"A Basic Day"

When I asked Heather what I should write today, she said that she "just had a basic day." I like those. In fact I vote for nothing but those from now on. She worked hard in physical therapy, standing several times and continuing to do exercises in bed. Other than that I have nothing new to report.

Nearly Independent Standing and an Allergic Reaction

Today when physical therapy came in to help Heather try to stand, Heather stood up very quickly and almost without any help. It was really great to see. She took a few steps, sat back down, and then stood again. It was harder the second time, but she did significantly better than she has in past. It was great to see. Her dressing changes have been much, much better the past couple of days, and her wounds look better every day. I saw her abdominal wound for the first time in about a week, and it is looking much better. It is really pulling together, and the nurses rave about how healthy the tissue looks.

We had a bit of a scare this evening. You know, we can't have things go smoothly for too long. Her hematocrit was a little low, so they decided to give her some IV iron called Venofer. Approximately an hour after they started the drip Heather had a major reaction to it. She first felt what she calls "extreme chills" that came on within seconds. She began shaking from head to food and her teeth began chattering. Her jaw began tightening up, and then all the muscles in her body began tightening up. It became difficult for her breathe, as it felt like her throat and lungs were tightening up. The nurses were quite concerned (as was Heather). Her nurse initially gave her Benadryl. This didn't seem to have much effect, so she then gave her hydrocortisone. Within about five minutes, Heather felt markedly better, and within ten minutes even better. She now seems back to normal. Of course the nurse said this is a very rare reaction. I could have told you that because Heather had it. Apparently if there is a low probability, negative occurrence out there, Heather will have it.

Thanksgiving

Heather wanted to share the following with you all:

Stronger Than Ever

Heather is doing really well. I can't believe how much strength she has gained even in the last few days. She really seems like her old self. I got to the hospital an hour or so, and it is just so good to see her doing so well. Shortly after I got here the physical therapists came in. They helped Heather stand three times and take a few small steps with a walker. I love seeing her feel better and able to do more. She acts like a woman with a mission...to get out of here.

Her wound dressing changes have gone quite well. Yesterday, she was feeling more pain in her abdomen without the wound vac on, so they put it back on. Heather says it feels much better. Having the wound vac on will also make physical therapy better because Heather won't be worried about the wound popping open. Hooray for progress!!!!

A Day Without Major Incident

Heather had a reasonably good day. She said that her daily dressing changes on her back and legs went well and that she felt the least amount of pain yet. She has been working with the physical therapists to build up her leg strength and maintain and build her upper body strength. I think the next big goal is to get her walking. Doing so would help many of her difficulties.

Dressing Change Okay Last Night

I stopped in to see Heather on my way to work this morning. She seems to have a bit of a fever, but was sleeping soundly. She said that the dressing change wasn't as bad as she thought it would be. She said the dressing at the top of her back fell off by itself, which suggests that it is really healing up. She said the bottom of her back was still painful, but bearable.

Blunders Cause Pain

Today the nurses changed the wound vac dressing in Heather's abdominal wound. You may recall that this is a foam that they cut to the size of the wound, cover it with tape, and attach a small vacuum hose to it for the purpose of sucking out discharge and improving healing. The problem was that they were supposed to change it on Saturday or at least yesterday because it is only supposed to be in for two days. However, there was some miscommunication, and it didn't happen until today. The problem with waiting too long, we found out today, is that the tissue begins growing into the foam which makes it very painful to remove.

I was at work today, so I missed all that excitement. Apparently it was incredibly painful, and they had to give her a lot of fast-acting, IV narcotics. On a positive note, the nurses said that the wound looks fantastic and is healing extremely well. They decided that because it looks so good it doesn't need the wound vac any more. They felt that it was wrong for the UofU to use the kind of wound vac foam (silver impregnated) they used on the last wound vac dressing. We didn't understand it either, as they had always used a black (instead of gray/silver) foam in the past. The nurses here said that the gray foam is more likely to cause the tissue to grow into it. They put a different dressing of some sort on it that no longer requires the vac.

