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?

Day 41 - Pictures from the Luncheon

Here is a picture of the whole family at the Kentucky Building after attending Tessa's recognition luncheon. Jan looks pretty good, don't you think? If you could not see the bars, it would not be noticeable at all.



Jan introduced her to a few people on the hill and Tessa was able to speak to several Western people that are involved in the Honors College. She is very interested in journalism, political science and especially studying abroad.



We learned a valuable lesson yesterday. Jan has some protein powder and we tried to make a yogurt smoothie with extra strawberries to help her get some calcium in her diet. It pretty much tore up her stomach for most of Friday morning until after lunch. She's all better now.

The other bummer is she is getting dizzy any time she is on her back. Guess how we wash her hair? On her back! It was a good thing the shower attachment for the tub worked out. We washed her hair in record time.

She thinks the dizziness may be related to sinus pressure, possibly related to a sinus infection. With her history of PSVT, she is not wanting to take a decongestant. She was been putting ice and heat in alternating sequence on her face and head to try to relieve the pressure. A trip to Urgent Care may be in our future.

Day 40 - Tessa's Luncheon Recognition

You may have noticed I placed a count down timer on the right margin. It may be a bit optimistic but we have a goal! Bilkmore will surely screw it up but I have a workable timeline in place.

Day 39 began early after Day 38 ended with Jan trying the bed for a second night. At 4:30 AM when nature called, she could not get situated back in the bed so she went back to the reclining lift chair. Setbacks are depressing. Now she has sworn off the bed for the duration.

Jan slept well last night back in the chair by just taking a single pain pill and a muscle relaxer pill. She did wake up cold and put her heating pad on her feet but other than that, she didn't require any additional pain medications after bedtime. It is now 6:30 AM and she had enough sleep to feel OK about going to Tessa's luncheon.

Speaking of the luncheon, today is Tessa's luncheon with the WKU President. I'm glad she was OK with her mother attending, halo and all. WKU has bent over backward to accommodate Jan. They are allowing her to park in the circle drive right in front of the Kentucky Building so she won't have steps and such to deal with. We are thankful for that. The event hasn't happened yet but I'll update later if anything interesting transpired.

I've been looking over the medical bills in my spare time. The actual CT scans I have on CD and the billable scans don't all add up. I'm trying to figure out what is what.

The hospital charged for a thorax, abdomen and pelvis scan but it is one continuous scan. Most places charge $3,000 for a full-body scan and they charged $2,300 times three for that one. Then they charged for a cervical spine, thoracic spine and lumbar spine scan that looks like the exact same scan to me. Again they billed it as three scans. I think they are used to insurance companies paying blindly and they are double-dipping. The total for CT scans alone was $14,500. The Medical Center in BG did one whole scan for $1,850 and a head scan for $1,400 on the visit two hours before Bilkmore did the exact same thing.

Based on my reading, she was exposed to the equivalent of 15 years of background radiation (three for each scan) in just four hours. Annual exposure to radiation should be limited to 20 mSv per year. She got about 10 mSv in the four hours between Med Center and Bilkmore CT scans on Dec 14th. I don't know that it is terribly harmful but it would seem they should have sent the scans with her to Bilkmore and at least looked at them first. Certainly, one more x-ray and one more CT scan will not put her over the annual limit, especially if you are creative and count the accident imaging as 2008 exposure. All other imaging is taking place in 2009.

If there is a next time, though I hope it never does, I ride in the ambulance and arrive with her. I hope it is the same if I'm the one injured. Too bad education always comes too late to help the ones you love. I hope some of you are learning from this. I won't say that makes it all worthwhile but I wish I'd have stumbled upon something like this prior to our accident.

Even though it will be paid by insurance, I'm motivated to keep them honest because they charged for a total of seven CT scans when they actually only ran her through the machine three times tops. If I can be the one that holds their feet to the fire and makes them accountable, I'm going to make it my second priority in life after Jan.

This is yet another reason I want to have her next scan in Bowling Green. The idea is that if we can get the CT scan on Wednesday afternoon and then go to Bilkmore with the scans in hand, it will be a shorter day. Knowing Bilkmore, it will be a bigger pain to try this than it should. I'm going to be adamant that they allow us this as it should be us, the ones paying, that determine how our money is being spent and the course of treatment. It isn't the nurse's body, it is Jan's that is being treated.

I've still not ruled out requesting a meeting with the hospital administrator. I've begun drafting a letter to him. I just need to research who to address it to. There is an address on the web page but I suspect it is about as useful as the patient advocate, which we've heard nothing back from. Probably a futile thing but if we don't complain, who will? If enough people complain, word gets around and then change will happen. I truly believe one person can make a difference, good or bad. I certainly will not recommend anyone going to Bilkmore and falling victim to similar treatment that we have experienced.

Day 38 - Night Without Pain Pills

Here we are at day 38 with 36 to go. We are halfway if the CT scan is on Feb 26th and shows sufficient healing! The end is in sight.

