Happy Friday Update from Annapolis

Hello dear family!

First off, today we are all celebrating Nancy's news of being CANCER-FREE! We love you so much. Grandpa and I hope you had a terrific day, Nancy :) Grandma was just as pleased as us to hear this good update.

-Elizabeth

 

Highlights from Friday, April 5:

- Guess who didn't have a catheter today? Go Grandma!

- Grandma worked with the Speech Therapist and Physical/Occupational Therapists

- Grandpa, Grandma, and Lizzie attended a "Care Conference" with key stakeholders involved with her care

- She went outside in her chair to enjoy the warm, sunny Spring day

 

Details:

Like yesterday, Grandma awoke to Friday feeling a little sleepy and grumpy (that's ok!). Our understanding is that she had a visit from the Speech Therapist (Kristen) and then some nurses came and "cleaned her up." The first thing I noticed when I walked in was that there was no catheter! Grandma was wearing some absorbant pants though, and so the nurses check those carefully to be sure everything stays clean and a UTI is avoided.

 

Annabelle, one of the Physical/Occupational Therapists, came in next with the muscle/brain pathway stimulator for Grandma's right leg (weaker, post-stroke). This machine "re-educates" the muscles to respond to the brain and therefore improve mobility. Since Grandpa and I remember that this aspect of treatment was one of Grandma's least favorites, we decided to engage Grandma in conversation while she underwent this therapy. (NOTE: During PT after her foot surgery, Lizzie had to endure many sessions with the same type of electrode machine-type treatment. They put these sticky pads on your skin that are connected to wires. The therapist gradually increases the strength of the stimulation until your muscles quiver involuntarily. It can be very uncomfortable, especially in the first few sessions of treatment). So throughout this particular session, Grandma did great. We spoke about upcoming news of Nancy's test results, my dad's eye surgery, and what April weather was like in Holland.

 

I personally was a little displeased with Grandma's nurse's aid today. For some reason, she did not separate soiled papers from a pile of used gowns/laundry items, so these (linens and trash alike) were all heaped on top of the trash can and pretty smelly. I asked twice for someone to come in and remove/sort these items, because in the meantime we had no trashcan to use. Strange! Even during the week, staff can be a bit unresponsive at first - and it sounds like some aids are more competent than others. On the contrary, Grandma's actual nurse (Jenn) for the day - she was very good.

 

The morning was filled with anticipation for the 11:00 am "Care Conference." We decided to have it in Grandma's room so that she could attend comfortably, as well.

Here are the basics from that meeting

 

***

Attendees - Speech Therapist (Kristen); Dietician (Alicia); PT/OT's (Annabelle and Trish* she's my favorite!); Social Worker (April)

 

Speech Therapist and Dietician: Have been helping Grandma to eat trials of pureed food and drinks with a honey-like consistency. On MONDAY, April 8, she would like to officially launch Grandma on a formal puree diet. Will need one-on-one supervision, since she is still mastering the muscles involved with swallowing. Plan for now is to continue on G-tube feeds with this diet. Grandma needs to finish 50% of her plate of pureed food before they can remove the G-tube. Grandma is weighed each Tuesday. Her weight has decreased since hospital discharge: used to be 122, now she is 117. She currently takes 7-9 seconds to swallow puree and/or liquids, which for us only takes 1-2 seconds. ST is open to teaching Grandpa how to supervise Grandma's eating so that he may feed her during the weekend (get some more practice when ST is not there). *ST stressed the importance of minimizing distractions while she is holding therapy with Grandma.

 

Annabelle: We are still working on the basics: strengthening her "trunk"/"core" muscles so that she can sit independently. Although she may often feel sleepy or too tired for therapy, it's important to get her going as much as possible. Build up stamina. *Annabelle stressed importance of minimizing distractions while PT/OT's hold therapy with Grandma. They say she is "easily distractable" and during this crucial time of re-learning the basics of balance, muscle strength, posture, etc., she must concentrate carefully on the task at hand during the sessions.

 

Trish: Grandma dressed herself this morning, with help. Combed her hair. Stressed that sitting and keeping balance are two key skills she'll be working on. Strengthening her back muscles is important. Recommends that Grandma speak with the in-house psychiatrist or at least chat intentionally with someone about the drastic changes that may take place now that she is recovering from a stroke. Given how active she was before the stroke, Trish has concerns that Grandma will become discouraged and wants to be sure she is fully aware of what happened to her body and how she can overcome. *(I really like Trish. She seems to have a true therapist's heart - she is firm without being callous or strict. She is also super knowledgeable. I hope Grandma works with her more in the future!)

