Thursday 3-28 Pictures

Physical Therapy and Speech & Swallowing Therapy.

Thursday 3-28

It's been a busy week but I'll do my best to get some posts up about the last several days as soon as I can.  Here's last Thursday; I'll cover Friday and the weekend tomorrow.  -Christina

My mom/Rosemary visited this day.  She said Grandma was sleepy but not all out groggy like she is on some of her tired days.  

Physical therapy came midday and put some electric muscle stimulator things on Grandma's legs to help her leg muscles work again.  She did not like it and that it felt terrible, trying to tell the therapist to take them off...!  After about 20 minutes (while mom and grandpa tried to distract her from the irritation of the treatment), the therapist took grandma to the physical therapy room, where they worked on a number of upper body exercises in front of the mirror..

Mom reports that while the nursing staff at the rehab center are passable, the physical therapy staff are excellent and very sweet with Grandma. This is great!

Grandma occasionally has a bit of trouble with remembering the year, her age, how long it's been since she had the stroke, etc.  She apparently told one therapist that she has not used her right side (arm or leg) for 4 or 5 years... When you explain to her her error she usually understands but sometimes questions -- she asked Grandpa the other night her age and when he told her 90 she said there "was something not right" about that.

After physical therapy (about 30 or 40 minutes) they took her back to the room, she sat in the wheel chair awhile longer, and then asked to get back in to bed since she could not keep her head up for much longer. Grandma does not have the muscle strength to manage her right side very well, but it is improving... just after PT she was particularly worn out.

Again, mom moved the chairs to keep Grandma's attention on her right side to encourage her to use those muscles and develop that strength. 

Speech and Swallowing therapist came with a tray of food!  Pureed carrots, pureed beans and rice, apple sauce and honey milk [I'm not sure what this is... -Christina]. Grandma did great and probably ate about 1/4 of the food there including drinking a sip or two of the honey milk from the cup.  Yay!

Grandma does continue to have some issues with short term memory.  For instance, she will ask for something from the house (shoes, blanket), but when Grandpa brings it she asks, "What did you bring that for?" Also, while she may have a really good visit one day, she won't necessarily remember much the next day, which probably is a significant contributor to her feelings of loneliness. We'll have to keep an eye on this.  Apparently this is pretty common with a stroke where Grandma's was, but we'll have to see how this develops; hopefully it improves.

Grandpa has also mentioned that in a lot of pictures, Grandma looks just like she was before the stroke, which I think is due to Grandma regaining control of her facial muscles; you'll notice she doesn't have as much of the right-side droop as she had right after the stroke.  (Yay, good job Grandma!) But as Grandpa also cautioned, the pictures also could give a misleading idea of Grandma's condition.  She does pretty well, but she is still has a long road to get back to "normal."

Overall, a good day.  Subdued, but good. Hooray!

Wednesday 3-27 Pictures

Pictures from Grandpa

 

Physical therapist & occupational therapist working with Grandma

 Grandma listening very attentively to a paper Joyce was reading to her

Grandma reading a card from Linda Barbour a friend from choir

Wednesday Was a Better Day

Joyce sent an update yesterday afternoon (1 PM) that was great!  See below (with some minor edits here and there):

When dad had left mom yesterday afternoon [Tuesday], she was sleeping deep, after a morning sleeping pretty deep through just about everything.
Well, we got to dad's about 5 PM and he wanted to go to the store, so Andrei and I went over to the rehab.

Mom was awake in bed looking sort of up at the TV.  She responded well when we got there, and was immediately talkative. She was very bright eyed, very lucid and clear. Her face had no droop, and she in fact looked fabulous.

I asked her some questions about the day, and she didn't remember much, but was very aware that she is out for periods of time.  She called it "off the map".  She talked on and on about how amazing it all is, that she is alive, that she can do what she can, but also how it is that she can tune out like that, and then come back and understand everything. She explained this very clearly. She was able to say that she is very much in the now. I asked her questions we have asked before- date, place, where she lives, kind of car she has, who is Lizzy's fiance, where does John live, etc etc. She got everything right. She seemed in awe as though she feels herself coming out of a deep sleep. That's the way she sounded and the things she said were so coherant. I brought in some lace with some French writing on it, and she read it and translated it. Overall, just very remarkable for me, but it seemed as though she realized this too.  I mean it.  She did mention in the beginning that she didn't really like it there though, because she said often she was alone and no one ever came to see her. She said she couldn't do anything about it, if she was cold or wanted to contact someone. That part she still couldn't get a handle on.