Day 36 was the first night she tried to sleep without the time-released pain pills. She slept OK but not the whole night. The stiffness at the lower lumbar near the pelvic junction is still a problem. The majority of pain has moved to her lower back where we suspect the lack of a proper fit on the vest is causing secondary pains that have nothing to do with the accident. These pains only developed after about day 30.

She can lay on her left side but not her right due to terrible neck pain. Again, this thing is not immobilizing her neck like it should. In my opinion, pain is an indication of stress due to a lack of immobilization.

Day 37 was the first night she tried to sleep in the bed with pillows propping up her back and head. There was some success but she woke up as stiff as ever, especially in her neck. She can get out of bed by herself but I'm not sure we've found the solution yet.

The pin sites are looking better after several days of applying sparing amounts of Neosporin. I clean them completely of any old ointment at night to allow them to air and then apply a fresh amount in the morning after the peroxide cleaning. This has been keeping the scabs from caking around the pins. I read and agree that we do not want the skin to grow to the pins and start trying to cover them. They are not permanent and we want no adhesion when they come out. The one will most certainly leave a pencil eraser sized scar. As she says, "That's why I have bangs."

Another interesting development is the half-dollar sized bald spot on the back of her head where she actually contacts whatever she is leaning or laying on. No other part of her head can make such contact so this single place takes all the contact stress of her head and the extra weight of the halo.

Things have progressed well through the first four weeks. At this point, we are a bit stagnant. The improvements come slower now and the changes are not all good, such as the low back pain. Things aren't bad but they certainly won't be great until the halo comes off. I suspect this is as good as it gets until that day. Then we start a whole new phase with the neck brace and physical therapy.

Other than walking in stores, I can't get her to do much exercise. She had me get the two-pound weights shortly after the accident but she's yet to use them. I know she reads this. Perhaps it will incentivize her to use them to strengthen her arms and upper body a bit. Her weight limit is five pounds in case anyone is questioning the wisdom of this. The nurse said she could do this as well.

We went looking for some long sleeve v-neck t-shirts. Colors would be good as the joke is what color shirt do you want today, white or white? So far we haven't found any. We can get long sleeve regular t-shirts or v-neck short sleeve t-shirts in colors but not both long sleeve and v-neck, white or colors.

We settled on supporting my company by buying some jersey shirts, one with black sleeves and one with red sleeves. Not being v-neck means we will have to slit them a bit deeper down the back but it will work out. She says she hates cutting up a perfectly good shirt but it is nothing compared to what the halo costs. In relative terms, it would take a thousand shirts to come close to the cost of the medieval torture device modern medicine has concocted.

Day 36 - Sleeping in a Lift Chair

It is now day 36 in a halo for Jan. Only 38 more to go, maybe less if the appointments work out to her advantage. Maybe more if they don't.

She is still sleeping in the lift chair loaned to her by her dean. She has not slept in a bed for the full 36 days. This is hard on her because she is a natural side sleeper. I'm trying to convince her she can sleep in her own bed with pillows propped around her body and head with a gap for her shoulder. That should keep any pressure points off of her arm and still allow her to log roll off the bed. Worst case scenario, she wakes me up and I help her. That's what I'm here for.

As handy as the lift chair is, it pretty much locks you into a position for the night. She was on the love seat while I sat in the lift chair. I drifted off to sleep for an hour, maybe two, and woke up stiffer than a board. I don't usually get stiff or have that kind of issue. No wonder her neck is so tight in the mornings. We apply heat to her neck every night and every morning to help ease the tension in those unused but stiff muscles.

Between the small reheatable bean bag type packs our dental hygienist gave us and the extra padding I clipped away, the little packs fit perfectly between the collar of the vest and her neck without a lot of extraneous shifting and fishing them in and out.

Her church sent over a full lasagna meal with salad and dessert for a Sunday meal. With all the gear she has on, eating is sometimes a problem. Since it naturally rests on her lower rib cage, she gets full quickly and then experiences gastric distress if she eats as quickly as a normal person. One of the side effects of the most powerful pain medication that she takes is the slowing of the gut. Peristalsis becomes sluggish and that exacerbates the condition. That lasagna was very good and she had to go rest after eating.

While Jan's niece, Emily, was visiting, I took the opportunity to partially reassemble my 39-year-old muscle car. It has been in some form of disassembly since Thanksgiving. I ordered parts before the accident and they arrived mid-week when we returned home from Bilkmore. It isn't finished but it at least has the steering gear reassembled.



Today is MLK Day and our daughter is off. Even though she won't be up before noon, she is in the house and Jan is having a good day so far. It is snowing but I have a 4x4 truck and I am going to work for a while just to get some things done that need on-site attention.

Day 34 - Modifications: Phase II

It is now almost five weeks of 12 down. The next appointment is at seven weeks, three days. We should be looking at the CT scan at the visit after that and, hopefully, the halo coming off. With any luck, she'll be out of it by Feb 26. Keep your fingers crossed.

After trying to find something that will fit over the halo-vest to look a little more dressy, I decided it was time to be a little more aggressive with the removal of nonfunctional fluff.

Here's the lamb's wool I removed from the vest. This is about the amount of fur I get off my dog when I shear her for the summer.



