Day 82 - Halo Minus 48 Hours

The halo has been off for two full days. As she prepares for bed, she has only had two halves of a pain pill and a valium and a half. That is a significant improvement in the pain.

I got her out for a little shopping at Krogers. She had already done two laps around the driveway. Between the two walks, she did just about a half-mile. As her strength and stamina returns, we'll push it farther as she can tolerate more.

Her second shower was less eventful. I've pretty much got the collar swap down. She can hold her head up by herself for the minute or two it takes to get the collar off, finish drying her neck and putting a dry one on. The pads easily dry overnight so there is always a fresh set of pads to go into the plastic when it dries.

She is still debating on trying the bed tonight or to stick with the chair. She's become comfortable with the chair but I suspect it is allowing her to be a bit lazy since it will lift her up. She's going to throw something at me for saying that. If I have a black eye, she did it!

After this post, updates will probably go back to every couple of days unless something significant happens. There is a new countdown for the next visit to get past the collar and into physical therapy. Just 26 days to go!

Day 81 - The First 24 Hours With A Collar

After one full day without the halo, the pain has eased. She is still hurting in her neck where the halo-vest had been pinching a nerve but we are hopeful it will recede quickly. So far she has only had one pain pill, broken in half and taken at two different times. After getting her up and cleaning her pin holes, I felt bad and was curled up in bed until almost 3PM with a stomach ache and killer headache.

The doctor did give her another collar. He was originally just going to give her another set of pads but just gave her the whole collar. So, now we have two collars so she can shower in one and change into a dry one afterward.

Speaking of the first shower, she was pretty apprehensive about her head while taking the collar off to wash her hair. In the end, it was pretty simple. The pin sites need to be cleaned three times a day and he told her to wash her hair every day and to just use plain shampoo. I'm also massaging the pin sites so they do not adhere to the bone.

Pain medication is way down again, thankfully. Less is doing more for her at the moment, which is a plus. We are breaking the pills in half, except for the time-release one, which is a bad thing to do.

A few more thoughts from the doctor visit yesterday that I didn't think to post. I wish she could have seen him from the very beginning instead of the rigid and utterly clueless nurse practitioner.

First, when I asked the doctor if I could take pictures, he said it was an odd request and nobody had ever asked that before but he didn't see a good reason not to allow it.

Second, he said she would need to see the same nurse practitioner next time at the same old place. I'm not thrilled but she can't do much wrong at this point since the halo is already off. If we'd have listened to her, the halo would still be on! She didn't want to see Jan until March 16th! If the nurse had ever had to wear one of these, she'd be more than willing to work with a patient to get it off as quickly as safely possible.

Third, the doctor said she would need the collar for only a month when the NP had said it would be six weeks in the collar. Physical therapy will be after she's regained some muscle strength.

The doctor cleared her for light-duty if she felt like it. Her weight limit has been increased from five pounds to 10. She's still pretty weak and tires easily but I'm hoping to get her out of the house on Friday. It is supposed to be 70 degrees tomorrow! The doctor said to walk as much as possible, it would be good exercise.

Finally, the doctor was surprised I wanted to keep the halo. I told them I was going to put it on eBay although it is generally instructed by a lawyer to retain all "evidence" until the claims are handled in case of legal proceedings. We haven't retained a lawyer and I hope it is not needed but that's no reason to be poorly prepared.

Day 80 - How To Remove A Halo!

Day 80 started with Jan still in her halo and vest. This is the last picture taken of her in it. We arrived at 3:45PM for the 4:15PM appointment. Registration was really quick and we had hoped to be back home quickly.

The doctor was running late due to a surgical emergency. Did I mention we spent two hours in the pediatric neurosurgery waiting room with children all over the place. She, literally, was the last patient he saw.

After the meet and greet, he started showing her the latest images. We pretty much knew what they showed and so did you reading this. The doctor then tried to show her the old images but could not pull them up. I offered to let him borrow my CD, which I conveniently had with me.

A nurse interrupted and Jan noticed she had a cervical collar with her. That made Jan smile as the doctor stepped out of the room to speak with her. When he returned, he then proceeded to explain the report and to compare the images. The statement we were looking for was announced, "The report doesn't seem very positive but it is healing nicely."

Jan was ecstatic! Then he said we just need to wait for the wrenches to which I said I've got them right here! Then he said she would be getting a collar and I produced the one we brought with us. He was starting to think I was reading his mind.

First, he removed the bolts that connected the halo ring around her head to the brackets that are supported by the bars. Now she was wearing a vest that was ready to come off. Her head was slowly tilting backward and the nurse braced her.

