He is doing fine, no glue or stitches on the kitchen counter needed. He has just a small scab left. One of these days he will learn to control that big head of his.
Ava on the other hand, looks perfectly normal on the outside. However, she received a much worse injury. She was at her best friend's birthday party, which was being held at an indoor swimming school. The kids were taking turns on the water slide, and had already completed many successful trips. Next think we know, Ava is flying through the air off of this 8ft tall water slide and lands flat on her back at the bottom of the ladder, luckily on a 1/2 inch foam mat. Ryan picks up a crying and stunned Ava, checks her over, gets her (and the staff) calmed down, and lets her have some juice. However 10 minutes later, Ryan gives me the nod that it is time to go. Ava started vomiting profusely. Elizabeth wanted to play twenty questions again, but some how I manage to get her and Casey changed and ready to go. I never thought we would get to the hospital. The drive seemed to take forever and Ryan is trying everything to keep Ava awake. I drop Ryan and Ava at the door and by the time we park the car and get inside they are already in a room. Sometimes, it is good to have a husband who is an ER doctor. She gets scanned right away and that is when we found out she fractured her occipital bone (blue line). Here is your quick anatomy lesson. The occipital bone forms part of the base and the back of the skull. The basal part of the bone forms a ring (the foramen magnum) through which passes the spinal cord. On the inside surface of the occipital bone venous drainage from the brain runs in the transverse sinuses. Ryan can answer any further questions you have.
Now Ryan is really worried. He is thinking of every possible bad outcome of traumatic brain injuries. Sometimes, I think no medical knowledge is a good thing. I thought, how bad can it be? There was no blood or bones coming out, and her head wasn't dented. She is just tired and her head hurts. I also didn't realize the crack is about 3 inches long and in a place where a lot of important things run down and out of the brain. Ava had to be transfered to a hospital that had a trauma team and pediatric neurosurgeons, so Ryan and Ava took an ambulance trip over to University hospital. Elizabeth really wanted to go for that ride. I got the other kids settle in back at home with a family friend and then rejoined Ava and Ryan at the hospital. They were still in the ER, Ava had received another head scan and a couple of bruises were noted on the front part of the brain and some minor bleeding. The trauma bay was starting to fill up with gun shot victims (Saturday night 10pm), so they finally got Ava moved up to the Pediatric Intensive Care Unit. Poor little girl was so tired, scared, and hurt. Plus, she was still throwing up. She would answer Ryan and I with a head movement or maybe a one word answer but that was it. She was hooked up to machines that tracked her heart beat, blood pressure, and pulse. She also had an IV and the nurses came in and checked on her every hour. The worse part was that Ava just wanted to curl up with her blanket "Ba" and suck her thumb, but every time she tried to bend her arm she would kink her IV line and set the alarms off. I spent the night with her in a chair next to her. It was tough form me to hear that their was nothing that could be done for her, and that they were just watching her so they could intervene quickly if something bad happened. I finally grasped the severity of the situation when Ryan and the neurosurgeon were looking at her head scans, and the doctor was saying that he was most concerned about a vein bursting near her fracture line, and that would become a surgical emergency which didn't always have a good outcome. That is something, no parent ever wants to hear. Ava spent two more days in the hospital under surveillance. On the second day, she started to eat some food and keep it down. Ava also started talking to us and laughing. Yeah! They let me sleep with her in bed the 2nd night, something that I hadn't done since she was a newborn. Her hourly checks, became every 2 hours, and finally every 4 hours, and most of her wires were disconnected. Her head had not magically mended itself, but the risk of very bad things was diminishing.
Here she is in the PICU on the road to recovery. I am glad I don't have a picture of her hooked to all the wires, looking so sad and pathetic. It really isn't an image that I want to remember.
When she got to the Transition Unit, Ava and Casey came for a visit to entertain and terrorize her. 
She was discharged from the hospital after a 3 day stay with no restrictions on activities. Just the stern warning not to get another head injury in the next 2-3 months. Easier said then done with an active three year old, but we are trying to get her to slow down. We took the ladder away on the trampoline, enrolled her in dance instead of gymnastics. She is not allowed to run on hard surfaces or climb on or jump off of anything over 3 feet high. So far, so good. She will go back in mid-September to make sure everything is healing correctly. We are just very thankful that she can walk and run, no seizures, she doesn't have her head held together with plates, screws stitches, and staples, and she has stopped complaining that her head hurts. It could have been so much worse, but she should be just fine! The most we had to do was re-teach a little potty training after the hospital stay.