It really took a lot off her shoulders. She doesn't look so much like a linebacker. We haven't tried the clothes on yet but they can't fit any worse than they did before the modifications.

Here's the old picture for comparison with the modifications completed. She's not in a picture-taking mood so the look says it all. I'm not sure but I think the front bar (her left) on the right side of the picture has slipped down! So much for stabilization. A halo is only 75% effective and a hard collar is about 50% effective. I'm going to take another one in the same place, in the same position to make sure the bars are not shifting.

Jan's niece came down from Frankfort for the weekend and some good friends came to visit with pizza! She is pretty worn out tonight and went to bed pretty quickly at 10:00 PM.

Day 33 - Two Days In A Row

Two days in a row we encountered other people that have had a brush with halos. Thursday, while shopping at Kroger, a woman kept staring at Jan on the way in.

She finally approached her and said, "I'm sorry to stare and I don't mean to bother you but my mother-in-law is in a halo and I wanted to ask if you found a good way to dress?"

We told her about the v-neck shirts and the slit down the back. She was grateful and we all lamented the lack of a support group for halo users and caregivers. No person could possibly wear a halo without a support person.

On Friday, we were in Kohl's with a mission to find something Jan could wear to Tessa's WKU Presidential Luncheon. A man we've traded vehicles with since 1997 was in the store. We spoke to him and he said he knew what she was going through. Sure enough, 12 years later, I finally noticed his pin scars.

At least we are seeing that others do survive this, despite the medical profession's best efforts to make it nearly impossible to remain sane and healthy.

We finally, after two days of trying, got an appointment back at Bilkmore for Jan 29th. We still have to do x-rays at Bilkmore but they assure us that it will not take long. The appointment is at noon and they say we only need to be there 30 minutes early to get the x-rays. If this goes poorly and turns into another seven-hour day I'm going to demand they allow us to get the images in Bowling Green because seven hours out of the house in a halo is sheer torture!

Despite the myth of the halo's immobilization, it does not prevent movement of the cervical (neck) vertebrae. Jan's neck pops all the time. Getting into the car on Friday caused something to cause her great pain. She says it feels like her neck shifted and is pinched. I'd call the nurse but it will take them the weekend plus two days to just tell her to take more pain medications. The vest is also causing pain in her lower back around the lower lumbar area.

The pins are looking better after Jan called back and we finally got them to look at the picture I uploaded. They said it was normal. I would know how? It wasn't like they gave us any instruction or guidance. Oddly enough, the rear pins that I was afraid would become infected because of the unshaven patches and the ground in hair look like the day they were put in.

The front pins looked the same from day one to day 22, one day after tightening, when they broke through the skin and opened up a slit in her forehead. They've both broken through now and when they finally called us back, wait for it, two days later, they said use a triple antibiotic like Neosporin. After cleaning them three times a day, alternating between hydrogen peroxide and Neosporin, they look as good as can be expected of a recent, to-the-bone gash. The scalp cuts she had were not this deep, just longer.

I swear these people have done her, and to a lesser degree me, a great disservice. They have done absolutely the bare minimum, maybe less, to get her through this and not a thing more. When it takes six days to get a nurse to call you back, that's beyond ludicrous. Maybe I should be grateful that we normally have a 48-hour turnaround on calls? Are my expectations too high?

I'm going to have tattooed on my chest the following:

If I'm not dying, I want a second opinion!
DO NOT TAKE ME TO BILKMORE No residents allowed to touch me!

That was not a joke! Maybe I'll have a custom medic alert bracelet made instead. I hate needles. Perhaps we will soon have an implantable RFID chip available that is tied to our medical records, a living will and specific orders. Should I start such a service and retire on the proceeds?

Day 31 - Seventh Day on Antibiotics

For a refresher, here's the pin site as I found it last Wednesday.



This is the same site one week later. I'm not sure I see any improvement. Just as much redness and more scabbing.

Day 30 - Popular (Second) Opinion

Jan is in bed (the recliner) so I can finally get the results posted. We saw the doctor in Hermitage this afternoon for a second opinion. He was very nice and made a lot of sense. He actually talked to us in an intelligent way and didn't treat us as if we were stupid. He says the break is bad but is better than it could be.

This image identifies the different types of C2 odontoid fractures. Type I generally is only treated with a collar. Type II, where the whole tip is broken, fail to heal in 50% of cases.

Jan's break is a type III. A type III fracture is when the pin and the front of the vertebrae is broken off as a single piece. It is through the body of the vertebrae, which usually heal quite well. Her's is all the way down to the bottom. He says there is less than a 25% chance she'll need surgery. Much better than a type II.

The x-ray is a frame from Jan's ER CT scan. It is a slice viewed from the front. It goes farther through the body than the typical type III in the illustration. The doctor thinks that should lead to good union (healing) of the two parts.

Jan really liked him and wished we'd have gone to his hospital to begin with. I think it has something to do with him saying young people heal well.

He was shocked they didn't shave the rear pin sites, as indicated in the instructions for the vest. It keeps the chances of infection way down. He also didn't like the particular model of vest as they are more cumbersome than the ones he uses. Imagine that, $6,300 for the Yugo of halo-vests! You can buy a good used Honda for that kind of money.

