Surgery

I thought I had better update the blog before I forget details.

Joel and I took Adam down to Denver Monday for his skin graft surgery. My sister, Adrienne, stayed with Jenna and Will and took them to their Dentist appointments in Cheyenne. Thank you, Adrienne!

We got to Denver in more than enough time, and continued to be amazed by the Children's Hospital. They are very efficient, quick, kind, and thoughtful. It's great to be at a hospital that is just for children, because they really think of everything. After we got checked in and taken back to Adam's pre-op room a nurse and NP came to take a look at him. After checking vitals and looking in ears and all that good stuff we pretty much just had to wait until it was time for surgery. They had a great playroom to wait in, and Adam got out some wiggles.

After quite a lot of time in the playroom we were talked to by the anesthesiologist and then Dr. Moulton (the 'head burn guy' and surgeon). Everyone explained things very well so we understood just what they would be doing. Joel and I were both able to go back with Adam to the OR until he fell asleep. He didn't like it when Joel laid him on the operating table, and he really didn't like it when they put the mask on his face to sedate him. But once they put it on he only screamed for maybe 10 seconds before he was out. It was a little hard for me to watch, and after he went out he made squeaking noises like he couldn't breath. I didn't like that at all, and I asked them what it was. They just said, "That's normal, sometimes they squeak a little." Then we had to give him a kiss and leave. I didn't like leaving him in the OR, but I knew he was in good hands. The anesthesiologist also gave him a caudal block (which is similar to an epidural) so his bottom half would be numb for awhile after surgery, helping to manage pain.

The surgery went very well. The nurse called us about halfway through to let us know how things were going, and that was much appreciated. They took partial thickness grafts from his left thigh and placed them on his right. Dr. Moulton did a sheet graft, which means he didn't put the donor skin through a contraption that stretches and perforates the skin, he just placed in on the burned areas that needed it. They also cleaned the burn on his torso really well while he was out, so it looks pretty amazing now.

His right leg is now splinted down to the ankle and wrapped tightly. We have to limit his mobility because the last thing we want is for the graft to shift. His left thigh is also wrapped, and they put artificial skin on that area to help it heal. The doctor said that the donor site should heal in 10-14 days, and the graft area should be basically healed in about a week.

Shortly after the surgery we went back to the PACU so we would be there when Adam woke up. Right when we got there he opened his eyes for the first time. He was so out of it he could barely focus his eyes, but it didn't take long for him become a little more alert. We offered him water and juice, but he didn't want either of those. As soon as we mentioned popsicles, however, he was all over that. His appetite showed up as soon as he woke up, which isn't surprising considering he hadn't had any solid food at all that day.

They moved him to a recovery room where he had more popsicles and some crackers. He complained a little about his toes hurting; we assume they were just tingling from the caudal block starting to wear off. Other than that he didn't really complain about pain at all. We only had to be in the recovery room for about 45 minutes and then we were free to go home. We were all excited to get back home!

Above and below: before surgery, just hanging out and waiting.

Above: finally some food!
Below: the first crackers: they seriously improved his mood

It hasn't been all fun and games since we got home. We aren't letting Adam walk anywhere, and he's in plenty of pain, so he is quite cranky. We have a few different meds for pain and others for itching, but he is still uncomfortable and cantankerous quite a bit. He does sleep fine, which is a big relief. He complains much more about his left leg (the donor site) than the right, which makes sense. He also complains about his torso being itchy, and today at the store he scratched so much that he drew some blood. We are trying to keep that under control with ointments and the oral meds.

We go back to Denver on Tuesday and they will change the dressings. I am anxious to see what it looks like, and to see what progress has been made. Hopefully he won't have to be in a splint after that! Adrienne will go home on Saturday and we will be sad to see her go. It has been really nice to have an extra set of hands, especially when Adam needs so much attention.

Verdict

It was the moment of truth today. We went down to Denver for yet another dressing change for Adam. It was a miracle that we got to the hospital on time and in one piece; the roads were absolutely horrible with snow and rain. It was very stressful, to say the least.

The doctor came in to look at Adam's progress after all the bandages were taken off. They are pleased with the healing on his torso and they will let that continue to heal on its own. However, the large white spots on his leg aren't doing so well. The doctor told us that if we let them continue on their own they will take another 3-4 weeks to heal and will end up as large, raised, red scars. After he let that sink in for a second he told us that his recommendation is to go ahead and graft the leg so it will heal faster and with less scarring.

