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.

Day 76 - This Is How It Works With A Halo

Day 76 and just four days to go. Four days! We've started a list of things to take with us, like a shirt that isn't slit down the back and has buttons for ease of dressing.

On the pain front, she's pretty much back to taking narcotics to sleep and some during the day for pain. It is not her neck like it was in the beginning, where the injury was. The pain now radiates from her back, around her shoulder blades and her arms. After a night of rest, it is better until about dark then the pain returns as bad as ever. Four more days.

Yesterday, she dropped something and bent down to pick it up. She said the room started spinning and she yelled for me. By the time I got to her, she was sitting in her chair but said she was dizzy. No idea what that was about. Probably something with the inner ear again.

This is in case anyone with a halo or supporting a halo user stumbles across this. This is how we wash her hair with a halo on. We are currently trying to decide when to wash her hair before the scan and halo removal. We've been doing that every two days since it is so exhausting for her and requires something for dizziness.

This is the chair setup we use so she can lay back with her head over the tub. Before this she was laying over the bed with her head suspended over it and pouring water from a pitcher over her. It was OK but took quite a while and I had to refill the pitcher multiple times. This takes about five minutes with her on her back. Wet, lather, rinse!


This is how we thread a towel through the back of the halo in order to keep the vest dry. It is best to use a smaller towel or an older towel that is not too thick as the extra bulk makes it difficult to not get it soaked.


This is the adapter I fashioned from a quick disconnect. It allows me to get the hot water to the faucet and then connect the hand shower head without having to wait for the water to reach a stable temperature.

Day 74 - Robocalled

Just six days and a few hours left.

We were robocalled last night from Bilkmore to confirm the appointment next Wednesday. I wonder if we will be robocalled again tonight for the second appointment on Thursday? I intend to cancel that one once the halo comes off next Wednesday.

She's been in almost as much pain over the last three or four days as she has been in since the accident. She's reverted back to taking stronger medication every day at least once. Her neck and shoulder muscles are so tight and sore that she can't stand it. They feel rigid despite muscle relaxers. I don't see how her muscles can be atrophied with so much tension in them. The halo must come off and in six days I think it will have been long enough!

It still annoys me that Bilkmore is such a well thought of facility yet they treat a very serious injury like nothing. No interest in patient health or well being, just where do we send the bill!

Day 72 - Scan In One Week

Just one more week until The Scan that will confirm the bone has healed! Eight days until the infernal contraption is actually removed! She says she just wants if off and one more day might as well be forever when you live day to day. She only cares about the day when the thing is going to be coming off!

I'm not wearing it, I'm just supporting her but I wish she were more positive. She irrationally fears the doctor won't take it off and that he'll make us come back the next day to see the NP or that the bone isn't healed and she'll have to wear it another four weeks or worse, surgery. It is hard to fight the negative energy.

She seems to think I'm torturing her with the yogurt but she will thank me when the doctor delivers the good news that the bone is well healed and the halo comes off!

Speaking of Bilkmore, six and a half weeks later, they addressed the over billing issues. They stated they gave her nine shots of morphine every 25-30 minutes. They did remove the second collar as a billing error. In rereading the reports on the visits, the 1/5/2009 visit notes the fracture in the x-ray. The 1/29/2009 x-ray notes no such thing so I'm hoping that means the bone was healing on day 46. If that's true, a month later should be significantly healed!

Now, a few pictures for illustration. The two images below are the same pin from above and below. This illustrates the amount of skin bunched above the pin and the skin stretched below the pin. From the above shot, you can barely see any of the unthreaded pin. From the below shot, you can tell that there is less of the pin buried.

Day 70 - Ten Weeks!

Today is 10 weeks since the accident and only 10 days or less, depending on what time of day you see this until the halo comes off! Single-digit days from here on out!

On the pain front, she thinks she's spent too much time working on her homework at the computer keyboard and handwriting on Thursday. I'm hoping that is it. She's tried to be proactive about getting up, moving around and not sitting in one place too long on Friday.

Saturday we had lunch with some friends. Unfortunately, she wound up having to take more strong pain medication to get to sleep. Her neck muscles and both shoulders were causing her a great deal of pain. She woke up feeling much better. I'm hoping today is a less painful day. With only 10 days to go, it is a shame if the pain grows as it gets closer to coming off.

