Day 111 - Pins Sites At One Month

It is now one month since the halo was removed. The pin sites are "healed" skin wise but the depressions in the flesh or bone are quite prominent. Here is the picture I took this morning. As you can see, the sites are clearly visible.

Jan has been taking her collar off for anywhere from several minutes to an hour at a time. She is not comfortable doing it but it does not hurt her any more than wearing the collar. She is showering without it as well.

She did not take much Tylenol yesterday but did use some heat packs. She also did not take a valium tablet at bedtime and she slept well.

If all goes according to plan, she will return to work on April 13th. She may only do a half-day or just a few days a week but she wants to try going back. Since she still can't drive we have rides to and from work set up for her. The fallback is me being the catch-all in case she tires quickly or misses her ride to work. Her fellow staffers where she works have already said they will run interference for her, keeping the curious away when she feels tired. I have no doubt they will take good care of her. Her boss did not expect her back this month but she is resilient.

We have plans for her to see some of her family over Easter at the old family church. Some of them have not seen her since Thanksgiving, four and a half months ago.

Day 108 - Physical Therapy? Soon!

Jan had her second visit with the doctor today and, as usual, a simple thing is over six hours. That's the worst of it. The good news is she can take the collar off any time she wants. The doctor said she needs to wean off of it, probably within two to four weeks. At that time, she can start physical therapy. Her next appointment is not until July 1 when he, hopefully, will declare her cured and free do as she pleases.

For those that wish more details, they follow. We left at 12:30PM, arrived at the hospital by 1:45PM for a 2:30PM appointment. At all of the old appointments with the neurosurgery clinic, she had to go to the imaging lab at the main hospital by shuttle and then always to the OTHER IMAGINING LAB because they were backed up and then back to the neurosurgery clinic. Minimum of one hour both times plus all the hassle of getting a halo patient into and out of a van twice.

This time, we stopped at the imaging lab at the children's hospital ground floor, since we are trained to do that by the old clinic. She registered at the imaging lab at 1:50PM. The orders were not in the system so the check-in person called up to the doctor's office and they faxed them down. We waited 20 minutes and they said they were faxing them down but they never arrived. The guy finally went up to the ninth floor and got them. It was now 2:15PM.

The guy returned with the orders for imaging in his hands and put Jan in the queue. That took another 20 minutes and she was now officially late for her appointment. When she got back to the x-ray room, it didn't say if the collar needed to be on or off. They called the office but didn't get the doctor. They paged him and it took another 10 minutes. He called back and said to take it off. Jan didn't feel comfortable standing unassisted without it so the tech put me in a lead apron and I held her hands. She had to hold her head normally then bend her head forward and backward for x-rays of each view. She got through it fine if a little shaky.

We arrived on the ninth floor a good 45 minutes late for the appointment but still sat another 30 minutes in the waiting area. Once in an exam room, we spoke with the physician's assistant, the one that actually told me that the nurse practitioner canceled the appointment and she had scheduled Jan back with the neurosurgeon. Boy, was she honest and enlightening!

I won't spill all the details but suffice to say the NP rejected Jan's appointment and the PA promptly took ownership of the case and things have been so much better. She listened to the horror stories about the halo installation, the poor fit and the lack of support from the neurosurgery clinic. She said she took over Jan's case now and it would certainly be a better experience. So far, she has been dead on. The PA also told us she would brief the doctor on the issues before meeting with Jan and me and that we should tell him as well since he is an assistant professor at the hospital.

When the doctor arrived, we were fairly sure he was briefed but he played it very professionally, saying he would follow up on our issues and that she was past that portion. He said it would only get better from now on. She can't drive yet until the collar comes off and she can look to her sides and her weight limit is just 10 pounds but she is basically free of the collar when she has the confidence to take it off.