 

Answers to our questions: For now, the best ways we can support Grandma are 1) helping her build stamina by not immediately going back to bed after therapy - encouraging her to stay in her chair or sit in her chair with a magazine or look out the window; 2) encouraging her to actively participate in therapy and concentrate - which may involve us taking a step back occasionally and letting the therapists work with Grandma one-on-one; 3) letting her sleep - especially on a weekend day when she does not have an active schedule of therapies (usually some therapy, with the exception of Speech Therapy, is given either on Saturday or Sunday). Sleep is good medicine because it helps her rejuvinate and heal.

***

 

After the "Care Conference," Grandma had some Physical/Occupational Therapy. She practiced standing up, which according to Grandpa was a little painful for Grandma today.

 

In the afternoon, we visited Grandma again and ran into Andrea Lev, the Administrator of Heritage Harbour Rehab Center. She had a very long and genuine conversation with us, and specifically addressed our concern that Grandma was not getting sufficient swallowing/eating practice on the weekends. I did not understand a lot of her explanations - mostly because it involved many details about Medicare that I do not understand - but what I gathered is that they keep track of the minutes of therapy Grandma gets each week. The institution is reimbursed for those minutes (?). The max level of reimbursable therapy per week is 720mins. Some weeks, Grandma gets 810 mins - so she is actually exceeding this top eschelon and getting more therapy than was necessarily promised to us. Andrea is very conscientious and said she asked Denzel (Head Therapist?) for a printout to see exactly the minutes Grandma has been getting, and shared this information with us.

 

Andrea said she will be on duty one day this weekend and encourages Grandpa to seek her out if he has any questions or concerns. She also shared a story about a man who had a very severe stroke who began very much like Grandma (little core strength, could not walk or sit up). After 45 days at HHRC working with the therapists, he was discharged yesterday and walked out with neither a cane nor a walker! Andrea said she practically burst into tears, she was so proud of him. She is confident that Grandma is capable of the same with some persistence. We cannot let Grandma assume that she will never walk again.

 

To end the day, we took Grandma outside in her wheelchair with plenty of warm layers and her shawl. Although Grandma was initially doubtful, we knew this would cheer her. And boy did it! Grandma was so pleased to feel the sunshine on her skin and hear the birds. It was a really beautiful way to spend the afternoon with her before she settled back into her bed for a nap.

 

Cheers to great progress for all today!

 

Love,

Lizzie

A trip OUTSIDE! #2

A trip OUTSIDE!

Today the DC area is seeing some gorgeous spring weather (60°F where I am in Reston; online I read that Annapolis is at 62°F!) and it looks like GRANDMA GOT TO ENJOY IT today! See this adorable picture of Grandma outside in the beautiful sunshine~!

Photos courtesy of Elizabeth, reporting from Annapolis. <3

Friday 4-5 Picture

Getting ready for a nap... Long and busy day so far! (~1 PM)

Thursday visit to Amish Market

---------- Forwarded message ----------
From: Elizabeth
Date: Thu, Apr 4, 2013 at 12:03 PM
Subject: Grandpa and I went to Amish Market

We bought some apple fritters to eat while visiting gramma. Grandma is have a pretty good day so far, bit she says she feels a little blue. We are going to give her lots of love today

Sent from my iPhone

Thursday Update from Annapolis

Hey, there! Today was another adventurous day.

****

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.

****

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

Wednesday 4-3 PT Pictures

---------- Forwarded message ----------
From: GRANDPA
Date: April 3, 2013, 8:33:51 PM EDT
Subject: 5 photos therapy mom 4/3/13

Again Mom had kind of a slow start. When I arrived mom was sitting in her chair with that Omnivision machine attached to her right leg. She said they had awakened her from her sleep too early for some kind of a test. Actually I heard later from the personnel that they knew nothing of a test but the speech therapist had been there early, and the speech therapist told me mom had done "marvellous", eating 80% of her oatmeal. Pt's had installed mom in the chair and connected the machine.

