Friday, March 15, 2013

Friday 3.15

[Sunday 3-17-2013] Sorry it took me so long to post; it's been a rough few days at work, home, and everything else so it's been hard to find time to sit down and write...  -Christina

Mom/Rosemary had a meeting with that Chesapeake Palliative Care (?) girl - Heather Travis.  She seemed utterly clueless as to what we've heard from the other nurses as to Grandma's progress, saying things that were really not true (saying things like that Grandma was not doing as well as the actual doctors have told us, etc.)!!  So strange.  In fact, I'm not even going to summarize anything she said since she was really off-base.  We're not really sure how she came by (whether she was sent by the hospital or not), but I personally suspect she was from some post-hospital-care facility and was trying to get us to transfer Grandma to their place so they could have our money.  How slimy!

ANYWAY!

After the meeting, Mom and Grandpa went back to the room and played some fun German dancing music and Andre Rieu videos for Grandma, and she really enjoyed this.  She was sleepier this day, and we suspect that some of the medications she is on have side effects that would be causing the sleepiness.  She is not on a ton of medications, mostly drugs for blood pressure but also something for her restless legs and Tylenol.  In any case, we hope to investigate that some more over the weekend.

While Mom and Grandpa were at lunch, this really sweet care technician came by. Mom says she had cute flowery tattoos and said she was "really sweet, so so kind" with Grandma.  She gave Grandma a bit of a BATH!  Cleaned her up really well.  "Mom looked great!"

After lunch, Mom and Grandpa found more YouTube videos of Grandma's favorite music -- Heino, Gerard Cox, Andre Rieu, and Freddy Alexander...  (Thank goodness for free wifi in the hospital!  This has been wonderful.)  Grandma was sleepy, but she really enjoyed the music, smiled, and mom even took her hands at some point and "danced" with her. Ha! So cute.

The hospital folks talked to Mom and Grandpa about Grandma's nutrition. Up to this point, Grandma was receiving her nutrition through a nasogastric tube (NG tube), the tube down her nose and throat to her stomach.  This tube is kind of a temporary fix (inserting it isn't a surgical procedure, just gets the job done), and it does make things a little more difficult with swallowing, could make some things irritated, etc.  So the next step would be to switch to a gastric tube, a tube from her stomach to outside her tummy where food and medications can be given that way. This is a very common procedure, and in Grandma's case is seen as a temporary setup, until Grandma can meet all her caloric needs eating food normally.  So the plan was to have the surgery this Saturday morning.

All in all, a lot of the same from earlier this week.  Kind of sleepy, but not unexpected.  Still need to keep Grandma positive.  I can't remember if I've said this before, but Grandma does have times where I don't know how clear her thoughts/understanding is but she will say things like, "I'm 90 years old..." "I don't know if I can do this..." "There's an end to everything..." and we have to remind her that she is not dying and is in fact doing very well.  There sill be difficult days, but everyone thinks she is progressing as expected and should focus on recovery.  Of course to what real extent of recovery remains to be seen, but keeping Grandma positive is very important right now.

Thanks for keeping her (and Grandpa) in your thoughts.  The cards and notes are wonderful!  We love to show Grandma her cards and re-read them with her to remind her how many people love her and are thinking of her.  :)

Thursday, March 14, 2013

Thursday 3.14

[Sunday 3-17-2013] Sorry, this was up Thursday, but then I had to edit it and forgot to re-post! So sorry!
-Christina

...........................

I haven't really heard anything since Tuesday, but hoping that "no news is good news" and assuming the last couple days have been a lot more of the same as earlier in the week.  Some reports below from Grandpa and Joyce.  My mom/Rosemary is going tomorrow for a meeting with a lady involved with the ultimate moving of Grandma to the rehab facility.  We'll see what she says.
-Christina

...........................

From: GRANDPA
Date: March 14, 2013, 11:20:30 AM EDT
To: ROSEMARY
Subject: Mom this morning

Nurse Stacy still here, but not tomorrow.
Told me occupational therapist was here & Mom did pretty good, but now she is worn out. I put the music on which she wanted low but follows attentively (moving her finger). Nurse had fed her some apple sauce, which she swallowed readably well, but they have to take some kind of test to check whether it actually goes to the stomach.
Another important point. Nurse said that under some kind of rules she may be considered ready for moving to the rehab pretty soon. If she does not properly swallow they would put some kind of tube in surgically to her stomach!  She talked like this was often done. She said she would hope they could keep her at least over the weekend! Of course I emphasized I would like to keep her here until she can move without a tube. (Mom just asked me to raise the music volume ). Stacy just said the speech was ready to come, but they agreed to postpone until later, hoping she'll be more perky  then.  Mom's legs also became restless again so they'll give her some Tylenol.