Anyway, dad showed up and she was sooooo happy- really excited to see him. Very cute. Throughout the evening, we reminded her that people had come to see her such as the doc and the pastor, and she did not remember. She is aware of the fact that she cannot remember this tho- and when I ask if that concerns her, she says yes.  I remind her that its going to get better, and to keep in her head that we are all, visiting all the time. After awhile, she was tired and decided to go- the nurses tuck her in.

We came back this morning [Wednesday].  She was awake. A little subdued, but still really with it. Almost like she is playing a game with us- like she knows the answers. Anyway, she had on some electrodes- they were doing muscle stimulation with her- a treatment that sends currents to her muscles - helping the brain to make new pathways to her muscles, to them moving. This was on her right upper arm.   Anyway, the nurses cleaned her up and and PTs come to the room.

Together, the two girls got her up in a wheelchair- she did well- now drooping and falling over.  Then a session of almost an hour I bet, of leg exercises, arm and feet exercises, neck and shoulder. And sit up straight. She was unbelievable attentive and successfull. The PTs were thrilled and complementary.  We thought she was pooped, but then the speech therapist (ST) came by quickly to do come swallowing with her. We got her apple juice and yougart.  You would not believe how enjoyable this was to watch. She was totally awake and cooperative. She laughed at our cheers and her progress. She had about 8 spoonfulls of yogurt and 6 sips of juice, of which she held the cup at the end. The ST asked about her food preferences and said in the end, that by the end of the week, she thinks she might be able to get a tray!  She is coming by tomorrow to eat a watery lunch with her. We were able to share the info about how she eats very slow, and her issues with that. Nevertheless, the ST was impressed. After all of that, she was tired, but not that zoned-out tired.

The nurse aid came in, and mom was put to bed for a nap. We have left to have lunch at home.  So far, so good!

So yeah, very good news all around.   So glad to have this great update from Joyce. :)

Tuesday 3-26 Pictures

Grandma in physical therapy in the morning.  

Working on bending and stretching legs.

Feeling kind of tired after physical therapy in the morning.

After being woken from a really deep sleep!  

(Sometimes I wish I could sleep that deeply...!) 

While this was another pretty sleep day, hopefully Grandma has some more alert days ahead.  This weekend is Easter and it would be wonderful to see her happy and alert for that. <3

Tuesday 3-26

Grandpa said that in the morning Grandma was kind of sleepy and not saying much.

Two therapists (Susan and another lady) dressed her in pants and a tee shirt, put her in one of those narrow straight back wheelchairs, rolled her to the exercise room, and withed with Grandma on bending her legs. Grandma had trouble holding her head up, was kind of tired.  Grandma was able to see Grandpa's car out a window in the exercise room. :)  Eventually, Grandma wanted to go back to bed so the nurse helped Grandpa take her back and get her settled, and she took a nap.

When Grandpa returned from lunch, Grandma was still sleeping.  

The speech therapist came, but they couldn't wake Grandma so she said she would come back.  Grandpa put on some loud music, and tried to get Grandma to wake up, but she still slept...!  The therapist came, and then a nurse, as everyone started to get a bit worried.  Her vital signs were fine.  Ultimately there were about 5 people in the room (including the Chief of Nursing Grandpa thinks), unable to wake Grandma, and then someone tried opening her eye and shining a light in it... which finally woke Grandma up to everyone's relief.  When this was later explained to Grandma, she said she felt bad about it, didn't know that was going on, but Grandpa reassured her and said that everyone was just happy that she woke up.

Grandpa put on some André Rieu music (cute classical stuff Grandma likes) and kind of danced with the laptop to the music, back and forth.  Grandma I'm told said to Grandpa, "You better not do that." Grandpa asked why not, to which Grandma said "you are not line with it," meaning Grandpa's rhythm was off. Ha!  They watched some more music videos on YouTube (great for Grandma; she loves music so much and I'm sure it helps with her brain's recovery) and then Grandma took another nap.

Unfortunately no speech/swallowing therapy again today.

The dietitian came in to introduce herself; Grandma would have been interested in this (since she keeps up on nutrition, etc.) but she is still asleep. The dietitian's only message was that Grandma's feeding has been adjusted for the high blood sugar -- I guess this is something that has come up recently but I'm not sure.  

It's difficult to put together these overview posts from all the emails and messages and other snips of information I get.  I usually write these just before I shower and go to bed and sometimes I'm so tired and I just rephrase and edit these emails so I apologize if the posts are sometimes a bit choppy.  Hopefully at least gives you an idea of how things are going...  It's a lot easier to write when I've visited in person, which I might be able to do this weekend.
Thanks.  -Christina

Monday 3-25

Grandma was awake when Grandpa arrived early in the morning.