The tingling in her leg is a pinched nerve, caused by the vest. The doctor said it was much like a bruise. With luck, it will resolve within a few weeks or months. The pin holes are healed but still noticeably deep. He does not believe they will change much other than the pinkness of the skin turning whiter. I think she should at least consult someone about reconstruction to at least lessen them. After all, her forehead was fine after the accident and they are the ones that scarred her, physically and mentally.

After reviewing her x-rays with us, he said it looked very good. He said she would not need surgery, would not be paralyzed and there was no danger of her damaging the bones in her neck. According to him, it is healed well enough. The bones will remodel for some time but the strength is good enough to have no reservations.

He said she could take the collar off any time she wanted and encouraged me to help her wean off of it. Jan has the prescription for physical therapy now and can start in as little as two weeks but should be completely out of the collar in four weeks. PT could last as much as six weeks, depending on progress.

We left the office right about 6:00 PM and arrived back home just after 7:00 PM. A long day but overall, it was a good visit. Jan broke down a bit while detailing the trials she, and I by proxy had been subjected to through the previous months. If only she could have seen him from the beginning, things would have been so much better, possibly even tolerable.

Posts from here on will probably be fewer unless there is a funny redneck story to tell. I will continue to update on significant items as they occur but I think the worst is definitely behind us.

Day 105 - Audio Sound Bite

At 15 weeks since the accident, 24 days since the halo came off and just three days until the return visit to the doctor, I finally figured it out. I recorded the visit where the doctor removed the halo. I've converted the audio on the cell phone to something I can upload.

Here is a slide show along with a snippet of the doctor's comments before halo removal, answering the question we didn't ask. Jan believes after I filed the complaint and caused a big stink, the doctor felt he needed to add an unsolicited verdict on the halo setup. This was the thing he said that annoyed me but I kept quiet because the halo was still on her at this point.

Day 104 - Jan Went Up The Hill

The scholarship interviews on campus were a test of Jan's stamina. She spent all day without a nap. It did get to her a bit and after lunch she had me put a heating pad on her neck. We finally arrived back home around 6:30PM and she was pretty tired.

We won't find out anything about the results until Tessa gets a letter next week. We have our fingers crossed! Even if she doesn't get the Presidential Scholarship, she has the Award of Excellence Scholarship and is in the Honors College. Between the scholarship and the KEES money, she should be pretty much set.

After all the running around yesterday, we only walked two miles but it was a day without a rest break that she is used to. She slept pretty well last night and now we only have to see the doctor on Wednesday to see what happens next! Hopefully, physical therapy will be prescribed.

Fingers crossed and hoping for the best!

Day 102 - Retribution!

Some times I think too much and other times not enough. Things bounce around in the back of my mind until they make sense. Or maybe they make me crazy. Either way, I wind up acting upon them.

On this occasion, I called Bilkmore and confronted them about the December 16th bill, the one where Jan wound up back at the ER because of them providing no halo instructions. If they had given her or me any useful information and expectations, she would not have wound up back at the ER in less than 24 hours! The short version is they wiped out the entire bill for that day! Minor victory for our team! Money isn't the issue. It is about what was not right.

Tomorrow is an all-day event on Campus for Tessa. Jan is a little anxious about spending the whole day without the comfort of a chair to recline in if she gets exhausted. It will certainly be a test of her endurance. I can take her home at any time and Tessa can handle it all by herself if need be but it is a family event and Jan wants to attend.

I'm going to make sure she gets a good night's rest and keep my fingers crossed.

Day 100 - How To Wash Your Hair In A Cervical Collar

Triple-digit days since the accident. Only seven days, as I type this, until she returns to the doctor. Jan is looking forward to it, but with some apprehension. Any change is stressful when you don't know what happens next. She has been walking three miles each day the last few days so that is building up. Physical therapy will be hard but it will get her back to normal.

The lady at Hello Halo blog was having trouble washing her hair. Since Jan washes her's in the shower every day, she and I came up with this arrangement where we remove the back of the collar and put a wide velcro strap across the back to hold her head in the collar. That way her hair isn't covered by the collar back that goes from above her ears to below her shoulders. In this picture, she has her hair pinned up to show the back of the collar as it wraps around and the black strap that gives her some support.

