

Surgery #7

2009-02-09T07:43:00.005-05:00

5:30 pm Meghan was grumpy and hungry but it turns out the anesthesia isn't agreeing with her tummy again this time. They are giving her morphine until she can keep a percoset down.

2:00 pm We've been able to visit Meghan twice in recovery. She's awake and in a bit of pain on the donor leg. Waiting for room availability.

12:00 pm Surgery finished. Dr. F said things went very well. She will have a wound V.A.C. for at least a week and a dressing on the donor site. It will take 2 weeks to know for sure if the grafting has been successful.

10:15 am Nurse called to let us know that surgery has started.

9:00 am Meghan's gone back to the surgical suite.

7:00 am Meghan's going thru pre-op.

Week 10 - another update

2009-02-06T13:24:00.002-05:00

Meghan had her follow up appointment at the ortho today. Her elbow and radius are healing as expected. Her ulna was the most shattered bone and Dr. W said it's still too early to tell if it's healing correctly.

At PT today, Meghan was allowed to ride the bike for 10 min in addition to her regular therapy for her leg.

Week 10 - update

2009-02-03T15:56:00.004-05:00

Meghan's skin graft surgery has been scheduled for Monday, February 9th at 9am!!!!!!!!!!!!!! This is very exciting news - Meghan can finally see the finish line on her race to recovery!

It will be a split thickness graft and recovery is expected to be 2-4 weeks. She'll go back on the wound V.A.C. for at least a week and then will have dressing changes until it's healed. She will have to avoid movement that might stretch or injure the graft for 3-4 weeks. The doctor expects her to be hospitalized for only one night after the surgery.

She has pre-op on Thursday and we will switch her from Coumadin to shots for the blood clot. Five days after the surgery she'll go back on the Coumadin and resume monitoring of the blood thinner. She will probably skip a dose of her methotrexate after the surgery but will resume the following week. We are hoping the Wegener's meds won't slow recovery from the grafting.

The size of the area on her leg getting the graft is approximately 24 by 18 centimeters (10 by 7.5 inches). The donor site (other leg possibly) is expected to heal within 1-2 weeks.

Week 10

2009-02-02T09:27:00.003-05:00

Meghan saw the plastic surgeon today. He said she's ready for the skin graft - which we already knew. His office will coordinate scheduling surgery "in a few weeks". Meghan isn't very happy with that time frame. He said it could be sooner but he didn't want to set her expectations too high. Scheduling depends on preauthorization by insurance and his surgery schedule availability.

She's no longer using her VAC on her leg and now has a huge bandage that has to be changed at home.

Week 9

2009-01-20T22:48:00.002-05:00

Wound healing continues to be heading in a very positive direction. Her arm wound is much, much smaller and her leg wound is nearing the point where it will be ready for the skin graft.

Unfortunately, Wegener's Granulomatosis syptoms are appearing and that has made us very nervous. A blood test came back positive for ANCAs (key indicator of autoimmune issue), her ankle was swollen one day last week, we noticed spots (vasculitis) again on her legs -- though very few, and she has a worrisome cough not unlike everyone else this time of year. Each of these symptoms are not very exciting individually, but knowing the history of how Wegener's developed last May - June we are not taking any chances. Her rheumatologist has started her back on methotrexate, an immunosupressing drug, and he will discuss her medication with the plastic surgeon. We are optimistic that Meghan has made it through the most challenging part of the recovery when taking methotrexate AND avoiding infection would have been impossible. We knew it was likely that she was going to have to restart the treatment. We had hoped it could wait until she was completely recovered.

Week 8

2009-01-14T14:08:00.002-05:00

Plastics guy came to the wound change today. He's pleased with her progress. He thinks we'll be scheduling a surgery date for the skin graft after he sees her again in 2 weeks. He said she'll be in the hospital over night after the graft but then she'd be going home with the wound VAC again. For two weeks after the graft, she'll be very limited in what she will be allowed to do so the graft can take. If we heard him correctly, he expects her to be fully recovered from the graft within 4 weeks of surgery.