Anyway after that machine was disconnected, mom sat in the chair quite listless & unresponsive, but interested in getting back in bed. So I got some nurses to do that. So she rested quietly in bed while I tried to liven her up with some music. Then the two physical therapists returned and were surprised to find mom in bed. They seemed annoyed at that and said things like sitting in the chair for periods of time was all part of the therapy. It seemed allmost reluctantly that they moved Mom back to the chair.

They then rolled mom to the therapy area where they supported mom practicing sitting on a kind of platform like a large bed and also brought in a mirror so she could see herself, and she also practiced grabbing objects like cones and passing those on to the pt. When this was over, they rolled her back to the room.

After sitting there for a while, I convinced mom she might like to be wheeled around various accessible areas, and that's what we did and she enjoyed, even meeting another patient from our community,who was also in a wheel chair.

Yesterday mom had done some of the moving of her chair herself but today she did not feel like doing that. Even so, she enjoyed this roaming around the place very much, but finally she said she wanted to be again put back in bed. So we found two nurses who did that, and soon after, about 12:30 we left and mom agreed to to take a nap.

This pretty well completed mom's activities for the day.

Lizzy & I then went home for lunch & did some chores till we returned to mom sometime after 4:00.

The remainder of our stay was spent chit chatting with her about the events of the day, etc etc, until it was time that we were going home for dinner. Mom seemed very content with the way the day had gone.

Back in her room after PT

Talking to Lizzy

Wednesday Update from Annapolis

Good morning, family:  Here are a few stories from Wenesday and Grandma's progress.

 

HIGHLIGHTS from Wednesday, April 3:

-Speech Therapist made a very early morning visit to Grandma

-Grandma worked with Occupational/Physical Therapists to build control of her "core" and manage her balance

-She visited the hallways in a wheelchair with Grandpa

-Lizzie gave Grandma a foot and leg massage, which she liked

 

Details:

Yesterday, Grandma reports that she was woken very early - as Grandpa wrote in his email - for a "test." We think Grandma may mean the Speech Therapist (Kristen), who came at 7:45 AM ("the middle of the night" according to Grandma) to officially begin her on a puree diet. Like Grandpa reported last night, Grandma did great! She ate 80% of her oatmeal and showed wonderful progress. Grandma needs to strengthen the muscles in her throat to swallow faster. This will allow her to progress in her diet and eat more of her favorite foods.

 

NOTE: To answer your questions, I asked the Head Nurse (Anina) why the sign about "NPO" was posted in her room yesterday. Grandma is beginning this puree diet, but only the Speech Therapist can bring her food for now. She still has some nutrition given to her by IV/tube. Once Grandma is set to eat on her own (right now the Speech Therapist stays with her while she eats), the nurses will bring food instead of only the ST. My understanding is that the NPO sign was simply a warning to the nurses.

 

Grandpa wrote a good summary of the therapy sessions that followed yesterday morning. These include putting the same brain pathway stimulator machine on her right leg/foot as well as getting used to the wheelchair. The nurses took her weight on a fancy scale in the "Bath Room" across from the dining hall. When I arrived to the Rehab Center, Grandma, Grandpa, and two Occupational Therapists (Jess and Annabelle) were working with Grandma in the large therapy room. She was sitting on the edge of a large, padded bed-like bench and looking into a mirror. Jess and Annabelle supported her back and shoulders, but the exercises that followed were truly to help build Grandma's "core" - including her abdomen muscles - and get a feel for her balance while sitting.

 

Jess sat on Grandma's right. She handed Grandma a series of colored plastic cones and asked Grandma to lean and reach with her left hand, grab the cone, then place that cone on her left side - gradually stacking these items. The exercise required a balance of many things simultaneously: Grandma worked on keeping her head up instead of letting it drop down to her chest. She worked on shifting her weight from the right, center, and left while using her core muscles to "ground" herself. She also attempted to maintain a good posture and test out her hand-eye coordination. The mirror helped with all of these movements, and the PT/OT's encouraged her to check herself in the mirror.

 

Grandma seemed a little bewildered and amazed during this activity, and noted it was very difficult. We explained that some of the difficulty was from resting in bed for 1 month. "The muscles in your stomach are sleepy," we said. The PT/OT's also noted that strokes can affect your balance and part of the recovery is working to restore strength in all of the muscles that help you stay balanced. Jess told Grandma that before she can walk, she must first build up strength to sit up tall by herself.

