First Wound Vac Change on the Heal

Well, we made it through the wound vac change but boy, it was rough! A good 45 min. of very anxious screaming, in spite of the meds. Some of it was anxiety and another part was real pain I know. The nurses did the best they could. And I already had a call from one of them this afternoon to see if we can get a better game plan for Thursday's change.

They were just getting their first introduction to his wound, so they are now able to brainstorm how to better approach it and make the actual process goes faster (there's lots of tape and sponge cutting, etc.). Plus we may try a stronger medicine. I sure hope we can find some ways to improve it...this was one of the most difficult procedures he's had including the 7 surgeries! Believe it or not, one of the worst aspects is all the tape stuck to the little hairs on his leg. They didn't put this one up as high, so it will be a little less big tape to remove next time.

He has complained a little bit about it hurting more and of course the wrap is different and the place the drainage tube comes out is different, so those are some little adjustments he has to make. But the good news his anxiety and pain didn't last too long and after we got home and had some comfort food, he has been fine. He did ask me how long until Thursday.... :(

They tell me the wound looks "good" - not sure how they came to that conclusion as we were all looking at the same thing and it didn't look "good" to me. His tendon is still exposed and there is still blood and an open wound with no skin on it. But I suppose they mean it's healing...which is our goal of course. The pics from today will be faxed, as well as the measurements they took, to Dr. Klingele who will note how it's going and maybe we'll get some feedback.

I asked Dr. King (the trauma doc) today how many stitches he removed...his administrative sec. says 20, but I counted 20 myself in just one location, so I'm sure that isn't right. He sounded like he was "guessing". I'll have to count myself next time we do a bath. I'm sure there are AT LEAST 30 just on the buttocks area (maybe more).

The weekend and Monday's procedure

We had a pretty uneventful weekend so far, except learning to live with "the machine". It has "much power" (ha, that's what we say about it...like toy story, "the claw is in control"), only has so much battery life and has various hic-ups which shut it off. The restart is always uncomfortable for him because it has a vacuum seal and the pressure kicks in when it is on. He gets used to it fairly quickly, but the start up bothers him.

He is still pretty immobile, but he hasn't had any real pain or problem with itching, so that is a great praise. We had Vacation Bible School this week and he actually attended every day. His class helpers were wonderful at getting his wheelchair up and down the steps to and from his class. They had to do it often...Josiah laughed at being called a king! The pictures of him are kind of sad...he is expressionless most of the time, kind of his feelings about his life right now.

My friend Ann's kids came to VBS for a few days and stayed with us. They have been some of Josiah's best buddies. Them being here was a great encouragement and a boost. He is frustrated, of course, that he can't jump and run like everyone else. They did play "mother may I one" day, wheelchair style!

I hope we are on the count down to him being able to walk some...maybe another 5 or 6days (the ortho doc told me two weeks on the 17th, so that would be July 1st). If it were just the bones involved, they would be letting him walk already, but the skin is the bigger issue now and they were concerned about pushing off on the tendon also. He may need therapy to help him learn how to reuse the tendon anyway...

The docs are saying tomorrow's wound vac change could be the most painful. We are giving him a strong pain med before we go. Pray that he will tolerate it well and that the wound is actually making good progress, even better than they anticipate.

What is a Wound Vac?

The wound vac has a clear tube running out from his cast that is attached to a sponge on his heel, which is vacuum sealed, preventing infection and keeping the wound dry. It promotes faster healing at the same time. It runs constantly...sounds like someone has gas all the time - ha! It is housed in a portable bag with a strap that you can sling over your shoulder. It's as unobtrusive as it can be I guess.

We actually have the weekend "off" from appointments. Monday is our next one and it is local, at the wound care center at the local hospital. They gave us a very strong pain med for him to take BEFORE the wound vac change (this is when then pull the sponge off and attach a new one). He has been asleep for all the other changes which were in the hospital on his bottom.

We are on a Mon-Thurs rotation for changing the sponge. The doc tells me it will get less painful as the wound heals.

He is back to wanting to not being seen with his new apparatus...and he is not interested in moving himself around at this point. Pray for his mental comfort with all that is going on. At least stitches are no longer giving us any problems!

After surgery

He's out...the bottom looks great. We don't need to see that doctor again - wha hoo!
The heel needs 3-4 weeks of wound vac treatment...meaning we take a vac home with us and get changes every 3-5 days. Part of the tendon died, meaning it isn't as thick as it should be. It also separated...they want it to heal where it is. It will heal completely. It may permanently affect the strength of him pushing off, etc...but time will tell for sure. In maybe 2 weeks, he will let him walk on the leg...