In addition, he was surprised they didn't keep her 24 hours because you are supposed to check the screws in 24 hours. He said he would have kept her for a day for observation and then she and I would have been instructed on how to care for the pins. I guess that is the problem with teaching hospitals. If there is anything requiring surgery, she won't be having that at Bilkmore!

In the end, he says they did the proper things to protect her neck but they could have been a lot better about her treatment in general. He would have done much the same thing. He also said that it might have been treatable with just a collar but he would not have done it.

We probably could have gotten him to take the case as they asked us at check-in if we wanted that. The problem was his office hours are one day a week in Bowling Green and the next slot was in March! We could have continued to drive to Nashville to see him but he recommended we stay with Bilkmore. Jan was fine with that and I suppose I am, too. At least we have some valuable information and Bilkmore is the only place responsible should there be issues.

Now we come to Jan's next appointment at Bilkmore on Jan 23rd. The NP has ordered a CT scan to "make us feel better" about the treatment. The second opinion doctor says that the only reason to order a test is if you are going to do something or change treatment. He says there is no way they are going to take her out of the halo at six weeks so why do it. I agreed and Jan is considering canceling the appointment in favor of me going to the luncheon on the 23rd with my father and Tessa. She wants to push it to the next week with just an x-ray.

Instead, we are going to see if we can just get x-rays in Bowling Green to avoid the hassle at Bilkmore with the shuttle and the extended duration between imaging and NP appointment. For a 10:00 AM imaging appointment, we need to leave by 8:45 AM. The visit with the NP is at 12:30 PM and you just know she'll be running late. At the last appointment she was 30 minutes late and the visit lasted an hour and a half. Even if we make this one shorter, it will still be at least 2:00 PM before we are done and another hour to get home makes it an all day affair.

Day 30 - Counseling and Second Opinion

Day 30, 54 to go!

Yesterday we went to see someone for counseling. I think we both have a lot of trauma related issues, me so more than Jan. We went to Sam's before my chiro appointment to get out and pick up a few things. It tires her out but she needs the exercise and to build some stamina. Another person came up to her in Sam's and said she went through a halo treatment, knew what she was going through and it gets better. The poor woman looked like she was near tears as if it brought back bad memories. It kind of tore Jan up, too!

The counselor said we are experiencing all the normal thoughts and emotional symptoms after such an experience. He recommended we see someone else that deals more with this sort of thing since he was more of a marriage counselor. We may need marriage counseling eventually but not at the moment. One of the people he recommended is a WKU person so Jan is going to contact them.

We've gotten all of our records and images together for the doctor to examine her and give a second opinion. I'm hopeful but not overly so. Realistic expectations need to be the norm.

A friend from Jan's church brought over the evening meal on Monday. It was wonderful barbeque meatballs, fixings and even an apple pie with ice cream. It is so comforting to know that everyone is praying and thinking about Jan when she really needs it. The next door neighbor is bringing supper on Wednesday. Who knows, I might actually gain back the 15lbs I lost in the first three weeks! I haven't weighed under 155 since my first year of college in 1980! All my belts are in the last hole and still loose!

I think after a full month we are starting to settle into a routine. I expect to not update but every couple of days from now on. I'll make exceptions for news that is out of the ordinary, such as the second opinion later today. You can still email Jan directly. She usually does an hour or so a day in front of the computer. It breaks up the day and gives her a reason to get off the couch.

Now, if we could just get that antibiotic finished and keep the pins clean, we'll have smooth sailing for the next seven weeks, five days.

Day 28 - Four Weeks Today

Despite it being a grim four week anniversary of the accident, things should be looking up. We are one third of the way through.

Yesterday was good in that Jan had her night guard modified by Charlotte and my mother fixed supper for us while we were in town.

Charlotte was absolutely great about staying late and working us all in. I thank her greatly for taking the extra time to get Jan squared away with her guard and being careful with the halo. She even found a couple of small bean bag hot/cold packs we could fit in Jan's collar area to relieve her tight neck muscles.

Mom made a great pot roast and fixings, including a peach cobbler! I think everyone left pretty stuffed. She also fixed the hem on some of Jan's new slip-on pants that were too long. When in a halo, slip-on clothing is a must.

We are still finding it tough to get in all four of the antibiotic pills. She wants to take a Nexium in the morning but if she has to wait to wake up, it is late in the day before the first dose of antibiotic. If I wake her to get the Nexium down so she'll take the antibiotic in half an hour, I'm the bad guy for waking her.

On the way home yesterday, we drove by the Kentucky Building and Jan showed Tessa where her and her grandfather need to go for the luncheon on the 23rd. That is CT scan day at Bilkmore. With any luck it will show some healing and give us an indication of what to expect.

If I sit quietly for too long I am still reliving the crash in minute detail, desperately thinking about what I might have done differently. It all seemed to go in slow motion as I heard the faintest of pops when the tempered glass blew out of the door, the crinkle of the windshield and then the rear window as it disappeared into a million pieces. People say these things happen so fast but the detail and clarity with which I remember it is all too real. As an intelligent person, I know I should let it go. Easier said than done, especially after only four weeks.

