mark.veerman.com

July 13, 2007

Courtney eye surgery

It's been a while since I posted anything about Courtney. She just had a follow up surgery on her eye, so now's as good a time as any.

Yesterday, Courtney had an eyelid lift. This is generally a cosmetic procedure, but in Courtney's case it may help her field of vision. Since her eyeball is set further back in the socket than the other eye, the eyelids don't have as much room to open. This eyelid lift could allow her to see slightly more and might help with peripheral vision issues. There might also be purely aesthetic benefits. Not only is her damaged eye sitting further back in the socket, it's also slightly lower than the right eye. This lift might help to mask either the depth or that height disparity. I'm not really sure which; only time will tell.

The surgery went well. She was wheeled in at 2:30PM, and wheeled out at 3:25PM. She was awake when they wheeled her out. She didn't sleep too well last night and this morning was pretty queasy and had a headache, but this afternoon she was feeling a lot better. Her eye is pretty swollen, so it's too early to tell what sort of benefits may be realized. I would guess that she's only opening the eyelid about 60%. Does that sound familiar? Thankfully, this surgery was under much better circumstances, and a lot less duress.

The surgery was performed by an octal plastics surgeon who specializes in eye-socket surgeries. He was recommended by the ophthalmologist we've been seeing at UVA, and we've been very happy with him. Before the surgery, he pointed out that her damaged eye might be slightly further away from the nose than the good eye. He said that he would look at the anatomy between the eye and the nose to see if there was any way to pull the eye closer to the nose. During the eyelid lift, he poked around and discovered that there was bone there instead of scar-tissue or normal tissue. I think this was considered likely, so we weren't surprised by that discovery. He explained that there was a procedure that would involve shaving away some of that bone to give him room to pull the eye closer to the nose, but obviously we need to wait until we can evaluate the results of the lid-lift before discussing that option. Regardless, this lid-lift afforded him the opportunity to see things first hand, and could help to inform future decisions.

All of this could make it sound like Courtney has significant disfigurement, which isn't true at all. If you didn't know Courtney before the accident, you probably wouldn't notice the eye disparity. It does show up in photographs which can be discouraging to her. In person though, Courtney looks just as beautiful as before the accident. She would probably disagree, but believe me, it's true.

On Wednesday she had an appointment with the orthodontist (she's had braces for almost a year now), and found out that she might be able to get the braces off soon. She'll be thrilled to eat without worrying about food getting stuck in her braces. Now that the teeth are back where they should be, we can ramp up the process of getting a permanent implant for her missing tooth. The orthodontist was able to give her a fake tooth that attaches to the wire like the other teeth and sits in the void looking very normal.

All of her scars have healed up nicely. It's amazing what a year can do to subdue the redness in a new scar. You can still see them, the most prominent being the trachiostomy on her neck, but they have faded dramatically. At some point we might opt for another surgery to make them even less noticeable, we'll see.

With the exception of this weeks detour, Courtney is mostly back to pre-accident health. She still has peripheral double vision, very minor facial nerve issues where touch induces a tingling sensation, and she doesn't smell very well [UPDATE: By this I mean her nose doesn't pick up as many scents, oops]. With the braces, implant, and a few more surgeries, it's likely that this accident will continue to alter our lives for at least another year, but from my perspective it's manageable -- and very normal. Courtney continues to astound me with her strength.

I think that's it. If you have any questions, post a comment or email me. Thanks for the prayers.

[UPDATE: Courtney's mom is here helping out with the kids and around the house. That's been a huge help.]

Posted by mark at 3:19 PM | Comments (0)

September 12, 2006

Courtney update

Wow, it's been over two months since I last posted about Courtney. Sorry about that.

Here's a quick summary of the recent medical issues and doctor visits over the past two months:
1. Of the 3 root canals that were incomplete, she now has two temporary crowns and is waiting on the permanent porcelain crowns.
2. She recently had a chipped tooth fixed.
3. Our main dentist sent her to an endodontic specialist to have some of her teeth checked out with some fancier equipment, and he discovered that 6 or 7 of her teeth on the top (even ones that looked fine) don't have any nerve sensitivity which means that eventually they'll need root canals if the nerves don't heal. We'll probably have to wait 6 months to a year before doing root canals to give the nerves time to regenerate. (see insurance note below)
4. I think she still has one partial root canal that's not finished, and I think the endodontic dentist is going to handle that one, but I'm really not sure.
5. No progress on the missing tooth implant yet. I'm not really sure why we don't have an appointment ... I need to get on that!
6. Her double vision when looking peripherally, including up and down, hasn't improved. Because of this, there are daily tasks that require her to move her neck more in order to get a square-on view of things. This extra movement was starting to cause acute physical pain in her upper back. She went to a massage therapist to see if that would take care of the problem, and while it helped, it didn't eradicate the problem. She then went to her doctor and he prescribed some muscle relaxants and within 3-4 days the pain was gone and she was able to stop taking the medication and thankfully she hasn't had a relapse in the past 2 weeks.
7. The scarring is pretty minimal, and has healed up really well. The most obvious scar would be the trach scar on her neck, but that doesn't bother Courtney all that much.

In conclusion, Courtney is really doing awesome. She has moments of fatigue and still needs rest on *some* days, but even that is not the norm. Granted, she's usually exhausted by the time I get home from work, but her life is back to it's normal fervor and she seems to be managing it well. In fact, if you didn't know about the accident, it's likely that you would notice the scars, and possibly the eye-socket, but you wouldn't have ANY idea how recent it all was. Courtney's spirits are positive, and she is back to helping out her friends, cooking meals, driving, and being the sweet encouraging person that I married eight years ago today!

James has started half-day kindergarten at a local Classical School and is really doing well. His kindergarten teacher is phenomenal and James is thriving. Emma has half-day preschool two times a week and is doing great.

On the health insurance front, I've managed to keep everything organized, despite the fact that the neatly stacked pile of bills and insurance statements is about 3 inches high. Most of the medical bills have been paid without question, but there are two big ones that they've balked on while waiting to make sure that auto insurance options have been exhausted. I'm confident that I've convinced the health insurance company that they should pay the balance of those bills ($133,000), but it's nerve wracking to know that they still aren't paid. I call at least once a week, and they've assured me that they are moving forward. Also, we have until October 14th, six months from the date of the accident, to have all medical related procedures *started* in order for them to be valid. That would include the root-canals and implants. As noted earlier, we don't want to do the root canals prematurely just in case the nerves decide to heal, so I've got to convince the insurance company that the consult visit was the "start." Please pray that all continues to go smoothly and we don't hit any unnecessary bumps.

Thanks again for all of your prayers, if you haven't seen her lately, you would be amazed at how far she's come. The double vision is still the biggest issue that Courtney is facing. It has made reading very difficult and not very enjoyable. It's still possible that this could improve, so please pray that it does.

[UPDATE: As noted in the comment below, Courtney DOES indeed have an appointment with the implant surgeon.]

Posted by mark at 3:40 PM | Comments (8)

July 10, 2006

Update on Courtney

I know, I know, it's been waaaay to long since my last update.

People haven't been complaining as vociferously when I don't post, so it was easier to ignore. However, people have started asking again, so here's the latest. It may not be as structured since I have a lot to cover. If in fact you thought my previous posts were structured.

Courtney is finally chewing a little, but still has quite a bit of discomfort in her mouth. She can barely open her mouth to insert two stacked fingers. By comparison, I can insert 4 (don't try this at home). She has two partial root canals that still need to be completed, and we haven't started the process of getting implants yet. The last time she went to the dentist was a few weeks ago, and he discovered that there was a dead sound when he tapped her four lower front teeth with his dental tool. In other words, on good teeth there was a nice, 'ting' sound, but the four front teeth sounded dull. He's not really sure what that might indicate, since there weren't any visible fractures on the x-rays. He's talking with some oral surgeons to see about getting an appointment with Courtney. It's possible that these teeth will need to be replaced with implants as well.

The 3 root canals that she had started (1 complete, 2 partial), served to reduce most of her acute nerve pain, however she still has a toothache-type throbbing that happens periodically throughout the day in the lower-right jaw that is a mild concern. It's in the neighborhood of the fracture and titanium plate. There's also a major nerve in that area, and Courtney still has a few chipped teeth that aren't fixed yet, so it's possible that the hot/cold sensitivity of those teeth is causing the pain. I doubt there's a serious issue with the fracture and/or bone.

Courtney also mentioned recently that her molar teeth on the back right aren't really touching. When she bites down, the left side comes together, but not the right. When you look at her teeth it definitely seems like her lower jaw is slightly lower on the right. In other words, if she partially opens up her mouth so that you can see the upper and lower teeth with a little gap in-between, the gap is larger on the right than it is on the left. I haven't had a chance to mention this to Dr. Park yet.

Courtney had a visit with the Opthalmologist a couple of weeks ago, and her eyeballs are back to seeing 20/20 which is great. Her eyeball motility (the movement in the socket) is also good. She still has pretty significant double vision looking up/down/left/right, so she has to look straight down to eat and read. Long term, this double vision is probably the single biggest concern. The opthalmologist still didn't think that moving the right eyeball forward was a good idea. In fact, when I asked if the depth issue was the reason for the double vision, he said that it wasn't. The scar tissue from the accident and surgeries has damaged/restricted the eye muscles and that the double vision was almost entirely muscular. There's a chance that as the muscles strengthen the double vision will improve. Please continue to pray that this will be the case. I think there's a surgery that they might be able to perform on the eye muscles, but obviously if things can improve on their own over the next 6-12 months we need to wait. From a purely cosmetic standpoint, he mentioned a surgery that they could perform on her good eye that would reduce it's depth to match the other eye, so that it wasn't as obvious. That surgery is relatively safe, and is usually employed for people with thyroid issues (which can cause bulging eyes). That would be 6-12 months down the road, and I'm not sure that we're really considering that.

This week, Courtney went to church for the third time since the accident. After not being able to go for such a long time, she's really loving it. A friend of ours recently had a baby, and was sitting to my left holding the baby. At one point during the service, Courtney who was sitting on my right, tells me that it looked like our friend has twins. While this serves to underscore the double vision problem, it was pretty funny.

The numbness in her face is a lot better. I think she still has tingly spots on the tip of her nose and chin, but for the most part it's improving. She mentioned last night that when she rubs the scar on her eyebrow, the spot on her scalp that was previously numb starts to itch. I'm betting that's a good sign of nerves regenerating. I haven't mentioned this earlier, but her sense of smell is still pretty limited. She can smell things like a grill cooking hamburgers, but couldn't smell the leather smell from her new minivan. Hopefully that will improve with time as well.

