Fearfully and Wonderfully made


She’s Walking –
November 14, 2008, 7:45 pm
Filed under: Life with. . ., Surgeries | Tags: ,

Giovanna is beginning to walk on her fixator foot!  This is a huge step forward.  She has not been willing to do this since surgery.  However in the past couple of days, she has gingerly put some weight on her fixator foot!  Today she took a few steps early in the day.  Tonight she was walking down the hall way!!!!!

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What is a Fixator?
November 11, 2008, 9:26 pm
Filed under: Surgeries | Tags:

I have been asked that question many times over the past three weeks.  It generally heps to have a picture to help explain what it is and what it does.  Below are pictures of the two fixators that Giovanna has had.  The procedure on the left leg was performed two years ago. 

Left leg done 2006

Left leg done 2006

 

 

 

 

 

 

 

 

 

 

Right Leg currently in fixator
Right Leg currently in fixator

This procedure is a surgical procedure used to lengthen limbs or reshape bones which in Giovanna’s case is being used to lower her heel and reshape her foot.  The procedure was originally invented by Professor Gavril Abramovitch Ilizarov using bicycle spokes in the 1950’s.  It was introduced to the west via Italian doctors and is now used routinely for treating bone and limb deformities.

For bone lengthening or reshaping (both of which have been needed by Giovanna), an external fixator made of stainless steel circle the leg externally is held in place with a series of wires (called pins) and bolted into the bones.  Stainless steel rings are fixed to the bone via stainless steel heavy-gauge wire (called “pins”). The rings are connected to each other with threaded rods attached through adjustable nuts. The circular construction and tensioned wires of the Ilizarov apparatus provide a great deal of structural support. 

During surgery, the bone is broken around the perimeter of the bone not totally separting it.  The bone marrow and blood vessels need to be left in tack so that they can provide the nutrients for the new bone as it is laid down.  While the bone is growing, the frame is adjusted by means of turning the nuts, thus increasing the space between two rings. As the rings are connected to opposite sides of the fracture, this adjustment, done daily, moves the now-healing fracture apart by approximately one millimetre per day.

In Giovanna’s case, there are two bolts by her heel which when turned push the heel down.  There is also one in front of the foot that brings the toes up.  As the process continues the heel lowers and the toes come up and in time they meet in the middle making her foot flat.  This will improver her gait and make walking less painful.  Giovanna also had an osteotomy in the mid foot to straighten her foot.  At her post op check ups the surgeon turns the bolt  to straighten her foot.  So going in for post op check ups is a bit painful for her as this turn tends to be more painful as it is not as incremental as the others. 

Her left leg/foot which was done in November 2006 took almost 8 weeks of pin turns before the position of the foot was correct.  The right leg/foot which is currently in the fixator should be done with pin turns in 3 weeks.  Once the foot is in the correct position, she will be in a holding position for about 4 weeks and then the fixator is removed and cast put on for another 4-6 weeks. 

We can see the end of the tunnel at this point.  I will be completing the final turns of her pins on Friday.  She will have another post op check up next week and the doctor will make any final corrections before she enters into the holding pattern.  The fixator should be off around Christmas time. 



Post op Check- up
November 7, 2008, 5:57 pm
Filed under: Uncategorized

Going back to the hospital after having surgery is not always an easy thing.  Giovanna really does not like people, especially Dr. G to look at and touch her foot.  However at this first post op visit, the best thing to hear would be that I was done with pin turns.  So with anticipation Giovanna and I head for the hospital for the clinic visit early on Thursday morning.

As suspected, Giovanna did not want anyone to touch her foot.  She is still complaining of pain in the foot and it is still a bit swollen.  However Dr. G. had a young doctor from Latvia that she took a liking to and let him touch her foot.  Once he got to touch it, she also let Dr. G look at it as well.  She was not excited when Dr. G began to crank on the pins and turn things.  He has one pin that is straightening out the foot that he turns.  He also worked on pulling up the front of the foot as well and cranked on that pin until Giovanna couldn’t take the pain anymore.  He asked me why she was so calm during this pin turning.  I said I used the medications to my advantage, especially the one that is like Valium to calm her down.  According to Dr. G., “better kids through drugs” was the method I used.  It worked!

So the good news – one more week of pin turns and the heel should be in the correct position.  Holding pattern in the fixator for about 3-5 weeks and then the fixator will be off by the end of 2008!  We have penciled in a couple of  dates.  At our next in clinic visit on 20 November, he will determine which date he wants to use! 

Three weeks of pin turns – not bad.  There is light at the end of the tunnel.  Pray that we can get the fixator off before Christmas – but we will take before the end of the year!



On Being Tenacious
November 7, 2008, 5:45 pm
Filed under: Uncategorized | Tags: ,

Tenacious is defined as not being easily pulled apart or persistent in maintaining adhering to or seeking something valued or desired.  When I think of something that is tenacious, I think of bulldogs – they do not back down easily.  Giovanna has been described as tenacious.  When the tenacity of one person is working with another person, great things can be accomplished.

