Day 51 Update - The (New) Holes In My Head

 Today, we will talk about the holes in my head.

I was going to tell you about pinsites anyway, but thanks to a last minute doctor’s appointment yesterday, the story just got exponentially better.

So as a quick reminder, the Halo brace is screwed into my head at four points. The bolts, or “pins”, that are used are screwed directly into my skull to a depth of just a few millimeters and tightened to 8 lbs of torque. After the first couple weeks of a somewhat-annoying constant tension headache, they honestly have not been terribly uncomfortable. As with anything, the body adapts and you just get used to the sensation of wearing a slightly-too-small hat 24/7. It always feels more like a band of pressure around the head as opposed to four distinct insertion points, and once I got used to it, it really has been hardly noticeable the last few weeks. I mean, as “hardly noticeable” as a Halo brace can be. 

With four pins screwing directly into your skull though, the Number One home maintenance practice required while in a Halo is what L and I affectionately refer to as “PinCare” - every night before bed we use q-tips and a syringe to clean around the pinsites with hydrogen peroxide or an antibacterial cleaner. Risk of infection at those pinsites is one of the only major “complications” of the brace, so we’ve been religious about cleaning and care on our daily schedule. 

Of course, the best laid plans of mice and men, etc, etc. 

A couple weeks into this whole debacle, Lindsay noted that she was still seeing a lot of active discharge from around the back pinsites. The front ones (in my forehead) - no problem at all, clean as a whistle with no issues. But the back ones were still, well, just oozing pus from what appeared to be still some active wound trauma right around/below where the pin inserted. (Did I mention this post might not be for the faint of heart of you out there? Read on at your own risk). At no point did the back pinsites ever HURT - which is still my primary metric for “is there an infection / is something seriously wrong” - for all their weeping and oozing they never got red or inflamed or started being painful. We dithered for a while on if this was normal vs severe enough to call the doctors about - we finally did make a few calls and I was given an antibiotic prescription. At my first xray follow up a few weeks ago the PA checked out the sites and said to keep taking the antibiotic and let them know if it got any worse. 

It never got much worse, but it really didn’t get much better, either. We continued to clean and pull a multitude of crumb-sized chunks of dried discharge out of my hair every night. Lindsay could show me pictures of the sites but of course I couldn’t see them - and still there was no discomfort or pain. I was scheduled to go in on Nov 3rd for my next x-ray shots, so we figured we were just holding on til then for the next in-person look. However, to my surprise, a couple days ago I got a call saying “Dr. Lynn has decided he’d like to see those pinsites in person so why don’t you come in this Thursday”. So into the car I was loaded (getting much better at that every time, for sure) and off we went. 

I was delighted to see Todd the Orthotist again in the doctor's office. He checked out the sites and hemmed and hawed, then Dr. Lynn came in and took a look as well. He said it was a good sign that I was not having any pain or tenderness - that would be the sign of a more serious infection - but he did say that based on how “open-wound” the back sites were looking, it would be a good idea to go ahead and put in new pins in an adjacent spot and remove those current back two.

Oh, well, okay, today just got more interesting. 

Dr. Lynn said it would be possible to schedule the procedure at the hospital and put me under general anesthesia, but in a moment of bravado (real or imagined, who can say), I suggested we go ahead and just do it right there in the office. No sense waiting, let’s just make it happen. So off they went to get the supplies they needed and I sat in a chair in the room wondering exactly what I had just agreed to. 

In a way, it wasn’t unlike a dental procedure (if you’ve ever had that done). Dr. Lynn came in and injected local anesthetic into the sides of my head (very much when they inject the like into your gums - that sharp needle and then that flooding/burning sensation as the agent spreads through the area). After about 10 minutes it had gotten nice and numb and so Todd brought forth his Special Magical Halo Brace Pin Screwdrivers and the new pins. The whole thing took only between five and ten minutes - it was like having my own personal pit crew working on me. There are numerous holes in the halo part of the brace, so Dr. Lynn started on the right side and screwed in a new pin in the slot adjacent to the current one. There was a mild stinging pain that the anesthesia didn’t quite cover, but the primary sensation was just pressure - a ton of pressure. As the bolt enters your skull, the best way to describe the feeling is as if your head was in a vise being slowly squeezed tighter and tighter...and tighter...and tighter. For about ten seconds I did in fact begin to wonder if my skull was just going shatter- the pressure started at the site and then just slowly radiated across my entire skull in slow moving waves. Once the pin was “set” though, it seemed to stabilize and lessen slightly. The pin on the left side actually went in a little easier - it seemed to sort of “balance out” the pressure waves from the right side - and once they were torqued to the proper amount, they simply unscrewed the first set of pins. I didn’t even feel them coming out at all (probably thanks to the fun new sensations going on with the new ones). 

