Category: Post Visit

… in my recliner using my laptop — having checked out of the Kittitas Valley Rehabilitation Center yesterday right before noon, after my physical therapy.   John drove me to CWU campus where we participated in a scholarship luncheon with my normal Friday group.   Then home – first time since I left at 3:00 A.M. with chest pains, the day after Thanksgiving.

I was hopeful John would continue the blog because my writing nowhere touches his, but he insisted I needed to pick up now that I’m home with access to my computer (wow.. have not touched it so almost forgot how to start a Word document).  John says he will do a couple more general things before he quits but the day-to-day ones I can do.  We have an appointment with the heart surgeon on March 9^th.  We will report on that and likely stop then.

Back to my first day home.  The 4 Brittanys were so happy to see me.   Meghan was the most responsive and sensitive first as I sat on the potty, my first stop in the house.  Then I walked to my recliner and got to pet Annie (youngest) and her dad, Dan.  Oh, Shay also came to say hi before I got back to the recliner.

It was a busy afternoon and I finally got to nap from about 4:00 to 5:20, and shortly after John and I went to a  home where our music group was having a potluck and play time.  We had to practice Irish music for an appearance the Saturday before St. Patrick’s day.  After bringing in the Mexican enchilada dish to share, John went on to the pharmacy to pick up the many meds I will have to take – no more nurses to hand them out.

My first night was longer than any recently because it was quiet and comfortable.  My only challenge is now I need John’s assistance to stand from the low & soft recliner.  All the chairs I have learned to get out of at Physical Therapy are higher and have a  sturdier push-up from seat.  It’s okay – I’ll get there soon.  I’m continuing out-patient therapy at the facility in town 3 days a week.

I’m so happy to be able to report I survived and am home again and regaining strength each day.   I could not have done it without the obvious help of doctors, surgeons, nurses, assistants, care providers, all the thoughts and prayers and contact from all of you, my friends and relatives.   Thank you all so much.  My most intensive support, love and concern, came from John, my sweetie.  It was rough on him to take care of the animals (3 horses & 4 dogs), and still make one or two trips to be with me in Yakima for all those many weeks.  I wasn’t transferred to the Rehab center here until Jan 20^th, and I could not get out of bed on my own for many weeks.   Then once there he visited for two meals each day.  At least the drive was closer.  He also has honchoed all the paperwork with CWU for retirement and cleaned out my office of the many boxes with materials back over all my teaching years (starting 1966 at Georgia State University in Atlanta).

So, I have written more than you will likely be willing to read, and there are many thank you messages to be done (I’ll get to some of those later) but, for now, I want to express a general Thank You! to those who got the word out to others, sent cards, presents, visited and so on.

I had contacts from all over the world.  It was very special.

Nancy

On Thursday we wheelchaired across the parking lot between the facility where Nancy is and another with assisted-living characteristics.  Nancy and other “fiddlers and friends” played music for a few folks in the dinning room.

Friday A.M. they have also taken the wheelchair away.  She is able to get out of bed and use the walker.  When it is not within reach she still is supposed to have someone move it into position and lock the wheels.  She can take herself to the potty, now fitted with a raised platform with arm rests.  This is making everyone’s day more pleasant.

If she is in a chair with a low seat she may still need a little tug to get vertical but less so each day.

Today I took my car to the back of the building.  Nancy trundled outside using the 4-wheeled walker and the physical therapist explained a safe way for her to approach, back up to, and seat herself in the passenger seat.  She did this more easily than we expected – even after a rather strenuous workout during the morning (inside) exercises.

The immediate need for the correct manner of getting in and out of the car is so we can go to another music session on Saturday.  The place is not far away but enough so that she is not ready to go that far with just the walker and I don’t want to push a wheelchair that far.  I think this little trip is on the level of Ivory Soap®-sure* but check back.

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* 99.44 % :  See 3^rd paragraph in History, here: http://en.wikipedia.org/wiki/Ivory_(soap)

The assembled members of the nursing and therapy council pronounced a stellar performance by Nancy at this point in her rehabilitation.

I think the thing that confounds just about all of us is that no one is quite sure of what Nancy is being rehabilitated from.  People tend to view situations a little differently based on their own previous experiences.  The views of the people we talked with today are influenced by the many patients they have cared for with injuries or strokes.  Nancy has a combination of factors that have incapacitated her but injury (a shattered hip from a fall, say) and stroke are not among her problems.