Because they had to use so much of the IV narcotics to get the abdominal wound dressing out, they could not give Heather any more for her legs and back dressings. They had to wait 6 hours to give more IV narcotics, so they put the legs and back dressing changes off until tonight. When I just talked to Heather (8:30pm) they had not yet done it. The problem with that is that the most well-trained wound care nurses are there during the day and they had put the abdominal wound dressing change off so long (They had told Heather they would do the dressing change in the morning, but didn't get to it until afternoon.) that they were off shift by the time the 6 hours were over. That leaves the job to a less well-trained nurse for tonight. The long wait also increases the chances that the dressings on Heather's back will stick to her and be more painful coming off. I am not impressed. It is bad enough that Heather has to go through so much pain, but when it is largely avoidable it is maddening!

In other news, Heather used the toilet for the first time in over a month and a half today. She had to be wheeled on a chair to do it, but it is big progress just to feel well enough to sit up. She seems to be doing better each day, but I think she will be doing remarkably better when they stop torturing her.

NG Tube Out, and Much Rejoicing

Heather reached another milestone of progress today. She was able to get her nasal-gastric or NG tube (the tube going in her nose, through her stomach, and into her small intestine that was used to give her nourishment and medications) out today. It was really starting to bother her, and she has been eating enough solid foods not to need it anymore. She is thrilled! She can breathe easier, there is no irritation at the back of her throat, and she no longer bumps into a tube any time she tries to bring anything to her mouth. It is wonderful to see her face (and kiss her lips) without anything in the way. Here's a picture:

Dressing Changes in a New Place

Heather had a good night in her new home away from home. She woke up with some nausea and significant fears about her first dressing change here. She was particularly concerned about what they would do with the dressings on her back. When they looked at her back dressings yesterday it was clear that they were far too soggy to leave on. This was frightening because it meant that they would have to peal off the dressing that seemed to be quite stuck to her. After much preparation and waiting, our nurse did a great job of taking the old dressing off. It was still quite painful and not fun at all, but we feel the new dressing the nurse put on will work better for Heather and will help her heal faster than what she had on. She is clearly healing because her back is not as tender, though it still hurts her quite a bit.

Heather says that she is feeling a little sore tonight and that her mood seems to swing quite a bit. Her brother, John, flew in from South Carolina today to help take care of her through the first part of next week while I am at work. We're glad to see him and other family members who have been so supportive through this whole affair. My sister and her family brought Hannah to see Heather in her new digs. It is always nice to spend time together.

Settled In

After a not so comfortable, but bearable, ride in an ambulance Heather has settled into her new home quite well. The Utah Valley Specialty Hospital is actually quite nice and were are very pleased to be here. It seems more peaceful, and the room is considerably larger. The facility has only been open for about two years, so everything is new and clean. Heather has a nice view of Mt. Timpanogos from her room. The nurses and staff seem very friendly and competent. The food is good. All-in-all we are very pleased and are glad to be here, closer to home.

Exercise and Dressing Change

We are excited about our upcoming move. From its website, the Utah Valley Specialty Hospital looks nice (http://uvsh.ernesthealth.com/). We leave the UofU Hospital tomorrow morning at 9:30.

Heather had a pretty good day. Her back seems to be healing and is much less painful. Physical therapy came twice today and helped Heather stand up twice. It was not easy in terms of physical and emotional pain, but Heather did it. The first time they used a "tilt table," which is basically a bed that tilts up so that the person on it can get in a standing position without having to actually get their body up into that position. The second time she stood up herself with the help of two physical therapists. It was great to see her in a position other than on her back. Because she has been on her back so long it makes her quite dizzy and nauseated to sit or stand up. She did great considering what it felt like to do it.

The nurses changed the dressings on her legs and abdomen today. They are looking great. The grafts seem to be adhering well and they look red and alive. Her abdomen wound is significantly more closed up than it was when I saw it last week. She still tires quite easily and struggles with sluggish bowels and frequent nausea, but it is exciting to see her making these improvements.

Moving to Utah County!

We just found out that Heather will be leaving the UofU Hospital tomorrow morning at 9:30am! She no longer needs to be in the ICU. She will be moving to the Utah Valley Specialty Hospital in Provo. It is a long-term acute care (LTAC) facility near the Riverwoods Shopping Center at the mouth of Provo Canyon. She will likely be there for a couple of weeks until she is strong enough to be admitted into the UofU's rehab center which is quite intense in terms of physical therapy. There is the possibility that she will go home from the LTAC, but it will depend on her and how quickly and effectively she gets stronger. So, she will get an ambulance ride tomorrow and will be closer to home. We are happy to see this progress.