The surgery is scheduled for Monday afternoon and we will either come home Monday night or Tuesday morning. They will take a partial thickness skin graft from his other leg (meaning they will take all of the epidermis and part of the dermis, but won't get down to hair follicles and sweat glands and all that good stuff). He shouldn't scar too badly on his other leg. They are going to put his leg (the burned one) in a splint for a week. They said he won't be able to walk and we'll have to carry him everywhere; I can guarantee that Adam is going to HATE that!

My sister, Adrienne, is coming over from Utah to help us out with the other kids while Joel and I are in Denver with Adam. I am excited to see her, but not too happy about why she happens to be coming! I did cry a bit when we found out we were doing grafts, but I am feeling much better about it all now. I am focused on the fact that he is going to heal faster this way, and scar less.

They didn't dress his torso today, just his leg. They did put a bandage on the deepest spot on his side (which isn't sticking at all, by the way) because they want it to be open to the air. He's developed a bit of a yeast infection on the burn because it's been so warm and moist for three weeks. They prescribed an anti fungal that Joel is picking up right now, and we are putting anti fungal ointment on the burn instead of antibiotic.

Hopefully we'll be ready for this new endeavor, and I want to thank you all for the love and support we've received over the last three weeks!

Below you can see the area on his torso that was very white last week. Now it is pink and on its way to being healed.

You can see one of the spots on his leg that is going to get a graft. The other spot is on the front, and larger than this one.

The Latest

We did things a little differently this week. Instead of changing Adam's dressing on Tuesday the burn nurse told us that we could change it Monday and Wednesday if we noticed Adam itching too much. So we went ahead and changed the dressing on Monday, but we forgot to take any pictures. We also decided to try doing it without giving him any Oxycontin; we won't do that again.

We changed him again yesterday and here is a picture of that. His torso is looking so much better, and a lot of the burn is basically healed, just discolored and sensitive. The white spot on his torso that was so concerning on Friday is starting to look better with a lot of pink showing up. His legs are a lot whiter than we would like, and we'll just have to wait and see what the burn team tells us in Denver tomorrow.

In other news, it is my birthday today. Yesterday I got to celebrate a little by hanging out at the Bade's for a ridiculously long time. :) Joel came over after Chad woke up and we played cowboy golf and Super Mario Brothers on the Wii. We were also able to give Adam another blessing.

This morning I opened gifts from the family (thank you, Joel and kids!!!), and tonight Joel and I are going to watch a movie and head to bed early so we can get to Denver in the morning. Hopefully the weather will cooperate!

Denver or Bust

I have seen the beauty of copying e-mails and posting them to the blog; it really saves me some typing! I've copied an e-mail to my sisters about our trip to Denver:

I thought I would write about our Saturday. We had a seriously great day! We took our kids to the Bade's and Chad's mother came over from Cheyenne to watch all six kids (a brave endeavor). We left Laramie around 8:30 and had a great time just riding down to Denver. We definitely don't get to hang out with the Bade's enough without our children. When we got to Denver we stopped at Krispy Kreme for a mid morning snack before hitting the temple. The "Hot & Fresh" sign was on and we all got a free doughnut while we were waiting in line! I did not know that this was something Krispy Kreme did, and boy was I pleasantly surprised. After picking out a dozen donuts (yes, a dozen, for the four of us:), we headed to the temple.

Believe it or not this is the first time Joel and I have ever been to the Denver temple. We know that is pretty lame, but we are happy we were able to finally do it. Sarah and Chad have been there countless times so it was great for Joel and I to both have a guide. :) We had planned this temple trip weeks ago and were really happy to be able to still do it after Adam was burned. We were worried about leaving him all day, but after seeing how great he was doing we knew he would be okay. We also knew it was important for us to get to the temple, especially now.

While sitting in the chapel waiting for the next session to start I grabbed a BOM and decided to flip open to a random page. Of course I had been thinking about Adam. I flipped open to Jacob and picked a verse. I saw that it was talking about the allegory of the olive tree and I almost flipped to a different page, thinking, "this isn't what I want to read about." But I decided that maybe I had picked that page and that verse for a reason, so I read the verse all the way through. It said, "Take thou the branches of the wild olive-tree and graft them in, in the stead thereof; and these which I have plucked off I will cast into the fire and burn them, that they may not cumber the ground of my vineyard." (Jacob 5:9) Of course I cried a little bit because what was the chance that I would pick a verse in the whole book that used the word "graft" when I was coming to pray that my son wouldn't need skin grafts. I had hoped that while I was there I would feel an assurance that he wouldn't need the grafts, but that didn't happen. Starting with that scripture I felt that he really might need the grafts, and that what Joel and I need to do is have faith that the Lord will take care of him and to just do our best with what comes our way.

