Saturday, April 30, 2011

Fran, April 30

Fran got some rest and was much better today. Her awareness level was as good or better than any time since the stroke.  Her mood was pretty good as well. I spent time learning some of the things I will need to know to care for her. Some of it is not very hard, like moving her between the wheelchair and the bed. Some of the other stuff is pretty difficult.  Both Fran and I will need to improve.

Fran has some sensation and some muscle responses on the left side, but no voluntary movement.  Her awareness of the area to her left is getting a lot better.  Originally, that part of the world did not seem to exist for her.

We are looking for live-in help.  Ana has some good leads and is working on the project.

Fran and I were unfortunately not able to attend today's celebration of life for our recently deceased friend, Ed Arkin. He was a good man and we will miss him.


Friday, April 29, 2011

Fran, April 29

Fran had a bit of a setback today.  I think she was tired from so many visitors yesterday.  She did not perform well in her therapy. She perked up in the afternoon after some rest.

We had the family meeting today with the staff, and I thought it was very positive. Her tentative release date was set for a week from today.  There is a large amount of work to do before then.  She will be coming home.  We will need equipment, training, and help.  She will continue with outpatient therapy at the rehab center.

With the recent trend, I am expecting considerable improvement over the next week.  I am not expecting much help from her left side, but I do expect big improvement in her ability to use her strong right side effectively.


Thursday, April 28, 2011

Fran, April 28

Dramatic improvement in awareness.  Fran is almost completely there. She is more talkative, and picks up better on what you are saying.  She also graduated to regular food and liquids.  She is off dietary restriction.

Tomorrow is the big meeting with the staff and our family to assess her progress and lay out what is next.  This will include her rehab doctor, some therapists, the case manager, and the social worker, along with Fran, me, Maliq, Rachel, Marshall, and Ana. 

Wednesday, April 27, 2011

Fran, April 26th and 27th

Sorry I missed last night.

Yesterday they found that Fran had a DVT (clot) in her leg that was inactive, but constituted some risk. We determined that they would put in a filter to prevent any clots from rising to the lung.

Today was major progress in her physical therapy.  Fran had a transfer from wheelchair to bed that would be classified as moderate assistance, a big jump.  She began at total and had moved to max assistance.  Based on the continued progress the therapist said she would recommend that Fran stay an additional week past the May 3 date.

Fran also made progress in what is called "speech therapy," but for Fran, is about swallowing. Fran's swallowing is now very good, and it appears that her dietary and liquid restrictions will soon be lifted.


Monday, April 25, 2011

Fran, April 25

The visitors over the weekend must have been very therapeutic. Fran was more alert and energetic than at any time after the stroke. I did not speak with the physical therapist, but I did see the speech therapist, and Fran appears to be progressing on her swallowing.  She drank some water without incident.

We have scheduled a "family conference" on Friday.  There the chief physician and the staff will explain where we are, where we need to go, etc. Fran's current release date is May 3, but that is not carved in cement.  We will know more about that on Friday.


Sunday, April 24, 2011

Fran, April 24

Today was a day of rest and visitors.  Out of town visitors included Anita Arikin, Marty Rubenstein, Karen and Peter Salant, and Sid and Barbara Finkelstein. Sid had been paralyzed by an incompetent chiropractor, and talked with Fran about his process of regaining function.

Fran ate in her room and ate much more than she had been eating in the dining room, confirming yesterday's discovery that she is not comfortable in the dining room.

She began the day very tired, but finished with some energy.

The most significant thing is that she appears to have some sensation from her left arm and leg. If this is real, it is new and very important.


Saturday, April 23, 2011

Fran, April 23

When it rains it pours. Today they discovered that Fran has a urinary tract infection sponsored by a resistant strain of e-coli.  They (the staff, not the e-coli) moved out her room mate and now requires anyone who enters to wear a yellow smock.  They are not restricting visits, except for people who do not look good in pale yellow.  They are administering an antibiotic that their testing indicates will be effective with this particular bug.

Fran was especially tired yesterday and today, which is likely do to this infection, which should be cleared up soon.

Because of the inconvenience, she ate in her room. She ate more than I have ever seen her eat.  When I asked her about it I found that she is not comfortable in the dining room.  So she can eat in privacy and then go out in her wheelchair on a tour.

Tomorrow is an off day for therapy.