For show and tell today we have a pin, made of nonferrous titanium. All the metal in the halo is titanium, which is only the pins and adjusting screws. The uprights and actual ring around her head are carbon composite while the blocks that attach it all together are plastic. This image is what is currently embedded from a 1/8th inch to 5/16 inch into her head at four points. She will be so happy to have them taken out. It is much sharper than it looks.

Day 68 - Just Another Day In Haloville

Not much news at this time. Unfortunately, this has all become quite ordinary and routine except for the pain. I'm sure Jan will disagree. We are just counting down the days and trying not to jinx it. I've got a reminder set to go set up the insurance and paperwork a day before the scan so Jan doesn't have to wait around beforehand. I want this to go as smoothly and quickly as possible.

Her neck muscles are giving her more trouble than anything. I attribute most of this to, are ready for it, the ill-fitted halo. Her neck has to support the halo in addition to her head. The muscles from the base of the skull just behind the ears are so tight they almost feel like bone!

Her right arm is hurting, too! I can't explain all the new pains she's having. She has been taking half of a narcotic pill on the odd occasion when Tylenol and valium will not give her any relief. She averages two halves a week of late but she asked for another narcotic last night even though she took Tylenol instead. If it gets worse, she'll wind up with more pain at the end than immediately after the accident. If it keeps up, I can only suggest calling the Bilkmore Neuro Clinic. Of course, it will be two days later before she gets a reply.

On another note, the salvage yard that bought my car tracked me down. They have pictures up online for prospective parts buyers to view. I have one of the most telling shots here with a link to my Google photo page if you wish to see more. Some of them are hard to look at when you remember Jan was sitting there.

Here's the album on Google Photos.

Day 66 - TWO WEEKS TO GO!

YES! We are in the home stretch!

This is the Aspen collar Jan will be wearing for some period of time after the halo comes off. It may not look very comfortable but then it is all relative when you have been BOLTED INTO A HALO FOR 12 WEEKS!

The NP previously said she would have to wear the collar for six weeks without taking it off for anything except showers and then to not move her head. She even said we should have two collars, one to shower in one and one to transfer to once done. I'm hoping the doctor is more reasonable.

Wearing a collar without any neck movement seems like a step backward in treatment. If the bone is healed, she needs physical therapy sooner, not later. The doctor will explain it thoroughly and to my satisfaction or I'm not leaving. The NP was terrible at communicating reasons, only repeating what the doctor allegedly said. Well, this time it will be the doctor so there can be nothing lost in translation.

Jan has, what I deem, an irrational fear that the doctor won't remove the halo at the March 4th visit and will force us to return on the following day to keep the appointment with the NP for actual removal. Yeah, not on my life! By all accounts, it takes less than 10 minutes to get it off safely!

Day 64 - Presidents Day

The nine-week mark has passed and we are starting the 10th week. Halo time is 80% complete as I type this. Just 16 days to go. Calcium infusions via yogurt and vitamins continue! We tried out the magic bullet with some smoothies made from yogurt and fruit. They turned out fair but Jan says the formula needs something. I suspect the lack of liquid from yogurt made them thicker than usual, too!

The Valentine's Day dinner on Saturday was very nice and Jan is glad she went. Earlier in the day, I had warned Tessa to let Jan get the door if anything came up because a few weeks ago I had ordered a dozen roses to be delivered on Valentine's Day.

On a poetic justice type of note, the primary health insurance company paid Bilkmore, as I had previously lamented. The difference is we finally got the statement from the insurance company on what they paid. The beauty is they knocked the original $26,003 bill down to $4,480! That's the whole thing down to just 17% of the original bill! That isn't even what any two of the CT scans were billed at and she had seven. That isn't even the cost they billed for the halo!

The $309 x-rays Jan has gotten at each visit have been knocked down to $54. It sounds like congress needs to investigate the billing practices of the medical industry!

I'm still not happy with Jan's treatment or Bilkmore but I'm happy they didn't get anything close to what they billed. It certainly was sub-par care from the neuro visit at 2:00AM of 12/15/2008 on through the two NP visits she's had, including the lack of callbacks.