Soon after that a man (a VERY tall man) came and asked Joel and I if we would like to be the witness couple. We've never done that before so we were not sure if we should even say yes, but Sarah assured me we would be fine (her and Chad have been the witness couple many many times), so we followed him and just did what he said! :) Really it was a fun thing to do and a neat experience. It turned out not to be scary at all, as I'm sure some of you must know because I'm sure some of you have done it before!

After the session, and buying a few garments, we headed out to lunch at P.F. Chang's. Joel and I had never been there, but man was it good. Have any of you been? Have you tried the lettuce wraps? They were so good that I could have licked the plate clean. After the meal we got our fortune cookies, and the message in mine seriously made me tear up. It said: "You will receive unexpected support over the next week. Accept it graciously." Who knew a fortune cookie could make you cry in the middle of a crowded Chinese restaurant? Well, it was a great message.

The drive home was a blast, of course, with lots of laughing, joking, teasing, Sarah cringing at Chad's driving, and eating more donuts. Good times. :) We got back to Laramie a little after 6 and our kids were great! Chad's Mom said that they had behaved themselves and Adam only cried for me when it was time for him to take a nap, but of course he quieted down after a minute or two. They didn't want to leave when it was time to go home. I could understand their sentiment.

We had such a great time, I am hoping that we will be able to get one more trip in before we move to Mesa.

At The Chang Man's house

On the way home...

More Stuff

As I'm sure you all know we went down to Denver again today to get Adam's dressing changed. He did pretty great and didn't cry or complain TOO much.

We were both pleased and displeased with today. In most places his burns look so much better. The spot on his ribcage that was very white before has turned very pink and is healing well. Many of the superficial burns are basically healed. However, there is a white spot on his side that looks a lot whiter than it did before. I'm not sure if that's because it was covered with dead skin before or what, but it now is very white.

When the doctor looked at it he asked how far out we were, we told him it's been 13 days, and he told us that when we got back next Friday they will make the decision about whether to graft or not. He didn't sound confident that they WOULDN'T have to graft, and I didn't like that much. He said that if they did graft they would most likely take the skin from him other thigh. They would do it the following Monday, the 26th.

I am still very hopeful that he will continue to heal and they will decide not to do any grafts. There are many reasons that I don't want him to have to get grafts, some of which include having to be put under general anesthesia, being admitted to the hospital again, and having his other leg hurt. We are praying hard that he will heal on his own, and Joel is going to give him another blessing.

I also asked the doctor about scarring, and he kind of looked at me like I might be crazy and said, "It's going to scar." It makes me sad to think that my baby is going to have permanent marks from this trauma. I hope that they won't be too bad and that it won't effect his self esteem or body image as he grows up. It's hard to imagine his skin being permanently altered from what it looked like just two weeks ago, before all of this happened.

We are lucky to be able to go to the temple tomorrow with some friends and I am looking forward to it so much, especially at this time in our little boy's life.

Bath

I'm sorry if I am going overboard with the pictures. I'm sure everyone is tired (or grossed out) of seeing pictures of Adam's burn. But just to warn you, I will most likely be posting pictures of his burn after every dressing change so that I am record his progress. So I apologize in advance.

We were able to change his dressing at home today. They told us to give him a bath, as well. We were nervous about it, but Adam did great. He didn't complain too much when we took the dressings off, which was probably the worst part in Denver. I think it's because Joel and I were a little more gentle than they are (they are used to doing it, and we don't like to hurt our baby). A lot of dead skin came off in the tub, like they said it would.

We put the new dressing on with Adam standing on the kitchen table. We tried to work quickly, and I don't think we took too much longer than the pros down in Denver, but Adam was definitely tired of the whole thing by the time we got done.

He is looking better each time, which is so great. We are basically back to our "normal" schedule, aside from the dressings changes and continued giving of pain medication. He sleeps normally, plays normally, eats normally, and even the diaper changes are back to normal. Only the young could rebound so quickly, I'm convinced.