Physical Therapist (Michelle Wilson) came in for an evaluation.  She had Grandma sit up with support, bend her arms and legs, etc.  Her right side is still weak, but hopefully that will improve with time.

Two other ladies from the facility came in: Tiene A. Gruber, Director of Nursing and another (Director of Social?)  Grandpa said one of these women came regarding Joyce's phone call and said she would investigate the issue the day before with the improper meal.  Grandpa said both of these ladies were very friendly.  (Joyce says she spoke with Missy Epps, the hospital RN and then Lisa McDonald, a Director of Nursing, maybe at the hospital? So many names to keep track of, but I'm putting them in there in case we later need to know who spoke to us about what...)

A nurse's aid came midmorning to clean up Grandma, and help her into pants and a tee shirt!  I'm sure it was nice to have some real clothes on for once... 

Grandma took a nap for awhile after that while Grandpa met with Marcia Matthews, Admissions Coordinator.  Grandpa discussed with her that we had heard Fairfield was better but were giving HH a try to see how it goes because of its closeness to the house.  She said someone from the Heritage Harbor Health Group (another medical facility where G+G have received checkups from time to time) would be there Wednesday for some kind of meeting.

At some point, Grandpa asked Grandma about putting on the TV, but Grandma shouted back, "No, I thought we were going home!"  When Grandpa explained that she was not ready yet, she said "why not, why can't we go home," and Grandpa very gently explained that they have to first make sure you can walk, etc.  So then they watched Grandma's show, "The Price is Right."

Not much else to report from Monday; Grandpa said they kind of sat around "waiting for things to happen," but not much.  I've been trying to think of some things Grandma might enjoy doing on days she's a little more alert... She's not able to do her cross stitch, she doesn't like to read or watch too much tv... Hmm. Let me know if you think of anything.

Sunday 3-24 Evening Pictures

Sunday afternoon, Grandma was moved to the Heritage Harbor (HH) rehab center again.  Those nurses there, well, I haven't seen for myself, but they seem to be a pretty flakey.  (Good thing Grandma has Grandpa, my mom, my aunt, and other visitors staying on top of these people!  Man!)

Apparently there was some sort of mixup -- When Grandpa arrived that evening right after the move back to HH, he found that Grandma was given a meal that evening that she definitely cannot eat -- As I understand it, she is still only cleared for pureed foods and honeythick liquids with the supervision of a nurse (in case something goes down the wrong pipe), but is receiving most of her nutrition through the stomach tube, which should be very clear in her file. But they plunked down a fish sandwich, fries, and veggies for her!  

**I think Joyce is trying to get in touch with the Director of the place to find out who messed up.  

Grandpa complained to the nurses who apologized and said there was some kind of mistake (not sure how you mess that up).  Grandma was "very alert" and "took everything in stride."  Two nurses also got Grandma all cleaned up for the night, and Grandpa helped Grandma figure out the TV remote, the remote with which she can call a nurse, etc.

Grandma also complained of a dry mouth and while it took awhile to obtain them, Grandpa managed to get the nurses to bring some of these sponge-on-a-stick things they use so Grandma can get some water without worry of choking (on say, a full glass of water).  Yay, Grandpa; a hero!  

Grandma also said something to Grandpa ("this thing is quite an ordeal") which he took to mean that Grandma is likely becoming a little more aware of her situation.

Lots of love and hugs for Grandma's recovery, and Grandpa's heroicism and wonderful, sweet support! What a wonderful man Grandma married. 

Sunday 3-24 Pictures

Pictures from my mom/Rosemary.

Sunday at Hospital, Then Back at Rehab

Here is an email my mom sent earlier this evening. -Christina

From: Rosemary Bolton
Date: Sun, Mar 24, 2013 at 6:43 PM
Subject: Today at the Hospital with mom

Mom was in room 440. This was the neuro floor and wow, what a great place.  All brain injury patients.  When I arrived, mom was relaxing but not fully awake. She just looked quiet.  Then we started talking and mom perked up, wanted to know the time, she knew it was Palm Sunday I am sure dad told her earlier.

Well, around noon mom's hospital doc, Dr. Farooq came in and said that he was discontinuing the antibiotics he was giving her. Her white cell count was down he said, I do not recall that he gave me a number. He also discontinued the oxygen. I asked him why she had that and he says they strap that on 90% of the patients that come in the ER -- almost standard procedure. haha

He said that Dr. Chopra at HH [Heritage Harbor rehab center] had already started mom on augmentin [an antibiotic] and that he would have to be the one to discontinue that.  So, this Farooq guy was really nice. He thought mom looked great, said her recovery is going very well, yes, there will be drowsy days and weak days, and very good days. He said mom could recover from this, he said "she just needs lots and lots of PT" [Physical therapy]  Her BP still gets high so he added hydrochlorothiazide, a low dose diuretic. Also a daily vitamin K with that.

