MRI results don't show any evidence of another stroke. The nurse said this could be due to the TPA doing its job well enough that the stroke might have been "erased" from view on the MRI. Blood enzyme tests show that heart damage might have occurred. Dad is still on a respirator and still sedated because when they pull him off the sedation, his heart rate and blood pressure go up. When they have decreased his sedative, he opens his eyes and can somewhat make eye contact. He moves his right arm (though it is tied down) and seems to also be voluntarily moving his left arm also. He has redness in his arms and face and we are not sure what is causing that--possibly the drug they're using to keep his blood pressure down.
There is no plan for the doctors to do anything but watch Dad today. A TEE might be performed tomorrow. That is a procedure where they run a camera down his esophagus to look at his heart. That would give a definitive opinion as to whether a heart attack or any damage to the heart has occurred.
Friday, December 24, 2010
Thursday, December 23, 2010
Another Stroke -- Left Side of Brain
We got a call at 8:00 am today saying the ambulance was taking Dad to the hospital. He was fine this morning, had a shower and was at breakfast when he became non-responsive. Jan arrived first at the hospital, then Ted, then myself.
His blood pressure was insanely high, he didn't know who was in the room and did not respond to Jan and Ted calling his name. He was flailing a bit, grasping at his face. When the nurse tried to put a breathing tube down his nose, they apparently cut him or something and he began to bleed profusely. They have him on blood thinners, so he is very prone to bleed. Apparently they had him lying down while the bleeding was going on and the blood ran down into his lungs and stomach. As they were trying to stabilize him, they had to put a tube down into his lungs to remove the blood. I am told this very much increases his odds of getting pneumonia. When moving him from the stretcher to the bed in the ICU, he apparently vomited a very large amount of blood also.
They gave him a dosage of TPA (not sure if I got that acronym right....but it's the blockage fighting drug) around 11:30 am. They were not able to get a full dose in because he began to bleed more. We watched them do an ultrasound on his heart, to try to detect if foreign debris had gone through a hole in his heart without first passing through the lungs. Normally blood is filtered in the lungs, but if the blood happens to go from one side to the other through a hole in the heart, the lungs do not remove the debris and it's possible something could go to the brain that way.
It is 5:00 now and Dad is sedated, with breathing tube and suction tube to pull blood from his lungs. He has been this way since about 11:00 am today. The doctors confirmed with a CT scan that a stroke has occurred on the left side of his brain. We won't know for sure how badly it affects him until they remove the tubes and stop sedating him. He opens his eyes partly for a second here and there. There is a lot of shivering of his left (paralyzed) side. He moves his right arm a bit also. So far, he has not acknowledged my presence. They will keep him sedated until tomorrow at the earliest, so that he doesn't try to pull out the tubes. The nurse says that he is in stable, but guarded, condition. I take that to mean that he could go downhill at any moment, so I am staying here as long as is practical. He does look peaceful as he sleeps but the tubes look pretty brutal when you think about it.
His blood pressure was insanely high, he didn't know who was in the room and did not respond to Jan and Ted calling his name. He was flailing a bit, grasping at his face. When the nurse tried to put a breathing tube down his nose, they apparently cut him or something and he began to bleed profusely. They have him on blood thinners, so he is very prone to bleed. Apparently they had him lying down while the bleeding was going on and the blood ran down into his lungs and stomach. As they were trying to stabilize him, they had to put a tube down into his lungs to remove the blood. I am told this very much increases his odds of getting pneumonia. When moving him from the stretcher to the bed in the ICU, he apparently vomited a very large amount of blood also.
They gave him a dosage of TPA (not sure if I got that acronym right....but it's the blockage fighting drug) around 11:30 am. They were not able to get a full dose in because he began to bleed more. We watched them do an ultrasound on his heart, to try to detect if foreign debris had gone through a hole in his heart without first passing through the lungs. Normally blood is filtered in the lungs, but if the blood happens to go from one side to the other through a hole in the heart, the lungs do not remove the debris and it's possible something could go to the brain that way.
