Thursday, December 07, 2006

Steady as She Goes

For those who depend on my blog for information, I’m sorry. I post only when a significant event occurs or a change in diagnosis or condition. At the moment Kathy and I are trying to get back into a semi-regular weekly regime and is more difficult than it seems. Kathy’s medical issues, the children, work and stress of daily life can get quite complicated. Mix everything up and top it off with the holiday season and it’s a formula to freak out!

The good news is Kathy’s condition. She is slowly “pressurizing” (I think?) and every day seems to improve slightly. Her headaches remain but are of less intensity and duration. Her nausea and low energy symptoms still persist and we are trying to find solutions. Dr. Kureshi plans to see her after Christmas and it appears she has made enough progress to warrant a good report card.

Kathy's getting adjusted to her new camber boots and walking easier. The great news is the boot can come off and go back on for showering and rest. Kathy has taken the boot off and tested her pain level-it hurts! Walking without the boot is extremely painful to her Achilles. Her right foot also wants to curl as before the surgery, so physical therapy might be needed. A nurse at Kathy’s foot doctor told us he had similar surgery and it took him almost 4 months to get back. (He loves to play soccer though)

The Christmas season is upon us and a special time of the year for families. I thank God this special time will include Kathy presence and warmth. Family activities and Christmas spirit have always been a favorite of hers. We thank you all for the amazing love and support you have given our family through the crisis and wish you a wonderful time leading up to Christmas.

Tuesday, November 28, 2006

Damm Headaches

Well, things went better with Kathy today. We got her medication organized so she could keep ahead of daily events. It seems to be working. When she is sitting or lying down the headaches have been manageable. But as soon as she gets up or moves an extremely strong pain grabs her. It seems as long as she holds a position she is OK?

We are in the process of deciding what to do with her shunt. As described above the shunt is not working as expected. She shows all signs of low pressure-headaches and nausea. But is it? It could be the difference in atmospheric pressure between her head and her drain in the stomach? The shunt may be malfunctioning? Is the valve type and design making a difference? Why me?

We went over the options today and Kathy is thinking she might wait out the surgery until she gets more information. What kind of shunt does she now have? What kind of shunt is Dr. Kureshi going to implant? How much, if any improvement is it going to make? Can her brain get “pressurized” at its current state and she starts feeling better? How does she minimize the complications? All good questions! We hope to get the answers before Kathy makes the next step.

Tomorrow Kathy has appointments with her infectious disease doctor and foot doctor. Her appointment with the infectious disease doctor is a final out patient visit to go over and get his suggestions to keep Kathy safe. Her foot doctor should remove and replace her casts with smaller ones. She can’t wait.

Hopefully everything will go great tomorrow and build up her confidence and strength. As each day goes by successfully we can build a baseline for her daily condition and be able to monitor it more accurately over time. We just hope Kathy is in the group of people who make up the largest group of shunt recipients, happy customers. Keep up your prayers please; we got a lot of time on this movie before it’s over!

Wednesday, November 22, 2006

A Thanksgiving Prayer

It has been a rough patch of road for Kathy. Since last week her headaches have increased and gotten stronger. In fact it got so bad last Saturday we had to rush her off to Sharp Emergency in San Diego. The doctors viewed her CT scans and stabilized her most extreme aches and pains. Everything pointed to her earlier diagnosis, overdraining. After 6 hours in emergency, she was ready to come home and hope for a better Sunday. Monday, Tuesday and Wednesday were like an up and down elevator, headaches, nausea and earaches came and went without warning. What's going on with this picture?

With a future of daily headaches, Kathy has decided the following. If she doesn't show marked improvement over the the weekend, we will move forward and have her valve replacement surgery as soon as possible. What will this entail? Dr. Kureshi will go in and reopen the incision in Kathy's head and replace the current valve with a new valve. The new valve will allow for less drainage, allowing Kathy's brain to regain its normal fluid and pressure level. Her many symtoms should go away, including deliberating headaches. Let's cross our fingers!

Even with mini-disasters daily we are so grateful for just having Kathy at home. Her parents have spent the last two weeks with us and have supported her and the family greatly. She is such a strong trooper and fights daily with little complaint.

Thanksgiving is a time to thank everyone for the love, support and prayers for Kathy's recovery. It is impossible to comprehend how important all of you have been to our family! A Thanksgiving poem for you:

Autumn leaves are falling, pretty colors everywhere.
Thanksgiving day is almost here, another day that we may share.
The things we take for granted are blessings from above.
The needs He has provided, were given to us in love.
Let's give thanks for what we have, bow our heads and together pray.
As we join our friends and family, on this Thanksgiving Day.

Friday, November 17, 2006

Low Pressure Alert

Well, how did Kathy’s neurology check-up go? We left early on Wednesday to Mercy Hospital for her CT scan. It was a good experience, quick and easy. The hard part was waiting around for 5 hours until she could meet with Dr. Kureshi. We filed out the appropriate paperwork and finally got into see her neurosurgeon. Immediately Dr. Kureshi diagnosed her CT scan. He felt it was possibly a case of the shunt over-draining. Her symptoms were consistent with low pressure in the ventricles. This was a very disappointing diagnosis.

What’s next? He suggested Kathy take it easy so as to allow her brain to adjust to the low pressure. Her shunt has a fixed valve and cannot be adjusted without surgery. He suggested she try to adjust to her headaches and other symptoms for as long possible (4-6 weeks). He explained the brain is a amazing organ and can adjust to thousands of variables. If things still did not improve, Kathy will hav to have surgery to replace the valve inside of the shunt. What a major pain in the backside!

Overall Doctor Kureshi was impressed just to see Kathy. He told her on numerous occasions he thought death was at her doorstep and a goner for shure. But thanks to the love, prayers and support from all of you Kathy is alive and fighting back.

I have not posted until I could give more news about Kathy’s adjustments this week. She started out as the perfect patient coming home from Sharp. Energetic and excited about every thing! (No more hospitals!) Lately the strain of the headaches and the symptoms of low pressure are taking their toll. It is distressing because Kathy started off so strong and seems so much weaker today. I hope it is just the old two steps forward and one step backward routine that has been the story of her recovery.

Bottom line Kathy is having difficulty adjusting to her shunts over-drainage. Low pressure has it’s dregs as does high pressure. We need to find a way to make her more comfortable during this adjustment process and find the right combination of pressure. If not, it going to be a tough six weeks! Please keep us in your prayers and thoughts!

Sunday, November 12, 2006

Eating Gilbert Grape

Kathy is having her headaches on and off this week. (Mostly later in the day or when she is laying down) We finally got the CT scan appointment with Dr. Kureshi for Wednesday at 8:30 A.M. Hopefully he will have an answer to her headaches.

Kathy continues to eat well and enjoy herself at home. She’s really eating like never before! She has breakfast everyday of toast, oatmeal, eggs and fruit. At lunch she has soup, a sandwich and fruit snacks. At dinner she has everything and anything. She is really enjoying eating for the first time in her life. Over the last five years, Kathy’s medicine has always affected her desire to eat. (Nausea-pain) I wondered how she lived on breadsticks and water for so long!

Kathy started therapy in Fallbrook this week. First was Occupational therapy. Her therapist decided Kathy does not need further assistance in adjusting to home life. She suggested Kathy needs more speech therapy. Speech therapy focuses on the cognitive aspects of her mental training. She suggested Kathy focus more on reading and mental development games. This should improve her self-confidence in moving forward from her injury.

I will post the blog Wednesday with Dr. Kureshi’s report. We both feel it has something to do with her shunt valve. Hopefully he can do some adjustments to the device to reduce her side affects and headaches. Get back to you….soon

Thursday, November 09, 2006

It's a Wonderful Week-Opps!

It’s been great to have Kathy home for almost a week now. She has really enjoyed every small detail of home life. We both thought it would be more difficult to integrate back into home life. Kathy has done extremely well on every count. She does her own upkeep with little assistance, looks forward to and enjoys three meals a day and of course has stayed religious to her physical therapy. She of course is unhappy with her ungainly boots and shoes but for another 6 weeks, she has little choice.

Physiologically her only hesitation is her self confidence and the constant fear of what the future will bring. I’m sure all patients who have gone over the falls like Kathy must feel this way. I keep telling her daily everything takes time and the pieces of the puzzle will to come together faster than you think. Relax your doing great!

Yesterday Kathy came down with a strong headache which lasted through today and so we called Dr. Kureshi this afternoon. After reaching him, he has decided to have her take another CT scan to make sure everything is ok. This evening Kathy feels slightly better with over-the-counter headache medication. I will keep you posted about the results tomorrow! Again, thanks for all the wonderful prayers and thoughts for Kathy’s recovery. She can’t remark enough on how much support and love got her through!

Sunday, October 29, 2006

Standing by the Dock of the Bay

Sunday, seven of us meet Kathy at Sharps Hospital. Kathy was officially checked out for the afternoon. We got her in the car and headed to downtown San Diego. Kathy wanted to visit the Fish Market to have her favorite, red snapper. She commented it would be great, especially without being cut into a thousand pieces like the hospital. We easily navigated to the harbor and parked. We wheeled Kathy into the restaurant and were seated with a perfect view of San Diego bay and the aircraft carriers. It was perfect San Diego weather, 75 degrees and clear. Kathy loved it. We continued to have long lunch until Kathy tired. We headed back to the hospital around 4:00PM and she was ready to lie down. Overall it was a great adventure after three months inside the confines of a hospital. I told Kathy next weekend not to expect such royal treatment. She looked worried. I continued and told her she would be home to make her decisions. She nodded in agreement.

Mexico -Way down here you need a reason to move

I have put off my trip to Mexico for as long as possible. Kathy is doing great with Sharp’s round the clock care and physical therapy. It seems like a good time to get our loose ends finished before she comes home and needs some real assistance. I will be gone Monday morning till Thursday night. If anyone can visit with Kathy it would be helpful. With Kathy being more or less normal now, she gets awfully bored with the long days in the hospital. She especially finds the afternoons and dinnertimes especially long. So, if you have the time Kathy needs the support. We thank all of you for the prayers and well wishes.

