Day 37 - Surgery the 8th

As we were driving to the hospital we got a call from the burn floor nurse asking if it's okay to start his surgery early. He was scheduled for 12:30 today, but they wanted him to be first today so we said "of course!".

We arrived just in time to walk him and his bed down to the pit stop pre-operative surgery area where we hung out with him and went over all the usual questions we've had every time before. We met with his anesthesiologist, surgeon Dr. Wi. and several other support people. Daniel seemed to be in a bit of pain or was possibly unsure and frightened a little by what was happening (by all the chatter and questions we were answering in front of him - no way around that really), but we both soothed his and held hands and played some music to help calm him.

Then it was time to say goodbye and head our separate directions. One nice thing about today is that his nurse for the past 3 days was allowed to scrub in and observe the entire surgery and would escort Daniel back to ICU so he will be able to help anesthesia to know if Daniel is coming around and needing additional pain management.

Dawn had picked up during rounds yesterday that the team talked about whether Daniel needed to be on "ICU" status and could be on moved to "Step down" status. The nurses argued that he still needed the extra support during wound care as it takes ~90 minutes to do that., but otherwise he needed fewer supports during the day and night. He is on fewer IVs, less need to monitor his status and he's almost to the point where we could start getting up on his own (not there yet) to walk around and be more active. Solid food is coming soon too.

At this point he would remain in the same room, it just means less care is required and that he is showing signs of progress on his long road to recovery.
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CORRECTiON!  Doh - I'm a bit embarrassed by this realization...
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I will state that all mention I have made in earlier posts of Daniel's Caloric requirements were WAAAYYY off. If you go back in time on this blog and read how I'd mentioned him needing 9000 calories or 6400 Calories or really just about anything mentioning specific Calorie numbers - that was massively incorrect. I was inferring those values from the hourly input on his tube feed machine which was wrong, but we've figured it out now.

As an example right now Daniel is playing catch-up since surgery (while his feeding is shutdown):
Daniel is getting a continuous flow rate of 75 ml/hour of food that has 1.5 Calories per ml and that's continuously flowing 24 hours per day (or until he catches up and they slow the rate down).

Thus:

75 ml/hour x 1.5 Cal/ml x 24 hrs = 2700 Calories 

daily if he were receiving this rate of food for the next 24 hours.

I can burn through 3000 Calories on a long-ass 65-mile bike ride or a triathlon race in several hours time and effort. I know what that feels like and the one nice thing about that is I can EAT WHATEVER I WANT (or a single item at Cheesecake Factory) and probably still not quite meet my energy recovery goal.

🍖🍗🍕🍎🍉

For what it's worth here's the metabolic cart results from yesterday. It shows his resting energy needs pre-burn to be 1509. (One Calorie = One Kcal) That is based on his age, weight, size, gender. The test also shows the energy he is using at rest NOW with his BURN injury. That value is 2278 Calories or about 51% more than before. That's on the high end of the range of what's been studied for in needs for burn patients. I've read that burn patients need anywhere from 120 to 150% of their pre-burn energy needs. We know he has a high metabolism as do I.

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Dan is out of surgery, but has yet to return to his room. We heard it went well and that he and his doctors would be back up in the ICU Burn floor in 30 minutes or so. We just saw one of his doctors dive into a meeting room so we know he will be arriving soon.

Dr. Wi. stopped in to say how pleased he was with the surgery and that Daniel did great. He said we were great too because we hang out and support Daniel so much. So everyone's great! But really he was just so happy with how Daniel has hung in there with all these surgeries!
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Dan's back now. He's settling down - out from under the anesthesia and grooving to the gentle warm dream-state of fentanyl + hydro-morphone.

We got a look at his neck and face from the last graft. It looks amazing! Give it some time and his mug will look pretty cute again.

His chest is completely covered and of course his legs are as well. His nurse A. attended the surgery today and reported that the doctors used donor sites on both thighs and a bit of his calf to cover his chest with about 9 strips of donor skin. Then the doctors glue each graft and staple the seams. In time his wounds will heal and will look pretty good as long as we stay infection-free. The donor sites on the legs will take anywhere from 6-12 months to heal and until then they will look VERY sun-burned.

While Dan was under anesthetic the OTs came into the surgery room and stretched his arms. He had developed contractures under his shoulders. They had to break the skin at his armpits to force the shoulders to stretch up into a position over his head then the surgeons added more graft skin underneath to allow more range of motion. Sounds painful and it is!

The remainder of the day will be recovery and rest. No wound care today as they did a lot of cleaning in surgery.

His donor skin site (his legs) is covered in two different regenerative pads. They have the amniotic fluid that speeds recovery. The other (Kerramax) is approved, but new to this hospital. The new covering holds the goopy stuff in better (I've written about the goopy stuff before).1