7/4 Wednesday Update

Initial Forum related to Tony's Near Death Journey

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7/4 Wednesday Update

Postby bb_secretary » Mon Jul 02, 2012 5:14 pm

The family spoke with Dr. Roth Monday morning and again on Wednesday, July 4th, so we now have more clarity regarding Tony's medical predicament. Please note the following information may contain some medically inaccurate perceptions because the reporter has limited medical expertise and is relaying perceptions from others who have conferred directly with the doctors.

This post is a revision to Monday's 7/2 Update to include corrections, additions and omissions as noted: Added a fractured wrist and a broken clavicle (collar bone). The broken elbow is on the left side, not the right, so all the major damage is to his left side with the exception of his fractured right wrist, which is consistent with a left side impact because we instinctually tend to bring our hand across for protection and balance. Clarified the pelvic fracture does not include the hip. More info regarding the first night, including multiple heart stoppages. Perception of Tony's condition and progress. Upcoming surgeries. Spelling change for Alexandra. Mike works in San Luis Obispo, but lives in Paso Robles.

Tony's major survival issue continues to be his internal injuries, especially the extensive physical damage to his lungs. A collapsed lung (pneumothorax) is not like deflating a balloon by letting the air out. A lung collapses when it separates from the chest wall and fluid or gas pressure which is not normally present in the pleural cavity between the lung and the chest wall begins to build and collapse or push the lung closed. I visualize it as the chest wall normally being attached to the lungs by the pleura membrane so that when we expand our chest it pulls the lungs open for inhalation. Tony's lungs and pleura membrane were damaged by his broken ribs and his condition is complicated by the bleeding and tissue injuries. All of his left side ribs are broken and some on his right side also. He has 7 chest tubes draining fluid and sucking air from various sections of his chest cavity and lungs. Since his chest can't "pull" his lungs open to inhale, they are being forced open with a breathing machine by rhythmically pumping air into them through a tube routed via his mouth and down his airway.

In addition to Tony's 7 chest tubes and breathing tube, he also has a couple of other drains and IV's so he is plumbed with about a dozen tubes that enter his body, plus his oxygen sensor, EKG, temperature probe, and hoses for his leg wraps to help circulation. All told he is connected to about 18 tubes, hoses, and wires.

An initial concern was excessive internal bleeding, so they were administering coagulants (blood clotting medication) to slow the bleeding. The internal bleeding has diminished and the concern has shifted toward pooling and clotting. If a clot breaks loose it could cause a blockage that might result in heart failure or stroke, so they have begun administering anti-coagulants while physically massaging his extremities to combat pooling via air boots that rhythmically inflate to compress his legs and push the blood along. By Wednesday, his bleeding is significantly reduced, but he is getting a lot of swelling in his joints, particularly his knees which are blown up like melons. Reportedly, the swollen joints are a result of the large quantity of fluids he has received and the swelling does not indicate a problem with his knees.

The first night (Saturday), Edward informed Ryan by knocking on Ryan's door in Ventura about midnight. Ryan dispatched and called his mom Shelia who met him at the hospital. They were at Tony's side later that first night and report he receive about 20 bags of blood. His heart stopped several times and they had to use the paddles to revive him. There was some correlation between the degree of sedation and his heart stoppages, so when his heart stopped they would reduce his sedation, which eventually resulted in him ebbing back toward consciousness manifested by trashing due to the pain, so they would increase the sedation level which would lead to iterations of the heart stoppage cycle. Ryan and Sheila also report that his breathing early Sunday was somewhat labored and spastic with some fluttering and convulsions.

By the time I saw him on Sunday evening, he looked calm and peaceful with rhythmic breathing. Both Ryan and Sheila report that he looked much better when they saw him Wednesday and were relieved to see him calm and breathing smoothly (on the breathing machine) with a regular heart beat.