Is this what is wrong with health care? Is this why they say costs are skyrocketing because they bill exorbitant amounts that mere mortals cannot hope to pay?

If some uninsured person walks into the ER and has the same treatment Jan had, they would be billed $26,000. If you have insurance, the same treatment is only $4,400. Is that fair? We need truth in billing! We need a single price for everybody instead of $29 aspirin.

Day 62 - Happy Valentine's Day

Day 62 with just two weeks and four days to go!

If Jan feels well enough for the short trip, we are going to the Shaker Tavern for Valentine's Day dinner. A group at her church organizes one every year. We haven't gone to one for a few years. A couple from the church has been offering to take us out to dinner more than once but circumstances have not been with us. They were the ones that invited us to Valentine's Day dinner. I hope she feels up to it this time. I will post pictures if there are any that turn out well.

Yesterday I took Jan by her work to visit with coworkers and to do a bit of work. Any excuse to get her out of the house and walking around is a good thing. It is the only exercise she can do.

I'm working from home with the odd day at the office so I've not used up as much leave time as she has. Her work's policy is to use all paid sick leave and then paid vacation leave before going into unpaid status. We asked if she could go unpaid immediately since we don't need the money and I'd rather have her not use up her vacation time. After this is all over, we need some time out of halo away from everything. But, I don't write the policy and her last paid day is probably next week with no vacation time to speak of for the rest of the year.

While we were on campus, I suggested she go volunteer in the nursing class so the students could get an idea of how to deal with a halo. There is a dearth of information and education on the subject, especially in the medical community.

On the way home, we went by her favorite store and picked up a single-serve blender-ish device called a Magic Bullet. We are hoping it makes getting her daily yogurt requirement easier by mixing it with fruit and ice to make a smoothie.

Magic Bullet Website

The insurance is all screwy now. Our primary health carrier is paying the bills when it should be auto insurance. I've called, futile as it seems, to inform them they are not responsible for the charges due to it being an auto accident. All that got me was another form to fill out and the explanation that it would all be ironed out in subrogation. My only concern is they actually paid Bilkmore for stuff I have contested, such as two collars and too many morphine injections. At this point, I don't care enough to worry about it. My only focus is on March 4th!

She felt really achy on Thursday and I gave her half of one of her better pain pills. It really helped. I let her have the rest of it at bedtime and she is back to Tylenol all day Friday and nothing so far on Saturday.

Now for some picture updates. Here's how it looks when she stands, as viewed from all four sides. You will notice how far forward her head is craned to "preserve" the all critical, overriding and comfort-be-darned spinal alignment!

Day 60 - Taxing Experience

Jan has only today and tomorrow to go on her latest antibiotic. Her neck muscles and the pins are all the pain she has at this point. The calcium intake and yogurt are continuing right up to the minute the halo comes off! I might let her slack off on the yogurt after the halo comes off but I'm still debating.

I took her to vote on Tuesday at Natcher Elementary. I'm sure a teacher had some explaining to do to her students as they looked at Jan walking the hall. We saw one of Tessa's former teachers and he recognized her and asked about Tessa. When Tessa voted later that same day he asked about Jan.

Then, the wind and rain were terrible on Wednesday! My mother arrived to stay with Jan for the day before it started the worst. She brought a pecan pie and a pumpkin pie with her. She also made supper before she left. It is a good thing Jan didn't get out that day. I went into work the whole day since I knew she'd have company. Her friend that originally cut her hair after the accident dropped by for a touch-up. It was a pretty busy day and she didn't even have to leave the house.

She wants to go grocery shopping today. If the weather holds and the day starts off well, we will go get some more yogurt that she loves so much.

If all goes well, on Valentine's Day we are going to a church function at the Shaker Tavern at South Union. She is a bit worried it will be a long trip but US 68-80 is a nice, smooth four-lane road and it is only 20 minutes away. I think she'll enjoy a night out, around other people.

Here's a picture of the halo and her head from the top. You can see that the left front pin has considerably more threads into the halo than the right front pin by a noticeable margin.



On a sad note, I finally started our taxes. How depressing.

