What is surgery?

A lot of people will ask us how many surgeries Ryan has had. And the truth is, I've lost count. I feel like it's something I should know when people ask me. I've been there for every single one.

But I'm having a hard time defining what is a surgery and what isn't. Is it cutting into Ryan's body to remove, repair, or reposition something? Does it require general anesthesia? An overnight hospital stay? A combination of these things? Is it not a surgery if they use a laser, but he was under general anesthesia? Is it not a surgery if they use local anesthetic, cut away at a part of his body, but he sleeps through it and walks away feeling fine? It's getting complicated to define "surgery".

All I know is Ryan has had a number of "procedures" this summer since the time I posted about his eyebrow transplant. (Was that a surgery? Local anesthesia, cutting and stitching, drove himself home?) In July, he had a graft to his right palm and releases in the tendons in his fingers. (General anesthesia, cutting and stitching, home that day.....surgery, check!) A couple weeks later he had laser resurfacing of his face and left arm. (General anesthesia, no cutting and stitching, home that same day.......surgery?) On his birthday in August, he had skin cut away from the titanium posts on the sides of his head in preparation for his prosthetic ears. (Local anesthesia, cutting and stitching, went to other appointments that same day and drove himself home....surgery?) And on August 18th, he had another eyelid release to both of his lower eyelids. (General anesthesia, cutting and stitching, overnight hospital stay....surgery, check!)

I don't exactly know how to define surgery and it doesn't REALLY matter. I just kind of wish I had an answer to the question when someone asks me how many surgeries Ryan has had. I guess being in our community that question comes up more often than you would think. Regardless, Ryan's having another procedure tomorrow. General anesthesia. Laser. Home. Call it what you want.

Something to raise an eyebrow at

We got home from our trip on a Wednesday and Ryan went in for surgery on a Thursday. This time he worked with Dr. Limmer to get some new eyebrows. Dr. Limmer and his staff are so wonderful and welcoming. And they do amazing work. It was all done in the office with local anesthetic. It was completely pain free. Ryan slept through most of the procedure. They removed a section of skin from Ryan's beard and sewed him back up. (I was in the office and watched them do this. First time I've ever been allowed to watch a surgery. Wow!) Then they put the skin under the microscope and removed each hair follicle. Next, they planted each follicle in Ryan's eyebrow region and Ryan had eyebrows! Apparently, the hair will grow for a few weeks and then all the hairs will fall out. It will take another 3 or 4 months for the hair to grow back and then we'll see what worked and what didn't. We expect he'll have another round of hair transplant to fill them in at that time.

Before

During

After

Less than a week later, on July 1st, Ryan had surgery on his right hand. They put a small graft on his palm, did some z-plasty between his thumb and index finger and index and middle fingers, and released some tendons inside his hand. Surgery went well and Ryan is feeling fine. He has a cast on his right hand to immobilize and protect the graft. He'll have the cast until the 23rd.

What's normal for us

I know this sounds crazy, but Ryan had hand surgery two weeks ago, and it's been so uneventful that I forgot I didn't post about it.  

We were sitting around on a random Tuesday talking about what procedures still needed to be scheduled and wondering when we wouldn't have to have that conversation anymore.  So instead of just talking about it, Ryan jumped on the phone and called his hand surgeon to get on the schedule.  They had an opening the following Monday and we took it.  

So yes, Ryan had hand surgery on April 6th.  They grafted the web spacing on his left hand between his index and middle fingers and his pinky and ring fingers.  They also released the web spacing with a z-plasty between his middle and ring fingers, no graft.  They took a full thickness donor from his left side and closed it with stitches.  They immobilized his hand with a splint and we were home before noon.  Ryan slept off the anesthesia for the rest of the afternoon and woke up hungry, but without pain.  And now two weeks later, I can say that not once did he require pain medication after this surgery.  Not even a Tylenol.  

We went back for a follow up last Tuesday.  They took off the splint and saw that the grafts look great and seem to be taking well.   They left the splint off,  so Ryan can drive and gently use his left hand.  We go back this Tuesday and if things still look good, he can begin physical therapy on that hand again.

Ryan's had so many surgeries that we've lost count.  I didn't mean to neglect to blog about this last one.  It just wasn't one of his more exciting procedures, and it truly felt like any other day.

How is it already Friday?

I don't know how this week got away from me, but I just realized that it's Friday.  I was going to post an update last night, but figured I would have a little more information after Ryan's follow up appointments today.  

