April 30, 2014 -- God Performs Surgery!!!

After a really long hard day yesterday, we are filled with hope that our Hope is on the mend!!! . . .

Ever since we came in on Friday, surgery has been mentioned as a likelihood!  They were willing to try some other options, in the hopes that surgery could be avoided, but kept expecting that eventually surgery would be necessary to both drain the hematoma (collection of bloody fluid), and clean out infection.  Once these post op surgical wounds get infected, they tend to open up and not heal for a long time.  As well, the hematoma kept re-filling and the doctors were surprised with how much blood continued to be in the drainage.  Surgery was being considered to open back up the infected front incision (about 5 inches in length), to clean out all the infection, to drain the hematoma and possibly insert a drain, if the area would allow one to work (the honeycomb fluid compartments made that more difficult).  If a drain would not work, then a larger area of the incision would be left open in hopes of aiding drainage of the hematoma.  **Infectious Disease doctors had recommended that the infection could not be resolved and IV antibiotics could not be stopped, until there was no more fluid collection present to impede the antibiotics from reaching the bacteria/infection.  Although surgery would have it's benefits, it also had cons such as the likelihood that surgery would need to be repeated, and the healing process would be much longer again.  But the important thing was to deal with Hope's two major issues. . . the infection, and the hematoma.

Just a recap. . . Saturday, we chose with the doctor to try draining the hematoma at the bedside under local anaethetic to see how Hope's body responded.  It worked, in spite of the honeycomb issue, and even more surprising was that no infection or pus was seen!  It was all bloody drainage.  Under the microscope, no bacteria were seen in the fluid that was drained from the hematoma.  Puzzling!  And on Sunday, the hematoma began to fill again until it was back to full swelling by Monday.  Then Monday morning, the far end of Hope's incision opened up about one stitch length.  Scant drainage was seen, and again no pus/infection, confirmed with a negative culture from the swab done of the open area.  Redness started to spread up the incision, giving the likelihood that it would all follow suit in opening up.  The doctors asked for Hope to have no food or fluids over night on Monday night so they could go ahead with surgery to clean out the wound of infection, and drain the hematoma and possible insert a drain if it would work, otherwise would leave more of the incision open to drain the hematoma.

Opening at the end of Hope's Incision

Hope had a pretty rough night on Monday night (night before last).  She slept very little.  She started having severe rib and stomach pain, along with headaches that kept her restless and unable to settle and sleep.  Just before Trevor and Gabs left for the night, we took Hope to the bathroom and when we looked down, bloody drainage was leaking all down Hope's side in the toilet and onto the floor!  As well, later while lying on her right side (side of the hematoma/incision opening), her hematoma started draining copious amount of bloody drainage.  She soaked through everything twice in the night!  She spiked another high fever on Monday night as well.  She was limited to having Tylenol only for pain and fever reduction, as Ibuprofen provided too much of an increased bleeding risk.

Picture I took to show Trevor and the doctors the next morning.  This was the first of two good size soaks of Hope's bed and clothing.  The little square red gauze was the dressing and the original drainage amount did not even soak that gauze to give perspective to the amount this was.  You can also see both serous clear fluid but also the amount of bleeding still present and coming from the hematoma.  This was from a two hour period!  Thankfully Hope's hemoglobin levels are holding up!

When neuro-surgery came by to assess her in the morning, they were happy to see it draining, but concerned about the amount of continued bloody drainage, the continued fever spikes, and Hope's general unwellness (severe pain, continued vertigo episodes, and increasing redness at the wound site).  Because it was draining such a large amount, they decided to try accessing the hematoma site through the wound, making sure that it had a good tract for draining, and to see if any pus/infection could be extracted.  The resident inserted a long sterile Q-tip into Hope's open wound, and slowly advanced it about 2 inches into the hematoma area, while the surgeon pressed and milked the hematoma for fluid/pus.  This invasive procedures was done with no medication and was very painful for Hope, but she was a trooper and even a rather matter-of-fact doctor was moved to compassion witnessing the strength God gave her amidst the tears and cries of pain.  He was only able to drain a considerable amount of bloody drainage, but absolutely no pus/infection was seen.  So, the neuro-surgeon decided to postpone surgery, because the wound had opened itself, it seemed to be draining the hematoma sufficiently as it was only re-filling minimally at this time, and there was no evidence of the presence of pus/infection needing to be cleaned out!  God had performed His own hand of "surgery" on Hope's body!!!  It will never cease to amaze me every time God acts on Hope's behalf as her Healer, Great Physician, and even Surgeon!  How could we not give Him our complete and total trust in every single circumstance. . . He is so faithful!!!  Please praise Him with us for His miraculous "surgery" without surgery. . . noticing that the timing was no coincidence of plans made on the best human knowledge and then God working at the last minute to make His hand evident!

Deuteronomy 32:4
"The Rock, His work is perfect, for all His ways are justice.  A God of faithfulness and without iniquity, just and upright is He."

Psalm 18:30
"This God--His way is perfect; the Word of the Lord proves true; He is a shield for all those who take refuge in Him."

Getting Set Up for the MRI of her Brain on Monday!

All Set!!!  Many people feel claustrophobic in this machine, but Hope did great!  This was the FIRST time Hope has had an MRI without general anaesthetic (going to sleep)!  It was much shorter (2 mins vs 45 - 90 mins), however, it was still a victory!  Daddy came up with a great game of counting and matching to see how close she was to an actual stopwatch time!  Such a clever daddio!!!

