Friday, June 18, 2010 at 1025

I'm very sorry I didn't post a new blog last night - I had to purchase a new laptop and I took it to our sleeping quarters to do the blog and realized I left the Internet cord in David's room.

David was actually very comfortable yesterday. It was extremely busy with guests. In the last two days he has had 15 to 20 visitors. Many of these young warriors become mentors after they have healed pretty well. Five of them came to see David. They had many different injuries. One of them still had his own leg on the right and had a regular prosthetic on the left, he was also carrying another one of his legs in his hand. All of these young men were very open when talking about their injuries. One in a wheelchair and wearing special compression stockings over his legs (one taken off just below the knee and the other a few inches above the knee. It was very interesting to watch him as he would just pop his leg up to his chest - he had that leg moving everywhere like it was new toy. I thought about that for quite awhile and started paying attention to what I do with my own legs - I realized that my legs are pretty active all the time too! It is quite surprising when I see what David is, currently, unable to do that are so routine for almost every one of us.

David was visited by the United States Marine Corp Gunner, which is a very big deal and David has a great amount of respect for these individuals. The Gunner showed David his injuries to his right hand and explained that he had many of the same procedures done to him. He had about 60% strength and usage of that hand and it was not obvious that he had received such serious injuries. I believe David's will be a bit more obvious because of the loss of his finger and the many deep scars that will be on his arm, but 60% usage and strength sounds great.

David has requested that we now be present when he is in recovery. It is very confusing when he comes out of sedation and it is very calming when we can be there to bring him to a point of focus.

It has become a bit of a traumatic experience every time David needs to be taken to X-Ray. To switch him from his own inflatable bed to the steel x-ray table and then roll him from side to side and take 5 or 6 different x-rays, then switch him back to his own bed is extremely painful. This last time he requested that I be the one to assist in X-Ray. Talk about cheap help. I was able to talk the x-ray technician into leaving David on his own bed and was able to assist in positioning David for each x-ray. It was still painful, but is was much much much much less invasive and painful for his. We were all very pleased. If I was an inventor, I could sure come up with some better ways to do some of this. Each time we had lift him and slide a plate under him, then position him, then take the picture, then slide it out and see if the x-ray gave them the information they were looking for. Then we would repeat that 5 more times. I know I worked up a little perspiration. It's also nice that I know how the bed works and can try to provide David with the most comfort.

Today is surgery day. The ORTHO team came in last night to get consent forms signed and told us they were going to be working on the wound vacs for both legs. They are just going to be doing a good inspection of the muscle and skin to make sure all is going well and then they will revise the wound vacs to allow the wounds to close even more.

We are watching the wound vacs all the time and the one coming out of the area on the forearm where the skin flap was taken has not put out any fluids for 2 days, so, I'm hoping things are healing enough to close that wound. I'm not sure if they actually do the close before they are ready to put on the skin grafts - it makes sense that they would want the wound open when that is done. Do I sound like a surgeon now?

I was called about 11:00 last night by the surgical team working with David's arm and they informed me that, today, they will be removing the external fixator (x-fix) from Davids wrist area. They want get his hand back in motion. He will still have pins in the broken bones in his hand but, if you recall, the fixator was in place to insure the range of motion between the thumb and the index finger one the skin flap heals - the skin flaps can easily constrict that area, when it heals, without the fixator.

Occupational Therapy also came in yesterday for about two hours and built David a cast that will enable them to change positioning of his fingers and wrist. The cast is a special material that is only put on the under side of the arm and wrapped with ace bandages to keep it in place. The cast is made of a material that is heated, in a water bath, to about 156%, which makes it pliable again. Each day they will come in and reheat the cast and change the position of his wrist and fingers to get him back to full range of motion. It is quite an impressive process and the young woman doing it is very fun to work with. She is very playful with David as she works through the process.

David was also visited by the IDEO company and was interviewed for almost 2 hours. They will be using some of David's thoughts in order to create better living environments for these wounded warriors.

So, all-in-all, it was a good day. The best part of the day was when we were told that the x-rays showed that the x-fix on his pelvis was not bent and did not damage the pelvic bone. If we're looking on the bright side, the incident with the x-fix catching on the bed gave the surgical team the incentive to revise the x-fix to a much lower profile. They were able to build an entire x-fix frame between the current x-fix and his skin and then disassemble the old one and cut the rods down another 4 to 5 inches.

That was a long blog - hopefully it helped you feel what we're all feeling. Many of the emotions now are when the good things continue to happen.

I'll Blog Later,

Dr. Lyon