Femur Fracture Story

Wednesday night Travis went to get his shower/bath after getting really sweaty after playing wheelchair tennis (heard about this from a kid at sledge hockey the week before). Scott said Travis had a blast playing, I was working hockey games that night. Travis stepped in the bathtub fine on his right (non-tumor) leg and when he stepped in with his left leg, he said his foot was on the white part (not on the blue mat) and fell. Scott said it was apparent that Travis more than likely fractured his femur. He said that T didn't want to go to the hospital in an ambulance and would rather sit in the car the 10 minute drive to Primary Children's Hospital.

I had the noise off on my phone, I typically do that when I am a scorekeeper in hockey games. Something told me to check the phone during a stoppage in play and I saw I had multiple missed calls from home. I thought that was odd since Scott was at home with the boys. I noticed I had several texts from Scott...the messages were "CALL US IMMEDIATELY. WE NEED TRAVIS' MEDICAL FORMS. HE MIGHT HAVE BROKE HIS LEG. WE ARE AT THE HOSPITAL. STAY AT WORK BUT COME AFTER.", "this is nolan texting", and "for dad". I immediately called Scott's cell and he said they were in the ED (emergency department) at Primary's. I called the lady that does scorekeeping scheduling and she provided me the names and numbers of others that would be able to jump in and help. The second phone call and we had someone on their way. Another hockey friend was one of the officials at the game and during the 2nd intermission (my replacement was figured out by then) and let him know what was happening. He knew of a person at the rink to help until my replacement arrived. I was on my way around 9:15p and walked in the x-ray room by 9:45p for the last 2 x-rays. At this point he had pain medicine, literally through the nose, and 3 x-rays.

One could see that positing his legs for the x-rays was painful for him even with the pain medicine; but as always, he was extremely brave. We were back to the room in the emergency department and waiting for the results. We remembered our friend Alyssa is a Child Life Specialist at Primary's and I asked her through Facebook if she was working, and she was. She came and Travis remembered she had the good movie selection. He decided he wanted to watch "Cars" and Nolan and Barrett wanted to play "Sorry".

Nolan hanging out with T, making sure the blankets under T's knee doesn't move

The nurse practitioner helping cover T came in and said that T had fractured his femur and they would admitting T. I asked to see pictures and she brought them up on the computer. I was on the phone with our friend Pat at that time (he and his wife offered to watch Nolan and Barrett that night), when I saw the x-rays below the decision was made for N and B to spend the night at their house.

With leg somewhat straight out

With leg in a "frog-like" position

The nurse practitioner said they were calling orthopedics and someone would be coming down to talk with us. I wanted to make sure that they knew that T's case had circumstances that don't make him your typical femur fracture. Pat and Kim picked up N and B, the orthopedic guy in the ER put T's leg in a splint to keep it immobile until surgery on Thursday, found out T's orthopedic surgeon does surgeries on Thursday (great news for us), T fell asleep. I ran home to grab a few things, including my phone charger, and returned to the ER by 1:30a. Scott headed home shortly after I returned to the ER (sleep and he needed a few things) and T was in his hospital room (3069) at 1:50a.

T fell asleep while waiting to be moved to a room

T's pain returned moving him from the ER bed to the hospital bed, so he received an IV dose of morphine. He slept off and on as the nurses checked on him frequently during the night. We were told sometime around 5:00a that T would be taken down for surgery at 7:30a. I intermittently "slept" and got up to be ready to go at 7:30a.

Hospitals are a maze even with plenty of sleep, I have no idea how we got to the pre-op room. Dr. Randall walked in and gave me a hug (I started crying again) and we talked. He said the surgery would involve going through T's tumor. The "good" news is that they typically make the incision on the outer side of the thigh and T has less tumor there. Dr. Randall had surgeries all day (wouldn't be able to get to Travis until late Thursday night if he were to do the surgery) and said that his cohort, Dr. Jones, would operate on Travis. Dr. Randall said he had full confidence in Dr. Jones and provided Dr. Jones Travis' background. We met Dr. Jones and Dr. Randall had to get ready for his 1st surgery of the day. Dr. Jones was the trauma surgeon for Thursday and is the other tumor expert orthopedic surgeon. Very, very blessed to have Dr. Jones on trauma surgery for Thursday.