And that was pretty much that. New pins in the back, two holes in my head where the old pins had come out. The skin there has enough elasticity to work to close itself over the old pin sites it seems, as no stitches or anything of that sort were required - Dr. Lynn said to just slap on the neosporin a couple times a day for a week and keep an eye on it. We’ll return back today (Friday) to have Todd check the back pins to make sure they are still at the proper torque (standard procedure after 24 hours with new pins). And then I go back for x-rays next Tuesday so that will be another chance to make sure all is well with the (new) holes in my head. 

I wasn’t feeling too bad for the first few hours after the new pin installation, but into the later afternoon the local anesthetic wore off and I started having flashbacks to those hospital-pain-levels from The Early Days. Back to chewing ibuprofen on schedule for a few days at least, it seems. Thankfully I slept just fine last night. Seems like moving around actually starts triggering more pain, but Lindsay says everything looks as good as it can for now. 

Oh and of course I have to share the two highest compliments received of the day. Both Todd and Dr. Lynn were MASSIVELY impressed with the shirt that Lindsay has custom cut for me to fit around the Halo that I wear when out in public. They both said in all their years of seeing people in similar circumstances, they've never seen something that cleverly constructed. All credit to Lindsay on that one - I'll show some more details in a future post on what exactly she's done to my shirts to make them wearable, but have to give her a shout out for that compliment. 

Oh and they both also said that I smelled remarkably better then most people they see in Halo braces. So, uh...good to know that my current personal hygiene levels are above the mean. 

Never a dull moment in this life, it seems. Dr. Lynn mentioned he had taken a look at the x-rays from a few weeks ago and he was very pleased, so hopefully we’ll get more of that good news next week. I also had a good chance to talk to Todd about the actual procedure of when they put the Halo Brace on, so I might unpack that a little more in a future post. 

New update will come next week after the next x-ray report! 

Next Update - Day 82

BONUS - For the Real Strong of Heart - Here's video of them screwing in the new pins as well as a link for pictures of the before and after of the infected pin sites

And here is a link to some very mildly graphic photos

Day 37 Update - Let's Talk About Neck Bones

If you want a career with a nice predictable schedule that never changes, neurosurgery might not be for you.

My first post-op appointment with Dr. Lynn was originally scheduled for September 29th, but a couple days prior I received a call from his office that unfortunately the appointment would have to be moved a whole week and a half later to October 8th. This was, at first, disheartening - this first post-op appointment would include x-rays to ensure all the bones in my neck were still aligned properly and we were on the right track, and I was anxious to get that (hopefully) good news report. Then, the day before the October 8th appointment, I got ANOTHER call that Dr. Lynn had been called into an emergency surgery the morning of my appointment but that I should still come in and see his PA who I’d met at some point during my hospital stay. While unfortunate to not get to see Dr. Lynn himself, I realize this sort of thing must happen somewhat regularly. Whose regular appointment did I bump when I had to have my Halo procedure? Must be a constant scheduling nightmare, since it’s not like emergency spinal surgeries and procedures happen on a nice predictable schedule, after all.