When I came in to see Ryan on Wednesday, it was just as I suspected.  Ryan had asked to be disconnected from his IV meds so that he could go home.  And they let him.  It was just a matter of paperwork to have everything ready for discharge.  So we ordered some lunch and chatted with each other and Ryan's many visitors.  At 4:00 p.m., I left Ryan to pick up the babies from daycare and Jaida from Drama Club, and got them home and fed.  I went back to the hospital at 6:00 and Ryan was ready to go.  All he had to do was get dressed and sign a couple of forms and a patient satisfaction survey.  We were out the door by 6:30.  

I've been amazed at how well he can see, given that he has bolsters on both his upper eyelids.  The first day there was quite a bit of swelling, but it's gone down enough that he has about a quarter of an inch of clearance when he opens his eyes.  It's been just enough to see where he's walking, what he's eating, and what's on t.v.  That's all he needs for now, I guess.  He's not in a lot of pain, and it's managed well with medication.  

Today, we went in for follow up appointments with Oral Maxillo Facial Surgery and the Burn Clinic.  OMFS took down the bolsters on his ears and declared that it was good.  His grafts appear to be taking well, and they are happy with their work.  It was the first time I got to see what they had done and it took me by surprise.  But then again, I didn't know what it was supposed to look like.  So I have to trust their judgment.  

Next, we stopped in the Burn Clinic and they decided to keep Ryan's eye bolsters on until Monday and his lip bolster on until next Friday.  Nothing is wrong, they just want to give them extra time to take.  We were given clear instructions for wound care for each of Ryan's wounds; what stays wet, what stays dry, what needs to be changed, and what needs to be left alone.  We follow up again on Monday with both clinics.

So, it will be a quiet weekend at our house.  Ryan isn't up for doing much and that's fine by me.  I took the girls to the library tonight and we picked out some good books for the weekend.  Please keep Ryan in your prayers as he recovers from surgery yet again.  It won't be the last, but we're getting closer.

Back in the operating room

After a lovely three months without a trip to the OR, Ryan had surgery yesterday.  And maybe to make up for all the time that they missed him, his surgeons kept him in there for nearly 8 hours.  Not that anything was wrong, they just wanted to be meticulous and productive. 

We arrived at 5:45 am to get checked in and prepped for surgery.  Two different services were working on him together yesterday, so we met with two surgeons, an anesthesiologist, and an OR nurse before they rolled him back at 8:00.  I made sure everyone had my cell phone number, then I went downstairs to the cafeteria for breakfast.  I kept myself busy with a couple of appointments at the hospital and met Teal for lunch in the surgery waiting room.  She brought me Pad Thai from our favorite place, and helped me pass a couple of hours waiting.  At about 2:30, she convinced me to have the volunteer call back to the OR to find out how things were going.  That was good because an anesthesiology resident came out and gave me a good update.  She let me know that Ryan was tolerating the procedure very well and his surgeons were working well together.  She warned me that she expected it to be another hour and a half.  So, I took a little walk and called Ryan's sister to chat.  When I was down the hall on the phone, the volunteer started calling my name because Ryan's plastic surgeon was done and ready to update me.  It was 3:45.  

He told me that everything went really well.  He was able to graft both of Ryan's upper eyelids with skin from Ryan's right side.  He took a composite graft of skin and cartilage from Ryan's ear and revised the center of Ryan's upper lip.  And he released the scars on either side of Ryan's nose, so as to reduce the pulling on the insides of his eyes and across his nostrils.  The doctor was very happy with how it went and believes Ryan will have good results.  He also told me that the oral surgeon successfully removed the cartilage that was left in Ryan's ears and "banked" it under his skin in the incision in his side from where they took the graft for the eyelids.  It will be there for safe keeping if Ryan ever needs some cartilage for future procedures.  They placed the titanium implants in Ryan's skull, two on each side, in preparation for his prosthetic ears.  And they took a skin graft from Ryan's right thigh to close the area on the sides of his head.  They got a lot done yesterday, and even though it took 8 hours, it was only one surgery, instead of two or three.  And that's what Ryan wanted.

Ryan was out of recovery by 5:00, and I walked with him as they rolled him up to the burn ward.  He was obviously heavily medicated, but talking to me coherently.  And not in any pain.  We got him settled in his room and ordered him a tray of clear liquids.  He was starving.  I had to get home to get the kids settled for dinner and the rest of the night, but I took his order for Dairy Queen and promised to be back as soon as I could.  I was back by 7:30 and he started right in with his Blizzard.  He didn't get very far before he got nauseous.  They brought him a little medication to stop the nausea and a little while later he tried to eat again.  But that wasn't a good idea yet either.  They brought him some stronger anti-nausea medication, and Ryan decided to sleep, instead of eat.  That was my cue to head home for the night.  