All of her scars are healing pretty well. The lip scar, and the trachiostomy scar both have a lot of scar tissue. Dr. Park mentioned earlier that he will probably "do some work" on those scars, whatever that means. When Courtney swallows, the trach scar moves and the skin bunches up on top of the scar. I'm sure she would love to make that less noticeable.

Courtney has started driving a little. She only goes to places that are accessible by secondary roads, and she is being extra careful. The prepared meals that were being delivered to our house by friends ended with June, so we're on our own. Now that she can make it to the grocery store, cooking meals is feasible, but I'm sure I'll be grilling an/or eating out a lot.

As far as Courtney's spirits, she's holding up pretty well. She still gets really tired, and needs a period of time every day for rest. As I mentioned previously, it's difficult knowing that some of the facial changes are likely permanent. As all of you know, Courtney's strength is her personality, and thankfully that hasn't changed one bit. I'm really proud of her and how she strives daily and has succeeded up to this point in keeping everything in the proper perspective. However, it's not easy and she would appreciate your continued prayers. A good friend of ours wrote something to the effect that our scars only serve to point to Christ's scars and the beauty of His sacrifice. That's exactly the sentiment that Courtney is trying to hold on to.

On a sad and unrelated note, Courtney's grandfather died last night. While his health wasn't great, it was still somewhat unexpected. We're leaving tomorrow for the funeral on Wednesday. We would appreciate prayers for her family and for our travels.

Posted by mark at 9:44 AM | Comments (7)

June 9, 2006

Dental update

Courtney has been experiencing a lot of pain in her mouth every time she eats from the exposed nerves in 3 teeth. Three nights ago, it seemed worse than usual, and I was concerned that something might be infected, so thankfully our family dentist was able to squeeze us in on Wednesday morning. First, he took a panoramic x-ray, and gave every tooth a thorough inspection. Surprisingly, the xray and his examination concluded that she only has ONE completely missing tooth (root and all). Aside from the missing tooth, there were 3 badly broken teeth, and a few other chipped teeth. He said that Courtney would probably only need one implant, and that he would be able to fix the other teeth himself. A couple of the broken teeth were snapped off at or just above the , but I guess there's still enough material there to work with.

Overall, it was a great prognosis. In order to fix the pain, the dentist said he had to do root canals on the 3 broken teeth. Given Dr. Park's rather stern warning about avoiding "invasive" dental work for 3 weeks, he called Dr. Park's office on Thursday to get authorization for the root canals. Thankfully, he got approval, so he came in on his day off this morning to do the root canals (During the summer, he takes Fridays off). I dropped Courtney off at 8:00, and when I picked her up 2 hours later, not only did she have the root canals, but she also had some temporary teeth. The dentist was able to use filling material to build up some semi-permanent teeth over the recent root canals. They look surprisingly good. I didn't realize how powerful that filling material was. Courtney now has most of her smile back, which if you know Courtney, was an integral part of her personality. It was a wonderful surprise.

Thankfully, he had a previous panoramic xray from a prior visit, so he was able to see a before an after picture of the damage. One of the cool things about the new panoramic x-ray was that you could see 3 of the titanium "plates". The one on her right jaw, and two on her lower right and left cheeks. They actually looked more like flattened links in a chain, or a series of connected ovals. Nothing like what I had expected.

Also, a couple days ago, Courtney realized that one of the wires from the arch bars had been missed, but thankfully it's not bugging her too much. The dentist was planning to remove it today, but ran out of time. We still have a normal cleaning scheduled for next Tuesday, so we'll get it removed then.

Courtney continues to make progress. While my reports have always been optimistic, and rightfully so. The fact remains that she's probably not going to be operating above 80% for a few more months. She can see pretty well looking straight forward, but her right eye muscle quickness and peripheral vision is still pretty impaired. Also, while she looks fantastic, especially now that she has some teeth, there are going to be some permanent physical changes to her face that will obviously take some getting used to, and we're still praying for continued recovery. Obviously this is emotionally difficult for Courtney. We would both appreciate your continued prayers. Seriously, I say this a ton, but not nearly enough, we have been truly touched by the tremendous love and support you have all shown for our family during this time. THANKS!

Posted by mark at 1:47 PM | Comments (3)

June 2, 2006

Adios arch bars

The infernal arch bars are gone. We just returned from our latest visit to Dr. Park's office. The procedure took about 30 minutes, and was pretty uncomfortable, but Courtney is thrilled to have all of the metal out of her mouth. It turns out that they are indeed "wired" and not stitched through the gum and above the molars. She has some other stitching in her mouth from where they went in surgically for the other repairs that will eventually fall out on it's own. Initially, I wasn't sure if that was related to the wiring of the jaw or not.

As it turns out, we AREN'T going to do another surgery on her eyeball. Dr. Park was concerned that any "futzing" with the eyeball could easily upset the level, and cause double vision. He said that usually a sunken eyeball is also lower, so the procedure does two things at once: move the eyeball up and out. In Courtney's' case, the eyeball is only sunken and not lower. Also, I guess it's pretty difficult to force an eyeball to move forward against the will of the eye muscles, and there's a good chance that it won't work. Given that likelihood, and the possibility of creating residual issues, it was a pretty easy decision. If they had done the surgery, the reason for doing it sooner rather than later is that the muscles in the eyeball will contract to the new sunken position and be much more difficult to move later.

Regardless, we aren't going to do the procedure, and are perfectly happy with the results. While I'm sure Dr. Park would have preferred to not have a slightly sunken eyeball, he's VERY pleased with the overall results of his first surgery. As he was leaving the exam room, he took a look back at Courtney and said something to the effect, "Sorry, I'm just patting myself on the back -- she really looks fantastic." That really helps to underscore the nature of the reconstruction and how far Courtney has come.

We're allowed to schedule a teeth cleaning and an x-ray with the dentist, but he's not allowed to do any extractions, impressions, or other invasive dental work for 3 weeks. We forgot to ask about when Courtney can start chewing again, but I'm betting it will coincide with that time frame. I'm planning to give them a call.

We're going to see Dr. Park in 2 months, and he mentioned that the next step with him will be some minor cosmetic procedures on two of the scars - the one on her lip, and possibly one on her nose. He seems pretty happy with the big scar over her eyebrow. I'm not really sure how soon that will be.

Courtney has continued to open her mouth more and more, but she can still only open it about 30-40%. She is concerned that she might not be able to open it fully, but I think we'll get there eventually. It was somewhat disappointing to know that they can't correct the eyeball depth, but knowing that we don't have another surgery and that there isn't the possibility of any setbacks from the surgery, is a welcome consolation. Courtney continues to get stronger and stronger every day. She's still experiencing some dizzy spells, and doesn't really trust her right eye yet, so she's pretty far away from driving.

Posted by mark at 11:49 AM | Comments (3)

June 1, 2006

Interview with me

Here's a link to the interview with me 4 days after the accident:

04-18-2006: Interview with Mark (14 MB)

I'm posting "with assumed courtesy" of:
WSLS News Channel 10
401 3rd Street SW
Roanoke, VA 24011
540-981-9110
Aired on 4-18-2006

[ UPDATE: I've encoded these vides to the AVI format which requires the DivX codec. You can download it from this page:
http://www.xvidmovies.com/codec/
Actual link to file is here: (http://download.divxmovies.com/XviD-1.1.0-30122005.exe)

Or you can download it here:
http://www.divx-digest.com/software/divxcodec.html#downloads
Actual link to file is here: (http://www.digital-digest.com/software/download.php?sid=622&ssid=0&did=1)

After installing the codec, you'll need to restart Windows Media Player. Thanks Nate! ]

Posted by mark at 1:03 PM | Comments (4)

May 31, 2006

Interview with Courtney

For those of you who missed the short window of opportunity to see Courtney's television interview on the WSLS website. I finally managed to rip a copy of the interview with Courtney. I've encoded two options: A high resolution option (43MB), and a low resolution option (14MB). The low-res version is perfectly adequate, but I'm posting both for long-term archival purposes.

I don't know too much about video formats, but hopefully you'll be able to watch it without too much difficulty. NOTE: I wouldn't suggest trying to "stream" these files (although it *might* work if you're patient). I would recommend downloading first, and watching offline. On most computers, if you hold down the right mouse button and click the link, you'll have an options to "Save target/link as". If you're on a Mac, and don't have a right mouse button, I think you can hold down the CTRL key and click the link to get download options.

05-15-2006: Interview with Courtney (14 MB) (high-res link is at the bottom)

I'm posting "with assumed courtesy" of:
WSLS News Channel 10
401 3rd Street SW
Roanoke, VA 24011
540-981-9110
05-15-2006 6:00/11:00 PM broadcasts

I'm also planning to post digital copies of the other news reports as I have time.

05-15-2006: Interview with Courtney (43 MB)

[ UPDATE: I've encoded these vides to the AVI format which requires the DivX codec. You can download it from this page:
http://www.xvidmovies.com/codec/
Actual link to file is here: (http://download.divxmovies.com/XviD-1.1.0-30122005.exe)

Or you can download it here:
http://www.divx-digest.com/software/divxcodec.html#downloads
Actual link to file is here: (http://www.digital-digest.com/software/download.php?sid=622&ssid=0&did=1)

After installing the codec, you'll need to restart Windows Media Player. Thanks Nate! ]

Posted by mark at 6:39 PM | Comments (0)

May 27, 2006

Unwired jaw

Courtney can now open her mouth. Yesterday, at Dr. Park's office, they removed the rubber bands that held her jaw together. I had misunderstood Dr. Park, and she didn't get the arch bars removed. Since the jaw has been shut for 6 weeks now, it is important for her to slowly stretch out the jaw muscles. I'm guessing they don't remove the arch bars because the muscles in the jaw are so tight that they don't have the clearance desired for extraction. Even if Courtney *could* fully open her mouth, and felt like chewing, she's not allowed. Dr. Park said that he wasn't worried about the strength of the jaw anymore, but really the facial fractures above the jaw. Since they were so many plates, it might take longer to fully mend. However, Courtney was able to finally clean the other teeth. I don't think Courtney's in the mood to French kiss right now, but it sure is nice to see her tongue. ;-)

Dr. Park seemed genuinely pleased with her occlusion (ie. how her teeth came together in back), so it looks like the setting/plating of the jaw bones went about as well as it could have. I'm sure it was mildly disappointing that she didn't get the arch bars removed. They are terribly uncomfortable, but Courtney was pretty worried about the process of taking them off, so I'm guessing that she tempered her frustration with knowledge of avoided pain.