It was relieving to learn on Monday that Diablo's unconscious state is not due to brain trauma. His medical team deliberately sedated him but did not induce a comma. As of Wednesday, he has been unconscious since they inserted his breathing tube shortly after arrival in the ER on Saturday. During that procedure, his heart stopped and it took about 5 minutes of activity to get it pumping again. They needed to use electric shock "paddles". Unfortunately, the revival process likely included repeated chest compressions which were traumatic to his already damaged chest and lungs. He was conscious during his rescue and spoke with the doctor prior to deliberate sedation. The family does not know how long Tony will remain in sedated unconsciousness. They suspect the reason for heavy sedation is to minimize pain and movement. For clarification, Tony is not in a comma and his extended unconsciousness is not related to brain trauma. His medical team does not expect brain damage.

It was also relieving to learn on Monday that Tony's spinal cord is intact, so he will walk again. There is some degree of cervical vertebrae damage (broken neck), but it appears minor compared to his other injuries.

His left side pelvic fracture was also discussed, but it does not appear to be "shattered" as some of the earlier rumors suggested. Surgery to address the pelvic fracture is tentatively scheduled for sometime next week, but it is a long and stressful procedure that uses a lot of blood, so his doctors will evaluate his condition before proceeding with pelvic surgery. His left elbow injury is significant and the term crushed or shattered has been used. His initial elbow surgery is scheduled for this coming weekend. He also has a broken wrist, but it does not require surgery, so they will likely cast it.

The family also noted on Wednesday that Tony has a broken clavicle (collar bone). He is scheduled for surgery Thursday, 7/5 to repair the clavicle, so his current surgery schedule is the clavicle on Thursday, the elbow this coming weekend, and his pelvis sometime next week depending on how he is doing because the pelvic surgery is a major operation that will stress his system.

It is very plausible that Tony will make a good recovery and most of his parts will rehab back to reasonable functionality, but as mentioned earlier his lung and chest injuries are very serious so for a few weeks he will be at risk of heart failure plus a range of other complications that may arise like infection, pneumonia, or stroke from blood clots. It is estimated that he will be in the ICU for at least 3 weeks followed by progressive transition to less intensive care and up to a year of rehabilitation.

The doctors plan to conference with the family once a week on Mondays for the next few weeks. Daily updates are not needed or planned. No news is good news. This is a marathon, not a sprint. We will try to update Diablo's status on this forum weekly or more often if we hear anything significant. If you want to contribute, your effort will be valuable in the weeks and months ahead.

Tony's female partner Alexandra arrived back from Romania Tuesday night. The family spoke with both Dr Roth, Tony's Trauma Physician, and the orthopedic surgeon on Wednesday morning at the hospital. Later Wednesday afternoon, Tony's sister Nancy traveled by train back to San Diego and Tony's brother Mike drove back up to Paso Robles.

In Summary for Wednesday. The doctors say Tony will have good days and bad. Fortunately, Wednesday was a good day and everyone involved is somewhat relieved and pleased with his progress, but he is still in very serious condition and will be for some time.

Please reply to this post if you have an update on Diablo's medical condition prior to next week's scheduled update. If you wish to offer personal comments or discuss other issues pertaining to the incident, please start or use another thread topic by clicking on the Diablo Down Forum link http://scpa.info/bb/forum/viewforum.php?f=15 and then clicking on the "New Topic" button
bb_secretary
 
Posts: 82
Joined: Sun Jun 06, 2010 2:53 am

Thursday 7/5 Clavicle Surgery

Postby bb_secretary » Thu Jul 05, 2012 5:18 pm

They took Tony for surgery on his clavicle (collar bone) about 5 PM on Thursday 7/5. If you don't see an update, please presume no news is good news, but keep sourcing your positive karma.
bb_secretary
 
Posts: 82
Joined: Sun Jun 06, 2010 2:53 am

Family Update Site

Postby bb_secretary » Fri Jul 06, 2012 9:06 am

As of 7/6/12, Tony's family has set up a site for status update notifications at
https://www.caringbridge.org/visit/tonydeleo
The SCPA Bulletin Board Secretary (bb_secretary) will no longer be posting updates to this site, so please visit the family's site for current status updates.
bb_secretary
 
Posts: 82
Joined: Sun Jun 06, 2010 2:53 am


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