Day 27 - Travel to Dental Appointment

Day 27, 63 remaining if all goes according to plan.

Jan got all cleaned up and even put in her earrings for a new picture. She's even trying to smile. We will pick Tessa up in a bit and we have to get Jan suitably medicated to withstand the trip. Hopefully we can get her night guard refitted to help keep her jaw in alignment. She thinks that is part of her neck muscle problems.

You may notice her tool kit taped to the front of her vest. That is in case of cardiac emergency, they can use it to remove it for CPR or other life saving emergencies. Apparently, they do this for all halo-vest users, not just her so no need to freak out. It is standard procedure.

Both of us slept pretty good last night. That's a big improvement. Sleep is one of those things you can't catch up on. Once you lose it, it can't be gotten back.

You can see her reading glasses hanging off the front of the vest where I clipped some of the lining away. You can see her neck now instead of a head perched on a pile of wool! She needs a new pair and we'll pick some out while we are out today. Not being able to move your head makes reading more difficult so anything we can do to alleviate the strain is good.

Day 26 - Confirmation! Second Opinion

It was confirmed this evening. Jan has an appointment in Hermitage, TN for a second opinion. That will go a long way toward easing out minds. The chiropractor I'm seeing knows of this neurosurgeon and thinks he will give us an honest opinion. This should decide if, despite the less than stellar communications and complete lack of compassion, Bilkmore is doing the proper thing. Just an eight page patient information packet between us and confirmation!

On another front, today was a really good day because the night was pretty good. She had very little pain but was a little dizzy when we washed her hair. That was a first but she thinks it was the antibiotic which is the only change lately. The infected pin is scabbed over and we are trying to keep it clean. Any infection should be dying off now. The last scabs on her scalp are finally coming out. I think they are just held in by the hair but they will come out when they are ready.

After we had her all cleaned up we went to my chiro appointment. The doctor hugged her. I doubt she will be going back to him any time soon due to her injury but he really likes her. It makes me feel better to know everyone that sees her wants her to get better as quickly as possible.

From there we dropped our daughter's latest ACT scores off at the college. They weren't in the system yet and the deadline is the 15th! It helps to know some folks and/or work there.

After that we went to lunch at Buckhead. People looked but most seem to have a touch of pity in their eyes. From there we went to her office to drop off a book that another instructor will need to teach a class she isn't going to be able to handle. Her coworkers that were there were all a little shocked but glad to see her. At the end of this visit she was very tired and needed a pain pill. She only had two regular pain pills today and that was after all the traveling around. The situation is definitely being improved by a good night's sleep.

After a short nap the good people from her church brought over another really nice meal. Everyone has been so thoughtful and helpful. I don't know that we'll ever be able to thank them all. We aren't great cooks ourselves but I hope we can repay them in some like fashion some day.

A family member sent us some information on the best neurosurgery hospitals and clinics. Bilkmore isn't even rated. Mayo Clinic in Rochester, MN is the number one.

Just knowing we are making some progress is a great relief. Between that and taking another Ambien last night at 10:30 PM when she went to bed, I didn't wake up until the alarm went off at 6:00 AM. That's the first real night's sleep I've had in nearly a month.

It is time for her last antibiotic of the day. Tomorrow we go to Leitchfield for a dental appointment. This is our family dentist that we've seen forever. They are friends and are very good about working around our current situation. The greatest dental hygienist around is going to take care of Jan's teeth. She has cleaned a person in a halo before so she knows what to expect. Jan's already deciding what medicine she needs to make the trip bearable.

While we are in the metro Leitchfield area we'll visit my mother. She's got a roast on and she will hem some of Jan's new clothes that are halo wearer friendly.

Day 25 - The Emotional Rollercoaster Continues

Our daughter has an awards luncheon for being one of the top students in the county on Jan 23, 2009. WKU is putting it on and rumor has it this is a prelude to some sort of scholarship. It will be held at the Kentucky Building on WKU's campus.

As it is, I was supposed to attend with her since Jan doesn't want to go but the only appointment we can get with the Bilkmore Neuro Clinic and the prerequisite CT scan is, wait for it, Jan 23, 2009. Since the CT scan is at 10:00 AM and the meeting with the NP is at 12:30 PM, there's no way either of us can make it. We've tried to get it rescheduled and the best they could do was scans one day and see the NP another day. LOVELY! Travel is the absolute worst for Jan due to her head and body being locked together. Every bump and crevice on I-65 transfers to her head and it makes her nauseous and gives her a headache.

My dad, her grandfather, has graciously agreed to join her in my place. Tessa says she's OK with it but it breaks Jan's heart that neither of us will be with her for what should be a happy moment. I hope she understands that her mother's health and well being is a top priority and that we love her despite our inability to attend.

All of the above contributed to today being a bad day. The most minor of bright spots was the check for the totaled car. I'd give twice that if it would make her whole again any sooner. Interestingly enough, I deposited it and they put an 11 day hold on the funds. I told them I didn't care, just put the check in the bank and let me finish getting groceries! Everything pisses me off!

