10+10+10,000 + 22 +100 =FUN!!!

Ten weeks since surgery (can now resume normal activity) + 10 degrees fahrenheit + 10,000 feet elevation (Alta) + 22 inches of new snow from the storm (19 of it since yesterday) + 100 inches of new snow in the last ten days = An incredible day for a return to skiing with Brian!!!

Nothing beats the feeling of your body vibrating from the explosive charges on the mountain from avalanche control--while you are inside the car in the parking lot at the base! Lots of the white stuff up there.

We'd been watching the storm tracks and eagerly totaling the new snowfall. What we got today was light, fluffy, Wasatch powder at it's best. There were some areas that had been closed off during the storm and were untouched. We found untracked powder all day long, finishing in the trees in the afternoon.

We even returned to the place of the collision that radically altered the trajectory of my ski season this year. Brian wondered if we dared go on the same chair, same run (third of the day), same location as when I was injured, but we passed through it without incident--just floating by on the powder.

I stopped in to the medical clinic there on the mountain at Alta to tell them thanks for taking care of me back in January and letting them know I was back on the mountain after carefully and precisely following the instructions of my craniofacial surgeon for convalescence (take note of it Dr. Birgfeld!). He remembered that I was a dentist and was up with another dentist (my brother-in-law Scott) and my sister held the IV bag as we drove down to the trauma center.

I even bought a new Alta t-shirt today to celebrate the occasion of my return to the mountains. In addition to the Alta logo on the front it says on back:

"Confidence: The feeling you have before you really understand the situation."

That pretty well sums it up.

A Day Out With Tom

Tom (brother) and I went fishing yesterday morning for steelhead on the Methow River. It was my first recreational day out since the accident. Fisherman sometimes refer to steelhead as "metalheads" so I had to tell Tom that even though I have titanium throughout my head, if he snagged me with his backcast it didn't count as catching a "metalhead". I didn't manage to land any fish and Tom just landed whitefish and tried to fight a steelhead with a broken reel, but it was a pleasant morning in the snow and my face didn't hurt!

Nose is continuing to regain some sensation. One night (very early morning) this week the nerves inside the nose decided it was time to reconnect and awaken me in the process. Next morning I could actually feel some air passing through my nose.

It is still quite tiring for my eyes by the end of the day, but I am very grateful to be able to be back at work with the great people with whom I work. My friend, Dr. Pierce, removed the last of the stitches from inside my mouth. I think I'm still happy that my mouth is numb. =-) Gradual continued progress is what I can hope for and am pleased to see it.

Feeling Teeth =-)

The end of last week I noticed the I was getting some sensation returning to my teeth. Today I chewed some Cherios there for breakfast and had a baby carrot for lunch. Crunchy food! I am also getting to where my mouth can open a little wider. Opening has increased 5 mm in the last two weeks. Soon I'll be able to take bigger bites than Mom would approve of =-o

By the end of the day my eye gets really tired and tends to swell up some. I have to rest at lunchtime with my eyes closed--sometimes I even get a nap. I find if I don't pace myself that it is not good by the end of the workday. I hope that the tired eyes resolve soon. I'd like to get back to playing the piano, but I need to use my daily allotment of vision for work, not play.

Pruning Ninja!

With my face hurting in the cold (circulation and innervation not normal yet) I had to put the balaclava up to the edge of my eye to cover my cheek. On the bright side, there is enough innervation returning to the cheek that I could tell it hurt in the cold! Eyes also don't tolerate the bright sunlight either currently so I had to wear sunglasses. The kids said I looked like a Ninja pruning the trees at home and at the office over the President's Day Saturday and Monday. I had to stay home and prune while the rest of the family went up to ski the new snow at Mission Ridge. Wish I were there! (but glad I was able to get the pruning done much earlier than I usually do and the days were wonderful for it.)

This photo is how my face appears today. Muscle function has returned to almost normal in the lip so it elevates into a smile rather than a sneer. Little by little improvement is occurring. I went to Arlberg Sports today to purchase a new ski helmet so I'll be ready come March 31 to head up to Mission Ridge and enjoy a little spring skiing. I now consider a helmet a very worthwhile insurance investment. I am grateful to be alive and grateful that for many years I've worn a helmet while skiing. I never thought I would need its protection, but glad I had it when I needed it!

