9/3/2011 - Day after Surgery

Sam is doing very well today.  He is resting a lot and has a Morphine pump that he can control.  He is able to keep the worst of the pain at bay, and it is enough to be able to sleep.  He looked pretty good right from the get go last night when we were able to see him.  He even asked me at about 9:00pm last night if I would read a chapter of his book to him.  I told him there was nothing that would make me happier.

Since I was pretty quick yesterday I will sum up a few surgery details.  The surgery lasted 7 hours and Sam's vitals remained great throughout.  The doctor spoke to us to go over everything that took place.  He indicated that as far as the space that was necessary to decompress they could have fused to the C2.  However, they have equipment that can load Sam's last CT scan and it can be used to do virtual surgery so the doctor can "try things out" prior to doing them.  He tried every scenario he could to fuse to the C2 and could not get a satisfactory position for the screws and plates.  He said Sam's individual anatomy was such that there was no good location.  If he had gone ahead with it the screws would not have been a stable as he would like for a successful outcome.  In going to the C3 vertebrae he said he got a beautiful strong hold.  In general people lose about 85% of their rotation when fusing to the C2 and Sam will lose about another 5% by going to the C3. 

On the skull decompression, he indicated that Sam's flow of spinal fluid was "borderline" with just the removal of the bottom of the skull.  He said that in the end he was not comfortable with it being successful long term at that level and made the decision to do the duraplasty as well.  (This is where they have to cut up the skull a little further, and need to separate it from brain membrane in order to remove a small portion.  They then cover it with a protective membrane.)  The risks of this are that they are now working with brain tissue during the surgery, as well as the chance that there could be a leakage of spinal fluid.  That risk should be over in about 2-4 weeks.  On both this and the fusion length, I am convinced the doctor made the right choice.  While it was not ideal to have either go that direction, I am happy that he made the choice that he felt most comfortable would be successful long term.  I don't wish to do this again!

He thought the chances were good that we would need to leave Sam on a breathing tube overnight, causing him to need to stay sedated for that time period.  Praising God that after the surgery, they made the determination that there had been no collapsing in his throat and the breathing tube came out immediately.

On Sam's first two sleep tests prior to getting his CPAP he had an AHI of 14-15.  This means he would stop breathing every 4 minutes all night.  On his CPAP, his AHI ranged from 4-5.5.  This means he stopped breathing once every 12-15 minutes all night.  The last two days of his traction his AHI was about 2.5, or stopping once every 25 minutes.  Last night, post op night one Sam's AHI was 0.3!!!  This means in the 9 hours he was wearing his CPAP last night he stopped breathing a total of 3 times.  Once every 3 hours.  That is the AHI of any average person.  It may be that if those kind of numbers hold up he may (though may not) be able to discontinue his CPAP in a few months.  Most of all we are praising God because what this shows us is his surgery was successful.  The nuero associate that visited this morning said he had hoped for good improvement after several days, and was pretty impressed at this immediate result.

Prayers for Sam today include managing pain and helping him get through a couple of big hurdles.  They would like him to sit up and he is quite reluctant, knowing that this will cause more pain that just laying flat.  He has been incredibly brave and it is so hard to ask him to keep going, but I think he will start to feel bolder after he moves a few times.

He also has pretty labored breathing right now.  They believe it is due to the weakness and congestion of his lungs after being down so long and then topped of with such invasive long surgery.  Once again it is imperative that he start to get upright a bit, and they will not let him put it off any longer than this afternoon.

Prayers as well that spinal fluid would not leak, or any kind of infections set in.

On the praise side, most importantly that his surgery went well, and that my Sam is doing as well as possible.  Praise God for the wisdom of all the decisions the doctor made and for guiding his hands.  I know I have thanked God and you all often for your prayers, but I need to let you know exactly how overwhelming your support has been to us.  We have received around 20-30 emails, messages, or comments every day, yesterday way more, I couldn't even tell you.  Some of them from people I don't know.  Many from people I haven't known for years.  This morning I took a look at the page views the blog had through out yesterday.  I am on the edge of tears as I tell you that 1,100 times you all stopped in your day to check on us.  That kind of support from loved ones and strangers alike staggers me.  I truly praise the God of all strength for the wealth of prayers that helped hold our family up yesterday.  I will praise God for you the rest of my life.  Thank you.