So, now I'm headed back in to check on my guy and make sure he gets something good to eat today.  We don't know when he'll be coming home from the hospital, but if it's up to Ryan, it will be soon.

Surgery hiatus

Ryan met with his plastic surgeon today for a follow up of his November 5th surgery.  Dr. Thomas is thrilled that everything is looking so good.  Ryan still has a bit of healing to do before he's completely closed up again.  But he's almost there.  Dr. Thomas agrees that anything else that we'll want to do (more eyelids, a little upper lip revision, maybe some dermabrasion) can wait until after the holidays.  So we're looking forward to having a couple months break from the OR.  Surgery is exhausting!  It will be nice not to think about it again until the new year.  There's still so much to do and it will be there waiting for us.

Recovering at home

When I came in to see Ryan on Thursday, he was already planning on coming home. He had a little trouble with nausea that morning, but managed to keep his lunch down. And he didn't have any problems eating the cake the Marines brought him to celebrate the Marine Corps' 233rd birthday. LtGen Flynn (CG MCCDC) and his wife were in town for the cake cutting ceremony, and visited with Ryan and I beforehand. LtGen Flynn had visited the last time Ryan was in for surgery in September, so he's been getting to know us pretty well.

Ryan was discharged at 5:00 and was very happy to be going home. Even though he had his own room this time, he never sleeps well in the hospital. Nurses come in every 4 hours to check his vitals and volunteers and chaplains are always popping in to say hello. It's very nice of everyone to want to visit with him, but after surgery, Ryan needs sleep more than anything. And he's too nice to ask anyone to leave.

We went in for a follow up appointment with Ryan's surgeon on Friday. Dr. Thomas is very happy with how everything is healing and anticipates good results. It's hard to tell what looks good and what doesn't when he's covered in blood and stitches. And you can't see the grafts under his eye and above his lip at all because they are covered with pressure dressings. Those will come off on Monday, so for the weekend he looks like he has a yellow mustache above his lip. It's actually quite comical. So we tease Ryan to enjoy it, since it's the only mustache he'll ever have. He hasn't been in very much pain at all, so that's been very nice. He's been up watching college football today and I got him hooked on Sudoku. (Thanks Rebecca!) He's been playing with the kids and offered to watch Noah for an hour so I could take Maya to gymnastics. He even changed a dirty diaper! So, all in all, he's doing pretty good for having had surgery 3 days ago.

Another surgery day

So, I've been terrible about blogging the last few weeks. And I've been meaning to catch everyone up on Ryan's trip to Europe and my quick (and unexpected) jaunt to DC, but for now I'll just have to settle for telling you about today. It's late, and I'm tired, and I just got home from the hospital.

Ryan was originally scheduled to have surgery on Monday, but his surgeon's daughter deployed to Iraq that day and he took the day off to say goodbye. Luckily, we didn't have to wait too long and got in today. Ryan was second case and didn't have to be at the hospital until 8:00 a.m. They did all his prep work and rolled him back for surgery at 10:30. I didn't know exactly how long it was going to take, so around the 4 hour mark I was starting to get nervous. But that's just when Ryan's surgeon arrived to tell me everything went well. He was able to put a full thickness graft under Ryan's lower right eyelid and above his top lip. They took a little piece of cartilage from what's left of Ryan's left ear and put it between his nose and lip to give it structure. They removed a scar on the left side of Ryan's nose and one along his left jawline, and advanced his cheek and neck accordingly. They removed some bulky skin between the inside of his right eye and the bridge of his nose. And they dermabraded the right side of his face and a few areas on his chin and left cheek. I think that's everything. No wonder it took 4 hours!

I was able to see Ryan in recovery at about 3:30, but he was mostly sleepy and recovering from anesthesia. I had to leave at 4:30 to pick up the kids and get them settled at home with dinner. I went back to the hospital at 6:30 to find Ryan sitting up comfortably and asking for ice cream. I ran downstairs and got him two ice cream sandwiches and a Gatorade. We sat and talked while nurses came in and out and then he took a little nap. He decided he was ready for food when he woke up and sent me out for McDonald's at 9:00. When I came back he was feeling a little nauseous but, with a little medication to help counteract that, he was certain he was going to be eating his meal. Visiting hours end at 10:00, and at that point, I was definitely ready to go home. Ryan's nurse is taking excellent care of him, and his charge nurse tonight is my very favorite!