Life Returning to Normal

This week I had a followup with Dr. Birgfeld at Harborview in Seattle. Recovery seems on track and I got the okay to resume some of my normal activities. So Thursday I flew to San Francisco for some professional meetings held Friday and then returned home late Friday night. Flights did not seem to bother my crushed sinus, for which I am grateful, but I was more fatigued than usual by the travel, but Dr. Birgfeld said that was to be expected.

After relaxing (recovering) Saturday, we all went up last night to see Brian participate in the Rail Jam at Mission Ridge ski resort. They had made a HUGE quarter pipe that was fun to see him and others do aerial tricks. Other obstacles to bump, leap, flip over, etc were set up as well. I did notice that the hardware in my face and/or lack of circulation resulted in my cheek feeling quite cold (but on a positive note, I could tell that it felt cold!) so I had to go inside periodically to get the cheek feeling more normal.

I'll attach a photo from this morning before church. I don't think I'm going to scare any children there today with my looks. Okay, no more than are usually scared after looking at me!

I am very grateful for the rapidity of my recovery. I feel greatly blessed by the faith and prayers of many. I credit the care and skill of the surgeons who worked on me. Some I meet comment that they can't even tell I've had an accident looking at me. Motor function to the lip is returning and sensation is improving still. I can close my left eye without hard exertion today for the first time. Nice to be able to relax my eyes and right and left eyelids close.

With Dr. Birgfeld

Met today at Harborview Medical Center in Seattle with Dr. Craig Birgfeld, the surgeon who put me back together, for followup. Healing is proceeding normally. He anticipates that motor and sensory function should gradually return to normal over about the next year. Improvements will likely be noticeable month to month rather than day to day as at present.

Today I was able to make the left corner of my mouth move up and out a little bit--much better than the complete paralysis that I had been experiencing. He said that I could resume driving if I could see clearly in the mirrors (I can) and could begin to resume normal activities, but should be aware that I will tire more easily during the healing process. I was instructed to massage the scars in the eyelids so that the lids would more easily move to the correct positions and so that they would not thicken in the areas of the scars.

I was happy tonight to be able to meet with my Boy Scouts for the first time since the accident. I am scoutmaster and it was a pleasure to be back with the boys. We'll be doing lots of hiking again this summer, so I am glad I will be recovered from surgery prior to that. I'll know life is returning to normal when my face doesn't hurt any more.

It Was a Good Day

Yesterday was a good day.

I was able to work in light duty tasks at the office from 7:30 until about 4:00 when I finally ran out of steam and Mary came to pick me up and take me home. I got a lot accomplished and it was nice to feel productive again.

Two of my assistants early in the day examined my face noted that my eyelids didn't touch when I thought I was closing my eyes--that would explain why my tear film seemed to be inconsistent and my vision somewhat blurred once I started being able to see out when the swelling let me actually open enough to see. My eyelid swelling had reduced enough more by the end of the day that my eyelids could touch each other. Once that happened, my vision cleared remarkably.

This morning it is a little cloudy again--probably overdid it a little yesterday and am swollen in the eye a bit more today, but I am encouraged at the progress. I have a followup appointment with the surgeon tomorrow and have a whole page of questions for him about when I can resume more activities, work my mouth to open wider, eat more than soft foods, drive again, and a host of other questions.

I am very grateful for the thoughts and prayers many have offered on my behalf. I feel greatly blessed in consequence of your love and faith. I thank you.

Higher resolution broken bone view

Tom helped me get a higher resolution image from the CT scan that shows the breaks really well before they were corrected surgically. You can easily see the displacement and the bones that are bashed into the sinus. No wonder it hurt!

Sunday, January 30

Today was my longest (in duration) trip from home since returning from surgery. Attended church services this morning and choir practice afterwards. Singing made my eye tickle, I suppose from vibration of the mesh plate that now is the floor of my eye socket. It will be interesting to see if that changes as the bone fills in around the mesh.

I can now feel light touch to the very corner of my upper lip as well as a little more of my cheek, and the bridge of my nose so that is continuing progress. Reading was easier today than previously. I can see the screen more clearly in front of me as I type this also, so that is encouraging.

Tomorrow the plan is to do some light tasks at the office and see how that goes, mainly some paperwork, year end tax related tasks, and some calculations of shared bills for the office. Hope to examine some new patient records and perform some treatment planning. Hopefully see a few patients, unless Tom and our assistants decide that I look too "scary" to do that. The need for precision and detail will be a good test of my progress. I am looking forward to it.