Today was the first time in more than 100 days that she took ibuprofen for pain. NSAID drugs (aspirin, ibuprofen, naproxen) are not good for broken bones in the early stages of healing. They are anti-inflammatory and the healing process requires the inflammation response to cause the bones to properly grow back together. She is not in a lot of pain but it is that annoying ache and pinch that just won't go away yet.

I was speaking with someone about our accident. After showing him the pictures of the Miata, he remarked that a taller vehicle, such as Jan's Honda Pilot, probably would have rolled sooner and more than once. Even so, a Miata normally has no roof protection but our Miata had a hardtop and the roll bar. The odds are, the Miata survived the rollover better than the Honda Pilot would have. A Pilot, while full-bodied, does not have a roll bar reinforced top. Just sheet metal.

I used to operate a tow truck for my father. I recovered a few rolled cars in my time. If you google some rollover pictures, you will see that cars and trucks without roll bars are not any safer than a Miata with a roll bar.

In the end, accidents happen and nobody can predict how it will end. Some times, surviving is all you can hope for.

Day 98 - Is This The New Normal?

At 14 weeks after the accident, it almost feels like this is the new normal. This is a normal Jan does not want, nor do I. She feels like her progress is so slow and she just wants to be back like she was before the accident. I know she can do this but she needs more encouragement. She thinks her progress is slow but it took seconds to break her neck, 80 days to get atrophied muscles and it can't all be undone overnight.

With only nine days until her next appointment, I am trying to keep her motivated. Some of the time, I wish she'd do a blog on her own. She is still working on her on-line class and contemplating how she can get to work with minimal effort. She wants to return to work but just doesn't have the stamina for a full day.

Today, she walked about two miles, part of it at the grocery where we got more yogurt! Even if she isn't a fan, it is helpful with healing the bones.

Day 96 - Lame Update

It has been 96 days since Jan and I had the accident but only 16 days since the halo was removed. I've been back to work for two weeks and she has 12 days until the next appointment.

Not much has changed since the last update. She continues to walk as much as possible but without the ability to go anywhere on her own, she feels a bit isolated and trapped at home. We IM during the day and I go home every day for lunch. She doesn't get out as much as she did with the halo. I try to get her out but she just doesn't feel like it some of the time.

However, yesterday, we all got out. Jan, Tessa and I went shopping. I did not take the handicap placard either so she walked a little more. Afterward, we picked up some dinner.

Two other halo wearers have come to my attention. One is like Jan, already out of the halo while the other is only a few weeks into her time. Jan has been emailing the new user with any helpful tips she has. Our thoughts and prayers go out to her.

Day 94 - Nothing Much To Report

Two weeks in the collar, two weeks to go before the next doctor visit. She's walking as much as she can. We did a mile the other night when she walked to her very pregnant friend's house. Triplets!

Her neck is a little stiff in the morning but nowhere near as bad as the halo! Other than that, she didn't take any valium or Tylenol today but she hasn't been sleeping as well. Tonight she wants to take a whole valium to see if that helps her sleep better. I say it can't hurt.

Now that I'm back at work we keep in touch by IM. She can do almost anything she wants except drive. Showering still causes her a little anxiety but I'm there if she needs me. I help her change the collar, dry her hair and clean the pin holes.

All of the holes are pretty much healed except the one. It looks like it is only held in by her hair but is hard as a rock. It will come out when it is ready.

Day 92 - Nurse's Choice For Halo Removal

Welcome to day 92, the official date the nurse practitioner would have picked for halo removal. Thank goodness I'm a stubborn so and so that argued with the powers that be for a revised schedule. We are almost half way into her collar phase. Next stop, physical therapy.

