Fearfully and Wonderfully made


Good Bye Chocolate Mint Candy Cane Cast!
February 10, 2009, 8:29 am
Filed under: Sugeries | Tags: , ,

Giovanna has had two casts with the last Ilizarov procedure.  Her first was a traditional Candy Cane strip pattern for Christmas, which was appropriate since she got the metal frame off before Christmas.  It was a wonderful Christmas gift.  Her second cast came shortly after Christmas.  She chose a dark color, I think it was officially maroon with green strips.  Her Sunday school teacher referred to it as the Chocolate Mint Candy Cane – an excellent description of the color!

Shortly after returning from Thailand it was time to take off the cast.  This is not my favorite part of the procedure.  While it marks the end of the process, there are some parts of this process that are really not fun.  The buzzing of the saw has always scared Giovanna in the past – this time it was not as bad, but still a bit scary.  However the hardest thing about this part is the hyper sensitivity of the foot with the cast off.  Not to mention the smell!  After having ones foot in a cast for just over 2 months – enough said!!  So when it came time for Chaz to wash off her foot, you would have thought she was being tormented!

She spent the rest of the morning in the wheel chair, afraid to put any pressure on that foot.  She had x-rays to check the position of the foot, met with PT for exercises, saw the doctor who was pleased with the position of her foot and orthodics to have her AFO fitted.  The doctor said she had to walk before she could leave the premises.  Talk about putting down the challenge – in the past it has taken several days for her to walk on her foot post cast.  So while in orthodics and waiting for the final fitting of her AFO, I started touching her foot and getting her used to pressure on it.

The time final came for her to walk with the AFO.  She wheeled herself to the parallel bars, got the wheel chair lined up, brakes set and then took off and walked the length of the bars – twice!  She then took her wheel chair and wheeled it back to the parking area.  On the way, Dr. G saw her, left a conversation and came out in the hallway to watch her.  He was pleased.

Now to work on stretching and getting things like the Achilles Tendon moving a more smoothly!



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. 



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.

 



Pin Turns
October 25, 2008, 8:35 pm
Filed under: Surgeries | Tags: ,

Yesterday was the first day of pin turns.  Dr. G. came in on his morning rounds and said the swelling had gone down enough to start the pin turns.  He would be back later in the day after clinic.  So we waited and did some PT and a walk. 

When he came back around 2:30 to attempt the first turns, Giovanna literally fell apart and panicked big time.  She threw such a fit that Dr. G. walked out and said, “I can’t do it.”  He said he would be back in an hour. 

During that hour, I talked with Giovanna and let her know what was going to happen.  She was not happy.  I think that she was still trying to get used to this thing on her leg and then there was the blisters that were getting bigger over time. There was also fear that it would hurt.  It was not a pleasant experience.

I also talked with the nurse and we were concerned about the fear factor which reared its ugly head.  The nurse suggested that we give her some pain medication that would help to reduce the pain as well as the anxiety.  We gave it to her about 30 minutes before the Dr. was set to return.  His phone conference ran late and she was able to get her other pain med as well.  By the time Dr. G returned, she was very calm and relaxed.  She was still alert enough to ask questions. 

For this go round, there are three pins (nuts) that need to be turned.  One to draw the front of the foot up and two to lower the heel.  The turns are done twice a day with each pin (nut) being turned a 1/2 turn each time – one full turn per day.  Over time the heel will be lowered enough to meet the raising of the toes – thus making the foot flat and should help her gait.  During this process of turning the pins, the bone is actually pulled apart which sends signals to the brain to lay down more bone – thus new bone = longer and more bone.  It is amazing to see how God designed the body to work.

The ride home from the hospital was quiet as Giovanna was pretty tired and heavily medicated.  She slept for the first hour or so which gave me time to get the prescription for pain meds filled and figure out the med schedule.  It is not easy to keep the pain med schedule straight.  She takes something almost every two hours to manage the pain.  We let her sleep at night until she wakes up unlike the hospital that woke her up every two hours for meds.  This will be one way that we can  begin to wean her off the  pain meds.

