Captain Jason

The latest news on the recover of Jason after his injury in Iraq by an IED.


Snail Mail:

Cpt. Jason Scott
WRAMC Building 20
Mologne House Hotel #316
6900 Georgia Ave. NW
Washington DC 20307

Phone: 202 577 0092

Sunday, December 04, 2005

The Past Week

I spent the last week with Jason relieving Dow and Katy so they could do whatever they need to do. First, I want to give a sincere thank you to Bill and Vira Sisolek for their excellent hospitality, providing me a place to stay while on the visit. Also, thanks to Lisa for arranging all of this.

The week at Walter Reed Medical Center was quite interesting. You see injuries of all sorts that bring to light the cost of any war. Mostly, I saw amputees, as I followed Jason around for his PT and OT, and such therapy is primarily devoted to the amputees at Walter Reed. I have to say I was impressed by the attitude of all the soldiers I met - no anger, no bitterness, just a positive spirit of moving on with their lives, solving the problem at hand, etc. Perhaps out of politeness such feelings are suppressed in a social setting, perhaps they surface later outside the boundaries of Walter Reed. But I never detected such feelings from any of the numerous soldiers I came into contact.

I had a chance to review some of Jason's x-rays. Not all of the exams were available for review as apparently some were taken in Germany and not easily accessible from the Walter Reed viewing station I was at. I was able to look at radiographs of Jason's left forearm, a single frontal view of his pelvis, and a CT scan of his face.

The film of his left forearm showed a shrapnel wound to the distal radius and ulna. The fragment appeared to pierce the soft tissue between the two bones, causing some fragmentation of the edge of the radius and causing an oblique fracture of the ulna. Plates and screws were applied to the radius and ulna for fixation of the bones (so they heal straight and don't move during the healing). I didn't see the acute films (presumably taken in Germany or Iraq) without the plates. I was relieved to see that the actual wrist joint was uninvolved. The very end of the radius was not fractured, so that the joint surface with all the small wrist bones is intact and he shouldn't have any arthritis or problems with movement on a skeletal basis. I believe the distal joint between the radius and ulna (involved in turning your palm up or down) was also uninvolved. My concern over where the shrapnel pierced was that there might be some injury to the median nerve (famous for being involved in carpal tunnel problems with people who are on keyboards a lot). Although it is difficult to know because Jason has a cast on, and so cannot move his fingers and thumb very well on that basis, he does show flexion of the fingers (as much as you can with the cast on), and appears to be able to move his thumb, although there is some stiffness in the thumb. His cast could come off Monday, so we should know more about the status of the function of his fingers (such as gripping the hand, flexing the fingers and thumb, etc.). The plates will probably stay in, unless down the line they cause some irritation. Taking the plates out just means another surgery.

The x-ray of Jason's pelvis showed several shrapnel fragments. I don't know when the x-ray was taken (i.e., before or after some surgery). I saw at least 10 shrapnel fragments extending from right to left. One was of fair size (2 cm if I recal), on the right medial inferior aspect. As there was only one view available, you could not assess the anterior-posterior (front-to-back) position of the fragments. All his pelvic bone, however, looked intact. There were no fractures. In particular, his hip joints looked completely normal. It would have been really valuable to see a CT scan of his pelvis. I'm sure one was done, but probably in Iraq or Germany. Not all shrapnel fragments are removed - it takes too much time to try to find them. And the vast majority sit in soft tissue (e.g., muscle, fat), are very tiny, and don't cause any problem. However, should there arise a problem from a shrapnel fragment, it can certainly come out (surgery). And, many of the fragments I saw could have been removed. I just don't know when the pelvic x-ray was taken and when he had surgery. Unfortunately, I never really got to speak to Jason's surgeon to ask about his pelvic wounds.

Jason's facial CT was impressive. His main injury was to his right maxillary sinus, which sits just underneath the orbital cavity. The CT scan showed extensive fragmentation of the lateral and medial walls of the sinus. There essentially were innumerable tiny "snowflakes" of bone from the injury, with much soft tissue swelling. There were likely very tiny shrapnel particles in the area as well. There were fractures of the floor of the orbit (which is the roof of the maxillary sinus), and I saw a chip fracture off a part of his mandible (probably the coronoid process). This latter fracture likely explains his tenderness in the middle of his right cheek, and is also likely causing pain as he tries to open his mouth (and he can only open his mouth slightly now). This mandibular fracture should heal, and he should be able to open his mouth normally as the fracture heals, but he needs to exercise this to help recover mobility. His temporomandibular joints were completely unaffected on the images I saw, so restriction of movement of his jaw is not due to any injury there. Looking at Jason, I have to say the ENT surgeon did a remarkable job. He basically had to reconstruct Jason's maxilly sinus. The walls of that sinus are extremely thin, and as I said above, were essentially obliterated on the inner and outer sides. I didn't get to speak to the ENT doc who did the surgery, so I can't comment any further.

Jason's right orbit, on the CT scan, seemed indirectly affected from the blast. No shrapnel was seen in the orbit, and the optic nerve looked intact. The floor of the orbit should heal fine. But I was wondering why the loss of vision in his right eye. I can only guess this is do to the compression blast effect on the globe (the eyeball and retina) and optic nerve, causing a shearing force effect, and so disrupting the connections between the receptors in retina and optic nerve. I never got to speak to the opthalmologist, but I did speak to one surgeon who confirmed that shearing injuries to nerves are seen with these blasts (IED's, grenades, etc.). I have no idea if any of these severed connections will reconnect improving Jason's vision in his right eye. His vision in his left eye, however, seemed to me to be good, and I suspect should be normal with corrective glasses.

Medical details aside, I think Jason is definitely getting stronger. I saw this in the brief week I was there. He is very stiff and weak around the right hip, but this is improving. On Saturday, I also saw him knock out several situps (abdominal or stomach crunches). It was like watching a recruit in boot camp. Quite impressive. In fact, a major general involved with recruitment was there watching (he had a son in PT that day who was also injured in Iraq), and was also very impressed. So, I expect Jason will be looking pretty buff here shortly!

All in all, a very interesting week. It is reassuring to know our soldiers get the care they need and have numerous benefits extended to them. I saw numerous families attending to their soldier. Jason's recovery will be long and arduous, but he has the family support and good attitude needed for a successful recovery.


Blogger Floyd said...

I am truly glad to read of Jason and his battle to recovery,I can only imagine the hell he must have gone through,being a veteran myself(1980),I am glad that he is getting good care and he will be in my prayers.

Sunday, December 04, 2005 8:31:00 PM  
Blogger Uncle Bob said...

I should have added: Jason gave me permission to discuss his x-rays on the blog. - Uncle Bob

Sunday, December 04, 2005 8:43:00 PM  
Blogger Adelaide Rowe said...

My father, a radiologist, would have been very impressed by your thorough assessments and your compassionate bedside manner. He too was an Army veteran, WW2. He was in a surgical residency before the war, and ended up heading a radiological unit in England. That lead to a very good residency at U of PA. What a blessing that Jason has you for an uncle.

Sunday, December 04, 2005 10:09:00 PM  
Anonymous Anonymous said...

Hi Bob,
We haven't met, I am Jason's aunt in Belgium. I read his blog daily with great interest and really appreciate your fine and detailed assessment. Of course, we worry about Jason's recovery and it was wonderful to hear your opinion. Thanks so much for taking the time to share it.
Judy, Stan and Ben

Monday, December 05, 2005 3:01:00 AM  

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