I wish I knew more about the damage done to organs and cells in the few days in late November and early December but it seems to me that the body’s natural repair of these things was a slow process.  During much of December this process was underway but complicated by the faulty heart.  This resulted in many days of “down time” for Nancy during which her muscles went unused.

In the midst of all this was open heart surgery.

Nancy can extract herself from bed, stand and move into either a walker or a wheel chair, and move about.  The seat of the wheel chair is lower to the floor than the bed so (today) it still required a helpful tug for her to achieve vertical status from the chair.  Still all this seems to be progressing well and a little faster than some thought it would.

One issue all would like complete recover for is the inability to maintain bladder control.  This function was compromised by the extended lack of use of the muscles and the use of a catheter.  In recent weeks Nancy has not been able to get out of bed on her own nor to get on to or off of the potty.  Help has not been timely, creating frequent unpleasantries for Nancy and the staff.

Following from Nancy’s increased mobility and ability to sit and stand from taller items, today a raised platform with arms was fitted over the low commode.  This and an introduction to “Kegel exercises” should soon resolve the problem and everyone, especially Nancy, will soon give a shout of joy.

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If you care: http://en.wikipedia.org/wiki/Kegel_exercise

Nancy was carted over to the hospital this afternoon and seated between the open ends of a horseshoe-shaped thingy that lit up a monitor with an image (in shades of white, gray, and black) of her mouth and jaw, and points south.  Lowest on the screen were the top two metal sutures used to tightly re-close her split sternum.  If you lower your chin to your chest you will come close to where the top one of these appears.

Nancy was given food items containing a small amount of Barium sulfate that acts as a contrast agent with respect to the body tissue and bones.  That is, whereever this stuff goes can be seen on the screen as near black globs.  Because Barium is of relatively high atomic number (Z = 56), its compounds absorb X-rays more strongly than compounds derived from lighter nuclei.  Although barium is a heavy metal, and its water-soluble compounds are often highly toxic, the extremely low solubility of barium sulfate protects the patient from absorbing harmful amounts of the metal. Barium sulfate is also readily removed from the body.

The compound is administered as a suspension of fine particles mixed with foods of different texture.  Nancy had grape juice, applesauce, a fruit mixture, mashed banana, and mashed chicken.  Following her time in the ICU with tubes down her gullet Nancy existed primarily on non-solid foods, especially fortified drinks.  As more-solid textures were introduced she became accustomed to small bites and tentative swallowing.  Frequently she would chew something for awhile and then spit out the solid parts.

The passageway from lips to stomach experienced little real action for many weeks.  The muscles along the way degraded, lost their tone, or underwent “disuse atrophy.”  I think this is what we suspected and confirmed today.

As Nancy ingested the barium sulfate laced food all parts worked as they should except at the very lower limit of the image there was a just noticeable slowing of the material (the dark glob on the screen) and then it dropped out of range for the set-up being used.  Thus, while her real food intake is improving she instinctively remains cautious and rightly takes small amounts and swallows carefully.

In the room today for the exam we had Nancy, the imaging specialist, two swallowing specialists, and me.  Not that my opinion was needed, but we all agreed on what we saw, and what we thought it meant.

During Nancy’s time in the hospital (except when sedated) she continued to use her hands and arms – right more than left.  Since January 20^th she has had therapy on a regular basis.  Yesterday she was able to play her violin for the hour jam session with her friends, and it is now six weeks since open heart surgery.

However, Nancy is not yet able to get herself out of bed nor into a standing position from a sitting position.  Noticeable progress is apparent as regards these very visible muscular activities.  The tone of these less used muscles is returning more slowly than those in her hands and arms.  It seems reasonable that the equally atrophied muscles used for eating that we cannot see at work will likewise take longer to regain their capabilities.

So, having found nothing really out-of-whack, we expect continued improvement.

[whack?  See:   http://www.worldwidewords.org/qa/qa-out2.htm ]

Well, the work week began.  Everyone did their job as usual.  Nothing was particularly exciting or new.  All those with some knowledge of the rehabilitation process that talked to us said it would be slow.  It is slow.  What more can I say.