Even though Ryan said he felt like he got punched in the face with a scalpel, he was already asking if he could go home tomorrow. And as long as his pain can be managed with oral medication, he can. The dermabrasion is the most painful part because it is open and raw. So, we'll see how he's feeling tomorrow, but hopefully, we can take him home. Please keep us all in your prayers. Thanks so much!

What's really going on

There hasn't been a whole lot happening on the homefront around here. Just living the dream, as usual. Ryan's hand is healing nicely and he continues to work on extension and flexion in therapy. He did have a bit of a skin reaction to the adhesive in the tape they used to dress his suture line, but we've found that his skin is much more sensitive than it used to be. And we're finding creative ways to bandage him without tape. He follows up with his hand surgeon again on Tuesday, and we expect he will tell us just to continue with hand therapy as planned. Ryan has also been working with his prosthodontist again since he's all healed up from his "face off" surgery. They made new molds of the sides of his head in preparation for making his prosthetic ears. It is a multistep process that involves making wax versions of his ears and taking pictures and measurements for placement. Then taking a CT scan of Ryan's skull and creating an acrylic model of Ryan's skull. Then making acrylic versions of his ears and finding the best location on his skull to drill and place the implants. They then make a marker for the surgeon so he knows where to drill during surgery. They place the implants and have to let them sit for up to six months before they attach the magnets and Ryan can use the silicon versions of his prosthetic ears. So......yeah, it's a process. We are planning to have the surgery to remove the remaining cartilage in Ryan's ears and place the implants in January. And we were hoping to combine that procedure with Ryan's plastic surgeon releasing his eyelids and revising his upper lip. But we met with Ryan's plastic surgeon on Friday and he doesn't think we should wait until January to do Ryan's lower right eyelid. And he wants to do Ryan's eyelids in two or three surgeries. So, now Ryan has eyelid surgery scheduled for November 3rd. It wasn't what we had planned, but preserving Ryan's vision is of the utmost importance.

Now, don't go worrying that Ryan is spending every moment dreading his upcoming procedures. Right now, he's too busy packing. Yes, he was invited to go France and Belgium on a 10 day tour of World War II battlefields with Operation Comfort. He is so excited! And while I have to admit that I wish I was going with him, I am thrilled that he is independent enough to go alone. This will be the first time he has traveled without me since he was deployed with the 26th MEU. The kids and I will miss him terribly, but he's in good hands and it's so good for him to have some time on his own again. Before his injury he was gone more than he was home, and now he never gets away. But more than anything, it's good for him to get a break from the hospital and all his appointments. If I can get him to take some good pictures, I'll be sure to post them when he returns.

While Ryan's gone, the kids will be sure to keep me busy with school, soccer, gymnastics, and the joy of parenting. But we also get the distinct pleasure of a visit from Ryan's youngest sister, Rebecca. She's been traveling Europe since May and is finishing that trip with a couple of hops across the U.S. Unfortunately, Ryan won't be here for her visit, but that just means we'll have to talk her into coming out again when he's home. And no one ever visits us to see us, the kids are really the main attraction. That's okay by me, I just can't wait to see her pictures and hear the stories of her travels.

Monday Fun Day Surgery

Today we had our first surgery experience in San Antonio somewhere other than BAMC.  I have to say they were pretty efficient compared to what we're used to.  Ryan's surgery was scheduled for 2:30 p.m. and they asked us to be there 2 hours prior.  They checked us in at about 1:oo, and took Ryan back to change into a hospital gown at about 1:30.  Twenty minutes later they let me go back with him and talk to the surgeon, anesthesiologist, and OR nurse.  I wasn't even back there 10 minutes and they were pushing "happy juice" in his IV and rolling him back for surgery.  The surgeon released the tendons in all four fingers of his left hand.  They were trying to maximize the flexion in his pinky and ring fingers and the extension in his index and middle fingers.  The most success was in the ring finger and index finger, with each meeting the goal we hoped for.  The pinky got about 90 degrees of flexion and the middle finger didn't quite get full extension.  He's got two incisions in his left hand and a splint holding his ring finger and pinky down.  The doctor wants him to try to move his index and middle fingers as much as he can.  They finished up surgery at 3:30, but I couldn't go see Ryan in recovery until 4:30.  His throat was hurting him more than anything else from the intubation.  They gave him some pain medication and he slept until 5:30.  Then we woke him up, got him dressed, and took him home.  Well, not before we stopped at Dairy Queen to get him a vanilla milkshake and a large hot fudge sundae.  (His throat was sore, so he needed the ice cream to feel better!)  He's resting comfortably on the couch right now, with his hand elevated, watching Monday Night Football.  Not too bad for a surgery day.  Hopefully he will continue to be relatively comfortable.  He follows up with his surgeon next week.  