They are sending us home with lots of equipment and training...and we will be able to do some of the changes locally before we have to come back to Columbus...so that's good. There is a wound care center at our local hospital just five min. away. We aren't supposed to be here too long today.

Steve is doing much better today.

Night Before Surgery

Steve is doing some better today - not 100%, but making improvements - they called it cellulitis and gave him an antibiotic shot plus follow up pills. Praise God we were able to treat it when we did.

We have to be at Children's Hospital at 6:30 AM!! so it will be an early beginning. He has been complaining about his stitches a lot, so we trust the stitch removal will be a relief to him. We don't know how long the surgery will last or anything at this point...but since both surgery teams will be in, I would expect at least 2 hours plus an hour of recovery. I will post from the waiting room as I am able. THanks for praying for us.

Today

Josiah had a pretty uneventful weekend...did pretty good getting around in the walker, doesn't have much pain to speak of.

However, Steve is taking his place for the day :) He has had an "annoying" place on his finger of his left hand for several days, it has had some draining pus, etc... and last night there was a lot of pain running up his arm, today he notices a red line from the finger to his elbow. So, we are going to the Er (our doc can't see til much later). We are assuming some kind of infection that can be treated with antibiotics...hopefully this won't mean an admission or anything. Sigh...God is in control.

In addition, tonight is the first night of our Vacation Bible School 6:30-8:30 and Steve is the main teacher.... We'd apprecitate the prayer.

This week...

We received a call on Friday this past week that they are going to move his surgery to Wednesday for stitch removal so the orthopaedic team can also be there to do remove dead skin on his heel and attach a wound vac. This is good to combine the two, so we only have one more time of being under anesthesia. However, it means a few more uncomfortable days with the stitches in.

He is getting along pretty good...something I said about making his arms strong must have motivated him to want to try the walker more, because he has been trying to get along more with it. And today he told me of ways he can "move himself" from place to place, including crawling and hanging on to furniture. This is good in that it shows he has some motivation to get going again, which he has been kind of lacking of late. We aren't as worried about a fall now because his stitches on the bottom are past popping open being a concern and the doctor said his foot bones are healing really well.

We celebrated Korrin's high school graduation yesterday, which was a great day. It was hard for him to be an observer and not a participant like usual...but he did find some alternative activities, like coloring. And he did go outside several times and seemed to enjoy at least watching.

Doctor Visit

Back from the orthopaedic doctor. All they did today was change the dressing on his foot and look at the skin on his heel. The good news is the bones look good and are healing nicely. The bad news is the skin will require more help to heal, meaning they will apply a wound vac to the skin on the heel for the next few days to a week, to promote healing.

So on Monday when he is having his stitches on the bottom removed, they will also have a team in to remove the dead skin (which is kind of like a large scab) on the foot, remove all the stitches and apply the wound vac. I'm not sure how the "portable" wound vac works...at the hospital, you had to be "plugged in" to e...lectricity for the vacuum part of the wound care to work.

Maybe portable ones are battery operated... We will find out. At any rate, it's a few more trips to Columbus next week. I am grateful all the painful parts will be under anesthetic.

We were in the parking lot and had someone come by and notice J's foot. He asked him how he injured it...when I told him it was being run over by a lawn mower, he shared with me that a friend of his was run over and only lived 3 months. It's a blessing to know our little guy WILL be well and WILL have a full recovery. God has been so merciful. Josiah is happy in spite of it all and adapting well to his limitations.

We are busy getting ready for Korrin's graduation party Saturday. It will be a fun day for us all knowing the progress Josiah has made and that we will ALL be here to celebrate. Come by and join us anytime in the afternoon!

Tuesday, June 15...18 days.

A good last few days...we're in a bit of a routine, though carrying him up and down the stairs and to the bathroom is anything but. His stitches don't seem to pain him and when I asked the dr. about some of them "growing over" with skin, he isn't concerned, b/c they will be removed under anesthesia.

Also, he reassured me the mephalex (sp?) sponge on his burn on his leg will be changed on Thursday and not to be concerned. So, that is good news. He told me today that he liked his wheelchair (isn't that a switch) and that he didn't remember asking me in the hospital when he would be a "normal boy". Praise God for short term memory loss.