The only thing mom said to me in regard to her recovery today, early early on when I just arrived, and she might have mentioned this to you Joyce, she said "I am concerned about being connected to all of this equipment" I told mom that the oxygen she did not need, she was not going to be getting any more IVs, (she has a port thing in now. I am not sure if they will pull that out) She was getting fed with a tube into her PEG. [her stomach feeding tube -CHA]  She has the foley catheter. I told her she was going to get rid of all of this stuff and eat on her own over the next few weeks. Every day was going to get easier and better.  She was really alert and perky. She needs her teeth in. Anyway, she seemed satisfied with my answer.

Daddy brought in some cute photos for mom to look at, she liked them, able to identify everyone. Interesting, today she seemed to have more trouble with words and naming things in the beginning of my visit when she was just relaxing, but as the day went on, and Particularly after PT, she was very chatty, asking questions, she listened when the doc came in as well (which was before PT).

So then, some cute girls came in, two PTs. Oh my gosh I loved them. I asked them if they could give mom PT forever, but they said they had to work at the hospital. drats!  These girls made mom do some exercises with her feet and legs. She had to flex and extend her ankles 15 times each, she was counting sort of, but the right side, that is WORK for mom. Then the PTs had mom flex and extend her leg at the knee (one leg at the time). Left leg worked fine of course and the right leg was a struggle. Mom is so funny I was watching her and she was trying with all her might to get that leg to bend, she was making some huffing and puffing noises and really trying. The PT helped her a little -- so this side also was to be done 15 times. I think mom only made 9 or 10. It was really hard, the part that made me laugh though was when she would get her knee up to a point, she would reach over with her left hand and try to get hold of her right knee to "help" pull it up, which was not what the exercise intended but it was cute. She never could really get hold of her right knee anyway but I was impressed with her strength on her left (good) side that she was able to reach up and over. They also put one at a time, each knee on top of a big pillow and had mom lift her foot. The PTs were impressed with moms strength.

Okay, after that, the PTs got her on the side of the bed and had her sit with her legs hanging over, feet on a pillow that was on the floor.  They brought in a mirror so mom could see herself and try to get herself straight. She did well, but for her right side, it is hard work. Mom tells me she does not feel fully on her right side, just some areas. So she might have numbness, or just altered sensations on the right. Her muscles are good. Mom told the PTs some time early on "I used to be able to do that" and they assured her that she will again.

I gave both of her legs a good massage after the PTs left. Mom looked pooped. Well, then the nurse came in and said that the paper work was being processed to get her out and back to HH. She could not give us a firm time for that.

Daddy and I were ready for some food. So we thought mom would conk out and we could go to the cafeteria.  Mom did not conk out, so we just told her we would get something to eat and be back.  We came back 40 minutes later and when we walked in, mom said "Hey you are back!"

Then there was a lot of talking going on with the three of us about going back to HH and mom seemed happy about it.

I showed her pictures on my ipad of some of my sewing projects, then daddy discovered a bunch of great old photos on mom's olden iBook, lots of great pictures of Brussels, and Greece, WOW, mom was a total snazz in her adorable outfits, goodness. She LOVED looking at the photos and she was remembering things.  It seemed the more photos we showed her, the more she remembered. Daddy had these old pics of mom helping gramma DeLeeuw (daddy's mom) do the knitting projects, and also fitting garments that mom made for gramma. Adorable pictures. I have to say, daddy's mom just loved mom. She thought mom was amazing that she could do so much, so many incredible things. I see a lot of Dolley in these old pictures of mom. Face shape, nose, eyes. Dolley would have been a beauty now in her 60's.

So I am hoping -- guessing that mom made the move in the "Limo" back to HH.  Daddy I hope the move went well.

I guess the only concerns I have at this time would be that:
- I hope the PT's at HH communicate with the "nurses" at HH about proper positioning in chair and bed.  The PTs at AAMC said mom should not flex her right knee like that all the time, try to keep her leg and hip anatomically straight and do that with the aid of pillow or roll.
- Some one needs to rub and massage mom's legs. hahahahaha she loves it. I think it helps her fidgetty left leg, and stimulate her right leg.  She should have her arms massaged too.
- Will Dr. Chopra at HH discontinue the Augmentin? I think Dr. Farooq was hoping he would.
- Mom needs to start wearing her teeth during the day… start slow if we have to, few hours longer every day if she is having trouble with sensations.  We do not want her to get sores from her dentures because she has not had them a while.
- Mom needs a lot of GOOD PT, and good nursing. Not just GOOD PT and babysitting by nurses. I do not want falling asleep in a wheelchair half the day.
- Daddy, you can tell the nurses at HH that mom used to be a volunteer, maybe she can help them... [hahaha, wow, that would be hilarious... -CHA]

It was a great day. Mom seemed happy, she and daddy are so cute together. Daddy is really so supportive and attentive. That is endearing.