Jan has been walking over a mile most days. Several days have been 1.5 miles so that is an improvement. She continues to feel insecure without the collar but she tests her limits of mobility with it on. She doesn't have the full range of motion but she is a little leary of trying too much. I have not encouraged her to test too far.

The back of the collar is board-straight with no anatomical curve like a human neck. To help, we took a trick from the halo days by putting a rolled-up washcloth between her neck and the collar to give her some support while laying on the pillow.

We did get a quick response from the neurosurgeon's office. They have responded in less than 12 hours, less than that when you consider I emailed them at 10:00PM and I had a reply by 9:30AM the next day! Thankfully, the x-rays she needs will be in the same building so no shuttles and no delays getting back to the office. The doctor may still be running late but what can you do about that?

Our curiosity has gotten the best of us and we are speculating on why the doctor told us we'd be seeing the nurse and then the nurse canceled our appointment and pushed us back to the doctor. Jan thinks it is because we complained. I think it is because they are afraid she is going to press it further. Either way, I'm only disappointed it didn't happen from the very beginning.

Jan still hasn't gone back to work. She feels guilty about it but a full day would definitely be too much for her right now. She's thinking of trying a few partial days. Tessa could take her to work on her way to school. I could pick her up when she was tired, be it lunch or any time before or after. Now that the pin sites have mostly healed over, it isn't as critical to keep them from becoming infected with three times daily cleanings.

For those that care, the big red car is back on the ground and drivable. I just hope it quits marking territory after the repairs.

Day 90 - Survey Says...

Three months. 90 days. It seems like an eternity ago that everything turned upside down, literally. It has been a long journey back for Jan and she still isn't 100% yet but progress is slow when you speak in terms of bones.

Yesterday Jan walked something over a mile and a half. Pretty good. I took her to the mall to get a jacket and a few other things Tessa had put on hold at Old Navy. I took her in my truck, which did not have the handicapped tag in it. This meant we had to park in a normal spot and she had to walk a little farther. She did fine. Jan thinks that when it expires at the end of the month I should renew it. I'm hoping she does not need it renewed after March 30th!

After we arrived home, there was a call from an odd number we didn't recognize. It was a survey about Bilkmore. Too bad it was only about the neurosurgeon that took the halo off. I dearly wish it had been about any other single visit besides that one! Would she ever have let them have it! Does anyone else think they are cherry-picking the visits they survey?

The pin sites are healing nicely. All but one is now a pink depression. The fourth hole, behind her left ear, is still a bit scabby but is also healing. They are still a bit tender but not overly painful. I continue to massage them as they heal to prevent the skin from adhering to the bone.

Another halo patient contacted us through the blog. She was in an accident and started her own blog. She was looking for advice and a friendly chat about what to expect. Jan has corresponded with her a few times. I'm sure the poor woman is overwhelmed, just as Jan and I were.

We cleaned out the closet of all the slit t-shirts. They are now in the garage and will be recycled as shop rags. Of course, if you know a halo patient that needs them, I'll gladly forward them on.

Day 88 - Appointment Rescheduled

The doctor's office called on Wednesday and we now have an appointment for Jan on April 1, 2009, at the children's hospital again. I've emailed them to find out about getting x-rays since we took the CT scan on CD that we had done in Bowling Green.

The cold weather has put a damper on her walking outside so we went to Sam's last night to get some things and let her walk around indoors.

She continues to exercise her neck in small increments when we change the collar in the mornings.

Her church brought over two kinds of chili last night. It was very good. There was also a pumpkin creme pie, too!

Standing for any period of time still tires her out pretty quickly. Moving isn't as bad. Pain pills are less frequent and valium is about the same. Tylenol is her current pain pill of choice.

Day 86 - Appointment Cancellation? NO!

Yesterday was the first day I returned to work. Jan spent most of the morning working on homework while I went to the office. We IM'd and I picked up lunch at Zaxby's. She's walking just over a mile each day.

She is showering daily even though it is strange for her after three months without one. Her pin sites are cleaned three times a day and are healing well but the depressions are still quite deep and pink.

