Post-Thanksgiving News from Karla

Augusto's Post Thanksgiving Update- by Karla

Augusto had some important developments in physical therapy - walking 100 feet on Friday with the modified walker, and demonstrating his skills to the kids on Sunday. It was so great to see him up!

We are all anxious for Augusto to come home and are practicing patience waiting for him to be ready. He'll need to be mostly independent (physically moving and transferring himself in and out of bed and wheelchair) in order to come home. He is making great progress towards that!

Thanks for your love and kindness, KARLA

November 25, 2011-- Thanksgiving report by Karla

Happy Thanksgiving Y'all!

Just spent a great day with Augusto (and extended Taylor family) at St. Davids rehab. We shared our homemade Thanksgiving dinner with him and it was so wonderful to be eating together! 

Elena, our daughter, made some terrific chocolate flan that we shared with all the nursing staff, making Augusto the most popular guy on the floor, as if he weren't already!

We brought in a 2 and a half foot Christmas tree donated by a terrific friend and decorated with ornaments that have our family photos on it. Also brought a photo album of family outings from the last year. 

Augusto and I are just so especially THANKFUL this year for our lives, and our families and friends that have helped us through this tough time. 

OK, now the really good stuff: Augusto's left elbow is progressing well enough that he can use his left arm "as tolerated," which means as long as it doesn't hurt too much. This is a great development as it means he can use both his right and left arms to move his body, instead of just his right arm. 

So, now in physical therapy yesterday, the therapist provided a modified walker, that has an arm rest for the left arm, so that Augusto could stand up and walk 5 steps!!! He is able to put some pressure on his right leg and most of the pressure on his arms at this time. 

The doctors said he has to be non-weight bearing for 3 months in order for his pelvic bone and fractures to heal. He's already put in 5 plus weeks so he is making progress. The therapists respect his doctors orders and also help push the patients to self-sufficiency. So, he's not ready to walk at length, but it is truly a big boost for Augusto to take some real steps to his ultimate recovery!!

In signing off tonight, I can't begin to tell everyone how important each of you have been to our rejuvenation and restoration. We are so lucky in so many ways. Many thanks and love to all!

Karla

MONDAY NIGHT, NOVEMBER 14, 2011

Augusto continue to improve in his recovery. He is at the St. David's Hospital in Austin in the rehab wing.  When he was transferred, he was still been fed through a tube since he was having trouble with swallowing (normal for his 3 weeks with breathing tube).  Today he "passed the swallowing test" Big Hurray for him. However the tube is still needed because he has to start swallowing liquids, Jello, etc. but not solids yet.  He is doing a lot of physical therapy, occupational, and others and gets tired so we call and talk to him for a very short time.  Karla is a tower of strength and has a great support group which has been invaluable. She is walking without the walker and the face is healing well.
She asks me to pass on to all of you the - how important this support has been.
We continue our way south aboard ALFIN sailing away from the cold weather and this is why I have been remiss lately in updating this page.  Thanks for your patience

November 7, 2011 Reported by Karla and summarized by Anita

This is Augusto's update, Karla just called.

-  NO canula oxygen,  now he is totally breathing by himself

-  Pneumonia, a little better.

-  Food: He is still being fed by a tube, Karla is going to ask the doctor to try a swallowing test later.

-  Respiratory system: Breathing is stable

- Awareness: Today was fine, though insisting to get a wheelchair to go home.  Last night at midnight

  the nurses noticed him confused in a awareness test, they say it could be because the length of time in ICU.

- He is in ICU, but in practical terms he is in Intermediate Care for the type of care he requires.  The room

  in the floor Augusto needs is still busy.

I'll keep you informed.

November 4, 2011-- Karla's report

posted: Friday, November 04th 2011 - 10:48 PM Augusto is still making steady progress! His lungs are looking " a little better" and all other indicators are stable at this time. The doctors have ordered him to intermediate care(!) but he has to wait until they have a bed open there. Probably tomorrow. He was really funny today at a mid day visit. More sleepy tonight. In intermediate he will have more rehab, but also opportunity for more sleep! I don't want to say he's tough but, he has not complained one bit, doesn't ask for pain medication, and has repeated said he is LUCKY to be alive and is thankful to all his doctors and nursing staff for helping him. However, the nursing staff do occasionally give him some pain medication to help him ease his effort of breathing, and now, thankfully some night time meds to sleep. Thanks to all our friends and family! Your continued support is sustaining us more than you know. Love Karla

November 2, 2011 At 2215 hr. (10:15 pm,)

Augusto is recovering well. However the doctors have warn us that the recovery is still a hard road.