Daddy, can you think of anything here that I did not cover?

I hope every one had a great week-end. I enjoyed this visit with mom and dad a lot today.

Love, Rosemary

__________

More from Saturday from Joyce:



From:  Joyce DeLeeuw
Date:  Sun, Mar 24, 2013 at 9:06 PM
Subject:  Re: Today at the Hospital with mom

Great summary of the day!

I am so sorry all that I didn't do it yesterday-- I actually wrote a huge long thing with too many detail, and went to send.... and it wouldn't connect. I lost it. Then too tired to write.   But it was very similar to Rosemary's description.  

She was sleepy in the AM, woke later, and was really talking a lot mostly about knowing that things were different now. But she said over and over that what is now, would be different in an hour, or the next day. That told me that she had a handle on the fact that she has these different "states" as dad likes to call them--- sleepy state, talkative making sense state, talking making no sense state, lethargic and dopey looking, or a panic look. She seemes to move into and out of these states. But maybe gradually, the changes won't be so apparent and pronounced.  Don't know.  She also had PT yestereday- very similar as today- very cute, very hard for mom, but so fabulous, I applauded and cheered when she got in that sitting position. It was like scoring a point!  I also liked this doc Farooq and it occured to me, dad, when we went to the Fairfield yesterday, he was the doc sitting at the central station - they said his name, I just didn't put it together, he didn't have his lab coat on.   [Dr. Farooq also works at the Fairfield rehab facility]

Regarding the concerns, I think we need to write this stuff down, as I agree there are things we need to stay on top of. Remember dad you were going to bring some familiar things to HH? Are you still going to?

Anyway, how can we make sure we get our communication to the staff?   How about a binder in color.  oh yuk.  whatever.

Anyway, dad have a great day tomorrow- now you are so close that hopefully you won't get so worn out with travel. See how it goes. I am really hoping for the best. We are a pretty good team I think!!!    

love joyce

Saturday, Still at Hospital

Grandma is still in the hospital but it sounds like she can be discharged tomorrow, upon a final review of her blood work.

Grandpa reported that today he visited with Joyce and that they had a pretty good visit with Grandma being alert most of the time, contented and relaxed.

They met the doctor of the department she's in now (neurology unit he thinks), Khawaja Farooq, MD.  He is the decider on when she could be released, and that would probably be tomorrow.

He and Joyce also checked with Heritage Harbor rehab center; her room is still available if she is released tomorrow as expected.  Even so, Grandpa and Joyce visited Fairfield and were given another tour.  While Joyce was impressed and I think believes Fairfield is superior to Heritage Harbor, and it is possible to transfer Grandma there if necessary, Grandma has indicated that she would prefer Heritage Harbor because it is so close to the house.  So let's hope that Grandma receives the proper care she needs there. <3

Cute anecdote from Grandpa's email: "[A]t one time later Mom apparently decided she was warm enough,  folded up the shawl [the knitted prayer shawl from the church ladies] quite expertly and threw it onto a table at her foot end." I can imagine this so well-- and glad that she was able to do that on her own today!  :)

__________

Some more notes from yesterday:

• Joyce spoke to the admitting doctor when Grandma was brought back to the hospital; he was very kind and happy to speak about what was going on.  
• He did confirm that Grandma's CAT scan had shown improvement.
• Her blood work had shown a moderate rise in white blood cells (WBCs), but not an alarming rise, and that even if the infection had cleared by the time she left for the rehab place there were other things that could have caused increased WBCs like this -- even just added stress to the body from having a foley catheter or the feeding tube, or the new environment at the rehab center, all the unfamiliar things Grandma has had to deal with -- kind of like the body is on high alert, just in case. 
• Grandma does not have increased temperature or any other reason why we would suspect infection simply from the increased WBC, so he ordered a new catheter to be placed and would continue to check for any other evidence of infection.

Love to all.

Back at the Hospital [Updated]

3:45 PM --  I just got an email from my mom; Grandma is back at the hospital today.

Grandma had a busy morning.  The nurses put clothes on Grandma, put her in a good wheelchair**, gave her a tube feeding through the gastric tube, she worked with a couple of therapists, had a bite of some food, and then she got quiet and "unresponsive" so the nurses called 911. [She's fine! Keep reading... -CHA]

Her blood pressure is normal, but the doctor yesterday did say that her white blood count was still stubbornly high.