My co-workers at Deloitte were great and brought us meals for the week. Plus, enough leftovers that I haven't had to cook all this week. Ava got lots of cards and little gifts from friends and family. She thinks that she has been celebrating her birthday all month long.
For those doctors out there, here are Ava's official CT findings:
There is a non displaced fracture in the midocciptial bone extending to the formaen magnum. There is posterior scalp soft tissue swelling. There are small foci of high density superior to the left orbital roof and along the right ryrus rectus. No evidence of mass effect, midline shift or hydrocephalus. No abnormal extraaxial fluid collections are present. The visualized paranasal sinuses and mastoid air cells are clear. Bilateral globes, optic nerves, and retro-orbital soft tissues are unremarkable.
Now Ryan is really worried. He is thinking of every possible bad outcome of traumatic brain injuries. Sometimes, I think no medical knowledge is a good thing. I thought, how bad can it be? There was no blood or bones coming out, and her head wasn't dented. She is just tired and her head hurts. I also didn't realize the crack is about 3 inches long and in a place where a lot of important things run down and out of the brain. Ava had to be transfered to a hospital that had a trauma team and pediatric neurosurgeons, so Ryan and Ava took an ambulance trip over to University hospital. Elizabeth really wanted to go for that ride. I got the other kids settle in back at home with a family friend and then rejoined Ava and Ryan at the hospital. They were still in the ER, Ava had received another head scan and a couple of bruises were noted on the front part of the brain and some minor bleeding. The trauma bay was starting to fill up with gun shot victims (Saturday night 10pm), so they finally got Ava moved up to the Pediatric Intensive Care Unit. Poor little girl was so tired, scared, and hurt. Plus, she was still throwing up. She would answer Ryan and I with a head movement or maybe a one word answer but that was it. She was hooked up to machines that tracked her heart beat, blood pressure, and pulse. She also had an IV and the nurses came in and checked on her every hour. The worse part was that Ava just wanted to curl up with her blanket "Ba" and suck her thumb, but every time she tried to bend her arm she would kink her IV line and set the alarms off. I spent the night with her in a chair next to her. It was tough form me to hear that their was nothing that could be done for her, and that they were just watching her so they could intervene quickly if something bad happened. I finally grasped the severity of the situation when Ryan and the neurosurgeon were looking at her head scans, and the doctor was saying that he was most concerned about a vein bursting near her fracture line, and that would become a surgical emergency which didn't always have a good outcome. That is something, no parent ever wants to hear. Ava spent two more days in the hospital under surveillance. On the second day, she started to eat some food and keep it down. Ava also started talking to us and laughing. Yeah! They let me sleep with her in bed the 2nd night, something that I hadn't done since she was a newborn. Her hourly checks, became every 2 hours, and finally every 4 hours, and most of her wires were disconnected. Her head had not magically mended itself, but the risk of very bad things was diminishing.
Here she is in the PICU on the road to recovery. I am glad I don't have a picture of her hooked to all the wires, looking so sad and pathetic. It really isn't an image that I want to remember.
When she got to the Transition Unit, Ava and Casey came for a visit to entertain and terrorize her. 
She was discharged from the hospital after a 3 day stay with no restrictions on activities. Just the stern warning not to get another head injury in the next 2-3 months. Easier said then done with an active three year old, but we are trying to get her to slow down. We took the ladder away on the trampoline, enrolled her in dance instead of gymnastics. She is not allowed to run on hard surfaces or climb on or jump off of anything over 3 feet high. So far, so good. She will go back in mid-September to make sure everything is healing correctly. We are just very thankful that she can walk and run, no seizures, she doesn't have her head held together with plates, screws stitches, and staples, and she has stopped complaining that her head hurts. It could have been so much worse, but she should be just fine! The most we had to do was re-teach a little potty training after the hospital stay.
My co-workers at Deloitte were great and brought us meals for the week. Plus, enough leftovers that I haven't had to cook all this week. Ava got lots of cards and little gifts from friends and family. She thinks that she has been celebrating her birthday all month long.
For those doctors out there, here are Ava's official CT findings:
There is a non displaced fracture in the midocciptial bone extending to the formaen magnum. There is posterior scalp soft tissue swelling. There are small foci of high density superior to the left orbital roof and along the right ryrus rectus. No evidence of mass effect, midline shift or hydrocephalus. No abnormal extraaxial fluid collections are present. The visualized paranasal sinuses and mastoid air cells are clear. Bilateral globes, optic nerves, and retro-orbital soft tissues are unremarkable. 
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