Complications

Hey there, friends. We've been back in the hospital with Otis since Monday (it's Friday now) following an unfortunate, and rare, complication from Saturday's femur fracture. Our energy reserves are pretty low at this point, so I've mostly just pasted the update below from an incident report e-mail I sent earlier today to one of Otis's case managers...which is exactly why it sounds more like a "just the facts, ma'am" incident report than it does an update to friends. We hope to be discharged soon (if you've ever spent any time in the hospital, you'll know that the discharge process takes a looooooong time), a little later this afternoon, and are eager to be back at home. As always, we appreciate any prayers, healing vibes, pixie dust, and love you may have to send out for Otis as he takes on this additional burden of healing in his right leg and his lungs. As you know, he's amazing, and way more resilient than any one human should ever have to be.

In the ED Monday night. His vitals and his spirits immediately
improved with the supplemental oxygen.

Resting and healing in the hospital.

A momentary burst of happy energy.

I squish on him, he tolerates me.

The Child Life department shared this really cool Vecta (NOT to be confused with Vecna!) sensory machine with us. It had all kinds of lights, projections, music, bells hoops, whistles, and yo-yos. Otis wasn't nearly as excited about it as Ryan and I were.

Last night of the stay, celebrating the all clear with some non-hospital takout.

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On Saturday, February 24 at around 9:00a.m., Otis fell out of bed over the low rail of his rented hospital bed. Otis had been in full time immobilizing braces and an abduction wedge following his planned bilateral hip surgery (VDRO/femoral varus derotational osteotomy) and right-sided pelvic osteotomy on December 11, 2023, and had recently been cleared to start removing the immobilizers during the daytime to begin rehab and PT. He had been hesitant to move his legs much on his own, and in one sudden and surprising movement, he kicked his left leg over and rolled out of the lower portion of the bed. During "normal" times, Otis is in a regular, queen-sized bed enclosed with high toddler rails. Due to the increased physical demands in caregiving following his return home from hip surgery, we have been using a rented home hospital bed due to its hi-lo function. Unfortunately, the guard rails on this rented bed, which has no guards at the head or foot of the bed, proved to be inadequate unless Otis is fully immobilized in his braces. Prior to this incident we had already begun to work with Otis's Rehabilitation doctor and durable medical equipment company on the beginning steps toward securing a permanent high-railed special needs safety bed for him, a process we know will take months to complete.

Otis was transported by ambulance to the ED at Children's Hospital in Colorado Springs, where he was evaluated and x-rayed. It was determined that he had suffered a nondisplaced fracture to the distal end of his right femur. Given the complexity of the recent surgery and new hardware in his hips, the orthopedic team was hesitant to rush him into surgery. Instead, they made a plan for us to continue to keep Otis immobilized at home in his post-surgical equipment, and to follow up in the orthopedic clinic the following week to discuss a plan that may or may not include surgery to repair the fracture. We were eventually scheduled to follow up in the orthopedic clinic on Wednesday, February 28. In the meantime, we would keep Otis immobilized and continue to manage pain and muscle spasms with medications at home.


Beginning Saturday night, Otis's night nurse noted that Otis's oxygen saturation was lower than normal for him while he slept, and that his respirations were more rapid and shallow than usual. He improved to normal range during waking hours on Sunday, but we noticed another drop in his oxygen levels (monitored with a finger pulse oximeter), that his heart rate was higher than normal, and that his respirations were once again becoming more shallow and rapid. First thingMonday morning we followed up with his home health nurse case manager and the orthopedic clinic first, as we assumed that the recent addition of oxycodone for pain was the culprit. Everyone agreed that we should hold the oxycodone and see if it made a difference in the oxygen saturation and other vitals. When these things did not improve over the course of the day, we called triage at the Children's Special Care Clinic and were told to go back to the ED, as Otis could be experiencing an embolism.


We arrived at the Children's ED at about 4:00p.m. on Monday, February 26 and stayed there throughout the night. In the ED, Otis was immediately placed on oxygen, bloodwork was taken to test for blood clots, and an EKG and chest CT were done. It was finally determined that Otis had a "fat embolism" from marrow globules migrating from the femur fracture site up into his lungs. Otis was admitted to the hospital at about 6:00a.m. Tuesday morning. While in the hospital, Otis has remained on 1 liter of oxygen, and the following tests have been performed to rule out blood clots and additional fractures:

• Echocardiogram
• Ultrasound of both legs
• Chest x-ray
• Brain MRI
• x-rays of both lower legs
• x-rays of right foot and ankle

Aside from the chest x-ray showing the emboli in his lungs, and the echocardiogram showing an anotomically and physiologically, although stressed, heart, all of these tests thankfully came back normal--no blood clots and no additional fractures. We have been assured that the fracture is considererd a "greenstick" fracture, and is thus not a bad one as far as femur fractures can go. Because of this, Otis should be able to continue to heal without any surgical intervention. We will just keep him in his existing immobilizer on that right side for a few weeks longer than originally intended. While inpatient, Otis has remained on 1 Liter of oxygen continuously, and he began to receive twice daily injections of a blood thinner in order to prevent blood clots from forming for the duration of his immobilization. We will continue to administer both once we return home. Otis will be followed by Cardiology and Pulmonology for management and eventual weaning of his oxygen. He will see his orthopedic surgeon in clinic for followup to make sure everything is still healing as it should.