The rest of Hope's day was a long hard one yesterday.  She was still having a lot of severe rib and stomach pain (rated 10 out of 10 on the pain scale), along with a headache (rated 5 out of 10 on the pain scale), guarding and tenderness of the hematoma.  Frequent dressing changes, which was causing lots of pain and irritation to her skin.  She lost her IV and had to have another one put in.  She had to go for X-rays, which were uncomfortable for her.  She had many different doctors in doing assessments to investigate some of her puzzling symptoms, like the vertigo.  This meant repeated assessments and position manipulations to try to induce the vertigo, which some were able to do, and some were not.  Many of these things were happening at the same time and were overstimulating and overwhelming for Hope, when she was already feeling lousy.  The worst part of the day was when the neuro-surg resident came back in the afternoon and repeated the invasive procedure with the Q-tip into Hope's wound opening. . . it was horrible!  There was much less bloody drainage this time, even with milking/pressing on the hematoma, so she inserted the Q-tip much further, probably closer to 4 inches, this time.  Daddy joked after all the tears and agony, that she was checking to see if she could find Hope's bellybutton with the Q-tip.  Gabs was here for it and listening to her sister cry and call out for help, as well as walking over to talk to her dad and seeing what was being done. . . Gabs turned as white as a ghost and almost passed out!  I saw her and had her go sit down out of sight right away, to prevent from having another little patient soon!  Gabs will definitely know what she's getting in to, if she decides to pursue nursing in her future!  This procedure was awful and very upsetting for Hope.  It was likely that she would need to have it done again a couple of times a day, so we discussed having her given some medication prior to the next time.

However, God's mercies were indeed new again this morning!  Hope had a great night's sleep and only awoke for the regular nursing assessments overnight.  She did not require any oxygen over night!  She did not complain of any pain!  She did not have any extra trips to the bathroom. . . back to just before bed and upon waking in morning!  Her hematoma drainage has slowed down considerably and her hematoma is not re-filling (swelling up)!  She looks much better now with better colour and no puffiness.  When neuro-surgery stopped by, they discussed whether to do the Q-tip procedure again.  With the help of daddy's posed reasoning of less bloody drainage, but still draining and not swelling, the decreased redness of the open wound, and the fact that little had been extracted with yesterday afternoon's procedure, they decided that the Q-tip procedure was NOT necessary this morning!!!  Hope was thrilled and relieved!!!  Hope has not had fevers since Monday evening, and she has not had any pain medication since yesterday afternoon. . . so she is definitely on the mend!  We are SO thankful!!!

So, how much longer will she need to be in the hospital?  We still don't know.  Her vertigo symptoms are going to be assessed today by an ENT doctor (ear/nose/throat) to make sure there is no ear involvement, but it is unlikely with no ear symptoms such as drainage or pain.  The neurology doctors that came and assessed yesterday were not able to discover a specific or treatable cause.  They just said that as this persists, Hope may be prone to develop migraines and to watch/be aware of that.  We will follow up with her regular neurologist at her next appointment.  There was talk of doing an ultrasound on Hope's hematoma site, but not sure if this will be necessary still with much less fluid present and surgery off the table.

So, it really poses around Infectious Disease doctors and what they come up with.  Hope's hematoma fluid that was drained on Saturday morning finally grew a culture of bacteria, identified yesterday afternoon as Strep.  The infection source was likely then the hematoma all along. . . the surgeon suspected a simple seroma or clear fluid collection had formed after surgery, but instead it also had blood collecting and then developed infection.  And this morning I was told by the charge nurse that this Strep bug is covered by both of the current IV antibiotics that Hope is receiving.  Finally an answer to what bug is causing the infection and the best treatment!  Now we are waiting for Infectious Disease doctors to make their final recommendations on what antibiotics, how long, IV vs oral administration, and length of necessary hospital stay.  We will keep you posted!  For now, please know that your prayers are being answered and this Peacock family is SO INCREDIBLY thankful to each and everyone of you for so faithfully following Hope's story and praying for her and for us!!!  As well as the constant outpouring of prayers, is the sweet notes of encouragement and acts of love. . . from a gas card and cupcakes left on our doorstep yesterday morning, to the cinnamon buns left on our door yesterday evening, the meals that have been delivered to the hospital and sweet visitors. . . we are truly blessed by God's loving provision for us through the many precious people He has placed around us.  We have had dear nurses. . . Hope cried when saying goodbye to one yesterday!  God is good. . . even in the midst of trials and suffering, God is always good, and His blessings are always evident as we look for them!  Yesterday through all the painful procedures, we encouraged Hope to focus on Phil 4:6-7 "Do not be anxious about anything, but in everything, by prayer and petition, with thanksgiving, present your requests to God, and the peace of God which transcends all understanding, will guard your hearts and your minds in Christ Jesus."  I wish you could have heard her singing this verse (it's a Scripture song we do in our church's Children's Ministry worship) to her nurse yesterday as she prepared for another painful procedure!  GOD IS GOOD!!!

You are dearly loved, sweet friends and family!!!

Hope is sporting her two pokes from Monday's bloodwork,
and the fancy bandaids that she is collecting.
Her count is currently at 16 pokes over the past 2 weeks!
God is growing her into one tough cookie!!!