This has been so hard to read and follow. I just read Laine’s blog on the Rolex website the other day and I read every inch of the COTH article so… We all gained this connection and now this. Laine is so young, May that youth hep her through this tough time and bring her healing. I admire her mother in having to make the choice about Frodo and now to keep it quiet as she attends to her daughter. She has no time to consider the sport or choices… Just the time to hope and pray and to one day find the words to tell Laine about her horse. May they all find strength.
How very sad. Poor Valerie to have that news yet to break.
I cant even begin to imagine. Her road to recovery will be a long one, but, if anyone can do it, she can.
Grab mane and kick on Laine.
[QUOTE=SR Rider;3179890]
God bless Laine and Valerie and place your protecting and loving arms around them
Give Valerie the strength and wisdom of a caregiver protecting her health in the process; give Laine the strength to heal emotionally and physically.
God give Valerie the rights words at the right time and give superhuman comfort to Laine at that time
amen[/QUOTE]
Thank you for this little prayer. It is so needed.
How sad, I can’t believe how strong her mother is through all of this. Jingling hard for all involved.
Just a note that the editor called me back and left a message for me to call her. Haven’t had time, but will call her tomorrow.
Everyone please pray for Laine and for her mother. I have no special insight but from reading the updates she appears still in tough shape, and being on the ventilator and having the tubes is very dangerous, and scary for anyone who sits in the room with her. Her surgery pushed back to Friday – can’t be good news. Her jaw will be painful! Oh I hope she doesn’t have too much to bear and can mend quickly, in all ways.
There but for the grace of God, go I – Jingles and prayers.
Speaking as an ICU nurse I thought I might explain some of the procedures and reasons for them. The tracheostomy (or trach) Lainey received is a routine procedure for someone who will be on the ventilator for a while or someone who will require jaw surgery and having the jaw wired shut as Lainey will and still need ventilator support. The trach will make weaning from the ventilator easier for her and will be more comfortable than the tube down the throat that she has now. Once Lainey is off the ventilator and doesn’t need the trach anymore the trach can be downsized then removed and the hole heals over leaving a relatively small scar. The fact that the nurses are easing her sedation some means her lungs are more stable and they can let her become more aware. Sometimes we knock pt’s out very deeply especially with severe lung injuries so that the pt doesn’t work against the ventilator making it harder to adequately ventilate them and supply their body with plenty of oxygen. The fact that they are letting her wake up more shows she is doing better from that standpoint.
UK has traumas come in and they often bump stable planned surgeries. That doesn’t mean that Lainey was too unstable for surgery it just means that more critical pt’s came in and took her slot. Her jaw while a terrible break (from what I read on the blog) is a relatively stable injury compared to someone who’s leg has been severed in an accident or a gunshot victim.
I worked at a trauma hospital for 7 years and have worked ICU for almost 9 years. I do not work at UK and do not take care of Lainey but this is just a clarification of how pt’s like Lainey are handled.
I am jingling and praying for a quick recovery for Lainey. I have comforted and held hands and cried with family members of pt’s just like her and I love my job very much. While not out of the woods Lainey sounds like she is progressing quite well for her injuries and her youth, fitness level, and determination will go a long way in making her recovery a quick one.
I also met Ralph Hill at Rolex this past weekend and that man amazed me. It is a miracle he is doing as well as he did considering the injuries he sustained. He told me every time he goes back for a checkup the Drs. tell him “You’re not supposed to be alive!!” He loves that he proved them all wrong and is itching to do more in the saddle. He said he is tired of riding the lazy school horses and wants to do more. He is an inspiration to all!!
Thanks for that explaination.
I am jingling for Laine and her mom and family (and the Brennans, for that matter). I do feel that she is doing the right thing for her daughter- and that it must be the hardest thing ever to do. I pray to God that I will never be in such a situation- and admire her ability to post on the blog. I hope that she knows how much we care and are thinking about her.
I wish I knew what to do and how to do it to make things easier for them.
