Ups and downs

My previous posts have been from my phone and since I'm not a huge texter they were brief, now that I have my laptop I'll try to  be more thorough. There have been ups and downs and it's been somewhat of a roller coaster.

Jerry's surgery to reconstruct his C Spine went very well, his surgeon was very pleased with the results. The surgery originally was expected to take about 12 hours but ended up taking 15 hours. There were no complications it just took much longer than expected. The surgery started with a halo placement and consisted of 3 phases:

Phase 1 (Posterior)
Removal of hardware
C5-C6, C6-C7 Osteotomies
C2 to T4 Screws and rods placed

In layman's terms this means access the spine from the back remove the hardware that was placed in 2009, cut apart the bone and fusion of C5,6,7 then place the new rods and screws.

Phase 2 (Anterior)
Removal of plate
C5-C6, C6-C7 Osteotomies
C6 Corpectomy
Instrumentation fusion

Again in simpler terms turn Jerry over and access the spine from the font, remove the plate that embedded and fused in to C2 and C6. C2 had to be partially removed, finish cutting apart the bone fusion of C5,6,7. Then completely remove C6 and insert a cage in place of C6.

Phase 3 (posterior)
fusion C2-T4

The final phase consisted of turning Jerry back over and accessing the spine from the back again and completing the fusion from C2 through T4 and removing the halo.

The Surgeon was able to free up and make room for the nerve roots from C2 to C7 as well as decompress the pinch at C7, he also removed a lot of scar tissue. The surgeon also mentioned something that he said was "Interesting", he said that Jerry's spinal sac (sac of fluid surrounding the spinal cord) pulsed which in a normal cord this would be expected however not what he would have expected with a spinal cord injury. Could it be a benefit of the stem cells? ...know way of knowing but as the doc said "Interesting".

Jerry is currently in the NICU at UCSF he remained sedated until the morning after surgery at which time he was extubated (breathing tube removed), he was so relieved to have the tubes out and it was like the voice of an angel hearing his voice and knowing his vocal cords were not damaged in the procedure. Jerry was stable Friday and even enjoyed visiting with some of his friends that are home for the holidays. Friday night Jerry began to struggle with secretions and breathing became much more labored, his blood pressure became to low requiring him to be on two blood pressure medications. The big challenge now is to keep his blood pressure stable and wean off the IV blood pressure med, he cannot leave the ICU until this happens. The blood pressure meds in conjunction with secretion meds causes Jerry's heart rate to run very high which causes anxiety and panic attacks.

Saturday things seemed to improve, Jerry was waiting for his swallow test, his secretions were under control, his pain was under control, his spirits were up. If he passed the swallow test he would of had his feeding tube removed however we never got that far. The machine used for the test was not operating and after about 40 minutes of trying to get it to function the tech decided to switch it out with another machine. After bringing the other machine the tech found that machine was not functioning either. It turns out in the whole campus there are only two machines and both were broke so after an hour and a half of messing with the equipment it was determined the test could not be done. Out of the blue Jerry began to plummet, his oxygen saturation dropped to 70 (normal should be 100) his eyes rolled to the back of his head and he became unresponsive. A team rushed in and worked to stabilize him and bring him back to consciousness, they contemplated re-intubating him at that point but determined the incident occurred because he was over medicated and he had just received a dose of medication that sent him over the edge.  He was not given the wrong dosage, the theory is that the doses were too close together and it built up in his system. He also had a build up of CO2 in his blood that contributed to the event. The doctors determined rather than re-intubate they would try forced oxygen first and it seemed to work. It looked as if he had avoided intubation which we both were so thankful for.

Jerry began having fevers on Friday and until now is still fighting it, the fever ranges from 101 to 103.4, he is up and down that range. The team began running tests to try and determine the source of the fever. It's normal to have a lower fever as the body tries to recover from surgery but not normal to fluctuate and climb so high. The doctor ordered an ultrasound on Jerry's legs and ran blood work, the results of the blood test were good, no infection present, C02 back within normal range, however the ultrasound revealed he had a DVT (blood clot in the right leg). It became a little tricky for the team to treat the DVT because he cannot be on blood thinners right now which would have been the normal course of action. The team did find a medication they felt comfortable using so Jerry is being treated at this time for the clot.

By Sunday afternoon Jerry had been awake 2 days, the team tried a few different medications to help him relax enough to sleep but nothing was working. The problem was the blood pressure medication and secretion medication were elevating his heart rate which prevented him from sleeping and caused anxiety and even panic attacks. They couldn't be to aggressive with sleep or relaxation meds because it could compromise his breathing. Jerry did manage to get about an hour sleep Sunday afternoon and had a small window where he felt OK enough to talk football with his brother, it really seemed to perk him up. Throughout the day Jerry's breathing became more and more labored and his secretions became more difficult to deal with. Jerry was very agitated throughout the night and into the morning.

Monday morning 5 am the doctors had come in to assess Jerry's breathing and weather or not to intubate, his breathing had become so labored he could no longer maintain the 98 to 100 oxygen saturation range he had been maintaining and was now struggling to maintain 90 to 95%. I think the consensus was to intubate  but before they could even prepare for it Jerry's airway obstructed and within a matter of seconds his oxygen level plummeted to 55. There was a frenzy of people running at that point, about 15 people all with different jobs. Some to clear the room, some bringing in machines, some on the phone consulting who knows who, others handling his breathing, someone giving iv meds of some sort, it was a frenzied mass  of organized chaos. Within minutes Jerry was intubated, I stood in the doorway, tears streaming down my face, praying to God to keep him safe while I watched this sequence of events unfold a thousand thoughts running through my mind in a single second. Is this it? Is he going to recover from this? If he recovers will he be ventilator dependent for life? What just happened? My knees felt as if they would buckle at any minute, I could stand no longer, I knelt to the floor and prayed "Please don't take him".

As quickly as it happened it was over, the frenzy of the room died down, "Good job team" was echoed as people slowly filed out of the room with a few people left behind to clean up and put things back in order. Jerry now intubated and sedated I held his hand telling him he's OK now, I was relieved he's now resting comfortably and stable once again but scared of what this meant for the future.

I haven't slept much in the last 5 days about 11 hours total and very broken up. Jerry was now sedated resting comfortably and I began to crash, I laid in Jerry's wheelchair and dozed off. I was out about an hour and a half when I was awoken by Jerry's spine surgeon. I'm so thankful he woke me up to talk, it gave me such a sense of relief to be able to get some of my questions answered. I was so scared that Jerry being re-intubated was an indication of the risk the surgeon warned about of being ventilator dependent for life. The surgeon assured me this incident was not that, if it was damage to the spinal cord from inflammation of surgery Jerry would not have been able to be extubated in the first place. He assured me he believes this intubation is temporary two to three days to let his body heal and rest. The plan is to keep him sedated until he is ready for extubation. The surgeon believes that Jerry may develop pneumonia, his theory is that at some point Jerry may have aspirated, blood tests now show he has an infection, his white blood cells are elevated. As of this minute x-rays don't show a pneumonia but his secretions have turned yellow. The initial testing of the sputem came back negative however it will take a few days to get the results of the culture, for now he's being treated as if he does have pneumonia with two heavy duty antibiotics.

There have been ups and downs, emotions all over the place but I'm grateful for this moment to have Jerry resting comfortably and stable.

Thank you all for continuing to keep Jerry in your thoughts and prayers, I'll post updates when I can.

Katie