Week 7 - update

2009-01-10T11:57:00.002-05:00

Meghan had wound care and a follow up orthop. appointment on Friday. The wound care nurse was "giddy" from the improvements in Meghan's leg. The orthopedic surgeon was shocked to see how much strength Meghan has in her quad muscles. For the first time, Meghan heard just how bad her injury was and how grim the original prognosis was. All four quad muscles had been completely severed in the trauma and have appeared to be healing just fine. The surgeon was ecstatic to see how well she can move her leg and told her she could take off the leg brace going forward. Meghan almost jumped off the table in excitement.

It was a day of good news for Meg.

Week 7

2009-01-05T21:04:00.005-05:00

Her fever is gone. Two days per week Meghan has 4-5 doctors appointments. She's still wearing a knee brace and has the wound VAC on her leg. Hospital bills and insurance EOBs are starting to arrive in the mail. The grand total is easily over $185,000 and rising.

Her left arm

Meghan's OT is very pleased with her progress at improving her ability to move her left fingers, make a fist, give a thumbs up, and turn over her hand. She's been given "permission" to lift up to 5 pounds and she can now touch her head with her left hand. The wound on her arm is healing very nicely and no longer looks like a zombie bite.

Her leg wound

Wound care nurses tell us it looks beautiful. In reality, it looks like rare pot roast and is very difficult to fathom still after 43 days. No infection. Granulated tissue is growing in strong and plastics guy thinks she'll be ready for a skin graft by late January.

Her ruptured quad

PT is taking things very slowly however Meghan has shown progress. She can bend her knee 95 degrees - that's up from 50ish after ICU.

Her blood clot

Vasc. surgeons want to keep her on blood thinners for 6 months and check her again at that time.

Her Wegeners

She had blood work done on 1/2 and will have blood work done monthly to monitor whether or not she is in remission. There is no precedent for someone to be in remission after only 5 months of treatment. But, we'll take it.

Day #35

2008-12-29T15:04:00.003-05:00

Meg's wound care with Dr. F went well. He's very pleased with her healing and anticipates doing the skin grafts at least 4 weeks from now. Meg and Mike went to the hospital for bloodwork to measure her progress on the blood thinner.

A quick note from Meghan :)

2008-12-28T12:50:00.002-05:00

Hello everyone!

So far this weekend has been pretty normal. It is really much better to be home than sitting in a hospital. I have been taking my shots pretty well I think- Mom is pretty good at giving them to me no matter how much I flinch.

Today Mom is washing my brace, so I am kind stuck on the couch until it dries. It's not so bad. I have been doing my OT- I can make a fist and touch my thumb and pinkie together! I also tried playing Guitar Hero on medium- not too bad, but my pinkie isn't completely ready yet.

Besides that, there isn't much news! I have wound care changes tomorrow with Dr. F and I have to go get some blood work done to find out about my blood clot. :)

Day #32

2008-12-26T08:59:00.000-05:00

Meghan had PT on her leg and it went well. She still has to keep the brace on anytime she'll put weight on her leg. Since she can't put it on and off by herself, she wears it 24x7 right now.

Mrs. M. came and cut Meg's hair and it looks GREAT!

Day #30 & Surgery #6

2008-12-24T10:13:00.010-05:00

Meghan's been too "busy" to update, so here's the latest.....

Monday - She had an appointment with the Vascular surgeon to set a time for surgery to remove the IVC filter. She then had a wound change and everything looked fabulous. No sign of infection whatsoever. She does need additional debriding but they said they may be able to do it at the same time as the skin grafts - it will be up to the plastic surgeon whom we will see Monday. Her wound can best be described as looking like she was bitten by a shark.

Monday night, Meg wasn't feeling well. She had 102 degree fever. Because she wasn't having any other issues, we opted to give her tylenol and call the dr in the morning unless the fever didn't go down. The fever went down with tylenol and she felt better.

Tuesday morning, her temp was normal or the fever was very low. She went to Occupational Therapy for her arm. Therapist Jamey was very surprised at how well she is able to move her arm, wrist and fingers given her injury. She will need therapy 2x a week for at least two months on her arm. After OT, Meg's temperature was back up to 100ish. She called Dr. F and spoke to a nurse. They didn't feel that 100-102 was that concerning and instructed Meg to stay on tylenol as long as she has fever and to call if it goes over 102. Tuesday evening, Caitlin made surgar cookies and Meg, Caitlin and the Lambert twins decorated them. Meg has to do her OT exercises 4-6 times per day. She was sore and tired and went to bed by 9pm.