The appointment with the PA was great. After a month of parsing the written (no visual) reports from several of my initial CT scans at the time of the accident, combined with a hefty amount of research on the cervical spine by way of Google and free-access medical journals, I finally came to a full understanding of exactly how the bones in my neck had broken. For those of you who are not, as of yet, experts on the cervical spine, please sit back and enjoy

BREAKNECK BEAN’S HIGHLY SCIENTIFIC LECTURE ON THE NECK BONE AREA

Okay, so, you have 7 vertebrae in your cervical spine, labeled C1-C7, that connect your skull to the top of your thoracic spine (your “back” spine, as opposed to the “neck” spine)

C1 and C2 - where the worst of my damage was located - are at the top, and they are a little different from all the rest - they have a unique mechanism that controls the rotation of your head from left to right. C1, at the very top, is “The Donut”. No kidding, that’s not my term, Dr. Lynn used that at one point describing things to me in the hospital, so that’s as scientifically accurate as it gets. C1 is a circular ring (hence, donut) that sits right beneath your skull - in fact your skull actually sits on two little “pad” areas right on the top. C2 sits right beneath it, and it is also semi-ring-like in shape, but with a really unique feature - a “Pin” that extends upwards from C2 into the ring of C1. The Donut rotates around this Pin as a pivot point, and that’s the entire reason we can indicate “No” to someone without having to use words. Left and right rotational movement - The Donut (carrying your skull) swiveling around this pivot point - got it? Yes, there will be a quiz at the end of this.

So when I crashed headfirst into the ground, a couple things happened.

First off, imagine taking a donut (in my head, for some reason, it’s always a sour cream donut - something about the shape of those makes me think of the bony ridges and processes of the cervical spine vertebrae) and dropping it on the kitchen floor from about chest height or so. Incredibly sad. Donut on the floor, probably split into multiple pieces. (Quick, 5 second rule, it’s still edible if you move fast!) That’s what happened to my Donut. It effectively cracked in three places - two sections along the back of the ring and one diagonal fracture towards the front and side. Unfortunately this did not qualify me for the very cool-sounding diagnosis of a “Jefferson Fracture” (named for Sir Geoffrey Jefferson of medical fame, not the 3rd POTUS, I don’t think HE was ever cool enough to break his neck) - this requires a “burst fracture” in four separate locations, and mine was only nice enough to break in three. So close!

Moving down the cervical spine, we find out what happens when force is rapidly applied to The Pin of C2 as The Donut around it gets thrown violently around. In this case, it decides to snap right off. This is naturally a serious - but also the most common - type of injury to C2, since that pin is sitting there like a turkey wishbone just waiting to be snapped. This is why I immediately couldn’t turn or move my head at all right after the injury - with that connection broken between C1 and C2, suddenly that whole pivot joint mechanism is very much non-functional. Some of my reading over the last month determined that one of the decisions between Halo brace natural healing vs surgery is based on how far this pin moves once it is snapped. There’s about a 5mm threshold, it seems - where if the pin bone moves out of place by more than that about there’s a much lower chance of being able to get it to reattach and grow back to where it should be on the base of C2. Mine moved approximately 4mm - any more and surgery might have been the only option.

C3-C7 are much simpler bones, they are sort of like building blocks that just go down the rest of your neck spine. My C7 had a bit of a compression fracture but nothing nearly as serious as what was going on up near the skull (had it been only the C7 fracture I suffered, Dr. Lynn said they would have put me in a hard neck brace for a few weeks and called it a day). As it was, in comparison to what was going on up in C1-C2, C7 was almost an afterthought by comparison.

I also learned - from one of the doctors in the emergency room - that your spinal cord controls more and more vital functions the further up it goes. So if you damage your spinal cord at C6-C7, you might suffer loss of function and control of your legs or lower body. Getting up towards C4-5 you’re talking much higher risks of becoming quadriplegic. The C1-C3 area is where autonomous breathing functions are located (this is the area that actor Christopher Reeve of “Superman” fame damaged in his horseback riding injury) - the doctor pointed out very kindly that had C1 or C2 been jolted enough to cause any spinal injury in that area, I very probably would have just suffocated to death in that ditch. Fun!

But with no spinal injuries, it was just a matter of determining how the bones could be put back together. Screws and pins would do it, a la the surgery option - but since C1-C2 control your neck rotation, that’s why you lose some of that functionality after such a procedure. Metal screws and bolts are great for holding things together, but not for allowing everything in your neck to work precisely the way it was designed. So, the Halo brace immobilizes everything while the bones grow back together, and here we are.