It is 5:00 now and Dad is sedated, with breathing tube and suction tube to pull blood from his lungs. He has been this way since about 11:00 am today. The doctors confirmed with a CT scan that a stroke has occurred on the left side of his brain. We won't know for sure how badly it affects him until they remove the tubes and stop sedating him. He opens his eyes partly for a second here and there. There is a lot of shivering of his left (paralyzed) side. He moves his right arm a bit also. So far, he has not acknowledged my presence. They will keep him sedated until tomorrow at the earliest, so that he doesn't try to pull out the tubes. The nurse says that he is in stable, but guarded, condition. I take that to mean that he could go downhill at any moment, so I am staying here as long as is practical. He does look peaceful as he sleeps but the tubes look pretty brutal when you think about it.
Sunday, October 31, 2010
October 31, 2010
Dad has had a few weird trips to the ER in the past few months.
In the month of June, all four of us were over taking Dad to lunch. He was very lethargic and leaning to one side in his wheelchair. He said he'd been vomiting earlier that day. We started to wheel him down the street to Subway when he said he thought he was going to vomit and wanted to be taken back to the care center. So we turned back and decided to bring lunch to him. He ate, but was acting really strangely and when one of us mentioned his speech seemed slurred, I figured those were all signs of a stroke and decided we might need to call a nurse and see what they thought. So that ended up in a decision to send him to the ER to be evaluated for a possible stroke. After several hours in the ER and a CT scan, the doctors said there was nothing wrong with him and no signs of a new stroke showing in the CT scan results. So we had the care center transport come pick him up and he went back...
On October 4th at 5:07 AM the care center called me and said they were sending Dad in to the ER again. Man, I hate those calls. I had just been to visit him the night before and he did seem very tired and was slouching to the side a lot and I could barely understand him. But, oddly enough, this time I didn't think much of it in the way of it being another stroke. So I just gave him a piece of cake and attempted to talk to him as he fed himself, but my understanding of the conversation was hit and miss. I went home thinking Dad was either very very tired or was losing his health slowly but surely. When I got the call, I was not surprised, but mad at myself for not sending him in the night before. Same as last time though, the CT scan showed no new signs of stroke. Blood work was all normal except he had a slight sign of a UTI infection. The doctor spoke to us about admitting him to the hospital to watch him, but in light of what had happened the previous ER fiasco, I opted to just send him back to the care center.
A couple weeks after that, they called and said they were wanting to send him in to the ER again, but I told them to hold off and just have the doctor come examine him. It was my thought then that it could be the meds he was on. They had recently added or increased the dosage of Cymbalta (an anti-depression medicine). So I asked the nurse to tell the doctor he didn't need any meds for depression or for sleep.
In subsequent visits, he has seemed more normal and lively, so I think we were right about the meds being the cause. One thing that is not good is the fact that Dad is nearly 200 pounds. He was 163 when we admitted him to the care center here in Utah. We have been feeding him way too many chocolate covered peanuts from the neighboring Sunflower Market that Dad has started calling the "Mayflower" for some reason... :)
We have a meeting with the care center staff on November 3rd, but I am sure it will be uneventful. Dad sees no improvement nor decline.
In the month of June, all four of us were over taking Dad to lunch. He was very lethargic and leaning to one side in his wheelchair. He said he'd been vomiting earlier that day. We started to wheel him down the street to Subway when he said he thought he was going to vomit and wanted to be taken back to the care center. So we turned back and decided to bring lunch to him. He ate, but was acting really strangely and when one of us mentioned his speech seemed slurred, I figured those were all signs of a stroke and decided we might need to call a nurse and see what they thought. So that ended up in a decision to send him to the ER to be evaluated for a possible stroke. After several hours in the ER and a CT scan, the doctors said there was nothing wrong with him and no signs of a new stroke showing in the CT scan results. So we had the care center transport come pick him up and he went back...
On October 4th at 5:07 AM the care center called me and said they were sending Dad in to the ER again. Man, I hate those calls. I had just been to visit him the night before and he did seem very tired and was slouching to the side a lot and I could barely understand him. But, oddly enough, this time I didn't think much of it in the way of it being another stroke. So I just gave him a piece of cake and attempted to talk to him as he fed himself, but my understanding of the conversation was hit and miss. I went home thinking Dad was either very very tired or was losing his health slowly but surely. When I got the call, I was not surprised, but mad at myself for not sending him in the night before. Same as last time though, the CT scan showed no new signs of stroke. Blood work was all normal except he had a slight sign of a UTI infection. The doctor spoke to us about admitting him to the hospital to watch him, but in light of what had happened the previous ER fiasco, I opted to just send him back to the care center.