Wednesday morning (today), her fever was at 100 again this morning. She went to wound care for a dressing change. They also said her fever was "not a problem at this time". After dressing change, she went to vascular surgery to remove the IVC filter.

UPDATE - The vascular surgeon could not remove her IVC filter because (drum roll please) Meg has a big old blood clot trapped in it. She now has to take a blood thinner pills until the clot dissolves and a week of daily shots in the stomach. The shots cost about $157 each. Thank goodness for health insurance that covers medications!!

Day #28

2008-12-22T09:11:00.001-05:00

Meghan has appointments with the vasular surgeon and wound care today.

Mom is officially turning over the blog updates to Meghan!

Day #26 & #27

2008-12-20T11:26:00.002-05:00

Meghan and Caitlin spent Saturday and Sunday with Shane, Terry and the girls.

Day #25

2008-12-19T17:57:00.003-05:00

Meghan enjoyed her first full day at home. There were a few "hiccups" with the wound V.A.C. and nurse mom has had to do some troubleshooting. There was also a merry-go-round of doctors appointments and scheduling snafu's to deal with. But, at the end of the day, she had her post-op orthopedic appointment and all looks well with her left arm. Dr. W told her she should take the splint off and work on range of motion stuff with her elbow and wrist.

X-rays attached. Can you tell where the cadaver bone is???

Day #7 in LTAC

2008-12-18T09:07:00.006-05:00

It's official! Paperwork is being signed. Doctors orders are being finalized. The case worker is scheduling appointments for Meghan to see Dr. W, Dr. F and the variety of other doctors she needs to check in with.

She's being given a portable V.A.C. that she'll be able to carry around with her. We loaded her up in the car. We drove through Atlanta's 4:30 pm traffic.

She walked from the car into the house.

Where we found cool signs from Caitlin.

She's home!!!

Day #6 in LTAC

2008-12-17T08:34:00.005-05:00

Caitlin is spending the day with Meg. Thanks to Kristen and Derrick for visiting last night. After hyperbaric treatment, Caitlin and Meg made Christmas crafts in the occupational therapy room.

Big news today - if Meghan's wound dressing change goes well on oral pain meds at 2pm, they will plan to send Meghan home tomorrow.

And.....it did go well!!! Word is that she will be discharged tomorrow afternoon!!!

Day #5 in LTAC

2008-12-16T10:51:00.004-05:00

Mom had a discussion with the Wound Care center at the hospital to find out what it would take for Meghan to get outpatient treatment there instead of being inpatient at LTAC. In summary, she would need to be able to handle her wound dressing changes on oral pain meds instead of IV pain meds. The wound care nurse thought she might need another debridement surgery after changing her dressings yesterday.

PT started working on bending Meg's leg. She went from 5 degrees to 50 degrees and has to get to 130 degree bend. PT and OT want to see her 3 to 5 times per week.

Day #4 in LTAC

2008-12-15T09:48:00.004-05:00

Meghan had hyperbaric treatment this morning and a visit from PT. Her wound dressings were changed.

Mom and Meg met with the case manager to get a better picture of what the plan is while she is in LTAC. The primary concerns for Meghan are avoiding infection and controlling her pain during wound dressing changes. The medical team in LTAC meets on Wednesdays to discuss her case. It sounds like they are still trying to assess what her needs are (ie IV antibiotics or not, physical therapy needs, occupational therapy needs). We learned today that if she were to go home, she would not get the pain meds she needs to make it through the wound dressing changes -- or she would have pills to take but no guarantees that it would control the pain. That information alone was very motivational for Meghan to stay in LTAC as long as necessary. We discussed consulting with a different plastic surgeon while she is in LTAC since Dr. F doesn't have privedges here and the wound care doctor said that further debridement could be done here if needed.

Day #3 in LTAC

2008-12-14T17:33:00.003-05:00

It's been a quiet day for Meghan. She had a visit from Dr. H who said they would re-evaluate her situation on Monday to determine if she needs to stay in LTAC.

Mike, Caitlin, Mom and the twins visited and walked around the facility with Meghan.

Day #2 in LTAC

2008-12-13T12:12:00.003-05:00

Meghan met with one doctor this morning who said he didn't feel she needed to be on IV antibiotics. PT came and ran her through the typical milestones for patients at LTAC. She could do them all: walk 150 feet, walk stairs, etc. The PT said they would just put her on a maintenance therapy plan while she's in LTAC for now. No word yet on what therapy she will need for her arm.