Saturday, January 29

A little more of my left cheek has sensation today. Brian went to teach and ski at Mission Ridge without me today. =-(

My eyesight is annoying me. An inconsistent tear film in the left eye leaves it a little blurry until I blink hard a couple of times. Unfortunately, I can't just close the left eyelids independently of the right (no winking yet) so have to blink both eyes, covering the right one so that I know when the left has cleared. Double vision is much reduced in front of my face, though if I am looking upward a person appears to have one of their heads at about their waistline. Brian said that if I went to the Ridge with him today I'd have thought they installed a quad at Chair 1, an over/under quad!

Sensation

Today I was able to discern light touch on my forehead above the eyebrow and near the hairline on the cheek in front of my ear. Upper lip, nose, and most of the cheek are still numb on the left side. I have started to have some temperature sensation in my left upper teeth.

Double vision still annoying, though I was able to read a little more comfortably today. I know Mary isn't going to let me go skiing with Brian until that is gone, so I guess he'll have to go to Mission Ridge without me tomorrow

Finished the last of The Lord of the Rings, extended version, DVDs today. Time to start on some Bill Cosby material tomorrow that Michelle & Hollis loaned me. I can't wait until vision stabilizes enough for me to read sheet music and get back to the piano.

Healing is a Process

Healing is quite a process--creative destruction. Damaged tissue removed and newly remodeled tissues laid down to make the repair. The body's recuperative powers are truly amazing.

Today I noticed that the incision at the left side of my nose is completely healed. Even as I looked into a magnified mirror I could not detect where the incision had been made--a testament to the skill of the surgeon (Dr. Craig Birgfeld) and the miracle of the human body to heal.

The three other incisions--one above and below the eye and the third inside the mouth above the lip--appear to be progressing well and healing without complication at this point. Vision is less than ideal--I wish I were able to go steelhead fishing with my brothers tomorrow, but somehow I don't think my casting would be very accurate! Besides, they'd have to interrupt their fishing every time I needed to tie on a new fly since I haven't gotten back yet the necessary visual acuity to thread the line through the eye of a hook.

Wednesday's Smile

Improvement continues

Improvement is continuing incrementally. Double vision is a little more noticeable today and vision a little blurred, but that's probably because the left eye is more open and I can see out it more today than previously.

Taking less pain medication. Reduced swelling = less pain, or at least that seems to be the case. Slept better last night so I'm sure that is having a positive effect as well. Have been able to read newspapers that stacked up while I was injured so enjoyed being able to see what's been going on while I've been somewhat out of the loop.

Continued Progress

This morning for the first time since the accident I was able to get a little air to pass through the left side of my nose. It is surprising how exciting little moments of progress can be. This tells me that the swelling there is resolving at last. This is where the maxillary sinus was crushed by the impact of the blow to my head so I am grateful and a little surprised to have some airflow back on this side. The surgery was unable to move the sinus walls back to position. The periosteum (fibrous lining that surround bone and contains blood vessels, nerves, and bone forming cells) of the sinus was intact and they didn't want to risk tearing or perforating it which would leave a bony defect, so they elected to maintain it as it was and trust to the body to do the necessary remodeling itself. (This is if I remember correctly what they told me after surgery--I was in a little bit of anesthesia and pain medication induced fogginess.)

I can also see out of my left eye--the swelling of the lids has reduced sufficiently that I don't have to consciously force the lids open to see from the eye. Though the vision is a little bit of double-vision, I was told to expect this and that it would resolve as swelling continues to reduce.

Had a pretty good night's rest. Was awake to be able to take medication, but not in any significant amount of pain so awakened refreshed this morning in time to be able to join the family for scripture study before Natalie and Brian headed off to school. We read of the Savior's triumphal entry into Jerusalem and a couple of parables from that account in Matthew.

I appreciate friends bringing us dinner for last night and tonight. They are soft foods that I can easily eat and it is much appreciated. Enjoyed the taco soup, fresh rolls, and brownies last night and look forward to lasagna tonight. And thank you to all of the others who have brought in delicious food and treats which have all been soft enough for me to eat-blueberry smoothies, tasty baked treats and myriad others. (Brian especially likes that there is just too much for me alone so he does his part to help keep things from getting too old!)