Moderators, could this thread be pinned up top? Like Darren’s?
Will there be an fundraising for them, do you think? I wish someone would open a Cafepress shop or something like that with inexpensive choices–or open an account at one of the free fundraising sites. I could donate, but not much. I could buy something, but not something expensive.
[QUOTE=horse-loverz;3180089]
Speaking as an ICU nurse I thought I might explain some of the procedures and reasons for them. The tracheostomy (or trach) Lainey received is a routine procedure for someone who will be on the ventilator for a while or someone who will require jaw surgery and having the jaw wired shut as Lainey will and still need ventilator support. The trach will make weaning from the ventilator easier for her and will be more comfortable than the tube down the throat that she has now. Once Lainey is off the ventilator and doesn’t need the trach anymore the trach can be downsized then removed and the hole heals over leaving a relatively small scar. The fact that the nurses are easing her sedation some means her lungs are more stable and they can let her become more aware. Sometimes we knock pt’s out very deeply especially with severe lung injuries so that the pt doesn’t work against the ventilator making it harder to adequately ventilate them and supply their body with plenty of oxygen. The fact that they are letting her wake up more shows she is doing better from that standpoint.
UK has traumas come in and they often bump stable planned surgeries. That doesn’t mean that Lainey was too unstable for surgery it just means that more critical pt’s came in and took her slot. Her jaw while a terrible break (from what I read on the blog) is a relatively stable injury compared to someone who’s leg has been severed in an accident or a gunshot victim.
I worked at a trauma hospital for 7 years and have worked ICU for almost 9 years. I do not work at UK and do not take care of Lainey but this is just a clarification of how pt’s like Lainey are handled.
I am jingling and praying for a quick recovery for Lainey. I have comforted and held hands and cried with family members of pt’s just like her and I love my job very much. While not out of the woods Lainey sounds like she is progressing quite well for her injuries and her youth, fitness level, and determination will go a long way in making her recovery a quick one.
I also met Ralph Hill at Rolex this past weekend and that man amazed me. It is a miracle he is doing as well as he did considering the injuries he sustained. He told me every time he goes back for a checkup the Drs. tell him “You’re not supposed to be alive!!” He loves that he proved them all wrong and is itching to do more in the saddle. He said he is tired of riding the lazy school horses and wants to do more. He is an inspiration to all!![/QUOTE]
I hadn’t read the latest update. I hadn’t realized Laine had been trached. Although it’s serious, it will make a big different in her comfort. I am not a medical professional, but a trach mom. Malcolm had a trach for 2 1/2 years. When he was ventilated, he was so much more comfortable with the trach creating the airway, than an ET tube down the mouth, through the larnyx and down the trachea. In many ways it’s much more invasive than a trach as an ET tube (an subsequent reintubations, if necessary) can do damage.
This is an ET tube through the nose with ventilator tubes attached:
http://family.webshots.com/photo/2719172980089794230txkYol
This is the same week with a trach, but unventilated:
http://family.webshots.com/photo/2455191580089794230ifbbnR
Laine probably wouldn’t be able to talk much with an ET tube, but with the trach she should be able to talk if there’s not swelling in the trachea or upper airway. She’ll just have to take a breath and cover the opening of the trach, the air will be diverted up and out through the vocal chords and she’ll have some vocalization. Of course if her jaw is wired shut, that’s a whole other issue. She’ll have much more freedom of movement with the trach because they are not as likely to let you move around, once she’s ready, with an ET. People with trachs/portable vents are mobile.
A new tracheostomy causes irritation of the mucus membranes around the site and she’ll have to be suctioned to move that sputum (lung gunk) out so it doesn’t sit in the lungs and cause an infection. Because of her collapsed lungs and broken ribs she won’t have the strength to cough it up herself. Hopefully, she’ll be off the vent and out of the trach by the time she’s that strong.