For instance, two years ago when Giovanna had her first fixator surgery, she left the hospital walking with a walker.  Upon getting home, she fell into a pattern of not walking, but scooting to get around.  When we went in for a post op check up, the therapist asked how Giovanna was doing with walking.  When I said she wasn’t doing much walking, the response was that if she was not up and walking by Friday (we were in on a Monday), then I would need to schedule time with rehab and Giovanna would have to come in and walk for an hour each week.  Giovanna was listening closer than I thought.  When we got home from that visit, she asked for her walker and began walking.  By the end of the week, just 5 days later, she was walking without any assistance.  She was determined not to have to spend any more time in the hospital! 

The flip side is also true, it one with the tenacious nature is working against you, progress is very slow.  Yesterday Giovanna was in for her first post op check up.  She was not walking well with her walker mainly because she was using it like crutches and trying to keep her fixator leg from touching the ground in any way.  By using the walker in a way that was not its intended use, she fell which has made her  not want to even attempt walking again.  So we began looking into gettin crutches as an alternative way for her to get around.  Giovanna was not excited about this prospect. 

When we got there one of the therapists, Cassie came out to meet us with a pair of crutches.  Giovanna was not interested and had total melt down.  For those at the hospital who have never experienced this side of Giovanna, it was eye opening and a shock.  We were trying to get her to walk with the crutches from the one side of the room to the other so she could get her x-rays.  She would have nothing to do with it and in the end got to ride over to X-ray in a wheelchair. 

After seeing Dr. G and having her pins worked on a second therapist came in with a second pair or crutches to try.  Giovanna was more interested, but still fearful of falling.  We were able to get her up and standing just long enough to determine that this pair was to tall.  So we did a little mixing and matching to get the “perfect fit” for Giovanna.  Then she  began to take more of an interest in them and was able to get up almost on her own to a standing position.  Another couple of tries and she was able to stand like she had been using them all her life.  We called in all the therapists that were in clinic so that she could show off her new skill.  She was beaming from ear to ear as everyone clapped for her. 

Once home, she began to want to use them and today – one day after getting her crutches, she can walk unasissted with them.  However her balance can get off at times and it is necessary to “catch” her before she falls.  She still beams from ear to ear as she “walks” through the house! 

Tenacity is a good thing when learning new skills!

yes-i-can

Yes I can use these!

 



Mobility is Coming!
November 4, 2008, 10:30 pm
Filed under: Surgeries | Tags: ,

Giovanna is behind where I thought she would be at this time with respect to walking.  Two years ago when she had her first Ilizarov procedure, she was walking without her walker 2 weeks post surgery.  This time, she is not even putting pressure on her foot, let along walking with the walker.  I have been trying to encourage her to at least crawl or scoot to get from place to place.  She has fought this idea with all her might.

That is until today.  I busy doing something and didn’t hear her calling this morning.  Since she wanted out of bed, she figured out how to get out of bed and scooted out of her room, through the hallway and living room and to the top of the stairs before I realized that she was up.  What a great relief to have her moving about on her own. 

When I asked her how she got out of bed this morning, her response was, “I sat up, put good foot down and gently pushed my foot down, held on and lowered by bottom to the floor.”  She was beaming as she said this. 

She still can’t get up on things like the couch or into the shower, but it relieves a lot of pressure on the backs of all around here.  It is so good to see that she has finally gotten over the “I am the princess – so I get to be waited on.”  to “I can move from place to place by scooting.”  Walking could come rather quickly, but she is still having a lot of pain when she tries to put pressure on it.



Signs of Infection
November 4, 2008, 9:45 am
Filed under: Surgeries | Tags: , ,

Before one can leave the hospital with a fixator, the signs of an infection are drilled into your head.  You need to know what to look for to prevent an infection from getting out of hand quickly.  So what are the signs of an infection:

Red area around the pin sites
Swelling around the pin sites
Oozing from the pin sites
Fever

So when one begins to see these things, you begin to suspect that there is an infection brewing.  But sometimes you just need a second pair of eyes to look at the sites. 

This was true at the Ayers house.  Giovanna’s pin sites were not looking good and I was beginning to add a 50-50 solution of saline water and hydrogen peroxide into the daily routine to clean out the pin sites.  But Sunday morning after looking at her pin sites, I decided to ask another woman at church.  Her son has had fixators before and she was very familiar with pin sites – good and infected ones.  

So when I saw her on Sunday morning, I called her over to just check out Giovanna’s sites.  She did agree that they were looking infected and that antibiotics should be started.  So after coming home from Church, I made the call to the inpatient care unit at the hospital and described what I was seeing.  The nurse agreed that antibiotics should be started.  Off to target I go! 

It is now two days later and it doesn’t seem like the sites have cleared all that much after 24 hours of antibiotics.  Giovanna is complaining of more pain at the pin sites when I clean them. 

Thursday she goes in for her first post op check up.  My prayer is that the sites have cleared enough that the dr. will give the ok for aqua therapy.  This should help her to begin to put pressure on her fixator foot in a way that is safe and not bearing full weight on it.  I am also in discussions with the rehab department as she is not using her walker correctly and has fallen.  So we are looking into getting her crutches. 

Lots to pray about with regard to this little one’s recovery.  Things are not going as smoothly as last time, but all in all we have seen God’s faithfulness over and over again.  It is easier to see His faithfulness during these hard times – probably because we are really looking to Him in ways that we don’t when things are going well.

Thanks for your continued prayers.  We love all the comments made here on the blog, even though we don’t always respond to them individually.  Giovanna loves to hear what people have posted.  She always smiles when we read the comments.