Cheesebugers in Paradise

Every day Kathy is progressing remarkably well. On my visit yesterday Kathy was being tested on every meal for consumption. She needs to eat at least 75% of each meal 3 times per day to get off her tube feeding. She needs to do this at least 3 days in a row. We ended up having a little confusion yesterday because we had planned dinner around a special cheeseburger from In-N-Out Burger. I brought in the burgers and shakes and noticed she was just starring down at this big dinner. We worked together and everything got done. (You know what I mean) She passed and got to go last night, for the first time, without the tube.

Today is a special event day-her recreational therapist is allowing her to leave the hospital for 4 hours. The family is going to pick her up and take her to the San Diego Bay. If she feels good enough, we are going to attempt to take her to the Fish Market Restaurant to get some of her favorites. Could you have ever imagined last Saturday, after double Achilles surgery, we would be going out on the town today?

Kathy will go to her therapy conference Tuesday and probably be issued a release date. I anticipate the date to be at the end of this week or no later than one week more. It’s pretty exciting times-Kathy is at the point where everything’s going her way!

Thursday, October 26, 2006

The Salt Mine


Kathy's enjoying her first supper tonight with Alyssa. Not really, she thought the food was very salty. Alyssa was'nt. If you want to bring outside food, it should not be spicy or salty. She cannot have any veggies like salads. Her menu does have many surprising options!

Everything needs to be in small amounts because Kathy is building up her capacity. Maybe call her at 858-939-4729 to converse these gastronomic issues directly to her.

Soul Food

Kathy scores another great day at Sharp. She took her swallow and eating test today and passed with flying colors. All the nurses and techs were jumping with joy when Kathy returned. She ordered chicken pot pie and pasta for lunch. Dinner she even ordered a Salisbury steak! The doctors will leave the feeding mechanism in her until Kathy shows she can eat the correct amount of daily nutrition. Kathy is so excited to have little things like milk. Her taste buds are very tender from the layoff but it’s just another step in her recovery.

Her daily rehabilitation team has her working hard. Liz today had her walk all around the facility inside and outside. She had her going up and down ramps and even up stairs. Between the 3-4 hours of therapy a day, Kathy is coming along very rapidly. The rumor is on Tuesday, during her patient conference, she will be assigned a discharge date. (I will bet money it's going to be on Friday the 3rd of November!)

Her shunt continues to operate well and she comments every day that things are clearer. She talked for hours with Alyssa tonight but was smart enough not to want to vote her absentee ballot. Except for minor things I would say Kathy’s recovery process is pretty clear.

Prada Watch Out!



As you can see my boots are in my favorite color. What a difference they make. I guess walking is a lot easier when your not trying to be a ballerina. I'm off and away!

Wednesday, October 25, 2006

Run Forrest

Kathy’s been quite the item of discussion around the Sharp facility. The therapist think Kathys progress has been so remarkable her recovery should been better documented. Why? They wanted to put Kathy on the Sharp Experience, there Hospital publication that highlights the truly amazing stories.

As Sunday moved into Monday, Kathy had her surgery boots removed and totally new casts put on. Kathy commented this was the most painful experience she can recall in her life. The staff let Kathy get her breath and they got her up to walk. It was painful but rewarding.

By today Kathy is motoring around like no ones business. In therapy this morning she’s using a walker and went a couple hundred yards today! Her feet are flat and unless for some strange reason, I predict she is going to walk fine with or without her boots. Her legs are working well, both left and right and over the next week she should get her tone back.

The greatest news is Kathy says the “Fog” continues to lift so it appears the shunt is working as designed. I still never got hooked up with Dr. Kureshi concerning what type was installed but it seems to be doing just fine. Her voice is stronger, her level of cognitive abilities are almost normal and she appears jumps and bounds ahead of yesterday. Every day’s becoming a treat, just coming in and seeing Kathy’s progress !

Saturday, October 21, 2006

Break a Leg

I'm in Kathy’s room at Sharp rehabilitation as I write this entry. Good old room 148-2. Kathy is sleeping after her successful double surgery. She came back to her room around 6:00 PM tonight from ICU. She was awake and talking but seemed weak. I asked her how she felt and she said she was uncomfortable. She has two casts on her feet that go from below her knees down to her toes. It looks like the movies. The great news is her feet look like they are in the right position. We talked and agreed it’s going to hurt like hell tomorrow.

I was surprised how alert Kathy was after her surgery. Her shunt seems to be working OK because she responded positively to my questions concerning her shunts performance. She also showed little or no hangover from her surgery anesthesia. She asked the RN for more pain medication and she was hungry.

At this point I guess you take everything in stride. Kathy is motivated to get home so I hope things will go well next week. She is a position to do really well over the next couple of weeks. Let’s GO KATHY!

Friday, October 20, 2006

Air Kathy

Kathy is having foot surgery on Saturday. They gave us little notice. Kathy has the classic dropping foot that people acquire during their extended bed stay. She was unable to work the problem out in physical therapy sessions.

The best solution is to do the surgery ASAP after identification. She gets the surgery tomorrow! At 2:00 PM Kathy will have her Achilles tendons cut and her feet placed in plaster boots for the next 4 weeks. The bad news is, she will be in the boot for at least 8 weeks!

The good news is that Kathy will come out running. She will have the best outcome possible having this surgery. Women who wear HIGH HEALS TOO MUCH also need this surgery.

I will post you tomorrow on her progress. She again will have surgery at Sharp Hospital. It will be at 2:00 PM and Kathy will be moved to ICU around 4:00 PM. She will probably stay on the 9th floor until Sunday. On Sunday she will be moved back to her room. I will keep you all posted! I hear it is a very painful post surgery!! PRAY!

Shunt Up!

Kathy’s latest condition has raised a lot of concern over the last few days. Kathy’s potential for shunt malfunction is in question. She has classic symptoms of shunt malfunctions: headaches, loss of previous abilities, vision problems, tiredness, sore neck, cognitive abilities and the foggy head syndrome. I notified Dr. Kureshi and Dr. Jahan that her shunt was not delivering the results.

The whole story started on Tuesday when her vital signs digressed. On Saturday, Sunday and Monday Kathy was extraordinary. Wednesday and Thursday her performance dropped off dramatically. I found out that shunts are rather complex beasts and their performance success can vary by 20%.

I have looked into the medical process “ventricular shunts” and it is a complex world. I feel comfortable with the expertise of Dr. Kureshi. I just wonder if the shunt is a fixed shunt, an adjustable shunt or a self adjusting shunt. The GOOD news! Kathy was much better today. She had dropped half her side effects and I’m hoping this means she has a self adjusting shunt. I am waiting for more information……..

Tuesday, October 17, 2006

Kathy's the Buzz of Sharp

Today was again a patient doctor conference day. (The difference is Kathy attended with me for the first time) We meet this morning and everyone was very excited about Kathy’s new progress. The buzz in the building was all about Kathy and her recovery. Everyone was so ecstatic about her change after surgery. They have seen it before but enjoy seeing Kathy in such a different light.

Her doctors reported medically everything looked good with the shunt “surgery” recovery going well. Her nurses reported Kathy is much more attentive to her daily personal grooming and actually can move herself around quite well. Physical, occupational and play therapy all reported their pleasure in her sudden progress. Kathy speech therapist was the most excited. He’s really an excitable emotional person and he showed it today! The staff thinks Kathy will still need a couple more weeks in the hospital before she can come home. She can now really start her rehabilitation therapy!

Not everything for Kathy is out of this world. Kathy still has tremendous headaches from surgery on and off during the day. Her focusing ability in one eye has weakened. She did have her swallow test today and failed. The good news is she is cleared to drink thicker liquids like milkshakes and pureed food. (She can still come home with the feeding tube the nursing staff commented) Her speech therapist is going to give her electrical stimulation of the throat to improve the strength of her swallowing mechanics.

Being in bed for 10 weeks has made Kathy’s feet point down to much. The lack of time standing on her feet has made her tendons stretch too much. She could try to get her feet straightened in therapy but this could take many additional weeks of painful walking. Even afterwards there would be no guarantee Kathy would walk normally. This has necessitated a decision to have surgery on her feet now. Everyone assures us this is an outpatient surgery. The surgeon cuts a unique S pattern in the back of her feet that allows the feet to be stretched out and angle normally. They then fit her immediately into a walking boot similar to someone with a badly strained or broken foot. Since weight is shared up and down her leg she should be able to walk in the cast the very next day. The time for recovery is less with additional confidence that she should walk normally. She will probably have the surgery in the next few days.

I had time to go through her physical therapy today and it was quite remarkable. She was a completely different person today. She followed commands easily, had a wide range of motion in her body and showed the physical conditioning she has had her whole life. Last week she could barely stand without assistance and barely walk. (I called it more like being dragged around) Today she not only walked with little assistance but twice down the test run! Her therapist today was Liz and she is very strong and demanding. She really gave Kathy a tough workout. It’s worth it because she stated to me that 99% of her patients walk out of the rehabilitation center when they go home! GO KATHY!

Sunday, October 15, 2006

Amazing Grace!

WOW is all I can say! Kathy’s surgery appears to be an unqualified success. The best description for what has happened in in her own very words, “it feels like I just came out of a fog”. When we visited today, she seemed to be mentally alert, talkative and concerned about her visitors. She acts very much like someone who has just awakened from a concussion; short on current events answers (like the current President or what year we're in?) but knows most generalities.

The amazing thing is she has taken control of her body movements and this should help immensely during physical, speech and occupational therapy classes. She actually requested to sit on the side of the bed this afternoon instead of lying down! She exhibits good humor, sharp wit and other strong emotion feelings. No more starring and easy distractions to contend with!

I’m truly "blown out of the water" when I compare before and after surgery. It is a miracle! I think each one of you will feel the same. She is currently experiencing some post surgery pain which seems to affect her sleeping mainly. We hope this will pass also.

If you are interested in visiting, I recommend visiting during the morning and early afternoon. With her freshness in the morning, I have come to the conclusion, Kathy and her visitors will share a more meaningful visit. Our family wants to thank all of you for your prayers and well wishes this weekend-IT WORKED!