A couple weeks after that, they called and said they were wanting to send him in to the ER again, but I told them to hold off and just have the doctor come examine him. It was my thought then that it could be the meds he was on. They had recently added or increased the dosage of Cymbalta (an anti-depression medicine). So I asked the nurse to tell the doctor he didn't need any meds for depression or for sleep.
In subsequent visits, he has seemed more normal and lively, so I think we were right about the meds being the cause. One thing that is not good is the fact that Dad is nearly 200 pounds. He was 163 when we admitted him to the care center here in Utah. We have been feeding him way too many chocolate covered peanuts from the neighboring Sunflower Market that Dad has started calling the "Mayflower" for some reason... :)
We have a meeting with the care center staff on November 3rd, but I am sure it will be uneventful. Dad sees no improvement nor decline.
Tuesday, June 1, 2010
June 1, 2010 (back in PT)
I just spoke with Jeff (Dad's PT specialist) who said that despite Sam's misgivings (I had talked to Sam last week about his thoughts on Dad's prognosis and they were pretty dismal), Dad had performed quite a bit better in his transfer from bed to wheelchair in his evaluation I'd prompted them to do last week. Jeff said that Dad was able to put a lot more weight on his good leg than he'd done before and that Dad took more initiative in getting himself up and out of the bed than he'd seen him do before.
As a result of the positive evaluation, Jeff is filing papers to get Dad back into PT for a while at least. Since he is now covered by Medicare Part B, I am not quite sure the duration of this PT schedule, but the PT sessions will be 5 days a week until Med B cuts him off. If we are still seeing progress, Med B might still pay for some or all of the PT, and even if it does not, we would pay out of pocket if Dad has a chance to get walking again. It is well worth the money!!
I knew it was a bit exaggerated when Dad self-described last week's session to me as "I got up from my bed and walked to the wheelchair" but I am glad to see that Jeff and Sam were able to see some measurable improvement. Either Dad has decided he really wants to get home and will push through the pain, or all that candy has done something as far as beefing up that good leg! :)
As a result of the positive evaluation, Jeff is filing papers to get Dad back into PT for a while at least. Since he is now covered by Medicare Part B, I am not quite sure the duration of this PT schedule, but the PT sessions will be 5 days a week until Med B cuts him off. If we are still seeing progress, Med B might still pay for some or all of the PT, and even if it does not, we would pay out of pocket if Dad has a chance to get walking again. It is well worth the money!!
I knew it was a bit exaggerated when Dad self-described last week's session to me as "I got up from my bed and walked to the wheelchair" but I am glad to see that Jeff and Sam were able to see some measurable improvement. Either Dad has decided he really wants to get home and will push through the pain, or all that candy has done something as far as beefing up that good leg! :)
Wednesday, May 12, 2010
May 12, 2010 (Meeting with ORN staff)
At our meeting with the care center's staff, which Dad attending along with Janice, Brad, and myself, we discussed Dad's state. Overall, not much has changed in months, except Dad's weight, which had sky rocketed since the last time we'd checked. He'd gained 7% of his body weight!!! I have no doubt that is because of all the visitors who've been bringing him candy, and because of all the lunches out we take him to. Dad's sweet tooth is insatiable and he does not seem to have the ability to recognize when he is full. If you put a bag full of chocolate in front of him, he will eat it until it's gone, no matter how huge the bag is!