...........................

From: GRANDPA
Date: March 14, 2013, 6:43:42 PM EDT
To: ROSEMARY
Cc: JOYCE
Subject: Update  at end of today (Thu, March 14).

Around 1:30 I left Mom's room to spend some time in the cafeteria, and after I came back a  rep of a group called Palliative Medicine Consultation, Heather Travis, NP, was waiting to meet with me & mom. At my suggestion she sat down with me, away from mom's hearing. (Actually, I just noticed that the name of her office is Chesapeake Palliative Medicine (445 Defense Highway) and I'm not sure now whether she is on the staff of the hospital).
Anyway she said that at some point a decision will have to be on how to proceed with mom, namely to move her (to a rehab center) with or without a tube (either thru the nose or to the stomach), and that all these methods have risks. For example, even with a tube, the patient could inadvertently take food by mouth, and in all cases food could wind up in the lungs. I don't think Mom at this time is able to make decisions about this and I said  I would consult with my daughters and that you would come in tomorrow and Joyce Saturday. She then suggested and I agreed to a meeting tomorrow at noon (if you can't make that let me know) and she then said that they could set up what she called a speaker phone connection so Joyce could participate). So I hope you two can have a preparatory get-together by think of questions, etc to ask this lady, who said she is member of a team that recommends or decides what to do. She seemed a very friendly and informed person. I am certainly glad however that you had decided to come here tomorrow.
In general Mom seemed to be kind of tired (sleepy) today. Nevertheless I think she did very well with the therapists. Particularly with the speech therapist checking on her swallowing. She ate a whole container of that apple sauce (about 12 spoonfuls!) and after that about 3 spoonfuls of that apple juice [honey-thick consistency -CHA] and then a spoonful or so of water. I thought that was real progress.
An another issue you may want to inquire about is that they found a big difference in blood pressure sitting up and lying down. I believe they were going to give her medicine for that.
Finally, however, it seemed to me that mom still has (or has wound up with) poor short term memory. For example asking where she is, telling me she does not have the right eye glasses, saying today she was married 70 years, that this year is 1998, etc.
So I'll see you tomorrow. (Just spoke to Rex and agreed to charge up the iPod and take the cable for connecting to the MacBook Air)

...........................

On Mar 14, 2013, at 7:07 PM, ROSEMARY wrote:

Oh my,
poor mommy with regard to her memory loss. I believe perhaps it becomes more apparent when she is fatigued after a lot of activity.
Yes, I will be at the hospital before noon. Hopefully. The only thing that would delay me would be some massive traffic tie up. I plan to leave the house here at 9:30, which is just the tip of the end of the rush hour here, so I will be there as soon as possible.
From everything I have read, this sleepiness is all pretty much par for the course for now.
I am interested to find out what new medicine regimen she will be on.
I hope you have a restful evening daddy. spend a little more time relaxing and reading something for enjoyment and go to bed early.
You need the sleep.
See you tomorrow
Love, Rosemary

...........................

From: JOYCE
Date: March 14, 2013, 9:57:45 PM EDT
To: GRANDPA, ROSEMARY
Subject: RE: Update  at end of today (Thu, March 14).

Hi Dad and rosemary,
Well,  I do hope that you can get a hold of me when you have this meeting. Rosemary, call me at either one of the numbers I gave to you.
Alot of these practicioners are consultants nowadays, (and it sounds like it based onher group name) , but its good because this topic is  part of her specialty  area.  Anyway, I think you could learn alot.  The tube in nose is the one that could become misplaced for some reason, and end up in the lungs instead of the stomach. Thats why they do the XRay before actually using it- to confirm placement. The other tube would be placed inher stomach- and come out of her tummy. You wouldn't have food end up in the lungs, but it requires a little procedure to make a hole t o place the tube thru- therefore, an opending that would always require a dressing (bandage) of some type.  That dressing would have to be changed regularly and the open hole is potential site for infection, so has to be taken care of a bit.  This is a common procedure tho, and nothing to be scared about.   Anyway, lets see what she says!
  Well, I guess with her short term memory problem, she may be lucky in some ways, and not in others. I mean it may bug that she has to keep asking about certain things or whatever, but at least she doesn't remember that she asked before and have to feel bad about it! Also, maybe she doesn't really even remember things that are unpleasent (getting the nose tube, or someting else) and have to ponder on them....
Have a good day tomorrow.                                 love joyce