Day 58 - More Antibiotics

Day 58, 22 to go until the halo comes off! Three weeks until the CT scan, also known as The Scan! I intend to have slides of the scan up before we leave for Bilkmore along with the report. There should be no surprise on the actual neuro visit.

I still have not received a call back from the doctor that we were promised last week by the Neurosurgery Clinic manager. His office called because he's the doctor Jan will be seeing at the children's hospital. There is only one acceptable outcome at this point.

While at the GP on Monday for lab results, the doctor looked at the pins and decided she could use another antibiotic. Third one in a month! These are not great pictures but they do exhibit what the back pins look like. I have trimmed as much hair away from them as I can from time to time but it is very hard to get to them. It is even harder to photograph. Her hair is a little damp from just being washed but that is the best way to see the pins. When it is fully dry the hair has to be held back with clips to even get a look at the rear pins.

The GP also had some advice for getting through the CT scan, take a whole valium an hour before the scan. He said it would be a better anti-vertigo pill than the plain dizziness pills she has.

Day 56 - Eight Weeks Later

Today is eight weeks since the accident. Jan doesn't take anything but Tylenol for pain for the last week. She can go almost all day without anything. I give her two Tylenol at night to get past the neck pain so she can sleep. She doesn't take anything stronger unless we are making a trek rather than a short trip. Unfortunately, the halo still causes her pain in her pins and the weight of it all is as tiring as ever. It was never properly fitted and pushes on her head rather than holding her head up. This, in turn, makes her shoulders sore from the constant shrug she subconsciously does to alleviate the pressure. So goes the endless cycle of needlessly annoying pain.

At present, Bilkmore is showing an appointment on March 4th with the doctor and on March 5th with the NP. We aren't going to cancel the appointment with the NP until we are certain that everything is falling in place. The last thing she wants is any delay getting out of the halo.

As an observation, I've noticed she no longer involuntarily moves her eyebrows and, by extension, her forehead. She still can if she tries but it doesn't happen automatically anymore. A smile doesn't result in any movement above the eyes. If you look at the previous picture at the WKU President's Recognition Luncheon, you can see it in her face. So, a halo has the same effect as botox! Doesn't everybody want one now?

She's been averaging at least one yogurt a day and sometimes two so that gets her more calcium! I'm positive March 4th will be THE DAY!

Jan had non-accident related lab work done on Saturday. She sees her GP to get the results late Monday. Nothing out of the ordinary. Routine cholesterol and glucose checks. While we are there she is going to get her inner ear checked as well as the pins looked at to be sure they are both OK. No more speed bumps to this recovery.

Day 50 - The Unforgiven

I hope this Groundhog Day is not like the movie, reliving the same day over and over!

Jan's appetite returned last night after she stopped the antibiotic. She was on the eighth day of 10. One doctor, relayed through a nurse that called, said to stop the antibiotic, don't take Immodium and they'd call in another antibiotic course. Jan wasn't really happy with that since she'd already taken an Immodium on Saturday night and had already taken the Sunday morning antibiotic. The nurse could not elaborate on the reason to not take Immodium and only repeated it. I see a pattern here with nurses.

For confirmation, she called the pharmacy again. They had the same old story about stopping an antibiotic before the full course would allow the infection to come back, possibly stronger, blah, blah, blah! Well, if it is causing side effects worse than the original illness, it is time to regroup!

Thankfully, a second doctor, one she prefers to deal with, called back and said to stop the antibiotic and get the side effects cleared up before she starts anything else. In her current condition, anything too stressful on the body is harder to deal with.

She has agreed to try more yogurt in her diet, which she hates. Twice a day is what she said since it will help replenish the good flora in her digestive tract. We've already tried the drinkable yogurt. That wasn't very palatable either. She's been taking a probiotic since the first round of antibiotics a few weeks ago but the latest antibiotic was so strong it didn't seem to help.

Never again will I look at the medical profession as if they are miracle workers. That day has come and gone. Never again will I trust the word of a doctor or nurse as gospel. Their interests are not always my best interests. Never again!