During the meeting, we discussed the following: We mentioned that it seemed he'd been a bit more upbeat lately, possibly due to his prescriptions changing. We asked them to look into the fact that the door to the outside of his room seems to never be locked and that anyone could possibly come in there. The door is also quite breezy and Dad says it often makes him cold. The usage of the braces we purchased for him seems to have done a bit of good in keeping his left hand outstretched instead of curled, and we mentioned that we've noticed they are not very conscientious about making sure the braces are put on every day. We also asked that Dad be re-evaluated for physical therapy and asked that the PT staff charge it to Medicare and see if they would pick up the bill for a 2-week stint. If Medicare won't pay, then we said to start doing PT two times per week and we would pay out of pocket for it. Jim (the social worker we meet with) said that he would talk to PT and call me back that same day. Dad asked if he'd been reported for any "inappropriate behaviors" and we (and Dad especially) were very glad to hear he has not been! :)
After the meeting, we wheeled Dad out to lunch and visited for a while. It is so nice to FINALLY have some spring/summer weather here!
Saturday, March 20, 2010
March 20, 2010
Yesterday Dad got a couple of spring-loaded arm braces to help stretch the contracting tendons in his left arm. He has no movement whatsoever in that arm still, and complains of "pins and needles" feeling.
The lower-arm brace will very slowly stretch the wrist from a curled position to straight or slightly bent back. He is supposed to wear that one 4-6 hours per day.
The upper-arm brace fits under his armpit, supports his elbow and goes to his forearm. That one attempts to straighten the arm at the elbow and un-twist it. That one can be worn overnight. The problem with that time-schedule is that the "qualified" restorative aids are only there from 6:00 AM - 2:00 PM daily.
I'm very concerned we're paying tons of money for these braces and the staff is not going to put them on at the appropriate times or intervals. We shall see, but I am quite frustrated with the lack of organization of Orem Rehab... The arm brace salesman suggested making a schedule and asking the aids to document when they removed or put on the braces. That could allow us to come in at nights when he hasn't been wearing the brace during the day and we could put it on him and have them remove it in the morning.
The brace salesman seemed to think we could be getting more help from Medicare than we're getting, so that has got me re-researching the coverage provided by Medicare Plan B. I read on their website that physical therapy is covered when ordered by a doctor. So that is the avenue I'm going to be taking. If that doesn't work out, we have decided to just pay for several sessions of physical therapy per week. We have to get dad out of that room. I think he's mentally and physically suffering from the lack of interaction with the therapists.
The lower-arm brace will very slowly stretch the wrist from a curled position to straight or slightly bent back. He is supposed to wear that one 4-6 hours per day.
The upper-arm brace fits under his armpit, supports his elbow and goes to his forearm. That one attempts to straighten the arm at the elbow and un-twist it. That one can be worn overnight. The problem with that time-schedule is that the "qualified" restorative aids are only there from 6:00 AM - 2:00 PM daily.
I'm very concerned we're paying tons of money for these braces and the staff is not going to put them on at the appropriate times or intervals. We shall see, but I am quite frustrated with the lack of organization of Orem Rehab... The arm brace salesman suggested making a schedule and asking the aids to document when they removed or put on the braces. That could allow us to come in at nights when he hasn't been wearing the brace during the day and we could put it on him and have them remove it in the morning.
The brace salesman seemed to think we could be getting more help from Medicare than we're getting, so that has got me re-researching the coverage provided by Medicare Plan B. I read on their website that physical therapy is covered when ordered by a doctor. So that is the avenue I'm going to be taking. If that doesn't work out, we have decided to just pay for several sessions of physical therapy per week. We have to get dad out of that room. I think he's mentally and physically suffering from the lack of interaction with the therapists.
Sunday, February 28, 2010
February 28, 2010
Dad was moved last week from his private room to a new shared room. He shares his (very nice) room now with a kid named Trevin. I call him a 'kid' because I'm not exactly sure how old he is. I was told that he had a brain tumor at some point in his adolescence. He is a full-grown adult in size, but his mentality is about that of a 5th grader. The only complaint Dad has had so far is that Trevin doesn't like it when Dad turns his TV up loud enough for him to hear it. Trevin is away a lot on weekends and some nights, spending time with his folks and grandparents. Last time Ashlyn and I visited, Trevin named Ashlyn "Super Princess" and myself "Super Queen" and followed us nearly out of the care center! Dad is hard to read sometimes, but hopefully he is glad for Trevin's company when he has it. Another great thing about his room is it also has access to the outside via double doors and it looks suitable to be used as a picnic area or playground when the weather warms up.
