One Week

It has been a full week since Thomas' accident and diagnosis of a broken C5 vertebra. Since much has changed in the past 7 days, and since these quick "status updates" don't really give you a full picture of his situation, Natalie asked that we share with you a fuller picture of Thomas' accident, and some peeks at what's next in Thomas' recovery. We'll try to do a longer post like this every week, to give context for the daily status updates.

THE INJURY + TREATMENT:

Thomas has a "unstable tear-drop fracture" in his C5 vertebra. Or, more specifically: a C5 flexion tear drop fracture, C3-5 ligament strain, C5&6 disc tear. Dr. Peters sent this information along:

The joints above and below the C5 vertebra are the most mobile of the entire cervical spine, which explains why it is common to fracture C5 in traumatic accidents.  In cases of severe neck flexion (i.e. chin to chest) that are accompanied by loading through the head, the C4 vertebra and C6 vertebra pinch C5 anteriorly. The resultant compression on the C5 vertebral body can break-off a teardrop-shaped piece of bone. 

The fracture can then slice the ligaments that run on either side of the vertebral bodies. Ligament damage results in a stack of vertebrae that are not stable. That instability can ultimately compress/shear the spinal cord if one or more in the stack shift position. Cord damage can also arise directly from the fracture (i.e. cord is sliced); but this is less common, as teardrops are usually on the -anterior- side of the vertebral body, not on the posterior side in direct contact with the cord. Vertebral instability can also result in compression of nerves that are passing in/out of the spinal cord, leading to peripheral nervous system lesions.  Hence, a halo is necessary to keep the stack from shifting until C5 heals.

A halo ring and vest brace is used to restrict head and neck movement after a fracture or neck fusion. It consists of 3 parts: 1) a fleece-lined plastic jacket that is worn on your chest; 2) a lightweight metal ring, or halo, that is fastened to your head with four pins; 3) Four rods that extend from the vest upward and attach to the ring. (Source: scroll down)

The halo was "installed" (we don't like that word either) on Friday. It is heavy, and awkward and uncomfortable, and Thomas still tries to nod his head too much (but when the breathing tube is removed, this shouldn't be a problem, because he'll be able to speak). He is handling the pain well: by Sunday night he was off any form of sedative, and every day his pain medication is reduced.


DOCTORS AND NURSES:

Thomas is in the Shock Trauma unit, on the floor dedicated to neck/spinal/neuro trauma. The team is highly specialized and very, very capable. (Thank you everyone for your words of support in this regard. We didn't doubt that they were the best, but we love hearing it from so many people!)

Every morning the neurosurgeon on duty visits each patient with their team of doctors/fellows. After a week, several surgeons have seen Thom and each one has been able to teach us something new! Oh, and they all wear pale pink scrubs, because pink is apparently the most neurologically soothing/comforting color. Good to know.

Thomas also has two nurses every day, and these are mostly the same people: Becky and Meredith have been working with him the most, and they are both fantastic! Becky is very patient, explains a lot, and has super fun Warby Parker glasses (Thomas loves Warby Parker). Meredith is very no-nonsense, while being just chatty enough to learn something of Thomas' personality. (We're mentioning them both to give you a better idea of the days, and because we hope they'll be his nurses for a while!) Yesterday Thomas' nurse was Dan; he has very self-depricatory humor. There is a "Nurse Ratched"--there always is. And a nurse from upstairs (Tina) did night duty on Sunday, and spent a hour explaining what drugs Thomas was on and what their side effects were, etc. etc., which was very, very helpful.

And then there are the Respiratory Therapists, who come in every four hours to give Thomas his lung exercises. They change daily, and mostly just come in and do their job. But some are helpful and informative, as you'll see below.


HIS LUNGS:

Thomas has been on a ventilator since his first night. Once the neck was stabilized, they began treatment of his lungs every four hours, using the ventilator. This treatment helps exercise and stretch the lungs, but it also shakes them up to release any mucus that is building up, to help prevent pneumonia. He hates this treatment, needless to say.

Monday's surgeon explained exactly what was at stake with his lungs: that they were trying to wean him off the ventilator, but that if he wasn't off the ventilator in ten days, they would have to insert a tracheostomy. So Mrs. Z (Natalie's mother) and Mrs. Peters (Thomas' mother, not Natalie! ;) began a novena for Thomas' lungs (as we mentioned).

On Monday night, the Respiratory Therapist told us they had switched the mode of Thomas' ventilator that afternoon, because Thomas was breathing entirely on his own! For four hours he had been breathing on his own, and we didn't know! It was super exciting! The ventilator is still on, in "Pressure Support" or CPAP mode. Now instead of actually inserting air in the lungs it is only supporting the lungs, so that when he exhales they do not collapse (this is what mode sleep apnea patients use). This is the lowest possible mode. Wonderful news!

Tuesday's doctor explained that Thomas needed to work on coughing, so that they know he can cough up any mucus that might build. All day his lungs and diaphragm continue to improve and he is very close to where he needs to be for them to take out the breathing tube!

MOBILITY + MENTALITY:

Thomas is very mentally alert, and very himself. We keep telling you this, but let's show you what we mean: He's cracking jokes (literally spelling them out word-for-word). He gets frustrated when we don't understand him. His pain does fluctuate throughout the day, but so far, they are able to keep his pain managed and watch it very closely. On a good day, his pain hovers around 3 on a 1-10 scale. He is calmer, happier, better when Natalie is around. 

When someone mentioned that she was given a bottle of very nice cognac, his eyes got big and wide and excited. When someone else suggested that when he has finger mobility, he could start doing technical piano strengthening exercises like the Pischna method, he said no, and started miming playing  piano-- not Pischna, or Bach, but Chopsticks!

But Thomas is not at mobile at all. He must be moved into different positions, while he is lying in bed, by the nurses. (More on the wheelchair below.) He can move his arms, shrug his shoulder, and he is gaining dexterity in his fingers: monday he pointed for the first time. Tuesday, he was using his pointer finger much more. It was a little victory when Natalie was praying the rosary out-loud, that he folded his hands together (loosely) while listening/praying. 

We have every expectation this will continue to increase -- as he gets stronger, and as the swelling goes down around the injury (which can take several months, honestly). He has not intentionally moved his foot or leg again, but still has sensation there. We need to keep praying for these things!

THE WHEELCHAIR:

It is a pretty arduous process to get into the wheelchair (they make Natalie leave the room). It's a very straight, high-back chair which gives him necessary neck and spine support.  Sitting up in the chair is a great way to build up his muscles, especially those in his diaphragm. And eventually he will have to support the weight of the halo alone: these are the baby steps.

On Monday, as you recall, he sat in a wheelchair for 90 minutes. Yesterday was even better! He sat in a wheelchair for almost four hours! He watched two episodes of a favorite show, prayed the Divine Mercy chaplet, and Natalie read to him.  

These steps forward do come with consequences; sitting up and supporting his own weight, and that of the steel halo, results in increased head and neck pain later in the evening. But the progress is great, and it is obviously worth it!


WHAT'S NEXT:

The main goal right now is to get off the ventilator! But he keeps accomplishing goals in that regard without us even knowing it, so we're very hopeful! He'll have a sore throat for a few days, but then he'll be able to speak, which will be wonderful!

Then they'll start discussing the next steps in Physical Therapy. One day at a time!


QUICK NOTE OF THANKS:

Natalie wants you all to know how grateful she is for your words of support and encouragement and prayer. She is saving them all for when Thomas has enough energy to read them, but can't wait to share them. In the meantime, feel free to keep sending cards and emails, writing comments, and please continue to pray!


Join us in prayer!