A lot of progress in a week

Ryan is feeling much better as each day goes by. He no longer requires the strong pain medication he was taking after surgery and was able to resume driving at the end of last week. That was a big improvement for me, because I've had to take him everywhere he needs to go for the last month. So now we both have a little more of our independence back. Ryan's face is healing nicely, as are his shoulders. He's not completely closed up yet, but he's almost there. He did have a little bit of graft loss, on the left side of his upper lip and small areas along his suture lines. But that happens and there's not much we can do about it. We're just praying that it heals in a way that won't require surgery to revise it. We can already see how the results of this surgery will make Ryan's face less tight and less painful, but for now we laugh because his face doesn't move much when he smiles or laughs. I imagine that's what it's like when someone gets a face lift, just kind of stiff. But once the swelling is completely gone, I think his face will move more.

He's been able to go out in public more in the last week, than in the last month. On September 11th, we attended a luncheon with Retired Army LtCol, Brian Birdwell and his wife Mel. Brian was working in the Pentagon on September 11th, 2001, when terrorists flew an airplane through his office window. He was walking down the hall when he was engulfed by a wall of flames, but his three officemates were killed instantly. It is a miracle that he survived and he shares that miracle with his ministry "Face the Fire" and book "Refined by Fire". It was great to meet Brian and Mel because we had already read their book and were encouraged by it. Later that night, Jaida and Ryan attended a free Tim Mc Graw concert on Fort Sam Houston. It was within walking distance of our house, so while I didn't get to go, I could hear everything. Jaida and Ryan got the VIP treatment, with great seats and free food from Chipotle! The concert was great and they had a lot of fun. At one point, one of the soldiers put Jaida up on his shoulders and Jaida swears Tim smiled and waved at her!

On Saturday, Ryan took Maya to gymnastics at The Little Gym and was impressed to see her tumbling and hanging on the bars. On Sunday, Jaida, Ryan, and I went to dinner at one of our favorite restaurants, Yokonyu, and then to the Majestic Theatre for the Broadway musical, The Color Purple. So, it's been good to get out a little after being home so much lately.

Jaida started soccer this week and Maya is a few weeks into the semester for gymnastics, so I'll try to get some pictures of my girls in action posted soon. Maya's birthday party is tomorrow afternoon. She turns 3 on Tuesday. Noah's latest trick is hiding his sippy cup. I've found old cups of milk in the toy box, trash can, bath tub, and pantry. I haven't caught him drinking 3 day old milk...yet.

Jaida at the Tim McGraw concert.

Ryan loves Maya's face in this picture. I love her crooked pony tails.

Noah explores the back yard with a stick in hand.

Still going in the right direction

Ryan had a follow up appointment in the Burn Clinic today and everything is looking good.  They removed the bolster from his upper lip and took all the staples out of the xeroform on the donor site on his thigh and the skin graft on his shoulder.  So, now he's staple free.  (Well, except for all the staples left under his skin from the skin grafts last year.  We see those on x-rays from time to time.)  The skin graft above his lip looks great.  That's the first we've seen it since surgery last Tuesday, so we're feeling pretty good about how that will turn out.  He still has a lot of swelling and all the suture lines and areas that had dermabrasion are scabby.  That's pretty much everything below his eyes.  As he heals all that will clear up and we'll really get to see what Ryan's face looks like.  We're looking forward to being to that point.  So, now it's just a matter of healing and getting back to the therapy routine.  We're just taking one day at a time.

Looking good

We went in to see Ryan's surgeon today and they are very happy with how things are coming along.  It's so hard for me to tell with all the swelling and crustiness, but the doc says it looks good, so I guess it looks good.  They took down his wound vacs, so that makes getting around a lot easier.  His left shoulder is just all stitched up, but his right shoulder has a meshed split thickness skin graft stapled to it.  That is the first time I've seen such a graft so soon after surgery, and certainly the first time I've been responsible for caring for it.  CRAZY!  But the doctors trust me, so I guess I shouldn't worry.  Ryan doesn't seem too nervous either.  They left the staples in the xeroform on the donor site on his thigh, but they will take those off on Monday when they take down the bolster on his upper lip.  Ryan is still feeling pretty good with all his body has been through these last few weeks.  And even though it's hard for me to imagine right now, he's already talking about when to graft his eyelids, de-bulk his ears, and do any necessary touch ups.  Probably not real soon.

