Progress is being made on the Nathaniel front. The plastic surgeon at Tel Hashomer saw Nathaniel a few weeks ago because there was a wound on his scalp that wasn't healing. He looked at it and said that there was a "foreign object" there. He didn't know what it was or what it was connected to and wasn't going to touch it without a neurosurgeon present. They thought maybe they could take care of it during the cranioplasty.
Last week we went back to Hadassah for appointments with the original plastic surgeon and neurosurgeon, at their request. The plastic surgeon at Hadassah took one look at the "foreign object" that the plastic surgeon at Tel Hashomer saw and knew exactly what it was. Let me explain. After the initial surgery, there was not enough skin to cover Nathaniel's head wound so they took a graft from his leg. That still wasn't enough skin, but they couldn't use more grafted skin because a graft must have something (like bone) to anchor to. After one month of trying to close the open wound piecemeal, they finally decided to do major surgery to close the wound. At that time, they also replaced the original brain covering that they had used initially. That surgery was a success and it closed the wound – all except for one little bit. Well, it seems that that little bit never closed. The "foreign object" was part of the brain covering that the surgeon left there because there still wasn't enough skin and they didn't want to leave the skull exposed. The Hadassah plastic surgeon cut out the foreign object in his office and said to come back in a month to see that the wound has closed. He gave us cream and treatments to use. The Hadassah doctors said not to consider any type of surgery (cranioplasty) until the wound has completely healed. Even then, there are a lot of skin issues with scars that need to heal and so forth. The doctors in Jerusalem suggest we wait until after the wedding (i.e., December) to do the cranioplasty. It seems reasonable to wait. He won't lose anything by waiting, and he might gain time for the scars to heal.
With that date in mind, it was time to think about removing the cannula (tracheostomy), which remained because the cranioplasty was supposed to be soon and it is easier to use that rather than to intubate. Today that day came. They removed the cannula! So far, he is not having issues with breathing, but we still have to be careful. He still coughs and his body is not used to getting the stuff all the way to his mouth just yet. I am cautiously nervous, but optimistic.
Nathaniel started taking Ritalin last week to help him wake up. We've seen some improvements with him responding. He follows requests more often (close your eyes, turn your head, move your hand). He could even bend forward and backward at the waist when sitting with the help of the PT. Today, the PT asked him to say, "Ahhh," and he whispered it. WOW! She kept asking him to do that. He only made the noise one more time, but many of the times she asked, he took a deep breath, like he was trying to figure out what to do. Maybe now that the cannula is out he will be more successful in making sounds.
All my prayers to Nathaniel and each of you.