Dad saw a neurologist (Doctor Groves) last Friday, February 19th. We had arranged the appointment to see if we could get to the bottom of Dad's complaints of pain pretty much everywhere on his body. The doctor did no scans or blood tests--just talked to Dad and did a few simple "follow my hand with your eyes" tests. As we assumed, the doctor thought a nerve disease such as fibro-myalgia was a possibility, so he prescribed a remedy for that. He's been taking it since last Monday, February 22nd, and says he has not noticed a change. We will give him a while longer taking that prescription before we rule that out as a cause.
There has still been no physical improvement, obviously, since the physical therapy stopped with the cancellation of Medicare payments (which also caused his move to the shared room) in the last week or two. We are looking into ways of finding Dad some part time physical therapy. The social worker said it would cost at minimum $25-30 for just 15 MINUTES of therapy. As this cost is prohibitive for us, we are looking into other alternatives for aid. Dad could qualify for VA benefits, but only if he happens to be destitute... I believe the same is true of Medicaid. It sure seems odd that one who worked his whole life to be self-sufficient and was smart enough to have medical insurance, long term care insurance, etc., would be "punished" due to his forethought....but unfortunately, that is how it seems to work. So we kids have decided we are going to have to get Dad to qualify for assistance one way or the other. Everyone we have talked to recommends "deceiving the government" (as Dad puts it). That means getting Dad's assets out of his name so that he can qualify for aid based upon financial need. That is this week's task--trying to learn about trusts or other measures that can be taken to allow Dad to still have his assets but not have them recognized by the government. This will become especially important in a couple of years since Dad's long-term care policy has a maximum benefit of 5 years. The assets must not have been in his name for several years (we have heard 2 or 3 years) in order for the government to allow eligibility for needs-based aid like VA benefits or Medicaid.
The great news is that Dad got a set of surprise visitors yesterday. His sister, Shirley Wallander, and her husband, Greg, came down from Billings. It was sort of an accident that they surprised him. They'd come down quickly and no one had had a chance to let Dad know they'd be here until they walked into his room. He said "Well.....Shirley!" and it was pretty easy to see that he was glad to see her and Greg. He also had another surprise that same day, as I let him know that Janice had her baby on Friday morning. With Jan having her baby and myself being sick for several days, not much information had been getting to Dad since he is so darned reticent to answer his phone!
Dad saw a neurologist (Doctor Groves) last Friday, February 19th. We had arranged the appointment to see if we could get to the bottom of Dad's complaints of pain pretty much everywhere on his body. The doctor did no scans or blood tests--just talked to Dad and did a few simple "follow my hand with your eyes" tests. As we assumed, the doctor thought a nerve disease such as fibro-myalgia was a possibility, so he prescribed a remedy for that. He's been taking it since last Monday, February 22nd, and says he has not noticed a change. We will give him a while longer taking that prescription before we rule that out as a cause.
There has still been no physical improvement, obviously, since the physical therapy stopped with the cancellation of Medicare payments (which also caused his move to the shared room) in the last week or two. We are looking into ways of finding Dad some part time physical therapy. The social worker said it would cost at minimum $25-30 for just 15 MINUTES of therapy. As this cost is prohibitive for us, we are looking into other alternatives for aid. Dad could qualify for VA benefits, but only if he happens to be destitute... I believe the same is true of Medicaid. It sure seems odd that one who worked his whole life to be self-sufficient and was smart enough to have medical insurance, long term care insurance, etc., would be "punished" due to his forethought....but unfortunately, that is how it seems to work. So we kids have decided we are going to have to get Dad to qualify for assistance one way or the other. Everyone we have talked to recommends "deceiving the government" (as Dad puts it). That means getting Dad's assets out of his name so that he can qualify for aid based upon financial need. That is this week's task--trying to learn about trusts or other measures that can be taken to allow Dad to still have his assets but not have them recognized by the government. This will become especially important in a couple of years since Dad's long-term care policy has a maximum benefit of 5 years. The assets must not have been in his name for several years (we have heard 2 or 3 years) in order for the government to allow eligibility for needs-based aid like VA benefits or Medicaid.
