Monday, January 21, 2008

Well, all of your prayers and the knowledge of this incredible staff have delivered all of us from the depths of our despair to the ability to comprehend that John may go home in 3 days!!!Here are the updates; I will share a bit of anatomy and physiology with you. Generally we all have 2 carotid arteries and 2 vertebral arteries that supply our brains with blood flow. The post-operative MRI showed that one of the vertebral arteries was not receiving flow. They initially were afraid that the hardware from the fusion could possibly be interfering, but he had no deficits and no neurological changes. The Circle of Willis is perfusing well. Because CT angiogram is such a new diagnostic tool, the doctors are still a bit mystified by the knowledge they obtain from this test. They stated that there have probably been patients who have been walking around postoperatively for years, and these things just took care of themselves. He also did not have a CT angio preop, only post-op. After consultation with the neurosurgeon, angio docs, and intensivist, here is the hypothesis and plan; they believe quite possibly the artery was injured when the fracture occurred @ approximately 0710 Thursday at the time of impact, when C4 was displaced. The displacement was not reduced until 1430 on Thursday afternoon. That would be a little over 7 hours that the artery was denied proper blood flow. The plan is to re-angio him on Wednesday to make sure there is no change. Provided no change, he will have collateral circulation where the injury occurred and people can live with 3 arterial vessels providing blood flow. Again, ANOTHER MIRACLE!!! I cannot take credit for all of this explanation, Dr. Cole, one of the neurosurgical fellows spent a good 25 minutes with me going over all of John's scans, CT's, MRI's, and CT angio. They have computers in every room, and can pull up all of the diagnostics so that family members can actually see the diagnostic pictures. He was able to show me the absolute drill down on the MRI where he had flow (on the right side), and where it wasn't, (on the left side). The angio confirmed that the hardware was not causing the arterial occlusion on the left side. Then in addition, I ran this all by Dr. Catavenis, the CCC intensivist @ PGHC, who confirmed that this could certainly occur. After the discussion with the neurosurgeon, they cleared John to be out of bed, and consulted with physical and occupational therapy.Physical therapy arrived at 1545 and requested a half hour with John. We came back at 1640 and he had been up and ambulated around the entire nurses station. He was stable on his feet. His only weakness is the left bicep, which will require outpatient physical therapy to help strengthen the left bicep. That was the initial area that was so painful to him until his displaced fracture was reduced. His drains have been removed, his IV's are out except for one heparin lock for IV medications, and his foley catheter is out. They are now discussing discharge planning. GET OUT!!!!!!!! I just can't believe it.Every one of ur friends, family and colleagues have been so incredibly supportive. We love you, all. Your prayers have delivered us from this catastrophe.