Surprise, surprise

So, I'm getting to the blog a little late today because things did not go as expected yesterday.  When I brought Ryan his McDonalds at noon, his PA said he'd been waiting for me.  That always makes me a little nervous, but this time it was for good reasons.  He said Ryan was doing great and his pain was really well managed, so they said he could go home if he was ready.  We went in and asked Ryan and he was ready!  I couldn't believe it.  After only one night in the hospital, after a major surgery, Ryan was ready to go home!  So, after getting paperwork, supplies, and a ton of visitors, we packed up and were home by 4:30 pm.  He still has wound vacs on both his shoulders and a bolster (pressure dressing) on his upper lip, but the wound vacs will be removed on Friday and the bolster on Monday.  He's relatively comfortable and just so happy to have some movement back in his neck.  His eye pain is gone and now the thing that bothers him the most is the donor site on his right thigh where they took the skin to graft his shoulder.  He's happy to be home and we're happy to have him home.  He hasn't been up and around a whole lot, but that's to be expected.  We're watching his face for any signs that things aren't going well, but his surgeon said that if it's going to fail at home, it's going to fail in the hospital and there's nothing we can do about it.  It's hard to tell what looks good and what doesn't, but so far things look pretty good.  Before when he would get skin grafts he was always bandaged up for several days.  So I don't really know what a skin graft is supposed to look like on day 2.  His PA did say that it's going to look worse before it looks better, so I try not to worry about it too much.  We'll be in the clinic tomorrow so they'll let us know for sure.  Just keep Ryan in your prayers and I know we'll be just fine.

All Good Things Must Come To An End

The title of this blog was selected by Ryan when we talked about it last night.  He was referring to the three weeks of living with his facial flaps and he was being VERY sarcastic.  Those flaps were no fun!  But we are happy to report that they no longer exist.  Ryan's surgery to disconnect them yesterday was very successful and the doctors are happy with the results.  In addition to disconnecting the flaps and finishing off his cheeks, they grafted his upper lip, did some dermabrasion on his nose, chin, and cheeks, grafted his right shoulder that was open when they took his flap, and reversed the pedicle to close his left shoulder.  A lot of that probably doesn't make sense to most people, but just know that he is doing fine.  His right thigh is sore where they took the donor skin for his right shoulder.  But the graft on his upper lip came from one of the pedicles of his flaps.  Just like last time, the thing he's been complaining about the most are his eyes.  We've learned that when they operate so closely to his eyes it disrupts the lymphatic drainage and causes extreme dryness in his eyes.  This time we've been very proactive and made sure we began lubricating his eyes as soon as possible after surgery.  I think it is working because he's not having near the eye pain that he had last time.  It's funny to look at him right now and say he looks great.  Most normal people would think he looks terrible.  He's kind of purple, swollen, bloody, and stitched up, but you can already see how nicely everything is going to heal.  And after three weeks of staring at his jiggly cheek flaps, he looks down right beautiful!

I spent over 14 hours at the hospital yesterday and was very tired when I came home.  So, I'll probably be updating Ryan's status in the mornings since I can't go and see him until noon anyway.  He's already called me this morning to give me his McDonalds order for lunch.  And he said he had a pretty good night, except for all the lights and beeping in his room all night long.  He's only sharing a room with two other people (so far) this time.  And I knew he was doing a lot better than last time last night when he was quoting lines from Jim Gaffigan's comedy routine.  All he wanted for food yesterday was popsicles, jello, chicken broth, and ice cream, but he told me he ate a big breakfast tray this morning and of course, he's already calling for his McDonalds.  

Please keep praying for Ryan.  I know it is working.  Once the flap is disconnected, even though it had three weeks to set up it's vascular structure, it is essentially a graft.  And grafts can retract and fail.  While everything looks really great now, I know your prayers will keep it that way.  My sister, Stephanie, is in town this week helping out.  So the kids and I are doing good.  Thanks for all your calls, emails, texts, and well wishes.  We appreciate them all!

Catching Up

Ryan came home from the hospital as scheduled last Friday afternoon.  He was happy to be out of the hospital and I was happy to have him home.  I no longer had the added responsibility of driving back and forth to visit him everyday, but having him home presents the added challenges of caring for him and everyone else at the same time.  Since having him home means no visiting hours, I haven't taken the time to update the blog before or after I see Ryan.  Ryan is here all the time, so usually if he doesn't need me, one of the kids does.