Ms. Lynn and Mom washed Meg's hair and gave her the spa treatment complete with toe nail polish and Meg's own clothes this evening. Mom brought Meg's balloons and stuffed animals that she's gotten since the accident and cards that have come in the mail.

Day #16.5 in ICU & Day #.5 in LTAC

2008-12-12T12:54:00.005-05:00

After hyperbaric treatment, Meg returned to ICU. The stitches in her right arm were removed. She's no longer using her morphine PCA pump and no longer getting IV fluids. Her catheter has been removed as well as the monitoring leads and bp cuff.

The doctor wrote orders to release her from ICU today. We spoke to the intake person from the long term acute care (LTAC) hospital. She told Meg that the average stay at LTAC is 25 days and that she was going to review her file and determine if they could get her into LTAC today or if she would have to go to the orthopedic floor until Monday. While the intake person was reviewing her file, Meg started walking laps in the ICU. Meg's nurse told the intake person that she didn't think Meg needed to go to LTAC and didn't know why she couldn't just go home with home nursing care. The hospital social worker, the intake nurse and mom discussed Meghan's immediate needs (IV antibiotics, hyperbarics, unknown physical therapy needs, etc) and decided that going to LTAC for the short term is the right thing for Meghan's needs right now. Her doctor agreed to re-evaluate Monday to determine if she should stay in LTAC beyond the weekend.

Mom was able to take Meghan out of ICU in a wheel chair to tour the rest of the hospital. Meg ate Chik-fil-a sandwich for lunch in the "main street" level. Then Meg walked from the Women's center (Purple tower for those who know the hospital) all the way back down the "main street" hall to the Green tower elevators, up to the ICU and walked right back into her ICU room.

6:00 pm - The wound nurse changed her leg wound dressing this afternoon in ICU. Meg needed 2 mg of dilaudid and 2 mg of ativan to get the tape off. The wound nurse said everything looks FABULOUS. She will have dressing changes M,W, and F of each week. The doctors finally got on the same page and all the decisions made and paperwork signed to admit her to the LTAC today. Meghan rode in mom's car (!!!) to the LTAC and was admitted into her new room. She's very excited that she has ABC Family channel as well as other cable channels that weren't available at the hospital.

Meg can have visitors 24 hrs a day with no limitations other than when she has therapy. She also has a direct phone number to her room. If you'd like to visit or call her room, please feel free to email for details or text or call Meghan's phone. (laura_lambert@bellsouth.net.)

Day #16 in ICU

2008-12-11T11:56:00.006-05:00

12:00 pm - Meghan's been in the chair next to the bed since returning from hyperbaric treatment this morning. We practiced getting up and walking but she's still tethered to equipment so she couldn't go far. They are planning to ask the doctor to order taking her off IV saline and monitoring today which will free her quite a bit.
4:30 pm - We were able to convince her nurse to free her from all the contraptions temporarily. We wrapped a sheet around her and she walked a lap around ICU. She's had no pain today and hasn't needed to use her morphine pump at all today. During her walk, she felt she doesn't need the cane they've loaned her and she didn't want the sling to hold her arm. She didn't need to stop and catch her breath or anything. Mom had a hard time keeping up carrying the V.A.C.! She climbed back into bed after the walk but didn't fall asleep. She likes that she doesn't want to sleep all the time, but she is starting to get bored and VERY sick of being in the hospital.
The wound nurse said they would be changing her leg dressing tomorrow.
9:30 pm - Dr. W says they'll move her out of ICU tomorrow. Not sure at this point if it will be to orthopedic floor or long term care facility.

Day #15 in ICU & Surgery #5

2008-12-10T10:08:00.008-05:00

Terrible weather in the area this morning, yet Meghan still was taken to hyperbarics. They told her she has 46 more visits to go.
1:30 pm Dr. F (the plastics guy) has taken her into surgery. Meghan and mom talked to him before the surgery: there's a 50/50 chance that this will be the last debridement (and surgery) until the wound bed is ready for skin grafting. She will still have the V.A.C. on her leg after surgery. They are not doing anything with her arm today.
3:15 pm Dr. F said surgery went well. He did remove a large area of skin and tissue from her leg and they replaced the wound V.A.C. He doesn't see a need for additional surgery for debridement. He will see her every other week at dressing changes and weekly when it gets closer to time for the skin grafts. The time frame is totally dependent on how quickly Meghan's wound regenerates the granulated tissue. Dressing changes will be every 3-5 days and may require heavy doses of pain meds. She will be in ICU at least another 24 hours. There are no limitations on her movement other than the cast on her arm and the knee brace to keep her quad muscle in place. Dr. F said it's likely the skin on her arm will heal on its own, but if not, he can graft a small piece to it when the leg grafting is done.

