Right elbow update - 2 days after surgery

A more thorough description follows with what was done to Daniel's right elbow... and then what he did to it afterwards... 😮

Daniel had surgery on Monday April 30th starting about 1pm. He was admitted at 11:30am and prepped for surgery.

The pre-hospital prep procedure was typical for a surgery - fast after midnight the night before and only water or preferably apple juice (that's new) that morning up until 9:30am. Some medications he's taking had to be suspended for the day or week leading up to the surgery. Also new to us for a surgical procedure was using Hibiclens cleaning solution during a shower the night before and the morning of surgery. We are quite familiar with Hibiclens from his infamous tub-room cleanings in the ICU, just not for a typical surgery. I think it's a good idea to do this extra washing from a avoid-infection mind-set. Also we had to avoid putting oil or lotion on his skin the morning of the surgery. We have used Emu Oil every day since his burn and it seems to have made his skin quite nice. The oils prevent the electrode sensor pads from sticking when they apply them in pre-op.

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The surgery went well. The doctor reported a range of motion of from between 20 - 135 degrees which is HUGE! Going in to the surgery we didn't think that we would see that kind of range of motion. We were told that this range might decrease, but we are doing all that we can with stretching and physical therapy to get that range as maximum as we can. During the surgery he was anesthetized, given Tylenol, Fentanyl, Ketamine and Oxycodone - all very strong stuff!

For pain we were given Tylenol and Oxycodone to use at home. So far we have held off on using the oxy. It has all those negative side-effects and as you'll read in a moment we don't think he's in such extreme pain that we need to give it - but it's there if we need to administer it at any time. They also gave him a scopolamine patch (seasickness) to help with the aftereffects and feeling of motion-sickness.

In the post-op recovery area he needed about two hours to get back to normal. His anesthesiologist check-in with him/us several times during the procedure. His surgeon Dr. C. also was there and writing up and discussing our next steps - We felt a lot of support from the hospital staff through all of the surgery.

After the surgery Dan's elbow was wrapped in heavy gauze and ace bandages making his arm and elbow look quite large. Underneath all that there's the obvious swelling. Under all that dressing is his swollen arm with two 6-inch posterior incisions along both sides of his elbow - a picture just isn't pretty for this... Obviously the incisions were all stitches up and those will be removed in two weeks. Near the end of each the incision were tubes to allow for draining.

During the first night home even though Dan seemed to be pretty heavily out of it, he decided to unwrap his arm, yank out the tubes and bleed all over his bedding. We think he did this shortly before his wakeup time in the morning. We found him sitting up waiting for us in the morning like we usually do with him, but of course we were shocked to see his arm all unwrapped, blood all over and um yea - bleechk!

We scrambled to get fresh dressing and called the surgeon's office to get an idea of how this might effect his recovery. With his tubes out of his arm the concern is that he might develop hematomas near his wound site that would have to be addressed. The tubes were in place to allow all the bleeding to seep out and drain into the dressing. His tubes were to be removed on Friday - three days after the surgery.

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So far there's no obvious indication (to us) that there's a problem. but we don't know really it there's an unseen problem lurking under his skin. His doctor will look him over on Friday as scheduled and we'll decide how to move forward.

Yesterday (day 1) we got his arm moving, but took it a little easy on him. Through all the movement Daniel didn't seem to be showing any signs of being in a lot of pain, but we know he's a tough guy. If it were me I think I'd be using the pain meds more, but Daniel is a special guy and seems to process pain differently than most people, or least me anyway. All we're giving him is Tylenol.

Last night (2nd night) Daniel yanked off his dressing twice. The first time I wrapped it up  and decided to camp out and listen closely all night, but I didn't hear any obvious noises. He can do this quietly apparently. The 2nd time this happened I was in the room sleeping by his bedside, but didn't even hear him do it. There was no large amount of bleeding or seepage from these incidents. He doesn't seem to be in pain while doing this and we're hoping he hasn't inflicted any damage to his sutures or skin.