Tuesday, March 12, 2013

Tuesday March 12

My mom and dad visited today.  Just a few things to report:
  • Another more quiet day, but Grandma is doing well.  She was sleepy at times, but she was alert and knew what was going on, happy, etc.
  • My dad put some music on her laptop for her to listen to, and she was SO happy to listen to that, even moving her arm to the music and "conducting" a little!  I think this was some organ music she received on CD in the mail last Monday from a friend in the Netherlands.  Perfect timing!  Music is fantastic for recovery from all sorts of brain issues/trauma.
  • Mom reports a nice woman from the rehab center came to visit, and talked about Grandma being transferred there soon.  Not sure when exactly that will be yet.
  • They've found that Tylenol helps a lot for Grandma's restless legs, so that should give her some relief.  If it was keeping her up at night, then this will hopefully give her some rest.
  • Mom says she talked to the neurologist who said that the drowsiness is normal and will continue for weeks or months, part of the healing process.

Sunday Pictures

A few pictures from Sunday.  
The first two are mine; the last one is Grandpa's.

A church friend brought the flowers from church that morning.

 Speech and Swallowing therapist working with Grandma

Happy Sunday!

Monday, March 11, 2013

Quiet Monday


Received a few messages today from Joyce and Grandpa.

Grandma was much sleepier today, which was a bit disappointing to Grandpa.  I think she was worn out from the weekend, especially Sunday with all the therapists and visitors, and Joyce and my mom/Rosemary agree.  

Joyce also suggested that perhaps Grandma is not getting a ton of rest when we are not around (in addition to also not getting rest when we are around), perhaps waking up at night too, so then she needs some days to rest up a bit more.  And it's not easy sleeping in a hospital to begin with!  (Honestly I feel this is to be expected; I myself was even wiped out yesterday and a bit today from the busy day Sunday and I'm perfectly healthy!)  

Mom/Rosemary added that from everything she has read, these days of extra sleepiness are to be expected and are a normal process of the healing post-stroke, and that just because she is sleepy and her eyes are shut, does not mean that she is not aware of sounds or activity.  Just knowing we are still visiting and being there for her will be a comfort. 

We will keep an eye on things, but I think we agreed it is not yet anything to be worried about and that for now it is important to remain POSITIVE and remember that this is all part of the process of recovery.

Joyce called the nurse to check on things and the nurse reiterated that Grandma was sleepier today but did not indicate that there was anything particularly bad about that.  The nurse said that the doctor was telling Grandpa that there are going to be some hard days, and some better days; this is just a harder day compared to yesterday. The nurse also mentioned that Grandma still has kind of restless legs (as we saw late in the day Saturday and Sunday), and the cause of this remains to be seen, but the doctor is looking in to it, getting in touch with Grandma's regular doctor as well.

Also, at some point today Grandma (unknowingly) pulled the NG tube out of her nose, and putting it back in went okay but I understand Grandma had some pain from that process.  Kind of awful to think about, but it is good that Grandpa was there to comfort her and the tube is seated just fine now (confirmed with X-ray).

Joyce also says she talked to Grandma on Grandpa's cell phone today.  She was able to state that she was tired and that it was a harder day. She stated she had eaten, she said that she was fairly comfortable, but that she was sleepy. Joyce said the same things to her as to Grandpa, and urged her not to be discouraged by the more difficult days, reinforcing that for the most part she is so much better than a week ago, and that she should not be afraid of the way she felt, that things would get better. Grandma said something about doing the best that she could, and Joyce applauded that as the truth. 

On Being Positive

Again, I think it is easy to feel discouraged by the ebb and flow of progress.  However, even though it is hard, it is important both for US and for HER to remain positive and remember that this is all part of the process. (There are some links in the Helpful Links page that speak to this.) Recovery will take time and Grandma is already doing so well, in just one week!  As I've said repeatedly, she will continue to have good days and bad days, but she is doing AWESOME for one week later and I think we saw this weekend that she really is continuing to make progress.  Yes, it is frustrating after a series of good days to have things seem to take a step backward, but she WILL get through this!  A sleepy day does not mean things are getting worse.  These are things we should remind her of as well.  

If you're the praying type (and even if you're not), please send your prayers (and positive brain waves and happy thoughts) to help Grandma and Grandpa to remain positive on the more difficult days. <3

Saturday Pictures 2

These are Grandpa's pictures from Saturday:

Good morning!

Getting ready for "launch"

Up, up and away!

Safe landing

 Rosemary, the Queen (napping), Elizabeth, Jerome

New "Helpful Links" Page

In my looking around online, I've come across a number of great resources for stroke patients, caregivers, and their families.  I have collected a number of these links a page which you can find by clicking the "Helpful Links" tab at the top of the homepage.