The stoma (hole) can close very quickly. If the trach comes out by mistake you have to move quickly to put a new one in. (Plus the breathing aspect …)
Here’s a picture of Malcolm’s stoma in the middle of the trach change:
http://family.webshots.com/photo/1526832243083214396WGgTmk
This is Malcolm in the pre-op room getting checked out by the nurse before his surgery to reconstruct his trachea. The contrast isn’t very good in the picture, but you can see there is a little depression under the trach (called suprastomal collapse). Some people who have that need surgery to correct it. Sometimes it is just cosmetic and needs no surgery unless for cosmetic reasons. Malcolm’s whole trachea was redone so his stoma was close surgically.
http://family.webshots.com/photo/2510895360089794230EIimnW
I have have a series of pictures of my doing a trach change on Malcolm when he wasn’t quite one. It’s not gross. In fact my gloved hands block the stoma most of the time. But it gives you a good idea of what a trach looks like, although Laine’s would be much bigger.
Here is the link to a trach change and suctioning (at home). For professionals, this is a “clean” procedure, not “sterile” at home.
http://family.webshots.com/album/526826386zikyPZ
www.tracheostomy.com
Suctioning can be uncomfortable as it literally sucks the breath out of you, but if done probably it shouldn’t hurt. The depth of the catheter used (they have centimeter markers) is measured against the length of the trach tube. In a child one should never go about 1 cm beyond the end of the trach tube. If you do, you risk traumatizing the carina (cornina) which is the point of flesh where the trachea branches into the two bronchial tubes (it’s the point of an upside down “V”). Sometime nurses aren’t careful. Sometimes you have to remind them NOT to do deep suctioning. Malcolm has had bruising and scar tissue from nurses suctioning too deep.
Trachs are scarey, but they are not the end of the world, and for Laine it should not be permanent unless she has some airway obstruction/collapse we don’t know about. Malcolm’s airway swelled and scarred nearly shut (about 3 mm diameter) because of long-term ET intubation. It is probably better that she does have a trach.
You can see the difference in comfort level, even in a baby. (Now if you browse, you’ll see him just a few hours after the operation to insert the trach with was traumatic for such a small baby and he indeed was puffy and gross looking.)
With trach: (Ah, I can smile and move my mouth and touch my face!): http://family.webshots.com/photo/1344114942045565162vrIrqn
vs.
without trach/with ET tube and vent lines
http://family.webshots.com/photo/1330888009045565162YFjtGS
Most people are downsized in the trach (meaning the diameter of tube is narrower) so they start to breath around the cannula (tube) and also through their mouth. Eventually, they may “cap” the trach so the patient can breath totally through the mouth/nose for a trial period in the hospital or at home. The trach stays in to keep the airway “patent” - open - in case there is a problem. Eventually, they’ll decannulate (take the trach out). Depending on how long the person has had the trach and if there was any airway collapse, the stoma usually closes up on his own.
I wish Laine all the best in her recovery. I know UK is a great hospital. We go all the way from Georgia to Cincinnati for Malcolm. There a lot of very good hospitals in that area, much thanks to wonderful philanthropists and horse people like the Lindners (h/j people).
Working against the ventilator is kind of hard to explain, but essentially the ventilator makes you take a breath at certain intervals set on the machine (also the depth of the breath), but if you’re too awake your breathing rate is higher and if you’re uncomfortable, which I hear it can make you panicky to have this machine breathing for you, you start to breath “over” the vent. That could mean you’re taking more breaths than programmed, deeper breaths, etc. Also you’re using more energy that the medical folks want to go towards healing. Most sedation meds (morphine derivatives) are respiratory depressants, meaning they lower the resp. rate, which is one reason why they can kill you. So it’s a double edged sword, keeping you sedated helps you heal faster because your energy/nutrition goes where the body needs it most, but sedation also requires ventilation at a certain dosage. Laine probably needed the ventilation to keep her lungs inflated. Even when you breath out, a certain amount of air stays in your lungs to keep them inflated (there is a word for it - tidal volume?), but with a collapse, the lungs need help staying inflated. I think she would gradually be weaned off the vent first showing her lungs could stay inflated during expiration. Eventually she might even go on CPAP (at least they do this with kids) to give her that extra puff so she doesn’t have to work as hard, then down to wall O2.
