Wednesday, February 10, 2010

“The Journey Continues”

4th Installment January 4, 2010...

After spending 6 weeks in intensive care at the burn center and 3 weeks in out-patient therapy in Salt Lake, Andrea came home September 2, 2000 and we settled into a routine of helping her with daily wound care/scrub and bandage changes, until the raw areas healed. There’d been more than 30 raw spots to deal with when she got out of the hospital (areas that had not been grafted, because they were small enough that they would eventually “self heal” with skin growing in from around the edges), and these were filling in.
The grafted areas had to be protected from rubbing. The grafted skin was itchy and dry--having no oil glands, because only the top layers of normal skin are “harvested” for use in grafting. Andrea had to diligently apply a special lotion to the grafted skin and donor sites after every scrub, before bandaging. After bandaging, she did stretching exercises and spent time using her pulleys; Lynn hooked them to the closet door in the living room where she could sit on a chair and alternately pull each arm above her head. Little Em was fascinated by the pulleys and tried them out herself. She also liked to help Grandpa with mommy’s arm stretches that had to be done several times a day.

Andrea was soon driving herself into town for her daily physical therapy sessions. Aggressive physical therapy is necessary to keep the healing skin stretched, to avoid loss of motion. Grafted skin tends to shrink and pull together as it heals, and any “self healing” open spots tend to form scar tissue that thickens and contracts. Without forceful therapy to keep stretching it, contracting skin on both sides of a joint may pull the joint into an abnormal position or make it impossible for the joint to be extended.

Andrea was also supposed to wear her pressure garments 23 hours a day to smooth the grafted areas and keep them from healing with lumps, bumps and thick scar tissue. Pressure helps scar tissue heal in a softer, flatter form. Maturing of grafts and scars takes many months, sometimes as much as 2 years, and burn patients are supposed to wear pressure garments during this time. Due to the claustrophobic feeling they gave her, and the way they intensified itching of the grafts (which made it impossible for her to sleep), Andrea didn’t wear hers very long. Also, the rubbery material pulled at the raw areas on her elbows and behind her knees and kept them from healing. She wore the upper garment periodically for about 7 months but didn’t wear the lower garment on her legs very much because of the big raw areas behind her knees. She chose to have thicker scars rather than prolong the open wounds that might need further graft surgery to close them. She didn’t want any more surgery.

She went to a local doctor in mid-September with intense pain in her leg, and he removed a staple that was working out. Thousands of small staples had hold the newly grafted skin in place, and even though nurses at the burn center try to take them all out after the grafts “take”, they usually don’t find them all. After removing the painful one, the doctor here x-rayed her arms and legs, and discovered 24 more staples. He wanted to surgically remove them, and called the burn center to see how to do it. They told him to not take the staples out—they would work out on their own during the next several years. Unless they cause problems, it’s better to leave them alone than to open up the fragile grafted skin to take them out—with risk for infection. Some have worked out during the 9 ½ years since Andrea’s grafting, but there are still a few embedded under the grafts.
That first winter was difficult and painful, necessitating several trips back to Salt Lake for checkups and regrafting one of her elbows. Both elbows had broken open while she was still in the burn ICU and this one was not closing up on its own. Instead, the raw area was becoming larger and was almost down to the bone, so it had to be grafted. She was unable to use that arm for awhile; it had to be immobilized in a splint until the graft was healing and wouldn’t tear loose with movement. Her ankles were still open and raw, but Andrea hoped they would eventually heal without surgery.
It was a long, cold winter. Andrea had always helped us with calving, but that year she was not strong enough, nor healed enough to be out working with the cows and calves. She couldn’t handle cold weather and we didn’t want risk of injury to her fragile skin. By spring she was eager to get more of her life back. She helped our son and his wife brand and vaccinate their calves.

Another milestone occurred when she got back in a tractor again to harrow our hayfields, to break up manure piles where we’d fed the cows through winter, spreadint them around as fertilizer. Driving the tractor to pull the harrow around the fields was a job she’d always enjoyed and she wanted to do it again. Her endurance was limited so she did it in short stints—just a few hours at a time, for 4 days. Lynn wanted to do part of it, but she insisted on doing it all. She wanted to prove to herself that she could still do it, and it was a way to help build up her stamina. Emily went with her in the tractor.
In late April she got back on her horse (Breezy) again, 9 months after her burn accident. She went with me to check gates and fences on part of our range pasture before we turned our cattle out on summer range. I saddled Breezy, but Andrea was able to get on the horse by herself. We rode 2 hours the first day and 3 hours the second day (checking and fixing fence) and she was really tired, but happy to be able to do this again.
In early May she rode with our daughter-in-law Carolyn on a longer ride to shut gates between our range and the neighboring range. A few days later she helped me take cows and calves to our upper pasture 3 miles up the creek. The front of the herd started trotting up the road, eager to go to new pasture, before the last ones were out the gate. Andrea had to gallop Breezy up the road to get ahead of the leaders before they got to a neighbor’s open driveway. I said a quick prayer, hoping Breezy wouldn’t stumble or buck. That mare is often silly and sassy on her first rides in the spring after a winter vacation. Andrea is a good rider, but she wasn’t very strong yet. She did fine, however, and outran the cows without incident.
She had several more rides that spring, and helped me and Carolyn gather cattle on our upper pasture to turn them out on the range. After that gather, little Emily had a short ride around the meadow with her mom, riding double on Breezy. Em had come along with Grandpa Lynn in the pickup truck while we were moving the cows, and was eager to go for a ride, too. She’s always likes to ride, and has been doing it since before she was born.
NOTE: UPDATE ON ANDREA’S RECENT SURGERY – Fast forward to the present. Andrea’s first surgery (for contracture releases) at the burn center in Salt Lake December 15, 2009 went fairly well. She went back on December 29 to have the stitches removed. Dr. Saffle did two contracture releases on her right hand/arm—one on the little finger that was being pulled off to the side, and one on her upper arm where contracting scar tissue was pulling her shoulder and spine out of line. The shoulder was still tight, however, because there wasn’t time that day (due to a scheduling error) to do the most crucial release at the top of her shoulder. That area was causing her the most pain and impairment of motion. Dr. Saffle only had time to do 2 of the 4 areas that needed releases. A surgical release over the shoulder itself would require more extensive work and additional grafting--and much more lay-up without being able to use the arm.
Within a couple weeks Andrea realized that she needed the additional surgery, because the continued pull at the top of her shoulder would soon negate the releases that had been done. She went back to Salt Lake on January 14 and Dr. Morris (the surgeon who did all of her original grafting, the summer of 2000) did the extensive release at her shoulder and armpit, taking a large patch of skin from the top/front of her thigh for the graft. This was the only place on her body that still had enough “untouched” skin—that had not already been grafted or harvested for grafting.
As I write this (January 17), she is still in Salt Lake, recovering from this surgery that was done last Friday, and she is hoping to be able to come home later this week.