Courtney's eyebrow and eye have continued to improve, but one of the issues that had become increasingly apparent is that her right eyeball is somewhat sunken. The level of the eyeball is correct, but the depth is not. It doesn't look terrible, but it is noticeable, so I asked Dr. Park about it. He agreed that the eyeball is definitely sunken, and that he would guess as much as 4-5 mm (I think that's what he guessed). He said that there was a procedure that they could do to try and move the eyeball forward, but that it had to be done sooner rather than later. When he asked Courtney how she felt about more surgery, her first response was, "I'm tired, I'm just really tired." However, she held it together, and he said that we could take the week, and next Friday when we return to have the arch bars removed, we could give him our answer. They would reopen/make and incision beneath her right eye, and also possibly go in through her mouth. The surgery would likely happen on Thursday the following week. At this point, I think we're leaning towards the procedure, but we have a few follow up questions that will help with the decision. Obviously, we need to weigh the risks, the likelyhood of sucess, and other complications. On the way home Courtney suggested that if she was going to have the surgery, perhaps they could remove the arch bars while she was under -- smart woman.

As far as Courtney's teeth are concerned, it doesn't seem to be nearly as bad as I initially thought. Courtney thinks that she's only missing 4 teeth. By missing, I mean above the gum line. In at least two of the front teeth, you can see that the root of the tooth is still there. Of course, the condition of the remaining teeth is somewhat in question, since it's obvious that some of her front teeth have been moved, but there's a LOT more to work with in terms of good teeth than I had thought. I cancelled the dentist appointment I had made for next Tuesday since I want the panoramic x-ray to be taken without the metal arch bars. I'll reschedule when I know more about the next surgery.

All in all, Courtney is doing fantastic. She's getting lots of exercise by walking, and is holding up really well. My step mom, Lynne, has been helping out this week (Emma went to Columbia with Courtney's mom). Lynne brought some exercies resistance bands and has helped Courtney with an exercise routine every day to start getting some strength back into her legs. She's been a huge help! Thanks for your continued prayers; we still have a long road ahead of us.

Once again, I'm sorry for the delay in posting this update. Work has gotten pretty busy, and I had a father-son campout at the neighbor's house last night. James and I had a lot of fun, but I probably only slept a total of 2 hours.

Posted by mark at 1:18 PM | Comments (4)

May 15, 2006

WSLS NBC follow up interview with Courtney

Yesterday, Melissa Martin from the Roanoke NBC affiliate came to Harrisonburg to do a follow up story on Courtney's progress. It was entirely Courtney's decision, and she agreed. She wanted an opportunity to share her testimony, and her biggest concern was that she didn't want anyone to think that she just wanted her 15 minutes of fame. I assured her that nobody would think that after hearing what she had to say. I hope you agree.

You can see the video of that interview for the next day or so here:
http://www.wsls.com
In the lower right corner, the video is titled, "Brake Drum Accident Recovery." Again, they did a nice job editing. They talk with you for 30 minutes, and then edit it down. I apreciated the fact that Courtney's testimony was left intact. It truly captured Courtney's spirit through this ordeal. You can read a transcript of the video here:
"Woman Talks About Being Hit By Brake Drum"
I have DVD copies of the previous news reports done by WSLS. If copyright allows, I may encode those and post them here for archival purposes.

Courtney is now almost entirely narcotic free. In the past days she's only taken 3 half doses, and those only at night. In fact, last night she didn't have any. Last week she was taking 5 full doses a day. The pain is under control with OTC Advil and Tylenol. Her primary discomfort now is jaw pain (possibly muscular), and major neck and shoulder stiffness. She had a professional massage last week, and we're scheduling one for later this week.

I heard back from our family dentst. He is going to contact Dr. Park to make sure that they are both on the same page. He was very sympathetic to Courtney's situation and offered to do anything necessary and possible in the interim to make her comfortable. Thankfully, she's doing pretty well, and can probably wait until after the jaw is unwired.

Overall, Courtney is holding up well. She has moments when she gets discouraged by the discomfort and knowledge that it's going to take a long time to fully recover, but she's hanging in there. She's still eating well, and continuing to slowly gain weight. She's taking short walks with friends and trying hard to stay up as much as she can during the day. She hasn't slept very well the past few nights, and is pretty frustrated about that, but that could be attributed to removing the narcotics after taking them pretty heavily for a month.

My mom and John left on Sunday, and Courtney's mom came back on Monday. We've still got tons of family help and fantastic food being delivered by our friends. If I continue to eat at the rate I've been eating, by the time Courtney is fully recovered, I'm sure to weigh 300 lbs.

[ UPDATE - The video is no longer available on WSLS via the links above. If legal, I'll post permanent links at some point in the future. It make take a few weeks. ]

Posted by mark at 4:07 PM | Comments (12)

May 12, 2006

Appointment with Dr. Park

We drove to Charlottesville this morning for a checkup with Dr. Park. The visit went well. He was happy with the trach hole, and said that we could take off the the cumbersome dressing and just use some vaseline and a bandaid. That made Courtney very happy.

He didn't say much about the eye or eyelid. He said that her eyeball movement is much better and was pleased that the double vision is mostly improved. He muttered a few things about something being off by a millimeter, and that the eyeball level seemed to be correct. I mentioned the opthomologist's statement about the eyelid being pulled down by the incision beneath the right eye, and I'm pretty sure that he dismissed this with mention of a structural issue caused by the amount of damage to the socket. He's definitely a perfectionist and the future of her face is most certainly in capable hands. I intentionally didn't ask any questions about the eyelid because he's been very forthcoming with details when he's ready. Courtney and I are both comfortable waiting and don't really need to be placated with doctor speak. All in all, he seemed to be pleased with her progress and that she's started to put some weight back on (about 4 lbs). He did express a desire to see her take less narcotic as soon as possible. We'll see how that goes.

He said that he would see us back in 2 weeks with the possibility of removing the "arch bars" and unwiring her jaw. The arch bars are wired through the gum and cinched down tight over the teeth near the gumline. In order to remove them, they'll give her a local injection and then pull the string/wire (whatever it is they use to tie them into place), out. He said it might be uncomfortable and a little painful, but I'm betting that the reward will be worth it.

I contacted a local dentist yesterday to start the process of getting him ready to see Courtney when the jaw is unwired. I haven't heard back from him yet, but I'm sure I will early next week. I want to make sure that Courtney will get priority attention as soon as she's ready.

Courtney is moving around a lot better, and seems to be holding up really well. It will be interesting to see how the reduction of narcotics helps her mobility and energy levels. We've both known that weaning off of pain-killers is a good idea, but the jaw pain has been pretty unbearable. I think it's probably gotten a little better over the last few days. When I ask her to describe the pain she says muscle tension in the left and right jaw and major irritation from the arch bars, and not nervey pain. We've applied liberal amounts of dental wax and will be adding in OTC advil and tylenol, so that should help. Please pray that if she experiences any discomfort that it won't be too much for her to handle. I think I've mentioned in previous posts that pain has been an emotional trigger for Courtney. Psychologically speaking this is probably healthy and necessary, but I don't want overwhelming emotions to affect her desire for increased mobility, etc.

We don't have any doctor's appointments for a couple weeks, so my updates might be less frequent, but I'll try to post something at least 2-3 times per week.

Thanks again for praying, sending cards, helping out with the kids, making meals, mowing the grass, etc. The knowledge that there are so many friends out there has kept Courtney sane, and really helps to put this whole crazy ordeal into a wonderful perspective.

Posted by mark at 3:49 PM | Comments (2)

May 11, 2006

Opthomology Report

Yesterday I took Courtney to Charlottesville for an appointment with the opthomologist. The visit went well. To summarize, Courtney currently has 20/40 vision in her right eye. I think this means that it takes Courntey 40 feet to see what most people can see in 20, but I'm not certain. The important thing is that this isn't bad at all, and I don't think that this would legally prevent her from driving; even without glasses. Assuming no change, she'll be able to correct this to 20/20 with glasses.

The only thing that they were somewhat concerned about was the lower eyelid. Her lower eyelid is pulled down slightly and is preventing her eyelids from closing completely. The opthomologist felt that the surgical incision beneath her right eye is drawing the eyelid down. I would guess that it could also be imperfections resulting from having a rebuilt eye-socket. We're keeping the still healing incision moist with vaseline, and hopefully it will stretch out as time passes. In the meantime, we're keeping her eye from drying out with drops during the day, and ointment during the night. The doctor surmised that some of her decreased vision could be the result of dryness.

They also re-did the same double vision test that Courtney did the night before her 3rd surgery (first with Dr. Park), and she showed dramatic improvement. She still has some double vision when looking down and right, right and up and right. They didn't seem to be too worried about the double vision. I would guess that as the muscles around that eye strengthen things could improve. The good news is that she doesn't have double vision when looking straight ahead, like she did before the surgery.

The swelling in her face continues to slowly decrease. Her right upper eyelid is slightly better, but I would still estimate that it's only opening 60-70%. There is still some swelling in her face, so it's still to early to know with any degree of certainty what we'll need to fix. She's starting to take longer walks, and that exercise should expedite the reduction of remaining swelling. She's amended her numbness meter to pretty much her entire face from the middle of her nose down, with the small exception of an area to the left of her mouth. Either it's gotten worse, or she is just more aware.

It's been a couple days since we've heard any air through the trach hole. We thought it was closed two days ago, but during a bad coughing fit it definitely leaked some air, so Courtney has had to still remain diligent in applying pressure when talking and coughing. I think we're really close to being able to remove the dressing from her neck. The dressing is comprised of a 5"x6" thick foam sticker that covers a piece of petroleum gauze and normal gauze. It prevents her from full and comfortable movement of her neck, and it's really uncomfortable. She can't wait to take it off. When it's off, she'll be able to take a REAL shower.

The mouth area is still the primary area of discomfort. I estimate that she'll only have a wired jaw for 2 more weeks. The sooner it gets unwired, the sooner she can get a full diagnosis from a dentist. I'm sure there are some pretty basic things that a normal dentist can do to alleviate a lot of pain. I can even see Dr. Park moving the unwiring up a week since it's pretty clear that she's not going to be using her teeth even if she can open her mouth. That is most certainly wishful thinking. I'll update you tomorrow after the appointment.

Sorry for the delay in posting this report. Now that I'm back at work and ramping up some moonlight client work as well, life is certainly getting back to it's pre-accident busyness.

