What's Up, Doc?

"Has anyone ever told you that you'd be better off amputating that leg, and living with a prosthetic?" asked Dr. Anderson, just one week ago.

Tim's eyes glazed over. It was obvious he was checking out. I carried the conversation from there.

Think about it. Considering the long term picture, might Tim be better off with a prosthetic?

If it were you on Dec. 7, and a doctor stood by your bedside and offered you the choice: the situation is such that the leg could be saved and you are healthy and young enough to tolerate the process of saving it...or you could amputate and get a prosthetic. What would you have chosen?

From early on, docs have educated and prepared us for amputation as a last resort, and for Tim, it remains a last resort. Plastics and reconstructive surgeons argue, with good reason, "There's nothing better than the real thing."  

Truth is, today's free flaps located on lower limbs, like Tim's, are serving as living research projects.

Time will tell. Some questions simply remain unanswered, especially with the very unique nature of each individual case.

More on this subject and reasoning later.

So it's still May 1, and the home nurse met us here at home earlier, at 4 pm, after we were discharged from outpatient surgery in GR. He was here to to start a PCA IV for Tim, but after trying for an hour, he was unable to get a line in. So as Tim and the kiddos sleep, I am awake waiting for a different nurse to arrive at midnight. Thankfully, Tim is comfortable enough to sleep for the time being.

So I've been wanting to do this for a while...to share a list of docs with you...

I am trying to gather information on the nurses, aides, etc., you know, the ones who actually do most of the work... ;) but here are the docs for now... :)

Let's start from the beginning...

As for Holland Hospital, I'm going by visual memory of face here, so if I'm off, please let me know. 

Giving thanks to God Alone for these doctors...THANK YOU, LORD FOR BLESSING THESE PEOPLE WITH GIFTS AND TALENTS! Thank you, Lord, for those who honor and serve You, and who acknowledge that You Alone are the Great Physician, and that You provide healing through them.

Although I said to the ambulance people at the scene, "WE WANT SPECTRUM!" obviously, there were reasons why Holland was the first stop. While Tim was being treated at Holland, Spectrum Butterworth sent an ambulance to Holland Hospital, as Tim met trauma protocol. The trauma unit at Butterworth is 6 years old. Amazing unit.

Dr. Douglas J. Hoey, MD. was the ER doc who immediately treated Tim at Holland Hospital on Sat., Dec. 7. I remember him being very focused. I remember him saying at the end of treating Tim, "No time for CT scan here. Get him to Spectrum."
                                                                                                                                                                                             

Derick M. Johnson, DO came to Holland Hospital ER to adjust Tim's hip and femur to restore blood flow to Tim's left leg. When Tim first arrived to Holland Hospital ER, he had no pulse in his left leg. After Dr. Johnson adjusted Tim's hip/leg, blood flow was restored and all in the room breathed a sigh of relief when they heard a pulse in Tim's leg. I only saw Dr. Johnson's back as he worked on Tim. I remember he was wearing a striped sweater. It stood out from the scrubs surrounding him. I simply remember praying.

The following docs are part of Orthopedic Associates of Michigan (OAM). Most we met while at Spectrum Butterworth.

Dr. James R. Ringler, MD was Tim's Dec. 8 surgeon, and we are thankful. He added a rod through Tim's broken femur, a pin at Tim's displaced hip and a pin just above Tim's knee. He added 3 plates and 11 screws to Tim's lower left leg and ankle. He discovered that soft tissue on the outside of Tim's lower left leg, near his ankle, had died in the crush injury. Dr. Ringler left the wound open with a vac to clean out the wound. 2 days later, Tim returned to surgery with Dr. Ringler for an "I & D" (irrigation & debridement). More soft tissue had died, so he cleaned the open wound and removed dead tissue. 2 days later, same thing. 2 days later, same thing, etc...until all the tissue that was going to die had died and been removed. It was critical that the surviving tissue remain as clean as possible. Remember that Tim was spreading manure in a corn field when the accident occurred. Although he suffered closed fractures, he had been scalped to the skull (open wound) and he had dozens of abrasions, where bacteria had crept in. For several weeks, the vac continued to pump "junk" out of Tim's bloodstream, preventing infection. Although we have a GORGEOUS picture of the wound, we will not post it here, as it is not "blog appropriate." But imagine a beautiful, bright red, fleshy, healthy wound. It was amazingly clean! By the time the wound was as clean as possible, it was open to the Tim's bone, hardware on the bone, and tendon. It was the shape and size of my hand (a little bit more than half the computer keyboard in length (left to right) and a full computer keyboard in width (top to bottom)). As you can understand, it was impossible to close the wound, and it required more than skin to cover it. It was a great loss of soft tissue. As the docs shared with us, it was clear that Tim needed reconstructive surgery in order to save his leg, and if reconstructive surgery failed, Tim would face amputation of his lower left leg. At that time, OAM reconstructive surgeons were consulted. Currently, we see Dr. Ringler once every 4 weeks. The next time we see him is mid-May. He shared a story with us. Years ago, every time just before they would start operating, Dr. Ringler's mentor doctor would ask the question, taken from the movie Airplane (which is one of my favorite movies), "Have you ever seen a grown man naked?" Dr. Ringler says, "Man, every time I think of that question, I now think of you, Tim. What a story!"

Dr. John D. Maskill, MD (OAM) conducted an I & D on Tim when Dr. Ringler was unavailable. Dr. Maskill was the surgeon who reached out to us saying, "God didn't save Tim because Tim needed saving, but because others do."

