Thursday Update from Annapolis

Hey, there! Today was another adventurous day.

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Highlights from Thursday, April 4

• Grandma began the day "in a grumpy mood," she said
• The Head Nurse and a doctor visited Grandma to check in
• She worked with the Speech Therapist and Physical/Occupational Therapists
• One of the ladies from the "stomping class" (ie. neighborhood exercise class) visited Grandma!
• Grandpa and Lizzie brainstorm questions for tomorrow's Care Conference (4/5 at 11:00 am)

Details:

According to Grandma, she woke up "in a grumpy mood." (Grandpa and I told her this was fine - that we all have days like that... I said sometimes I go to work grumpy and have to put on a pretend smile all day). Grandpa says that Grandma did complain of some pain on her right (weaker post-stroke) arm this morning. We wonder if it is from the stroke/recovery or if she simply slept funny in the bed last night.

First, the Speech Therapist (Kristen) came in to help Grandma eat by mouth. According to the ST, she didn't eat as much for breakfast as yesterday, but her swallowing was good. The ST says that Grandma's little eating this morning is likely due to a few things... first, that she had been woken up very recently and even Grandma admits she always takes a bit of time to wake up. Second, Grandma is gradually fed with the G-tube from 2:00 pm - overnight, until 10:00 am the next day. The ST says this could cause Grandma to not feel hungry enough to eat when she comes for therapy. Grandma's nurse says they stop feeding in the G-tube between the hours of 10:00 am and 2:00 pm daily, to allow Grandma to work with the ST, PT, and OT's without the extra tube.

After eating, Grandma worked with two new Physical/Occupational Therapists, Sue and Christine. They put a machine on Grandma's right leg to stimulate it. Grandma consistently notes that she feels discomfort and/or pain when therapy involves this machine. She was also moved into the chair to perform some additional therapy, but since Grandma felt a little sleepy and grumpy this morning, my understanding is that she did not do as much PT/OT today.

Around mid-morning (11:00am), the Head Nurse (Anina) and a man named Dr. Chawdra (spelling may be incorrect) visited Grandma to check in and provide an update. Anina told me that Dr. Chawdra was a doctor specialized in infectious diseases. They said that they have been monitoring Grandma with her catheter, and wanted to be sure things were ok because one of the nurses said that Grandma's urine was dark and had a bit of a strong odor. Dr. Chawdra said that Grandma's white blood count had gradually gone down from a few weeks ago, and that this was good progress. He said that Grandma showed no external signs of a Urinary Tract Infection now, and that on the contrary, she was alert and appeared normal. "My job is to treat the patient, not a catheter, and so far, I see no symptoms that indicate a UTI," he said. Nevertheless, Dr. Chawdra and Anina said that another culture had been sent to the lab to be sure that no UTI is present. As soon as the results are in, they will share them with us.

Dr. Chawdra said that he would like to remove Grandma's catheter as soon as possible. Although they take all precautions to keep things clean, any "foreign body" like a catheter creates a risk of infection. They would like to see Grandma using the toilet, even if it is with assistance. They asked Grandma if she had ever had difficulty urinating before - even before the stroke. They seemed pleased with her answer (she said no) and noted that this means the catheter can be removed very soon!

Grandpa and I left Grandma alone for a few hours to rest, as she was tired from the bit of therapy she had in the morning. When we returned, the Speech Therapist visited at 1:00 pm to help Grandma eat lunch. She ate about 30% of her pureed turkey and cranberries and also enjoyed some juice and water - all with a honey-like consistency to practice her swallowing. Grandma needs to eat even the juices and drinks with a spoon, so that she does not take large "gulps." The spoon helps to regulate the size of sips she takes so that she can focus on swallowing. Grandma did great eating this afternoon, took her time.

The ST said she would like to put Grandma on a "pleasure feeds" diet - meaning she would eat the puree whenever she wanted. However, someone must always be present to supervise her independent eating (as mentioned before, this further explains the NPO sign above her bed). Kristen (ST) explained a challenge with all patients who are transitioning off a G-tube: first, the goal is to taper off, not to drop it all at once. She also must work carefully with the dietician so that Grandma does not lose a lot of weight. The G-tract feedings must decrease in order for Grandma to feel hungry enough for "pleasure feedings," yet we must ensure she maintains her current weight in order for everything to work properly. It is a tender balance that must be carefully orchestrated. *Expect to hear more about this tomorrow and/or Monday!

Grandma had a visitor from the "stomping class" today. She was so happy to see one of her friends - I think her name was Mary. Mary brought a beautiful card with many signed messages. Grandma recognized her immediately, and started asking a lot of questions about how life was going. Grandpa and I think Mary's visit cheered Grandma's spirits. By the end, she was cracking jokes and being her usual self. I think it also reminded her how much she misses being busy, and inspired her to keep making improvements so that she can leave the Rehab Center.

Grandpa visited Grandma again before dinner, this evening. He reported that Grandma still has trouble reading with her glasses and expressed tonight that she had restless legs. We will all be thinking of her tonight, and praying that she has a peaceful, restorative sleep! We encourage her to press the red button to call the nurse when she needs help.

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UPDATE: Tomorrow morning at 11:00 am is the long-awaited "Care Conference." Grandpa and I put together several questions, including:

1. From your observations, how much are Grandma's challenges neurological (ie., results of the stroke and recovery), and how much merely muscle weakness (from being in bed for 1 month)?
2. How many stroke patients have you helped rehabilitate, and what seems to be the largest challenge during recovery?
3. How can we BEST help Grandma as she recovers?
4. Why is the weekend rate at Heritage Harbour Rehab Center the same as the weekday rate, but includes NO therapy (ST, PT, OT)?
5. Why does the therapy machine for her right leg (weaker, post-stroke) cause Grandma pain? Can you offer any explanation - is this typical?

Please let us know if you have any questions you'd like us to add.

Love,

Lizzie and Grandpa