I hope this help people understand some more from a family’s point of view. I wish I could give her mom a big hug. I hope she’s not there in June, but I’m taking Malcolm to Cinci for a check up. I hope one day I can give Laine a hug and tell her and her mom how brave they are. Maybe they’d like to see what Malcolm went through, though different circumstances.
During Rolex when people were posting that day either from KHP or watching the webcast there was mention of them traching Frodo.
Do any vet-types have insight as to why that would be done? I was talking with my ICU nurse mother (also a horse person) and we weren’t exactly sure how his injuries warranted that… heck, I didn’t know they even trached horses. I figured there was some sort of intubation for big surgeries (colic, etc) but never really thought about a trach on a horse.
ThinLine is one of Laine’s sponsors, in fact, we were her first sponsor and I believe she was one of the first riders we sponsored as well under current ownership. Laine is very dear to us so we are currently accepting donations on her behalf on our website, as well as a Laine Ashker Package, which includes her favorite ThinLine products where 30% of the sale price of each package goes to Laine.
Poor Valerie!
Our thoughts and prayers are with her this day and in the many days ahead.
When I first met her, she had just lost someone very dear to her…and through it all, she was a very gracious, kind, and caring person. [If Laine hadn’t told me of her loss, I wouldn’t have known what she was going through.]
We had gone to her place to have a look at a horse listed for sale, and she sat there on the bleachers talking with us as if we’d known each other for many years. She’s a very wise horse person herself! She and Laine offered to let my daughter come stay there with them so that Laine could work with her…we’d never met before! If the distance wasn’t so far, we would have loved to let our daughter train with Laine!!
They love their horses SO MUCH!! I’m sure this is going to be VERY hard on them both…as we read from her on the blog. It’s just so sad.
She’s a VERY strong woman!! So, if ‘anyone’ can make it through this rough time, and get her daughter through it, I feel she’s one to do it. My heart just breaks for her!! For ‘both’ of them…
God Bless them and help them through this horrible time.
Becka
I just found a page on the University of Kentucky Hospital website that lets you fill out a form and they print and deliver to patients.
While her mother has asked that Frodo not be mentioned for the time being, I’m sure general well wishes and prayers would be appreciated: http://www.ukhealthcare.uky.edu/eGreet/
Even when you breath out, a certain amount of air stays in your lungs to keep them inflated (there is a word for it - tidal volume?),
That would be the residual volume. The tidal volume is the amount of air moved with each breath.
being on the ventilator and having the tubes is very dangerous, and scary for anyone who sits in the room with her.
Why would you consider being on a ventilator and having an ET, NT or trach tube dangerous??? It is, as opposed to dangerous, life saving. It may be scary to someone who does not have a medical background, but dangerous??? I’m very curious as to why you think that.
[QUOTE=Tiki;3181574]
That would be the residual volume. The tidal volume is the amount of air moved with each breath.
Why would you consider being on a ventilator and having an ET, NT or trach tube dangerous??? It is, as opposed to dangerous, life saving. It may be scary to someone who does not have a medical background, but dangerous??? I’m very curious as to why you think that.[/QUOTE]
Dangerous … wrong word. Can have side effects, mistakes can happen, yes? Extended intubation can lead to tracheal stenosis in infants, children and adults, but life saving, yes. Can mistakes and injury to the larynx/trachea take place? Yes. I just meant there are risks.
There is a new update on her website this afternoon, sounds like she is still making progress:
"It’s been five days since Laine’s terrible fall and with each new day we’ve been blessed with signs of progress. One of the emotional elements of healthcare management is to prepare families for both good and bad days. The proverbial emotional roller coaster ride. So, far our set backs have been few and Laine’s forward steps have been consistent. One backward step came about last night when Laine’s fever suddenly spiked up to nearly 103. It was determined that she had an infection and a case of pneumonia; both being complications that are quite common with a lung injury of this sort. They started her on three seperate antibiotics and her fever has already come down significantly as a result.