Anyway, yeah, thanks for coming to my TED Talk about neck bones.

So the report on the first post-op x-rays was very good. Fractures can still be seen in several areas, naturally, but everything is lined up where it should be and that’s exactly what we want after one month. Amanda, the PA, said we usually don’t start seeing actual “fusion” of the neck bones until 8-12 weeks, so hopefully we’ll get an even better report at my next check-up in early November (assuming Dr. Lynn doesn’t have to reschedule on me 4 more times). Mostly I’m really curious to get his opinion on my injury as a whole and ask him some specific questions (especially about the procedure when he “set” the neck bones and they put on the brace) so look for more reporting on that subject down the road.

Otherwise, life is good and I’m really feeling fine. It seemed to take about 4 weeks for my body to really “get used” to the Halo - it’s still awkward and cumbersome, but MUCH less so than it was those first couple of weeks. The human body is remarkably adaptable. As odd as it sounds, the screws in my skull aren’t even uncomfortable now, I just register their presence but there’s no pain at all, just a slight pressure. And most days, the neck itself feels pretty good. I’m still mostly sleeping sitting propped up in a chair - it just seems to be the most comfortable position overall - and I’ll wake up most mornings with a lot of stiffness or a sore spot in my neck, but it almost always works out pretty quickly after I get up and move around. Work keeps me busy, Graham keeps me entertained, and Lindsay keeps me from doing anything stupid that I shouldn’t, so all-in-all - the prognosis is good!

Oh and just wait, the next post is gonna be about “pin care” on the screw sites in my skull and that’s gonna be REAL fun. Stay tuned!

Edit - The Next Post - Pinsite Fun

First post-op Xray after a month - 
Pin bone aligned and beginning
to reattach

CT Scan day of the injury -
"The Pin" of the C2 circled

Day 22 Update - A Visit to Todd and Other Miscellaneous

For as bad as everyone complains about the road conditions and potholes here in South Carolina, I’ve honestly never really been bothered by them that much. Well, that is, until I rode in the backseat of a car in a Halo brace where every slight bump and jolt seems to resonate into the bars of my cage. But, on Day 14, it was time to venture back into the outside world for the first follow up appointment with Todd the Orthotist.

I had met Todd in the hospital a couple times - he came by before the Halo installation to take some basic measurements for the procedure, and then afterwards for a post-op screw tightening. This would be just a basic check up to make sure everything with the brace was still behaving exactly as it should. My first follow up with Dr. Lynne the neurosurgeon wouldn’t be for another couple weeks still, at which time we’d actually see how the neck healing was progressing.

Oh, here’s a good spot to talk about a quick CLOTHING update - the vest part of the Halo sits right on your skin and never comes off, but as usual, Lindsay had gotten clever. We took a couple of my sleeveless t shirts and cut the shoulder sections apart, which allowed me to step into a shirt and then slide the front and back now-separated halves up through and underneath the vest and secured under the shoulder sections. There’s just enough wiggle room to get a shirt threaded underneath, which not only allowed a layer of fabric to protect my skin from any irritation, but also allowed me to not feel like I was half naked all the time. This was fine for getting around the house, but further creativity was needed for going outside the house. We made some creative cuts into the back of a large zip up fleece jacket for it to fit around the bars of the Halo in the back. Not perfect, but pretty good for a first attempt. We’ll have plenty of time to keep experimenting with a couple of other extra large hoodies and shirts I picked up as well. One may be in a Halo, but that doesn’t mean one can’t attempt to be as fly as possible at all times.

Snug in my jury-rigged jacket and folded into the car again (much easier than when coming home from the hospital, great strides in mobility over the last week and a half!), we trundled on down to Todd’s office. It was a pretty simple visit all things considered. Todd checked everything out to make sure it all looked good and showed us that the foam pads lining the inside of the vest are actually removable without having to take off the vest itself! With creative use of trash-bag liners to separate the foam from the velcro lining of the vest, it can be removed and swapped out for alternate foam pads should we desire to wash or air out the pads from time to time. It was - while not exactly painful - a rather jostling experience, so I doubt we’ll be doing it every day or two, but it’s good to have the option ready for whenever we need it.

