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I went in early today and was in the PT room while Nancy did the therapy thing.  Among various exercises they got her out of her chair and with the support of the ‘walker’ she managed about 100 feet.  They did this three times starting from the chair each time.

We name things strangely.  For example we claim to park on a driveway and drive on a parkway.  We all know to get olive oil they squeeze olives. So, then, how do we get baby oil?  The ‘walker’ isn’t properly named.  It doesn’t walk, even when you push it.  It slides.  They seem to have rubber cups or tennis balls on the end of the legs.  If it has wheels, it rolls.  If it has both does it slide-roll?  We should call it a slideroller.

Anyway, that is the most exercise she has had since she walked to the car the morning she was having the heart attack – November 27^th.  This was more difficult.  We applauded when she finished the third trip.

Nancy is making slow progress with regaining her physical abilities.  They had her using a walker today and the two PTs (physical therapists) with her did not have to save her from falling or anything else.  She didn’t go far but she did move her self around and about.  They help her stand-into-the-walker and then return to a seated position in the wheelchair.  She stayed in the chair for awhile after returning to the room and then a PT visited the room to help her stand, swivel, sit, and pivot back into bed.  None of this is she able to do on her own but they are helping her do it – not doing it for her.

The food leaves a lot to be desired but I’m supplementing by sharing a milkshake with her and carrying in yogurt.  She did have a soup tonight that was good but the sliced tomatoes, while red, were not.  I suspect that the meals are crafted to provide complete nutrition for the day if the person eats all (or most all)  of the three meals.  That’s not happening with her and probably not with most of the residents.

Visitors brought both flowers and candy today  — she ate the flowers and I ate the candy.  Just kidding.  Actually, the flower was a potted one and I can bring it home, find a bigger planter for it, and keep it going as an inside plant – it is a white Kalanchoe.  You can find a picture of a red one here:

http://www.hendriksgreenhouses.com/img/plants/kalanchoe.jpg

They added weights to Nancy’s ankles, one pound each, part way through the workout today.  That’s how progress is measured.

Actually, they had to.  She now weighs less than when we married in 1969.

That seems like another world and another lifetime ago.

Maybe the physical therapy will redistribute the remaining excess stuff a little but I suspect this weight loss thing will cease as she rebuilds some muscle.

When she lost some weight last summer we went to a few garage sales and picked up a few things and also ordered a few things from a company that started and grew along with my father’s family back in Warren, Pennsylvania.  History here:

http://www.fundinguniverse.com/company-histories/Blair-Corporation-Company-History.html

Our family never got involved except I’ve had cousins work there and they and other family members would buy returned goods on special days (at pennies on the dollar).  That’s our once-upon-a-time connection in case you need to know why we buy clothes from a small company in a small town in a place we have never lived.

The clothes purchased last summer are now too large.  Guess what’s next?

If we consider last Friday to encompass part assessment and part therapy then today was the first real day of working on rehabilitation.  Nancy seemed happy with today.  When in bed she really has nothing to do although she has done a little reading and a little phoning.

Reading for entertainment is not something she is accustomed to but I have a few magazines, mainly the Smithsonian, with articles she will read.

Too much time on the phone drains the batteries and she can’t manage yet to reach the outlets to keep it charged.  She always wants to have a little power left to call me if she thinks of something I need to know, do, or bring.  And her voice, hands, and arms are not as strong as needed to talk for long.

The point of the above is that I think she is happy for the interruptions to having nothing to do brought on by the therapy sessions – speech, occupational, and physical.  All are necessary but returning to a normal existence means being able to get out of bed and walk without assistance and that she cannot now do.

If she can get to the point where she can get into a wheelchair on her own then she can prowl the building and become engaged in other things and other people.  There is a piano in a community room and she could maybe brush up on her skills.  We will have to check on that as they may limit access to the piano to certain times and people.  A lady from town came and played a few days ago for some of the residents and does so weekly.  She then visited Nancy as they know each other via a university activity.  Playing piano ought to be good therapy and self entertainment.  I’ll have to get her to ask about this.

Visitors – that is about it.  Several people visited Nancy today but there was not a scheduled event in the sense of, say, physical therapy.  Her food trays continue to have a small drink that we thought was a mixture of something and cranberry juice.  No so claims tonight’s server.  I thought the something was white grape juice.  The color, if not from cranberries, must be Red Dye #40.  Just one of life’s little mysteries.

Nancy has been moving her legs more while in bed and can bend both at the knees quite well.  Ten days ago she could not do this, especially the left leg which at that time was burdened with excess fluid and the knee hurt when we moved it for her.  Both issue are gone and it gives us hope that she will make great progress in the coming week with out-of-bed therapy every day for five days.

