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.