Friday, October 13, 2006

Kathy is at SHARP not SCRIPPS-She is Doing Fine

I talked to Dr. Kureshi tonight and he was pleased with the surgery he performed on Kathy this afternoon. Everything went as predicted. Now we both realize that the rest is up to God with her progress. He made no promises but felt things would improve. He is naturally someone who does not promise anything. This I imagine is from his experiences and the shear nature of being a neurosurgeon.

Big Change, Kathy was NOT moved because at the last minute De. Kureshi decided to do the surgery at SHARP and not SCRIPPS. (Possible complications) Kathy is resting in ICU at SHARP and Dr. Kureshi felt she would be moved back to her room possibly Saturday. So everyone who has volunteered to assist me during this busy time-Kathy is either in SHARP ICU or in her room. Again that’s to everyone, especially Debbie, Mickey and Macy! I’ll report her progress later and were hoping for the best!

Thursday, October 12, 2006

As the Shunt Turns

Dr. Kureshi has decided to move in and install a shunt in Kathy head as described in the Blog earlier. He can only reserve two dates in October, tomorrow or October 27th! With the pressure moving higher it was decided sooner than later. (They called me at 2:00 PM today to tell me) He claims it is a relative simple operation with all of the normal disclaimers. He will install a drain in Kathy head behind her ear and run a tube from the valve under the skin to her stomach to drain.

Late morning they will transport Kathy from Sharp to Scripps Mercy. The surgery will commence at 2:30 PM and should take a hour or two. She should be in surgery ICU shortly afterwards. Her stay will be based on how stable she is. When she is stable they will transport her back to Sharp Hospital. (You all have her old Mercy ICU number)

Everyone from Dr. Kureshi, Dr. Jahan to the nursing staff thinks Kathy will benefit from the surgery. Her fluids seemed to build slowly over the last days and this has resulted in her responses going downhill. Her shaking has increased, her hands and feet have curled up and her concentration is diminished. They took a MRI and it showed increased fluid levels. All signs point to performing the surgery. I will keep you posted on her progress……

Wednesday, October 11, 2006

Help-I will be gone for two days this week

I am traveling to Charlotte, North Carolina for a customer event this Friday and Saturday. It would be helpful if anyone could visit Kathy on these days. Again, the best times are after 12:00 PM and up until 7:00 PM. I will fly back Sunday and can be with Kathy in the early afternoon. A thousand thanks to anyone who can visit!

Cruising Altitude

Talked to Dr. Jahan about getting Kathy’s surgery changed back to an earlier date this month. Dr. Kureshi changed her date to accommodate my scheduling. I did not realize it would be 15 days later! I suggested to Dr. Jahan the sooner Kathy could get the new PT line installed the faster she is going to get to the next level He agreed and is working to get a sooner date.

It just seems like the pressure is slowly building back in her head. She has kind of just held steady this week and her attention span is just not there. I’ve talked to others and they concur. This surgery should relieve this problem and hopefully produce a break out.

Kathy talks very well on the phone and is slightly more mobile. She can talk, when she feels like it, to her visitors. Her mental abilities are better this week-in occupational therapy she played Yahtzee! We sneak her a little bit of milk, jello and other things and just cross our fingers about her swallowing! I hope she will be able to pass her next swallow test because the darn feeding tube is still in her stomach. With that out and the PT line in, maybe we can just get the heck out of here.

Kathy had Debbie, Milt, Pat, Athene, Alecia, Alyssa, Leslie and I as visitors today. Alyssa and Alecia did her nails and she looks great. She seems a little off today but maybe she’s just tired. Her mind seems to be fine but the old saying “mind over body” is difficult. Maybe tomorrow she’ll bounce back!

Monday, October 09, 2006

Dog Day Afternoon

Right now Kathy’s rehabilitation is going steady but slow. She is incrementally improving everyday but no big steps or breakthroughs. At times I get frustrated about her progress. I guess I expected her to be walking more and being more like she was. It’s been 5 weeks since we have gotten to Sharp and I worry that she has peaked. Well let’s hope not!

The good news is Kathy’s antibiotic IV is finally out after 2 months! She no longer needs her pic line on her arm, FREEDOM. That irritating machine is out of her room with is constant alarms and bells. One more line to go and Kathy will be free of all her attachments. What line is that? It’s her feeding tube. Last week Kathy again failed her swallow test and the tube looks like its going to be in her for a couple of weeks. BUMMER!

When ever anyone is visiting Kathy, you should ask her to do her swallow exercises. I keep reminding Kathy that if she can pass it and start eating, the earlier she’s going home. Kathy really is at the point where she wants to come home. Maybe this is a good motivation for her? Let’s hope so!

Thursday, October 05, 2006

A Surgeon's Work is Never Done!

I went down to visit Kathy with Alecia and watched her go through her different rehabilitation classes. Kathy was especially alert and operational today and went through her classes with verve. The buzz in the hospital was that Kathy was talking much more and was actually hitting the call button and asking for assistance. Everyone was pretty up about her rehabilitation progress this week!

I did have another medical conversation with Dr. Jahan this morning. He commented that he wanted me to call Dr. Kureshi office about Kathy’s latest CT scan. I called Dr. Kureshi and he was concerned that Kathy’s fluid level was still too high for his comfort. He explained the following: Kathy’s spine produces fluid that flows between the spine and the brain. This fluid flows into her ventricles. The problem is the spine produces it and expunges it also. The valves between her spine and brain are scarred from the infection and do not let enough of the fluid pass back into the spine to be expunged. The fluid builds up and create high pressure in Kathy’s ventricles. This could impede her recovery short and long term. The best way to cure this is to install a permanent PT line from her brain that empties into her stomach. (He was happy about her clinical results from the spinal tap but the fluid level is now back to almost before the tap) This operation would entail a cut into the skin in back of her ear area and he would drill a small hole and install a line and valve from her head to her stomach. He would attach a thin line and run it underneath the skin into the stomach which would automatically at all times drain the excess fluid. This would be a permanent connection for the rest of her life.

What are the ups and downs of this operation? The downs would be the potential for a complication during the surgery. He feels this is minimal. The ups would be Kathy possibly could recover at a greater rate with normal brain pressures. This would allow for a permanent solution to the fluid build up. He has been right ON with Kathy’s care so I asked him if it would be OK to consult with Kathy. I explained the benefits to Kathy and she agreed to go forward. He plans to do the surgery in 10 days or so. This would evolve taking Kathy to Scripps for the day to do the surgery and then transferred her back to Sharp’s afterwards. I will post everyone on the date!

Wednesday, October 04, 2006

Check Me Out!

Tuesday was Sharp's bi-monthly review of patient progress. The goal of the meeting is to update family members on the patient's progress. The following issues were discussed:

First: Medical Doctor: Dr Jahan was pleased with Kathy's overall medical progress. She is doing great, except that pesky fever she is going through. He is recommending Kathy gets another MRI and CT scan to update Dr. Kureshi. Overall, Dr. Jahan thinks Kathy will improve over the next two to three weeks if she remains hospitalized.

Second: Occupation Rehabilitation: Robbie commented Kathy continues in a"total assist" mode and her sessions are inconsistant. Kathy performs only when she stands and does her exercises. Robbie was hoping for Kathy to make more progress after her spinal tap than she has.

Third: Physical Rehabilitation: Lori commented Kathy is hanging in there. She has progressed to the point of using a walker during rehabilitation. Her right leg is still unable to move normally and needs assistance. She is encouraged! Kathy needs to stay focused on exercise.

Forth: Speech Therapy: Lance can tell Kathy is more responsive after her spinal tap. Her core activity is improving and her speech is clearer. She can identify most objects and printed words. Kathy can construct sentences and initiate conversations. He feels overall, she has progressed well over the last week.

Fifth: Her Case Worker: Christine feels the insurance might allow Kathy to stay another week or two. The staff agrees with me on one thing, Kathy is progressing and two to three weeks of therapy would be very beneficial to her overall recovery. Fight the insurance company!

Go SHARP STAFF! YOU ARE THE BEST!!!!!!!!!!!!!!!!

Monday, October 02, 2006

A Special Group

I wish to thank everyone for all the prayers and best wishes for Kathy’s speedy recovery. The flowers and gifts have been wonderful and appreciated. Many of you have visited Kathy during her hospital stay and I thank you very much.

I wanted to acknowledge a "special group of people" with a heatfelt and deep "WE LOVE YOU" for coming by frequently and supporting Kathy during her Sharp’s stay! THANK YOU FOR ALL YOUR LOVE AND PRAYERS!

The Troopers!

Athene and Jonathan
Debbie and Mickey
Randy, Kiki and Megan
Trevor, Jennifer and Alyssa
Merilee
King
Alecia

Looking on The Bright Side

Dr. John Jahan, Kathy’s primary doctor, stopped by during physical therapy and we had a good chat. He gave me mostly good news on Kathy’s physical condition. The spinal and brain fluid removed from Kathy a week ago, tested clean. Her overall red and blood cell concentrations are very good. The biggest news was her improved progress on two of her oldest and longest medical conditions.

Kathy, as we all know, has been on various pain medications during and after her three back operations. She has had extreme back pain for now almost 6 years! This medication has put a huge strain on her internal organs, especially her liver. Dr. Jahan was happy to report Kathy has recently worked down to an extremely small amount of pain medication. This was possible because of her extensive stay in a controlled hospital environment and her body’s decision to focus less on her old pain centers and transition its priority thinking to her other problems. (It’s kind of like hitting your one thumb with the hammer to reduce the pain feeling in the thump you just hit?) With the reduction of pain medication, plenty of rest, controlled environment and a good steady supply of high quality diet, Kathy’s liver functions are back to normal. So when Kathy gets out of this mess, she can have some positives to help her handle all the crap she had to go through.

Kathy’s current medical problems center on a lower track infection that's giving her elevated temperatures. When I left tonight, her temperature had climbed above 100 degrees from the infection. This was the third day of her body going up and down on this infection. Hopefully the doctors will get it under control before it triggers anything else!

Tomorrow I will meet her team in the conference room to review her progress. I will report back to all of you how far they feel she has come since being at Sharp’s for four weeks. Wow, it’s already October!