Yesterday they noticed Augusto was tired, sleeping all day and not very responsive. In checking all of this some analysis revealed a loss of the hemoglobin numbers, they had to give him some blood and investigate the source of the problem. His feces showed blood in them and an endoscopy was ordered, which revealed nothing to blame the bleeding for.  Today at noon they did a colonoscopy, which was also negative. However, the hemoglobin is going up and no more internal bleeding was noticed.

The pancreas continues to leak but from 200 cc a day it has dropped to 100 cc and the doctors believe it is in route to heal itself as expected. He keeps responding to the pneumonia treatment and was more alert and responsive today. We are all waiting, as the doctors said, when we have a full day with everything OK, we’ll transfer him to the intermediate care unit.

We keep saying… ! Go Augusto Go !


This is Karlas's update on Augusto:

All, sorry for the delayed update. Got home late from the hospital last night. Augusto was having a bit of fever so was not in best shape to see visitors. He's still in ICU as there have been some secondary issues (pancreas, pnuemonia,) etc. that are being addressed. He is breathing shorter more frequent breaths because his lungs don't fully expand right now because of the fluid around the pancreas and weak diaphram. Thus he is not talking up a storm as yet. This is short term as this will clear up as the pancreas heals itself. Doctors want him to have a all round great day in ICU - on all levels- before moving him to intermediate care. These secondary issues are part of the hold up, but he is in great hands at Brack and they are working every angle of his care. Saw him this morning and his fever was broken and he was in a lot better spirits. They are still putting him through PT and Respiratory therapy every day. Today they were working his thigh muscles. For those of you who want to see him, I will let you know when he is ready for visitors. Thanks for your patience with us. In the meantime, if you wish, you can send him an email to our casavillalon@austin.rr.com email address and I will read it to him in the hospital. I am sharing with him all your great wishes and love. It is working!!! I still am trying to rest in order to help Augusto as he gets better and can come home. Thanks for ALL your terrific support! Love, Karla

Saturday, October 29, 2011

Greetings. Augusto has shown tremendous improvement in his recovery. Not completely out of the forest--but much, much better. He is going through heavy therapy to strengthen his lungs and swallow food after two weeks with a respirator tube down his throat.  He has been given the status of "stable" and is supposed to be transferred to another floor, where he will receive intensive re-hab.  The family is deeply grateful to all who have been so supportive.  Anita, Jose's wife has spent a week there reporting daily on his condition. Karla is fine after her orbital bone surgery and goes every day to the hospital to see Augusto.
Keep him in your thoughts and prayers,  since he still has a road full of work to get jumping again.

THURSDAY, OCTOBER 27, 2011 AT 1300 HR. EST

This morning's report was composed by Karla's sister Kathy:

Great news:  The lung doctor and trauma team think he is doing so well, more responsive,more alert. They are going to try to take him off of his respirator today or tomorrow.  They will do a swallow test on him but it will probably  be two days before he is able to eat or drink, but hopefully he will be able to talk to us.  He is getting stronger everyday.

TUESDAY, OCTOBER 26, 2011

TUESDAY, OCTOBER 26, 2011

Greetings with good news: Augusto has been improving much as he wakes up from sedation. First let me start with Monday’s activities.  Augusto had a CT Scan of the abdomen area, where we know the Pancreas is leaking at a low output. As I mentioned before, when the output is low the doctors expect it to heal itself, so they are monitoring this drain. The scan did show that the Pancreas was somehow damaged in the accident.  The second issue the scan showed was not known to us before. This is that somehow one of the adrenal glands was also damaged. The doctors do not think this will have more consequences.

At the same time on Monday, they also made a scan of his head, because they wanted to make a neurological assessment. They found some fluid in the brain but nothing unexpected. They think that this fluid will be re-absorbed by the brain and do not think there will be other consequences.