The great news is that Dad got a set of surprise visitors yesterday. His sister, Shirley Wallander, and her husband, Greg, came down from Billings. It was sort of an accident that they surprised him. They'd come down quickly and no one had had a chance to let Dad know they'd be here until they walked into his room. He said "Well.....Shirley!" and it was pretty easy to see that he was glad to see her and Greg. He also had another surprise that same day, as I let him know that Janice had her baby on Friday morning. With Jan having her baby and myself being sick for several days, not much information had been getting to Dad since he is so darned reticent to answer his phone!
Wednesday, February 3, 2010
February 3, 2010 (Meeting with ORN staff)
Today Brad, Janice, and I met with the social worker, the nutritionist, and the physical therapist at the care center (Orem Rehab and Nursing).
Probably the most important thing we learned today was that the PT specialist agrees with our perception--Dad has not been improving at all. The main reason for his lack of improvement is that he has, or at least *thinks* he has, too much pain all over his body to actually try to do any serious rehab. We asked them to get Dad a neurologist's opinion on how that pain could be caused (if he could possibly have fibromyalgia or some nerve disease, etc). Since he also had the swelling in his right hand this past week, some form of arthritis could be an explanation. The social worker also suggested it was possible that he was making up the pain to get attention. The physical therapist also noted that when Dad says he is in pain, his voice and facial expression are completely lacking any sign of pain--no wincing, no grunting, no raise in vocal pitch, etc., and that those details led her to believe he could possibly be making it up in his mind. Until we get to the bottom of this constant and ubiquitous pain, there is really no chance of Dad improving enough to be released from the care center.
Because Medicare will no longer pay for Dad's care if his progress stops, we will soon (within the next week or two) have to invoke Dad's long-term care policy through State Farm and use his Social Security income and other income to pay for his care. If he is being treated with physical therapy, he cost per day in ORN is $350, which amounts to more than $10,000 a month. Without physical therapy, the cost is substantially less--$145 per day. So, we need to make the decision whether we all want to go broke trying to keep Dad in physical therapy, or just give up on him.... The physical therapist is pretty doubtful Dad could ever attain any progress, but I think there is a chance that if we could get to the bottom of his pain, we could get him working hard on his rehab. Hopefully the neurologist's exam can help us make a more informed decision.
I talked with the VA people today, hoping there would be some hope for veteran's benefits, but I think that is a lost cause. Unless Dad had served in a war or during a war era or sustained some sort of injury during his army service that has become chronic, there is no benefit he is entitled to from the VA.
Dad has lost nearly 15 pounds since his stroke. His last-recorded weight (taken a couple days ago) was 160. He was 172 when he entered ORN and we think around 175 before the stroke. We've noticed this loss more in the last few weeks. His appetite seems diminished more than usual lately. The nutritionist said the nurses' records state that he takes in about 2/3 of all the food they give him, which is never cause for alarm because most people don't like every type of food they are given. We will try to bring in Dad's favorite foods more often now, since the weight loss is substantiated and we've obtained permission from the staff to bring in food whenever we want.
Dad's preoccupation with his bowels and with his hemorrhoids was also discussed today. After the meeting with the staff, we went and talked to his nurse, who is nearly positive Dad does not even have any sign of hemorrhoids. We asked her to examine him the next time they were changing his brief and confirm that. At least then we could tell Dad there is no reason for worry in that area and that the pain must not really be there, or is caused by something else.
So there was not a lot of good news today, which we were expecting. Still, it is hard to deal with decisions that will have to be made soon.
Probably the most important thing we learned today was that the PT specialist agrees with our perception--Dad has not been improving at all. The main reason for his lack of improvement is that he has, or at least *thinks* he has, too much pain all over his body to actually try to do any serious rehab. We asked them to get Dad a neurologist's opinion on how that pain could be caused (if he could possibly have fibromyalgia or some nerve disease, etc). Since he also had the swelling in his right hand this past week, some form of arthritis could be an explanation. The social worker also suggested it was possible that he was making up the pain to get attention. The physical therapist also noted that when Dad says he is in pain, his voice and facial expression are completely lacking any sign of pain--no wincing, no grunting, no raise in vocal pitch, etc., and that those details led her to believe he could possibly be making it up in his mind. Until we get to the bottom of this constant and ubiquitous pain, there is really no chance of Dad improving enough to be released from the care center.