My mom/Rosemary thinks that perhaps they freaked out, but we have not heard from Grandpa so I don't have a lot of details.

**They have special narrow wheelchairs that help keep her sitting upright since she is not very good at sitting up on her own right now.

___________

4:05 pm -- Per my mom's comments on this post (click below), the rehab nurses apparently panicked, not realizing Grandma had gotten sleepy and zoned out!  *sigh*  *shaking my head*

__________

8:30 pm -- Grandma's fine.  Received another email update from my mom:

I talked with a nice guy nurse there in the ER.  He said mom is resting comfortably. She is alert and pleasant, talking a little bit in the usual slurred speech.  He verified that this was normal for post stroke patients at this point. A little bit of alert and awake, and then very sleepy.Dr. Tim Woods is informed that mom is back.They will transfer her to a room on a medical/surgery floor in the next two hours.She is doing fine. They did a CT scan, it looks unchanged, healing, no new bleeding. Mom's vitals BP temp are good and great.This is all good news. The ER nurse guy said he did not know exactly at this point where she will be but on a nursing floor as she is stable.

In short: Grandma is back at the hospital, but nothing different from before.  She is fine; it's just that the people at the rehab place freaked out when she got very tired after a busy morning.  I'm not sure what the plan is for how long to keep her at the hospital, but I guess we'll see how this weekend goes.

Thursday 3-21 Pictures

Grandpa wrote late last night with some adorable pictures of Grandma.

She was feeling depressed at one point in the evening, saying things like she had last weekend at the hospital, and feeling like she was never going to get better, etc.  Grandpa watched some TV with her and she had some food.  Later, she said (without Grandpa's asking) that she felt happy again, so that was a good ending to the day.

As my mom said this morning, many people have this after a stroke or brain injury.  It is so frustrating to have so much of your independence taken away from you so quickly and the task of working toward recovery can seem daunting, especially at 90 years old.  We must allow Grandma to say these things, get these thoughts off her chest... and then encourage her and remind her of how well she is doing, how far she has come, and how very much we love her, will listen to her, and will help her get better.

One day at a time. <3

 

Wednesday and Thursday

Wednesday March 20:

• When Joyce arrived, Grandma was sleepy as usual but alert.
• The nurse said that a new CAT scan had been done and was good, showing healing in her brain.  Medically she's considered stable.  This is good.
• The nurse also told Joyce that Grandma's discharge was planned for that day!
• Joyce met with the doctors on duty, Dr. Atkins, who said she felt really good about Grandma's condition.
• Physical therapy came by in the afternoon to work with Grandma.
• Joyce and Grandpa met with the hospital liaison for the Heritage Harbor rehab facility, citing some concerns raised by some other woman Grandpa had spoken with at the neighborhood health group, regarding the staff. Apparently there were some complaints with customer service and patients having trouble with the nurses.  
• This woman assured Joyce those problems had been addressed, but I guess they had some misgivings so Joyce talked to the health group woman who indicated that the "culture" at a different facility (Fairfield in Crownsville, MD) was much better and that were it her own mother she would have chosen that one instead. 
• Ultimately they decided to go with Heritage Harbor since it would work out better for Grandpa (so close for him, walking distance) and if things didn't work out we could see about having Grandma transferred to Fairfield (except this place would require some driving and it's better if Grandpa does not have to drive as much).
• Joyce had to leave in the afternoon, but the ambulance took Grandma over to the Heritage Harbor facility soon after that.
• Joyce did add that at some point in the afternoon, before the move, Grandma "was awake as could be. Her eyes got big and she started asking questions and then singing, etc. It was funny. Mom was great." [-- so cute; wish I could have been there! -CHA]
• While Grandma was in a room with another patient for the night, she will ultimately be in a private room at this place, which is terrific.

Thursday March 21:

• My mom/Rosemary went out with Grandpa today.
• She indicated that the upstairs rooms of this place (where Grandma was for the night) are a bit noisy, which she thought might have been taxing to Grandma's brain, but when asked Grandma said she did not feel tired.
• Mom said Grandma was semi-alert today and knows where she is, but had some common troubles when fatigued like having difficulty forming words and relating correct information. "Nothing terribly out of line, but she could not remember her age and other number associations. She could read the clock. She told us the time."
• Mom said Grandma also "slept what appeared to be deeply, but she was paying attention at other times. Sometimes you think she is completely conked out breathing deeply, but she will wake up in an instant and laugh at something said."
• Today the Physical Therapy and Occupational Therapy nurses came in to do an assessment of what Grandma could do in terms of range of motion and strength.
• Grandma was put in a wheelchair for awhile today too, which is the first time in two weeks that Grandma was upright in a straight chair. (The chair she was in at the hospital is more like a recliner.)
• The Speech and Swallowing therapist also came by to have Grandma do some exercises with her mouth and tongue.  She did really well, but Grandma was too tired to do some good swallowing, so they were not able to give her pudding. Maybe tomorrow.
• Mom made sure to order an air flow mattress for Grandma's bed.  This mattress adjusts its puffiness from time to time kind of like an electronically-pumped air mattress that adjusts its pressure every few minutes.  This will help keep Grandma from getting sores from laying relatively still in bed for long periods of time until she is able to really move around on her own better when she gets uncomfortable.
• In the afternoon my mom and Grandpa went to check out the other facility, Fairfield Nursing Center, in Crownsville, MD, just to have a look around.  "That was a really nice facility, very open and a good layout, wide halls, sinks right next to the doors in every room . . . This is a great facility but this would be a hard drive for daddy." [Maybe about 15-20 minutes? -CHA]
• They went back to the Heritage Harbor place to see Grandma again and spoke with the Director (Andrea something) and a woman in charge of floor operations about some concerns about Grandma's care and the staff there.
• They also met with the doctor (Dr. Chopra), who will come in three times a week at this place.
• He indicated that Grandma's white blood cell count is high again. Usually this indicates a possible infection somewhere (white blood cells fight off infection).  I'm not really sure what to make of this, since Dr. Woods at the hospital said Grandma would not be moved to the rehab facility until she was cleared of any infections...
• The doctor said they would start Grandma on a different antibiotic since whatever she received at the hospital was not effective apparently.  This is a common next step, we'll see how that goes.  They are also going to do some tests in the morning. If they can't clear the infection or determine the cause, Grandma will have to go back to the hospital.
• Grandma was partly sleeping during most of the later part of my mom's visit, but she was alert and responsive while Mom and Grandpa talked with the Director of the facility.

So that's all I have today.

Hopefully now that Grandma is in rehab and her care will be more focused on improving her strength and abilities we will continue to see more and more progress.  Keep up the prayers and positive thinking! <3

Moving Postponed

My mom and sister went over to Annapolis today.
I haven't heard much, but here are the key points:

• Grandma has another urinary tract infection.  They started her on antibiotics today.
• As a result, unfortunately, today was NOT moving-to-the-rehab-place day.  She will stay at the hospital another few days until cleared of infection and then she can move.
• Mom said Grandma was sleepy but that she looked good.

I'll probably have more news tomorrow once I've talked to my mom, but I expect it's a lot more of how Grandma has been in the last week.  Keep up the happy thoughts and prayers for Grandma to get over the infection soon, move to the new facility, and get focused on her rehab!

Follow up:  My mom left a comment on this post; click below to see it! :)

Sunday 3-17 Pictures

Click any image to view a larger version...

 Getting comfortable in the morning

Listening to fun, happy music on YouTube videos on Grandpa's Macbook Air

Even the dentist sent flowers for Grandma! 

Other members of the "press corps"!

One of my moms "motivational signs" for Grandma :) 

Lunch in the cafeteria at the hospital.  Grandpa has taken to the place, suggesting to Grandma, "When you get better, we should come back here to eat; the food is good and there's free parking!"  She thought that was funny, but I'm pretty sure Grandpa was serious...  :)

A Better Day - long post

Today, I (Christina) visited with my parents.  We arrived trying to feel positive and wanting to talk with the doctor about things, and it was a pretty decent day all around.

Grandma was very sleepy again, but the nurse says she does not remember anything from yesterday -- the nurse had asked Grandma earlier this morning whether Grandma felt good today [yeah] and whether she felt better than yesterday, and Grandma basically said she didn't remember yesterday.  I wonder how much of this is her difficulty with short term memory and how much of this is due to the amnesia medication they gave Grandma before surgery (sedative and would keep her from remembering anything from surgery)-- maybe it took awhile to wear off and messed with her mental processing and ability to remember anything.  In any case, we were all kind of happy for this...

Grandpa arrived shortly after we did.  We played some music, talked to Grandma, tried to encourage her to wake up and sit up a bit.  Grandma complained of feeling "dopey" today, and we reassured her that we were going to check but that we suspected that some of her medications could cause drowsiness.  She seemed to accept that as a decent explanation, perhaps even feeling like, "Ok, so it's not just me, it's the meds." (In fact, I ultimately looked up these drugs in the afternoon and most of them did list drowsiness or tiredness or similar symptoms as potential side effects, and I'm sure that with all of these combined it wouldn't be a surprise if at least one was making her a bit sleepy.)