The good news is that Laine’s lungs continue to gain strength and her doctors have again lowered the level of assistance being contributed by the ventilator. At one point, Laine was drawing almost all her own breaths. It turned out to be a bit premature, so they went back to the previous settings. Laine’s jaw surgery is now scheduled for first thing Friday morning. The plan is to plate the lower jaw line and then reset the right upper jawbone and then wiring it all together.
As far as Laine’s attitude goes, she is an amazing kid. They’ve begun to cut back the level of her pain/comfort meds so from time-to-time, she’ll drift back into consciousness, opening her eyes and trying to get herself oriented. She’s begun to ask the obvious questions, like what happened and where am I? Not a moment after she was asking about her beloved horses, Frodo and Eric. Keep in mind that communication is now done by lip reading and hand gestures because the tracheotomy has rendered her vocal chords temporarily inoperable. There is a certain “fiest” in Laine today and while the communication process is very frustrating, she was tried desperately to communicate in her sedated state. There was one point that Laine was particularly struggling to ask the nurse something that she couldn’t make out. Eventually, they were able to determine that she was asking for a mirror. Now, while that’s normally a simple request, one has to think about the benefits of providing it in this instance. We did, she looked for a moment and then drifted back into a peaceful rest."
UPATE 05/01
The latest update from the blog
It’s been five days since Laine’s terrible fall and with each new day we’ve been blessed with signs of progress. One of the emotional elements of healthcare management is to prepare families for both good and bad days. The proverbial emotional roller coaster ride. So, far our set backs have been few and Laine’s forward steps have been consistent. One backward step came about last night when Laine’s fever suddenly spiked up to nearly 103. It was determined that she had an infection and a case of pneumonia; both being complications that are quite common with a lung injury of this sort. They started her on three seperate antibiotics and her fever has already come down significantly as a result.
The good news is that Laine’s lungs continue to gain strength and her doctors have again lowered the level of assistance being contributed by the ventilator. At one point, Laine was drawing almost all her own breaths. It turned out to be a bit premature, so they went back to the previous settings. Laine’s jaw surgery is now scheduled for first thing Friday morning. The plan is to plate the lower jaw line and then reset the right upper jawbone and then wiring it all together.
As far as Laine’s attitude goes, she is an amazing kid. They’ve begun to cut back the level of her pain/comfort meds so from time-to-time, she’ll drift back into consciousness, opening her eyes and trying to get herself oriented. She’s begun to ask the obvious questions, like what happened and where am I? Not a moment after she was asking about her beloved horses, Frodo and Eric. Keep in mind that communication is now done by lip reading and hand gestures because the tracheotomy has rendered her vocal chords temporarily inoperable. There is a certain “fiest” in Laine today and while the communication process is very frustrating, she was tried desperately to communicate in her sedated state. There was one point that Laine was particularly struggling to ask the nurse something that she couldn’t make out. Eventually, they were able to determine that she was asking for a mirror. Now, while that’s normally a simple request, one has to think about the benefits of providing it in this instance. We did, she looked for a moment and then drifted back into a peaceful rest.
[QUOTE=Tiki;3181574]
Why would you consider being on a ventilator and having an ET, NT or trach tube dangerous??? It is, as opposed to dangerous, life saving. It may be scary to someone who does not have a medical background, but dangerous??? I’m very curious as to why you think that.[/QUOTE]
I think that anyone not accustomed to seeing a person lying in bed with tubes coming out of several places and beeps and pumps and monitors overwhelming. That is what I was trying to explain in simple terms that her procedures and machines are routine treatment for her injuries and to hopefully show that they are not dangerous and how they are helping her.
You wouldn’t believe some of the questions I get asked about pt’s and their machines and while some may seem silly to me I often have to take a step back and realize that this is not an everyday scene for most people and start explaining things at the most basic level.
Keeping my fingers crossed for a quick and uncomplicated recovery for Lainey.