Because Medicare will no longer pay for Dad's care if his progress stops, we will soon (within the next week or two) have to invoke Dad's long-term care policy through State Farm and use his Social Security income and other income to pay for his care. If he is being treated with physical therapy, he cost per day in ORN is $350, which amounts to more than $10,000 a month. Without physical therapy, the cost is substantially less--$145 per day. So, we need to make the decision whether we all want to go broke trying to keep Dad in physical therapy, or just give up on him.... The physical therapist is pretty doubtful Dad could ever attain any progress, but I think there is a chance that if we could get to the bottom of his pain, we could get him working hard on his rehab. Hopefully the neurologist's exam can help us make a more informed decision.
I talked with the VA people today, hoping there would be some hope for veteran's benefits, but I think that is a lost cause. Unless Dad had served in a war or during a war era or sustained some sort of injury during his army service that has become chronic, there is no benefit he is entitled to from the VA.
Dad has lost nearly 15 pounds since his stroke. His last-recorded weight (taken a couple days ago) was 160. He was 172 when he entered ORN and we think around 175 before the stroke. We've noticed this loss more in the last few weeks. His appetite seems diminished more than usual lately. The nutritionist said the nurses' records state that he takes in about 2/3 of all the food they give him, which is never cause for alarm because most people don't like every type of food they are given. We will try to bring in Dad's favorite foods more often now, since the weight loss is substantiated and we've obtained permission from the staff to bring in food whenever we want.
Dad's preoccupation with his bowels and with his hemorrhoids was also discussed today. After the meeting with the staff, we went and talked to his nurse, who is nearly positive Dad does not even have any sign of hemorrhoids. We asked her to examine him the next time they were changing his brief and confirm that. At least then we could tell Dad there is no reason for worry in that area and that the pain must not really be there, or is caused by something else.
So there was not a lot of good news today, which we were expecting. Still, it is hard to deal with decisions that will have to be made soon.
Monday, February 1, 2010
January 31, 2010
My visit tonight with Dad seemed a little more solemn than usual. Though he seems to have up and down days, I think Dad is becoming increasingly depressed. His good hand (the right one) is swollen for some unknown reason, and is painful for him to use, so when I and my family showed up around dinner time, he was glad we were there. He was sitting there staring at his tray of food with no way to feed himself, and said "Oh, well I was just going to flag a nurse down, but now since you're here, you can help me eat my dinner." Dinner was manicotti, steamed vegetables, dinner roll, and vanilla pudding. He didn't care for the manicotti, but ate most everything else.
We asked the nurse what might have happened to his hand and she suggested rheumatoid arthritis, but Dad has never had that in his life. Apparently there is a blood test that can verify if that is in fact the problem. So we have asked them to do that test. Dad suggested the injury was caused when he nearly fell off his wheelchair during a shower and tried to catch himself with that arm and hit the elbow on the wheelchair or something else that was hard.
He had been put on morphine last week due to his complaints of pain, but that rendered him too tired to go to his physical therapy, so they have taken him back off the morphine and tried Celebrex and possibly some other pain medications. We will clarify all of that at the meeting with the staff on Wednesday. He looks to me like he's losing muscle tone and that he might have lost some weight. I am also going to ask the staff to weigh him again and compare that to the weight he was when he entered the care center. I am not certain, but his knees both looked swollen to me as well, and his left arm is usually swollen and still is.
It is very difficult for us to reach Dad's doctor. I've never run into him there in all my visits. I am pretty sure the doctor had not been in to see him for possibly a month up until about a week ago. Apparently even though Dad's injury to his right hand had been noted on Saturday morning by the nurse, the doctor had not been contacted by Sunday night, presumably because it was the weekend--when I asked why they hadn't figured out what was wrong with him yet, the nurse said, "We can't call the doctor now." It seems pretty odd that a doctor would not be on call over the weekend hours. I will also express our concerns about the lack of a doctor's supervision during the meeting on Wednesday.
We asked the nurse what might have happened to his hand and she suggested rheumatoid arthritis, but Dad has never had that in his life. Apparently there is a blood test that can verify if that is in fact the problem. So we have asked them to do that test. Dad suggested the injury was caused when he nearly fell off his wheelchair during a shower and tried to catch himself with that arm and hit the elbow on the wheelchair or something else that was hard.