I’ve got some paperwork to catch up on.  You probably do to.

Nancy did well in the physical therapy room today.  She was helped from the wheel chair into a standing position and into a simple ‘walker’ and as she walked I followed with the chair.  While upright she is supported by another person holding onto her “gait belt.”  You may know this by another term, such as transfer belt or transfer aid, and it may (or may not have handles or loops for the assistant to grab.  The ones used for Nancy are simple heavy canvas straps with a single buckle.  Not fancy but they give a sturdy no-slack support.  She did two rounds of the circuit (about 100 feet) during the first excursion.

A person from a medical supply firm showed up with a half-dozen walkers of various styles.  The PT crew inspected them and used another lady and Nancy to test them for sturdiness and height.  Unlike the one Nancy has been using in the PT room, these were more fancy, with wheels (with hand brakes), and a seat.  Most are gray or black but the model that seemed most suitable for Nancy had a dark red anodized aluminum frame.  [Years ago when I was pretending to be an archer I assembled arrows both from wood and anodized aluminum.]  The process is described here:

http://en.wikipedia.org/wiki/Anodizing

Most folks are more likely to see this surface treatment on promotional items such as you will find by using Google Search, click on “Images” and cut-and-paste the following as a search phrase

[  carabiners “anodized aluminum”  ].

The ‘walker man’ had a bluetooth headset for his cell phone and talked with a person in their warehouse during his demonstration.  Very convenient.  It made me wonder why out in the facility the patients must still summon help by pressing a button on the end of a ten foot cord that then turns on a small light over the doorway in the hall – a light that might not be seen for several or several tens of minutes.  Then an aid comes into the room, turns out the light, assesses the patient’s need, and either helps or goes and finds someone, like a nurse, who can.  This signaling method became practical about 1910.  You do the math.

On another front the morning nurse did not have on her chart that it was allowed for Nancy to have the small carton of chocolate flavored drink with which she has been taking pills.  Two of these a day has been standard procedure now for at least a week.  Not this morning!  A little later someone brought her a cup of vanilla ice cream.  Then at supper an aid promised to bring her a scoop of strawberry ice cream.  The person was interrupted and that scoop never showed up.  The indignity of bureaucracy, procedure, and slow motion chaos is impressive.

The case was simple really.  A patient inmate is to be moved out of the middle space in a room with three.  Nancy is expected to need a place to be while her floor is cleaned and waxed.  Someone carries items from Nancy’s bedside table to the new and temporary location thinking she might want them there.  That was nice of someone.  Only that came before they actually moved the lady out. When they got around to doing that they packed up Nancy’s stuff and carried it to that lady’s new space.  When Nancy was returned to her room late in the afternoon no one was around that was involved in all the moving.  This morning with a bit of discussion among the workers Nancy’s stuff was tracked down and returned.  No harm, no foul, as some say.

For Nancy today was routine.  Several types of therapy.  Continued incremental progress.  They are going to send her over to the hospital (about 5 blocks) and have her inspected by a gastroenterologist.  That’s someone who studies your gastro, I guess.  On Wikipedia it claims such a person – a highly trained specialist – studies the digestive system and its disorders.  That sounds better than having someone poking around your gastro.

The major news of the day is a new roommate.  The facts.  Small town 20 miles from EBRG.  Well built, old homes on large lots. Elderly lady.  Husband deceased.  No family for hundreds of miles.  She falls in the kitchen, smacks the back of her head and breaks a wrist.  She can’t get up or out and can’t reach the phone that rings periodically.  On the third day, the caller, calls others in the town and they go and find her.  The main problem is dehydration and a lot of bruising and the previously mentioned injury.  A bad deal that could have gotten worse quickly.  Did I mention it was her right wrist?  And, yes, she is right handed.  Bummer.

I have to go and pick up a certificate of appreciation from the Kittitas County Conservation District tonight.  I don’t need the sheet of paper but the food is good, they serve me for free, and they are nice folks.  I help unbox, sort, re-package, and sell native trees and shrubs each spring.  So, I won’t write again until Friday evening.