 

After the session, Grandma returned to her chair and her room. Instead of climbing back into bed, we encouraged her to stay in her chair, which she said she liked. The three of us had some good chats together, and Grandma seemed in pretty good spirits. She asked about how everyone was doing - dad, Jerome, my work, etc. and remembered that I was getting married "at the end of the year." Grandma joked, "you and Jerome can try to compete with 65 years." I thought it was very impressive that after all the activity of the morning, she was able to pull those details out. Go Grandma!

 

While on the topic of Grandma's memory, she remembered many other things. She recited her address correctly as well as little phrases in German and Dutch. "Although it seems much of me has been 'shaken up,' somehow the languages remain!" she exclaimed. Given how much joy Grandma gains from knowing and studying languages, this is certainly a blessing. Grandma still says she struggles with short-term memory - particularly with recalling the day's events, especially if they are early in the morning. "I fade in and out," she notes.

 

Next, Grandpa suggested that Grandma take a ride in the hallways in her chair. She agreed, and Grandpa pushed her the length of the entire 1st floor wing of Heritage Harbous Rehab Center. Grandma remarked on the beautiful pictures on the walls, and enjoyed peeking out the windows at the end of each corridor. Still an extrovert and social butterfly, she waved to the nurses and several other patients. Throughout this experience, Grandma did a great job keeping her pretty head up.

 

After visiting in the hallways, Grandma returned to her bed. We returned home for some lunch and when we visited again at the Rehab Center, Grandma said she had tried for a long time to grab her blanket, but that she was having difficulty propping herself up enough to reach for certain items. It seems that helping her to regain strength in her arms and core/abdomen will alleviate some of the frustration she feels. To help her relax, I gave her a foot and leg massage, which really cheered her up.

 

Grandpa and I begin to wonder if a stroke can cause changes in one's eyesight. Grandma looked at some comics in the newspaper toward the end of the day, but she observed that things were blurry. Grandpa read some outloud to her. However, Grandpa said that she usually looks at the paper with a magnifying glass. She still has doubts that the glasses she has are the most recent pair.

 

Some nurses came in to check on Grandma's glucose levels. Her sugar levels are great, and in normal/healthy ranges. I also noticed that Grandma didn't experience a big drop in blood pressure or become unresponsive after all the therapy - but was able to keep herself in good spirits during the majority of the day. The nurses encourage Grandma to push herself to "fight" the drowsiness she feels, saying that she needs to stay awake as long as possible. We will continue to encourage her, because she is making progress everyday.

 

*****

Love to you all!

Tuesday 4-1 PT Photos

---------- Forwarded message ----------
From: Elizabeth
Date: Tue, Apr 2, 2013 at 3:07 PM
Subject: Amazing!!

Grandma did many reps of lifting 1/2 pound on her right arm. Amazing!! The therapist is really sweet

Sent from my iPhone

Tuesday (Apr. 2) Update from Annapolis

Greetings, family!

Here's an update on today's visits with Grandma. Grandpa has been sending additional details throughout the day; please feel free to ask any questions you have! AS AN UPDATE, the "Care Conference" we planned to attend today actually took place yesterday (the visit from April, from social services). The big, official "Care Conference" is scheduled for this Friday, April 5. This meeting will include Grandma's therapists, nurses, etc. who will provide input on Grandma's recovery.
-Elizabeth

***

HIGHLIGHTS from Tuesday, April 2:

• Grandma began the day with some drowsiness, yet worked with the Occupational Therapists to stand using parallel bars as support
• She received a visit from Andrea Lev, an administrator at Heritage Harbour Rehab Center, who gave her some encouragement
• Grandma saw the Physical Therapist/Occupational Therapist and lifted some 1/2-pound and 1-pound weights on both arms!
• Dr. Chopra (spelling?) visited Grandma with the Head Nurse (Anina)
• The "Care Conference" is scheduled for Friday, April 5 -- we misunderstood the date
• Grandma requested we bring magazines and picture books for her to look at

Details:

Today was another day filled with challenges and great recovery milestones. We learned that the Speech Therapist visited early in the morning to begin Grandma on her pureed diet (ie., moving away from the liquid nutrition from a tube). However, Grandma was a little drowsy this morning, or "dopey" as she describes. For this reason, the ST delayed the start of her puree diet. Perhaps related or unrelated, there is a sign above Grandma's bed today (posted April 2) that reads: "Pt. is NPO! No food or drinks please."