My work changed the FMLA date on my form to yesterday and informed me YESTERDAY! To get me through the expected recovery period, I faxed another form to the neurosurgery clinic to get it filled out since she still can't drive or turn her head.

I emailed the clinic to follow up on the fax since they have been horrible about getting anything completed. You can measure their response time with a calendar. Within an hour of the email, I received a call to cancel Jan's April 2nd appointment! No reason, only that the doctor's office would call to set up an appointment instead. I can't say I'm sorry we won't be seeing her again. After all, she'd still have had Jan in the halo for nearly another week.

Next, I faxed the form to be filled out to the doctor's office since the nurse canceled her. I faxed it in around lunch and I got it back by 3:30 PM! Amazing! Unfortunately, we did not get the replacement appointment call. I'll call at noon tomorrow if they haven't made a new appointment by then.

For show and tell we have the halo and vest assembled off the patient. It can be assembled symmetrically but it never was.

The back and front of the vest should have been positioned at the same level on the body. Instead, the back was at least a few inches above the front and it rubbed the area at the back base of Jan's rib cage nearly raw. I suspect she was only a few days away from a pressure sore.

Day 84 - 12 Weeks Since the Accident

How would you like to have this framing your view for three months? Never changing, never shifting, literally a portable prison with no escape. You can't see your body from the waist up except in a mirror or the ground in front of you as you walk. No looking over your shoulder at all! This is the view from a halo wearer's perspective.

Not much new to report. Pain is much lower and Jan's sleeping in the bed now. She's walking at least half a mile a day and building up to more. I suggested she use the treadmill since it is right next to my office but I think she's afraid of the stairs.

I came up with another idea to allow her to wash her hair easier. The back of the collar is quite large and comes up over halfway between the ears and the top of the scalp, making it nearly impossible to wash the back of her head and neck. I took a long velcro strip and fastened it to just the front on both sides so that her neck is exposed in the back and all of her hair can be washed. This keeps her neck and chin supported since she mostly leans forward while washing her hair and the time without the back is about the same as when we change it and dry her hair.

She thinks she still looks a little right when she is sitting in a neutral position, caused by having her head pointed right for 80 days. Time will tell. I'm sure Nurse Ratched (One Flew Over the Cuckoo's Nest reference) will have an excuse and equally useless explanation of why it doesn't matter and it had to be that way.

If we had let the NP decided when to get the CT scan instead of pushing for what Jan wanted, she'd still have another eight days in the halo instead of three days in the collar already!

After much thought and careful consideration, I've decided to contest the emergency room charges for the 16th of December. It is too bad the insurance company already paid their part because had the doctor, nurse, hospital or anyone that came in contact with us noticed Jan's higher respiration rate and lower blood oxygen levels due to the vest being too tight, it would have been completely avoided. To drive an hour, spend three hours in the hospital and be charged $2,300 to have the vest waist belt loosened by four notches when it was improperly fitted in the first place, is beyond my ability to swallow.

You can tell, I can't let it go. I get that but they won't learn unless someone makes them listen. Maybe it is me that makes them take notice. I seriously doubt it will have any effect but I'm too hard-headed to give up and they did not perform the required tasks nor give us the most rudimentary of halo-vest instructions.

Day 82 - Halo Minus 48 Hours

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

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

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

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

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

Day 81 - The First 24 Hours With A Collar

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

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

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

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

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

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

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

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

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

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

Day 80 - How To Remove A Halo!

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

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

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

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

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

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

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

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

Yes, day 80 ended without a halo!

Day 79 - CT Results

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

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

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

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

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

There is no significant callus formation.

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

Here's the latest little movie.



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

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


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

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

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

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

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

Day 78 - The Scan Is Tomorrow!

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

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

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

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

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



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

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

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

Prayers and good thoughts much appreciated!

Day 77 - Reflections And Regrets

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

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

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

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

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

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

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

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

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

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

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

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

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