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. 



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. 



Post Op – Week 2
October 31, 2008, 9:30 pm
Filed under: Surgeries | Tags: , ,

Post Op week two is almost complete and it has not been an easy week.  While the pain management has been somewhat easier this time, there have been some other issues which have made things more challenging.  Giovanna is more engaged this time and wants to try doing more things, which can be a good thing at times.  She tried cleaning her own pin sites today and did a fairly good job!  However due to the nature of the condition she has, it is hard for her to reach all of her pins. 

There are also blisters – some over the incision sites while others are near her pin sites.  Some of these have sprung a leak, which increases the risk of infection.  The two biggest blisters have both had some issues over the past couple of days.  One is near the base of the toes and is referred to as a sweat blister.  The one over the incision site is no longer filled with clear fluid but the dried blood from the incision has mixed in, making it look really bad.  But according to the Doctor it provides a good sterile environment for protecting the site from infection.    There are at least 4 blisters around pin sites, which makes cleaning the pin sites difficult and painful.  She has been a trooper through all of the cleanings and pin turns!

Her foot is still swollen, which makes me think that there is an infection brewing.  I been applying some  essential oils that are known to help fight infections.  This mornig when she got up, the swelling was down some.  Now that she has been up and moving, the swelling is back.  There has also been some drainage from a couple of her pin sites, another indicator that there might be an infection, so I cleaned all the pin sites with Hydrogen Peroxide today.  She is not running a fever, which is a good thing.  If things aren’t better by Monday, I will need to call the doctor and have them take a look.  I already have the script for an antibiotic!  Just what I need – one more med to keep track of.  Pray that the essential oils would clear any infection that might be brewing under the surface.

Then there is the mobility issue.  By this time with her surgery two years ago, she was weight bearing and  walking without the walker.  This time she is not bearing weight yet and uses her walker like crutches!  It is rather comical to see her push the walker just a few inches forward and then “hop” on her good leg to go forward.  It is slow, but steady progress.  She has not been allowed to use the walker without supervision, but last night decided to try it on her own with some not so good results.  She took a tumble with most of the impact/weight of the fall on her fixator leg/foot.  It was a bit loud in the house for a few minutes until we could get her calmed down enough to hear what happened.  Thankfully a warm shower made everything better!

It has been good that the weather has been nice for late October in Minnesota.  She has been able to get out and go for “walks” in the wagon.  Tonight she was sitting by the fire in the fire pit as the trick or treaters came by.  She had a fun time watching all the festivities, but eventually wanted to go around the cul-de-sac and have some fun herself. 

She is now tucked into bed for the night.  Pray that she will sleep through the night and that the swelling and drainage will clear over the weekend.



The Rhythm of Life
October 28, 2008, 3:41 pm
Filed under: Surgeries | Tags:

Hospitals have an order to them.  There nurses change at 7 AM, 3 PM and 11 PM.  It is great when the same nurse works the same shift each day – brings continuity and comfort to those in the hospital.  They have a computer that keeps track of all the meds one is taking and when it was given.  Nurses make their “visits” about every 2 hours.   Most doctors make rounds around 7 AM.  One knows what to expect when you are in the hospital. 

Meals are delivered at the same time each day.  The dietitian comes around to take orders from the kids!  Giovanna has a big smile on her face when she gets to order anything she wants to off of the menu.  Her favorite meal – rice with steamed veggies, chicken noodle soup and applesauce.  For breakfast she got to order Fruit loops and I didn’t even bat an eye!  She loved this part of the hospital stay.

So when I told her what needed to be accomplished before we could come home, she was excited, but also liked the comfortable routine of hospital life. 

So once we got home, it was wonderful to come home to a hot meal that had just been delivered.  Giovanna ate  a lot – almost like she had not eaten all week!  She really did eat, but probably not as much as she does at home.  It was so nice to have all the family together again.

However getting into a routine at home has not been as easy.  We have gotten used to later nights which means that mornings don’t start as early as I would like.  Giovanna is sleeping better, especially since we let her sleep until she wakes up with some pain.  Unlike the hospital which would wake her up every two hours for the meds.  This is helping to wean her off the pain meds or at least relax the schedule a bit.  She is not so dependent on the meds at this point. 

One of the big differences this time is that there are two pin turns each day instead of one.  So trying to figure out when to get her shower, pin cleaning and first pin turn in  during the morning has been challenging.  Then to get the second one in before Gary gets home along with the school prep and teaching that needs to happen – It can be overwhelming at times. 

But we are finally getting the med schedule and pin turns/cleaning down and most of it gets down before Gary gets home.  It is nice to have a quiet evening with little medical stuff to do.



Hospital Week – In Pictures!
October 26, 2008, 10:59 pm
Filed under: Surgeries | Tags: , ,

Here is a pictorial look at Giovanna’s week at the Hospital!

Giovanna packed all her special things!

Giovanna packed all her special things!

 

Time for some silliness with Big Sister!

Time for some silliness with Big Sister!

Some of the "gifts" received!

New Toys!

Therapy is hard work.

Therapy is hard work.