Ryan is doing better and better everyday.  His pain is very well managed and his energy is pretty good considering his limitations.  He went to the hospital Monday, Wednesday, and Friday for follow up appointments, and each time they were very happy with how he was progressing.  We met with the surgeon yesterday and he's confident that Ryan will be ready for the next surgery on September 2nd.  It's pretty awkward for Ryan to have "bridges" of flesh connecting  his neck to his cheeks, so we're looking forward to having that disconnected.  And I look forward to not having to do the wound care necessary for his flaps.  I keep asking Ryan what people would do if they didn't have a strong stomach.  But we both know it is a means to an end and having that burn scar off of his face will be such an improvement.  Not just aesthetically, but burn scars contract and pull his eyes open, cause him pain, and drastically increase his risks of skin cancer.  Having that gone will be good for so many reasons.  

His eyes are doing much better than last week too.  His right eye, in particular, developed a lot of swelling under the membrane and ophthalmology was watching it closely.  We just had to be really aggressive with the eye drops and goggles and by Wednesday, Ryan was able to get his Boston Scleral Lens back in.  His lenses provide constant moisture for his corneas and protect them, but with all the swelling they didn't fit.  Now that he can wear his lenses, he still needs drops for the area of his eyes not covered by the lenses but he's much more comfortable and can see better.

So, ten more days until the next surgery and Ryan being able to move his neck freely again.  Please keep us in your prayers in the meantime.  This really isn't fun, but we're managing.  

Post-op Day Three

Ryan's appetite is coming back! Not with it's same voracity, but it's certainly better than the last few days. When I called him before visiting hours began to see if he wanted me to bring him something other than hospital food for lunch, I knew he was starting to feel better because he asked for a Double Quarter Pounder with Cheese, Fries, Coke, and an M&M McFlurry. He didn't actually eat it all (like he normally would), but he made a good effort. And he fed himself for the first time since surgery too.

Sleeping in the hospital is always a challenge for Ryan, especially when he has to share a room with 3 other people. But last night he slept better than he had the previous two nights. Maybe that's why he was feeling so much better today. And he's looking good too. The color and temperature of his flaps are the best they've been yet. His doctor is really pleased and confident that everything is going to turn out nicely. The swelling is down a little bit since yesterday, but still looking just as it should. I've taken a few pictures of Ryan the last couple of days and shown them to him so he can see how things are coming along. But he still is constantly asking me if his eyes, his flaps, his pedicles, his wound vacs, etc., look okay. And they look great, but sometime between the 15th and 20th time he asks me, I start telling him that they look awful and he should probably stop asking me. He doesn't stop. And I've also started telling him that he looks like a character from the "Austin Powers" movie, "Fat Bastard". He actually agrees with me on that one.

The doctor says we're on track for Ryan to go outpatient tomorrow. And we're both looking forward to that. I always forget how exhausting it is to spend all day at the hospital. When I'm away from the kids all day, I feel guilty that I'm not home. And when I'm away from Ryan, I feel guilty that I'm not at the hospital. Meanwhile, nothing is getting done at the house. Laundry, groceries, cooking, and more are all being neglected with each passing day. They will still be there when Ryan comes home and I don't have to spend all day at the hospital. Then I'll just have to add wound care, pain management, and who knows what else, to my list of things to do. But never fear, Ryan's sister, Rhonda, is flying in tonight to save the day. She offered to stay for a week and help me with the hardest part of these three weeks. I love her!

In other news, Noah has been taking his first steps this week, but I wouldn't yet call what he does "walking". Maya just found out she will be transitioning to a preschool class at daycare. She's not yet 3 years old, but she is potty trained and has good language skills so they are moving her up a little early. Jaida is visiting family in Oregon and will be home next Tuesday. We miss her and can't wait to have her home. She's had quite the busy summer. She starts 8th grade on August 25th. So you can see, there's always something new happening at our house.

Post-op Day Two

Ryan looked much better today than he did yesterday. While he wasn't feeling really bad yesterday, he wasn't moving around much either. He pretty much just laid there with his eyes closed. Today when I came in he was sitting up with his eyes open, talking with visitors. So his eyes are feeling a lot better, and so is he. He still isn't eating much, but I'm not too worried. I know that will come back. It always does! And his flaps are still looking good. They are a little more swollen than they were, but not as swollen as some of the guys I've seen. And the swelling is normal too.