Though his dad and I and others will carry memories for a long, long time, God has blessed him to not remember a lot. We have continued to receive the blessings of caring friends' visits, food and cards. We are so grateful for the outpouring of love and support we have received.

Sunday

Josiah attended church today! We carried him from the van to the nursery and then back out...he sat in a chair on a pillow. He got more comfortable with the wheelchair by the end of the day. A friend up the road came and brought a ramp for our steps, so getting him in and out is much easier.

We are all sleeping better in our own beds. He has more appetite today and enjoyed some cinnamon toast crunch, and canteloupe, gifts from friends (he ate other good food too)! He seems more like himself today. Going to church was a "hump" we got over I think...like now that he's been out, going out other places will be easier.

It's wonderful to see him relax and be at ease...I think he doesn't know how to handle so much attention that he gets sometimes when people are inquiring after him. Maybe he is a little TOO relaxed :) but I am still grateful everyday, for his life and increased strength and mobility.

We do have the appointment on Thursday in Columbus, but we are also planning for Korrin's re-scheduled graduation party on Saturday the 19th from 12-5 p.m. I have several friends helping out and Steve's mom will be here, so we should be able to get it all together. I am glad we waited so we can all enjoy her day.

4th day Home

The wheelchair did arrive, so we now have the two options of transporting Joisah around: the walker, which he is still a bit unstable with and the wheelchair. He didn't like the idea of the wheelchair AT ALL the first day an had to be kind of pushed in to it (not literally of course :) ). Now, he has caught on to the benefits of being able to self propel. It is a very smooth and easy to maneuver chair. He has been sleeping in his own bed the last few nights and that has been better for him and me to get better rest. Last night, he slept all the way through and didn't wake up at all.

He doesn't complain too much of pain, but moving him still requires very careful and precise movements. His stitches bother him a lot, mostly itching. Moist heat seems to help. I have to carry him a lot of places still and moving him in and out of the wheelchair is needed, which is definitely strengthening my upper body.

Can't remember if I wrote this already, but the orthopaedic appointment is the 17th to change the dressing on the foot and look at the skin on his heel. They will tell us then what the next move is. He is also scheduled on the 21st to have the sutures taken out. He will be under anesthesia for this and will likely have a lot of pain and discomfort after since they are staying in so long. They decided to leave them in longer b/c as the surgeon told me, his skin wants to go back where it was, so if we take them out any sooner, it could "pop back open" but some of the skin looks like it has already grown over the stitches....

He has a lot of fear of being "seen" by anyone for some reason. He usually covers his head...he did this a lot in the hospital, so I don't know if we will be outside much ...maybe after the stitches are out he will get more comfortable. Because of that anxiety, I'm not sure he's up to much company. He and Micah play a lot, which is a huge blessing. He loves Micah unconditionally and wholeheartedly.

Steve is still struggling with his own thoughts and all that he went through in the rescue process. Pray for him, for peace and restful nights. He is carrying a heavy load that I'm not sure he's been able to let go of for too long.

I am feeling more rested every day and have had some wonderful help from my mother and mother -in-law, friends and neighbors bringing food and gifts for Josiah to help entertain him. We have felt supported in prayer by so many of you - thank you.

Home!

Well our first night in our own home was great...Josiah is set up in Clay's room which is on the first floor. He has a walker for personal transportation and they are bringing a wheelchair sometime today. His foot is completely non-weight bearing, so that's the big issue. His bottom actually doesn't seem to be bothering him too much.

We go back to the orthopaedic doc on the 17th to look at his heel. The skin there doesn't look good on the back of his heel (I saw it). They may need to remove it but are still hopeful it will heal on it's own and the dead skin will "fall off".

They are delivering a wheelchair today, a neighbor is bringing a ramp so it will be easier to get him in and out. He's doing quite well actually, not in much pain as far as I can tell. They are concerned about him being "weaned" off the stronger meds he's been on in the hospital and we've been trying to fill a persc...ription they gave us...but so far, he's not having any probs.

I feel like I've been run over myself...all the stress just catches up to you I guess. I slept in Clay's room (which is where Josiah is sleeping on the 1st floor) on some cushions to make sure how his first night went. He didn't actually fully wake up, but he did cry out several times and I had to hold his hand a little bit. He drifted off without any intervention. He's probably just used to being woken by the nurses every 2-4 hours...his body is on auto pilot (ha).