The good news is that Augusto was “waked up” by stopping the sedatives, and he made several signs of being aware. He can’t talk due to the respirator pipe he has in his throat, but he did indicate he recognized Anita (Jose’s wife) and, by pointing at pictures shown to him, he communicated that he wanted to watch TV. Next he indicated that the channel that first came on was not to his liking, and Karla said that the Travel Channel was his favorite. When that came on, he recognized the host, etc.  This is the best news of his ability to communicate that we have heard so far.

Karla, is, as I write, undergoing surgery to repair her fractured left orbital bone. She will spend tonight (Wed.) at the hospital and will probably return home tomorrow. We all wish Karla the quickest recovery from this.

Stay tuned for more good news, Kiko

MONDAY, OCTOBER 24, 2011 1000 HR

Augusto is responding very well as he wakes up slowly from sedation.  He responds when we ask him to give us thumbs up, or blink your eyes, move your foot etc.
Doctors are monitoring some pancreatic leakage at low output and will do a scan today to zoom into the causes.  They say that most of the times the issue corrects itself.
Today he was put into the SPONTANEOUS breathing mode for a while for the first time since his Saturday surgery. They will repeat this this afternoon and so on to get him trained for breathing without the respirator.
The plan is to make the scans and act according to its results. They are contemplating the final wake-up and removing the respirator. Once this his breathing is stable and on his own, they will probably move him to another floor to start re-hab.
We are happy with these improvements, recognizing that we still have a long-haul ahead, but encouraged.
I will be leaving Austin at noon to continue our trip to warmer waters and will be in touch to keep communicating with so many of the friends and family. Kiko

DESCRIPTION OF AUGUSTO’S SURGERY

TO REPAIR THE AORTA’S INJURY

PERFORMED IN 10-21-11

BY DR.  MARK FELGER AND DR. SCOTT SEIDEL

UNIVERSITY MEDICAL CENTER-BRAKENRIDGE-SETON

AUSTIN, TEXAS

Introduction:  Endovascular repair is a relatively new procedure to repair aortic aneurisms or traumatic injury without the need to open the chest.  In this particular case, the surgical procedure required two separate procedures. Due to the location of the aortic tear, on the inner side of the aortic arch, the insertion of the Thoracic Endoprosthesis (the stent) will block the “outlet” of the subclavian artery, which provides blood to the left arm. Therefore, the first procedure is to make a by-pass between the “left common carotid” artery feeding the brain and the subclavian, which will be locked. This also was done without opening the chest cavity; it was performed through the area of the neck just above the clavicle bone.

Once this was completed, an incision was made in the inguinal area and the left inguinal artery, where the doctor introduced the “Gore-Tag” (commercial name of the stent used) and drove it up to where the two inguinal arteries form the abdominal aorta, and continued up to the thoracic aorta (an arch, see drawing below). The device is then deployed, expanding all around and giving support to the injured artery, which will in time repair itself with its own tissue. The following sketch depicts the procedure.

SATURDAY, OCTOBER 22, 2011

Augusto spent the night well and with no problems. They are keeping his blood pressure reasonable low to allow by-pass to heal well. He is resting and with all the functions doing well. The plan now is to continue to allow him to recover while still sedated. Several of the doctors were here already this morning, answered all of Jose's and my questions and agree that his surgery yesterday was successful, long lasting and that will allow him to live a normal life.  In a few days, they will start to wake him up, and let him do all his breathing spontaneously (now he's on his own for several hours a day) and then move him to another floor for rehab, etc.

Karla continues to improve, she is walking all around the house with a walker and she is schedule for surgery to repair her left orbital bone on Wednesday. Her pelvic fracture did not require surgery. 

End of surgical episode at 1130 hr.

Dr. Felberg, the Cardio-Vascular surgeon just came to tell us the operation is finished and everything went as expected. He explained, as we questioned him, that the injury was bad and that in these cases, 85% of the patients do not make past the emergency room. Augusto will not suffer consequences as far as longevity, quality of life and movement.  He added that if he continues doing well, he will send him back to Brakenridge Hospital this afternoon instead of tomorrow as thought before. We are happy to say the least.
Now he starts his recovery period, this may take some time and support.