Improvement Continues

As I continue living my double life, I have once again left my work/home/Hannah self behind and have reverted back to my hospital/Heather self. It is great to see Heather. She looks significantly stronger and healthier to me. Part of her healthier look, that took me about an hour to figure out, is that she is no longer using any oxygen to help her breathe (She was using a nasal canula or tube that you often see oxygen users using.). Apparently she still has oxygen handy at night, but hasn't been using it much during the day for the past couple of days. Her voice is almost back to normal and her tracheostomy is nearly healed closed. She loves being able to talk without difficulty.

Today they removed about 100 staples that were holding down the edges of Heather's skin grafts on her legs. She said that this was quite painful, but nowhere near as painful as the back stuff. The doctors and nurses continue to say that the grafts look great.

Today the physical therapists came in to get Heather to stand up. She was concerned about this because she was sure the movement involved would cause the dressing to rip off of her back. The physical therapists insisted, so she tried. As she began to stand up the dressing ripped off her shoulder blades. Heather was not impressed. It is not as bad or as painful as it was several days ago, but it is still frustrating and painful. It is a tough balance to strike because the back will get better faster if the dressing isn't disturbed all the time; however, the longer she goes without standing up and walking the harder it will be for her to regain her strength.

Heather asked me to thank all of you for the abundant prayers, cards, phone calls, gifts, visits, and general kindnesses that have been heaped upon her. They mean a lot to her.

More Pain, But Doing Well

I spoke with Heather, and she is currently doing quite well. She had a rough morning. Her day began with a dressing change in the "Tank Room" (This is a completely tiled room where they can give people a shower in bed.). In order to take her to the Tank Room they have to transfer her from her bed to a plastic covered metal bed (It has a thin mattress that is covered in plastic.) that can get wet. Apparently Heather's back was stuck to much of her bedding, so this transfer ripped the bedding off her back and was excruciating. The pain was intense even though they gave her several different narcotics and other pain killers prior to the transfer and during the entire dressing change. The dressing change and shower were also very painful. She said she wasn't sure she was going to make it through it.

They used a different kind of dressing for her back that is a kind of thin foam pad that is impregnated with silver and other antimicrobial chemicals that is supposed to work as well as the other dressing they used. She was worried this would burn and be painful like the previous one, but she said that it immediately felt really good. They secured this dressing with a mesh t-shirt of sorts that seems to hold it in place quite well. Heather was pleased with this arrangement.

The doctors and nurses looked at the skin grafts on her legs during the dressing change and said they look fantastic! We are thrilled with this news! If they continue to heal as they seem to be, she shouldn't need any further surgeries or major procedures. My guess is that they will soon want to get her out of the ICU and into inpatient rehab.

After her dressing change Heather did quite well throughout the day. Physical therapy came and tried to get her to sit up, but she was feeling quite exhausted. My guess is that in the next few days she will begin to feel like doing more and more to build up her strength. It is really nice to see her make this progress; however, there is part of me that won't let myself get too excited about it for fear that something terrible will happen again.

Wound Dressing Problems

I'm back home with Hannah again, so I can only give you second-hand reports. Apparently this morning while taking Heather off a bedpan (a joyous experience in and of itself) the nurses and aids accidently grabbed the piece of wound dressing covering Heather's lower back (they originally used 7 or 8 pieces of the dressing to cover her back. Each piece is about 6" X 12") and pulled it off. This whole endeavor was quite painful, but what made it worse is that she is now without a wound dressing on that lower portion of her back. In addition, one of the pieces on her shoulder slid up, so they took that one off too.

This means that Heather will need to have a new dressings put on to cover the bare parts of her back. The thought of having to go through that burning pain again is overwhelming to her. They won't do anything until tomorrow when she has a dressing change on her legs. They are thinking of trying a different kind of dressing, hoping it won't burn like the last one did. However, it is also lined with silver and will probably burn as well. The other problem is that the part of her back that is not covered now may be stuck to her bedding. We are hoping that, having had a few days to heal, the nerve endings won't be quite so sensitive and that she won't experience anywhere near the same kind of pain she did yesterday.

Other than that fun piece of news, she said that she is doing pretty well. She is still quite tired much of the time. In addition, with all of the narcotics she is taking, her bowels remain quite sluggish. The constipation makes her feel nauseated and uncomfortable.