Posted by mark at 10:23 AM | Comments (2)

May 8, 2006

X-Ray for Emma (she's okay) and status quo for Courtney

On Saturday night, my dad was passing through town to see Courtney and the kids. He was swinging Emma around by the arms for a few seconds, and immediately after putting her down, she started complaining about a sore arm -- thanks Dad! ;-). I thought the arm might have just gotten tweaked and that she was scared to move it out of remembered pain. She wasn't crying at all, just not moving the arm. When I tried to move the arm, it did cause pain, but I've seen enough episodes where the "memory" of pain looks the same as actual pain. So, I figured it would be better in the morning after a night to forget that it had happened. On Sunday, she was still complaining about the arm, and didn't use it much all day. If it hadn't been Sunday, I would have taken her to the doctor then, but naturally, these things ALWAYS happen on Sunday (see below for story about Emma's stitches). Emma was able to bend it up and down without pain, but any sort of rotation of the forearm caused pain. I decided to give it until Monday morning. This morning, it was still about the same. She was acting totally normal, but not using the arm. So, after dropping James off at school, I took Emma to the doctor. The first doctor/nurse-practioner thought that the elbow had gotten dislocated and popped back in, and was concerned about the clavicle (collar bone). In retrospect this was the extreme diagnosis. So we were sent to the outpatient clinic for an x-ray .After the x-ray, we went back to the pediatrician where we were informed that thankfully, nothing was wrong. Another doctor/nurse-pracitioner came in and told me that Emma most likely had a "nursemaid elbow." (the practical diagnosis) In short, a tendon in the elbow pops over to the wrong side of the elbow bone. If I had known the procedure, that I know now, I could have fixed it in 2 painful seconds on Saturday night and it would have been better in 20 minutes. Either the tendon had popped back in place when we were positioning Emma for the x-ray, or when the nurse was checking her before or after the xray. Some children are more inclined to get this type of thing, and should be less so as the elbow bone grows bigger with age. I'm thrilled that I don't have TWO patients in the house.

The reason I waited until Monday was because I wanted to avoid the emergency room at all costs. The Sunday before the accident, Emma had slammed her thumb in my car door. She had a pretty deep laceration, so a friend took me and Emma to the hospital where she got two traumatic stitches. Given that recent experience, and the emotional trauma of "the accident", I was hoping that we could avoid the emergency room. She actually liked going to the doctor and getting an x-ray.

Courtney is also doing pretty well. Her eyelid still only opens about 50-60%. There's definitely *some* swelling left in her face, but I'm not certain that the eyelid is going to improve a lot more past it's current point. It's very possible that we'll have to deal with that issue later with an octal-plastics surgeon (a year from now). She's been washing her face with a washcloth without pain, and the lacerations and surgical incisions seem to be healing nicely. Courtney definitely looks a little different, and is still pretty banged up, but I remind her daily of the fact that God spared her life and that she looks fantastic given the extent of her injuries. We're being diligent about managing her pain in order to keep the dental/mouth pain at bay, and that seems to be really good for spirits. I'm dissolving chewable ibuprofin in water, and the addition of that OTC medicine seems to have helped with the time between doses of the strong stuff.

Courtney mentioned a few more details about her condition that I wasn't fully aware of. When I described the extent of her numbness in an earlier post, I only referred to the tip of her nose ... I guess her whole nose is numb. Also, when she mentioned that she didn't have double vision, she failed to mention that sight out of her right eye really isn't that great. Some of this is caused by having an eyelid over a portion of her eye, but even if I were to pry that eyelid up, her vision wouldn't be pre-accident normal. We have an appointment with the opthamologist in UVA on Wednesday, so I'm sure we'll know more later this week.

Courtney's parents left on Sunday morning, and we both miss the help of her mother. She was a great help and huge emotional support for Courtney. My mom and John are coming to town on Tuesday night to help out for a week, but it's just the 4 of us in the house for a couple nights. It was weird to be sitting in what felt like an empty house last night. Yesterday, the kids and I bought a new TV and DVD player for our bedroom. The one we had in there was pretty lousy and hard to see from bed. I also got Courtney a handful of movies (mostly Indie films and chick flicks) ;-). Since she's going to be in our room a lot more over the next month or so, I thought that it would be money well spent. Sometimes, Courtney needs to escape the downstairs chaos for some mental rest, but doesn't really want to sleep. Since she can't read for too long because of the eye, movies are the best option. A friend also brought by a couple books-on-tape that will also be nice.

Thanks for your continued prayers for Courtney. She still has a long road ahead, and is encouraged daily by knowledge of your support. I read all of your comments and emails to her every night.

Note to local friends: Courtney is ready to start seeing more visitors, so give me a call if you would like to stop by for a few minutes. I want to coordinate the visits to one 15 minute visit per morning and a possible 15 minute visit in the afternoon -- so hopefully you can try to combine visits with other people that you also know. I know I sound like the visit-cop, but there are a hundred people that want to see Courtney, so thanks for putting up with me. My cell phone is 540-421-1367.

Posted by mark at 10:38 AM | Comments (10)

May 5, 2006

Appointment with Dr. Park

The appointment this morning with Dr. Park was somewhat disheartening. We were both a little too optimistic, and feel like our expectations after this morning are more reasonable given the extent of her injuries.

I'll start with the right eye. When I asked about the eyelid opening, he reminded us that it wasn't going to be perfect, and that it would likely improve from where it is now, but that it probably wouldn't open as much as the left eye. He was very guarded about saying just how much the difference would be. He also mentioned that the lower eyelid does seem to be a little lower than the other eyelid, however the level of the eyeball does seem to be correct. He said that you can see a little too much white beneath Courtney's right eye. He then mentioned that after at least a year, depending on how things look, he might recommend an ocular plastic surgeon to make some additional adjustments. Again he was very guarded about giving us anything definitive with regard to the final result, which really is quite sensible. I remember the head trauma surgeon in Roanoke warning us not to start making plastic surgery appointments until 6 months had gone by. I guess it's pretty common for things to change slightly throughout the healing process. It certainly wasn't what we wanted to hear, but putting it into the perspective of the past two weeks it is definitely something that we can live with for now. Courtney seemed to handle this pretty well.

Now for the teeth. I asked him if he had any oral surgeons that he recommended and whether or not we should start trying to schedule this next step. He said that we were months away from oral surgery, and that we have a few months of "hygiene" and cosmetic dentistry before we get to the implants. I had been thinking along these lines when we were in Roanoke, but had started to think that it would be quicker than I originally feared. In considering this on the drive home, it certainly makes sense. First we'll have to restore and care for the teeth she HAS in all sorts of ways: Moving them into the right position, adding crowns and other cosmetic restorative work, gum healing, etc. before we even consider replacing the missing teeth with implants. I'm not exactly sure what he meant by hygiene (in the context of healing), but I'm assuming this has something to do with restoring gum health and other daily maintenance issues. Perhaps there are temporary dentures that Courtney can use in the interim between real teeth maintenance and oral surgery. Dr. Park suggested we start with our family dentist and then proceed from there.

Courtney has some numb spots on her face and head. The biggest spot that feels numb is from her right chin up to the tip of her nose and then draw a semi-circle back to the chin. She also pointed to a numb spot on her scalp that I wasn't previously aware of. We asked about these and Dr. Park said that some would heal within a month, some would take a year, and some numbness could be permanent. There's no way to say definitively which would heal and which wouldn't.

He did remove the nose-cast, and told Courtney that she could start washing her face more aggresively, and in fact encouraged her to gently scrub the cuts in order to keep them clean. He looked at the trach hole, and said that while it is only a pin-hole, we still need to try hard to prevent air from escaping so that it can close up completely. It might be a few more days before that's completely closed up. Who knows? He did say that with the trach bandage on, and not having a nose cast, Courtney could be a little less careful about splashing water. Washing her face and hair just got a lot easier.

Courtney has major pain and discomfort with the teeth right now. Some of the holes from missing teeth and broken teeth are really painful. Even though she's still taking her pain medicine regularly it often doesn't eliminate the mouth pain. This pain and today's confirmation that the teeth restoration process is going to be lengthy was pretty discouraging to Courtney. I didn't ask about the timing of unwiring the jaw since we're planning to see him next Friday.

Overall, I'm thankful that Dr. Park didn't voice any serious concerns and that, while slow, Courtney is healing. Obviously, we're both still very thankful that she's alive and doing this well only 3 weeks since the accident.

Posted by mark at 10:57 AM | Comments (4)

May 4, 2006

Message from Courtney

Courtney didn't want to hassle with typing (and possible looking at a computer screen) so she hand-wrote a note to all of you.

-- MESSAGE FROM COURTNEY --
To my dear friends and family,

I just wanted to let all of you know how much (and words can't express) I appreciate your prayers, kind notes, phone calls, visits, yard work, house cleaning, flowers, etc., etc., etc. I've been so overwhelmed by all of the love and concern you have shown towards my family and me. God has graciously placed us in a sweet little nest that has surrounded us in love. I send much love back to friends and family near and far. Let me just tell you, I don't have a cute little basket of get well cards, I literally have a laundry basket full!

I want everyone to know one thing for sure. The accident was horrible, the pain real and I have been scared at times but ... from the moment that thing smashed through the window to this present moment the Lord Jesus has not left my side. I have felt His strong arms around me and He has gently and lovingly carried me through this ordeal. I just want everyone to know that. I can't remember all the verses, but since I woke up from my first surgery I've had the hymn "O Father You are Sovereign" running through my head. What a blessing those good hymns have been to me. My God is an awesome God. The God who created this beautiful earth is also our Great Physician, and praise the Lord He chose to spare my life and is now healing me.

I wish I could hug each of you and look you in the eye to tell you I love you, but for now I send via blog!

Love,
Courtney
-- END MESSAGE FROM COURTNEY--

I took the liberty of Googling for those lyrics. I'm 95% sure I got the right hymn, I'm not at home to confirm with Courtney:

Words: Mar­ga­ret Clark­son, cir­ca 1980. These lyr­ics won a hymn writ­ing con­test in Christ­i­an­i­ty To­day.
© Hope Publishing Company.

O Father, You are sovereign
In all the worlds You made;
Your mighty Word was spoken,
And light and life obeyed.
Your voice commands the seasons
And bounds the ocean’s shore,
Sets stars within their courses
And stills the tempests’ roar.

O Father, You are sovereign
In all affairs of man;
No powers of death or darkness
Can thwart Your perfect plan.
All chance and change transcending,
Supreme in time and space,
You hold your trusting children
Secure in Your embrace.

O Father, You are sovereign
The Lord of human pain,
Transmuting earthly sorrows
To gold of heavenly gain,
All evil overruling,
As none but Conqueror could,
Your love pursues its purpose—
Our souls’ eternal good.

O Father, You are sovereign!
We see You dimly now,
But soon before Your triumph
Earth’s every knee shall bow.
With this glad hope before us
Our faith springs forth anew:
Our Sovereign Lord and Savior,
We trust and worship You!