This morning after a shower (his arm is all wrapped in his dressing and a plastic bag to keep it dry) we had him all dressed and ready to go eat breakfast. Dawn left him alone for less than 60 seconds and in less time he had already removed the dressing AGAIN and was leaving drops of blood around the house as he walked up to his room. He seems to know he should not remove it, but waits for any quick chance to slip out of it.

This last time he bled quite a bit - maybe that's good as that's what is supposed to be happening??? We only know now that we have to be in complete contact and watching him closely so we can't leave him alone even for a moment! He can be determined and single-minded in purpose once he decides something. So with teamwork we will keep his dressing on until we meet with his doctor in the morning tomorrow.

Tonight I think we will need to sleep in his bed with him so he knows we are "watching" and we are aware of ANY stirring going on.  Wish us luck!

Elbow Surgery for HO

It's been one year and 3 months since Daniel's burn accident. It's been a long journey, but we've reached the point where an operation on his elbows is possible. We chose his right elbow for the first operation. Why? That's his dominant hand and it doesn't bend at all. The left elbow bends only a little, but it's bent at about 90 degrees and that's enough of a bend that he can feed his face, scratch his head and get a lot of other things (with difficulty and a bit of creativity) done. His right elbow is locked at about 45 degrees - so not as useful at this time except to put on socks.

We met with several orthopedic specialists and we think his orthopedic surgeon Dr. C. is great! We are fortunate to have her performing his surgery. She was very patient and thoughtful throughout the process of meeting, planning and performing the surgery. She had various other support people that we also met with and the team worked really well together. (Plastic surgeon, anesthesiologist, nurses, techs). She's also about to have a baby so there was a backup colleague observing and standing by in the OR - just in case!

Short recap: You may recall that the burn caused a somewhat rare response in his body that caused bone to grow outside of both his elbows. It happens in some burn patients. It's called heterotopic ossification or HO. I've written about it in prior posts so I won't go into more detail, but suffice to say - it sucks for all kinds of reasons!!

Daniel was super happy this morning. We had to get a bit crafty with preventing him from eating anything the entire morning and lunchtime. We tanked him up with food the night before, gave him an extra meal before bedtime and then kept him distracted in the morning. When we left for the hospital he was smiling and happy and skipping. When we arrived his festive mood continued. No one could be happier. Who does this before a major surgery?

He brought smiles to all the other waiting people in the surgery waiting area. We got him in his gown and he snuggled into his surgical bed with a warm blanket and waited while they prepped him with wires, monitors, and IV. It was only after a lot of boring discussion, signature releases, and poking/prodding that he got a bit quieter and settled down.

We received positive updates from the OR nurse after 2 hours, and after 3+ hours the operation was complete. We met with Dr. C. who had pictures to show his now extensive range of motion. Before he had zero, now he has from 20 - 135 degrees of motion in his elbow! That's about the best outcome possible we could have hoped for. Once he heals the range might lessen some, but for now we are excited with this result. If his recovery goes well he will be able to actually use his elbow again almost like a normal person!

Here is a picture where he is just recovering in the post-op area. Normally they don't allow family back in this area, but Dan gets special treatment - he's VIP.

So we are home now after a long day at St. Joseph's. Daniel has a huge dressing around his elbow. The tissue will drain and we were told to expect a lot of blood. With a procedure like this where you chip and hammer away actual bone there's a lot of bleeding since that's where blood is made - in yer bones ya' know? So a couple of days with this dressing, then there are drainage tubes that Dr. C. will remove. In less than two weeks she will remove his stitches and then we hope the healing will be far along. 

Starting tomorrow we will have him moving his elbow as much as we can. A little at first, then more as his pain and discomfort drops. We have a CPM machine to help bend his elbow slowly, but we also plan to assign as many activities as we can once he is more himself. For tonight he can sleep and rest up. 

It's super important to get his elbow moving as much as we can get away with. It might be painful at first, but Daniel is quite an awesome fellow. If there's one thing we've learned through all his surgeries and the painful recovery as a burn survivor it is how tough he is! There's also a drug (indomethacin) we will give for several weeks that is reported to help keep the HO from returning. The real therapy and movement begins tomorrow!