Sunday, October 01, 2006

Just Shopping


Kathy always loves to shop and I brought her a new catalog to look over. She forgot I was even there!

Here Comes the Sun

Kathy and I are sitting outside as I write this update. We are so lucky the weather is San Diego is always beautiful. Kathy is really enjoying her time out of her hospital room and soaking up the rays. Overall this has been a good week with great progress reviews from her speech and occupational therapists. The last few days Kathy has had a slight fever and some stomach issues. I hope to get these straightened out with her team at our meeting on Tuesday and able to report back to you.

The next two weeks are very important for Kathy because everyone is trying to get her home. Anytime you can visit and try to get her to engaged would be helpful. That would be making a strong effort to get her to communicate and push her. I think she is much more capable than she is showing. She just feels like not doing things because of all the recovery issues. Let's try to get her going!

Wednesday, September 27, 2006

Thanks for the Coverage


After a business stop in Nogales, I was able to spend the weekend in Tucson with Kellen and Megan. I went with them to the USC vs. U of A game and got to sit in the student section. The Wildcats held USC to 10 points well into the fourth quarter but lost in the final minutes. Had a great time and I wanted to thank everyone who came to visit Kathy in my absence.

Tuesday, September 26, 2006

Plodding Along

Sunday and Monday were slow days for Kathy. Her rehabilitation people were concerned about her progress combined with her not feeling well. I went early today, to view if she was improving, especially after her weekend procedure. Her speech therapy was moving slowly but she is moving along with him! Her voice is still weak and she still cannot pass her swallow test. They are trying to get her to pass it in her room so when they take her to the hospital, her success rate should be high. I tried to get the therapist to realize she can talk if you get close up to hear and she needs to focus from her left side on his word association tests.

Occupational therapy and physical therapy both went better today than yesterday. In fact her occupational therapist remarked it was Kathy’s best day since she got to Sharp! She was answering basic questions and handling good all of the duties she was tested on. Physically, they have Kathy strapped into her wheel chair because she inadvertently tries to stand up. I guess this is progress.!! Again, Kathy is rolling along slowly but ever so solidly forward. At times I wonder if she will take 3 weeks or 3 months to get back to some form of normality. We love you and hurry up!!

Monday, September 25, 2006

New Look

It's time for a look change! Don't Panic!

Spinal Tap

Saturday the Doctors inserted a needle into Kathy’s back and removed excess fluid from her spine. They hope this proceedure will make it unnecessary to operate on Kathy and insert a line into Kathy’s skull to drain excess fluid. (More hair removal and insertion of a line similar to the one she had a Scripps!)

The doctors hurriedly did the proceedure on Saturday in hopes of improved physical therapy progress this week. Kathy had a great day on Saturday spending the afternoon outside in the sun and listening to music. I will update you on her physical rehabilitation progress this week! Thanks for the prayers, flowers and cards-Kathy really enjoys them!

Wednesday, September 20, 2006

Help!

I'm going out of town on Thursday evening and hope someone is able to visit with Kathy on Friday or Saturday. The best times to visit are from 10:00 AM to 3:00 PM, during her rehabilitation and 6:00 PM to 9:00 PM.

In the morning she is more alert and happy. You can accompany her to her rehabilitation classes or wait until her return. From 3:00 until 6:00 she is doing her personal thing, so after 6:00 is a great time to visit. Any help would be appreciated. HINT-If she doesn't talk, put your ear close to her face and she will try to talk back! Good Luck and THANKS!

Tuesday, September 19, 2006

He's Back!

Today was an interesting day. First I missed Kathy’s doctor’s conference because I thought it was tomorrow. Just a bad job of reading dates! I talked to Kathy’s case manager and she gave me the following recap. Kathy is still a moderate to maximum assist patient. She has to be assisted in all activities from personal care to therapy sessions. Her team is concerned that over the last two weeks, Kathy has not improved as much as they desired. They acknowledged she’s had a few set-backs (they also admitted they are less experienced with rehabilitating brain abscesses) but they want an outside medical opinion to see if a medical problem is slowing her rehabilitation progress.

Guess who shows up this evening, but none other than Dr. Kureshi himself, her neurosurgeon from Scripps? We had a good talk and he has decided to recommend the following to Kathy’s team; Kathy has slightly inflamed ventricles that have shown up on her recent CT scans. He noted this is not un-normal in someone recovering from Ventricilitus and could have built up over the weeks. He feels reducing pressure either by removing excess fluid from her spine or inserting another brain drain could give the ventricles time to shrink and heal. This would lessen the brain pressure and lower inflammation. I am waiting for the two teams to decide on the best route. Not this again!

Officially Dr. Johan, her MD, is preparing her for the necessary steps for future home care. The inside opinion by staff is that, Kathy is still four to six weeks away from going home. Again, I want to thank the staff of the Sharp Hospital Rehabilitation for a wonderful top drawer job they are doing. I just cannot compliment them enough!

Monday, September 18, 2006

Walking Tall

I spent time today with Kathy during her occupational therapy and physical therapy. Due to my schedule, I seem to miss the daily physical therapy sessions. It's been almost ten days! It was extremely painful to watch the first time but today she was moving extremely well compared to her first day. She could stand straight with little assistance, except for balancing. She can move her left leg and foot smoothly when walking as well as everything on the left side. The right is still giving her problems but moves much better after therapy. I feel confident that within weeks she will be walking without assistance.

Dr. Kureshi (Kathy’s neurologist) was planning to stop by Sharp Hospital today to review his star patient. Tomorrow, I hope to hear positive news from the staff about his visit? Kathy still has this unique ability to talk on the phone but NADA in person. Totally frustrating! I was researching ways to communicate with brain injurie patients and came up with theses suggestions.

In some instances, the person with brain injury will be unable to adapt or compensate for her communication weaknesses. Therefore, people in the environment may want to consider what they can do to make the communication easier. Questions people in the environment might ask in order to help a person adapt their behaviors include:

1.) Did this person understand what I said?

2.) Was my rate of presentation slow enough?

3.) Did I give clear, step-by-step directions?

4.) Did I use puns or humors that were not understood?

5.) Can I help the person understand better by using pictures or writing the steps?

6.) Am I distracting this person with too many gestures, too loud a voice and/or too many pauses in my speaking?

7.) Is the environment too loud, congested, bright and/or confusing?

8.) Can I simplify this communication by speaking in shorter, clearer sentences?

9.) Can I provide a more organized explanation of what I expect to be done?

10.) Are there others in this situation that can help?

Saturday, September 16, 2006

What Condition your Condition is In

An overall condition check on Kathy from August 31st through today (Her Sharp Hospital Stay)

Brain Swelling: Recovery has been steady. The doctors have ordered recent CT scans and MRI tests. Her progress seems to be acceptable to her neurologist.

Infection and Blood infection: Kathy is on a 24 hour antibiotic intravenously and will be so until the first week of October. All activity appears to be in recession.

Eating and Nutrition: Still receiving 2500 calories a day intravenously but not eating solid foods. For some reason Kathy cannot pass her swallow test? She needs to pass to move on and begin eating normally and resolve her stomach issues.

Right Side: Kathy is getting strong, especially with her upper body. Her shaking is controllable and her overall control is incrementally improving.

Speech: Can converse normally on the phone but with a weak voice. It is very difficult to get Kathy to communicate when directly in her presence. She uses eyes, facial and hand communication instead of voice to communicate. She did muster out two comical sentences to me yesterday! (Still has that sense of humor) Kathy has acknowledged she feels awkward trying to talk face to face. (The phone for some reason is automatic)

Walking: Kathy is improving slowly but still has a long way to go to come home or use a walker. She has good upper body strength but seems challenged with her legs and feet.

Brain/Emotional functions: Seems at times to be 90% or better understanding but other times seems confused when given choices. Still shows some indifference and lack of attention skills as one’s visit stretches out. Emotionally seems to be in a much improved state of mind this week.

Overall: Most of Kathy’s physical aliments seem under control except her ability to eat solid foods. She is still unable to function normally walking or talking. This could be the direct result of the abscess damage to the brain. I feel she's going to be OK with continued intensive rehabilitation. We are encouraged. Thanks for your prayers and thoughts!!!

Friday, September 15, 2006

Speak no Evil

Kathy is involved in a long process of rehabilitation. I am not updating the site as much because Kathy’s condition is stable and her progress during rehabilitating is more incremental. Medically, Kathy is doing well with no new flare ups and all her vital signs positive.

Today Kathy looks great with her wavy blonde hair flowing over the pillows. She is taking on the phone and seems very communicative and lucid with each caller. JUST AMAZING! For some reason Kathy is not comfortable in front of people taking yet? (I will have to talk with her doctors on this one-again) On the phone she is doing amazing. Her answers are structured and complex with good tone. (Almost normal) Her voice level is low but she can speak up when needed.

Her physical therapy is progressing OK. She admits it is very difficult and this is her biggest roadblock in getting out of the rehabilitation. She is working with her therapist twice a day and improving. I hope that next week she will be able to start moving around in a walker.

Monday, September 11, 2006

Feelings

The small things went well this weekend. Kathy had a good mix of friends and family visiting and ramped up her emotions accordingly. She did better at smiling, winking, hand motions and being aware of her visitors. A few hours in the sun, you could see Kathy enjoying every moment. You can really see her communication feedback revolves around her emotional feelings at the time of contact.

On Monday morning the doctors moved her feeding tube from her nose to her stomach. Kathy looks beautiful as ever, without that damm tube in her nose. She was drowsy this afternoon and her rehabilitation people let her rest. She’s rearing to go tomorrow!

At times, it’s frustrating visiting Kathy because she shows such little interest in her visitors. I have asked the doctors why she acts this way and they suggested some reading material to help me out.

“What the Patient May Be Feeling”

“Perhaps the most disturbing to survivors who have sustained a brain injury is the loss of identity. Many of us take for granted the things with which we identify ourselves; our job, our relationships and roles. Imagine all of a sudden not being able to go to work, drive a car, cook a meal, play a game, help your children, go for a walk or even hug your family. Not only that, but you require assistance from others for even the most basic skills. Brain-injury survivors must come to terms with the new limitations, new roles, new sense of who they are, and where the fit it. The person she knew before the injury has been replaced by someone who is, in essence, a stranger. This can be more difficult to deal with than the physical limitations.