 
 

Dr. Michael R.F. Jabara, MD (OAM) conducted an I & D on Tim the day before Christmas Eve, in place of Dr. Ringler. When he offered to order Tim a beer from the hospital cafeteria for Tim's 12/26 birthday, I interjected, "Ha. Ha. No thanks." Dr. Jabara brought his daughters with him on Christmas Eve to make rounds. I saw them later that day at Meijer while they were grocery shopping. I was there to pick up some Christmas goodies for our family Christmas party, which we had in Tim's hospital room.

Dr. Viet Do was one of the reconstructive surgeons to perform Tim's Jan. 8 muscle free flap and skin graft surgery. He removed muscle from Tim's left abdomen and connected it to Tim's open wound vessel by vessel, filling in the "hole"/open wound on the side of Tim's leg. He also did skin grafting, harvesting one and a half layers of skin from Tim's left thigh and placing it over the muscle flap. We were seeing Dr. Do weekly, then every other week, and currently, we see Dr. Do once every 3 weeks. In addition to overseeing Tim's flap and graft, Dr. Do also oversees Tim's open wounds, pressure sores, nerve damage in Tim's right arm, and ligament damage in Tim's finger. Once the muscle flap was completely healed and closed, Dr. Do referred Tim to the OAM foot and ankle team of docs, due to Tim's "drop foot" status. Dr. Do may eventually remove some of the volume from Tim's muscle flap, when the flap shows signs of being ready for this. He is also prepared to operate on Tim's arm, and he will see the open wound on Tim's head to full healing as well. The open wound on Tim's head is healing beautifully. It will either heal enough so that Dr. Do can eventually close it, or Dr. Do could put a skin graft over the wound. Time will tell. We see Dr. Do next week. Fun facts. Dr. Do immigrated from Vietnam to the USA with his parents and siblings in a mass exodus when he was 3 months old. Dr. Do is just younger than Tim and slightly older than me. We know more about these docs than we ever thought we would, but why not? God crosses our paths for reasons. 

 

Dr. Steve C. Naum MD was Dr. Do's reconstructive surgical partner in Tim's Jan. 8 free flap and graft surgery.

Most recently, Dr. John G. Anderson, MD, met with us regarding Tim's foot drop status. He explained that the only way Tim will walk on his left foot again is to operate. During the May 1 outpatient surgery, he released Tim's Achilles tendon, posterior tibial tendon (the tendon along the inside of the foot) and the tendon of the big toe. Come Monday, May 5, Tim will be weight bearing with boot (yes, another boot, which was fitted to Tim following the May 1 surgery...this is Tim's 4th boot. Tim is to wear this boot 24/7.) With upcoming additional and aggressive physical therapy, which starts Monday, Dr. Anderson predicts that Tim will be walking (in a "clubby" sort of way) within 2 weeks. As I shared earlier, at our first consultation with Dr. Anderson, after he examined Tim's foot, ankle and leg, his question to Tim was, "Has anyone ever told you that you'd be better off amputating that leg, and living with a prosthetic?" Dr. Anderson asks this because he takes one look at farmer Tim and is truly concerned with Tim's quality of life. Following surgery on May 1, he explained that arthritis has already set into Tim's ankle. Scar tissue will continue to form, and when Tim's ankle becomes stiff and tendons need release again, he will do the best he can, but there may be limitations at that time, as they have already been released. once. I asked Dr. Anderson if Tim's leg is viable. He responded, "Well, he has a lot invested in that leg. Let's give it a shot and see how it behaves."

 

I also saw Dr. Anderson's face when he walked in the consult room. Beaming, 2 thumbs up. He said, "Tim's gonna' love it. He's gonna' walk. I'm absolutely shocked that his ankle looked as good as it did. Unbelievable."

 

It's a true story, people. This is A PATTERN! IT IS WHAT WE HEAR from these docs. We simply shrug our shoulders and say, "It's God. It's Prayer."

 

Understandably, based on what docs have seen of lower-limb free flaps, the swelling of Tim's leg will stick around for 2-3 more years, as blood vessels create new pathways where the ones before were destroyed. We anticipate more surgeries, but we don't know for what, or when they would be. We anticipate that from now on, Tim will live with physical pain. This is all part of living day by day, as a new normal. From what we understand of those who live with lower-limb free flaps, they finally feel a bit "like they did before" 5-6 years following the trauma to the leg. That puts Caleb at 17, Joel at 15, Lilly at 14 and Luke at 11. So this is a new normal. It will simply take time and patience for our family to adjust. We covet your continued prayers.

 

 OH, BUT WAIT! THERE'S ANOTHER DOC!!! 

 

 

WE ARE EVER SO THANKFUL for Dr. Jon Kroeze MD of Lakewood Family Medicine in Holland!  Tim's Primary Care Doc, Dr. Kroeze stays in the loop with meds and local care when needed. It was the best to go see him, after we were HOME! ...a familiar face from home.

We give thanks to God for your faithful and continued prayers. You can appreciate that when you go through something like this, it is exhausting and tiring. It is difficult to see the big picture when you are in the details of drying and cleaning between Tim's toes, changing the dressings on his wounds, picking up prescriptions and giving meds, getting to doc appts., being involved with physical therapy, and being a wife and mom. Oh yeah, and an ice cream twirler at the Spot...which I've almost got the twirl...so close!!!

But that's beside the point.

As life goes, this is nothing I expected to be dealing with. Which is exactly what life brings. I can't do this on my own. Are you crazy??? I have no choice but to fall on God's grace every single minute. PLEASE do the same. Let God carry you! You are never alone. Always in the gracious, precious, everlasting and powerful grip of our Lord and Savior, Jesus Christ.

Join us as we continue to Give All Glory to God.

P.S. I took a little break from writing to meet with the home nurse, who showed up at midnight. She got the line in. Tim's doing great. :) Now time for sleep. More blogging later.