Dressing Change

As I mentioned, we went back down to Denver today to get Adam's dressings changed. They did need it, as they were not covering some parts anymore. He was pretty active over the last few days, although he did slow down a lot from the first day. It was obvious that he was feeling a little stiff and hesitant to move.



Adam didn't have morphine for this dressing change; we gave him some oxycodone 30 minutes before his appointment to try and help with pain. I think the morphine made quite a difference last time, because in some ways it was worse today than it was on Tuesday. We could tell he was in pain, especially as the nurse took his old dressings off. They did stick a bit in some places. After the nurse got everything off we covered him up and she went to get all the supplies ready and tell the doctor that Adam was uncovered.



When the doctor came in he thought it looked better than last time. He said very confidently that his leg would heal completely on his own, and he thought all of his torso would as well. As the nurse redressed him, she gave us instructions on how to do it because Joel and I will be changing it next Tuesday at home. We also are supposed to put him in the bath when we change him. We are a little hesitant about that, but they reassured us that the water would sting at first but then would feel good. They sent us home with all of the supplies for changing, so we'll see if we can manage it next week. We do have to go back to Denver on Friday so they can change it there and see how it's healing.


Overall it wasn't too bad, but it was definitely hard to experience again. I hope that the dressings changes will get better (a lot better) as things heal.

Here we are, waiting for the doctor to come in.

The uppermost part of the burn that has the white color to it is the deepest area. If you click on the picture to make it larger you may be able to see the reddish dots, which is called "budding". It is the new skin beginning to grow.

A few more pics

Adam is holding the remote, which had a speaker in it. He really liked to hear his movies.
This was not long after we got home on Tuesday.

Jenna, Will, and Grandma made signs for Adam.

Adam is doing well, although he's being a little more cautious and hesitant in his movement. I think the high of being home is wearing off and the pain is winning out a little. We are going back down to Denver tomorrow for a dressing change; wish us luck, Adam doesn't get morphine this time.

Pictures of Adam

Above and below: In the ER in Laramie

Below: ER in Denver

Below: In his room

He always wanted hugs, which consisted of him tightly wrapping his arm around my neck. I loved it.

A nice juice box: we gave him as many as he would take.

Physical Therapy

Standing by the window, enjoying being out of bed.

First dressing change and dibridment

After getting the new dressing.

Adam

This post is going to be quite a mish mash. First I tried to just copy and paste some e-mails that I sent to my family, but I couldn't get it to work, so I began writing out our story from the beginning. Then I had a friend tell me how to make the e-mail work. I am including both what I started writing, and the e-mails. Sorry about the overlap, and sorry about how incredibly long it's going to be.


Here's what I started writing this morning:

I was trying to avoid having to write this post. I tried to copy and paste some e-mails that I sent to my family so I wouldn't have to re-tell everything, but it won't let me do that. So, as a warning, this post is going to be extremely long and detailed for record keeping purposes, I'm sure I will forget a lot of it very quickly. I will post pictures next.

Saturday evening Joel went to the Priesthood Session of General Conference and while he was gone we decided to make some donuts. They were tasty and the kids enjoyed them. After they were done it was time for baths so I unplugged the deep fryer, pushed it back on the counter, and went upstairs with Will to give him a bath.

When I was just finishing up giving Will a bath- he was out of the tub with his towel on- I heard Adam scream. I knew right away that something was seriously wrong, because he wasn't just crying. I could hear that he was definitely hurt, and he was also panicked. I ran downstairs, and about halfway down I just knew that it had to be the oil. I ran into the kitchen at top speed (and of course fell because the floor was covered in oil). Adam was stading there, clothes soaked in hot oil, screaming. I immediately pulled his clothes off and put him in the kitchen sink because I was going to spray him with cool water. I thought at first that maybe it wasn't too bad, the oil had been off for at least ten minutes. and Adam's skin just looked red. But then I saw that his skin started to slough off, spots of blood were appearing on his torso, and over his rubs were strange dark purple marks. I didn't put any water on him because I was afraid that his skin would just come right off and he'd have no defense against the open air. I grabbed my phone and for one split second I thought "Joel, or 911?". Obviously it didn't take me long to make that decision and I called 911 right away.

By this time Jenna had come out of my bedroom where she was watching T.V. She was really worried and sort of freaking out, partially because she could see that Adam was in a lot of pain, and partially because I was freaking out. I was trying to hold it together on the phone with the dispatcher, but Adam's skin was starting to blister and look worse. After I gave her the info and she said an ambulance was on the way I hung up with her and called Joel. Eventually he answered (he had to get to a place where he could answer) and he came home quickly. He got here less than a minute after the paramedics.