Many times, an individual who has suffered a brain injury will experience feelings that others would consider natural, such as frustration, disappointment and depression. However, injured individuals may also experience feelings that come as a surprise to family members and loved ones. Without the ability to care for herself, the patient may begin to feel useless and helpless. Having to rely on someone else to take care of one’s basic needs can make the patient feel like a burden, no matter how good the caregiver is at assuring the patient she isn’t.

One of the issues that brain-injury survivors frequently encounter is that they do not appear physically disabled. In fact, their disability may be solely cognitive in nature. Without the physical reminders, others may not be aware of the patient’s limitations and can act intolerant, causing the patient further embarrassment and frustration.

The patient may or may not express these feelings. Putting yourself in her shoes, and putting inside aside your own issues and wants, will help you really understand what the patients needs.”

Saturday, September 09, 2006

Let the Sunshine In

Friday we had a good day with Kathy. Alecia came down with me to visit and I picked up Kellen at the airport. For Kathy, this seemed a good combination and she reacted much more with her voice, actions and expressions. It became clear as the other kids showed up that Kathy’s lack of speech and emotion revolves around her emotional state at the time. Being the fourth major surgery with difficult recovery, Kathy is probably mentally distraught about her condition and what lays ahead. She feels badly about herself, her recovery is long and arduous and she is unsure of her health.

I talked to her doctor and her MRI came out neutral/positive. This means that there could be some swelling but the neurologist needs to compare the last MRI to the current. If this is a problem, they will transfer her back to Scripps for more tests. Is this crazy? Well, I hope it isn’t a problem.

We had an interesting time with Kathy and her physical rehabilitation team. Kathy had to walk three times. She was totally unable to walk without full assistance. It was quite painful to watch her being helped just to move one foot forward and then the other. She did pull herself up on the parallel bars and stand up on her own. She did other exercises and her team is so supportive and professional. I salute them.

Her physical side looks to be a long way off. I can see now why she is scheduled to be in the facility for 5 weeks or more. The highlight of the day was being able to spend a half and hour outside with Kathy. This was the first time she has spent time in the sun and open skies in 30 days. She had a blast.

Wednesday, September 06, 2006

Everyone's Opinion in 15 minutes

Today was the first big conference with her staff. They had a whole time allotment of 15 minutes for discuss Kathy's condition. (I guess they have a lot of patients) Just doesn't seem right? I left the notes at work so these are from memory:

1.) First her medical doctor commented that she was progressing acceptably with all of her antibiotics and tube feeding. He was concerned about her speech progress and lack of communication. He wanted to address every level so medically he ordered a MRI taken this afternoon. He also decided, to reduce her pain medication so that was not a factor in her being less alert and talkative.
2.) Her physical therapists and Nursing reported that Kathy was able to perform only 20% of normal day to day activities and needed assistance 24/7.
3.) The speech therapist commented Kathy did not pass her swallow test Tuesday and he wanted to have the gastrologist move her tube from her nose to her side and enter directly into the stomach. This was safer and more humane he felt. In addition this would be better for Kathy because she no longer would have to be feed through her nose which numbs some of her senses. He is concerned of the lack of daily interface and speaking.
4.) Her psychologist has not started his evaluation but will do so today. He will review her physical damage to see how it relates to the way she is acting today.

The room contained over (9) doctors, nurses and therapists assigned to Kathy to address the different levels of medical care. They all admitted they had not had sufficient time to evaluate Kathy due her late arrival last week and the holidays. The staff was surprised to hear that she communicated so well over the phone and had no expert explanation for me. They commented this week Kathy should get more out of her 3 to 4 hour a day of physical, breathing, speech and occupational therapy. I was a little stunned when later, I talked to her case manager, who has been in the business for 25 years, and her evaluation of Kathy has her spending much more time in rehabilitation than 5 weeks! I don’t know if Kathy or I can take it that long.

It’s nice to report that everyone at Sharp is extremely professional and most important, pleasant to deal with. The pace of the unit is much slower and peaceful than at Mercy. Overall, at this moment, I am very happy that Kathy is at the Sharp Hospital facility.

Tuesday, September 05, 2006

Pedal to the Metal

Everyone is back from the holiday and the Sharp parking lot is full. I was able to spend some time this afternoon with Kathy during physical rehabilitation, which was pretty interesting. She is starting to be tested on her coordination and strength She has a long way to go but she is trying hard.

I found out she failed the swallow test this morning, so she is going to have to wait to have the tube removed. The feeding tube doesn’t come out for 3 days after you are cleared so it looks like another 5 to 6 days at least. FUSTRATING! If Kathy can get going physically, everything is going to come together, especially when she builds up enough strength to get in and out of bed.

She is stangely playing “mute" and it is almost impossible to get her to talk to you when you are in the room. If you have a moment and want to talk to Kathy, you are going to be more successful attempting to call the room and hope the nurse picks up the phone and hands it to Kathy. Weirdly enough she can stay engaged for some time on the phone. I asked the nurse why? Both said that they had patients in the past like Kathy and they turned out fine. They could not give me a medical answer but made me at least feel better.

Kathy’s daily rehabilitation schedule goes like this:

7:30-8:00 Respiratory therapy
9:00-9:30 Occupational therapy
11:15-12:15 Physical therapy
3:15-3:45 Speech therapy

They seem to run a loose ship, so times may not be exact. So if you are trying to visit or call, she could be anywhere. The best time to visit, based on my experience is around noon until 3:00 PM because Kathy is the most alert. Again, thanks for your prayers and support.

Monday, September 04, 2006

Laboring to Understand

Kathy’s in the hospital on Labor Day, a kind of special weekend for our family because we have two major birthdays (Plus her Fathers) during this holiday. Alyssa turned 17 and Trevor turned 26. Kathy always found this time to be so busy with kids going back to school and the two big birthdays. (Kathy loved to go out and buy the kids to many gifts) She wanted to be such a big part of Alyssa’s senior year because this would be our last child in high school.

Well, we had a wonderful birthday party with Kathy in her room on Sunday. I, Alyssa, Trevor and Jennifer spent the afternoon opening presents in front of Kathy. We had a "no candle" light birthday cake for Trevor because Sunday was his special day. The nurse looked the other way so we could give Kathy some cake and milk. (Not allowed on her chart) The weekend was busy with Alyssa having a big party at our house on Friday, enjoying her main gift, taking 12 friends to the Padres game on Saturday, meeting up with family for Sunday brunch and enjoying a surprise dinner for Trevor at Dave and Busters in San Diego Sunday evening.

Kathy’s overall condition: She is still medically restricted because of her feeding tubes and antibiotic tubes. Her pneumonia is still present but in recession. We hope by the middle of the week, Kathy will get off tube and be allowed to eat. She will be fitted with a portable IV tube for her rehabilitation classes. Overall Kathy looks good and you can tell she is getting a little stronger. She sits in a wickedly cool wheel chair (I want one) during the day and starting next week will start into her full rehabilitation schedule.

Mentally Kathy seems running in the sand. She has her moments during the day but most of the day she is either staring straight ahead or sleeping. For me, this is very frustrating because I want her to get mentally better like her physical side. She can communicate with you through her hands and eye movements but that’s about it. Her voice is still very weak and I have not heard more than a few words out of her mouth. She has been on the mend for about a week now but she has not made any big breakthroughs. When it comes to taking (or using her right side), reasoning, problem solving Kathy has a long way to go to do simple interfacing. I thought it was quite a stretch when people told me that Kathy looked like she was a candidate to spend 5 weeks in rehabilitation. Now I concur with their assessment and only hope that the program staff can get her mind moving quickly. I have a meeting with her team of doctors on Wednesday to review where Kathy is today, what her program will be, what to expect and how long it will take. Maybe I’ll feel better on Wednesday? Off to the Sharp Rehabilitation BBQ ............

Saturday, September 02, 2006

Look at Me Now Mom!


Now going into 4 weeks of recovery, some of us who visit weekly have forgotten how good Kathy looked. I thought this would be a refresher picture not only how she looked but the way she she's going to look when we get her out of rehabilitation.

(The picture was taken at the National Park in Uruapan, Michochan Mexico during Alyssa's spring school break in April 2006)

Friday, September 01, 2006

Wake Up Little Sunshine

It was Kathy's first complete day at Sharp. Everyone seems eager to get to know Kathy and details about her condition. Her doctor on the floor is Dr. John Jahan. His specialty is rehabilitation therapy and is the chief doctor. I reviewed the schedule and Kathy has a well designed and structured program, especially Mondays through Fridays. She starts with occupational therapy in the morning, speech therapy around noon and in the early afternoon, physical therapy. Today she got around 1.5 hours of work which will grow to 3 hours by Monday.

Kathy is still being fed through a nose tube that empties into her upper intestine. She just seems unable to handle the speed of water when she swallows. Next Tuesday they plan to administer a barium upper GI to check for problems. On Wednesday or Thursday of next week I will attend a conference with the various doctors to review Kathy's current condition. Questions like what is going to be done, her schedule and how much time to expect Kathy to take for recovery will be discussed.

Sharp Hospital conducts (3) events a week for family's education. This covers areas of interest such as relationships, communications, how the brain works, mobility, family caregiver advice and community resources. They handed out, an interesting book called "The Journey Toward Recovery. I will enclose a quote:

"Brain injury strikes 1.5 million people per year. That's one injury every 20 seconds. Approximately 500,000 of those injuries hospitalizinglization and close to 75,000 result in death. Between 70,000 and 90,000 survivors sustain injuries that are long term or permanent. There are currently 5 million Americans living with disabilities resulting from brain injury. Although these figures are discouraging, they may help caregivers and friends realize that they are not alone."

Thursday, August 31, 2006

If your In the Area?

I will be involved with Alyssa's and Trevor's birthdays on Friday and Saturday night. We will celebrate both on Sunday PM with Kathy. If you would like to visit with Kathy any of these afternoons or evenings I would welcome it! Thanks for the prayers and love!

