We have a date for the move to rehab
There will be a bed on Thursday! Plus, they're doing as much rehab as is possible while he's still on the surgery ward.
His CPM (leg-moving machine) which had been on a haphazard, 2-3 times a day schedule at 60 degrees max is now 12 hours a day (6 on each leg), rotating around the clock 2 hours on, two off. They're bumping the angle up 10 degrees each nursing shift change until he gets at least to 90 degrees. During two of his 2-hour-off breaks during the day, he's getting PT, which will include some sitting-in-chair time but which will take up the entire 2 hours. During the remaining 2-hour-off breaks, he gets to eat (CPM needs him to be too flat to eat easily) / bathe / whatever else needs doing. Doctor wrote orders that his catheter can come out whenever he's ready for it to come out. He's still stuck with the IV and heart / pulse monitors until he's off the surgical floor, though.
He can eat a sandwich without choking on it. He says he moved himself into his chair almost by himself today (they use a plastic slider sheet for that). One of his PT exercises involves pulling himself up towards the head of the bed, so if he slides down too far, he can fix it himself. His PT was having him do almost all of the "pull your knee up towards your chest" work today - two days ago, he couldn't even begin to lift that leg. Other than pushing with his heels / putting weight on his knees, everything is at the "anything you can do without unbearable pain couldn't possibly damage you, so if you can do it, you can do it" stage.
His doctor (Dr. Swenning, the osteopathic surgeon) says 3 weeks before he can start beginning to be weight-bearing on the left leg, which is about the same time they'll do the bone graft, which would keep him off that leg for maybe a week. And once he's weight-bearing on one leg, he'll be able to go short distances with a walker, rather than being wheelchair-only. We think he'll be on the rehab floor for a week or two, so there will be a relatively short period of time that he couldn't get into the bathroom at home. So no need for remodeling or anything - they'll just do a portable toilet chair for a couple weeks. It's still going to be months before he'll be weight-bearing on the right leg - maybe January. Six to nine months for his recovery to be most of the way to where it's likely to be, so sometime between April and June, with continued improvement for up to 18 months, and where ever he is then is where he's likely to be long-term. They're anticipating not full range of motion (135 degrees) but at least 120 degrees, which is enough to do the stuff you'd normally want to do.
Bad news (from my perspective, mostly because it's not at all what I would have guessed) is that the risk of bone infection lasts for a year or so. I'd figured that once the bone grafts healed, that was it, but apparently not. I really need to walk away from Dr. Google on this one, because every hit I get says "[pick any surgical treatment he's gotten] is generally reserved for the most extreme cases." The next time I talk to one of his doctors, I'd like to ask how they graded the fracture. I suspect it's either a "not very bad" III-B, or a "really really bad" III-A - and the difference in infection risk between the two is like 40% for a III-B and 5% for a III-A. AFAICT, the dividing line between A and B is "adequate soft tissue to cover the bone without moving tissue around / taking free tissue from somewhere else," and while I know he lost a big chunk of his lateral quadriceps (vastus lateralis?), I'm sure the PA said today that he had some remaining muscle under the skin there. If it is a III-B, then it is what it is, and there's nothing we can do to change that, but if it's a III-A, I won't worry for a year about a 5% risk, you know? Ah, see, this is why Dr. Google really is my friend. Those numbers are old. Current studies suggest Type III in general is about a 15-20% risk of infection, and that the treatment he's gotten has been ideal for the injuries he has, and is of the sort generally recommended to reduce the risk of infection.
Don't click anything that shows up below this. I didn't put it there, and deleting it doesn't make it stay gone.
His CPM (leg-moving machine) which had been on a haphazard, 2-3 times a day schedule at 60 degrees max is now 12 hours a day (6 on each leg), rotating around the clock 2 hours on, two off. They're bumping the angle up 10 degrees each nursing shift change until he gets at least to 90 degrees. During two of his 2-hour-off breaks during the day, he's getting PT, which will include some sitting-in-chair time but which will take up the entire 2 hours. During the remaining 2-hour-off breaks, he gets to eat (CPM needs him to be too flat to eat easily) / bathe / whatever else needs doing. Doctor wrote orders that his catheter can come out whenever he's ready for it to come out. He's still stuck with the IV and heart / pulse monitors until he's off the surgical floor, though.
He can eat a sandwich without choking on it. He says he moved himself into his chair almost by himself today (they use a plastic slider sheet for that). One of his PT exercises involves pulling himself up towards the head of the bed, so if he slides down too far, he can fix it himself. His PT was having him do almost all of the "pull your knee up towards your chest" work today - two days ago, he couldn't even begin to lift that leg. Other than pushing with his heels / putting weight on his knees, everything is at the "anything you can do without unbearable pain couldn't possibly damage you, so if you can do it, you can do it" stage.
His doctor (Dr. Swenning, the osteopathic surgeon) says 3 weeks before he can start beginning to be weight-bearing on the left leg, which is about the same time they'll do the bone graft, which would keep him off that leg for maybe a week. And once he's weight-bearing on one leg, he'll be able to go short distances with a walker, rather than being wheelchair-only. We think he'll be on the rehab floor for a week or two, so there will be a relatively short period of time that he couldn't get into the bathroom at home. So no need for remodeling or anything - they'll just do a portable toilet chair for a couple weeks. It's still going to be months before he'll be weight-bearing on the right leg - maybe January. Six to nine months for his recovery to be most of the way to where it's likely to be, so sometime between April and June, with continued improvement for up to 18 months, and where ever he is then is where he's likely to be long-term. They're anticipating not full range of motion (135 degrees) but at least 120 degrees, which is enough to do the stuff you'd normally want to do.
Bad news (from my perspective, mostly because it's not at all what I would have guessed) is that the risk of bone infection lasts for a year or so. I'd figured that once the bone grafts healed, that was it, but apparently not. I really need to walk away from Dr. Google on this one, because every hit I get says "[pick any surgical treatment he's gotten] is generally reserved for the most extreme cases." The next time I talk to one of his doctors, I'd like to ask how they graded the fracture. I suspect it's either a "not very bad" III-B, or a "really really bad" III-A - and the difference in infection risk between the two is like 40% for a III-B and 5% for a III-A. AFAICT, the dividing line between A and B is "adequate soft tissue to cover the bone without moving tissue around / taking free tissue from somewhere else," and while I know he lost a big chunk of his lateral quadriceps (vastus lateralis?), I'm sure the PA said today that he had some remaining muscle under the skin there. If it is a III-B, then it is what it is, and there's nothing we can do to change that, but if it's a III-A, I won't worry for a year about a 5% risk, you know? Ah, see, this is why Dr. Google really is my friend. Those numbers are old. Current studies suggest Type III in general is about a 15-20% risk of infection, and that the treatment he's gotten has been ideal for the injuries he has, and is of the sort generally recommended to reduce the risk of infection.
Don't click anything that shows up below this. I didn't put it there, and deleting it doesn't make it stay gone.