Let me know if you come across any good pages to add to this list and I'll put them up.

Sunday, March 10, 2013

Sunday Socialite!

Grandma had a busy visitor schedule today!

In the morning she had Physical Therapy.  Grandpa was there for about an hour or so before my husband (Jason) and I arrived at maybe 11:45.  Joyce came after lunch.  Then there was the Speech and Swallowing therapist, a lady from church (Marion) with the flowers from the service that morning, the President of the Heritage Harbor chorus grandma sings in (Maggie), and their church pastor (Bill Hathaway)!  And I believe Sally (Dolley's daughter) was going to visit this evening after we left, too.  I told Grandma that one of the nice things about being in the hospital is that she's probably seen more of us family in the last week than she has since Christmas, and all of her friends come to her! She thought that was pretty amusing.

Keep in mind I didn't see Grandma Saturday and this was the first time I saw her since Tuesday, but I thought she looked great today.  Tremendous progress from last Tuesday, and even Grandpa thought she was a little better than Saturday.  Fantastic last few days in contrast to the not-so-great Wednesday and Thursday.

Vitals are stable, medication for infection is working.  Nurse didn't say anything about her temperature or BP today, just that "everything looks good" so I imagine that includes her fever having gone away. Yay!

Grandma was a chatterbox today!  She is talking longer and more clearly.  Where earlier she was only speaking in short sentences or a few words at a time, she was speaking in fuller sentences, a few at a time today.  She continues to follow the conversations in the room, looks around the room pretty easily now, and stays awake and alert for longer periods of time.

Joyce is going to give the Discharge Coordination nurse a call tomorrow to see when they think Grandma might be moved to that rehab facility in Heritage Harbor and check with the facility Admissions lady about what else needs to be done on our end to ensure there is a room available for her when that time comes, but that is at least several days off I think.

Speech and Swallowing update

  • This therapist comes in every day to see how Grandma is doing with speaking and with swallowing, since the muscles on her right (stroke) side are a bit weaker than her left, and it will take some practice for her to work back up to "normal."
  • Grandma was given a little sponge on a stick and asked to "brush" her teeth and tongue with it and she did this very well.  I'm sure that felt pretty good!
  • The therapist worked with Grandma to eat some applesauce on her own and swallowing.  She did great, and the therapist says she is cleared for snacks (e.g. applesauce, pudding, mashed potatoes, mashed-up banana, other puréed food, honey-thick liquids) whenever she wants them! (So long as a nurse is around.) Another milestone accomplished!
  • Since she appears to be swallowing pretty well (acknowledging that her right side is weaker) the next step is to work on her endurance.  That is, Grandma needs to be able to keep up the energy and use of her muscles to eat a meal.  When she is at the point where she can eat her meals and meet her caloric needs on her own, then they can take the NG tube out of her nose, but until then they want to make sure she is getting enough calories by being fed through that tube.
  • In a few days they will do a swallowing xray to check how her throat muscles are doing.

Attitude

When asked how she's doing, Grandma was pretty upbeat today.  "I'm not complaining at all," she said. She noted repeatedly, "Most people don't make it to this age," and that she felt pretty positively about how things were going.  Although she doesn't remember everything fromt he first few days of her time in the hospital, she is encouraged when we remind her of how far she has come, comparing earlier in the week with where she is now. "Even I am surprised," she said, in reference to how well she was making progress with everything.  She added that "some people have this stroke and they don't live through it," and that others "don't do as well after," trying to keep things in perspective.  Grandpa said he reminded her this morning that they have been together for so many years and he would like to continue with that... and Grandma agreed.  Considering how she sometimes gets depressed by her limitations with getting older, this is great to hear and I think it is good to keep her thinking positively. <3

Cute anecdotes:

  • Sometime when I was out of the room for a moment, Joyce asked Grandma if she was interested in having some music brought in sometime, and Grandma started SINGING. "I make my own music!" (I'm so sad I missed this!)
  • Grandma was so talkative today that the Speech and Swallowing Therapist at some point had to tell Grandma, "I'd love to hear more of your stories, but we have to get through this test...!" Sounds like the Lena we all know, chatting people up!
  • At the end of her visit, the Speech and Swallowing therapist assured Grandma, "Believe me, you won't have this forever, things will definitely improve," to which Grandma responded emphatically, "Yeah, I hope not!!"
  • I announced to Grandma that my mom had text messaged me asking, "How is the Queen of Everything doing today??" Grandma thought that was funny.  I told her that I contemplated bringing in the tiara I wore for my bachelorette weekend in May so that everyone would know that "the Queen is here" but none of us were expecting Grandma to say, "Nah, don't really need that... Everyone knows it anyway!" I thought Grandpa might fall over, he was laughing so hard. :)
  • We put on the TV in her room for a little while and came across a channel that was showing a motocross race, which I guess Grandma had never really seen before.  She kind of shrieked at the crazy jumps the riders were making.  So sweet to see her excited by this.
  • As we were leaving, I asked Grandpa if there was anything he needed help with at home before we left for Virginia, like dishes, laundry, or cleaning.  He said no, but confided, "In all of our years together, I have never had to do the laundry. Your uncle John the other day showed me how to do it, and even made some labels on the machine, 'Step 1', 'Step 2'... And actually, it's kind of easy... I got everything washed, ran the dryer, sorted things...!" He seemed kind of proud of himself. I told him, "Yeah this must make you appreciate all the things Grandma has taken care of all these years!" He agreed, said it was kind of humbling. :)  <3
I think that's about all I have.  I have some pictures myself, and Grandpa just sent me his... I think I'll post those tomorrow.

Thanks again so much for all the prayers, positive thoughts, good vibes, etc.  I do pass your messages along and Grandma is just so humbled to hear about everyone who is thinking of her!

-Christina

Saturday Pictures 1

My mom/Rosemary sent these pictures along from her visit from yesterday (Saturday).

Sitting in a chair! Working with one of the nurses I think.

Resting

The Presbyterian Women of the Congregation at church brought by a handmade "prayer shawl" on Friday. What a sweet label they put on it!


Elizabeth saying goodnight before going back home.

Sitting Pretty Saturday

Sorry this post was delayed; I spoke to my mom/Rosemary late in the day about her visit Saturday and was too pooped to finish up chores, write, AND make it to bed at a decent hour for our visit today. But at least it's good news! -Christina


On Saturday, Grandma got to sit up in a fancy lounge chair for most of the day, rather than lying in the hospital bed!  Probably a nice change of scenery for her.

My mom/Rosemary went to the hospital this day with my sister Elizabeth, who was unable to visit earlier in the week since she had ben fighting off an infection (cold or flu I think).

Grandma looked great this day!   She is no longer hooked up to any IVs, just the NG tube down her nose/throat, and a port for medications in her arm. The nurses check her vital signs manually every few hours (as opposed to in Critical Care when she was hooked up to machines that checked everything constantly) and her vital signs have been great: blood pressure back down, fever was down, and she was responding very well to the antibiotics she had been given for the urinary tract infection.  Sounds like it was another good day.

Although she still takes a lot of naps during the day, Grandma is able to spend more time awake and alert; last week when I saw her on Tuesday she would last about 15-30 minutes before feeling sleepy and taking a nap, but on Saturday my mom reports Grandma was able to sit and chat and "socialize" for an hour, hour and a half at a time!  It is still important that we let her rest when she gets tired because she needs that time to heal, but it is great that her "endurance" if you will is improving.  (Entertaining all these guests is hard work! ha!)

Mom reports that a Physical Therapist came by to check how Grandma was doing as far as movement. She can bend her knees, move her legs around, can shrug both shoulders, and point her toes!  Although she has some trouble raising her right arm (the stroke side), she can fully extend it with some encouragement.  Awesome!

When I first saw Grandma on Monday afternoon, she had a hard time keeping her eyes all the way open and was "in-and-out," talking a bit and then napping again.  Saturday I'm told her eyes are much more open, and she can move her eyes around a lot better, even looking to her right (stroke site), which is terrific.  On Tuesday she had trouble seeing the clock on the wall in her room; Mom told me Grandma can now see the clock just fine. (She is able to look around better which is probably a contributing factor in that progress.)

I think Grandma is eager to get moving again.  She has been a little restless, wiggling her legs around.  (She's not one to sit still for long, and she's now been in the hospital almost a week!) She continues to get some cramps in her legs, but as she starts using those muscles again that should go away.

As far as Grandma's attitude, I think she has good times and not-so-good times, which is rather understandable.  She acknowledges that she is 90 years old and "not many people make it to this age," and when we tell her how her progress is going beautifully she feels pretty encouraged by this news, but I think she also has her moments where she feels like, "I'm not sure if I can do this."  Thus, it has been really important for us to remind her that things will get easier and will get better.  How she is now is not how things will be forever; this is just a step.  Sometimes it can be a challenge to keep her spirits up, but I think the past couple days' progress have been so encouraging, both for Grandma AND Grandpa that even though there might be "good" days and "bad" days, the general trend is one of improvement!

(Mom, let me know if I missed anything or if there are any other little anecdotes to add...?)

I'll post on my visit today (Sunday) very soon. <3