Day 20 - Clarifications

Someone asked how Jan was. First, she is neurologically intact. That means all her toes and fingers work just fine. No wheelchair and no paralysis. The halo is to stabilize her neck while it heals. Today is three weeks with nine to go without divine intervention. If I can finagle her out of it a week or two early I will. We are thankful for that. Now we just need to get it adjusted so that it is more comfortable for the rest of her sentence.

She actually gets around pretty good considering she can't twist her body from the base of her rib cage up and her head is completely encased in, as she calls it, the bird cage. She can generally stand and sit unassisted but sometimes an awkward position requires assistance. Her dean loaned her a lift recliner and it has been a Godsend. Not being able to see behind you makes sitting an act of faith. The counter height kitchen table with the tall chairs are another fortuitous item. She can easily and confidently seat herself in them.

She is sleeping most nights in the recliner. She can not lay flat on her back and sleep. The couch sometimes is her daytime resting spot where she will take the pressure off her behind. She can lean over on the couch or love seat and prop pillows in such a way as to relieve the pressure of the vest for a time.

Most mornings, if they are good mornings, she will make her own breakfast. The first week was all bad mornings and she was quite helpless. She has made remarkable progress in dealing with the extra 12 pounds on her head. Worst thing is she will sometimes hit her halo bars on a cabinet door because she can't see it or doesn't realize how far it sticks out when she tries to close it.

Getting in and out of cars is quite difficult. She can't see the door frame and I initially had to guide her in and out. She's had enough practice that she can almost do it herself but I give direction to make sure she doesn't bang the halo, which hurts.

I've procured a handicap placard for the car so I don't have to drop her off at the door and run back from a parking space. She can walk but uneven ground is scary due to the tripping hazards. Steps are also a big fright. She can't see anything on the ground closer than about eight feet in front of her.

We've discovered the easy way to wash her hair. First, we thread a small towel through the back bars and tuck it in so that water will not get on the lamb's wool liner. Next, she lays in two front-to-front kitchen chairs such that her head is suspended over the bathtub. I stand in the tub and pour warm water over her scalp and wash it in a manner similar to how a beauty shop would do it. We then blow dry it to keep water out of her vest.

The sponge bath can be partially done on her own now. I still have to get under the vest for her along with the top of her forehead, under arms, shoulders and back of her legs.

She can dress herself except for the halo specific things. The current favorite is the v-neck shirts we purchased. We slit them about a foot from the rear neckline down. She then steps into them like a dress and we wriggle them up under the vest.

I'm filling out paperwork on renewing my passport. I'm thinking when this is all over we should go somewhere to try to forget the months this has robbed from us.

Tomorrow is the first visit at Bilkmore's Neuro Clinic. She's got everyone's phone numbers in case I get arrested because I don't intend for them to just push her back out without making at least some positive adjustment to her vest and her head orientation.

Day 19, Part 2 - Road Trip!

Yesterday we went on a short shopping trip to Target. We spent an hour browsing the store. She wanted some of those slipper socks, the ones with non-skid soles, to wear around the house. We also bought a 5-pack of v-neck t-shirts for her to wear under the vest. We slit them about halfway down the back so she can step into them like a dress. The back of the vest hides the slit.

After an hour, she was really run down. She has no stamina at the moment and she is stronger now than at any time since the accident! We have a ways to go but she'll get there.

We did have an interesting experience in the store, besides all the staring. A man walked up to her and announced that he knew exactly how she felt and what she was going through. When he said that, I immediately started looking at his forehead. There were the telltale scars only a halo wearer would have. He gave her some words of encouragement.

We also ran into one of her friends that had some good ideas on how to get some sleep. She suggested asking about using fentanyl patches since she seems to build a resistance to the drugs and her sleep is severely interrupted at 3-hour intervals. She also suggested asking for some Ambien to help her get some restful sleep. We have to do something as the wear and tear of lack of sleep are tearing her down.

