One Smoothie at a Time

Today, Steve met Dr. Hammoudeh for the first time since being awake and out of the drug induced coma.  On our way to the appointment in Glendale this morning, I recapped the role Dr. Hammoudeh played in Steve's treatment and how I believed the good doctor was integral.  Steve listened intently and asked a few questions and still, when the doctor walked into the exam room, I was surprised to see Steve surprised.  Somehow, I forgot that Steve was really meeting him for the first time.  Before the doctor walked in, however, we were relieved that they wanted to take Steve's first post-op x-ray.  We've been waiting for almost seven weeks to see if Steve's mandible is healing well.  The success of all of the treatment Steve has had up until now has been contingent upon whether or not the jaw bone, which was shattered into thousands of pieces, is healing and calcifying back together.  So, needless to say we were really anxious to see the results for ourselves.

First, the doctor examined Steve's mouth and felt along the outside of Steve's jaw bone.  He was very thorough and he took his time.  He seemed very happy with the outside appearance of Steve's jaw and especially, the sites where the pins of the fixator go into the mandible.  Without patting myself on the back, I have to boast that I have been extremely diligent about keeping Steve's pins clean.  As we were admonished so many times in the hospital by practically every doctor involved in the care of Steve's jaw, the pin sites are very much subject to infection.  And if Steve were to somehow contract an infection in his jaw, that could be absolutely disastrous.  So I was very happy that the doctor was happy with the pin sites.

Finally, the doctor showed us the x-ray (which I took pictures of with my cell phone, hence the poor quality of the picture):

The left side of this x-ray, which is actually the right side of Steve's face, shows the devastating injury.  Right above the top of Steve's metal pin on the right side of his face (left side of the x-ray), you can actually see where the jaw bone was sheared off.  All of the teeth on the bottom right side of his mouth (left side of the x-ray), are gone and most of the jaw bone too.  The three teeth on the bottom which are sort of grouped together are all loose and the doctor said that Steve will lose those once his mouth is unwired.  Below those three teeth are several bright spots on the x-ray which are bullet fragments but Dr. Hammoudeh said that bone will grow around those and they will not be removed at any point.  Basically Dr. Hammoudeh said that clearly by the x-ray, you can see what a catastrophic injury this is.  However, it is fixable with bone grafts, likely from Steve's pelvic bone, and then of course dental implants.

After reviewing the x-ray with us, Steve mentioned to Dr. Hammoudeh that he had been feeling a sharp point from one of the metal bands around his teeth that are keeping the jaw wired.  Steve asked the doctor if he could look at it and possibly fix it.  The doctor reexamined Steve and found a piece of Steve's jaw bone sticking out and determined that was what was poking Steve.  I'm so glad I had my eyes covered with my hands because the doctor took one of his tools and clipped the bone like it was a fingernail.  Steve is so brave...I would have fainted!

We asked Dr. Hammoudeh what we can expect in the upcoming weeks and months.  The doctor said that Steve will likely go about two more weeks with his jaw wired.  When his jaw is unwired and opened, he will lose all the teeth that are loose because they could cause an asphyxiation hazard. The unwiring of the jaw will be an outpatient surgery.  He will also still be on a liquid diet because they won't want to risk damage to the healing jaw bone so they will prohibit him from chewing solid foods.  The external pin fixator will remain on Steve's face for AT LEAST three more months.  Then they will reevaluate.  When they remove that, it will be another outpatient surgery.  At some point, when they are ready to reconstruct the jaw bone, they will likely use Steve's own bone from a bone graft of the pelvic bone.  That will require a short, possibly one or two day stay in the hospital (back to USC University Hospital).

All in all, we were very happy with Steve's appointment today because we feel like we have a better idea of how the bone is healing.  We were also happy to hear what's in store for Steve.  He was really worried about another possible long stay in the hospital.  Next week we have more appointments but for now, we are happily, gratefully taking one day and one chocolate peanut butter smoothie at a time.