Surgery progress at 1055 hr

One OR nurse just came to say everything has gone fine and they will finish in 30 minutes. The By-pass was done, they have finished inserting the stent and are doing some small patching somewhere. He is strong and doing well. Will sent another post as soon as he comes back to ICU
By the way, the attention at the ICU is unbelievable. Every minute of the day, repeat, every minute, he is under surveillance of never less than 2 RNs and at time up to 6 between RNs and technicians of some specialty.  He has over 12 tubes going somewhere and when a nurse heads for one of them, there is no hesitation, the level of efficiency and training is laudable.

Friday Morning Surgical procedure

Augusto was taken to the OR at 0720 hr. The procedure for the repair of his torn Aorta artery, on the descending arc of this main artery includes:
First incision was made at 0850 hr. on the left side of his neck. They will reach the artery that goes to the brain and make a by-pass to the artery that goes to his left arm and which will be closed by the stent that will next be installed.
Next they make an incision on the groin to reach the inguinal artery and introduce the stent here, which will be located on the arc of the aorta where the damage is located.
We expect surgery to be complete around noon and will report results.

Tomorrow Morning, October 20, 2011

Orthopedic surgery scheduled for 0800 hr. Job is to close the gaps on the two Pelvis fractures and fasten them with screws and pins. We will report results upon completion.
Thanks you for your interest.

Wednesday, October 19th

Dr. Brown came early and talked to Jose & myself. He is happy with Augusto’s progress. There was some more fluid drained from his left lung but the right one is clean and they will remove that canula inserted on the side of his chest. Scheduled surgery will proceed as stated.

We are encouraged by the way he is responding to treatment and fighting to come out shining.  The kids are well and yesterday we went to see Julian play football where he did good and the coach called him out at the end and congratulated him in front of his buddies.

Thanks to all for your thoughts, prayers, wishes, etc.
Kiko, Mari, Jose, Karla, Kerry, Elena & Julian

Tuesday, October 18th - post surgery

Augusto just returned from surgery and Dr. Carlos Brown came to talk to us. 

The surgery went very well, he was able to close his abdomen and Dr. Boyd review the Pelvis fracture and moved it a little but nothing else. He needs surgery for this so they have scheduled the following:
 
Thursday

• They will operate and fix the Pelvis first from the front and then on his back side and install some pins on the pelvis to fix both fractures.

Friday

• They will transfer him to another hospital where they will repair the "tear" on the aorta.

Thank you all for the tremendous support without which this would have been almost unbearable. We are not out of risks but it is looking good. 

Thank God for this gift.
Kiko, Mari, Jose R., Karla, Kerry (Karla’s sister) Devin and the kids here.

Tuesday, October 18th

Hi everyone and thanks for your support. We need it, believe me. Sorry I did not report last night, it was late and I was exhausted (of doing nothing but wait)

Augusto's condition is better today, we met with the doctor of respiratory system and he said his lungs were much better today. They disconnected him for a while and was breathing well by himself. We believe he hears us sometime and responds by moving something. By the way, this state is induced by PROPOFOL to keep him sedated.

On the other hand we learned that he also had a Liver laceration although classified as 1 of 4 levels. Therefore he is a little Jaundiced today, they say it is OK.

The other correction is that the Aorta did not have an aneurysm, but a "tear," a "rupture" due to the impact. This was the source of the bad internal bleeding along with the Spleen, etc. That has been stopped or almost stopped.

Today he is going into surgery. They will attempt to close his abdomen. He was left open because the two flaps do not meet to "zipper" at the center due to swelling. If they cannot close him, they will bandage again (By the way, something called "The Bogota" patch, for being first done there)

The other procedure is to work on the Pelvis and see what is needed. He has two fractures and is open as pair of wings. Vertically, all the parts are aligned which is good news.

The Aorta repair will have to wait a few days but it has been planned.  His blood pressure is been kept steadily at 100/50 and maintaining it well.

Karla is improving, I just saw her walking with a therapist. She is improving in general but the surgery for the eye-socket repair will wait for swelling to reduce. There seems not to require surgery for her Pelvic fracture. The kids are well and went back to school today. There is a lot of support from friends and neighbors.