They had me wrap Adam in large sterile pads and carry him out to the ambulance. I was still trying to hold things together. It was hard to see my baby in so much pain, and once the paramedics got there and they were supposed to take care of things it's hard to stay strong. I'm not sure if any of you have experienced something similar, but it feels like you should be able to put some of the burden on them, and that's when the tears start flowing. At least for me.

Anyway, we rode to the hospital in the ambulance, and in the E.R. they put in an I.V. and started giving him fluids as well as morphine. The E.R. doctor looked at him and told us that they would most likely be sending him to Greeley (where they have a burn center) or Denver Children's Hospital. They estimated that the burn covered 20% of his body.

Joel got to the E.R. shortly after we did, thanks to some neighbors of our that saw the ambulance and came to take care of Jenna and Will. We are so grateful to them for their help in our time of need. Joel called a man from our ward and as soon as we got a chance they gave Adam a preisthood blessing.

We got many calls and texts while we were in the E.R. from people who had found out about what happened and offered their support. It meant so much to us to see what great freinds and family we have. I called my friend Sarah to tell her what happened and she immediately came over from Cheyenne to get my kids. I knew they would be in good hands with her family, and that they would be comfortable with them. We have wonderful friends.

After the doctor made some phone calls we found out that we were going to Denver Children's. We found out later that it was because the burn center in Greeley didn't have a pediatric anesthesiologist on hand and they weren't sure if Adam would need surgery. Adam's pediatrician happened to be in the hospital at the time so she came down to see us. She figured that they would fly us, either helicopter or fixed wing. When we found out that we would be going down in the ambulance she was pretty surprised. I didn't know enough to be surprised, I just wasn't looking forward to Adam having to make that long trip.

We decided that I would ride down with him; he was still on my lap and he didn't want to move at all. I did have to hand him off to Joel for a minute while I used the bathroom before the trip, and that was hard for all of us. Of course, any movement at all was quite painful to him, even with the morphine.

So I rode in the ambulance and Joel drove down after packing a few things that we might need while we were down there, since we didn't know how long we would need to stay. The ride in the ambulance wasn't fun at all. The I.V. pump stopped working and the EMT didn't know how to fix it because they don't use IV pumps. After some phone calls he eventually just set the pump aside and did it himself, trying to keep a steady drip at the right speed while in the back of a moving vehicle. The temp in the back of the ambulance was a little crazy, up and down. This was furstrating to me since burn victims have a difficult time regulating body temp and Adam was going back and forth between cold and clammy and sweating heavily.

Eventually we made it to Denver where we were admitted through the Emergency Room. They gave him more morphine and put on a temporary saline gauze dressing.


Here is where the e-mails begin:


Instead of writing about what has been our life for the last three days I am just copying some e-mails that I sent to my family:


So you may all have heard by now that our little Adam had a bit of an accident. Last night (Saturday night) he knocked over some hot oil on himself and was burned pretty bad. Joel was gone to the priesthood session, so the first thing I did was take off Adam's clothes and call 911. I thought for a moment that he might be alright because he was just red, but then I saw his skin begin to slough off. Joel rushed home when I called him and he got there shortly after the paramedics.

Adam and I rode to the hospital. When we got there they put in an I.V. and gave him fluids and some morphine. He was sitting/laying on my lap and he didn't want to go anywhere. I didn't want him to go anywhere, either, of course. It hurt him very much just to move, so we did as little jostling as possible. He is burned over the right side of his torso and about half of his right thigh and up his hip is also pretty badly burned. Luckily he isn't burned on his face, hands, or genitals, so we dodged a lot of bullets right there. Joel called a guy from our ward and he came so they could give Adam a blessing.

The E.R. doctor looked at him and decided that they needed to send him either to Greeley or Denver because they couldn't quite deal with this kind of burn on someone so small. After calling Greeley, where there is a burn center, they decided to send him to Denver Children's because Greeley didn't have a pediatric anesthesiologist on hand and they didn't know if he would need surgery.

They sent us in the ambulance, and our pediatrician who happened to be in the hospital at the time was pretty surprised. She thought they would fly him, either helicopter or plane, but they didn't. Even the EMT in the back of the ambulance said he was surprised they didn't just fly him. It was a long ride down to Denver for Adam and I. Joel went home to pack some things and came down in the car.