Grafts Look Good, Trach Tube Out

Heather had her wound dressing change this morning at about 8:00am. The doctor said that the grafts on her legs look really good and seem to be progressing as he would hope and expect them to. The wound on her abdomen looks really good too. It has closed in significantly and seems to be healing really well. The doctor also said that she could get her tracheostomy tube out. He and ne of the residents came in a couple of hours after the dressing change and took it out. They put a piece of gauze over the hole and taped over it to seal it. It bubbles up a bit every time she breathes or tries to talk. They said the hole should seal closed on its own in anywhere from a few hours to two days.

After they finished dressing her legs the pain began. They had to change the dressing on her back where the skin was taken for the grafts. This is definitely the source of most of her pain. Despite the nurses best efforts to give her plenty of pain medications to prepare her for this dressing change, it was excruciating for her. I got to see the donor sites for the first time, and they are much larger than I had thought. It appears that they took four strips of skin off her back, each approximately 3"-4" wide and 12"-18" long. So, basically the entire surface of her back is one large sore. They only went deep enough to take the top layers of skin. So, it is not a bloody, red open wound, but rather it looks like a bad scrape all down her back. They had to wash it all and peal off the old dressing. This was quite painful. The most painful part of the dressing change involved an area low on her back where the original dressing has shifted up. This left the lower part of her wound exposed, and the diaper they have her on stuck to the wound. It was terribly painful to pull this off of her skin.

The new dressing they put on seemed to cause more pain than taking the old one off did. It is a special dressing lined with silver that has antimicrobial properties. This dressing can stay on until the wound is healed. This is a real blessing because it means that she won't have to go through daily wound dressing changes on her back that would be necessary otherwise. However, for a small percentage of people this dressing burns for 10-30 minutes when it is first put on. Of course, Heather falls in that small percentage. She was in significant, almost unbearable pain for about an hour after the dressing change and then has gradually been able to experience some relief in the time since. They gave her tons of different pain killers, trying to help her feel better, but nothing seemed to work at first. She seems much more comfortable now, and is sleeping.

We hope she won't have to go through any of that again. I hate to see her hurt. I'm excited about her progress though. Thank you for your prayers in her behalf.

No New Is Good News

I have very little to report today, and I consider that a very good thing. My greatest desire is that this blog will become extremely boring because all I will have to say is that she is doing great.

With the exception of some sluggishness in the bowel department, Heather has continued to do quite well. We are looking forward to tomorrow's dressing change, hoping that the grafts on her legs will look good. We really hope that they will be adhering nicely and that they will look healthy enough that she won't need to have any more grafts done. We would also really like to get her tracheostomy tube out. I will let you know what happens tomorrow.

A Good Day

Heather really did well today. She had little if any pain, was nausea free, and seemed to be more herself than I have seen in several days. We had a couple of visitors, including Hannah, which was nice. Heather was able to take several long and peaceful naps, and generally seems rejuvenated. She was even able to watch a full movie without falling asleep (She hasn't been able to do that since she got to the hospital.).

It is really nice to be able to hope that we may be through all the surgeries and scary parts of this ordeal (though it is still very possible that Heather will need additional grafting or other procedures). It feels like the light at the end of the tunnel is getting bigger and looking more like a reality. Maybe it is a foolish or false hope, but it still feels good to us.

Doing Great This Morning.

Heather is doing really well this morning. She says that she is in no pain, has no nausea, and has an appetite. She also says that she doesn't remember anything that happened during or after the surgery last night, which is a real blessing. It's wonderful to see her feeling so much better than she has for the past couple of days.

There are three main doctors that work on rotation here in the burn unit (Dr. Saffle, Dr. Morris, and Dr. Cochran - I'm not sure of the spelling of those names). Dr. Morris has been on since we got here, but he is rotating off today. Dr. Saffle is covering the weekend, and I believe Dr. Cochran will be on for several weeks starting on Monday. Dr. Saffle started the Burn Unit between 20 and 30 years ago, and is a revered figure in the field of burn care. He came in to see Heather this morning and said that if her wounds look good on Sunday and it appears that she won't need any further surgery, they will take her tracheostomy tube out on Sunday. That would be fantastic!

Late Surgery and Autografts

Heather didn't go into surgery until 4:45pm. It was a rather miserable day of anxious anticipation and nausea. She was quite nervous about this surgery. She was specifically worried about the pain of the donor sites and having to go back on the ventilator (Last time she was on the ventilator she felt like she couldn't breathe, and it was very distressing to her. Imagine how anxiety-provoking it would be if you had to breathe through a soda straw, and you will have an idea of why she was worried about it.).

