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