Chapter 8 #4
“Of course.” Kelly reached for the control panel and turned her music on low. Honestly, she needed some time with her thoughts, too.
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Tessa: Sorry for the long message but this is the best way that I can think of to answer your question.
Morning Routine
Stiffness is worst first thing, especially his jaw and back. Mornings are going to be the slowest part of his day. His jaw might do a small involuntary shake/tremor (“mini earthquake”) when he first starts moving it.
Getting out of bed takes longer than just “getting up”. His muscles and grafts have stiffened overnight, especially because he sleeps in one position for hours.
He’ll need to do jaw exercises. This needs to be done every morning, stretching and working the jaw to maintain what range of motion he has. Definitely necessary before he can comfortably eat or speak much.
For his eye prosthetic, he should be removing it at night before going to bed.
He’ll need to clean and reinsert the prosthetic in front of a mirror.
Don’t be surprised if he wants to do this in private either.
It could take time for him to open up about his eye more than anything else.
His socket may need ointment before the prosthetic goes in, depending on overnight irritation.
Showering is important, but also comes with strict instructions. Lukewarm water ONLY as hot water will hurt his healing grafts. Also, fragrance-free soap. (I added some to his go bag.) No scrubbing on graft sites, patting only.
Moisturizing is ESSENTIAL! He’ll need to do a full graft site moisturizing routine immediately after showering before skin has a chance to dry and crack. And remember to pat dry. Absolutely NO RUBBING. Make all the dirty jokes you want, but that is not up for debate.
Okay, his compression garments are where things can get complicated.
Normally, he’s got 2 sets to rotate, but washing and drying isn’t going to be easy on the road.
I’ve added extras to his bag as well. His arms, hands, legs, and the front of his torso can be managed independently.
However, he’ll need help with his back. No matter what he says or how he argues, he’ll need help with this area.
He can’t see it, can’t fully reach it, and it needs to be smooth with no folds or pressure points.
There are fasteners that are awkward and slow with his limited grip strength.
Nighttime Routine
Remove his compression garments for the night and swap for lighter nighttime compression depending on graft site needs. You can hand wash the garments in lukewarm or delicate cycle in mesh bag, air dry flat. Never heat-dried (destroys elasticity). Basically wash them like your favorite bra.
Full moisturizing pass on all graft sites and checking for new irritation, splitting, or changes. Feel free to send me pictures if you think something looks suspicious or you just want to double check. Trust me when I say better to be safe than sorry.
He’ll need to remove his prosthetic eye at night to let the socket “breathe” and reduce irritation. Clean the prosthetic and (if needed) apply ointment to the socket.
He’ll need to do evening jaw exercises and stretch session before going to sleep.
His sleep position is important. He should be on his right side to protect the prosthetic socket side from pillow pressure and keeps facial hardware off direct contact.
Use the body pillow to support his back and to help keep him from rolling in his sleep.
It might take him longer than it used to to settle, which is completely normal.
Help adjust pillows, maybe the temperature in the room is too hot or cold for him but seems normal to you.
It is okay to experiment so long as he doesn’t pull on a graft.
Medications
Pain Management:
Gabapentin 300mg - take 1 capsule by mouth three times daily (morning, afternoon, bedtime) for neuropathic pain. May cause drowsiness.
Ibuprofen 600mg - take 1 tablet by mouth every 6-8 hours as needed for pain. Take with food. Do not exceed 2400mg in 24 hours.
Acetaminophen 500mg - take 1-2 tablets by mouth every 6 hours as needed for breakthrough pain. Do not exceed 3000mg in 24 hours.
Skin/Wound Care Medications:
Mepitel One non-adherent dressing - apply to open or sensitive graft sites at each dressing change
Bacitracin zinc ointment - apply thin layer to any open areas twice daily
Eucerin Advanced Repair Lotion (fragrance-free) - apply liberally to all graft sites minimum 3 times daily and immediately after showering. Do not allow skin to dry out.
Hydrocortisone 1% cream - apply sparingly to graft sites as needed for itch relief, no more than twice daily
Prosthetic Eye/Socket Care:
Sodium chloride 0.9% (sterile saline) - use to clean prosthetic eye daily and socket as needed
Refresh Lacri-Lube ophthalmic ointment - apply small amount to socket at night before prosthetic removal or as needed for irritation and dryness
Refresh Optive lubricating eye drops - instill 1-2 drops in socket as needed throughout the day for dryness and irritation
GI/Bowel:
Docusate sodium (Colace) 100mg - take 1 capsule by mouth twice daily to prevent constipation. Increase fluid intake.
Omeprazole 20mg - take 1 capsule by mouth once daily before breakfast for GI protection while on NSAIDs
Mental Health/Sleep:
Sertraline (Zoloft) 50mg - take 1 tablet by mouth once daily in the morning for mood and sleep regulation. Do not stop abruptly.
Hydroxyzine (Vistaril) 25mg - take 1 capsule by mouth at bedtime as needed for sleep and anxiety. May cause significant drowsiness.
Nutritional:
Burn recovery high-calorie supplement - consume minimum 2 shakes daily in addition to regular meals. Target caloric intake 3,500-4,500 calories per day.
Multivitamin with zinc - take 1 tablet by mouth daily with food. Zinc supports wound healing.
Vitamin C 500mg - take 1 tablet by mouth twice daily. Supports collagen synthesis and graft healing.
Tessa: I know this is a lot. Please don’t hesitate to ask any questions.
His stubborn ass isn’t going to let him ask for help, so it unfortunately is going to have to fall to you to watch for signs he doesn’t want seen.
If I’m at work, I might not be able to answer you, but Bear is also available and I’ll get you his burn doctor information, too.
Good luck, babes, and I’m so glad to hear the two of you are finally together.