© Hope Publishing Company.

Posted by mark at 5:08 PM | Comments (2)

Quick update

Nothing much to report, so I'll be brief.

Courtney is moving around a lot more.
Her jaw/teeth hurt a lot more, so she's actually talking less and less.
The trach hole will likely close up either today or tomorrow ... it's really close.
Her eyelid still only opens about 50-60% so despite what the doctor said two days ago I'm still concerned about that. We see Dr. Park tomorrow morning at 8:45 so hopefully he'll have the same hopeful diagnosis. I'll be sure to give a full report on the appointment.

Sorry for the short update. I'm trying to get back into the groove at work, somewhat reluctantly, and it's more difficult than I would have suspected. Probably because Courtney is still at the beginning of the healing process, and it would be nice to stay with her and help out, but the show must go on ... and she's in good hands with her mom.

Posted by mark at 1:55 PM | Comments (3)

May 2, 2006

Unexpected trip to Charlottesville

Courtney is still doing great. She's still lethargic and weak, but she is hanging in there. Her mom has been with us now for quite a while now and her assistance has been invaluable. The kids and household are definitely in good hands. With all of the great food that's been delivered I'm eating better than ever.

Now for the unexpected trip to Charlottesville. Courtney had a "nose cast" thats sole purpose was to keep the bridge of her nose from flattening out while healing. In other words, it was there to keep the bridge of her nose pinched. It fell off, and one of the things that Dr. Park was explicit about at the hospital was to keep that on as long as possible, and hopefully for 4 weeks. I called the practice and they said that given the explicitness of Dr. Parks' comments (he's on vacation until Thursday), it would be a good idea to come on over to Charlottesville to get a new one put on. I guess it's pretty common for them to fall off, and they usually only last about a week. We only had 1 hour and 45 minutes to make the drive to Charlottesville before the office closed, so we had to take the highway route and Courtney was very brave and didn't experience an unmanageable amount of anxiety during the trip.

I do have some good news from the trip. While we were there, I asked the resident doc that replaced the cast a few questions. 1. Is it normal for a trach hole to take this long to close up?, and 2. Are you concerned about the eyelid only opening 60%? To the first question, he said that trach holes often take a while to heal up and that we shouldn't be concerned. To the second question, and also the best news was the he didn't think that there was any problem with the eyelid and that it was most likely swelling. I asked about possible nerve damage and he said that the nerve that controls eyelid control is pretty deep and that its unlikely damage would have many other obvious repurcussions. He said that blood that drains out of an eyebrow often pools in the eyellid/socket and doesn't continue to drain downwards like other areas, so it's common for swelling in that area to take a long time to subside. While it wasn't from the mouth of Dr. Park, it was said with great confidence and I have no reason to think we were misinformed. That was very encouraging.

Courtney's mouth has started to bother her more and more. She has these two metal bands strapped to the upper and lower jaws. They are stiched in all the way through the gum and cinched down tight (thankfully while you're completely asleep). They are necessary for "wiring" the jaw. I can't remember the technical name for them at the moment. Anyway, as you can imagine, they are enormously uncomfortable and as the other surgical pain subsides mouth pain will most certainly rule the day.

As expected, the pain of this ordeal and the protracted nature of her recovery has started to take a minor toll on Courtney's resolve. She's still doing great, but she knows that she's a long way from fully healed and is tired of being the helpless patient. In other words, she is emotionally tired and will continue to need daily empathy and support. My goal in the next few days is to get as many calories and nutrients into her system as possible, encourage a lengthening of the span between pain meds (only if possible -- I can just hear all of our nurse friends telling me to take this slow, and I do agree with them), and to try to get her more mobile. The sooner she can feel like a "woman with a wired jaw in need of dental work" and less like a "woman recovering from trauma and multiple surgeries" the better. I'm sure it's difficult for her to hear me and her mom dealing with discipline issues with the kids, cooking, laundry, etc. and she can't do anything to help.

She was awake a lot today, so she should rest well tonight. I would say that on average she was alert for most of the day today, which is a big improvement.

Anyway, I'm certainly good at being verbose when there's not much to report. I get daily reminders to post these updates, so I know they are appreciated for the moment. However, I can't help feeling a bit like the latest reality show. ;-) I promise to shut up when Courtney or my audience tells me they've had enough.

Posted by mark at 7:03 PM | Comments (5)

May 1, 2006

The accident

Based on a number of queries, it's obvious that not everyone knows the full story of our accident. I thought it might be helpful to get the full story in writing from my perspective to appease the curiosity of our friends and save me from a sore throat. ;-) This is mildly graphic, and was actually more difficult to write than I thought it would be, so be warned.

On Friday, April 14th, we were heading South on Interstate 81 in VA. to Courtney's parents house in Columbia, SC to celebrate Easter. Courtney was driving, I was in the passenger seat, and the kids were both in the back seat of our 1998 Toyota Sienna minivan. I believe they were watching Toy Story at the time. At approximately 11:00 AM, while driving in the left lane, Courtney was talking with her mom on the cell phone giving her our location and ETA in Columbia when an 11lb piece of steel (see pictures inline) came through our front windshield hitting Courtney square in the face. I don't remember the sounds, but I vividly remember seeing the gaping round hole in our windshield, about the size of a soccer ball, and seeing Courtney looking very awkward. She did not look natural, and her left arm was hanging off to the side with palm facing up. It was terrifying. I grabbed the steering wheel (I think we were in the right lane at this point), and righted the car and simultaneously slammed on the brake. I think we may have brushed the curb slightly, but there weren't any marks on the tire. I distinctly remember thinking as the car stopped, oh crap, I just stopped on the interstate. I looked behind and saw a dark SUV coming, but not too fast. I must have also been having the thought that I should continue driving to the shoulder, because when the SUV bumped us, we rolled forward about 50-100 feet where I steered the van to the shoulder. At the time of the incident, were were crossing over the James river about 50 or so feet below the car. There is a rather imposing railing, but it's not inconceivable that a car going 65 might crash through or over that barricade. At that point, with my foot on the brake, I opened Courtney's door from across her chest, threw out the piece of steel, which was sitting on her chest, and stuck my head out her door and screamed two or three times to the woman who had already gotten out of her car to call 911. I knew exactly where my cell phone was, but for whatever reason chose to let them call 911 while I tended to Courtney. I took off my polo and started to apply pressure to the big laceration above her right eye. I don't know why, but I actually opened her right eyelids to see that the eye was okay. She had a tear in her lip that was split wide open, and there were multiple teeth missing and one of her front teeth was hanging awkwardly. Every time I tried to tend to her lip and mouth, she would stop me, and at one point told me that she thought her jaw was broken.

At some point, I remembered that she had been on the phone with her mom, and I saw the phone lying open in a straw bag that we keep between the seats. I picked it up with my right hand and her mom was still on the phone and was obviously extremely upset -- she had heard everything. I told her that Courtney was badly injured and that we had called 911. She asked me where we were, and I looked over and saw that we wer exactly at mile marker 165. I think I told her a few times how badly Courtney was hurt. I may have tried to reassure her that she was going to be okay, but I don't remember. I certainly wasn't trying to soften the blow at that point. I then handed the phone to James and she tried to calm them down. Both kids had been crying hysterically since the accident. The woman, who's husband had called 911 was sitting half in the back seat trying to talk with the kids. I can't say enough about the people who bumped into us and then stopped. They were obviously uncomfortable, but they were doing everything they could to help me out. I think the guy called 911 three times to speed them up.

After about 10 minutes, Courtney told me that she thought she would need some help and that we should call someone. I'm a bit of a do-it-yourself-er, so humorously, Courtney may have thought that I would try to save a buck by fixing her up myself. I assured her that help was already on the way. I don't think she ever lost consciousness. I also realized that I was still pressing the brake with a lot of force. I put the car in park and relaxed my leg. I actually had hamstring soreness for a couple days after the accident from either the adrenaline response of first throwing my leg to the brake or the 10 minutes of pressing on the brake. Who knows? The emergency response teams showed up in about 15 minutes (I don't really know how long, but I wasn't getting impatient so it must have been no more than 15 minutes). I helped them put a neck collar on Courtney, and then I got out of the way while they got her out of the car and onto a backboard. They made the call to airlift her pretty quickly based on the extent of her head trauma. I answered some questions and talked with a state trooper for a few minutes. They eventually loaded Courtney onto an ambulance and transported her to the next exit for pickup by the helicopter. I wasn't present for the loading into the ambulance and stayed at the scene with the kids, so I never saw the helicopter. The emergency response team was great. They couldn't have been more helpful and responsive. When Courtney was being removed from the car, someone took the kids to the fire engine to preoccupy them. In fact, one of the workers gave Emma and James $10 for a treat when they got to the hospital. The couple driving the SUV that had hit us offered to take me and the kids to the hospital, which was nice because that was probably more expedient than waiting for the State Trooper. He was friendly, but his lack of urgency was mildly frustrating. After what seemed an interminable amount of time, I transferred our bags into the SUV, and had a few moments alone with the kids. We quickly prayed for Courtney, and a few minutes later we left to go to the hospital. The hospital was about 30 minutes from the accident. The kids talked up a storm the entire way.

At the hospital, I was met by a "patient liason" who was extremely helpful. She was available to help me out with the kids, and all of the luggage I had taken out of the car. They put us in the chapel, which was a nice quiet place to corral the kids. After the kids were settled, I went to check on Courtney. I was told pretty quickly that she was stable and getting a CT scan. I'm not really sure when I found out that her whole face was fractured, but I do remember the trauma surgeon telling me that due to the extent of Courtney's injuries, she was recommending that a local ENT surgeon look at her. She didn't think it would be a problem getting Courtney pushed to the front of the surgery queue, when/if the ENT surgeon on call was ready to go. When Courtney was admitted, they used the wrong name, and when the ENT doctor first showed up he couldn't find her, so he left. He was paged again, and thankfully this time he found us and informed me that his associate Dr. Mao would actually be doing the surgery and that he would go relieve her from her office duties so that she could come to the hospital. At some point along the line I was also informed that it didn't look like she had any major brain or skull injury.

The time in the ER was surreal, the kids were pretty wild. The woman was great, but given the trauma of the event, and the lack of a schedule/routine, the kids weren't behaving well at all, so I couldn't just ignore them and stay with Courtney. I spent the next 2-3 hours bouncing between the chapel and the ER. Courtney was "stable" so she was being largely ignored during those 3-4 hours. There really wasn't much I could do and felt pretty helpless. They had given her something for the pain, but she was in obvious discomfort. At one point, she threw-up what looked like a quart of blood. All of the trauma to her lip/mouth was going straight into her stomach. During surgery they did give her one unit of blood. I cannot remember when she eventually went into surgery, but it was probably around 4:00 PM. I think she went into surgery a few minutes before Courtney's parents arrived. They had dropped everything and drove the 4 hours to Roanoke from Columbia. My sister and her husband showed up a couple hours later to help out.