I appreciate the cards, notes, and expressions of support that I have received from many of my friends, neighbors, and family. I am strengthened by your love, encouragement,and support.

Systems Reboot

My various organ systems that have been shut down for a week or more are slowly rebooting. Yesterday was able to eat some food (soft food) in relatively normal amounts and close to something of normal mealtimes. That hasn't been the case since before the accident.

Eye swelling is reducing. Still can't read easily and am doing this mostly with just one eye open. Difficult when I normally wear "readers" at the computer and when reading. Readers don't fit on my face very well right now, what with swelling and ice pack.

Maybe I should get a monocle like Col. Klink of "Hogan's Heroes" and I could use that with my one good eye?

Pre op and Post op CT scans

Pre op

Pre op

Post op

I've uploaded the 3D reconstruct of the post operative CT scan. This shows the location of the four titanium plates that were placed to reposition the bones to their appropriate locations. Not visible in this view: The titanium mesh material used to rebuild the base (interior) of the left eye socket. It looks pretty cool on the CT slices. When I see better, I'll see if there is a way to get a nice view of that. Nice job with the placement. Hats off to the surgeons!

Michelle suggested putting some 3D views from before surgery on this post so thy are here as well above the post op image. Note the displacement downward and inward of the cheekbone and also that it is smashed out on the side.

And now for some photos.

Thursday morning just before surgery

The area of the Hospital where he was placed after surgery.

Rob's exciting hospital room as seen from the hallway.

Rob's visitors (Michelle and Hollis) taking advantage of the internet.

Friday morning

Saturday morning

Sunday afternoon (look, there is almost a smile now)

Shaving

Shaving with my electric razor is a little interesting. Where my face is swollen the whiskers stand straight out and so it is very easy to shave them off. However, where the swelling ends there are some unusual contours that are not usually present in my face and these do cause a bit of a challenge.

Life Imitates Art

As I awakened from surgery Thursday I managed to catch sight of myself in the mirror The first thought that occurred to me is that I very much resemble a painting from Picasso's Cubist Period. (You art folks know what I'm talking about.) I think that maybe Picaso was a craniofacial plastic surgeon on the side and just painted post-op pictures!

The morning after

I arrived at the hospital just before the Residents (specialists in training) came into see Rob. They took out the nose pack. Now he can breath much better and for that he is very grateful. He had to have some work on his nose because one if his sinuses was compressed in. (No, he didn't get a nose job while he was at it.)

He seems quite tired today even though he feels like he rested well last night. At this point, I'm not sure if he will feel well enough to be released later today or not.

Mary

Finally there is a room.

It took pretty much all day for a room to open up. We arrived at the hospital at 6 a.m. with surgery complete by 10:30 a.m. Put in a hospital room at 4 p.m. Long, long day! Rob is feeling very glad for the invention of pain medicine. Hopefully he will feel a bit better tomorrow. When Rob is feeling better, he can give you all of the technical details.

Mary

'Twas the night before surgery...

This is Rob after a full day at pre-surgery appointments. I think one guy leaving the cafeteria thought he was a security guard and was very careful about telling him he was just leaving the cafeteria for a minute and would be right back.

Mary

Surgery Finished

The Surgeon just came to let me know everything went fine. They put lots of hardware in in face in various places. He should be good as new (or old as my children would tell us.) He's in post-op and should be moved to recovery soon. Maybe I can take some post-0p picts just for Natalie.

Mary

The Face

Natalie said that the picture on this web doesn't do the injury justice and that I should post another picture which shows how the bruising has spread. So here is another picture for your viewing pleasure. It really looks worse in person.

Return of "Feelings"

Rob wrote this last night and asked me to post it today when I got to internet (We don't have internet where we are staying.)

"So today I finally started to get the feeling back in my cheek and in my lip for the first time since the accident. Just in time to have surgery and get it numb again! Maybe I'll get the feeling back faster after surgery? One can always hope.

Dr. Birgfeld said that it would probably be two weeks before I'm able to be back at work full time. I am certainly glad that I have such a great partner and staff who can keep things going while I am temporarily disabled.

I am truly grateful that I was not more seriously injured in my head or neck. It certainly could have been much worse and I consider myself very fortunate."

