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.