I saw her just before she went into surgery to tell her that I loved her. She said a few somewhat unintelligible things, they gave me her rings, jewelry and she went into surgery.

Posted by mark at 12:45 PM | Comments (6)

Hurry up and wait

It's slow healing time now. Sorry for the delay in posting an update, but there hasn't been too much to report. Courtney is still very tired, and doesn't talk much. It is very tiring for her to talk. She's able to make it between pain medicine doses without too much discomfort and on a few occasions has stretched the time. Obviously, she's going to feel a lot more energetic when she's not on so much medication, but we want to make sure that the pain doesn't get out of control. She has her days and night a little confused. In the late afternoon she is a lot more alert, and I was able to watch a couple TV shows last night with her. It was nice to be doing something normal again. However, that alertness was also the cause of a restless and poor night's sleep. Hopefully, as she continues to heal, she'll be able to talk and walk around more during the day so that her schedule re-aligns with the rest of the world.

She's doing pretty well consuming her 4 Ensure shakes per day, and I'm starting to add in some other vitamin/nutrient/protein drinks into her diet as she is able. Friends and family have been great about sending us liquid-diet powders that should really help with her healing and energy levels. The primary concern in her diet right now is calories. I need to get the maximum amount of calories in her system with the least amount of fluid. Given that her energy level and desire to eat is limited.

Two days ago, we did have one minor issue that was a reminder of how weak she is and her need to take the recovery slowly. After a morning bath, I was taking her downstairs in preparation to see her first visitors for just a couple minutes when she said that she needed to sit down. So, we sat down on the top stair. After a few minutes she said that she didn't feel that great and wouldn't be able to make it downstairs. I told her I'd cancel the visitors and that she should get back in bed. Halfway down the hall, she fainted. Thankfully, I was fully prepared and we both gently sat down. I eventually got her in bed where she slept for a couple hours. That was scary for her because she equated the fainting feeling with not getting enough air, and made me take off the trach dressing immediately after sitting down. It's remotely possible that I put the dressing on too tight and restricted blood flow in her neck, but I'm guessing that the real cause was heat from the bath and over exertion. At least that's the story I'm sticking to. ;-)

The trach hole continues to heal ... slowly ... It's now the size of a pencil (down from a dime), so we're getting closer. I had hoped that this would heal faster, but it's really difficult to completely restrict airflow with bandages. Also, Courtney has been couging a lot so some air escapes even when she's pressing on the dressing while coughing.

Courtney is glad to be home, and the kids are doing great. They love having mommy home, and are being very patient. I've been able to play with them as well, so their life is slowly getting back to normal as well. The biggest issue with the kids is noise. One of the side-effects of the pain narcotics that Courtney is taking is sensitivity to noise. Our kids have never been good at "inside voices," so we have to limit their time with Courtney to times when they are mellow-tired (as opposed to cranky-tired) or watching television.

I do have a mild concern with regard to Courtney's right eye-socket. The eye level is almost perfect. I think the depth of the eye is also great. These conclusions are supported by her ability to see without double vision. However, her right eyelid still only opens about 50% - 60%. I would guess that the swelling is down about 80-90%, and it's difficult to quantify how much swelling it takes to obstruct eyelid functionality, but I would be lying if I said that I wasn't a little concerned. On this point, I am taking great confidence in Dr. Park and his staff who haven't mentioned anything as signifigant as a partially obstructed eyelid. I know that Courtney is likely worried about this as well, even though I've tried to reassure her that swelling is the likely culprit.

I'm partially back at work this week, and that feels really weird. Slowly but surely we're all moving back into our normal routines; at least what constitues the new normal.

Posted by mark at 9:06 AM | Comments (1)

April 28, 2006

Home sweet home!

This morning Courtney and I left Charlottesville at 10:30 and had a leisurely drive back to Harrisonburg. It was an emotional moment for Courntey as she was both excited and nervous about being home. The kids had been well coached with regard to Courtney's appearance, speech with a wired jaw, and the need for caution with her face. After a few moments of nervousness (more with Emma), they eventually warmed up and were obviously happy to see their mommy. They were generally happy to see me as well, but I was definitely the side-show.

Courtney continues to improve. She's very weak and tired a lot -- the fatigue can be attributed to the liquid diet and pain meds, but the swelling continues to subside and her vision still seems to be great. I would guess that she has lost about 15 lbs since the accident. She was already very trim, so it's weight that she didn't need to lose. Gaining weight on a liquid diet is very difficult if not impossible. Her trach hole is continuing to heal although it's been difficult to keep the dressing tight. When Courtney talks and coughs, she has to push on the location of the hole, and it's often difficult to press hard enough. However, I think it's still healing and should be closed back up in a few more days. When that's healed, she'll feel a lot more comfortable.

We're obviously thrilled to be home, but there's still a lot of recovery. She's so weak and tired that the thought of visitors is still something that concerns her. We'll probably keep it to 2-3 people per day, and maybe not start until Monday. That's completely up to her, but I think she'll be feeling a LOT better by Monday.

I forgot to mention that the morning after the surgery when Dr. Park was checking on Courtney said, almost as an aside, that Courtney was "tough as nails." I couldn't agree more. Courtney is doing great handling all of this. I'm sure that she's been internalizing a lot of emotions, which has been necessary up to this point, but I'm certain that the next few weeks of laborious healing are going to be seem long and tedious. Pray that she'll continue to be encouraged with the progress and patient in the next few weeks. You can also pray that the kids would be patient as we continue to remind them to BE CAREFUL and in fact have already asked why mommy doesn't talk much.

A hearty thanks to the crew of friends that mulched our yard. It was awesome to drive up and see such amazing landscaping. Also thanks to the friends who have overseen the mowing of our yard. I'll try to thank each of you personally in the next few days, but please know that it was hugely appreciated.

Posted by mark at 6:08 PM | Comments (1)

April 26, 2006

Out of the hospital and trachless

I was sitting with Courtney at 8:30 AM when Dr. Park walked in. I didn't realize that he was also planning to come by. Anyway, he was very happy with what he saw. At the time Courtney was sitting up in a chair drinking her breakfast and looking pretty good. He checked out some things and then I could see his wheels spinning for a second. He asked if we felt confident being out of the hospital, and a few other questions about our plans if we were out, and then said that if we could come by his office at 1:00 he would take out the trach. He felt that she was breathing really well through her mouth/nose and was obviously happy enough with the surgery results that he didn't see another surgery in the near future. So, given that, he gave the order to set us free. That was obviously a very exciting moment for Courtney.

We were discharged from the hospital, and went to Dr. Parks' at 1:00 PM. He removed the trach and bandaged up her throat with a tight dressing and said that in a few days it would close up on it's own and heal itself without any stitches. Pretty cool. The key is to keep your fingers pressed over the hole when coughing and talking to prevent as much air from escaping as possible. She is having some air containment issues, so I'm going to try to retighten the bandage in a few minutes.

We're settled into a local hotel and are comfortable. We're going to take our time here until she feels strong enough to go home. She's obviously desperate to see the kids, but we want to make sure that she's ready. At this point emotions are literally painful as they are usually accompanied by facial movement. ;-) Also, even though they discharged her from the hospital, she did have 6 hours of surgery yesterday and is still getting all of the anesthetics out of her system, and being close to the hospital and Dr. Parks' clinic for a couple days is reasurring to Courtney.

I want to thank you all again for being the best friends on the planet. We couldn't have made it this far without your prayers and support. Thanks!

Posted by mark at 6:17 PM | Comments (15)

Morning update

Amazing! I saw Courtney this morning about 6:30AM and she looked great. There is a lot of swelling, but she is able to open both eyes and according to Courtney, she no longer has double vision. The swelling is nothing like it was in Roanoke (and is much more uniform). They switched out her trach to a #4 cuffless which is about as small as they come. Essentially this is the best scenario for normal breathing assuming they want to leave the trach in for a few days. They still haven't capped the trach, but I don't think her upper airways are too swollen, so that shouldn't be a problem.

About the only difficulty for Courtney was coughing. She was having trouble coughing stuff up so they had to suction her airway a few times which, according to Courtney, is scary. Getting the smaller trach should help her to get more coughing strength and also as she wakes up more and starts to sit up this should improve. I don't think they had her on too many narcotics this morning, she was really sharp and writing clear notes on her clipboard.

According to the 4 or 5 residents (believe it or not I don't know how many) we saw this morning from Dr. Park's office, they would like to discharge her at some point this afternoon, assuming she is able to drink enough. They are going to give her a portable suction device to take with her, which will be handy with a wired jaw (actually, it's just a bunch of rubber bands).

As far as the eye alignment goes, it really is an amazing improvement. The lack of double vision is a huge encouragement as this would seem to indicate that everything is back to normal. I think it's entirely possible that the slight disparity I see is only swelling. Regardless, the improvement is dramatic and I couldn't be happier. None of the doctors this morning verbalized any concerns, so I take that as implicit good news.

If we get out of the hospital today, perhaps I'll let Courtney give you the next update. Thanks for keeping up with our progress and your continued prayers. When I think of where we were 12 days ago, and see where we are now, it is nothing short of miraculous.

Posted by mark at 6:26 AM | Comments (8)

April 25, 2006

Post surgery update

I was finally able to see Courtney after her surgery. I was a bit mistaken in my previous post. When Dr. Park called me it was to tell me that all of the plates had been replaced and that things had gone well. What I misunderstood was that she was still "open." Two hours of stitching later, she was out of surgery. The surgery took a total of 6 hours. So, 2 hours after THAT we eventually saw her at 7:15PM. Her room and/or nurse wasn't immediately available, so I sat with her (only mildly conscious) for about 2 hours before her room was ready. She got into her room sometime after 9:00PM. During transfer to the room, she awoke fully and was quite alert for the last few minutes that we were with her. She is breathing exclusively through her trachiostomy. In order to administer the anesthetics, they installed a "cuffed trach" which has a balloon that occludes the airway to the mouth/nose forcing all air out of the trach, and hence all of the anesthesia into her system. Prior to the surgery, she had been using a capped cuffless trach which essentially forces most air out of the mouth/nose, with the exception of air that leaks out the edges of the trach hole.