The Trouble with VISA e-mail alerts

We are getting ready to pay the bill at the Alta Ski Area medical clinic (they are seasonal, so don't bill insurance, but expect payment at time of service) and I hand Brian the VISA card so he can run it and sign the receipt. As he brings it back to me I remember that Mary has the VISA account set up so that any time there is a charge it sends her an e-mail listing the charge and location.

"Great, Mom will now know if she looks at her e-mail that we're at a medical facility. Brian, it's time to call your mom and let her know I've been injured in a ski accident."

Glad I realized before she found it on her own.

Salt Lake City ER discharge

Okay, we took off all my ski clothes so the ER wouldn't cut them off (Alta medical staff suggested this--thanks) and then while I was getting CT scans and other things Marianne, Scott, and Brian ran to the hotel to change out of their ski clothes and Marianne could drive my car back to the hospital and Scott could go to Park City to meet Bethany and William.

So when we are getting ready for my discharge, we realize that ALL of my clothes and shoes are now at the hotel and nobody is at the hotel to bring them. GREAT!

So we inform the nurse of our predicament and she manages to find some old scrub pants and some rubberized red socks to wear underneath my oh so fashionable hospital gown. I think I must have been quite a sight exiting the ER that day.

Surgery scheduled

Met this morning with Dr. Birgfeld, craniofacial plastic surgeon for clinical evaluation, review of the CT scans, and surgical planning. It appears that we will do some orbital reconstuction with an allograft material--titanium mesh with other components to get the floor of the eye socket built back up.

There is about a centimeter missing that has been displaced downward into the sinus. By the time the cheekbone is moved laterally about another 5mm to the appropriate position, the defect in the floor of the orbit would be 1.5 cm so rather than using an autologous graft which would involve the risk and morbidity of a donor site in my hip, he'll use an allograft. Using the allograft avoids that, the titanium mesh assists with osseointegration and will likely provide greater stability. I guess this material is kind of like plastic surgeon spackle paste except they use it for bone defects rather than sheet-rock defects.

I appear to have sustained multiple fractures on the left side of my face: four fractures involving the zygoma and it's attachment to various other facial bones, a small nasal bone fracture that we will likely leave unreduced, fractures of the lateral wall of the maxillary sinus, anterior wall of the maxillary sinus, and medial wall of the maxillary sinus impinging toward the nasal septum, the medial aspect of the orbit and the floor of the orbit.

Surgery is scheduled Thursday morning. I will be Dr. Birgfeld's first case of the day. He said no contact sports or skiing for 6-8 weeks after surgery.

Rick's response (Rob's brother)

All the more reason to stick to fishing - I've never had someone come flying out of the brush on the bank and nail me in the head (although if you get in Tom's way near the first gate at Nunya, you might get hit just about as hard, and it is worse because those titanium spikes in his wading shoes really dig into your back as he runs over you after he knocks you down!). Oh, and just because you see two fish now, you can still only count one...no inflating the fish counts!

CT Views of the Injury--OUCH!!!

I thought I'd share a couple pretty cool views I pulled off my CT scan. I'm grateful there was no cranial involvement and that it only involved one side. Tom, you've been saying for years that I needed my head examined so now you will have access to a complete CT examination of my head for your perusal.

Here's Rob's account to a friend:

"I was struck by another skier who was flying through the trees from above me at Alta and didn't see me until moments before the collision. At least six facial fractures. Will have evaluated in Seattle and probably surgery next week to fix. It was a great powder day and it was only the third run of the day. The rest get to ski today, but not me. =-(

Mary's flying to SLC today to drive me and Brian home. Between double vision and pain meds I can't really drive it. Worse yet, I'll bet Mary takes the medical and airplane costs out of my skiing budget--no more trips for a couple of years-oh no!

The ER doc thanked me for wearing a helmet. The skier struck me with his shoulder just above the temple. I think my goggles and helmet are what actually broke the bones.

I'll keep you updated as warranted, but your prayers would be appreciated. Two of the fractures are of the orbit (eye-socket) and it is displaced downward so my eye is lower and I have double vision. Hopefully the surgeon will be able to get it back at the right level--thus my request for your faith and prayers.

Rob

P.S. Unfortunately it was a great powder day and it was only our third run of the day. =-(

Coming Soon: The way it really happened, by Robert Merrill

One of our friends suggested we put up this blog to keep everyone posted on what is going on with Rob and his recovery. Very soon we will post his story and keep you updated.