Switching gears now. My sister, the nurse, says that if we go to therapy, the first thing the therapist is going to ask me to do is to forgive the people that I hold responsible. I'm not ready to do that just yet. Filing complaints makes me feel better than any therapy could. I need to stay agitated for a while longer. It helps me have the will to deal with these people. When I'm not, I'm ambivalent and I let things slide, sometimes until it is too late to do anything productive.

After 50 days without any counseling, I don't think it will make any difference anyway. We needed it on Day 1. In my opinion, that window has closed.

Day 49 - Gastric Distress and the Great Indoor Flood

First, the two items in the title are not related so don't panic.

Day 49 started just like day 48 with Jan's tummy still in turmoil with the antibiotic. Just two more days of that. She tried to contact the pharmacy and the urgent clinic that prescribed them to no avail. In the end, we decided it was better to take a single Immodium to try to alleviate the symptoms than to continue dehydrating unchecked. Hopefully, someone will call back this morning. She's still not eating much and that bothers me but she eats what she can. Toast and Jello are not very filling or nutritious.

The preacher brought over some food yesterday afternoon but Jan only ate one of the cranberry jello squares and a crescent roll. Something is better than nothing even if it does have an extremely rapid transit time.

She's not running any sort of fever. We have been monitoring her blood sugar as well just to be on the safe side. It is usually in the 90s or just over 100 so that seems pretty stable. She has some general lab work coming up this week and she wants to postpone it. She's agreed to call the doctor to see if the medications she's on will skew the results. I don't think painkillers will have any effect that can't be accounted for.

The vest is causing her a lot of pain in her shoulders. She's humping up her shoulders in a permanent shrug all the time to take the pressure off of her neck. The NP and the halo guru say it is supposed to be supported by the belly. It is amazing how these supposed professionals could care less for the secondary problems this thing causes and have no interest in even attempting to correct it. I finally had enough and took some of the lambswool we'd cut out and stacked it under her shoulder straps. At least she doesn't have to keep as much pressure on her shoulders to take some of the weight off.

I finally think I can articulate why I distrust the NP so much. She is not a doctor, first and foremost. She may be good at the basics but she does not have the knowledge of a doctor. She may have seen a lot but she is actually only parroting what the doctor tells her and I believe things get lost in translation. Her solution to everything is more pain pills without ever understanding the underlying cause. Her complete and total lack of willingness to even consider adjusting the vest tells me she has no skill to speak of. All she ever wants to do is tighten, tighten, tighten.

The Great Indoor Flood

For something on a completely different subject, the Great Indoor Flood of 2009 hit last night. Our washing machine has a very small hose, about a quarter of an inch in diameter, that senses the water level. It came off once early last year and flooded the utility room and then the kitchen while the lady that cleans the house was doing a load of towels. Once in five years didn't upset me too bad. You can guess what happened again last night.

Luckily, I had the wet/dry vacuum handy and immediately started throwing towels all over to stop the flood from reaching the hardwood floors. Then I vacuumed up three tanks of water in about 45 minutes. That's about 15 gallons! Jan called Tessa to come home and help as I would not allow Jan to do anything but tell me if water was getting on the wood floors. She sat helplessly in a dining room chair. I don't want to think what would have happened should she have slipped!

Tessa baled out the washer enough that we could spin the water out while I continued to pull another tank and a half of water out from under the dishwasher, refrigerator, washer and drier. Tessa threw some soaked rugs out on the rear deck before heading back out to be with her friends. On her way out of the house, she slipped on the wet deck and landed on her purse. She was OK but broke the LCD on her camera. Some days it just doesn't pay!

The washer hose is clear plastic and is nearly inaccessible. I can sit behind the washer and then stoop low enough to snake an arm up to get the hose back on. I'd done it a year ago. This time the hose had swelled slightly and I assume that is why it came loose again. I clipped the swelled portion off to get a better seal and reattached it.

Three hours and two laundry baskets full of soaking wet towels later, the place looks like the disaster zone it was before the flood. The only thing ruined was my back from stooping over to get all the water up. Much better today.

The repair has held long enough for me to watch it do a few loads of towels this morning but I no longer trust the attachment. I've nicknamed the clamp after the NP at Bilkmore because all I need to do is tighten, tighten, tighten! It is a five-cent spring clamp I can squeeze off and on with my fingers. I'm going to the parts store to get a worm gear hose clamp to make sure this doesn't happen again.