Day #14 in ICU

2008-12-09T07:55:00.005-05:00

While Meghan's been in the hospital, there's been a lot going on at the hospital itself. Here's a shot of the new entrance that was just opened and the Christmas tree on top.

Hyperbaric went well this morning. Dr. W and Dr. F (ortho and plastics) visited her today to check out her leg and arm wounds. They have removed the V.A.C. on her arm! They put just a dressing on it and expect to change it every three days or so while it heals. She's already moving her arm around freely even with the cast on. This was a very big success for her to get rid of being tethered to that V.A.C. on her arm. Unfortunately, they had to give her extra pain meds to deal with removing the tape and it's made her sleepy again.

Mike visited with her tonight. She's in good spirits.

Surgery #5 scheduled for 1:30ish Wednesday afternoon.

Day #13 in ICU

2008-12-08T09:00:00.007-05:00

The plan this week is for Meghan to go to her hyperbaric chamber treatments on Windy Hill every morning around 6:00 am then will be returned to the hospital afterward.

Meghan's had a busy morning. Her HBO treatment was bright and early. She was able to take a nap when she got back to the hospital. Then PT arrived and got her up and walking. She walked out of the room and into the hall before returning to the chair in the room. She's eating ham and mac 'n cheese for lunch in the chair beside the bed. It's so good to see her out of that bed!

Had a good conversation with the plastic surgeon today. He said that the tissue on her leg has to "declare itself" and that may take another week to two. Once they are certain which tissue is not going to survive, they will finish debriding the wound and then she'll continue with wound V.A.C. therapy to prepare the wound for skin grafting.

Another surgery has been scheduled for Wed afternoon or Thursday morning to debride her leg wound and replace the V.A.C. dressings.

Day #12 in ICU

2008-12-07T11:03:00.004-05:00

Caitlin's visiting with her today in ICU. She slept as much as she could even though the nurses turned her at 3am. The Benedryl she took last night seemed to help her sleep more restfully.

Her blood counts dropped during the night so they're giving her two units of blood today. Hopefully this will help her feel less tired and sleepy, too. Dr. W and Dr. K came by on their rounds. They expect to move her to the long term care facility (LTAC) by Tuesday if a bed is available. If a bed is not available, they plan to move her to the orthopedic floor in the next day or two until the LTAC is available.

Day #11 in ICU and Surgery #4

2008-12-06T08:39:00.009-05:00

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

2008-12-05T09:06:00.007-05:00

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

2008-12-04T09:14:00.009-05:00

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

2008-12-03T08:59:00.007-05:00

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)

2008-12-02T21:09:00.007-05:00

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

2008-12-02T09:15:00.005-05:00

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

2008-12-01T07:38:00.009-05:00

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

2008-11-30T09:10:00.012-05:00

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.

Day #4 in ICU

2008-11-29T08:48:00.011-05:00

8:30 am
She says she had a good night. The nurse cleaned her last night and changed her linens. Night nurse K is from Memphis so they had long conversations about that. Nurse D this morning says her blood sugar is good and her blood counts are good. Her wound VACs seem to be working well. Unfortunately Meghan can't eat or drink until after they do the IVC filter procedure. She's very sleepy and says her pain is a 5-6 out of 10. She's listening to Charmed on TV while she rests with her eyes closed.
10:00 am
They've taken her down to the vascular center to do the IVC filter. It's not supposed to take very long.
11:00 am
That was quick! She's back in ICU and awake.
12:30 pm
She's talked to her dad and nanny, Caitlin, Michael and McKinsey. Dr. K's made his daily visit to check for Wegener's issues. He's continually checking her kidneys for red blood cells and keeping an eye out for vasculitis again. So far no issues. She got a very cute nurse bear and balloons from Grandpa and Patty - Thanks!!! We started watching the GA v GA Tech game until she got sleepy again.
2:30 pm
Physical therapist arrived to have a sleepy, grumpy Meghan do "exercises". There was a little bit of confusion about which body parts to exercise. For now, they've asked her to just tighten her left quad and glutes, circle her feet, use her right arm as much as possible to help avoid muscle loss in addition to her left hand/finger exercises.
5:00 pm
Quite a bit of napping and a visit from Kat and Ross.
10:00 PM
She had chicken pot pie for dinner, a visit from the respiratory therapist who removed her oxygen tube and a bath. Caitlin and Mom brushed out her hair for the first time since the wreck and found at least 10 more pieces of glass from the rear window of the car. We french braided her hair and she looks FABULOUS!!!

