Tomorrow is going to be a big day; JoAnne will have serious surgery on her R leg, and will also have a tracheotomy. See below for the details on these...
TRACH SURGERY- As you know, JoAnne has been breathing with the help of a breathing machine. This is because the heavy sedation and medication that she has required due to her injuries does not allow her lungs to function on their own. They've considered bringing her "up" a bit by discontinuing the heavy propofol (it's not great to be on heavy sedation for too long), but they determined yesterday that she is still not strong enough to breathe on her own, even with lesser sedation. One of the reasons for this (besides the general trauma her body has undergone) is that she's a heavy smoker, and her lungs are not as healthy as they could be.
As the team has been weaning her off her heavy sedation a bit, they've begun to realize that her breathing tube is not and will not be comfortable for her. A tracheostomy is a procedure that creates a fixed breathing tube in her lower throat, bypassing her mouth in the process. The nurses continue to emphasize how amazingly comfortable it is for patients, and it is also better for her mouth and throat (which have become dried out) as well as her lungs (which require suction due to the smoking gunk in there).
JoAnne will get a trach tube put in tomorrow during her surgery, and this will allow her to be more comfortable as she begins to wean off the sedation in the coming weeks. The condition of her lungs and overall strength will dictate whether she can breathe on her own (and therefore, be conscious)... let's not get ahead of ourselves on that one, though.
LEG SURGERY- the doctors have been carefully assessing JoAnne's condition over the past two weeks, and have been focusing on the stability/improvement of three things in particular:
1. her ability to fight infection (measured by WBC count)
2. her heart stability (measured by blood pressure)
3. the extent of bacteria spreading throughout her pelvic region (her abdominal area is in the clear, supposedly)
They have been waiting for all three things to stabilize or improve to the highest possible point, and all at the same time... and this has finally happened! Her WBC has risen to the point that she can attempt to fight bacteria on her own. Her blood pressure is stable, even with less sedation. And her every other day wound vacs have shown that there is very little left to clean/remove as far as bacteria and destroyed tissue go. This is amazing, but it will unfortunately not last, as JoAnne's body is under a lot of strain due to the large, open wound on her R leg/buttock. And, until it is closed up, she is also at risk for more spread of bacteria, putting her immune system, heart and other organs at risk.
The surgeons have decided that they will need to perform surgery on JoAnne's R leg, removing it and using the healthy tissue to build and cover her exposed pelvis and right buttock. As terrible a thing as this is, her leg is no longer usable, and putting the rest of her body at risk. They firmly believe that this is the best way to save JoAnne's life (and preserve her upper body strength, which she will need). According to the three considerations that have needed to stabilize over the last week, they also believe that the timing is right to do it tomorrow.
THE BIG LEAP- We had told you all that after her first surgery, JoAnne was given a 10% chance of survival. After a few days she was given a 25% chance. Now, the surgeons estimate that she has a 35-50% chance! The thing is, though, that there is no chance for that number to increase if she does not undergo this surgery. Once they are able to cover her exposed wound, she will be able to stabilize and legitimately heal. If they don't do the surgery, she will be at risk for that number to drop considerably, back-tracking in her recovery.
Tomorrow is going to be a big leap, but a necessary one, as we can only move forward at this point. There is no going back, and there is honestly no staying where she's been, as that puts her at greater risk for one of the three important things to decrease or fail. The surgeon conceded that this is a big surgery, and that it's risky, especially for someone her age. She could lose blood, an organ could fail, etc. That said, they believe that there is no other option, and that moving forward is the only way to ensure that she is no longer at risk for infection and that her organs are given a chance to improve and thrive on their own. The surgeon seemed very confident that she would survive tomorrow's operation, but we must prepare for this big leap- for Joanne and for us.
UPDATES- We expect JoAnne to go into surgery before mid-day tomorrow, and expect the surgery to last 4-6 hours. We will keep you all updated on any progress we hear, and will send out an update immediately after hearing that she made it through. Many, many thanks again for your prayers, love, vibes and well-wishes... we've had some amazing support near and far and as scary as this big leap is, we feel confident that it's the right thing to do.
Much love to you all and talk soon!
Hannah, Jani, Kelty & Price
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