It's Been a Hard Days Night

The good new is Kathy has moved on to rehabilitation! That means the immediate threat of her brain abscess recovery and pneumonia has been reduced to a management status. As I am writing this blog she is hard asleep.

The Sharp medical staff has spent the day validating everything from Scripps documents. Since the responsibility is on Sharp to maintain her at a high level, they need to do their own analysis and due diligence. I will find out more tomorrow when I meet with her case manager.

Information on her stay at Sharp Rehabilitation Center:

Sharp Rehabilitation Center
2999 Health Center Drive
San Diego, California 92121

Room 148

Room Telephone Number 858-939-4729 (She probably cannot answer the phone until Tuesday due to her strength)

Talking to the staff they prefer visitors to come from NOON until 10:00 PM daily. She is involved in daily therapy form morning until 4:00 PM daily. They will give her light therapy on Saturdays and Sundays off. They encourage visitors to come in the late evenings/nights or on the weekends.

Wednesday, August 30, 2006

Frequently Asked Questions About Sharp Rehabilitation


Frequently Asked Questions About Sharp Rehab

Sharp Rehabilitation Services — From Possibility to Ability

For nearly 45 years Sharp Rehabilitation Center has provided comprehensive inpatient and outpatient rehabilitation services to Southern Californians.
Our continuum of rehabilitation care includes programs and services designed to address all types of injuries and illness. From the basic orthopedic injuries to complex conditions, such as stroke, brain injury and spinal cord injury, Sharp provides specialized programs and services to meet each individual’s needs. In addition, Sharp is the leader in providing support services to families and care-givers.

The following are some of the more frequently asked questions.

What type of patients do you serve?

Age range is between 14 and 90 +. Regardless of injury or illness, patients are seen if they have physical and cognitive functional limitations that can benefit from our services.

What types of inpatient services are offered?

All programs and services are individualized with your treatment team. The team is lead by a Physiatrist (physician that specializes in Rehabilitation) and includes nurses, physical, occupational, speech and occupational therapists. Other team members include social workers, psychologists, case managers and discharge planners. The patient and family are at the center of the team. Your team will meet at regular intervals to review your progress.

What types of specialized programs are offered?

Sharp rehab offers specialized programs for stroke, brain injury, spinal cord and other neuro musculoskeletal injuries.

How does inpatient rehabilitation differ from an acute hospital?

Patients and families should understand that an inpatient rehabilitation is different than an Intensive Care hospital setting. During the first 24 hours at an inpatient rehabilitation center, patients will receive an extensive assessment from various health care professionals to determine their physical, therapeutic and psychological needs. Following this assessment, and in collaboration with the patient and family, an aggressive “plan of care” is developed.
Once the plan of care is outlined, patients are expected to work hard to participate in scheduled therapies and educational programs. Families and care givers are also encouraged to participate. This insures that the patient and family receive the most from their time spent in the rehabilitation program.

How long do patients stay for inpatient rehabilitation services?

Length of stay is based on each individual’s treatment goals and determined by the rehabilitation team. The rehabilitation treatment team continually monitors the patient’s progress and works with the patient and family/care-giver in preparing for discharge. Currently, our average length of stay is approximately 19 days. Depending on type of injury, length of stay can range from 10 - 40 days.

What happens after discharge?

Sharp offers an extensive list of outpatient therapy programs and services to help patients increase functional abilities. These services may be offered here at Sharp Memorial rehabilitation Center or at our other rehabilitation centers located through out San Diego County. In addition to therapy services, Sharp offers a variety of support activities and groups to help with re-integration into community living.

Is the cost of Inpatient Rehabilitation covered by my insurance?

In most cases the answer is “yes”. However, health insurance is more complex than ever before. Sharp will provide a knowledgeable and experienced staff to address insurance questions and concerns.

How do you measure your success?

Several measures are tracked to determine success. Upon admission to the Rehabilitation Center, every inpatient is rated on their abilities to perform activities such as dressing, mobility, communication. Through-out the inpatient rehabilitation stay, progress measured and tracked and at discharge, each patient is rated and increased functional ability is documented.
83% of our patients return to home at discharge. After discharge, each patient is contacted to determine their status and progress and to measure their level of satisfaction with the services they received. During 2005, our patient satisfaction scores were as follows:

94.1% Overall patient satisfaction
94.3% Likely to recommend Sharp Rehab to others
95.4% Sharp Rehab Program helped you reach your goals

The Razor's Edge

The eagle has landed. After all the gymnastics, we have finally gotten Kathy into Sharp Rehabilitation. Sharp Rehabilitation is one of the best facilities in the county and has quite a reputation for excellence. Tomorrow at 10:00 AM, Mercy Hospital will transport Kathy to Sharp and get her checked in. After touring the facility yesterday, I feel Kathy should excel in this type of team work environment.

Today Kathy was poked, pushed and tested to her abilities. She again was issued high marks from her infection disease doctor and pulmonary doctor. They are amazed at her success and truly enjoy checking up on her. She successfully completed her limited therapy today and she looks forward to the acute care she will receive in her new facility. GOOOOOOOOOOOO KAAAAAAAAATTTHHHYYYY!

Tuesday, August 29, 2006

Rancho Levels Of Cognitive Functioning

Not at bedside, some of you might wonder how Kathy's mental recovery is progressing. A good tool is the "Rancho Levels of Cognitive Functioning" scale reported earlier in my blog. After review (1 to 10 highest) , I would guess Kathy tonight is a strong level 6.

After reading the scale closer, a lot of people I have run into over the years do not even meet level 9 or 10 ! My gut feeling is Kathy is much more on top of things than she lets on and is sometimes masking her progress with emotional duress and fatigue. The biggest road blocks lies ahead is not her mental recovery but probably getting her strength back and balancing her right and left side. We all know one thing about Kathy, this probably is the easiest road block ahead!

My Conclusion: READ BELOW

Level 6 Confused-appropriate Assistance

Inconsistently oriented to person, and place. Able to attend to highly familiar tasks in non-distracting environment for 30 minutes with moderate redirection. Remote memory has more depth and detail than recent memory. Vague recognition of some staff. Able to use assistive memory aide with maximal assistance. Emerging awareness of appropriate response to self, family and basic needs. Emerging goal directed behavior related to meeting basic personal needs. Moderate assistance to problem solve barriers to task completion. Supervised for old learning (e.g. self care). Shows carry over for relearned familiar tasks (e.g. self care). Maximal assistance for new learning with little or no carry over. Unaware of impairments, disabilities and safety risks. Consistently follows simple directions. Verbal expressions are appropriate in highly familiar and structured situations

Pick of the Litter

Today I visited two potential physical rehabilitation sites for Kathy’s recovery. First I visited Sharp Rehabilitation and afterwards San Diego Rehabilitation Institute. Sharp has a well respected program and the hospital is rated high on most surveys. The rehabilitation equipment and rooms seemed extensive and first class. They have a specialized brain injury department with respective therapy equipment. San Diego Rehabilitation’s program seemed less extensive and modern. I liked the way the hospital was laid out and the rooms are better than Sharps. The people seemed friendlier but SDR does not have the reputation or the equipment that Sharp’s posses. The new rehabilitation nurse thought highly of Scripps Encinitas rehabilitation facility (she worked there for 10 years) and I will add that to my list. Too Confusing?

Kathy’s voice came out clearer with her speech therapist this morning. Later in the day she did about a half hour of physical therapy and was very weak when attempting to sit up or stand for a few minutes. (She is going to need lots of therapy to get her standing after three weeks in bed) Her respiratory doctor swung by and said her pneumonia is under control and he expects it to be gone in a few days. She slept the afternoon

This evening we made calls to family members and friends and Kathy seems very understanding of each conversations. She responds as if she was having a normal conversation but with a very weak voice. This is quite unusual because rarely will she talk to anyone in her presence like she does on the phone. Maybe because she can use visual feedback like eye movement and hand signs she chooses not to engage? The phone requires her to say something to the other party on the line?

Kathy’s case manager thinks she will be OK to transfer to a rehabilitation facility in the next two to three days…..

Monday, August 28, 2006

Manic Monday

Kathy had a busy Monday with everybody at Scripps back at their posts. She had visits with her pulmonary doctor, her infectious disease doctor, her primary doctor, her medication doctor, her team doctors from ICU, her RN, her RN assistant, her breathing treatment technician, her speech trainer her physical trainer and her San Diego Rehab facilitator all in 4 hours! Great News! They were all pleased with her appearance and progress over the weekend!

Physically, her pneumonia remains a threat but she is breathing steady and seems to be on an upswing. (Please don't move her and screw this up) Her bacteria cultures remain negative for blood, urine and brain fluids. About the only thing wrong is she says she is a tad warm but her temps remain around 97-98 degrees.

Mentally, Kathy is a becoming a classic case of brain trauma recovery. She knows things are not right and is worried. We try to give her hourly accolades and "thata girls" but she knows it's going to be a battle. Lately, I finding it more time intensive and difficult to keep Kathy positive and focused. The good news, Kathy has spirit and is trying hard every day.

Tomorrow I am going to check out Sharp Rehabilitation (I've heard good things) and make sure I'm making the best possible choice. Kathy had great fun today, listening to her iPod, getting books and magazine read to her and a throng of evening visitors to bolster her. Thanks to all of you!

Sunday, August 27, 2006

Visiting on Monday and Tuesday

If you want to visit Kathy, I could use the help when I am not there. I will be with Kathy in the morning Monday but no coverage in the afternoon or evening. On Tuesday I will be with Kathy in the afternoon and evening. Of course any visit will be appreciated!

She will have rehabilitation during the day and in most cases you are welcome to stay!

Again, thanks for the prayers and support for Kathy-WE LOVE HER

Remote!

Sunday Kathy seemed to be relaxed and stable. They moved her from the 10th floor to the 6th floor and twice on the 6th floor. She currently is in room 606. (Thanks-not 666) All her vitals are good with plenty of oxygenation and a steady heart rate. She does seem to have a little shake in her hands and right leg that is bothersome. Overall her physical condition, even with pneumonia, is getting incrementally better. When you walk in the door, immediately Kathy looks like she’s feeling better and more rested.