The nurse we met today was wonnnderful.  She was great to talk to and was attentive to make sure Grandma was receiving things as needed.  While it took awhile for her to get some information she was good about following up with us and making sure we had a chance to talk to the doctor (Dr. Timothy Woods).  That doctor was also wonnnderful and was happy to stay and talk and explain things!

This is what we learned today:

• There are two types of strokes: clotting (ischemic) and bloody (hemorrhagic); Grandma's was hemorrhagic, and caused a bleed a bit bigger than a golf ball deep in Grandma's brain.  The doc described this as "not huge," "not a major bleed," but not itty bitty.
• Clotting strokes (where part of the brain stops receiving blood due to a clot) have a relatively "predictable" course of recovery, often described by the time it commonly takes to achieve certain milestones ("three days, three weeks, three months"). 
• Bloody strokes (where a sudden bleed causes parts of the brain to have trouble functioning by putting pressure on parts and messing up neural transmissions) are a little trickier, recovery is much more variable. 

• Part of this is because we have to wait for this blood to get reabsorbed and see how things improve.  The doctor said this could take a month, month and a half or so, and we will see some improvement just from that over time.
• The other reason recovery is a little more variable and harder to predict is because we don't know how her brain will do while things develop-- I think the doctor indicated that it's possible for parts of her brain to recover better than others, since the blood on her brain will ultimately affect parts her brain more or less than others. We will just have to wait and see how things go.
• While she will continue to improve, the question is also when will that improvement level off (probably some months down the road, or longer, depending) and what level of improvement there will be.  He seemed positive, but again we'll have to see.
• The doctor said he thought Grandma was "progressing as expected" and that her sleepiness was totally normal.  He assured us that her alertness will continue to wax and wane until her recovery reaches a stabilized point, but that in the meantime it is good for her to rest.
• The stomach tube, he reiterated, is a temporary thing.  The NG (nose) tube she had is pretty irritating to have for too long (He said almost all patients will rank it worse than any other medical tube including IVs and catheters.) and that this gastric (stomach) tube will not only be more comfortable, but it will help her as she learns to swallow better.  (She has trouble controlling the back of her throat, so this is something she will continue to work on in rehab.)
• Grandma will keep this tube for maybe 1-2 months.  He added that, "If, after that time, we see no improvement or a deterioration in her condition and ability to feed herself, then you have to ask yourself a philosophical question about, 'what are we doing here,'" but reiterated that he thought she was making good progress and didn't anticipate things getting to that point.
• Because she still has occasional issues with swallowing, her ability to take food by mouth will take some time and has to be with the approval of and probably under the supervision of a Speech and Swallowing therapist, but in general she is getting there and has shown she is capable.
• Grandma's chart shows something about "DNR" status (Do Not Resuscitate); between the nurse and the doctor, neither was entirely sure how that was in her chart, who put that there, and why, but the doctor said this is NOT affecting how they care plan for Grandma and that it would only come in to play if her heart were to just stop and he did not anticipate that happening.  (I imagine Mom/Rosemary will investigate this further when she returns to the hospital tomorrow, but I don't know...?)
• The doctor also apologized for some of the communications about doctors dropping by being inconsistent, saying that they've had to shuffle a lot of staff around due to people being out for illness, and one of his doctors had to leave for his mother's funeral, so it's been a bit of a struggle covering everything.
• THE BIG NEWS TODAY:  Because Grandma received the gastric tube Saturday morning and was starting back on food (via tube) today, assuming she tolerates that okay (which she should because it's the same stuff she received through the nose tube), SHE CAN BE TRANSFERRED TO REHAB TOMORROW!!  
• The doctor said that assuming everything goes smoothly, she can be transferred to that place in Heritage Harbor near their house (so close, Grandpa could walk there).  Hooray!
• What might hold this up is if the facility doesn't have any vacancies, or if they have some other reason they can't admit her at that time, but we have our fingers crossed that everything will go great tomorrow without hiccups.

Grandma listened through most of this entire discussion.  She picked her head up and followed everything pretty well, and seemed encouraged by the doctor's positive attitude about the whole thing... and the prospect of moving tomorrow.

Mom, Dad, and I left around 4 PM, but I understand that Grandma had physical therapy at that time and while she struggled a little to keep up she completed everything "reasonably well."

I might add some other anecdotes tomorrow if I can, but really that's the BIG NEWS today so I think it's a good place to stop for now.  I also have a number of photos to add from my camera, and I'll try to do that tomorrow too.

 KEEP UP THE HAPPY THOUGHTS