They continued with the leech therapy today, but we had a little added excitement. The nurse who took care of Ryan had never worked with leeches before. A more experienced nurse came in and showed her how to get them started and then left her alone to catch them as they fill up and fall off. Well, Ryan's nurse wasn't 100% comfortable with the leeches. So, when they finished up she just grabbed them with a handful of gauze pads and quickly threw them in the trash. Well, leeches are living, moving beings...and they didn't stay in the trash can. A little while later, I nearly screamed when I saw a leech inching across the floor leaving a trail of blood. His nurse jumped up and grabbed it but didn't know what to do with it. Then we saw a second one on the floor near the trash can. There was still a third leech unaccounted for that the housekeeping staff discovered shortly after. The nurse was so embarrassed and the whole ward was making fun of her and giving her funny nicknames like DJ Leechy. And she has since learned that after a leech gets his last meal, you destroy him in a cup of hydrogen peroxide. While it may sound cruel, it's much more hygienic than letting them leave blood trails all over the floor when they escape the trash can.

Post-op Day One

If Ryan's nurses didn't know how much he likes to sleep late, they know now. After they resolved Ryan's issue with his eyes, he decided he had some sleep to make up for. When I came in at noon, his nurse told me that he'd sent her away and said not to come back until I arrived to feed him lunch. He wasn't mean, just clear. :) And even though he didn't complain about his pain, he hardly ate anything so you know he wasn't feeling great. He didn't do much besides rest today, but he did get out of bed and sit in a chair for about an hour and a half. The physical therapist came by to range and stretch his hands. His surgeon stopped in and said that he was looking great, but as a precaution he prescribed leech therapy for his left cheek and nitroglycerin paste for his right cheek. Both recommendations should dilate his capillaries and improve circulation to ensure the viability of his flaps. While leeches may make some people squeamish, this is not Ryan's first encounter with the blood sucking parasite. They used leeches on his eyelids after a procedure last October. It doesn't hurt, in fact, he can hardly feel it. And to show what a sense of humor Ryan has about it all, he often names his leeches. Today they were Albert Einstein, Kelly Clarkson, and Kareem Abdul Jabar. I asked him why and he said they were all American Idols! Whatever makes him happy!

I'm hoping he's a little more talkative tomorrow and a little more hungry. But all this is to be expected after such a major surgery. We're just taking it moment by moment. Thank you to everyone who posted a comment or sent us an email. It helps to know you're out there sending us your support and love.

Surgery update

We went in yesterday morning at 6 am expecting Ryan to be the first case as scheduled.  It wasn't until about 9:30 that we found out that they had two urgent cases and the schedule had been adjusted with Ryan being bumped to third case.  Ryan didn't mind too much, he just laid back and took a nap.  They finally rolled him back at nearly 1 pm, but not before letting me kiss his scarred cheeks goodbye.  The next time I saw him his shoulders would be replacing the skin on his face.

The doctors came out at 4:30 and let me know that the procedure went well.  They were able to remove a lot of the scarring on Ryan's face and completely close his left shoulder.  There is an open area about 2"x3" on his right shoulder that couldn't be closed.  They covered it with integra (synthetic skin) and a wound vac, and will go back and graft that area later.  I got to go see Ryan recovering in ICU at about 5 pm and he was still coming out of the anesthesia.  When he finally began to rouse himself, I asked him how he was doing and he said, "Hurting."  He told me he felt like he got hit by a Mack truck.  The nurse gave him some pain medication and something for nausea, and he drifted back to sleep.  He woke up shortly after and was doing well.  By 7 pm, he was ready to move down to the Burn Ward and his pain was down to a 5 on a scale from 1-10.  While they got him settled in his room, I ran downstairs to Burger King and brought him back a large vanilla milkshake.  As soon as he got that, he sucked it down and was feeling pretty good.  Of all the things that might be bothering him, his eyes hurt the worst.  They didn't do anything to his eyes, but because they were working so close to them they were open a lot of the time he was under and became really dry.  He's used to wearing his moisture lenses all day and hasn't had to deal with dryness in his eyes since he got the lenses.  His eyes were throbbing when he woke up and he could hardly feel anything but the pain in his eyes.  While we waited for his eye medication to show up in the computer, I soaked gauze bandages in ice water and pressed them to his closed eyes.  That gave him some relief until we could get his eye drops and lubrication.

When I left him last night at 9 pm, his pain was down to about a 3 and he was listening to his iPod and trying to sleep.  I called this morning and talked to his nurse and she said that his eyes were the only thing that were bothering him last night, but once they got the right combination of lubricants down, he fell right to sleep and slept through the night.  Visiting hours start at noon today, so I'll be going in to see him then.  We'll know in the first couple of days if the surgery was completely successful.  So please pray that the flaps have good circulation and Ryan remains as comfortable as possible.  Thanks so much.