The mental picture is a little more complicated. I’m sure it will take time and lots of frustration. Kathy tends to loose interest in minute to minute events but sure likes her TV! I don’t know why, but I think the constant change of pace on the TV screen keeps her attention. She does recognize people and understand what you’re talking about but does not seem super interested. She is right now controlling the TV and having a glycerin stick.

Tomorrow, Kathy will get back into all of her therapy; physical, swallowing, speech and breathing. Sometime tomorrow, they will give us more information on when she will be transferred to San Diego Rehabilitation. IF ANY OF YOU know stories of good or bad on San Diego Rehab, Continental Rehab, Sharp Rehab or Palomar Rehab, I would appreciate it. I hope to make a run to personally visit the facilities tomorrow.

Information on Kathy's Rehabilitation Facility


Kathy's next stop!
Web Address:

http://www.alvaradohospital.com/CWSContent/alvaradohospital/ourServices/medicalServices/SanDiegoRehab

San Diego Rehabilitation Institute
Inpatient: (619) 229-7380
6655 Alvarado Road, San Diego CA 92120

Suffering a disability or having a loved one suffer a disability can be a devastating experience. There are so many things to consider such as finding the care and support to help restore the quality of life that is often taken away. That’s why at the San Diego Rehabilitation Institute (SDRI), we specialize in striving to restore patients to a high quality of life after experiencing disability.

As one of the greater San Diego area’s leading centers of comprehensive rehabilitation services, SDRI’s team of dedicated professionals understands what the challenges of disability are. We have the skills and specialized programs to prepare our patients for their return to home, family and employment. Our success has been built on honest, cooperative relationships with our patients, their families, physicians, employers and insurance companies. We believe that a team effort is critical to our patients’ success and we strive to work closely with all parties for quality treatment for our patients.

Transitional Care

SDRI’s 30-bed Transitional Care Unit (TCU) offers both medical and rehabilitative services. The TCU provides short-term skilled nursing care for people who do not require the entire resources of an acute hospital but still require 24-hour nursing care. The unit also provides a link in the progressive recovery of patients who are recuperating from a condition that requires rehabilitative specialists. Our goal is to deliver quality medical and rehabilitative care in a cost-efficient manner in a comfortable and caring environment.
Some of the medical conditions we treat in the TCU include:

Diabetic complications
Surgical aftercare
Persistent infections
Infusion therapy
Wound and burn care
Organ transplant aftercare
General skilled nursing
Some of the rehabilitation conditions we treat in the TCU include:
Spine/back conditions
Joint replacements
Orthopedics and multi-trauma injuries
Cardio-pulmonary conditions
Neuromuscular diseases
Neurological conditions

Get Out of that Funk

Kathy is remaining in ICU today because of the shortage of staff on the 11th floor. Kathy’s pneumonia is improving slightly and the doctors feel she is doing good enough to not only get out of ICU but then go to rehabilitation. They estimate a few days to stabilize on the 11th floor and by Tuesday or Wednesday she will transported to rehabilitation. She has been approved to go to San Diego Rehabilitation where she will spend upwards of 3-4 hours daily of physical and mental rehabilitation.

Kathy’s metal side is pretty alert which makes her susceptible to the ups and downs of daily hospital life. She expresses all the feelings, happy, bored, tired or in pain. Lately she has been slightly depressed so today I hope top cheer her up by bringing in her iPod, pictures and magazines. Her emotional side is down so I have to remind myself to not put too much on the table.

The seeming good news is the most serious physical dangers are behind us. We need to keep a watchful eye on the pneumonia and hope for the bacteria issues to stop. All her cultures remain negative at the moment. Her Doctor came by yesterday afternoon and wanted to get her dentist's telephone number so he could discuss with him the possible causes of the abscess. He reminded me that Kathy will have to take antibiotics for the next 6 months at least. Heading off with the goodies….

Saturday, August 26, 2006

Where's Waldo?

The Scripps Mercy shell game is on. On Wednesday they moved Kathy from the second floor ICU to the eleventh floor regular. They then moved her twice to get her to a private room. On Thursday they moved her back to ICU on the second floor. On Friday they moved her from the ICU on the second floor to the ICU on the tenth floor. She is currently on the tenth floor. Rumored today she is moving to the eleventh floor. That will be 5 moves in 4 days!

If you plan to visit, please be patient and hope they don’t lose her!

A Walk in the Park

Yesterday was a good day for all of us. Kathy responded in ICU to her intensive care and medication. Dr. Ballon-Landa, her infections specialist, continued to give her new combinations of antibiotics to improve her condition. Kathy pneumonia, luckily, is limited to one lung and with breathing treatments every three to four hours, she was breathing easier. Mentally, Kathy is pretty much back to her peak progress showed on Wednesday. She's alert to conversation and even attempts to comment or talk when she wants to make a statement.

What next? Well, today if Kathy keeps up her strong recovery, they will want her to move back to 11th floors (Hell level) for the next few days. If the nurses on floor 11 don’t make mistakes and put Kathy back into ICU, she should move on to a rehabilitation hospital in a few days. At the rehabilitation hospital, they supply acute care, but more importantly provide Kathy with 3-4 hours of therapy to improve speech, memory and her range of movement. Scripps advised us she would probably need around (2) weeks in rehabilitation before coming home. At home she would need some assistance until she feels comfortable.

Macy suggested two facilities near Mercy hospital, San Diego Rehabilitation (Macy’s old haunt) or Continental, located across the street. I am going to check out both this weekend to find the best for Kathy.

This morning, the nurse reported Kathy had a good night, got her bath and hair shampooed and is looking beautiful. (Kathy told me last night she wanted to cut her hair off-I think people’s comments are making her feel self conscious about her hair) She had a strong headache (?) and they gave her Imitrix, her migraine medicine. She was sleeping well this morning……….

Friday, August 25, 2006

Kathy's Internal Bacteria Specialist


Dr. Ballon-Landa was board certified in Internal Medicine in 1980. He was also board certified in Infectious Disease in 1984. Dr. Ballon-Landa received his medical degree from Northwestern University in Chicago in 1977. He is a past president of the Infectious Diseases Association of California, and is a councillor in the board of the Infectious Diseases Society of America. He received the prestigious "Clinician Award"

Above is the Doctor that is working on different combinations of penicillin and antibiotics to treat Kathy. He is considered one of the best in the business. Keep up the good work Doc!

Pneumonia

I called Kathy’s nurse Rachael this morning and she was doing better breathing and seemed more comfortable. Her CT scan of the lung last night was not good and confirmed a severe case of pneumonia. Her pneumonia is affecting her one lung in the lower lobe and the other lung in the upper lobe. About the only good thing to report is, she has not gone on a ventilator and her vitals are steady.

Her blood bacteria cultures are not taking so they think she might have cleared up but it will take a few more days to review the cultures. Her culture on her brain fluid does show bacteria and they are taking a more intensive approach.

Kathy’s nurse is concerned she has so many things going on and is worried about a quick outcome. She cannot predict how and when she will improve. She also noted that Kathy seemed down in her sprits and I hope we can get her BACK UP today. Whoever sent flowers, thank you! I have to pick them up from the 11th floor and take them home because in ICU you cannot have flowers.

Thursday, August 24, 2006

Conspiracy Theory

Kathy seems to have fallen victim to the hospital curse. Today she was being pushed hard by speech therapy to eat solid food for lunch and she eventually got some of these gastric juices into her lungs. Shoot, she wasn't even allowed to drink water but they wanted her to eat solid foods! Obviously, this got down into her lungs accelerating damage to her lungs.

The doctors spent the afternoon giving Kathy breathing treatments and injections of medicines to improve her intake of oxygen. She showed so little improvement combined with severe congestion, she was put back into ICU for safety. She is set up to have a lung CT tonight.

This is two steps back and one step forward! I am totally upset and fustrated because Kathy was so close on Monday to breaking out and heading for full recovery.

Kathy is in non surgical ICU (acronymsm NSICU -acrosss from surgical ICU). After visiting her room tonight she is in good hands. (I am actually relieved) The 11th floor medical coverage had a lot to be desired. Everyone here is trying their best but the demons of the hospital are taking there toll.

Answers to Monday's Question


What do Randy D. Haskell and Kathleen D. Newhouse have in common?

Both had fathers in the avocado business

Both lived as teenagers in Valley Center

Both went to Orange Glenn High School

Both had employment connections to West Pak Avocado

Both have Bob and Debbie Shuford as friends

Both have the same Neurosurgeon: Dr. Kureshi

Both had surgeries in Mercy Hospital

That is 7 things in common at least! I don’t know how to call a clear winner here. Maybe a good consolidation prize is warranted! Thanks

Morning Update and Room Change

I talked to Kathy’s nurse this morning and she said everything went well last night. Really nothing to report except they will be drawing samples this morning to see how the infection is progressing.

Kathy has been moved out of ICU into a private room, 1101. The room is located on the llth floor of the main hospital building. Official visiting hours are 12:00 PM to 10:00 PM everyday. When Kathy has no work scheduled the nurse said visitors could come by as early as 9:00 AM. Her nurse recommended visiting after 10:00 AM.

Visiting will be more convenient because she has a private room with less stringent rules and regulations.

Wednesday, August 23, 2006

Two Steps Forward and ONE STEP BACK!

As the saying goes today was that one step back. Kathy started the day out with optimism. Her brain tube was removed and stitched over, the team raved about her progress and she was being moved out of ICU. But the whammy hit! Kathy took a late morning nap waking up to a fever, fast breathing, fast heart rate and disoriented. Her disoriention was so bad she would barely respond to the nurses instructions. What had gone so wrong in a few hours?

Her fever was suspected to have caused the disoriention but where was the fever coming from? The doctors took a CT scan and found nothing, they took blood and urine samples looking for bacteria. The blood came back positive. Did Kathy have a blood infection? How could this be possible with so many antibiotics going through her? Did she get infected when they took out her tube or did something in ICU give her the infection? Did she have Sepia (blood infection) or was it something else?