Jenna and Will were well taken care of after this all happened. Some neighbors of mine that are also in the ward saw me walking out to the ambulance with Adam and they came over to take care of the older two kids. When I was waiting in the E.R. I called my friend Sarah and she immediately drove over from Cheyenne (they were there with her family for Easter weekend) and picked up my kids. She took them back to Cheyenne and as far as I know they have participated in the Easter activities that Sarah's family does. Brenda is on her way down right now, in fact she should be getting close to Cheyenne now. She's going to take care of the kids while Joel and I are down here.

When Adam and I got here to the Children's Hospital they fixed his I.V. that had a clot in it and they put a saline gauze dressing on it for a temporary dressing. They gave him some more morphine, but he really wasn't complaining too much.If he wasn't having to move then he was fine, but with any adjusting it was obvious that he was in pain.

In Denver the blisters looked horrible. I've never seen blisters so big; I thought they would burst before holding that much liquid. Joel took a picture of a blister on his leg in Laramie, and looking at it now it doesn't seem so bad compared to what it looked like when we got here to Denver.

Two surgeons came to see him and they told me that it is all first and second degree burns. Those usually heal very well and he might not even have any scarring. They thought he probably wouldn't need any skin grafts, but they said they wouldn't know that for sure until the head burn guy came and saw him on Monday. They said he would certainly be here until Monday or Tuesday. I can't imagine going home tomorrow because I wouldn't know what to do with him. The physical therapists will come in tomorrow and get him walking around. He wants to get up today, and they said we could let him, but every time we move him he whimpers.

Last night at about 1:30 they put a real dressing on it that included about 20 tubes of antibiotic ointment and petroleum gauze, then wrapped with coban. After he got that dressing I was able to get off the gurney and lay him on it, so then I was able to drink some water (I'd turned down all water before that so I wouldn't have to go to the bathroom when he was on me). They won't change that dressing until tomorrow.

Right now Adam is eating and drinking normally. He's watching movies and he's even joked around with us some today. The first time we had to change his sheet and diaper today he was in a lot of pain and he outright cried for the first time since the accident actually happened. After that they gave him some Oxycontin for the pain.He did much better the next time we had to change things.

We have really seen how blessed we are and how many people we have in our lives that care about us. Last night our phones were ringing or beeping constantly with people asking if we were okay and if there was anything they could do to help. It has been wonderful to have that support, even if there is nothing that people can actually do.

I've sent some pictures that Joel took on his phone, but I'm not really sure what they are of. :) I haven't looked at them.

Joel and I are holding up. Joel slept a lot yesterday, so he actually wasn't too tired last night. We got 2-3 hours of sleep last night after Adam was admitted, so I'm sort of running on fumes right now.

Well, I can't think of anything else to say. Thanks for any prayers you can send our way. We love you all.

Sarah



Hey. I have some time so I thought I would update you all.

We are just hanging out at the hospital right now. Adam did pretty well through the night. He did have some low blood pressure but it wasn't something they worried about, they just checked him more often. He also didn't urinate at all through the night, so by the morning they were talking about possibly using a catheter to drain his bladder. He'd had a lot to drink and his IV was still running, but no pee. However, after he was up and awake for awhile he did urinate. A lot. Joel and I changed many wet diapers (which is a bit of a process; one that Adam doesn't like).

Anyway, a doctor came in this morning and said that as far as she could tell there was no reason to keep him here after the burn team changed his dressings. I was a little surprised about that, and worried also. I wasn't sure I would know what to do with him at home or how he would handle things. A few hours later physical therapy came in and she had Adam throwing balls and sitting on the edge of the bed. Then she had him walk across the room and play with more toys over on a bed that Joel and I are using. He was throwing without any problems or complaints of pain. He could bend to pick up a toy, and he even climbed onto the bed (it's really low). She was really happy and impressed with how he was moving and she said he didn't seem to have any limitations with mobility, besides the bulky dressings. None of his burns are over joints, so we don't have to worry about the bending and stretching that would happen with that. It was scary watching him be so active; I was really worried about the blisters and the sensitive skin under the dressings. But I trust that the therapist knew what she was doing, and it was a relief to see Adam moving around so normally. He was really enjoying being able to play after being trapped in bed all day yesterday.