He had been put on morphine last week due to his complaints of pain, but that rendered him too tired to go to his physical therapy, so they have taken him back off the morphine and tried Celebrex and possibly some other pain medications. We will clarify all of that at the meeting with the staff on Wednesday. He looks to me like he's losing muscle tone and that he might have lost some weight. I am also going to ask the staff to weigh him again and compare that to the weight he was when he entered the care center. I am not certain, but his knees both looked swollen to me as well, and his left arm is usually swollen and still is.
It is very difficult for us to reach Dad's doctor. I've never run into him there in all my visits. I am pretty sure the doctor had not been in to see him for possibly a month up until about a week ago. Apparently even though Dad's injury to his right hand had been noted on Saturday morning by the nurse, the doctor had not been contacted by Sunday night, presumably because it was the weekend--when I asked why they hadn't figured out what was wrong with him yet, the nurse said, "We can't call the doctor now." It seems pretty odd that a doctor would not be on call over the weekend hours. I will also express our concerns about the lack of a doctor's supervision during the meeting on Wednesday.
Monday, January 25, 2010
Jan 25, 2010
I haven't updated the blog in a month because there really has been nothing to report. Dad has seen pretty much no progress that I can detect. He is tired of being in the care center, and often says "How are you guys going to get me out of this place?". Our standard answer to that is, "You will have to stand up and walk out the front door." Although he seems to really enjoy going to physical therapy so that he can watch the other patients and interact with the staff (mostly inappropriately--you all know Dad :)), he gets a little lazy and doesn't stay awake or involved during some of the therapy sessions. We just keep reminding him that he needs to work hard during the therapy and then work harder when he's alone in his room in order to see progress. He says everything hurts and wants us to help him move even his right leg. We really don't know how to better help and motivate him.
He has been complaining of pain during urination, so we had him tested last week and sure enough, he had another bladder infection. His other complaints are consistent from the beginning: sore neck, sore back and rear end, sore right knee, sore shoulders, and the pins and needles feeling when his left arm is moved.
Mae and Keith Reynolds came down for a visit a couple weeks ago. It was so nice to see them. I love all of Dad's sisters. They are so fun. Dad was a little rude, in my opinion, but I suppose one always likes to be blunt and complain to their siblings since they feel comfortable doing so. Betty, Shirley, and Kathy say they want to come down for a visit as well, and we are excited for that. It is nice to have someone else come down and see what they think of Dad's progress and argue with Dad a little bit. :)
After 3 pairs of new shoes, we are hopeful that the new Converse ones Jan got him will be up to his standards. Dad is unbelievably picky about shoes, we have discovered! Luckily Target accepts returns of barely-used shoes without the box. :) He also complains that all his clothes are too hot, so I grabbed him some lighter sleep pants and light-weight socks as well.
It is about time to line up another meeting with the hospital staff to hear their assessment of Dad's progress. I will post again after we have done that.
He has been complaining of pain during urination, so we had him tested last week and sure enough, he had another bladder infection. His other complaints are consistent from the beginning: sore neck, sore back and rear end, sore right knee, sore shoulders, and the pins and needles feeling when his left arm is moved.
Mae and Keith Reynolds came down for a visit a couple weeks ago. It was so nice to see them. I love all of Dad's sisters. They are so fun. Dad was a little rude, in my opinion, but I suppose one always likes to be blunt and complain to their siblings since they feel comfortable doing so. Betty, Shirley, and Kathy say they want to come down for a visit as well, and we are excited for that. It is nice to have someone else come down and see what they think of Dad's progress and argue with Dad a little bit. :)
After 3 pairs of new shoes, we are hopeful that the new Converse ones Jan got him will be up to his standards. Dad is unbelievably picky about shoes, we have discovered! Luckily Target accepts returns of barely-used shoes without the box. :) He also complains that all his clothes are too hot, so I grabbed him some lighter sleep pants and light-weight socks as well.
It is about time to line up another meeting with the hospital staff to hear their assessment of Dad's progress. I will post again after we have done that.
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