Home Again

Just a quick update for now. It has been a long week and I have to get some sleep.

Judi came home today and is doing very well. One of the samples taken under the bone flap did finally grow out a "bug." It took almost a week before it surfaced so we have spent the last couple of days determining the best course of action to ensure the infection is cleared up once and for all. An interesting item is that the overall belief of the team is that the infection was there when the bone flap was inserted last year and just took a while to surface.

She will be on IV antibiotics for the next four weeks followed by eight weeks of an oral antibiotic. The IV schedule is a killer. One of the doses is at 2AM and it takes about an hour to go in which will make for some long nights for the next month. Hopefully we can get on a twice a day schedule vs. the current three a day schedule once the levels stabilize. Thanx to my sister -in-law (Karin) for stepping up and helping me with the 10AM dose. There is some issue with business licenses that prevent Judi's caretaker from administering the antibiotic.

Judi seems to be at about the same place mentally as she was before the surgery. I was really worried about this since she showed significant losses following the last surgery that took a long time to recover. She has been very tired and hopefully that is just a result of the entire hospital stay and not a longer term problem. She has been cleared to go back to outpatient rehab and we'll just have to watch her head like a hawk. Her Dr. did make a decision not to have her wear a helmet due to a concern with some edges of the skull having the potential to damage the skin if it was repeatedly rubbed. We will have to be very very careful.

I'll provide more detail and some addition info when I have more time. Just wanted to let everyone know she was home and doing well. Thanx for all the thoughts and prayers - we surely need them.

Steve

Surgery Follow Up

Well, another one is in the books. Judi had surgery Wednesday afternoon and we had to remove the bone flap that was created during the craniotomy procedure last year. I can't describe how disappointed I am that we had to do this, but it is what it is and we'll move on.

When Judi's bone flap was re-inserted, there were three areas where some bone loss occurred. This is not uncommon. The most pronounced spot was just about in the top middle of her head and was about the size of a quarter. We had noticed that the skin in these areas pulled inward over time as opposed to growing across these areas which is what normally occurs. Her neurosurgeon could not explain why this was happening and had not seen it before (good old Wilkerson luck at work again). We had been watching these areas for quite some time to monitor for any indication of skin breakdown since this was essentially the only barrier between the outside world and the dura matter which surrounds the brain. The area on the top of her head was the culprit.

The surgery was very successful and it appears that we caught it right at the start. All of the dura matter was still intact and showed no signs of degradation or infection. Several samples were taken to determine what type of infection (if any) was present in the areas surrounding the brain. So far everything has been negative which is excellent news. This is not only important for the right side of her head, but also indicates that there is likely no infection that would get to her shunt (installed on the left side) which would require removal/replacement. The fact that there is also no indication of infection in her blood stream alleviates the concern over the hardware that is in her back becoming infected as well. If it gets infected, it could require removal/replacement as well. So if you wondered why this is such an emergency for Judi, this should give you a good picture of why.

The neurosurgeon did identify a very thick layer of scar tissue under her bone flap when he removed it. It is typical to have some, but this was much more than normal. Some of you may know that Judi's brain had never returned to the normal position on the right side after all of the surgeries were done. There is a possibility that this was the cause. So if there was any silver lining, this was probably it. The surgeon also identified what caused the skin to appear "pulled in" across these areas. For some reason, her skin adhered to the edges and cracks where the bone flap and existing skull mated up up. It was just a matter of time before the skin pulled apart in one of these areas.

Sooooo, where are we today. The bandage was changed this AM and the incision looked great. She is very tired and comes and goes pretty frequently from sleeping to awake. She is moving everything she moved before she had the surgery (very good news - last time it was a couple weeks before it came back). I also got her to smile and laugh today so I know she is getting better. I think the key difference for her this time is that her awareness level is VERY high. I can't say this any other way - this time she was VERY scared. I could see it in her eyes and I did everything I could think of to re-assure her (including not letting her know I was scared too). If no infection surfaces, she will be able to go home Mon/Tues time frame. She'll be able to go back to outpatient therapy, but will have to wear the dreaded helmet again. She'll get IV antibiotics for 4-6 weeks as a precaution and if all goes well, we'll be back in 3-6 months to have the prosthesis installed (yep, another surgery). Not sure yet how this will impact her ability to get neurofeedback therapy.

Thanx to everyone for the support and prayers as we have gone through this latest bump in the road. Judi had a lot of momentum going before this last surgery and I pray that she will be able to continue improving when we get her back home. We could sure use your prayers to keep the healing and recovery process moving in a positive direction. I'll try and do a better job of keeping the blog up to date, but time has become a difficult commodity to come by these days. I had been working on a new entry for a couple of weeks before all of this happened. I usually don't have time to sit down at the computer until the very last thing of the day and often wake up in the same place I started (must be gettin' old).

Steve

Hi all! Dad has been up to his ears in the business of day to day life, so I'm going to give you a quick update.

Mom was readmitted to the hospital Monday night over concerns about a spot on her head where the bone flap is recessed. There are signs of infection which is a cause for concern because it can infect the bone, as well as the membrane and tissue underneath.

She will undergo surgery (again!) this afternoon to fix this issue. There is a small chance that they will not have to do anything major, and a plastic surgeon will simply fill in the area. It's more likely, however, that the bone flap that was originally removed just after the accident and replaced last August will have to come out again and be discarded. After a period of healing, a prosthetic flap will be made and inserted.

We are frustrated and saddened. If the flap has to come out it means another big surgery, and she will have to be without it for about six months. This means she will need the helmet, and extra caution pretty much 24/7, as she will have a portion of her brain only protected by skin. We're not sure, but this will probably mean putting a stop to the neurofeedback for a while as well, which is frustrating because it seemed to be showing some improvement.

In any case, we are just trying to take it in stride. At the beginning, we were told there was a chance this would happen, and Wilkerson luck seems to be showing itself again! But we'll keep our fingers crossed and see this through.

We will update again later to let you know how everything went. Thanks as always for your care and concern.