I think I have found a doctor that will see her for a second opinion! He has an office in Bowling Green but to see him faster, as in this coming Tuesday, we are going to his Hermitage office. The hope is that if he'll take her, we can see him in Bowling Green. At any rate, a second opinion is what I really need for peace of mind. All I have to do is fill out the new patient forms they directed me to on the web. Cross your fingers!

Jan has called the NP twice. Once on Tuesday and again today. They just won't call us back. They have abandoned us! We were reading her medical records of the ER visit and discovered she also has a T2 and T3 endplate fracture. Why didn't anyone tell us this? Is this not the most ridiculous thing you've ever heard?

The scoop on the new pain med is mixed. She took it at 10:00 PM and woke up at 4:30 AM. It may take some adjusting. She is going to try 10:00 PM again tonight and see if it results in a pattern.

Getting four antibiotics down in the day is tougher than we imagined. She hates to take them on an empty stomach so she is still going to have to take one at bedtime, empty stomach or not.

I don't know if I mentioned it before but her front (anterior in medical BS) pins have always looked like the skin on her forehead had a bit of a bunch above the pin and the skin was pulled tight below the pin. It has now self corrected by effectively ripping her forehead to relieve the bunch/tight skin. The NP accused her of holding her eyebrows up when they put the pins in and I know she did not. Dr Second-Year-Resident inflated her forehead with about 10cc of xylocaine in each pin site that swelled the skin. Once the swelling went down from the local, the skin was pulled and bunched.

I have a request from the patient. Would people please stop saying the time will pass quickly. She's desperately tired of hearing that and it does not help her spirits. It only reminds her that she isn't even to the half way point. More than once she has wished they'd put her in a coma and wake her when she's healed.

I'm a realist and not much for blatant, unrealistic optimism. My statements about the situation are deemed to be negative at times. For instance, some loony doctor in the ER told her after the halo went on that she might only have to wear it for six weeks. He must have been using the extra morphine they said they gave her because NOBODY gets out of a halo in six weeks and I told her so. Unrealistic expectations are the root of depression and I'm afraid of that now.

Yes, we are thankful she is alive, that I'm alive. We are overjoyed that she is not paralyzed and ecstatic because she should make a full recovery but that is no reason for her to have been treated the way she has. She shouldn't have to pay for living by being made miserable at the hands of uncaring doctors. It certainly doesn't instill trust in the providers.

We are seeing someone on Monday to help us work out the grief and pent up feelings left by this traumatic experience and I'm not talking just about the accident. I know I have so much anger toward the medical profession that it affects my objectivity but my gut says keep fighting because I can't depend on the professionals.

My sister and aunt, both nurses, said that the NP telling me, "Why don't you treat your wife if you can do it better!" was completely unprofessional. Trust me, I am documenting these things for future reference!

Day 24 - Infection

One of Jan's halo pin sites is infected. Today when I cleaned it I got a lot of debris on the swab. We put in a call to the Bilkmore Neuro Clinic yesterday and they never returned the call.

Today it looks like the pin has fully pierced the flesh, leaving a small void around it and it is red around the perimeter. I finally called back and asked to speak to someone immediately. I have got to find someone else to look after this. I now detest Bilkmore and think they are either overworked or just incompetent. I'm so frustrated with the whole affair I can't see straight!

It wasn't like this Monday. They tightened her pins, which twisted them and dug them deeper into her skull. Click on the image to see a high resolution image of the hole in her head. They did call in a keflex antibiotic. I pray this resolves it quickly.

Day 23, Part 2 - Planned Excursion

Jan wants to go somewhere tomorrow and I'm all about accommodating her wish to get out of the house. It takes about an hour to wash her hair, get cleaned up and a new t-shirt wriggled under the vest. The portion I trimmed away in the front and back of her neck opening was agreed to by the NP for anyone that thinks I'm being reckless. I assure you I am not doing anything to harm her or endanger her recovery. Most of the time I feel like I'm the only one that is trying to make it as fast and painless as possible. The medical people certainly have little regard for the mental state of anyone wearing one of these things. Heal the spine, damn the person!

One thing I forgot to mention yesterday. The NP and the halo expert both said the long protruding bar in the back may account for some of her discomfort when laying on her back. I doubted it because it is resting against a quarter inch of hard plastic which is then padded with massive amounts of lamb's wool. They nonchalantly loosened all the attaching points for the offending bar and proceeded to push it up. When I saw six inches more of it going up above her head, I vetoed that! She can barely get into a Honda Pilot, a very tall vehicle, with the existing height. If it stuck up six more inches she'd be bumping it and hanging it on everything in sight. You can't make a 5'6" woman suddenly have to deal with a 6' stature! I asked if I could chop it off with a cutoff saw and they didn't seem to like that idea. I'm telling you, this is a mechanical problem and these people must have never seen an erector set as children.

At any rate, her medication is doing wonders. She takes it at 8:30 PM and it knocked her out at just before 10:00 PM last night. She wakes up at 5 AM and takes a valium and rests a bit more before getting up. Once she's up and has had breakfast, she lays back down for a few hours for a nap. She is going to try taking it at around 10:00 PM tonight to see if she can sleep until 6:30 AM and then stay up.