My mom is here for a few days and Steve's mom just left...I think she will be back when mine goes home, so someone else is running the house enabling me to just tend him and catch up. Our town and friends and church family has been wonderful, so supportive, so "there for us". I know the Lord is hearing us and giving us His strength for all we need to and have faced.

My mother in law did all my laundry :) and the girls are running errands and helping to keep the place running, so I am truly blessed.

Thanks for praying. Our current request is on-going for no infection...and specifically about the heel that the dead skin will fall off on its own and new skin will take its place and we can avoid a graft....

Day 10

Josiah had a comfortable night overall, but his pain level is still higher - he is using his pain button a lot. His little backside looks like a railroad docking station....I'll have to ask someone how many stitches.

The Orthopaedic doc says they will see him in a week after we go home to take a look at the skin on his heel. If it is infected, it will have to be removed. If not, they will leave it alone, trusting the body to fix the skin itself. They also want to get him up with a walker today...not sure how he will tolerate that with the increased pain in his bottom.

Maybe he will be allowed to eat today. The Trauma doc said 24 hrs. possibly.

Mom didn't sleep too good; noisy interruptions at 11, 12:30, 4:30, 6:00, 6:10, 6:30, 7:00 and 7:40!!!

Continue to pray about no infection, the skin on his heel to heal itself so we won't need skin grafting or another procedure (removing dead skin) in a week. If we go home tomorrow (Trauma doc is still saying this), we will be back to Columbus in a week for the Ortho and 2 weeks to have the stitches out...so unfortunately this won't be our last visit.

I have seen the buttocks wound now several times. It doesn't look to me like he will need plastic surgery. His contour looks pretty good. Maybe a little smaller on that side, but not so awful bad. We'll see...at any rate, that problem is down the road to face if necessary.

My parents are coming to visit today.

My verse for today..."love covers a multitude of sins." :)

Just saw the Trauma doc...he is completely stitched closed! Now, we wait. Approx. 24 hours to 48 for him to "check" the wound for infection and we will continue no food, only liquids and the immodium until then. He is saying if all looks good, maybe even Wed. night we could go home.

It's all contingent on whether there is any infection. The ENTIRE wound is closed, even the small area he thought he wouldn't be able to close. PTL! We won't get our hopes up yet...but he did say the "H" word (Home)- yippie!!!

So, our prayer is that there will be no infection in the wound. If there is, it's gets much more complicated...meaning they have to re-open it. He is already been on liquid antibiotics since we've been here, so they can't give him any more that way. He said we would need to come back in two weeks to take out the stitches and it will require putting him out again b/c there are SO MANY (boo hoo) stitches and they are hard to get to...too much pain to not be sedated.

Just saw the orthopaedic doc...there is an area bigger than a silver dollar on ankle by his achelles tendon that is darkened and hard...he opted not to remove it b/c that exposes the tendon and could cause damage to it. The skin could still heal itself to some degree he said...if not, it still needs time to prepare itself for a graft (the body is very cool all it does). So, that's a wait and see game. We don't know about care for this wound yet b/c the reg. doc that has been doing his care had a funeral and will be back tomorrow. So, we'll know more then. At any rate, this will not hold us up from going home.

Looking back at one week over

For the first time since being here, Josiah rolled to his stomach on his own. They scaled back his morphine and he still hasn't used the button for self-medication. He doesn't complain of pain much, just lots of discomfort...his foot is still pretty bothersome. Mom didn't sleep too great last night...another round of new nurses with a slightly different routine.

Not really expecting much to go on today except maybe some wound care and dressing changes...most people, even therapists and activity personnel will be "off" I am told. That might be a good thing as it's usually quite a revolving door here..."someone" always wants to talk or look at something. Steve encouraged me to read Philippians 4 today....lots of words of blessings and promises of God's provision.

"I have learned to be content in whatever circumstances I am...I can do all things through Him that strengthens me...And my God will supply all your needs according to His riches in glory in Christ Jesus...And the peace of God, which surpases all comprehension will guard your hearts and your minds in Christ Jesus." Amen

Steve will be here after church today and plans to stay over.

June 5, 2010 a.m.