As a description of the attention and service he gets in this wonderful Trauma Center, I'll tell you that he has:

• Seven computer screens monitoring hundreds of functions.
• One man-nurse, 24 X 7 standing in front of the monitors every minute of the day
• One Chief-Nurse, a lady-nurse, literally breathing behind the neck of the poor guy monitoring Augusto.
• He has seven bags containing something and dripping into his system
• Two separate automatic systems monitoring his blood pressure
• He has one tube draining the left lung, one for the right lung, one drain for urine, and one drain for the abdomen.  He has one drain tube into his stomach to keep it empty and clean while they feed him through another tube into his nose and pass the stomach into the intestines. He has an IV inserted through his shoulder area into the superior Cava vein and directly into his right Atrium.
• Automatic pressure-pulsing on both lower legs and feet.
• His ICU cublicle is maintained at 0.010 inches water pressure to prevent any outside air to move into the room

Do not have to tell you all of this looks impressive.

Thank you all for your thoughts and prayers, please continue and I will keep reporting.
Kiko

Newspaper Narrative

Villalon, husband seriously injured in traffic collision
By Ben Wear | Tuesday, October 18, 2011, 11:31 AM

Karla Villalon, the City of Austin Transportation Department’s public information manager and formerly an aide to ex-Austin Mayor Bruce Todd when he was a Travis County commissioner, and her husband Augusto were seriously injured early Sunday after their car was hit by a pickup at the Loop 360 and RM 2222 intersection.

The driver of the pickup, Johnny Alberto Dimas, 17, is in custody at Travis County jail and faces three felony charges of intoxication assault and one misdemeanor assault charge. Dimas and his passenger, Leslie Arellano, like the Villalons, were hospitalized at University Medical Center Brackenridge. Dimas’ injuries were minor, according to an arrest affidavit.

According to the affidavit, at about 7:40 a.m. Sunday Dimas was headed eastbound on RM 2222, going 85 mph in a 55 mph zone, when he lost control of his vehicle. After hitting a guardrail, his pickup broadsided the Villalons’ car on the driver’s side as they waited at a red light on Loop 360’s northbound access road. Augusto Villalon was behind the wheel.

Dimas failed sobriety tests administered at the hospital, according to the affidavit.

Karla Villalon suffered pelvis and eye bone injuries. Augusto Villalon suffered cardiac arrest and had internal bleeding, according to the affidavit, and was in critical condition initially after emergency surgery. No update is available today on his condition.

Karla Villalon is a key aide to Robert Spillar, the city’s transportation director, and has been heavily involved in the city’s urban rail initiative.

Corrections - Sunday, October 16th

We learned through the media that Augusto had suffered a Cardiac Arrest. We questioned this and the Dr. corroborated it and was surprised on how it reached the newspaper. It happened at the ER and it was very short, he responded to treatment.
We also learned from the Cardio-Vascular surgeon that there was NO aneurysm but a “Tear” or rupture of the Aorta, causing internal bleeding.

Sunday, October 16th

My family and friends:

Augusto Jr. and Karla were wrecked by two drunks this Sunday morning. This is the current status:

Augusto is in the ICU of the Brackenridge Hospital in Austin, TX. He is kept unconscious for obvious reasons. I just saw him and Karla, it is midnight and I need some rest. Will continue to update as we know more.

Augusto's damages are as follows:

• Compound fracture on left arm
• Multiple fractures on the pelvis
• Large amount of internal bleeding
• An aneurysm on the curve of the Aorta
• Loss of his Spleen at surgery
• Rupture appendix
• Some lacerations

It was about 0800 hr. They were driving to their exercise trainer's home for their Sunday work-out. They stop at a light and advance on the green when two drunks in a truck ran the red light, and crashed on the driver's side of Augusto's car.

Augusto survived the first surgery trying to stop the bleeding. They sent him to the ICU but did not close his lower abdomen surgery cuts in order to keep and eye. Two hours later returned to Op. Room for more surgery. At this time they removed the Spleen and discovered the aneurysm.  If he does well for 48 hours they will attempt to repair the Aorta. Augusto has no spinal damage, head trauma or other bad stuff.

Karla fared a little better since she was on the passenger's side. 

Karla's damages are as follows:

• A big trauma hit on her left eye, fracturing her orbital bone.
• Multiple fractures on the Pelvis and
• A fractured left tibia.

She will go into surgery tomorrow morning to repair the orbital bone. They have to take her left eye out to repair the bone and then place it back in the socket. Her eye sight was not damaged.

Maria, Jose and myself are here and will continue to send up-dates as we know something. According to the ICU personnel, Augusto has a chance to make it for the next 48 hr. Let's pray for this.