Last night was a bad night after we returned home. She's worried she is a burden on me and that everyone has abandoned her. I fear she is slipping into depression and I need to get her help. In the end, this could be more devastating than the physical injuries she's sustained.

The plus side of her being tired after such a short time out in the store is that she slept much better last night. She slept from midnight to 6 o'clock! On top of that, her neck still hurts but not as much. Maybe we've finally turned the corner at 20 days. Only 70 to go.

Day 19 - The Bills!

The mail brings interesting letters with very large amounts in them. The ER visit in Bowling Green was $5,600. The 16 hours we spent in Bilkmore's ER was $26,000. Of that, $6,300 was for the improperly installed, incorrectly sized halo.

Thankfully, the amount owed on the bills we've received so far is $0. It should remain that way since I've already had the deductible taken out of the proceeds from the totaled car.

One of the annoying parts is the charge of $45 for some quantity of Lortab 7.5/500 that she was not given. She wasn't allowed to have anything to drink until nearly being discharged. I'm surprised they didn't charge us $29 for a six-ounce can of Sprite! They also billed her for two Aspen collars. I know they didn't give her a second one because the one she has is bloodstained. She only has one that we were sent home with so that's an overbill, too! Come one, how many collars can a person go through arrival and being fitted with a halo in six hours?

They also billed her for 9 morphine injections in 16 hours when I know they didn't give her any for the last couple of hours. I think she got one every two hours so eight should have been the max unless they gave her one immediately upon entry and one immediately before exit, which they didn't.

I did save the insurance company the cost of a rental car since my wife won't be driving her car. Even if she was driving, I've got my truck for a daily driver.

The worst part is seeing my wife in pain. She has horrible mornings. The muscles on the left side of her neck are banjo string tight and she cries in pain. This has only gotten worse since we arrived home 18 days ago. After nearly three weeks, we finally have the first visit to the neurosurgery clinic with the nurse practitioner. She better be able to do something about the halo's fit or my wife is going to lose it!

Her neck hurts so bad in the morning she tries to stay awake well into the wee hours of the morning. There has to be something they can do to alleviate it besides making her a junkie. At nearly three weeks the pain should be less, not more. They just want to medicate her more and not resolve the root cause because after all, "She broke her neck and it is going to hurt!"

Day 18 - Halo Vest - Wrong Size?

After doing a bit more research, my wife and I have come to the conclusion the vest for her halo is not only installed crooked but it most likely the wrong size. Based on this chart at the manufacturer's website, she would have gotten a better fit in a large rather than a medium.

Her waist and xyphoid exceed the medium numbers. She has a long torso so her shoulder to iliac crest is 19 inches when the measurements for a medium vest are 18 inches and a large vest is 19 1/2 inches. Her is a diagram of how the measurements should be taken.

I'm going to push very hard to have them fit her with a proper, and hopefully more comfortable, vest when we have her first two week follow up which is actually three weeks, moved up from 24 days!

She understands that it isn't going to be comfortable but it can definitely be made more tolerable for her. With nine more weeks to go, it is definitely worth making some adjustments to make it more tolerable for her.

	HALO VEST
	Xyphoid Circumference	Waist Circumference	Shoulder to Illiac
Size	Measurement B	Measurement C	Measurement D
Small	26” - 33”	28” - 34”	16 ½”
Medium	33” - 40”	32” - 38”	18”
Large	40” - 46”	36” - 42”	19 ½”
X-Large	46” - 50”	40” - 46”	22 ½”

Day 17 - Finally! Some Information On Two Fronts

Here are a few slides from her CT scan on the day she was injured. These were taken at the Medical Center in Bowling Green. Pretty obvious to the untrained eye it is broken.

This image on the left is the top of her C2, viewed from above which displays the front where the C1 rests on top of the little point of bone that allows head movement. To the right is the visible crack as viewed from the side.


