Tuesday, July 29, 2008

Kyle Update

WARNING: THIS POST CONTAINS GRAPHIC SURGERY PHOTOS

So I realize most of you will probably read the disclaimer above and scroll down out of curiosity. In fact your chances of actually reading this entire post are probably greater because of the disclaimer. But, seriously, if you're squeamish at all, you may not want to look at some of these photos from my brother's recent and final surgery. Only Kyle could convince his orthopedic surgeon to bring his patient's digital camera in the operating room and take some live shots of muscle bulging out of the incision in his leg. It was about the closest we got to Grey's Anatomy, House, and Scrubs during the past two weeks when Kyle was hospitalized. But for real - the photos are graphic. I predict my father-in-law, Amy, Leigh, Dalgo, and Rory will love them. The rest of you all might hate me after you scroll down (Remember I warned you!) and proceed to throw up.

So, where to begin...

On Monday, July 14 Kyle called me and said dad was taking him to the doctor because he had severe pain in his left leg that felt like a really, really bad cramp and was getting worse as the day passed. The doctor he first saw, an family practice physician, wasn't sure of a diagnosis, but gave Kyle a steroid shot and sent him home. Kyle continued to hurt badly through the evening and had the doctor phone in some pain medication, which didn't help. He also realized he wasn't able to raise his toes on his left foot. Being the tough guy he is and with what we now know is basically the equivalent of Superman's pain tolerance, he put up with it through the night and I tried to get him an appointment with another doctor the next morning - to no avail.

Fortunately, a co-worker at GLS had a connection to an orthopedist at St. Vincent's named Dr. Buggay and got Kyle an appointment first thing Tuesday morning. At lunch, I got the call that Kyle was going into emergency surgery to relieve the pressure in his leg, which was something like 190 instead of the normal reading of 10. Turns out Kyle had Compartment Syndrome - which in its chronic form is common in athletes and in its more acute form is almost always the result of some direct trauma to the affected portion of the body - in Kyle's case, the anterior muscle compartment of his left leg. The doctor made a large incision to relieve the pressure and tested the muscle for life by shocking it. The muscle did not respond and did not look healthy, which led the doctor to believe some of it had died due to lack of oxygen. (Kyle wasn't operated on until 24 hours after the pain first started. With Compartment Syndrome you operate ASAP to try and save the muscle.) The doctor wasn't sure how much function Kyle had lost or if he would be able to regain any or all of it. He also had no idea what caused the Compartment Syndrome because Kyle had no trauma but luckily ruled out a tumor or neurological disorder, though there was talk he might have a predisposition to blood clotting.

Kyle was in the hospital for three more days before coming home - still unable to lift the front part of his foot and walking with a cane. He went for a follow up on Monday and was told he would be fitted for a brace on Thursday to help him walk. On Tuesday (a week after the first surgery) he received a call from the orthopedist's office asking that he come again for another examination. An hour later, he was told he needed to have surgery again that day to remove some of the dead muscle that was causing irritation and preventing his body from healing. This was hard to take since removing the muscle did not give us much hope for the restoration of his function, and we also had just gotten through a long and unexpected hospital stay, as well as days of recovery pain for Kyle, and now we were about to do it all over again.

But God was gracious and gave Kyle a successful surgery. The orthopedist, in consultation with a vascular specialist, took a conservative approach and decided to only remove the muscle under the irritated area which he knew was dead to give any possibly viable muscle as much time as possible to heal. That meant he left the wound open, installed a drain to drain the fluild from the wound, and scheduled a third surgery for Thursday.

God was so good to answer all my prayers for Kyle's third surgery: the irritation had subsided where the muscle was removed two days before - showing that was the right move on the doctor's part; no other muscle had to be removed; and the doctor was able to close the wound with stitches without having to do a skin graph. Kyle went home Friday on crutches and still without the ability to lift the front part of his foot, though some of his small toes were responding.

So now we continue to pray for healing, and each day Kyle recovers more. He can't put any weight on his foot for several weeks and is off work for just as long. He has a follow up doctor's appointment on August 7th when he will be fitted for a brace to help him walk. As he recovers more he will start rehabilitating the muscle to try and see what movement he can recover. If any muscle function does return, the doctor says it will be in the next two to two and a half months.

Thank you for all your prayers and concern. These have probably been some of the hardest two weeks of my life, and Robert was out of town for the first week of surgery so that made it even harder. It was extremely disheartening to see Kyle (my strong, solid, active, wiser, smarter, servant-hearted brother) not be able to walk normally. It honestly still is. But God is good and has a purpose and plan that is beyond what we can comprehend. I have and at times continue to struggle with anger at God and the situation, but Kyle's faith has been an inspiration and conviction to me. He knows God is and work in this situation for His glory and our good, and he is hopefully waiting to see how God's plan fleshes out. Our family is closer and has certainly been touched by the amazing love and support of so many of our family and friends. Thank you for your prayers. We covet them still and ask you to join us in praying for God to restore Kyle's muscle function but mostly that His will be worked in our lives through this situation and throughout Kyle's recovery.

Until then, Kyle is passing the time at home winning his inheritance from Big Mama in games of Texas Hold'em and canasta. Give him a call if you get a chance. I know he'd love to hear from you.

Ok - here are the graphic pics I promised. They start easy and get worse.


Kyle following the first surgery.

The incision was about 5 inches.





Now here are the pics from the third and final surgery:





This is actually the gauze left in the wound between surgery #2 and #3 - not muscle

Here's the muscle

Click and you can see even more details.



Stitching up the incision.



Dr. Buggay

Kyle under anesthesia.

Nurses being silly.



Apparently they have lots of fun in the OR at St. Vincent's!





Dr. Buggay. He was great.


And finally, my youngest brother Ryan's attempts to entertain Kyle after surgery.




Here are some good links on Compartment Syndrome if you're curious. We all became mini experts over the past few weeks:

http://orthoinfo.aaos.org/topic.cfm?topic=a00204
http://www.nlm.nih.gov/medlineplus/ency/article/001224.htm
http://www.mayoclinic.com/health/chronic-exertional-compartment-syndrome/DS00789
http://www.sportsinjuryclinic.net/cybertherapist/front/lowerleg/anteriorcompart.htm

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