Two good things did happen as a side effect of the flood. I was so tired I slept without an Ambien and the floors were cleaner than they have ever been. All things considered, I rather have taken the Ambien and skipped the flood.

Day 46 - The Long Road to Bilkmore and Back

Jan had her second visit to the Bilkmore Neurosurgery Clinic today. This is a long one so get some coffee.

It snowed at least an inch on Wednesday in Bowling Green. Jan was fearful she would not be able to make the trip to Bilkmore if the roads were slick. I assured her the interstates would be top priority for both states. Our driveway melted off thoroughly without any help so I knew the interstates would be clear. We did not have any trouble reaching Bilkmore. The problems always start AFTER we arrive.

The double whammy of sinus infection and antibiotics had upset her stomach more than on Tuesday. She didn't eat much on Wednesday and I was concerned about her. She still wasn't very hungry this morning and was afraid to eat much before traveling. All I could get down her was some toast and jello. We did manage to get her hair washed without being dizzy which alleviated a lot of her anxiety. She was worried but we got through it. After the visit she was hungry and we got a Wendy's burger. So far, so good!

I gave her a pain pill, the first in three days, before the trip to Nashville. They tightened the pins and I'm sure she'll need a valium soon. I've come to the conclusion that the pins, once tightened on Jan 5th, shifted the entire halo around her head up by about a quarter inch. All of the pins have an opening below them. Yet again Dr Sloppy has demonstrated his lack of experience by doing a poor job of selecting sites! This may be accepted medical treatment but it is barbaric.

Jan says it feels like the halo gained a few pounds after tightening. When they tightened it, she could hear the bolts crack when the torque wrench reached the torque value. I can only imagine what if feels like and I don't think I'd like to experience it.

My sister, the nurse, told me about filing a complaint with the state medical board against Dr Sloppy. I found the form at the TN Medical Board website and am filling it out. It probably won't do any good but I'm going to put it down on paper. It is the least I can do to repay him for all the lovely work he did on my wife. His dedication and attention to detail... OK, you can see right through my sarcasm, can't you?

This picture was of the whiteboard in the exam room. The people that schedule these things told us to get there a half-hour early to get the x-ray. I knew they were lying because I could hear them speaking! We arrived at 11:18AM, were signed in and all paperwork filled out by 11:21AM (they documented it as that time) and then we had to wait 20 minutes for the shuttle. They sent us to the main x-ray lab but they were backed up again and wanted us to go, literally, 300 yards down the hall to the other x-ray lab. I went off on them!

A nice lady at that x-ray lab got Jan a wheelchair and even rolled her down with me trailing her coat and essential travel gear. She asked something about the x-ray and I let her know I'd never be back to Bilkmore once we were done. They had done nothing but jerk us around from the very first ER visit and I was not happy. After we reached the other lab she went and found a director and he had a little meeting with us.

We expressed our displeasure with the whole series of events and he said that was not the Bilkmore way. He agreed that 13 days was not very quick turn around for a call to a nurse. He said we should have heard back from the patient advocate since it had been a full month. He also said he would let the chief of neurosurgery know and there definitely would be something done. He stated this was a top priority with Bilkmore. I hope he is right and I'm going to be sending the medical board complaint in tomorrow's mail.

The following picture was on the wall of every exam room. Kind of ironic considering the difficulty we've had with everything Bilkmore. I do not believe we've had excellent care. I don't believe what Jan has experienced qualifies as adequate care. Guess what number I'll be calling once we get an appointment?



We finally arrived back at the clinic around 12:40PM and it was almost 1:00PM before the nurse practitioner arrived and she left almost immediately saying she had a meeting! She left us with an RN that had never tightened a halo and she acted intimidated by it. I was just about to tell her to stop when the NP returned and said the meeting would have to wait.

She told Jan the pins were tight but I watched her turn the first pin, the left front one nearly a full turn before it clicked. She started with that one the last time and turned it a half-turn then. That is not an indication that a single pin is loose. It is an indication that the first one tightened will always be the loosest one.