Not getting a detailed response from her doctors tonight, we cannot be sure. All I know is, Kathy regressed in a big way today until she rallied tonight to come back within 50% of her morning progress. I just hope her progress continues overnight and we get a good explanation tomorrow. Kathy's fever is down and her medications have been changed. I constantly read and hear the best way to stop any infection is getting quick treatment and Kathy did so. Keep your fingers crossed.

Tuesday, August 22, 2006

Prognosis Up

All indicators were up on Kathy’s prognosis today. She had her CT scan early morning and everything was good. Dr. Kureshi will pull her pressure tube out tonight when he does his evening rounds. Most of the day I spent back at work and I am not able to give you much news. We did show up late in the afternoon and she was with her speech therapist. Everything went well with Kathy, she was able to do complex assignments and even write out words when words were tough to pronounce. She finished her session on a high note writing my name when asked who her sugar daddy was! We came back later this evening and Kathy was asleep, her back giving her some problems. Hope to work out that situation Wednesday morning with her pain management doctors. Keep up the prayers please-there definitely working!

Monday, August 21, 2006

Best Times to Visit Kathy

Kathy is still weak and people have asked me how not to overload her. The best thing is visitors not to trickle in during the whole day but visit her when she is the most rested. I will return to a limited work schedule on Tuesday, Thursday and Saturday of this week. This will allow people to visit Kathy in the mornings when she is the most rested. Also, around 4:00 PM she is alert and again at 8:00 PM after shift change. Please feel free to call me anytime about anything!Thank again for your wonderful support and prayers!!

Getting Better Every Day

Last night Kathy got a CT scan and everything looked good. She continues to have a lot of junk in her lungs that the breathing specialist works on four times a day to get up and out. She did not pass her physical therapist tests this afternoon so she must stay on the feeding tube until tomorrow. Overall her condition remains good physically, low brain pressure, decreased white cell count, moderate use of medication, good breathing, steady heartbeat and normal temperature. The only thing she is behind on is her right side catching up with her left side’s dexterity.

Her mental condition continues to improve with less sleeping, more concentration, good reflex to commands, ability to be cognizant of her visitors and what they say, speaking small sentences and good recall of her memories. She currently is under the care of a full time nurse, neurologist, internal medicine doctor, a physical therapist, breathing therapist, speech therapist, transition administrator and numerous others. She is in good hands.

Hopefully tomorrow the planned CT scan will allow Dr. Kureshi to remove her brain tube and passing tomorrow's speech therapist test will allow removal of her feeding tube-no more tubes! This landmark will allow her to transition out of CUI into general care. We had an interesting visit this afternoon from one of her original admitting doctors. She had a special attachment to Kathy because she had earlier in her life experienced a brain abscess exactly like hers. She told us that Kathy had gotten Staphylococci bacteria most likely from her mouth area and the size of the abscess was around 2 cm in size, growing left to right. She was glad to see Kathy have a miracle because she thought her swelling was so severe, she might not make it. She’s so exited and wants to later share her experiences with Kathy.

Again “A laymen’s description of a brain abscesses”:

“Brain abscesses commonly occur when bacteria or fungi infect part of the brain. Inflammation develops in response. Infected brain cells, white blood cells, and live and dead microorganisms collect in a limited area of the brain. This area becomes enclosed by a membrane that forms around it and creates a mass.”

Sunday, August 20, 2006

Eureka-Kathy is Back!


Unbelievable is the best way to describe today. Kathy not only came out swinging but she appears to have regained most of her mental abilities today. I don’t know how to measure her progress but she could be back to 90%-99%. She not only got her right side movements going as strong as her left side movements but seemed in control of her body too. Mentally she had it all; understanding, processing, alertness, full control of her physical functions, talking (in whispers) and even attitude. All of us were totally blown away with her responses. Physically she went all day with her pressure tube closed, ventilator removed, morphine turned off and appeared ready to come home. I have to pinch myself to remember how depressed we were yesterday and within hours she was 180 degrees different. I don’t want to get too excited about her progress but this was an outstanding day. Keep up the prayers and love, its definitely working!

Contest Question?

What does Kathleen D. Newhouse and Randy D. Haskell have in common?

Please post your answers to this comment link below-The winner will get a prize. I will give you the answers and winner's name Tuesday

Sunday-Nocturnal Sightings


I knew as soon as I would post my frustration over Kathy’s progress she would do something. The great news is that she took her agility test at 6:00 AM today and she not only did her left side good but raises her right hand to her face! She was able to raise two fingers up on both hands and wiggle both toes. Not only was the nurses excited but Kathy looked excited too. She was awake more last night than in the past few evenings. Conscious time was spent scanning her eyes around the room and starring at her fingernails. I think this was in response to Trevor telling her Saturday he would paint her fingernails bright green while she sleeping. Maybe things are looking up……I will see for myself later this morning.

Saturday, August 19, 2006

Brain Injury: Severity Levels and the Recovery Process

Prognosis

People often want to know when their loved one will get better and how much the person will recover. These are very difficult questions to answer because of many uncertainties about brain injuries. Your health care team will do their best to provide you with the most accurate estimation of recovery that they can. Sometimes, however, the most honest response will be a frustrating one: “We’ll just have to wait and see.”

Many factors affect the rate and extent of recovery after brain injury. Your loved one’s physicians will be collecting and integrating all the information available as they make their assessments. Some of these factors include pre-existing features:
the medical history of the person, age, history of previous neurological problems,
the injury itself (the type and location of the injury, the depth and duration of coma, the presence of low blood pressure or oxygen levels after the injury) and
current findings (results of physical examinations, radiological studies of the brain, etc.)

The Recovery Process

The fact that the brain recovers at all is remarkable in many ways. A brain injury causes the death of brain cells (neurons). Unfortunately, the brain is one of the few places in the body that cells do not seem to regenerate. Yet, people with brain injuries often make tremendous gains.

Scientists are still unsure about all of the mechanisms that allow for brain recovery. Possibilities include: some of the neurons are just bruised or swollen and not permanently damaged. As the bruising and swelling improve, the neurons start to function again;
other parts of the brain take over the functions of the damaged areas and new connections between the remaining brain cells may form.

Regardless of the reasons, people can get better after a brain injury. However, for the reasons mentioned, predicting the degree and pace of recovery is very difficult.
A person’s recovery after a brain injury goes through a series of stages. After severe brain injury, the sequence is:coma, coma emergence, post-traumatic amnesia and
resolution of post-traumatic amnesia.

More information about these terms follows, but keep these points in mind as you read it.
These stages represent only general categories. Sometimes, recovery can stop at one of these stages and not progress to the next stage. The transition between stages is rarely abrupt; it is usually very gradual. Every person recovers at an individual pace, so it is difficult to compare the experience of one person to another.

Much of the recovery after a brain injury occurs early after the injury – usually within the first six months. Most experts agree that the brain can continue to heal for up to two years after an injury. Even after two years, people can continue to slowly improve. The reason for this continued progress is that many of the gains after the first year or two do not depend so much on the healing of the brain, as on the learning of new skills. Although difficulties, such as muscle weakness or poor memory, may not change at this point, people who are recovering are learning ways to compensate and become more functional. The recovery process at this point is more like being back in school than recuperating from a surgery.

After a severe brain injury, the person is in a coma. This means that they are unaware and unresponsive. It is a state of unconsciousness. The person can not be described as asleep or awake; there are no sleep-wake cycles. They do not speak, follow commands or open their eyes. There are, however, stages of coma, such as lighter or deeper, and these are usually measured by the Glasgow Coma Scale (GCS), see Table 1. The higher the score is, the lighter the coma stage. A person with a score between three (which is the lowest possible score) and eight is considered in a coma.

As a person’s score improves, he or she is considered to be emerging from coma. These changes usually take place gradually. For instance, people may start to open their eyes or show evidence that they have sleep cycles, but they may still be unable to speak or follow commands. As these abilities appear, the GCS no longer applies. Most rehabilitation centers now use the Rancho Levels of Cognitive Functioning to describe the progress of the person at this point (refer to Table 2.).

The term minimally conscious state refers to people who demonstrate some (but very little) awareness and responsiveness to their surroundings. Their responses are typically inconsistent. Thus, they are not considered comatose or vegetative. As the name suggests, a person is considered conscious in this state. Occasionally, physicians may prescribe medicines that help stimulate the brain, especially if a person is not becoming more responsive with time. Some people do not progress beyond this stage in their recovery process.

Most people move beyond this stage and enter what is often referred to as post-traumatic amnesia. As the name suggests, this is a stage in which the person has serious memory problems. However, it does not refer to all problems with memory after a brain injury. Post-traumatic amnesia is a technical term that refers to the stage that people are in after emerging from coma. Its main feature is the inability to remember any information from day to day. As a result, the person with a brain injury is disoriented and confused (they do not know where they are or what has happened to them). This does not mean that a person is unable to benefit from therapies, however. Evidence exists that people are able to retain basic skills that they are taught without remembering that they learned them! This is sometimes referred to as procedural or implicit memory.

In addition to having memory problems, people in post-traumatic amnesia are often agitated. Some of this agitation is a result of the brain injury itself, and some is simply a response to the confusion a person feels at this stage. It can be a frightening experience to see a loved one during this time. It is important to remember that the behavior you see is not under the control of the person. The physicians may sometimes order medicines to help relieve some of the agitation. In addition, they may order some sort of physical restraint to prevent persons in this stage from hurting themselves or others, such as a special bed or mitts. Just as important are the other steps that the whole team will take.

Post-traumatic amnesia is thought to resolve when these people are able to consistently remember basic information from day to day. Most likely, however, they will never recover any memories from a short time before their accident through the resolution of their post-traumatic amnesia. It is also important to realize that these persons can still have significant problems with their memory even though the post-traumatic amnesia has resolved. After the resolution of post-traumatic amnesia, further recovery continues. Again, it is extremely difficult to predict just how quickly and how much recovery to expect.

If you are interested in the TABLES ( Glasgow Coma Scale and Rancho Levels Of Cognitive Functioning) please go to the following link:

http://lifecenter.ric.org/content/2162/index.html?topic=1&subtopic=271