Todd answered a few of our questions and said - barring any unforeseen circumstances - the next time we would see him would be to remove the Halo in however many months down the road Dr. Lynne decided it was time. Optimistically, nothing with the Halo will need adjustment throughout the process - he said to give him a call if any head pain worsened, as that could be a sign that one of the skull screws was loosening and needed to be tightened. He was able to provide the trivia tidbit I had been wondering about - that the entire Halo contraption weighs about 12 lbs total - and also provided us with the wrench set that I must carry with me at all times in case of some catastrophic event in which the vest would need to be removed. Literally, I can’t take this thing off without three separate wrenches for the various bolts and screws that hold it together. That done we returned home and back to our normal routine.

We’ve stabilized into a pretty normal routine at this point. I’m still sleeping in my recliner each night and have graduated to reclining slightly (still more comfortable to sleep mostly sitting up vs lying down - I think this has to do with how the weight of my head is distributed between the four skull pins), and this allows me to keep my feet propped up to avoid any swollen ankles. I’m able to get around the house more and more normally, if still at half-speed or so. Turning or rotating is the most deliberate action - I’m getting better at a smoooooth turn where my entire body rotates at once (I mean my head has to move with the torso, it’s locked into place) - but the smoother the action is the less strain I feel on the neck as I turn. Weekdays I make the climb up the stairs to my office where I’ve found that one thing the Halo is good for is curbing my low-grade physical ADD - whereas before I would often get up from my chair every 20 minutes while working to go do something I had just thought of or been distracted by, now it’s easier to sit and work for at least a couple hours at a time without moving, as it’s when I’m stillest for long periods of time that I am most prone to (almost) forget about my portable, wearable metal cage.

“Pincare” is a new part of our nightly routine as well. One of primary things you have to take care of while in a Halo is maintenance of the four sites where the pins screw into my skull. The four sites have to be cleaned daily to ensure no infection sets in. Using Q-tips and and an antimicrobial/bacterial cleanser (off-brand Hibiclens), Lindsay swabs around the sites to ensure they’re staying as clean and germ-free as possible. Currently, the back two pin sites are causing a bit of consternation. They didn’t shave or trim my hair at all when they put the screws in back there, so for one they are a little hard to see and get to, but for two those two sites are showing some signs of a yellowish discharge (sorry people, no filter here when it comes to the gory details). This is not necessarily abnormal or a huge warning sign as redness, irritation/inflammation, or pain at the sites would be (really the sites don’t hurt at all), but we’ve upgraded (on Todd’s instructions) to using hydrogen peroxide on those sites for a few days for some added cleansing benefit. I’m really not concerned as long as there is no pain or redness - Lindsay is a bit more cautious - but between the two of us I’m confident we would catch any true problems in the early stages and head them off then.

Still plenty of things to do, so thankfully I have never been bored. It is a little astounding how much extra time I feel as though I have some days. In my “previous” life between cycling, running, and working out I was often being physically active for 15-20 hours per week, so to have that much extra time now to sit and get extra sleep, extra reading/gaming/watching done, etc is really a shift in “how I spend my time”. It’s all pretty productive though, so I’m happy.

The higher amount of neck pain I was experiencing last week seems to have subsided a bit. I’m usually only taking a few ibuprofen at night when the fatigue of the day allows more soreness and tenderness to creep in, and to help alleviate any pain that might keep me from sleeping. I’m sleeping pretty well actually, usually in chunks of at least 3-4 hours at a time and sleeping soundly while I’m out. Rest is when the body heals the most, so I’m trying to keep doing as much of that as possible.

I’m constantly reminded - and humbled - by how many good people surround me in my life. Daily reports of people thinking, wishing-well, and praying, as well as dozens of friends stepping up to help provide meals, help around the house, and offers of assistance for anything that we might need over the next few months while I’m facing some of these physical limitations provide daily encouragement and a level of support for which I can never express enough gratitude in return. This recovery may be a tough journey, but I’m very fortunate to not have to walk it alone.

Next Entry - A Discussion of Neck Bones

Graham the Occasional Lapdog 
provides regular emotional support