She was in surgery for almost two hours. When she got out, she was in terrible pain. It took the doctors and nurses 30-45 minutes to finally get the pain under control (This was not for lack of effort. They were trying everything they could to make her comfortable.). During that time she was rocking her head back and forth and moaning in pain. I think it was probably the worst pain she has experienced in her whole time in the hospital. It was very distressing to all involved. I hate seeing her suffer like that. She is much calmer and more comfortable now. She is in and out of sleep and seems to have the pain under control.

Dr. Morris said that the surgery went well. They took about 180 square centimeters of skin from her back in four long strips (I got the idea that they were about two inches wide and between 8 and 12 inches long, but I could be wrong.). They were able to cover all of her leg wounds, stapling and suturing the skin on. It is her back that is causing most of her pain now. The leg wounds don't hurt much because the wounds are deep enough that most of the nerve endings are gone. However, on her back the wounds are just deep enough to hit all of the nerve endings.

Dr. Morris said that the grafts do not always take, and there is a 5-15% chance that she will have to go back in for more grafts. He is still concerned about the cellulitis in both of her hips. He said that it is not getting worse, but it is not getting better as quickly as he would like. He said that still thinks that it will get better on its own (with the help of antibiotics), but that the worst case scenario is that they will have to make a deep cut on each hip and attach a wound vac to draw the infection out.

He said that they will try not to move Heather much at all for the next three days. On Sunday they will do a full dressing change and see how the grafts are doing. Next week they will begin getting her to move and trying to stand up again. He said that if her breathing continues to go well, they will likely be able to take her tracheostomy tube out and let the hole (or stoma) close. That would be exciting!

He cannot predict exactly how quickly she will heal, but his best guess, barring the need for more grafts, is that she will be here on the burn unit until about Thanksgiving. After that she will need to spend a couple of weeks in an inpatient rehabilitation unit. He said that he feels that she will be able to be home by Christmas. I hope and pray that will be the case.

I asked Dr. Morris about scarring. He said that she will definitely have significant scarring on her legs and some scarring on her back. He said that everyone scars differently. The scars on her legs will most certainly be extensive and quite visible. The ones on her back may be very faint and hard to see, or they may have a rougher texture than the surrounding skin and be quite visible. He said that scar tissue contracts significantly. So, it will pull the flesh surrounding the wounds together, which will lessen some of the indentations on her legs.

We hope that we have just gone over the last major hurdle to Heather's recovery. We hope that the grafts do well, and that she doesn't have to go back for more.

Nausea

Heather has had a difficult day. She woke up feeling some nausea that seemed to worsen as the day went on. This makes it really hard for her to stay up-beat. She did some physical therapy where they put her on a board that helps her stand up. As they were standing her up she vomited and has continued to feel nauseated since. There are many possible reasons for the nausea: she is eating fattier foods than she has eaten in a month; the narcotics (which slow down bowel functioning) she is taking and new foods she is eating continue to disrupt her bowels; she has skin from another person on her legs that her body may already be fighting against; etc.

Dr. Morris came in and said that she will be going into surgery tomorrow afternoon to get autografts (grafts using her own skin, taken from her back and sides). He told her that the donor sites (i.e., the spots from which they will take the skin for the grafts) will be quite painful for two days and moderately painful for 10 days. She was already anxious about this autograft surgery, but hearing that was quite distressing to her. She said that she doesn't feel like she is up to dealing with the pain of the autografts and the nausea at the same time (not to mention that she is just tired of being in the hospital and having this ordeal go on so long). She seems a little overwhelmed tonight. As always, your prayers on her behalf mean a lot to us.

Staples Out and More Standing

Heather had a wound dressing change yesterday. I wasn't there so I don't know exactly how it went, but apparently they felt her wounds and the homografts looked good. They removed the staples that held the homografts in place. She said that it did not hurt this time, which is nice. She has been having really good days lately. She was able to stand up for about 10 seconds yesterday (with support) and has been increasing her strength daily. She spent considerable time with her tracheostomy button in and has been eating more solid food. I can't wait to see her tonight after work. They have her scheduled for surgery tomorrow, but it is very unlikely that that will happen. It is my understanding that they want to give the homografts more time to adhere and will likely wait until next week for surgery.