She's sleeping so much better that she finally bugged me enough about the tingling and numbness I have between my shoulder blades when driving to go see her chiropractor. I did mention this to the GP when we had our shared visit on 12/23/2008 that it had started after the accident. I said it gets numb and tingles like it is asleep between my shoulder blades when I drive or have to have my unsupported arms in front of me. He said take advil or motrin without even touching me or seeing exactly where I was indicating. Jan says I don't complain enough. I was unaware that was a trait I needed to develop.

The chiropractor x-rayed me and did some e-stim, which is also called a TENS unit, on the first day. They put four pads on my back and the tingle of the e-stim feels just like the tingle without the numbness. Strangest sensation, indeed.

I got the results of the x-rays yesterday. My neck has lost the curve from C1 to about C4 when viewed from the side. My neck has a very slight "S" when viewed from the front. It would appear Jan's spine is in better alignment than mine! The chiropractor said it was definitely from the accident. This is just a cell phone camera shot so the detail isn't good but it is pretty obvious from all the spine pictures I've seen lately.

I also told the GP at the same visit that I wasn't sleeping much and he suggested benadryl. That was a flop! The dramamine didn't seem to have much impact either. I stopped short of combining Wild Turkey and benadryl.

Jan then called in and got me a prescription of Ambien. I took the first one last night about 11:30 PM. I wasn't really tired but I needed to get some sleep. I immediately went to bed upon taking it as it is supposed to take effect in 15 minutes. I closed my eyes and the next time I opened them I looked at the clock. It was now 12:00 midnight. I closed them again and tried to fall asleep. When I opened my eyes again it was 12:30 AM. One more time I tried to drift off and again I saw 1:00 AM on the clock. This is actually worse since I was getting midnight to 3:00 AM and then an hour between jolting awake episodes. Luckily, I was out from 1:00 AM to 6:00 AM.

Is that an improvement? Five contiguous hours is better than three but I wouldn't call it a night's rest. Have you ever had those dreams where you are falling and are jolted awake with every muscle in your body tensed as if to brace for impact? That's what happens to me constantly through out the night. My heart is racing, I have a bad feeling and I braced for impact. I do not remember the dream as much now but I suspect it is still something accident related.

Day 23 - New Medication, New Modification

The timed release pain medication let her sleep from 10:00 PM last night until 5:00 AM this morning. She took a muscle relaxer for her neck cramps then and rested a bit more. She's up and around, feeling better.

She says I'm too negative about some of the stuff yesterday and that she is OK with the results so I should chill out. I am going to trim a bunch of the lamb's wool off of the parts of the vest liner that her body absolutely cannot contact, such as the back of the neck and the V in the front. This will let her have a little more sense of freedom from the scratchy wool. Due to the way this thing works, if she could touch those areas, it would NOT be working.

It is obvious that if this halo-vest is the pinnacle of medical technology for spine immobilization, the pinnacle isn't very high. It is also quite apparent that the people designing these things have never even attempted to put one on. It looks OK but the lining and design do not match up to the stated goal of the device once applied to a human form. For $6,300 you'd think they could at least make it a more custom fit. Perhaps Apple should get into medical devices. The margins are certainly excellent. BTW, the same halo-vest in other parts of the world is only $1,200 so that's a 500% mark up!

I've trimmed off some of the lamb's wool in the front. She says it feels a little less hot and smothering. That's a good sign! I'm going to work on the back at her next bath.

Here's a picture of the piece I cut out, only about a half inch wide but it made a big difference. I will get a new picture of her when she's ready that shows how the modification looks.

Here's the t-shirt mod in case any other halo wearers or halo support persons need a visual of the process. First is the normal shirt and second is the modified item with the slit back.

Day 22, Part 2 - The Rest of the Story

It has been a long day and I know I've taken a while to get this up. My apologies! For those of you that noticed a lull in Jan's email replies from yesterday, there was a computer death in the family. Her computer kept shutting down for no reason with increasing frequency. A faster and much quieter computer replaced it this morning.

And now, the rest of the story. I'd like to state, this is my view of events. Jan sometimes disagrees with my exact phrasing but not enough to make her own blog.

After moderately medicating Jan we set off for Bilkmore around 1:00 PM for our 2:30 PM appointment. It takes just over an hour, depending on the city traffic once you hit Nashville. Today wasn't bad and we found the Neurosurgery Clinic with little trouble. The handicapped mirror placard is a real time saver since Jan's gate is a bit slower than before the accident (BA).

The first thing we did was to register and then take the shuttle over to the main hospital to get some x-rays. I also dropped by and picked up her records and images to date. The main x-ray lab was quite busy so we were sent "just down the hall" to the other radiology lab. Poor Jan was worn out after the half mile round trip walk. I watched as the x-rays popped up on the console and could see what I felt was the problem. Her back vest plate is shifted to one side. The x-ray tech was non-committal, "I just shoot them."

We then returned to the Neurosurgery Clinic around 3:15-ish. We had about a 30 minute or so wait for the NP to show up. When she arrived she started to explain things but stopped and went after the spine model. I pointed to the spine and said, "Jan's fracture is here." She looked and me a bit funny and agreed, "Yes."

