2/5 - Amputation Surgeries are Tomorrow at Noon

As you already know (from reading the title of this post), Jamie will be having her amputation surgeries on Friday, February 6 at noon. In brief, the surgeries performed on Friday are two Below the Knee Amputations (“BKA”) and ten Finger Amputations (“FAMPS”; yeah, I made this up just now). The FAMPS will involve only the removal of dead tissue, but there’s more on that below. She will indeed be losing the majority, we think, of most of her fingers, but, in typical doctor fashion, we haven’t been told anything specific about what can be saved and what can't. The doctors can’t confirm what can be saved until they’ve cut into the finger skin to see how deep the necrotic tissue goes. So, though they won’t be sticking Jamie’s fingers into cigar cutters (SNIP!), they’re not sure how much will be saved until they’re in there.

Speaking of “we won’t know what we can save until we’re already in surgery cutting” (that needs an acronym too), Friday’s surgery is taking place exactly two months, to the day, after we were told in Austin that Jamie would require two hand amputations at the wrist and faced the prospect of having one, if not two, above the knee amputations (“AKAs”). As you know, that sage advice, and a fortunate introduction to Dr. Lin a few days later, was all it took to make us leave Austin for Houston. (Also, whereas that conversation took place on 12/6, Jamie’s surgery will be taking place on 2/6. My lucky numbers are 126 or 26 FYI. I’m not cool).

Now, the introductory stuff is over. I’m sure you have questions about this and I want to get to all of them. So, let’s take it from the top. I’m going to think of questions that have been or will be asked of us and answer them, in turn. And here we go.

1) “What the Hell? Didn’t I JUST see a report on TV that said, basically, ‘Jamie’s recovering. Everything is cool. Hyperbaric chambers are magic?!?’ ”

- First, yeah, that IS indeed an odd coincidence that we're going to surgery the same week as the report. Here’s the deal: On Monday, everyone comes in to interview and record Jamie and friends. What a good report, btw! On Tuesday, at literally the same time that the report is airing on the 6pm news in Houston, KC and I (Roni had a time-conflict) are speaking with two of Jamie’s doctors about her condition, advising us on the risks and potential benefits of further delaying Jamie’s amputations. It was during this phone conference that we decided to move ahead with the surgeries as soon as possible (at least, as soon as possible for non-emergency surgery), which ended up being Friday at noon.

2) “What did you all talk about in that meeting on Tuesday? Haven’t you all been pretty staunchly against the idea of cutting too soon? What caused the change of heart?”

- While the details of our talk on Tuesday aren’t any of your business (nosy), there isn’t too much exciting information that forced us to change our minds. We’ve always looked at this as sort of a sliding scale. On the one hand, we had weighed the risks behind waiting to perform the surgeries - sepsis, infection, getting necrotic tissue into the blood stream, wet gangrene, death – and the likelihoods of their occurring. On the other side were the benefits – saving fingers, legs, feet, walking – measured against their percentages. Basically, our position has never changed, but over the last few weeks, we’ve seen the rate of recovery slow down, as has been expected. There have been additional complications, as discussed by mom in her posts. These include the blood clot caused by the pic line, some puss action near her foot, the flare up of MRSA on her hand, the catheter Jamie’s had for almost three months, and so on. The percentage chance that these problems could cause her to lose all of the progress she’s made has steadily increased over time. It hasn’t spiked or anything, but it’s been looming larger as of late. On the other hand, the consensus seems to be that, despite our major strides in saving a lot of “grey-area” necrotic tissue, we physically cannot hope to resurrect what has died a few months ago (After all, Jesus was only down for three days, not three months, so I’m not sure we can expect a similar miracle). Basically, the chances for improvement are now outweighed by the chances for disaster. In the end, after KC, Roni, Jamie, mom and I got together to discuss, it was an easy decision, albeit a terribly difficult situation.

3) “OK, quit rambling. What’s the deal with her surgeries? Shouldn’t you get to that?”

- Sheesh. OK. As I mentioned above, Jamie will be having two BKAs performed on, duh, her legs. She’ll also have the FAMPS performed on her hands. [Last time I’m saying this, but NO her hands aren’t being cut off, just parts of her fingers] The surgery will be at noon tomorrow, Friday, February 6. No, I don’t know how long it will take. I’m sure we’ll post something on the internets about this once we know anything. [UPDATE: The surgery should take less than 4 hours] Now to the specifics –

Legs – As far as amputation surgeries go, BKAs are… wait for it… pretty cut and dry. ZING! What we’ve been hearing is that you cut the legs so that the stumps fit into the prosthetics. I’m not sure of the exact length needed, but I do know that Jamie has more than enough viable leg. As a general rule, you amputate so that there is less bone remaining than there is skin remaining. This is how the human body generally works. Otherwise, we’d have bones sticking out of our fingertips. Jamie will leave surgery with two open wounds on her legs and then, 2 to 3 weeks after Friday, we will use one skin flap per leg to close the wounds, once they are sufficiently clean of infection, necrosis or whatever. That about wraps it up, for the legs.

Hands – This is a bit more interesting. On Friday, we’ll do ten FAMPS. Now, remember what I just said about the general rule being that you leave more skin than bone? Well, here, we’re going to do the opposite. We’re going to save as much bone as possible because we’re going to try to grow tissue on those appendages through a procedure called a Groin Flap. Essentially, two to three weeks after the FAMPS, they’ll perform another surgery. The Groin Flap refers to (1) an incision that they will make in her abdomen or groin, then (2) they will take one of her hands/set of fingers and place it into that flap and leave it there for 2 or 3 weeks. The point is that, when surrounded by other healthy tissue, the extended bone-stumps will be able to support tissue growth and will lead to longer fingers. That’s the plan. Once one of her hands has been incubating in the groin flap for 2 or 3 weeks, we will remove Hand 1 and then do the same thing for Hand 2.

4) “Wow, this sounds intense. Sorry for being such a jerk with my questions, earlier. Can/should we come visit? What’s the best way to help?”

- Hey, it’s all good. I’m not sure about the best way to help right now. I know that Jamie appreciates all the support and loves to receive letters and things like that. Unless you’re a starter on the A-Team, then perhaps you should postpone your visit until next weekend, subject to any changes. I mean, look: Food is nice, but you’re really just feeding us, and we don’t need anymore chocolate. Starbucks gift cards are always welcome too [ :)]. In fact, I could still use a new laptop… ok… just kidding (no I’m not, I need a laptop). In the past, we’ve had some great offers to send products/devices (voice recognition software is a good example), but we hardly know what our needs will be in a week, let alone a month or a year. So, for the time being, just keep praying and sending support through whatever medium you see fit.

There will be more updates coming, but I’ve got to get on the road to Houston. This news conference is over. Peace out.