Day #3 in ICU

2008-11-28T08:54:00.006-05:00

Meghan had a rough night. They're giving her 2 units of blood this morning. Her hematocrit had dropped to 25 and hemoglobin to 8 ish. Mike is visiting with her this morning and says she's eaten very little breakfast and resting while she listens to the TV.

The wound care lady came to redo Meghan's VAC dressing. Fortunately they were able to give her more pain meds to get through it.

Ortho doctor update - things are looking good and we may not need skin grafting. They are going to bring a vascular doctor in to consult just to make sure blood clots aren't going to be an issue. They've given her "exercises" for her left fingers that she needs to do 10 times per hour.

Rheumatologist update - Dr. K lowered her daily dose of the steriod

She's pretty out of it this morning...the extra pain meds have pretty much knocked her out. She says she doesn't like being "loopy".

We're a little worried that she's not eating. Doctor told her that her body needs food to heal. She says she has no appetite. We were able to get her to drink three good sips of an Ensure protien drink before lunch.

We caught her in a brief lucid moment and had her speak to her dad.

Lunch arrived - yummy pork chop and sweet potatoes. She ate a good bit of it.

Afternoon was one loooong nap for Meg. Kat and Ross came to visit and Meghan brightened up at seeing them.

Vascular doc visited and said they would take her down to put in a filter to prevent blood clots tomorrow. Not sure what time.

Sounds like Meghan ate a good dinner tonight....she sent Mom a text to let us know. A respiratory therapist visited to make sure Meghan was doing her breathing exercises.

Meghan's evening was spent watching the Lord of the Rings and chatting with Mom and Caitlin. She's doing her finger exercises. Caitlin took Meghan a little Christmas tree to decorate her room.

Thank you Momo and Danny for the balloons and Bear -- now known as "Tex".

Day #2 in ICU & Surgery #2

2008-11-27T21:07:00.001-05:00

Meghan's a tropper! She went into surgery #2 at 9ish to clean out more of her leg wound and her arm wound. Nurse Beth said she did WONDERFUL during surgery and that we had a very remarkable young lady.

Dr. W was more positive today - the skin is still there and that allows the granulated (??) tissue to rebuild so that if a skin graft is necessary the wound bed will be ready for it. They replaced her VACs and returned her to ICU.

Post-op was a tough day. She was in some pain and the anesthesia got to her. They had to change her linens which is painful for her. Fortunately she got quite a bit of rest during the day and was awake when Mom and Caitlin came back to visit at 8:30pm.

Dr. K and Dr. W met to discuss our options for treating Meg's Wegener's. We are hopeful the disease will take a break and give her the next two weeks to get these wounds to heal.

Thanks for visiting, Rob!!! Meghan got her flowers from Faye and Chris today too. Although we can't put flowers in her room, she can see them through the window just outside.

Update - Meghan was watching the Friends marathon and looking perky at our 8:30 visit. She had some chicken broth and enjoyed chatting with Caitlin.

Day #1 in ICU

2008-11-26T21:50:00.001-05:00

Meghan got the bad news about her injuries bright and early from Dr. W. She was very upset to hear that she wouldn't be able to take her finals at KSU next week.

Dad and Terry went into see her and were surprised that she was awake. She was very glad to see them and she got to talk to Nanny. Deanna came to visit and brought a cute bear.

Meghan got to eat normal food today! Bacon and eggs for breakfast, roast beef for lunch and chicken for dinner. A nutritionist visited and said she was on a diet designed to help boost her immune system and give her extra protien for wound recovery.

