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.

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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*

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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 

Saturday 3-16-2013 Pictures

A Difficult Day

[Written Sunday 3-17-2013. Again, it's been a rough weekend. Sorry for the delay... -Christina]

Elizabeth and her fiancé Jerome visited, as well as Joyce.  In the morning, they all cleaned Grandma and Grandpas house, vacuuming, cleaning the kitchen and bathrooms, running laundry, etc. so now the house is super clean which I'm sure Grandpa appreciates.  It's hard doing all of this on your own, especially when you're not used to handling these things to begin with.

The afternoon was kind of difficult.  While the gastric tube surgery went well, and Grandma was happy to have the visitors, my sister reported to me late in the afternoon that at some point Grandma all of a sudden started saying things like "I'm done." "I want to go home." [Not home to the house, but home to God.] "At this age, it's ok." [Kind of like, I'm ready to go, I've had a good life.]

Naturally this was upsetting, and they weren't really sure how to take all of this.  This isn't inconsistent with Grandma's previously-mentioned wishes (prior to the stroke) that she didn't want to live "hooked up to a machine," but considering Grandma's progress it was really hard to hear her go on like this.  I wasn't there, so I don't really know how things happened after this, but looking back the general thoughts going on that evening via emails and phone calls included:

• We know Grandma's wishes, and this is her decision, yes.
• However, it is kind of also our duty to be encouraging and help her stay positive while she still has a good prognosis -- and her treatment is still focused on recovery, not just "making her comfortable."  She is not dying and not being sustained merely by machines. 
• We should still have hope for all of this, and will have to see how she feels tomorrow and the next day... One day at a time.

So yeah.  Saturday was a rough day. I think we were all emotional wrecks, trying to process this information and figure out where to go from here.

I had a giant piece of greasy pizza from the grocery store for dinner, I just didn't care. But I felt a bit better later in the evening after I had some time to think and get back to focusing on what comes next. <3

One day at a time...

Friday 3-15-13 Pictures

Here, Grandma is reading someone's card.  

She could read the printed words, but had some trouble with the handwritten note... but then, even my mom couldn't figure it out entirely!

Grandma and Grandma really enjoy all the wonderful cards she's received. :)

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.  :)