Friday, April 22, 2011

Fran, April 22

Today we solved the mystery of the cat scan.  We could not figure out who ordered it or why.  I asked Dr. Stone and he said he did not know.  He came to me a few minutes later and apologized, saying that he had ordered it.  He had been extremely busy, as he supervises the whole rehab facility. The reason for the scan was that he wanted to use a mild anti coagulant to prevent future strokes, but he had to make sure there was no more bleeding.  In fact there was no bleeding, so he can go forward.

Fran was very tired this morning, but better this afternoon.  There were no more leaps of progress, but no setbacks either.


Thursday, April 21, 2011

Fran, April

By all accounts, Fran continues to make excellent progress.

Up to this point I have encouraged all visits.  However, the therapy staff is concerned .  They explained that her sessions are quite strenuous, which is evident to me.  I can see how tired she is following a session.  She needs to rest between sessions.  The staff feels that the visitors are preventing her from resting sufficiently.  They have asked that people come after 3 PM on weekdays.  On weekends, any time is OK.

I hate to do this because I know Fran enjoys the visits, but I trust the staff and want to follow their wishes.

Wednesday, April 20, 2011

Fran, April 20

Lots of visitors today.  The most notable thing for me was that Fran's mood seemed much better and she was not as fatigued. Others noticed this also.

Fran had a visit with Alice's dog, Sasha yesterday and today Cyriaque and Raquel brought their Beagle to visit.  We can take Fran in her wheelchair to the yard outside the front entrance for these visits. She likes this a lot.

Her therapy session continue, with a focus on finding center, balance, standing, and taking a few steps.  I did not see any of the sessions, but Fran said she did OK. She also had some work with reading and other visual tasks. Her acuity needs improvement, but I think this will come back very well.


Tuesday, April 19, 2011

March 25

For those who do not yet know, Fran suffered a stroke on Wednesday.  She went immediately by ambulance to Scripps Memorial Hospital, where she has received world class care.  On Thursday she underwent surgery, via catheter, to remove blockages from her brain.  The surgery, which took 4 1/2 hours, was successful. She is now under heavy sedation in the ICU, where she will remain under constant observation for several more days.  The neurologist is optimistic about her recovery.  The problems are on the right side of the brain and she has weakness on the left side. She is undergoing tests to discover why this happened, so we can prevent a recurrence.

She is under what may be the world's best care.  I will try to keep you updated as we know more.  I am sure this list is not complete, and I will add to it as I collect emails.

Thanks for all of your expressions of care and concern, and offers of help.  There is not much any of us can do right now but hope and pray for her speedy recovery.


March 28

Progress is good.  They have taken Fran off sedatives and she is slowly waking up.  They will probably take out the breathing tube tonight or in the morning. They found a small irregularity in her aorta which is the probable source of the clot, and they will be able to deal with it.  I will know much more tomorrow about her condition and plans going forward.

Thanks again for all your support.


March 30

Progress is steady but very slow.  Fran is more alert and responsive and can open her eyes a bit.  They are testing her respiration to see if she is ready to have her breathing tube removed.  so far, she is passing, so they might remove the tube tomorrow.  They do not want to do it prematurely, as the repeated insertion can cause some problems.

They wheeled a patient out today.  Why? I asked.  I was told that he was "too sick" to be in the ICU.  That creates perspective. (He went to the cardiac care unit)

Fran's next stop will be the rehabilitation unit...soon I hope.


March 31

Today was a day of rest and testing.  They are making sure that she can breathe on her own prior to removing her breathing tube.  She is doing fine and hopefully the tube will be removed tomorrow.

She is more responsive each day and very well aware of who is there and what is going on.  When Rachel (her pregnant daughter-in-law) is there. Fran puts her hand on Rachel's belly.

More tomorrow.


April 1

Today was a day of slow progress.  In all her tests Fran can breathe on her own.  The question is can she cough forcefully enough to clear her airway. Dr. Dhupa will decide tomorrow morning if she is ready to have the breathing tube removed.  They do not want to take it out and then have to put it back in, as it can cause irritation and even damage.

Fran is fairly conscious some of the time and is starting to open her eyes. Even at this level, her personality is there.

Hoping for good news tomorrow.


April 4

Another day of slow but steady progress.   She can talk but it is very she writes...a lot.  At one point she noted that "the suction tube tastes like poison."

She did not do quite well enough on her swallowing test to get off tube feeding, but I expect her to pass tomorrow.

I expect her to be out of the ICU tomorrow or Wednesday and in rehab by the weekend.I hope that prediction is more accurate than was my bracket.

She mentioned that when visitors come, they should not try to get her to respond.  She is very aware and will respond when she wants to.