Along with other muscles the tongue and swallowing apparatus degrade with inactivity.  This is apparent with Nancy and I just assumed time would fix the issue.  Not so maybe.  And in the meantime there are things that can be done to make eating and taking pills safer and exercises to bring back the functions.

A speech therapist worked with Nancy yesterday to assess her status and explain to us how this part of her recovery would go.  For example, food that sticks to the inside of your mouth, such as bread or corn, should be avoided.  When taking pills one should tilt the chin down toward the breast bone so as to close off the airway (trachea) to the lungs.  When we swallow a flap, called the epiglottis, moves down over the larynx to keep food out of the windpipe.  For Nancy these parts don’t work as well as they should and so by choosing foods carefully and by being careful she can prevent swallowing and coughing problems.

She is also taking the anticoagulant Coumandin® which interacts with vitamin K which is found in green vegetables among other things, for example blueberries and tuna in oil.   The greener the veggie (usually) the more vitamin K.

So the food she gets needs to be selected to account for these two concerns, swallowing with ease and not messing with the Coumandin®.

Her lunch included a cup of lasagna, a round soft bread stick and a cup of broccoli. One out of three made the grade.  I guess the message didn’t make it from the speech therapist to the kitchen.  Although, we both think something was said about the food service folks not being able to adjust until Monday.  I guess I’ll have to stop and pick up a milkshake on my way tomorrow.  And yesterday the Director brought her orange juice with a high protein addition.  Today they were out of orange juice.

The bathroom door squeaked enough that if someone opened it, it would wake a sleeping person.  Today I forced the pin out with a knife and put a bit of “this ain’t butter” spread on it to cure the noise issue.  We will continue to educate the staff about the food issue.

I got up early this morning and sorted through some of the clothes here and carried various things into Nancy.  Two T-shirts were among the things and as I took them out of the bag Nancy remarked that one was an XL and the other an XXL, and she was right.  Still, she hasn’t been in street clothes since November 27.  Okay, so the stuff wasn’t new but she looked like a new person.

The therapy crew got her dressed and she spent 3 to 4 hours doing occupational, speech, and physical therapy.  Some of the time was spent just answering questions and making base-line assessments but she did quite a bit from a wheelchair and briefly stood between parallel bars – standing, moving forward and backward, and moving muscles that hadn’t been moved in 8 weeks.

She got a powered bed and can now raise and lower the entire platform and/or tilt the foot or head areas.

She had several visitors including a couple of young friends that because of age restrictions are not allowed in the local hospitals.  (Coughs, colds and the swine flu scare even caused the local hospital to remove all the magazines and booklets from the waiting rooms.)  But the rehabilitation center expects visitors and seeing old friends (well, young friends) again was a nice surprise.

And in the mail today came a plastic card – densely printed with information.  It came from the company that supplied Nancy’s new heart valve and it has all the relevant stuff a medical specialist might want to know about it – including the name of the surgeon that stitched it in.  Like other important cards it is to be carried with you.  For the wallet, more stuff.  And in this case, it is new.

So, last things first.  The elderly man mentioned yesterday was keeping his wife from getting good sleep so someone reported that the couple thought it would be a good idea to move him out.  The woman told me she did not ask for nor like the move but Nancy became a convenient ‘necessity’ to accomplish what someone wanted.

It seems the move from Yakima was approved by the insurance company for a 3-day evaluation period with, upon asking, a 7-day follow-on.  Then each 7-day period has to be approved prior to the end of the prior period.  This protocol seems not to have been understood by everyone aware of Nancy’s arrival and so the messages we were getting were jumbled and conflicting.

Confounding the issue was Nancy’s late arrival (just before 4 P.M.) in contrast to the more common morning arrival.  Thus occupational and physical therapy folks were very busy with their duties.  With various functions going on all day they have problems keeping to a schedule if something unexpected happens.  If someone needs a bath and that team shows up just before the therapy team then there is a reshuffling of appointments as if one had missed the partner in a square dance move.

By late this afternoon either Nancy or I or together had visited with most of the folks working to coordinate her rehabilitation.  We got to explain her condition and how she got to this point and they began to put together a plan to move forward with her needs.  As I understand it this is what is needed for the place to get approval for the following week.

I now need to gather proper shoes or slippers, and enough clothes for her to appear in public.  Ye ‘old hospital gown won’t do in the physical therapy room.

It used to be people had ‘family doctors’ but now we have ‘primary care physicians’.  We are back in home territory now and I alerted our doctor and he came by and visited after seeing his clinic clients.  I left the two of them after a bit to come take care of things at home – feeling a whole lot better about today than about yesterday.