On Wednesday the staff got Nancy out of her bed early and off to the therapy wing of the facility.  Then they took the small stuff in her room,  piled all on to the beds, and wheeled the three contrived wagons out and down the hall.  We have deliberately limited the things I take in but still there were chairs, night stands, waste baskets, and Nancy’s magazines, a few personal items in plastic bags, a dog biscuit box with greeting cards, and a small yellow lined tablet with her notes – a daily log of people, events, and comments. I did not see this but I have an image of the Oklahoma Joads leaving the Dustbowl and heading for California.  The purpose of this evacuation was to clean and wax the floor while having only one person without much stuff to deal with.  (Some long term residents have decorated extensively.)

While the beds were parked in the hallway the magazines and the yellow note pad and therapy-related papers disappeared. The things might have gotten stuffed into something or into someplace we don’t know about by the movers but they were not around to ask when Nancy was allowed back into her room.  The alternative assumption is that one of the residents wandering the halls carted a few things off to another place.  The nurse was not surprised about the missing items and wrote a memo to add a search directive to alert the staff at the morning meeting.

With the floor of her room freshly waxed they taped it closed like a crime scene and took her into the middle space of another room that is the permanent home to two very elderly and frail women.  The families of these two have decorated the spaces with personal and family items.  Nancy’s temporary space, between these two decorated oases, impressed me as being starkly empty.  She sat in the wheel chair beside an unmade bed, a table with a glass of water, and a cell phone.

The afternoon was saved by having her hair cut.  Since arriving in EBRG Nancy has had her hair trimmed by the same lady and she came at Nancy’s request.  So in an empty spot between the home-like spaces of two elderly strangers we both got new looks.  Why not?  My hair needed cut.

Some progress was made on the food issues today.  The speech and swallowing specialist worked with Nancy prior to lunch and then came to her room to watch while she chewed and swallowed.  When one doesn’t swallow well it is called dysphagia, or disordered swallowing.

To get proper nutrition food has to be prepared in a manner to make it easy to swallow and some foods have to be avoided.  We have assumed, in Nancy’s case, that her difficulties originated from the insertion of a breathing tube (endotracheal intubation) in the ICU.  There is a possibility that her problem preceded that and the intubation just added to an existing issue.

As early as last spring we recall some episodes of her not being able to swallow well, followed by spitting up something she had just tried to swallow.  This may be a false lead and her problem might clear up with a bit more time and exercise.  Swallowing a liquid such as water or anything else like water can be a problem because it goes down so quickly that your throat, being a bit out of practice, doesn’t have time to close off the airway.  Liquids that are a bit thicker – tomato juice, say – allow more time for a sluggish throat to function.  Thickened soups and drinks are recommended.

So, the dysphagia consultant examined the food in Nancy’s lunch.  There was ground meat (beef, maybe) with a gravy and mashed potatoes without gravy.  Well the problem with ground beef is that when cooked it adheres together (think of a grilled burger – if it didn’t stick together it would fall through the bars of the grill).  Thus, the meat portion met the letter of the directive but not the intent.  The consultant took it back to the kitchen and came back with the stuff newly ground.  That helped.

At supper the protein portion (tuna, I think) was prepared properly and brought in a bowl, that is, not as a sandwich.  No chewy sticky bread is good.  A thin watery soup accompanied the meal.  Not good.

I keep two canisters of yogurt in a small ice filled cooler in her closet.  We used one of those with supper to help add calories and nutrients.  The soup went back to the kitchen untouched.  I suppose I will be carrying corn starch or tapioca in small plastic bags to add to soups such as that tonight.  Carrying small bags of white power around in these troubled times seems to be unwise, however.  I may rethink this issue.

At this point a don’t consider a lazy day as being a good day.  Without weekend therapists Nancy doesn’t get out of bed.  She does move her arms and legs but there is very little stress on the “getting going” muscles.

I hope this stage is soon over and she can get in the chair and scoot around the halls on her own.  I don’t think she minds the inactivity as much as I do.  Getting up, in the chair, and then standing and walking is very hard for her now – a real exertion even with help.

She will go to a doctor’s appointment in Yakima on Tuesday afternoon.  This ride will be in a wheelchair in a van.  We expect she will get the stitches out where the chest drain holes are (were) but we do not have an idea what else will be accomplished.

We also think her current roommate will be going home on Tuesday.

Good or not, this week will bring some changes.