Today once Giovanna had her shower, we did the pin turns and they went much better.  It was helpful to have some distraction, like her brother playing a game with her.  Life will get easier over time.

Continue to pray for the swelling in her foot.  It has begun to rescind, but it is not gone.  Also the blisters are continuing to grow – which is freaking Giovanna out.  There is too much wrapping on the foot, but Giovanna is reluctant to shed much of it.  We are removing it for the night in the hopes that her foot will cool off a bit and reduce the swelling and the size of the blisters!



Pin Care 101
October 23, 2008, 7:05 pm
Filed under: Surgeries | Tags: ,

Here is the disclaimer – this post could be hard to read as it talks about the pin cleaning process – if you are sensitive to these things, be careful. 

The first time that that Giovanna sees the fixator without any dressing and on her leg for the first time is always traumatic.  Today was no exception.  She had just been out to feed the birds and was a bit chilly from the short walk.  So naturally the shower seemed like the best option to warming her up. 

Nurse Carol and I worked out the details of what would be the best option for her – it was decided that the shower was the best option as it had a bench that she would sit on.  We got her into the shower and took off the dressings – she freaked when she saw it and panicked when she got to the shower and there was not pillow to rest her foot on.  It seemed like it took forever to calm her down.  Finally she calmed down and began to enjoy the shower.

After the shower it was time to clean pins.  Here is a glimpse into what life will be like for me over the next 2-3 months.  The fixator is held onto the leg with a 2 bolts (in the tibia bone) and a series of wires that run in and out of her leg and to the circular parts of the fixator.  Each time a bolt or wire enters through the skin, it is call a pin site and this needs to be cleaned daily.  It is through these sights that infection can enter into the body and cause all kids of chaos. 

To clean the pins, sterile cotton swabs, (think q-tips with a long wooden handle), are put into a steril saline solution.  Then one cotton swab is used for each pin site.  The goal, at least for this first cleaning is to remove as much of th dried blood from the surgery as possible.  The warm shower takes off a lot of it, but there is still some on the skin near the pin sites.  The cotton swab needs to go around the pin site completely, pushind the skin down to keep it from “tenting” or climbing up the wire.  I didn’t count the number of pins today, but last time there were about 20-25 pins.  There are about the same number this time, I think.  Each pin site has to been cleaned at least once per day.    This generally takes about 20-30 minutes.  Today it took a bit longer as I was asking some questions and remembering the steps to cleaning.  Giovanna was calm and was still while I cleaned all the pins.

Some of the sights were oozing a bit which made things interesting.  The incisions were still caked with blood and in some places there were some blisters covering the incisions.  This was a new development -there were not blisters yesterday.  The pediatrician was called in to verify what we thought was true – the blisters weren’t there yesterday.  According to Dr. S. the blisters are the best sterile protection that the incisions can have – the goal is to keep them intact.  If they pop, then there are other issues and the will need to be treated. 

The blisters are caused by the continued swelling as well as sweating due to the the wrapping that was on the foot.  When Dr. G. cam in tonight to begin the distrations or pin turns, he looked at her foot, the blisters, and the swelling and decided that she was still to swollen to start the pin turns.  This puts getting discharged by Friday in question.  The swelling has not gone down much in the past 24 hours – it hasn’t gotten worse, but the improvement is miniscual. 

So we wait and put lots of ice on her foot.  Dr. G’s asistant, put some dressings on the incisions that were oozing the most and put an ace wrap on her foot to put some pressure on the foot and hopefully get the swelling to begin to rescind. 

Giovanna now has to stay in her bed, with the foot elevated and two ice packs on her foot.  She is crabby and wants out.  The only way to get the swelling down is to keep her foot up with ice.  The ice packs are now wrapped to her foot with an ace wrap.  The night should prove to be interesting!