T in the pre-op room

The anesthesiologist discussed different drug options he could use during surgery for pain control. We decided against the one that went in directly to his nerve, no sense in aggravating any other area of tumor. I don't know if he knew how involved T's tumor actually is. Soon enough, the time came for Travis to head to the OR. We gave Travis a kiss before surgery around 8a and went to the waiting room. The anesthesiologist has a great way with kids (I don't remember his name, but I'm sure we'll see it on his bill) and he challenged T to count how many butterflies are painted on the ceiling while enroute to the OR. T was already at 5 before the anesthesiologist started counting. ;)

Scott and I checked in at the surgical waiting room. Travis' wasn't in the regular schedule paperwork, but the lady found him under trauma. Our friend Vanitta joined us around 9a, it was so great to have her there. The 3 of us were visiting, telling stories, and laughing at times. Our friend Conrad had surgery earlier in the week and was still at Primary's, so he and his parents (Danielle and Eddie) came to see us in the waiting room. Dr. Randall stopped to talk to us (Scott hadn't made it through the surgery area maze when he was in to talk before surgery) after talking with the family of his first surgery patient. We had forgotten to mention to Dr. Jones that we wanted to see a picture of T's tumor, so Dr. Randall took a few pictures when he was in there getting an update for us. He also kept us updated when he was between surgical patients...he's great! I will not post the picture here, but I do have it.

Surgery time estimates were anywhere from 1.5 - 2 hours to 2-3 hours. Given T's narrow femur and femur bowing, we figured the time would probably be on the longer side. Dr. Randall said that they may need to insert a plate typically used for the radius in your arm, smaller than the femoral plate. They didn't want the screws to take up over half the width of T's bone. During the night we emailed Travis' geneticists in Salt Lake City and at the NIH about the break and surgery in case they wanted any samples for research (we signed consents our first trip to SLC in 2010). May as well. Dr. Viskochil was out of town, but Dr. Stevenson was able to get word to the OR about the samples, not in time to get a bone piece though.

Dr. Jones came to talk with us about 11:15a, Travis was out of surgery. He said that he had to place the plate on top of T's femur due to the small size and shape of the femur on the outer edge wouldn't support the plate. He said they took a sample of T's bone marrow and sent it to the lab, it looked "different" (I can't remember the word he used), but that could be from the fracture or neurofibroma into the bone (we knew that already). They also took samples of the plexiform since they were in there. (Dr. Randall said earlier it looked like healthy / not cancerous tumor.) That will be good to have for later. A few x-ray pics of the plates (not quite done with surgery)

Side view x-ray of thigh
with plate on top of femur
(diagonal bone in top pic is right femur)

Top view of T's left femur.
Note how it bends near the bottom.
some overlap between pics

T is to be non-weight bearing or only toe touch downs for 6-8 weeks. He said to follow up with him in a week to 10 days. We chatted about other things as well, very personable surgeon. I think we were in there 15 minutes, overall good news. Travis' scar is ~8.5 inches with ~100 stitches...all absorbable.

At 11:35a we got word we could see Travis in recovery. He was sleeping soundly, but looked great. We talked to him for a few minutes, he slept until they pulled the monitor pads off his chest...then he woke up.

When we got to recovery

T waking up in recovery

Apparently Sochi (stuffed animal kitty) broke her leg, so they wrapped her up and gave her a surgical mask. Details that make a huge difference to kids. :) Travis remained awake and vitals looked amazing, so he was back in his room around noon.

Nolan and Barrett arrived at the room with Pat around the same time as Travis. T was glad to see brothers and they were really glad to see him. Our friends Jean, Jim, Lynn with her daughter Annie, and Lorraine stopped by to see T (and help load him up with cars). ;) Travis stayed awake for a while feeling ok, then took a nap from 3p-6p. Lynn's family took Nolan and Barrett for the night. Travis and I fell asleep pretty early and slept pretty solidly most of the night.