I was getting my hopes up that we would be able to go home today; seeing him move around reassured me that he would be okay at home. Not long after the physical therapist left our nurse came in and told us that she'd heard from the burn team and they wouldn't be changing his dressings until tomorrow. Bummer! So we are definitely here for one more night, but we should pretty definitely be able to go home tomorrow. About 45 minutes ago the "head burn guy" came in to talk to us a little about what the plan is. They will change his dressing in the afternoon, and we'll need to come back on Friday to get it changed again. He said that after that, if we feel comfortable, we can probably just change the dressings at home twice a week. He said that they like the entire burn to be healed in 21 days, and if there are parts that aren't healed after that time they will possibly do skin grafts or things like that. When he sees the burn tomorrow he will be able to tell us whether he thinks it will heal on it's own, how long it might take, the risk of scarring, etc. I am really looking forward to the dressing change tomorrow. I want to see if his burns have improved at all, I'm anxious for his dressing to be on a little more securely and with better coverage, and I want to know what the doctor has to say about it. I'm dreading how it will hurt Adam, but he's really been hanging tough for the last few days. The morphine that they are going to give him beforehand will surely help, as well.

They hep locked his IV a few hours ago so it's nice that he's not tied down as much. He still hates having the IV in his arm, though.

Jenna and Will are at our house with Brenda. I don't remember if I said in my first e-mail, but it's been great not having to worry about them. Knowing they are in great hands is such a huge comfort. I miss them both a lot, and I can't wait to get home to see them. I was hoping that they might be able to come visit us today, but children under 12 aren't aloud to visit on this floor. Adam is also on contact isolation, so he's not aloud the leave the room at all. The people that come in; doctors, nurses, therapist, etc. have to put on a gown and gloves to come in. Joel and I don't, which is nice. They do it with all burn patients because of the risk of infection.

Adam is about to take a nap now, and we are just going to have to hang out for the rest of the day. We are in good hands here, so it's really great to know that Adam is well taken care of and in the best place possible.

We appreciate your love and support.

Love!

Sarah



Last night was a better night than the previous one. Adam slept very well and the nurse didn't interupt us much. We were expecting to see the burn team in the afternoon, so we were quite surprised when the burn nurse came in at 9 and told us that she was preping everything for the dressing change and they would get us in there at 9:15. Our nurse gave him some morphine so it would help durring the change.

Joel and I put on gowns and I sat on the table with Adam while they changed it. The nurse is the one who did all of the changing, there was a PA in there also who documented where the burns were, color, area, severity, etc. but he didn't do anything with the changing itself. The nurse cut off the first dressing and Adam didn't like that so much. After that she cleaned it, and he really didn't like that. Some of the large blisteres on his leg were still intact, though somewhat deflated. The went ahead and took all of the skin off of those, and also a lot of the dead skin from the torso. That was really hard for me to watch, but she did a great job and worked quickly. After she got it cleaned she paged the doctor and he came in to look at it. He said that from what he could see he guessed that it would heal completely on its own, but he'd have a better idea as time went by. He pointed out the areas that were the worst, and areas that weren't so bad. To the lay person (me) the worst parts didn't look so bad; it had a whitish color, which meant it was deeper, but to me it didn't look as horrible as the red inflamed aread. Yeah, I was wrong. He has two main spots that have the write color, on on the front of his ribcage, and one on his back.

The nurse finished the dressing, but in the middle she asked if we could stand him up because that's how she'd be able to do it most effectively. It hurt Adam a lot to stand up. As he stood up Joel was in front of him and Adam cried, "Dad, help me!" It was completely heartbreaking. But he made it through it and didn't do bad at all.

As they were changing the dressings we had the chance to ask questions. The said that he might scar, but the more artificial areas would probably just end up being a pigment discoloration that would be nearly impossible to see as he got older. As for the deeper areas they really couldn't say; it was too early to tell. I asked if we should try to limit his movement or activity at all, and they said definitely not; he needs to be as mobile as possible. I said I wasn't sure they knew who they were talking about.

We have an appointment Friday morning to get the dressing changed again. On Friday we will see how it's healing and decide if we will go back on Tuesday to change the dressing again, or if we'll just do the dressing changes at home after that.

It was great to get home, but we've run into a new obstacle. Adam is SOOOO active. It's making Joel and I crazy, and I'm definitely paranoid about it. I'm finally convinced that if it doesn't hurt for him to do it, he won't do it. However, he is wreaking havoc on his dressings! I'm not sure they're going to make it to Friday! Joel and I will definitely be doing some patch jobs to keep things covered.

Sarah