FRIDAY — PT outside

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 3rd paragraph in History, here: http://en.wikipedia.org/wiki/Ivory_(soap)

WEDNESDAY — progress assessment

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

TUESDAY — shura

Same ‘ol, same ‘ol today – nothing new or different.  But tomorrow is big!  There’s to be a council of care givers.  Someone (Who?) set up a meeting (Where?) to discuss –I don’t know (What?).  I do know that the time of this meeting/council/shura is 2 P.M. Pacific Standard Time because Nancy told me that much.  Why?  I don’t know?  She told me today so I could be there tomorrow – I guess.  Without a time clock to worry about, I don’t care what time it will be.  I’ll just wait.

I will, seriously, report on the meeting after it happens.  Meanwhile, if you need a good chuckle, try this video:

http://www.youtube.com/watch?v=sShMA85pv8M

MONDAY — swans

A swan seems to take off with difficulty, some even say clumsily.  Once airborne the legs tuck in and the neck stretches out – and the clumsy becomes graceful in flight.

Nancy is close, but not yet able, to get started on her own.  Wheelchair, potties, and most beds are low and she just can’t quite get up from them.  In the PT room they have a bed that is higher off the floor.  From it Nancy can get her feet on the floor and with the high handles of her ‘walker’ she can establish vertical posture.  Then she is ready and able to travel.

The grace of a swan in flight?  Maybe not.

But grace, nonetheless.

SATURDAY — rant

Friday evening, with Nancy doing well, I decided I would stay home on Saturday morning.  So I did.  I stayed home this morning to do a few things and failed – not in staying home but in getting anything done.  Dogs and horses needed attention. Nancy called several times.

Her roommate’s daughter had stopped at a well know food place and bought a milkshake – “one of the best shakes in town.”  Nancy thought she might like one.  To kill two of us birds with one stone I decided to order my meal as well.  $10 later I was on my way.  Why does a small milkshake cost $3.00 when I can buy a half-gallon of ice cream (on sale) for the same price?

Next “milkshake day” I’ll make it at home and carry it in.  And don’t get me started on how little things cost when I was young!

It is late afternoon and I’ll soon be headed back to town.  We have 100% cloud cover and it is sprinkling and I have to go out and feed horses.  And the dogs want to go out and run in the muck – not a chance!

I’ve looked all over for a phone number she wants.  Can’t find it.

Ran her soiled shirts (blouses) through the laundry.  Then ran the dish washer just to claim I’d done something useful.

In December Nancy was in the hospital and I bought a cell phone.  It has a camera.  It isn’t of much use unless I can get the images from it to my computer.  It has “Bluetooth” and a USB port.  I haven’t figured out the Bluetooth thingy yet so I went (today) and bought the appropriate cable for the USB connector.  I just spent an hour trying to figure that out.  No luck.  So I will make another trek to the AT&T store to see if they have any idea.  If that doesn’t work I’ll have to go find an 8 year-old.

Rant over.

FRIDAY — what’s a whack?

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 20th 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 ]

THURSDAY — catching up

It is late afternoon.  I just returned.  Early A.M. breakfast with Nancy.  Then home to take care of horses and dogs.  11 A.M. meeting with human resources folks at the U to begin final paper work to transition to full retirement.  Home for lunch.  To “rehab” facility carrying violin.  The group Nancy plays with, played at her place at 2 P.M. today.

The therapy folks had to finish with Nancy early today (nice of them to do that) so she could rest an hour before the musicians began arriving at about 1:45.  She has seen some of them (most maybe) since last playing with the group in November.  This was her first play-date in nearly 3 months.  It is fair to say they all had a grand time, especially her.  To the entire group and a couple of spouses — Bravo!  (Made me tear-up.)

Now I’m home fixing supper – then I’ll jump in the car for the fourth time today for a drive to town.  This trip is for a meeting of our horse riding club for whom I do a small monthly newsletter.

Yesterday, just to catch up, I did breakfast and supper with Nancy.  Lunch I did with a dozen riders (I skipped the ride).  They parked near a trailhead of the cross-state (old RR) trail that is close to a restaurant.  Today it is raining so they picked the best day of the week to ride.

Tomorrow is the “swallowing study” so I expect another interesting day.

TUESDAY — a lot like Monday

Nancy is still troubled by the process of getting pills down, food swallowed, and having it all proceed through as it is supposed to.  The upper end of her digestive system seems to take issue with what most of us would consider food.  However, she does fine with fortified liquid drinks, especially if chocolate infused.  She has also reached accommodation with yogurt (orange cream) and various puddings, and last night with supper she was given puréed strawberries. These are high calorie items and can be fortified with protein, vitamins, and minerals and so, nutrition-wise, she is being adequately supplied.

Much of the issue with real food develops with the acts of chewing and swallowing, and, of course preference.  A finely chopped egg or tuna mix (no bread) will suit her,  but ham salad mix will present a problem if the ham had a rind on it that wasn’t taken off prior to grinding or chopping.  She won’t deal with those pieces and in trying to separate them out much of the dish is trash.   A ground beef–noodles–sauce dish is no better than one with an outer rind because of pieces of gristle.  In this institutional setting there isn’t much hope for refinement.

With her physical abilities improving (slightly) each day we can look forward to the time when she is home and I can begin with better ingredients and take the time to improve them with selective cutting and discards.

She remains scheduled for a trip to the local hospital to have a “modified Barium swallow” study.  It will be something like this: She will be given small amounts of a Barium preparation of varying consistencies from thin liquids to paste to a piece of coated cookie. As each of these is ingested the examiner(s) will observe images in real time on a screen and determine if and where there are problems.  Nancy is scheduled for early afternoon this Friday and afterwards I will know more.

MONDAY — hey, it’s a Monday

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.

SUNDAY evening — off topic

Many years ago (1986) Nancy and I were traveling and ended up in McCall, Idaho on the day the space shuttle Challenger exploded.  We stayed in our room and watched the television reports for hours.  I hadn’t thought of that recently even on this weekend when NASA has been trying to launch Endeavour.  But today I was sent a link to a video of a bird named after that space shuttle and as there is nothing new this evening regarding Nancy I will simply suggest you first read about this bird here:

http://en.wikipedia.org/wiki/Challenger_(eagle)

Then copy-&-paste the following into a Google search window

Petopia: Challenger the Celebrity, Free-Flying Bald Eagle

and you should get a link to the page.  Click on it and than click to watch the video. There are other sites with this video but this one worked well for me.

If you are not from the USA you might not get the same thrill out of this as most US citizens do.  My own thought was that I will feel a similar emotion when I watch Nancy pass outside of the rehabilitation center under her own control and walk free.