Then, they put the collar on her to help her keep her head up. She wasn't thrilled with it but she was just happy to not have the halo on anymore.

Finally, the doctor and his assistant removed the ring around her head by working at opposite corners and loosening the pins together. Funny, that's how I said it should have gone on! They held the ring in place until the last pin was removed and lifted it off of her head! The left front pin looks quite deep but the right one looks like it might actually heal without too much of a scar.

Yes, day 80 ended without a halo!

Day 79 - CT Results

She was pretty worried she wouldn't be able to lay still for the CT scan. Thankfully, that's over with and it wasn't the much longer MRI. The scan was done today at 2:15 PM. The interesting part of the report says:

1. Healing changes are evident within the comminuted C2 vertebral fracture with no change in position of alignment since 12/14/2008.

2. Nondisplaced fractures of the anterolateral aspects of the posterior arch of C1 remain unchanged.

Compared to the prior study of 12/14/2008 obtained from Bilkmore, there has been no change in position or alignment, and there is some evidence of healing at the fracture line at the base of the odontoid and within the anterior mass of the Cs vertebra.

The part that doesn't sound as good is this part:

There is no significant callus formation.

Other than that, I'll post the newest images. I see definite material where there was clearly open space. The part about no significant callus formation is not too troubling because as a healing indicator, that often trails real-world bone healing by a few weeks.

Here's the latest little movie.



The quality is low to save bandwidth but if you look at yesterday's movie, you can see noticeable changes that look encouraging.

Here are some more images. This first one is a side by side of the front of the C2 fracture. The first CT scan from the accident is on the left and the same images from today's CT scan on the right. The images are not as clear as I'd like but the obvious black (fracture) is much less visible in today's images.


This is the side view of the same C2 vertebrae with the fractures oriented the same, old on left, new on right. The gap has nearly closed and there is material filling the gap. I'm no doctor (or nurse for that matter as the medical profession likes to remind me) but this looks like substantial bone healing to my untrained eye.

For the final piece, here's the top-down slice that is pretty evident of the damage. You can see that it isn't completely healed but then again that really isn't expected. It just needs to be strong enough to allow the halo to come off and for her to transition to a collar.

Pray the doctor sees it my way! I don't think she can take much more. Her pain is off the chart. She has had as much pain medication now as when she first came home. She just sits in the chair and rocks back and forth in a zombie state. I've given her pain pills as close together as allowed, valium whenever she asks and the time-released pill at 7:30 PM on top of all that. She's got heat packs on her back, shoulder blades and right arm in hopes that will alleviate at least some of the tension and pain. Sunday and yesterday both were bad but not as bad as today.

Jan is in so much pain that she can't stand it. The narcotic pain pills fail to provide significant relief. It dulls it but it isn't knocking it back to a functional level for very long. She thinks it is more muscle spasms than anything but the valium isn't helping as much as it did before. She used to average two a day or less and now she is up to four and five a day without the same level of relief. The prescription says one every six hours but the NP verbally told her she could take two at a time. We haven't resorted to that yet because she resists it. Similar change for the pain pills, too. She used to be down to nothing besides Tylenol and now she's at five or more narcotics a day plus the time-released to sleep.

When she's awake she's been pacing the floor, trying to find a comfortable spot to rest with no relief. I've been helping her put heat on her shoulder blades and at the base of her neck/shoulders, which is nowhere near her injury.

Day 78 - The Scan Is Tomorrow!

Tomorrow is the day for THE SCAN. Day 78 with only about 50 or so hours to go.

I will probably be posting every day for a bit as this is a transitional phase. Things will be happening much quicker for a bit. If this bores you, Tuesday, Wednesday and Thursday will be the days to check the blog for definitive information. They will be later in the day so as to get the pertinent information included.

Here's a little movie I managed to construct of the scan images taken the day of the accident. It is only of the first and second cervical vertebrae (C1 and C2 respectively) and only takes 12 seconds total. I've learned a lot about spines and the upper cervical structure in the last few months, mostly out of necessity.

The circular bone in the first few seconds is C1 with two fractures at roughly the 4 o'clock and 8 o'clock positions. These fractures are very visible at the two second mark. Pausing it may help. C1 is the base on which the skull moves about at the top of the spine. This is how you make the 'yes' gesture.

You can also see the top of C2, the odontoid, as the round object at 12 o'clock. This vertebrae is what allows the head to rotate left and right as in the 'no' gesture. As the image progresses, you can see the odontoid fracture from about five seconds to 10 seconds. Look at the 11, 12 and 1 o'clock positions to see these C2 fractures.