For instance, think of a bicycle wheel with spokes. If you only had four evenly distributed spokes and they are even the slightest bit loose, tightening only one to a specified value will make the others tighter and shift the hub, in this case Jan's head, from the center. No mechanical skills at all with these people! No wonder the pins are ripping the flesh.

Then, when she tightened the lock nut she didn't hold the pin while torquing the lock nut. If you do not hold the pin while tightening the lock nut the torque value is invalid. It will most likely be tighter due to additional torque on the lock nut. Very poor technique and bad assembly procedure. I'm way more precise with my valve adjustments than they are with the human body! I kept my mouth shut for Jan's sake, despite my desire to scream.

The NP said the spine is still in alignment and we are doing a good job of keeping the pins clean. What's new? I'm angry and frustrated, not incompetent!

I let Jan do as much of the talking as she would and could. If there was resistance to Jan's wishes, I piped up with a more outrageous demand and made her seem quite reasonable. The NP/voodoo witch again said the vests never fit well and to just take it. Could she care any less? You know what? If you don't try to improve the fit I can guarantee it never will fit properly! How would you like to wear an off-the-rack suit not quite your size for three months without even attempting to tailor it?

Jan asked to have a CT scan done in Bowling Green on the next visit and the nurse started saying it wasn't time since this was only her second visit. I quickly informed her it was 7 weeks and she had previously said we could have had a scan on this visit if we wanted. I strongly (maybe loudly) voiced my opinion that we wanted a CT scan on the next visit and we wanted to get it in Bowling Green! All of a sudden the NP is afraid of subjecting Jan to too much radiation! Wow, what about the four full scans and two neck and two head scans she had on 12/14/2008 when Bilkmore could have used the scans from the Medical Center if radiation is a major concern? Sounds like she's using a straw man argument to me. She is going to get one less scan now than she would have previously.

She then started saying the accident was 12/14/2008 and she could not get a CT scan before 3/14/2009. I corrected her by telling her that 12 weeks is 84 days and three months is 90 days, a week longer. The NP sent the nurse after a calendar. Mind you I've calculated it out several times and have a reminder every Sunday of the week count. She was arguing with me but agreed once she used a calendar. Twelve weeks put it at 03/09/2009.

Jan turned upon the NP's sympathies to explain that we left at 10:00AM and it was now 1:30PM and would be closer to 3:00PM when we got home. Five hours for a "simple" office visit is a long time out of the house for a halo wearer. Surprisingly, she agreed after a brief refusal. I don't think they like working Mondays so she agreed to March 5th or 6th and we would need the scan on the previous day from Bowling Green. A week later than I hoped but not March 14th!

Then, the NP said she would be in a collar for six weeks and she could not take it off for anything but a shower and even then to not move her head. I've read literally a dozen accounts of people having this injury and wearing a halo. Some only wear a brace to strengthen the neck muscles and some don't wear one at all. Nobody I've read an account of has worn one for six weeks without removing it for anything but showers. The NP even said to use two, one for showers and another to change into after. You can be assured I will be diligent in getting the correct answer despite the NP's statements.

To top it off, she will NEVER see the actual neurosurgeon that is on her records. He isn't even in the same building!

If it isn't healed after 12 weeks, it isn't going to heal. My reading of studies shows that most people wear a halo for 8-12 weeks, depending on age and general health. Most CT scan studies show that most healing occurs between the fourth and eighth weeks with minimal additional healing occurring between the weeks 8-12.

Bones heal much like cuts. A scab forms to cover the damaged ends. Jan's break is deep into the cancellous bone. That's the soft spongy part that has all the blood supply. It is analogous to the flesh under your skin. The two sides of a fracture grow together much like your skin closes the gap in a wound. The cortical or hard bone covering is like the outer skin.

Right now and ever since the accident Jan has been getting a minimum of 100% of the daily recommended allowance of calcium and vitamin D. She hasn't had any NSAIDs because they reduce inflammation, which is the bodies reaction to an injury. Reducing the inflammation retards the bodies natural healing ability. Tylenol and narcotics do not have this effect.

I know, I read too much but when I feel I'm getting better information from the internet than from the person treating my wife, especially when I seem to be getting a consensus, I just do not trust the care she is getting.