An Attempt to Stand Up

Heather had a great day yesterday. She spent considerable time with her tracheostomy button or plug in. This makes her work harder to breathe because she must do so around a tube with holes in it that is in her trachea. She seems to be getting much stronger with it though. She also worked really hard in both of her physical therapy sessions yesterday. On Sunday when I was there she was unable to lift a 2-pound weight with her right hand/arm, and yesterday she did. Her right arm is weaker than her left because for a long time it had all kinds of IV tubes, blood pressure cuffs, and ventilator tubes in/over/on it so she could not move it as much. She also tried to stand up for the first time in weeks. She wasn't able to get fully up, but with help was able to raise herself a little off the bed. She hasn't been able to do much to build strength in her lower body because they don't want movement to upset the grafts.

Heather's favorite visitor, Hannah, came to see her yesterday. Apparently they read stories together and enjoyed Heather's new ability to talk. Hannah told me all about the visit as I was taking her home last night. She seemed most struck by Heather's oxygen nasal canula, her bed (and how it changes from a "chair" into a bed), and the squeeze toys (a pig, an owl, a fire truck, and a penguin - Hannah didn't like the fire truck because it was "scary.") physical therapy has brought to Heather so that she can work on her grip strength.

Heather is scheduled for a wound dressing change today. They will again evaluate the wounds and grafts to decide when to do the next surgery. It will likely be next week.

Thank You

I got home late last night with Hannah to find that people have been quite zealous and extremely generous in their desires to help and be kind to us. I called Heather and we both cried, feeling overwhelmed by all that everyone has done for us. It seems "over the top" to us, and we don't understand. We don't know what to do but to lamely say, "Thank you" to you all. The caring, support, kindnesses, and love mean a lot, big or small.

Heather's sister, Heidi, who came down to Utah again on Saturday (She has taken off work and has come down from Jackson, WY to be with Heather at least four times. She has been at the hospital almost as much as I have, and has been a tremendous help to Heather.), sent me the following in an email this morning. I thought you all might be interested.

Hi Mark, I just had a few things to tell you. For one thing they took the ventilator out of Heathers room last night! Which I thought was a really great sign, not to mention there is more room now. Also Heather said yesterday : "I think I'm getting better". I asked her if that was the first time she really felt like that and she said yes. Not sure if you know this but she also told me she doesn't remember the days between the hysterectomy and going to ICU at all. She doesn't remember all that bloating and pain, which I think is a good thing.

A Good Day

Heather seems to be doing really well today, though she gets tired quickly. She has not been on the ventilator at all since Friday morning and it seems that she will not go back on it again. She actually seems more comfortable off it than on now. She continues to breathe through her tracheostomy with an oxygen mask right in front of it. Occasionally she plugs her tracheostomy with a "button" and breathes through her mouth and nose, with oxygen in her nose; however, this is still exhausting to her after a while.

The doctor and nurses changed her wound dressings today. Dr. Morris said that her legs look quite good, but that he wants to wait a few more days to see if the cadaver grafts will adhere a little better. He looked at the cellulitis that is now on both of her hips. He said that he was not too concerned about, and that it is probably caused largely by her lack of movement. He seemed to feel that it would resolve. The next step is to look at the wounds again on Tuesday to see if she is ready for autografts.

She is enjoying eating very small amounts of food, though her stomach isn't used to food after being off it for a month.

She Eats!!!

Heather had a really good day and a mixed night. It is currently almost noon on Saturday and she has been off the ventilator since yesterday (Friday) morning. The button or cap in her tracheostomy tube seemed to tires her out yesterday, but she has had it back in today for several hours and is doing great. It is fantastic because it is a big step forward, and it allows her to talk whenever she wants. It would be wonderful if she didn't need to go back on the ventilator again.

She had a difficult night because her bowels haven't been working very well again, and they gave her a stool softener called Senna that really makes her feel terrible. Within five or ten minutes of taking it last night she started feeling nauseated and continued to feel so throughout the night. It just really doesn't agree with her. She said that she thought she was going to throw up all night. She has been feeling a little better this morning, but not great.

The worry of the day today was that her feeding tube became blocked. They were worried that they might have to take it out and put another one in, which would not be much fun. However, with a few tricks they were able to get it flowing again.