We had a pretty good night except for some malfunctioning machines that beep when you don't want them to, just the "usual" interruptions. The OR doctor we saw today said there is a small piece of skin on the back of his ankle that still doesn't look good. It may need grafting if it doesn't heal on its own...that is something to ask the Lord for. They have him on immodium, but his bowels are still in action, though it is liquidy...of course mom is his favorite "cleaner upper", which makes for a lot of up and down. He told me I needed the exercise once, when I mentioned being tired of doing it - ha. I suppose it's true :)

His sisters will be coming for the first time today...so that will be nice for me to see them. I miss all the kids. We have been e-mailing and calling some, but it isn't the same. Alayna pitched her first time at softball the other night and I wasn't there, boo hoo. Micah went home yesterday...I think he needed a break. I enjoyed a nice long break while Steve was here...saw the sun and felt the breath of the wind on my face - ahhh. They have nice big showers in the Family Resource Room, so I took advantage of that too. It was a very refreshing afternoon.

We actually made it into a wheelchair in the afternoon and went outside - on the 3rd floor they have a play area. There wasn't much J. could do of course, but he counted while Micah raced, and tried to throw a b-ball to Steve so he could make a basket. It was good for him to see the outside as well. It's not an easy trip dragging his pole, watching for i'v. cords to get tangled, but it was worth the trouble.

Just came out - they closed 85% of the wound!!! Unbelievable by human standards since he expected to be able to do a "couple" more stitches. If the wound vac falls off we are leaving it off!!!! yeah!!!!!

June 4th

Josiah was taken to surgery early due to a cancellation. This will just be a wound vac change and foot dressing change, unless the doctor can pull his skin together on the buttocks wound more than he is expecting. We had a pretty good night of sleep. The nurses gave me an egg crate to sleep on my very hard bed, so it was like heaven when I laid down. They worked really hard to leave us alone and we had very minimal interruptions between 11 and 7:30...it was nice to have some privacy as all day it is like a revolving door...everyone wants to be helpful, but it is tiring to constantly be discussing with many different groups. They give him a light sedative before going down the hall to the OR which helps him a little, but it is still a VERY tearful good bye at the door - today he was clinging to me and begging me to go with him. I have to return the laptop I borrowed at 10 a.m. so I don't know when I'll get back to the computer, but will try to update later. Steve will be with me after the surgery and maybe I can take a break later when things are stable. Thanks for praying. I read Psalm 46 today...Something about everything falling apart...God is my refuge and strength, my ever present help in times of trouble....and later, be still and know that I am God.

Today, June 3

This started out as a great day...Josiah was happy, pain free and showing some mobility, able to lift each of his legs on his own (even though his right is so heavy). He has a 6 inch burn on the outside of his left shin. The dr. says this is superficial and won't require treatment. He also has a burn on his left hip being treated the same way. Yesterday he had a complete clean out of his colon to attempt to not infect his cuts on his bottom. Today, he is just running liquids straight through him and the colon is NOT stopping yet, in spite of several doses of immodium. I am told they are going to double the dose tonight. The catheter is out, which is more comfortable, but with the amount of fluid going in, the need to empty is VERY OFTEN...might be an interesting night of sleep. Anyway, they found some feces attempting to get under the wound vac, which required a VERY painful clean out procedure. It is so hard to watch and hear (he cries loud and hard). That process over, he is happy, enjoying some cards and gifts from a few friends. He has lots of movie choices and plenty of clear liquids, though I can't talk him into the broth choices yesterday. He only ordered lemonaid from the "food service" all day. Thankfully the nutrition and liquids going in through the PICC line (a permanent IV in the arm through a larger vein) must keep him satisfied somewhat. He does ask for food occasionally, but

Josiah's Accident May 29th 2010

On Saturday, May 29th, our lives were turned upside down! Micah was mowing, Josiah playing on the trampouline, Steve mulching, Lydia was at Walmart with Steve's mom. In a crazy instant moment Josiah ran toward the mower, slipped and fell under it. So Josiah and Lydia have been at Children's hospital in Columbus ever since. He has underwent 6 surgeries (2 together each time with different teams of surgeons) to treat 6 broken bones in his right foot, a few superficial burns (right leg and hip) and a very serious deep wound to his buttocks. The initial surgeries just basically patched him up and allowed them to attach a wound vac, which is a silver nitrate patch with a plastic seal and a drainage tube designed to promote healing and keep it dry. The cut goes all the way down, almost to the anus, making it extremely difficult to treat and to keep dry and un-contaminated by feces. He hasn't had a drop of food since we've been here and only a few cups of liquid by mouth. The rest of his hydration comes from i'vs and nutrition in bags dripping into his veins. The days are just one big cycle of treatments and doctors and nurses. This is a great hospital and they are super accommodating and parent friendly, however, going home isn't on our radar yet....