Like yesterday, Grandma went with the Physical/Occupational Therapists in a wheelchair again, this time learning to push the wheels along herself. She also gave a go at trying to move herself in the wheelchair using her feet. Once in the therapy room, Grandma was helped up to stand at these new parallel bars - a different set of equipment than yesterday's standing exercise. She did great, but I think she was feeling the effects of drowsiness still and may have appeared a bit bewildered. In either case, she showed big bravery, and Grandpa encouraged her!

After returning to her room and bed, we had a visit from Ms. Andrea Lev, one of the administrators (or perhaps "the" administrator) at Heritage Harbour Rehab Center. She was very nice, and took time to listen to Grandma as she described how she was feeling. She also was very intentional about sharing that Grandma was making big progress. Grandma shared more doubts that she would recover, but Andrea urged her to keep trying. "You have some wonderful support from your family, and the therapists here are great and can get you moving again," she told Grandma.

One observation that Grandpa and I made was that Grandma appears to be able to read just fine. She took a careful look at the cards from some of her friends that arrived this week, which perked her up.

Despite showing short-term memory challenges related to reporting her age, the year, etc., Grandma acknowledges these challenges and recognizes when she might be mistaken. Today, she was under the impression that she was 100 years old. She also has some difficulty remembering conversations from a previous day, or something she sees on TV earlier in the morning.

I notice that Grandma is very close to her normal self when she is feeling perky. She becomes very conversational, asks Grandpa and me questions, nods, points, raises her eyebrows - even cracks some jokes! She has been comfortable listening and speaking Dutch and German. She said "bonne nuit" and "a demain" (good night and see you tomorrow in French) to Grandpa and I when we left this evening. All very impressive!

When chatting about her recovery and healing process today, she told us: "It's difficult, but it's the way it is."  She also said, "I see things I used to do, and now I cannot do them." These include movements like standing on her own and eating her normal meals. She likes to hold Grandpa's hand when she feels discouraged.

We notice she fluctuates between feeling positive/accepting vs. discouraged about her condition.

Indeed, even the smallest interaction during the day can make the difference between these two outlooks. Today, Grandpa gently asked Grandma to repeat the following phrase: "Every day, in every way, I am getting better." With love in her eyes, Grandma sweetly repeated this sentence. When Grandpa described a visit to the Hearing Aid office later this month, Grandma said: "I'll come along with you!" I think a small and emerging part of her is beginning to see her progress.

Speaking of progress, Grandma "wowed" us all when a sweet Physical/Occupational Therapist (Trish) visited Grandma for some weight exercises in bed. First, she lifted a 1-pound pole above her head with her left arm. She did several repetitions. Perhaps the first shocking milestone was that while she was lifting this pole above her head, she lifted her right arm (the weak arm after the stroke) to her nose to itch it!! That was truly impressive to all in the room. Next, Trish strapped a 1/2-pound weight to her right arm and she began to lift that arm as high as she could with the weight on. She did so well! Last, with 2 strap-on weights on each arm, Grandma lifted both arms simultaneously. Trish showed Grandma some resistance exercises that we can help her with - placing our hands on Grandma's right (weaker post-stroke) arm and asking her to push against us - either out, up, backward, or inward. These will make all the difference in helping her regain strength.

Trish gave Grandma a special apparatus to squeeze to rebuild the muscles in her left hand. "Please squeeze it 40 times," Trish said. Grandma did it very quickly, and even showed off a bit by doing more than 40 squeezes! I helped her to count the repetitions. By the end of the session, the therapist was laughing and saying the Grandma was making huge progress. Apparently when Trish first saw Grandma 1 week ago, the most she could do with her right (weaker post-stroke) arm was shrug her shoulders. Go Grandma!

The last activity before leaving Grandma in the evening was a visit from Dr. Chopra (Grandma's doctor) and Anina, the Head Nurse at the Rehab Center. They seemed to be pleased with Grandma's progress, and both expressed a desire to see Grandma's catheter removed soon.

I asked Grandma's nurse for the evening, Fatima, about the white sticker on her left arm. I learned that this is a Clonidine patch for blood pressure which is changed once every week. Tomorrow this patch will be changed and a new one will be placed on her arm.

Grandpa is now visiting (after dinner) with Grandma to bring her some clean t-shirts/laundry and some picture books and magazines to look at. Grandma said she was "bored" occasionally so we are looking forward to providing future entertainment for her! Social services also offers activities. We may look into those.