The major excitement of the day is that she had her first drink and ate her first food in a month! A speech therapist just came in and evaluated her ability to eat and drink. After not using her mouth and throat muscles for eating and drinking for so long, they want to make sure she can eat and drink without it going into her trachea and lungs. She did great, so my days of eating Heather's hospital meals are over. I couldn't be happier, even though the food here is actually pretty good. It was like Christmas for Heather to finally be able to wet her throat and taste some new tastes. The speech therapist tested her with ice, water, milk, applesauce, and saltine crackers. Heather seemed to love them all. However, combined with the nausea she already had this morning, the "newness" of food in her stomach seemed to make her feel even more nauseated. They just gave her some anti-nausea medication, so hopefully that will help.

Speaking Like a Pro...Almost

Heather's sister Holly wrote the following update for her siblings, so I pirated it rather than writing my own. Thank you Holly.

Hello everyone.

Just a little update. There haven't been any big procedures today, but a big milestone was just reached. Heather is basically talking. She was last night, but only when she covered her tracheotomy with her finger, which was kind of a pain. They just put a cap on her tracheotomy and have a tube sending oxygen in through her nose, so she is just breathing and talking all the time. Talking, of course, is gravelly but stronger and stronger.

She also just had the revelation that she can swish juice around in her mouth, then suck it out with a tube. Tasting something besides water for the first time in a month or so was like heaven it seems.

Tiauna just brought Hannah over for the third time. She seems to be getting more used to this weird situation. Heather being able to talk to her made it a lot better (though she was here before they put the cap on). It is really good for Heather to see Hannah.

Heather will be getting two units of blood today because her hematocrit is low. She also continues to do physical therapy, though with her leg bandages on she won't be able to work with them for a few days. She is lifting arms, with weight and can lift her back off of the bed a bit from a seated position.

It's SO great to hear her and not speak for her!!

She Speaks!!!!

They just took Heather off the ventilator and she can talk! She has to hold her finger over the hole in the tracheostomy tube and her voice is very faint and gravelly, but she can speak. She loves it, and so do we.

Information from Dr. Morris

Dr. Morris said that the surgery went quite well. He said that the tissue looked good with the exception of a few small spots (dime-sized) that he needed to remove. They placed the homograft and he is optimistic that it will "stick" well. He also said that the new tracheostomy tube seemed to work well, and it should allow her to talk when she is off the ventilator and the balloon that fills the area between the tube and the inside of her trachea is deflated. He said that he was unsure about the cellulitis, other than just to watch it. He said that he thinks it will just resolve with the antibiotic they are giving her.

They will change her leg dressings on Sunday and will have a sense then of how the grafts are doing. If they are doing well, they will look at doing autografts (grafts using her own skin) early to mid next week.

Out of Surgery with Little Information

Heather is out of surgery and seems to be doing well. They told us she would be in surgery for two to three hours. We went to lunch for an hour and a half, and when we got back she was already out of surgery and back in her room. So, we missed being able to talk to the doctor about how it all went. She seems comfortable, and it appears that they did the homografts. She has already been able to get enough air around her new tracheostomy tube to make some vocal sounds. She is too tired and weak post surgery to see if she will be able to talk when off the ventilator, but it seems very likely.

I will post again when I have more information about how the surgery went.

Great Legs!

Today Heather's day started out great. She seemed to be feeling great. She worked really hard in her physical therapy and was off the ventilator for two hours. She was quite exhausted after all that. She also had a dressing change on her legs, largely for the purpose of looking at the wounds to find out if she is ready for grafts. The doctor said that her legs looked great (I'm trying to keep my jealousy under control.), and that the wounds look ready for homografts. So, tomorrow she will go to surgery in the afternoon for the grafting and to get a new tube for her tracheostomy. They will put a smaller tube in so that she can plug it off and force air around the tube to talk. Last week when they plugged off her tracheostomy she wasn't able to get any air around the tube. We're crossing our fingers that the smaller tube will work. It would be really nice to hear her voice again. The docotor is still somewhat concerned about the cellulitis in her left hip, but they will just continue to give her antibiotics and watch it closely.

Changing of the Guard and Slow Improvements

I am back at work during the day and at home at night with Hannah for the next few days. Heather's sister, Heidi, came down from Jackson, WY again over the weekend (went home this afternoon) and her other sister, Holly, flew out from Washington D.C. last night to spend a few days with Heather while I am down here in Utah County. Heather's parents are also back up at the hospital today. As you can tell, Heather is well loved and taken care of.