The were watching her blood count today but by 5pm it appeared to be holding steady in the 8's - it was 13+ when she got to the ER on Monday.

Dr. W visited and said he wanted to do surgery again tomorrow. He also said that methotrexate was not going to be allowed while she's recovering from this trauma. This upset Meghan because she knew the methotrexate had been working to keep her Wegener's at bay.

Dr. F - AKA "the plastics guy" (plastic surgeon) came by to visit Meghan and gave her an optomistic view of the potential for skin grafting on her leg and closing the wound on her arm.

Dad and Terry visited had to get back on the road and said their good bye's to Meghan. It really meant a lot to her to see them.

Surgery #1

2008-11-25T23:00:00.000-05:00

Meghan went to surgery at 3:40pm. Mom, Mike, Caitlin and Josh waited in the surgical waiting room after following Meghan through the halls and through pre-op. Nurses called to the surgical waiting room hourly with updates.

"The doctor has wrapped the wound on Meghan's leg."
"The doctor has finished the ulna (plates and cadaver bones to fill in the shattered parts)."

Dad and Terry arrived at 6pm-ish and were quickly brought up to speed on her progress. Michael and McKinsey returned with Mike for an adventure at the hospital and to "eat out" at the hospital cafeteria.

"The doctor has finished the radius (more plates and cadaver bones to fill in the shattered parts)."

Then the doctor came to the waiting room around 9:30ish.

He said that Meghan's leg wound and arm damage was more serious than we thought. She will need many surgeries to repair the wound. He explained how her two bones in her forearm were repaired and that her wrist was also pinned. He did not fix her elbow in this procedure because she had been under so long. He also told us that Meghan would be in ICU while the wound needed attention.

Mom and Dad went to see Meghan in recovery. Mom went home to try to get some sleep (after having only1-2 hours of sleep over 24+ hours). Shane and Terry went to a hotel and Meghan was in ICU by 11:30 pm. Nurse K called and gave Mom an update on Meghan and the rules for ICU visitation.

The ortho floor

2008-11-25T07:00:00.000-05:00

Meghan saw her ortho (Dr. W) bright and early at 7am. He said she had broken both bones on her left forearm and possibly fractured her left wrist. He also wanted to X-ray her left elbow. He checked out the rest of her and said the wound on her right leg would be troublesome to close given the tension on the leg (it was very swollen) and her sensitive skin (due to the prednisone). She wasn't allowed to eat since we knew surgery was definitely going to happen.

Her potassium was low so they gave it to her in her IV which was very painful.

Unfortunately, Xrays and CT Scans had to happen first and then she had to "get in line" for an operating room.

The Emergency Room

2008-11-24T21:30:00.001-05:00

Meghan was taken to the trauma room and her clothes cut off. In the abulance they discovered a terrible gash on her right leg at the groin that crossed her thigh toward her hip. She was sent for CAT scans and then brought to ER room 10 where Mike and Mom were waiting to see her.

The nurses in ER took the boards off of her and gave her massive doses of pain killers. Mom washed the blood on her face and found there was just a half moon scratch under her chin. Her right arm was bandaged and her left arm in a splint.

She was sent for X-rays and it was confirmed her arm was broken. The nurses splinted her arm which was very painful for Meghan. Then the nurse cleaned off her right arm and discovered she needed stitches. The doctor put in 12 - 8 on top and 4 on the bottom. It looked like hamburger meat.

Mom and Meghan waited in the ER until about 3:30 am for a room on the ortho floor.

Miracle - No head trauma, no spine/neck trauma, no internal injuries

The Accident

2008-11-24T21:16:00.005-05:00

Meghan was driving home from work on Monday, Nov 24th when she had a terrible accident. Fortunately, no one else was injured.

A young man (Jamie), got out of his car and went to help Meghan. He called Mom at home around 9:20ish and notified her that Meghan had been in an accident. He told Mom he would stay with her until the abulance arrived and that he had gone to EMT school. Mom drove to the accident site.

At the site they told Mom that she probably had a broken arm and possibly a leg injury but that she was concious and talking (and in pain) the entire time. Meghan was somehow wedged between the seats with her head near the rear windshield.

They had to cut the roof of the car of to remove her from it. The abulance took her to the hospital.

Miracle - she made it out of this car alive and she was the only one who went to the hospital.