Next in the left image is the same bone farther down where the ring that surrounds the spinal cord is visible. The rear of the bone appears intact. The right image is of the same area a little more to the center of the spine.

The nurse practitioner finally called us back on Dec 29th while we were at the cardiologist's office. My wife had an episode of PSVT (paroxysmal supraventricular tachycardia) in early December. She had a heartbeat of 160 bps for more than an hour with a BP of over 200. She originally had that appointment for Dec 15th at noon. Unfortunately, we missed that one due to still being in the ER at Bilkmore with her new headgear.

So, the cardiologist says that three episodes in two and a half years is not significant enough to warrant going on a maintenance medication. That is encouraging. He says it isn't life-threatening and when the vest comes off he'll want her to get an echocardiogram, which is a technical way of saying heart ultrasound. We have that appointment for the first week of April. With any luck, she'll be out of the halo long before then.

Back to the NP of neurosurgery. She profusely apologized for the wrong and/or lack of information we received. She explained that she'd wear the halo for 12 weeks, regardless of what anyone else told her because they won't even look at healing until 12 weeks. The first visit is just to find out if she is still in alignment and to tighten the head bolts. She's not looking forward to that. The same thing will happen at eight weeks. Only at the 12-week visit will they actually do a CT scan to check for healing. If it is not sufficiently healed, they will determine if it is healing and will continue the halo for another month or she will be evaluated for surgery. I'm not really happy about her having to suffer for 3 months only to find out she would still have to have surgery anyway.

I'm still debating on whether to have my wife call the patient advocate over this whole affair. The ER nurses and the attending doctors were fine. They kept her comfortable and the pain manageable. However, the on-call neurosurgeon was another story. He seemed impaired as if sleep-deprived when he arrived at 2:30 AM to install the halo-vest. He kept referring to events that would take place in the future as tomorrow when he really meant in a few hours. I asked for clarification since I was definitely sleep-deprived and going on 20+ hours without sleep myself. This appeared to agitate him for some reason. Another sign of sleep deprivation and unprofessionalism.

Then as he was attempting to get the vest situated and he commented that it was crooked. Jan heard him say it, too! So, if the foundation is not correct, what does that do for the rest of the construction? Any contractor will tell you it won't work out well. So, now the bars are being installed by Dr. Crooked. After getting three bars installed, the fourth was at such an acute angle it wouldn't connect to the halo around her head. When I pointed out he could loosen another axis to get the additional working room, he said, "Who's the expert here?" Despite my usual smart-aleck self, I kept my mouth shut but certainly wanted to reply, "I don't know. Maybe we should page one!"

The points she should make to the patient advocate are as follows:

1) Her head is rotated 20-30 degrees clockwise from forward
2) They did not shave the posterior halo screw sites, difficult to clean
3) Gave us no guidance on pin care, didn't tell us to clean them or how
4) The vest was put on crooked and the doctor that did it acknowledged it
5) They have little or no concern for the person being traumatically put through this

I've always heard good things about Bilkmore but my faith is greatly shaken in the medical profession in general.

Day 14 - Two Weeks Later

First, this is a bit of a rant but I need to vent!

It is now two weeks later and the ordeal has stabilized. She will recover but I have major concerns for the way it will heal. Her head is rotated 20-30 degrees off of forward and her shoulder straps absolutely never touch her shoulders. She can't move her head so it can't be her fault.


When seen from the back, you can see how contorted the bars are. That is an indication of how far off the back is from the centerline of her spine.



On top of that, I've spent that last two weeks trying to get a local neurosurgeon, any neurosurgeon, to see her so we can avoid the tiring and jarring 65-mile drive to Nashville. She is a halo leper! Nobody will even look at her.

On top of that, her front pins appear to be migrating and weeping a pale yellowish fluid. There is bunched up the skin on top of the pin and it appears skin is pulled tight below the pins.

I'm becoming totally disgusted with the entire medical field. How sad is it when my insurance company has been the best people I've had to deal with?