Heather had another wound dressing change today. The report is that her wounds continue to heal, but very slowly (slower than the doctors would expect). Though we would all like to see her heal faster, we'll take any progress we can get. They have been somewhat concerned about her left hip over the past several days because it has shown signs of cellulitis.

Wikipedia definition of Cellulitis: an infection of the deep subcutaneous tissue of the skin. Cellulitis can be caused by normal skin flora or by exogenous bacteria, and often occurs where the skin has previously been broken: cracks in the skin, cuts, blisters, burns, insect bites, surgical wounds, or sites of intravenous catheter insertion. Skin on the face or lower legs is most commonly affected by this infection, though cellulitis can occur on any part of the body. The mainstay of therapy remains treatment with appropriate antibiotics.

Yesterday when the doctor looked at it, he thought it was looking better than it had on previous days. They are giving her a strong antibiotic and watching it closely. I would sure like to see her leg situation more resolved. They are currently thinking of taking her to the OR again on Thursday for homografts, but it will depend on how the tissue looks at that point.

Heather has been working hard to build her strength. Today she was able to sit up straight (without leaning back against the bed) for quite a while. She hasn't done that in a couple of weeks. She also has more range of motion in her arms, which is exciting to see. It also affords her ever-increasing independence.

A Much Needed Visitor

After more than a month apart Heather and Hannah got to spend some time together today!!! Hannah was a little uncertain about it all at first, but with a little time she seemed to warm up to it all. It is a little hard to get used to all the strange noises, smells, and sounds of the hospital. It is also odd to see someone you love with machines and tubes connected all over her body. We brought Hannah into the room three times over a two or three hour period. After the second time she was begging to go back in to see Mommy.




























The doctor said today that he will probably take Heather back into surgery on Thursday to see if homografts (with cadaver skin) are a good idea. He said that her legs continue to improve.

A Good Afternoon

Despite a somewhat painful and difficult morning, Heather had a very good afternoon. She felt great, comparatively. She worked really hard in her physical therapy, sat up in her bed for several hours, was joking with us, and felt relatively little pain. It was fun to see her feel so good. It was a dramatic difference from this morning and the past couple of days. Here are a couple of pictures I took this afternoon:














Here's Heather enjoying the light from her new window:

Wounds Heading in the Right Direction

The doctors and nurses changed the dressings on Heather's leg and abdominal wounds today. Because the wounds are still quite painful and extensive they sedated her to make these changes. They allowed me to stay in the room while they did so, which I greatly appreciated. It is not fun to see the way Heather's body is hacked up, but I would rather see it and know what is going on than not. She has large chunks of flesh missing from her legs, but the doctor thinks the wounds are looking better. The infection and necrosis seem to be under control, and the tissue is more granulated and vascularized (i.e., the cells are regrowing and blood vessels are supplying the area with blood/oxygen which is necessary for healing and for future grafts to work). The doctor was pleased with the progress, slow as it is. He said they will again wait a few days and see how she does. If she continues to do well they will consider doing homografts again.

It is strange to be in the room during these procedures. I am not the queasy type, so the blood and open flesh don't bother me from that standpoint. It is just odd to be in a room where all, myself included, are dressed in plastic gowns, hairnet caps, rubber gloves, and surgical masks; my wife is laying there naked with major parts of her flesh gaping open down to muscle; and all these strangers (5-7 people) are moving her around washing her and placing large segments of black foam and plastic over her wounds. To top that all off, Heather is sedated through all this, but not completely asleep. So she is awake just enough to hazily respond to simple questions about her pain, but doesn't seem to notice all the gyrations they are putting her body through to change her dressings. All in all it is just a strange experience.

She is sleeping now and pretty wiped out. Her hematocrit came up to 24 today, after receiving two units of blood yesterday. We'll see if it improves or if she still requires more transfused blood.

Last night they moved Heather to a new room so that she could have a window. It is a smaller room, but it is wonderful to be able to get some natural light in the room. It is really hard for her to maintain a sense of reality when there is no difference between day and night. She is quite excited about her new room. She has a lovely view of the Huntsman Cancer Center and the hills behind it. Some people have noted that I haven't made it clear what hospital we are in. We are in the Burn Trauma ICU of the University of Utah Hospital in Salt Lake City.