This is where we find out if the vitamins, calcium, yogurt and not the least of all, prayers worked! The obvious voids of dark area on the 12/14/2008 scan should show some gray and even flecks of white where the bone has healed and started to mineralize. That is what we are hoping for. By the end of tomorrow I should be able to post the updated version with any healing indicated.

Interestingly enough, I am having a hard time finding a definitive answer about the strength of a bone after a fracture. Some information says it is not stronger, which is certainly true in the first few months after a break. Still other information says it will be stronger than before.

Exercise and especially weight bearing workouts done properly will cause the bone to be stronger but that is also true of non-fractured bones. Bones are not static, they are constantly being remodeled due to loads and use. It may take up to a year or more for the bone to be fully remodeled but that does not mean it isn't completely healed. It should already be very strong and most reports state it should be 80% of pre-injury strength by the eighth week. After the eighth week it slows down dramatically. So, here's to stronger bones and more yogurt!

Prayers and good thoughts much appreciated!

Day 77 - Reflections And Regrets

11 Weeks today! Day 77, three to go. The ending to this book has not been written but this chapter is nearly over.

I've been doing what I usually do late at night, reading. This time I'm reading up on doctor-patient relationships. Jan has the right to be an integral part of her treatment. So far she has been treated like a passive bystander. I've printed the patient's rights and responsibilities information and will be taking it to the appointment with us. If she is given any flack over her requests, I'm going to show them, in their own black and white document, where her wishes must be considered equally. So far, I would have to say I do not believe these people are challenged very often and certainly not very aggressively.

Speaking of aggressive, I've been accused of being very aggressive about my wife's treatment. To those critics, I ask what you would have done differently if your loved one was in a similar situation? I certainly have asked myself that many, many times. There are certainly things I could have done and should have done differently.

If we had been fully informed of the consequences known to be associated with halos, I'm pretty sure that other options would have been thoroughly discussed before this thing was put on in haste. Pin loosening is the most frequent problem followed by site infection, neither of which are pleasant. Nobody described this vile thing to Jan or I before it was assembled. The sheer shock of seeing it on a person is enough to scare someone. You'd have to agree, any time the medical world does anything in six hours, that was lightning fast compared to the first two week appointment taking three weeks and the second two week followup appointment at the six week, four day mark, only to be outdone by the third two week appointment at 11 weeks, three days!

The use of the halo in the first place is my biggest regret. While a halo might be standard treatment for upper cervical fractures, it is not the only accepted treatment. There are other options for completely non-invasive immobilizations like a minerva collar that are better tolerated and certainly have lower risk of infection since the skin is not violated. Of course there is surgery if it were bad enough, which the NP stated she would have had herself. I still can't believe she said that. How do you trust people like that? Perhaps you can see why I have doubts about the validity of the limited information we've been given. I truly believe they saw a training opportunity for a wannabe doctor and let the dog loose on fresh meat.

Did I misplace my trust in doctors? Did I put too much faith in the wisdom of others? Was I not a strong enough advocate? Should I have been an even more demanding bastard to get what she deserved rather than what they were willing to give? I tried my hardest and best with what I was given and could learn. Was it not good enough? I certainly was lacking in my ability to get her the best care she could. The choices we make limit our options.

For this trip, unless she is now a surgery candidate due to non-union, the halo will come off on Wednesday. She has actually gone backwards on pain. She went from no narcotics for a few weeks to now using multiple pills a day and the timed release one again at night. And once she starts the narcotics we have to reintroduce the additional medications that are required to keep her digestive tract functioning.

The attitude has been, "she's in a halo, she's not going any where, see you in 12 weeks." Never mind that she broke four bones in her spine and she's developing problems BECAUSE of the treatment method!

I probably could have had her seen more often but the results were so universally frustrating and pain inducing that I figured the fewer exposures to anyone related to Bilkmore was less of a chance for them to inflict misery on her. With their scheduling and appointments, it seems like they wanted to see her less than they did. At least she will be seeing the doctor for the final visit with the halo.

I really desire for her to be done with them when the halo comes off but I know it will only change the mode of torment rather than end it. The weight and rigidity of the halo will be gone but the stiffness and pain will remain until the neck muscles recovery from lack of use.

Some medical professional will eventually have to release her from the collar, although it will merely be a documentation formality since the collar is velcro rather than bolts. The whole thing is a catch 22. She can't remain off without confirmation she's being treated by the doctor but she can't return to work until the doctor releases her!

I just wish the fear, uncertainty and doubt had been this easily cleared away in the beginning instead of at the end.

Congrats, Bilkmore, you now rank lower than Greenblew on my list of places I'd die before being taken to under any circumstances, including an emergency! You can put that on my tombstone.