Day 44 - Sleeping When You Can't Lay Down

With the sinus infection and the inner ear problems, Jan can't lay flat or the room spins so fast it makes her sick. The dizziness medication doesn't completely alleviate it so we can't wash her hair the usual way until that clears up. It may take 10 days for the antibiotic to resolve it. She did not have much of an appetite yesterday due to nausea but she did eat and take all her meds. She even ate some chicken and rice for supper.

Someone suggested shaving cream to wash her hair and then rinse it out with a damp washcloth. I'm going to be the guinea pig on this since I can always take a shower and if it makes hair fall out, at least I'm not wearing a halo and I can wear a cap! I'm waiting for my hair to dry to see if it looks nasty or just oily.

She is sticking her tongue out at me in this picture. She's been colder than usual, probably related to the infection although she never ran a fever. This is how we keep her warm at night.



The lift chair controls are under the blankets and I have another blanket draped over the halo to keep her head warm. There are also small heat packs you can't see on each side of her neck. Those muscles are always tight and always bothering her. The little TV tray to her left is where she keeps her cell phone, TV remote, a drink, extra medication and the gas logs remote if she gets too cold. She can't see any of it and has it laid out where she can find it by feel.

Despite the awkward sleeping arrangement, she slept pretty well last night on only one pain pill and one valium. That was the only pain pill all day! At least her stomach is settling down. She had bacon and waffles for breakfast and her blood sugar was only 96.

Anyone local to BG knows we got an ice storm overnight. Trees were down across the road and schools canceled. I just hope it all clears up by Thursday morning when Jan has her next appointment on day 46.

Day 43 - Complaint Letter

Late Addition:
Jan thinks the below is a little harsh but I have copies of the documents in question. If I have proof, it isn't being harsh, it is an opinion based on the previous six weeks of experience. Jan also asked me not to mail the letter until after her next appointment on Thursday.


After six weeks and only one visit, I finally printed out the complaint letter. I believe the nurse committed fraud when she filled out Jan's FMLA paperwork because it clearly states under Number of Visits: 10 outpatient visits. How can we get nine more visits in with her current 3-4 week appointments?

On my form for FMLA, she wrote "weekly visits to neurosurgeon radiographic studies, halo tightening, medication adjustment, skilled observation intermittent." I think she blatantly lied, to put it bluntly. She has never had any intention of seeing Jan weekly or even every other week.

The Patient Rights document they have up on their website is so much lip service. So many things were not adhered to on this document that it literally isn't worth the paper it would take to print it.

Note that the bottom of the middle column has this text. This had better be true because the level of care could not fall any lower short of refusal to continue treatment.

You and your family/guardian have the right to
express dissatisfaction regarding the quality of
care without jeopardizing future care.

Day 42 - Six Weeks and Counting

Six weeks today have elapsed since the accident. We are definitely at the halfway mark and maybe a bit beyond. It seems like only yesterday I was standing over my injured wife, her head bleeding and me still trying to get a cell phone signal to dial 911. Ten hours and two hospitals after that she was in the halo. Twenty hours after the accident we were home again from the south instead of from the north. Twenty hours and $36,000 in bills! Reality has set in.

Jan has a sinus infection and that is what is causing her to be dizzy upon laying down. We've got some antibiotics, again! The doctor also gave her a prescription for the dizziness so hopefully, she will be able to get her hair washed again soon.

We stopped at a bike store on Saturday to try and find some of the little mirrors they put on helmets to see behind them. It would have worked great but the mirror attachment is too narrow for the width of the halo. Just our luck. We might try the other bike shop in town to see what they have.

Warning: This picture may disturb some people. It is reduced in size to obscure the detail. Click on it for the full-size image.

I have an extra pin that was left in the bag the halo came in. I placed it in Jan's halo ring near one of the existing pins in her forehead. This may help to illustrate how this thing is anchored to her skull and the depth of penetration through the skin.



Notice that the entire spike portion is in her skull and one-third of the remaining unthreaded shank is in the skin. This is what we clean around at least twice a day at all four corners of her skull. You can see the indention in her forehead. Anyone think this is fun?