April 6

More slow progress.  The pulmonary doc said he was finally confident of Fran's breathing. Her white cell count is OK and she has no fever so the upper respiratory infection seems to have abated. More of her speech is now audible. However, she did not pass the swallow test. She was tired today, and is very anxious to get some real food and drink.  She is now getting brief physical therapy.

Hopefully tomorrow we can spring her from the ICU.


April 7

Nothing was dramatic today.  Fran's breathing is solid.  She is talking more, and is generally more alert.  She did not pass the swallow test, but that should not prevent her from getting out of the ICU.  The docs are all happy with her progress.

She says thumbs up to visitors.  Suggest you call me to coordinate. 858-775-9224.


April 9

More little bits of progress.  Fran passed swallowing, level 1.  She can eat purees, so I made her favorite, split pea soup.

She made a phone call to Barbara Binns, which rather surprised Barbara. I think she wanted Barbara to take her somewhere. I don't blame her.

Her consciousness level is improving (Fran's not Barbara's) and she can carry on a brief conversation. She gets fatigued quickly.

I think she is going to leave the ICU tomorrow and will get to rehab sometime next week.


April 12

Fran is now in the Scripps Encinitas Rehabilitation Center.  It is simply the best.  Dr Kocharian had to fight to get her in. Bless her. Fran was delivered by ambulance at about 3:45 Pm today. They will evaluate her in the morning and start her therapy.

Fran is getting into phone conversations.  She had lengthy calls with Maliq and Deborah today.

She will have to work very hard at the Center, but she is the one to do that. 


April 13

Day 1 at Encinitas Rehab was a grueling series of evaluations.  The staff is really excellent at establishing rapport with the patients. Fran already trusts them.  And they work her very hard. They will be coming up with a set of goals and a treatment plan in the next few days.  Meantime Fran continues to improve slowly.  Her alertness level is better, and her ability to communicate is better.

I actually like the pureed food, but she does not.  So I will make her a smoothie in the morning.

I am convinced that she is in the right place.


April 14

Fran got her last tube out today. It was a feeding tube that went in through her nose and dangled in front of her face with some colored stoppers.  Marshall told her she looked better without the tube.  "It wasn't my color," said Fran.

She is really being tested by the rigors of the rehab facility. She has physical therapy, occupational therapy (which is stuff like teeth brushing, showering, etc.), and speech therapy (which for Fran is mostly swallowing). After each session she is pretty tired.

I am getting more optimistic daily about what they can do there. She has a very long way to go, but she is in the right place to get there.


April 15

Another upgrade today.  Fran has gone from honey-thick to nectar-thick liquids, and from pureed to chopped food.  Let me tell you, the chopped food is better.

She is getting quite a workout in her sessions and she does not feel she is making enough progress.  But Fran has NEVER felt she was making enough progress. The therapists say progress is OK.

She is enjoying her visitors, but sometimes she gets tired and needs to rest. But overall, the visitors are very important to her.


Fran, April 17

Fran took her first steps today.  Of course, she did not saunter off down the hall.  She needed a lot of support from the physical therapist.  But the progress was real and large.  Because of the shut down of her left side, she has to learn a very different set of responses.  What her brain thinks is standing straight is no longer straight.  She has to look in a mirror and correct. But she is learning how to do it.

Her mood is better, her eating is good, and she looks great.

We had lots of visitors today, and she liked it a lot.


Fran, Monday April 18

Today was another day like yesterday, with a lot of hard work and slow progress.Dr. Stone, the neurologist in charge of the unit sat down with us at breakfast and told Fran that her progress had been remarkable in the week that she had been there.

She is getting more hours of instruction, between 3 and 4 hours a day, combining physical therapy, occupational therapy, and speech therapy (swallowing).  She is quite tired at the end of the day. I think life for her is like it would be for you if gravity were not constantly in the same direction.  She has to completely relearn her orientation in space.

She is eating more and her sense of humor is still strong.


Fran, Tuesday April 19

Another exhausting but successful day for Fran.  Dr. Stone told her that she had done in one week, what took most patients two weeks.  And she got her first chance at real food, a tuna salad sandwich.  She said it was "mighty good."

Alice brought her  little puppy Sasha and Fran was allowed to go into the front yard of the hospital to meet them.

Fran's dear friend Karen Salant arrived this afternoon for a long visit.

Fran is trying to learn where her "center" is, a concept that we take for granted, since it is built in.  Now she has to learn it all over again.