She went on and explained how the nerves radiate out from the vertebrae and what is controlled by each level. She touched one and started counting and I impulsively said, "C4" to which she finished counting and asked if I'd studied the spine. To which I replied, "I've had three weeks of nothing from the medical experts treating my wife so I did my own research." She kind of raised her eyebrows and went on.

We started addressing our concerns: Jan's lack of sleep, increasing pain and the poor fit of the vest being the main ones. The NP agreed to let Jan try a timed release pain medication to see if that will allow her to get a full, uninterrupted night's rest. She said the pain is just something to manage. I'm not thrilled with that but if we can get Jan some rest, whatever it takes.

The poor fit of the vest was a bit contentious. I was adamant that it could be made more comfortable or it was the wrong size based on my reading of the manufacturer's web site. The NP did loosen the waist straps another notch, which puts them at three. That tells me she is at the outer edge of a medium if it only has three notches to go. She finally had them page someone from the halo-vest provider to come in and check out the situation. She believes he is the "expert" in halos. He arrived about 30 minutes later and said that if anything Jan's was too loose!

I again produced the manufacturer's web page of the sizes and pointed to Jan's measurements and the vest sizes. It was at this point the NP wasn't as thrilled with my self education as previously indicated. At one point she told me I should treat my wife myself if I knew more than she did. Let's just say I got under her skin and we now have an understanding. The NP now knows I'm not a push over and I am not stupid.

Once everyone cooled off (and I didn't go to jail) she said we were doing an excellent job of keeping the pin sites clean. Metal is piercing skin and that is always problematic. She and the "halo expert" asked about the t-shirt Jan was wearing. I explained how we slit them down the back and she steps into them like a dress. The slit is hidden by the back of the vest. They thought that was pretty ingenious.

All things said and done, more was said than done. She did spend about an hour and a half with us and showed us many x-rays. She tightened the four pins in Jan's skull and loosened the waist straps by one notch. If you read the documentation for this halo stuff, you'd think it was possible to kill the patient by simply touching the upright bars or changing the straps. Let me tell you, the NP held onto the bars for leverage while she cranked down the pins in Jan's skull. Yet another case of medical Do-as-I-say-not-as-I-do. The NP even said that if she, herself, were injured, she'd want surgery over the halo! Why weren't we given that choice? Her excuse, Dr Second-Year-Resident thought it best without consulting us first.

The good news is we go back in two weeks (never thought I say that!) and she is going to order a CT scan to confirm what a single plane x-ray cannot, alignment and actual bone placement. I still do not like the rotated head but the NP says that it will 100% not result in any permanent damage. She better be right.

On the plus side, if all the calcium, vitamin D and protein we've been pumping into Jan has done any good, at six weeks the CT scan might show something. If we can short cut the 12 weeks by even one week safely, it would be worth it. The NP did say she'll need a collar for six weeks and then physical therapy after that. Her proposed release date is now set at May 6, 2009!

At this very moment, Jan is resting after having taken the timed release pain pill at 8:30 PM and turning off the TV at 10:00 PM. I've got my fingers crossed. I, myself, am going to try a dramamine tonight to see if I can sleep beyond three hours. So far a shot of Wild Turkey just made me sweat, wine had almost no effect and benadryl just made my mouth dry out.

Day 22 - The First Check Up

It was three weeks ago today that Jan was placed in a halo-vest for treatment of her type III odontiod C2. The pain has been increasing and her pain medication has increased to double her original tolerance. The first week she was taking three pain pills but lately she has been taking five or six a day.

We've got a list of questions for the clinic visit and something has to be done. My aunt, who is a nurse and ran a home health care business in North Carolina says that if they can't do something to help her, we should contact the Mayo Clinic in Florida. She believes they can work miracles!

This is pre-visit and everything following this will be post-visit.

Day 21 - Lunch Out With Family

My father typically has a lunch at a nice restaurant for the family as our Christmas present. I'd much rather us all get together than worry about presents. It brings back more of the reason for Christmas. It is about family and isn't about blatant consumerism.

We usually do this gathering in Bowling Green as there are plenty of good places to eat. We've picked Longhorn for today's outing. My dad, to his credit, said he wouldn't have it unless Jan went along! She is still very apprehensive about going out in public but she can't stay home for nine more weeks. She has to get out and move around. Otherwise, she'd be no better off than being in a hospital bed in traction like they used to do in the barbaric days of old.

She was feeling a little sorry for herself this morning. She even threatened to not go to lunch. I'm trying to impress upon her that she has to complain to the doctors and nurses tomorrow or they are just going to let her suffer for nine more weeks. They obviously won't listen to me. I can't help her if she won't help herself at least when we go to the checkup.

Lunch really wore on her today and she is resting now with half of a valium and a pain pill. Her left shoulder and arm are really sore for some reason.

While we were at lunch, my dad and his sister recommended we check into the Mayo Clinic in Florida. She says they can fix other doctor's mistakes. Something has to be done and I'm investigating every possibility. If tomorrow goes badly, that's the next step.

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?