T's orthopedic guy at Shriners (Mike Pond) returned my call on Thursday afternoon and he was glad that Dr. Jones did the surgery since Dr. Randall had scheduled surgeries on Thursday. He said Dr. Jones is fabulous and would do a great job. Turns out Mike had a preview of T's injury, not knowing it was T though, as the orthopedic dr on call Wednesday night also works at Shriners. She was telling the other docs at Shriners during their clinic on Thursday that she had a trauma patient that fractured their femur and had NF1. We have the best team for T in place.

Friday morning our friends Pam and Allison stopped in for a visit (more cars)...T doesn't mind at all. :) Travis had a rough morning into the afternoon. He didn't want to eat nor drink much, much less be moved around. Physical Therapy came by in the afternoon and he was understandably nervous about getting around. We brought his walker up and he did a few hops on his right foot...he realized he didn't need to put his left leg down (the drs earlier in the day said the plate would bear the weight). He went for a wheelchair ride around the hospital and to the 4th floor balcony where we would watch fireworks that night.

Travis with PT on Friday

View across the valley from the 4th floor

T took a nap and started to finally feel a little better in the evening...he devoured his waffles and started drinking more. Scott, Nolan, and Barrett arrived back a little while later to get the "glow stick" party started. Travis wasn't thrilled about hopping on his right foot to get to the wheelchair, but did good. We were met by our friends Netie, Dan, Jonathan, and JJ to watch the fireworks...great view across the valley.

Glow stick party watching fireworks from the 4th floor

A few more hops after we got back to the room to get to bed and we were out for the night. The strategic timing we had for the medicine worked and T felt pretty good when he fell asleep. He wanted the bed all to himself last night.

We slept good again last night and woke up to one of the drs coming to check on T before his surgeries this morning. We talked that we would be comfortable bringing T home today if T was eating and drinking good and had another time with PT to help us and him get around. Travis started the day with some sips of Oreo milkshake. Scott, Nolan, and Barrett arrived and I headed to the Ronald McDonald Family Room for a much-needed and appreciated shower. Shortly after I returned, PT arrived and it was time to practice transitioning into/out of bed and "walking" using the walker. T did great walking into the hall, even faster on the way back to the room and bed. ;)

After resting Travis started feeling better and wanted to eat lunch...he devoured his mac and cheese. So wonderful he was feeling so much better. :) T also got to meet one of the hospital's therapy dogs, Snoopy.

T and Snoopy, he wasn't afraid of him though.

Soon enough it was time to get prescriptions, load up, and head home. Another strategically timed medicine dose and we were out the door (Scott, Nolan, and Barrett headed out shortly after PT). We arrived home around 2p and T's been sitting on the couch in the front room...Scott, Nolan, and Barrett rearranged the front room to accommodate changes where T won't need to go downstairs. Nolan and Barrett are with friends at CUMC's family camp weekend at Pinecliff tonight. Travis took a little nap and continues to eat and drink great.

T in the car on the way home

T at home

We are so thankful for all the thoughts, prayers, texts, messages, help, visits, etc for our family. While we have a scary road ahead...no guarantees of the bone healing due to the decreased bone density due to NF. We are fortunate this happened after our summer quick trip to Wyoming and Colorado (and NOT on the trip). The trauma orthopedic surgeon (Dr. Jones) was the other orthopedic surgeon well versed with tumors and Dr. Randall was also performing surgery Thursday. Thankful that the initial thoughts from the NIH (numbers maybe next week) are stable tumor, better to do surgery through stable tumor than actively growing tumor like T had last summer. Thankful NO cast nor splint this summer. :) Thankful the pain meds are working. 

The plan...praying for complete healing, no peg-interferon injections for a while

Tuesday...T's dressing can be removed and can have running water over incision

est Friday...T's 1st follow-up appt

est 2 weeks...bath and pools OK (if incision healed completely)

4-6 weeks...another follow-up appointment