In order to be discharged tomorrow, her swelling will have to be reduced to the point where they can install a capped and cuffless trach, and be convinced that she can breath through her upper airways. She'll also have to be able to drink enough sustenance through a straw as there isn't a NG feeding tube this time. Finally, she'll have to be able to controll whatever pain she has through liquid form (ie. not iv narcotics). If her swelling doesn't get worse over night (I'm not sure if it will or not), she should be able to see. She opened both eyes reasonably well despite the new swelling.

They really did a GREAT job with the adjustments. It's still too early to tell HOW good, but both Dr. Park and the chief resident are confident that the imperfections will not be too noticeable. A huge improvement from this morning. The protrusion to the right of her right eye is completely gone, the jaw which previously seemed ever so slightly misaligned does seem better, and the eye is MUCH better. I do think the eye *might* still be a little off, but it's too early to tell. After surgery, the chief resident did remind me that she had some pretty serious bone fragmentation and that the repairs won't be perfect. So, while I've been rather positive in posts up to this point, I have to be realistic in that the repairs might not be able to hide the damage 100%. At least I have the confidence that we've done everything medically possible. We'll have to wait and see what is revealed as the swelling goes away. Dr. Park does his rounds at 6:30 AM so it's possible we'll get something more definitive at that time.

Courtney doesn't have a private room as they don't exist at UVA. If her pain can be controlled and Dr. Park is comfortable discharging her, it might be nice to get her back into a hotel room for a few nights of REAL peace and quiet.

Good night!

Posted by mark at 9:44 PM | Comments (1)

More good news that I forgot to mention earlier

I completely forgot to mention that Dr. Park said that the Corona incision (from ear to ear above the hairline) wasn't necessary. I'm sure that along with the obvious other good news that this will be a great source of comfort for Courtney.

Posted by mark at 5:11 PM | Comments (2)

Out of surgery and initial report from Dr. Park

Courtney is out of surgery. I got a call from Dr. Park about 4:30 to tell me that they were done. He said that they had replaced all of the plates in her face including her jaw which is now wired. I asked specifically about the eye, and he said that in the operating room the eye alignment seemed great, but that he wouldn't be surprised if after the swelling went down that there was a slight disparity. However, given that they were specifically trying to fix that problem, I doubt that a slight disparity will be anywhere near as noticeable as it was this morning. He said that they were able to get the jaw aligned better as well. He did say that she was pretty swollen again and that it would be 7-10 days for that to go away completely. Given the extent of the surgery he did decide to admit her for the night, if I didn't have any problems with that ... of course I didn't. Although given his feelings about hospital stays and limited use of pain meds, I fully expect him to discharge her tomorrow. We'll just go straight to the Hampton Inn and camp out there until Courtney feels ready to go home. I'm guessing this will be Friday or Saturday. The phone call was more of a courtesy to let me know that the surgery went well and that he was done. He said that it would be at least a couple of hours before she was in her recovery room.

After I've had a chance to see Courtney, I'll post again to let you know how she's feeling and how things look, although I might play the same card as Dr. Park and reserve judgement until the swelling has receded.

Thanks for the prayers!

Posted by mark at 4:31 PM | Comments (0)

Courtney is now in surgery

Courtney has been in surgery now for 2 hours. I got a call from her nurse after she was asleep to tell me that the anesthesia had gone smoothly. The chief resident confirmed that the surgery would be 4-5 hours long, I didn't see Dr. Park this morning. Courtney was calm and holding up really well before surgery. My sister came back over from Charlottesville this morning to help me get Courtney to the hospital. My dad flew in from Orlando at about 11:30 and was able to pray with us before they wheeled her away. Believe it or not, but I'm not 100% certain that Dr. Park plans on admitting her to the hospital after the surgery. I would be VERY surprised if she wasn't, but there is enough ambiguity that her location tonight is up in the air. All of my nurse friends tell me that she'll be admitted.

I stil think that she'll get discharged at some point on Wednesday. Currently I'm planning to stay here in Charlottesville with Courtney the first night out of the hospital. So that would put us home Thursday or Friday.

Also, Courtney is not ready to get visitors. It's been a pretty emotional couple of weeks and she has only seen family with the exception of Carolyn and her friend JT (who have been helping us out). I know that a bunch of you are itching to see her, but I'm certain that we'll be back in Harrisonburg before she'll feel like she has the emotional strength for visitors. Thanks for your patience.

I'll be sure to post an update tonight after the surgery, but not until after I see Courtney, and then get back to the hotel after dinner.

Posted by mark at 1:09 PM | Comments (3)

April 24, 2006

update after a VERY LONG DAY

Okay, where do I start.

After talking with the docs in Roanoke, and some nurse friends, it was determined that ambulatory transfer to UVA was a long shot. So, after a few conversations with Courtney she agreed to make the trip in "the van" with our neighbor Carolyn, also a doctor, along for the ride. Early this morning, I dropped off Courtney's brother at the hospital to see Courtney before flying home, and then I drove to meet Carolyn at the halfway point to Harrisonburg since Courtney's dad was able to drive her halfway.

We went straight to Roanoke Memorial Hospital and Courtney was unplugged from the IV (for morphine), and she was given an oral pain medication, her discharge papers, her films/xrays, etc. on CDROM, and prescriptions. There wasn't a pharmacy in the hospital so we decided to just fill it in Charlottesville. Carolyn read to Courtney throughout the trip to keep her occupied, and the trip went very well. Courtney even remembered to ask about the accident location as we got near it. I wasn't going to say anything.

After filling her prescription, and getting directions to Dr. Stephen Park's office (the ENT/facial surgeon), we made it with 15 minutes to spare. We were admitted quickly, and met with Dr. Park's chief resident for a few minutes where he just checked out Courtney. A few minutes after that, about 5 doctors walked in, including Dr. Park. He did a bit more poking and prodding, and then sat down to give us the scoop. He said that he was going to make a number of "adjustments" to the initial surgeries. I'm too tired to go into too much detail, but basically he said where they would go in to make the fixes. Over the eyebrow (from the accident), through the jaw, under the right eye -- there was actually an incision here from the first round of surgeries that I didn't notice previously because of the swelling. He also said that they would have to add an incision on the bridge of her nose, and then the kicker was when he said that given the protrusion of her right cheekbone they would most likely have to do a Corona cut which is basically temple to temple over the high forehead (above the hairline) in order to make the necessary fixes without interfering with a rather important optical nerve above the eyebrow. This of course, really upset Courtney, she wasn't prepared for a shaved head. However, in less than 30 seconds she had already regained her composure and told him to do whatever he needed to do in order to fix the problems. I can't tell you how proud I am of the strength that she has shown through all of this. He also mentioned that he was planning to make adjustments to her jaw as well. All of this was more than we expected, but it was encouraging to know that he felt that he could make improvements. He of course gave me the, "We might not get her back to exactly the way she was before the accident..." line, but it was still encouraging.

I've downplayed the appearance up to this point because I wanted to wait until the swelling had gone down enough to make a fair estimate. The right eye is noticibly lower and slightly sunken. While I would be perfectly happy to have Courtney live the rest of her life the way she is now, it was still hard to see her that way, knowing that if that WAS the final result how hard that would be for HER.

The first hurdle of the day was when Dr. Park said that Courtney had to report tomorrow at 11:00 AM for surgery at 12:00 PM. He had no intention of admitting her to the hospital today. So, I thought Courtney could just stay at the hotel that I had arranged for myself, so I didn't think there would any problem. In the meantime, Carolyn caught a ride home with a nurse friend of ours who also works at UVA.

Dr. Park's team was also concerned with the functionality of her right eye, since it's slightly dilated more than the left eye, so they decided to get a full workup from an opthomologist. After leaving Dr. Park's, I drove Courtney by myself to the eye doc. About 20 minutes into this visit, Courtney started to feel some pain, and started to get upset; she was exhausted, and was really starting to hurt. At this point, given Courtney's anxiety/pain and all of the coordination that was still necessary, I started to mildly panic. I made a few phone calls, and eventually got my sister to come over from Harrisonburg (1 hour away) to help me out. We eventually left the eye doc after about 2 hours. The prognosis was generally optimistic, but guarded. I was pretty distracted, but I think most of the issues they noticed are swelling/trauma related and should improve/heal over time. Dr. Park should be informed of their findings and the surgery should continue as planned. Part of this is CYA on the part of Dr. Park. They wanted to make sure that her current eye condition was documented so that we can't say that they caused new problems. Regardless, I feel comforted by the thoroughness of the exam.

Anyway, because of the pain she was having, I called the ENT doc on call and got him to up Courtney's pain dosage and that seems to have done enough to keep her from getting acute pain.

Now for the second hurdle. We got to the "RED ROOF INN" one block away from the hospital which I had booked earlier for $70 per night. I figured, it's next to the hospital in the middle of UVA, and couldn't be THAT bad for $70 bucks. Anyway, I couldn't have been more wrong. They were doing construction EVERYWHERE. I thought it would be constrained to the lobby, so after registering, I walked Courtney through the construction and drywall dust to the one working elevator (the other was being used by construction workers). We went to the room, and I knew almost immediately that it wasn't going to work. It smelled like paint, and was really lousy. I've stayed in some really bad drive-up motor lodges and this was worse. When I went to take Courtney back to the car, the elevator was broken. After trying to call the lobby to figure out what was wrong (they never answered), I went to see what was going on. I found some workers who didn't speak English who helpfully pointed out the stairs. Anyway, to make a long story short, I had to help Courtney walk down 5 flights of stairs in order to escape that RED ROOF INN. Given the extent of the work they were doing, they should never have opened for business. Even if it was just me staying there, I wouldn't have stayed. Trust me, I'm not being picky, it really was terrible. Tell all of your friends to never stay at a RED ROOF INN. There, I feel better now. ;-)

We found a Hampton Inn down the street which is fabulous. Only $20 more a night, but 1000% better. I gave her the slightly overdue pain meds in the parking lot, my sister showed up, and the day got a lot easier. Courtney immediatly took a bath (something she's been dreaming about for days), and seems to be doing really well. It was a long day, but I think she is really enjoying being out of the hospital.

Thanks for the continued prayers, tomorrow is going to be a big step in the right direction. They think the surgery will last about 5 hours. Please pray that everything goes smoothly and that Courtney will get some rest tonight.

Excuse the length and type-os, I'm pretty tired.

Posted by mark at 8:53 PM | Comments (6)

April 23, 2006

More progress

Courtney continues to heal. Her right eye is now opening about 60%, but that is exposing the double vision which was to be expected, but it's pretty severe. Not only is she seeing double, but one of the images is lower than the other.

She's also started having anxiety issues at night. She remembers almost everything about the accident and much of the time in the helicopter on the way to the hospital and also while awaiting surgery. She's started to replay the accident in her mind. This happened to me for the first few nights, but I'm already sleeping well again. I'm expecting it will take a lot longer for her.

I was planning on taking her to UVA myself, but she's expressed a STRONG desire to be transported in an ambulance, so I'm going to look into our options today. She has occasional coughing fits that have her worried, especially since her jaw is wired shut. In the hospital bed she has suction available to help clear out what she coughs up. So, her concerns regarding transport are both psychological and practical. After researching the options, I'll talk with her about it more this afternoon.

One of the most encouraging things for me is to see the return of her personality. She's now talking and smiling (as best she can), and is showing amazing fortitude. She's still on a lot of pain medication, but is thinking clearly and is alert for most of the day. She's taking a walk with her parents at the moment. In an hour or so, they are heading up to Harrisonburg to spend the week watching the kids. Courtney's brother has been here the entire time and has been a huge help. It's been nice to have him to hang out with. He'll be heading home tomorrow morning.

I was in Harrisonburg for one night two nights ago. I went to see the kids, do some laundry, pay bills, and other micellaneous stuff. The kids are doing really well under the circumstances, but they are ready to see their mommy. Now that Courtney is talking better, we might try to call them for the first time this afternoon.

We've received good news about the doctor that the ENT surgeon here set us up with at UVA. It turns out he's one of the best ENT/facial reconstructive surgeons in the business. I think he literally may have even written the textbook. Of the six phone calls that we made to people in the medical community in UVA, all six came back with glowing endorsements for this physician. Once again, this underscores God's providence through this entire process. According to our doctor here, who filled him in on her condition, the UVA doc expressed confidence that he would be able to make the necessary adjustments. We'll know more tomorrow afternoon.

Sorry for the short delay in posting this update, the trip to Harrisonburg was quite a whirlwind.

Posted by mark at 9:45 AM | Comments (3)

April 21, 2006

Update and CT scan results

Courtney is doing awesome. She is completely alert, the swelling has continued to go down. I would guess that her right eye is now opening about 20-30%. She had the NG (nasal/gastric) feeding tube removed a few minutes ago and her mood improved immediately. That was a HUGE source of discomfort for her. With the tube out the extreme discomfort when swallowing was relieved almost instantly.

We did see the ENT doctor a few minutes ago as well and that visit wasn't quite as positive as we could have hoped, but it's good to have more information. I'm not exactly sure where there are bones and where there are plates, but here's the scoop. The bone/plate underneath and to the left of the right eye has basically floated out and to the right. This has resulted in the protrusion that I mentioned yesterday as well as a lowering of the right eye in the socket. If I had to guess, that eye is sitting a 16th of an inch lower than the left eye. The ENT surgeon here in Roanoke feels that she's done everything that her skills would allow and has recommended a transfer to UVA for some additional surgery by a specialist. The most important job in this sugery will be to raise the level of the right eye so that it's the same height. This should prevent double vision.

Thankfully, she has a collegue in UVA that is planning to see Courtney in his office on Monday afternoon. He does surgery on Tuesdays and Thursdays. We're going to check out of here on Monday morning and drive ourselves to Charlottesville on Monday morning. He'll admit Courtney on Monday night after seeing her and hopefully be able to perform the surgery on Tuesday. We're in the process of performing our due dilligence in confirming this doctor's credentials, but feel confident that this is the best course of action. He's also and ENT doctor, but is also a facial plastics surgeon, and feels confident that he can perform the necessary adjustments without the need for an octal plactics (eye socket) surgeon.

Courtney is charged with the tasks of excercise and eating (through a straw of course). Her spirits have improved dramatically since the feeding tube was removed. It was a little discouraging for her to know that more surgery looms, but I've tried to focus on the many positive things that have transpired up to this point.

Courtney's parents came back today and are planning to spend the next day or so with Courtney, but are then going to go back to Harrisonburg to be with the kids. My dad and Lynne are leaving doay; they've been watching the kids all week. I'm planning to go home tonight to do some laundry and see the kids. I'll come back tomorrow sometime. While I was praying that we wouldn't have additional surgeries, the head trauma surgeon here reminded me that this isn't a setback, but merely the next step in Courtney's recovery. Rarely is facial trauma of this magnitude repaired in one step.

Once again I want to thank you all of your prayers and support. Our whole family has been overwhelmed with the show of kindness. We love you all.

PS - If you've left me a message at home or on my/Courtney's cell phone and I haven't returned your call, please know that I've been on the phone about 3 hours a day and am not intentionally ignoring you. ;-)

Posted by mark at 2:01 PM | Comments (6)

April 20, 2006

CT scan

The ENT doc just checked on Courtney. They ordered a CT scan to see about two things:

1. The swelling to the right of her right eye seems to protrude too much, so they want to confirm that it is in fact swelling and not bone. If it's bone, than some adjustments might be necessary.

2. Since the eye in that right socket seems to have restricted movement when looking up and looking right, they want to make sure that the restricted movement is due to swelling and not the plates. That would also require a surgical adjustment.

I'm thankful that they ordered the CT scan as those were two concerns that I also shared. I'm praying that it is only swelling, but know that there's a good chance that Courtney will have to undergo a 3rd surgery.

To quote the ENT doc., "We really want to hit a home run with Courtney since she's so young." I couldn't agree more.

Thanks for praying. She is getting the CT scan tonight sometime after 4:30 PM.

Posted by mark at 2:36 PM | Comments (5)

What a difference a day makes!

Yesterday morning Courtney was disoriented, frustrated, and tired. Today, she is much more alert, a lot more lucid, and even took her first 25' shuffle down the hallway and back with the help of a nurse. She is getting a pseudo-shower at the moment, which, if I had to guess, is probably going to be a huge boost for her morale. The sponge cleaning that she's received to date have done little to placate her desire to be really clean.

Her trachiostomy tube has been capped for almost 24 hours, so that means that she has been breathing almost exclusively through her nose and mouth. This cap also allows her to speak with some difficulty so that has really helped. Given this progress, the head Trauma surgeon is prepared to remove the trach as soon as he gets word from the ENT surgeon that there aren't any more procedures (see below). She has started to take in some fluids through her mouth, and if she can down 3-4 cans of Ensure per day they'll take out her feeding tube. She still has trouble getting the strength to suck fluids through a straw, so she might not be ready for at least another day, but we are making progress.

She did see herself in the mirror for the first time, and didn't seem to be visibly upset, but I'm sure it was difficult for her. She really does look fantastic considering what she looked like 3-4 days ago. Please pray that she'll be patient and appreciative of small progress.

Her right eye is still swollen shut, but she can open it about 20% upon request which is definite improvement. She had a minor skull fracture above her nose that they have been monitoring. There was a chance that this fracture would not heal itself and slowly leak brain/spinal fluid out of her nose. We haven't seen any type of fluid for 3 days, which is a good sign that it has sealed itself. 80% of the time, this particular type of fracture will heal itself, so I'm happy to report that this seems to be the case.

So, please pray that she'll be able to consume the requisite amount of liquid food so that she can get the feeding tube removed. They often cause ulceration and can be quite painful. Also pray that the swelling would continue to reduce and that the ENT surgeon would conclude that the initial surgery was a success. It would be nice to avoid adjustment surgeries if at all possible; specifically with the right eye socket. Finally pray that Courtney would keep her spirits up and not get too discouraged. She asked me what day it was today, and when I told her that she had been in the hospital for 6 days, she said, "Wow."

I think that's it for now. Thanks again for all of the encouraging notes, flowers, and prayers. It's made this experience a lot more tolerable.

Posted by mark at 11:42 AM | Comments (0)

April 19, 2006

Thanks and update on Courtney

Before I give you and update on Courtney, I want to thank everyone for their prayers, phone calls, and support during this ordeal. It has been a huge help to experience the overwhelming expressions of love for Courtney. Thank you!

Considering the magnitude of what happened, Courtney is doing really well. The swelling in her face and neck has continued to reduce, she is on a smaller diameter trachiostomy tube that should allow her to breathe more and more through her nose and mouth (which is wired shut). They are still confident that she will retain full unimpaired vision in both eyes. I don't know the exact count, but she has a number of titanium plates in her face. They had to rebuild her right eye-socket and has a plate behind her eye to keep it positioned in the right location on her face. Even though she has at least 5 plates in her face, there isn't a single incision, other than the two cuts from the accident (above the right eye and lip). Amazingly, they were able to do most of the work through existing lacerations and through the jaw. One of the things that the doctors are monitoring as the swelling goes down is the mobility of her eyeball in that reconstructed socket. They are also checking that it's on the same horizontal plane as the left eye. If mobility or level aren't correct, they may have to go back in to make some adjustments. It's too early to tell. As of today, she can open her left eye about 90%, but she keeps it closed most of the time. The right eye only opens naturally about 10%.

The dental work she's going to need will probably be the most signifigant long term recovery task. I just found out this morning that the damage was even more extensive than I had originally thought. However, this is most certainly a secondary concern. There are extremely advanced methods of restorative dentistry and orthodontia that will most certainly be able to help us out.

They moved Courtney out of intensive care yesterday morning, which is nice because the visiting hours are more relaxed. For the last few days Courtney has been in and out of restless sleep. When awake, she's generally alert. I don't think she's sleeping very well, and is growing more and more restless. It's easy to get really confused when your on so many narcotics and you haven't opened your eyes for 4 days. Since she has a head injury, they aren't able to give her any sleep medication. Hopefully, being out of intensive care will help to re-orient Courtney back to a more normal schedule. I think they also start the slowly reduce the narcotics. Both of these should hopefully alleviate some of her distress and impatience, and hopefully she'll get some restorative rest..

We're hoping that she'll be able to start swallowing better today, as this will precipitate being able to start on real food (blended of course), and water. She is desperate for liquid in her mouth, but they can't start that until they are convinced that she'll be able to swallow correctly, as they don't want it to end up in her lungs instead.

A local news station did a piece about our accident. I post this with some reservation, but they did a nice job, so ... for what it's worth. I was extremely reluctant to do the interview, as there were obviously other things on my mind. Also, I have an inherent distrust of the media, especially stories about personal tragedy that don't really effect other people. However, given that she asked nicely, the obvious highway safety issue, and my desire to give God the glory, I decided to relent. You can ignore the hero title, that's obviously a little much. ;-)

http://www.wsls.com/

The kids are back in Harrisonburg with our awesome network of friends who have childcare lined up through June. I'm sure they can't wait to see their mommy, but we want to wait until she's a bit more presentable and can talk.

Anyway, I've got to get back to the room. I'll try to post some more updates here, as I have time. Thanks again for your prayers and support. It's been huge.

Posted by mark at 10:39 AM | Comments (9)