Monday, September 21, 2009

Pressed For Time

Note added on October 6: Updates on Mr. AOW are now being added to this post.

As regular readers here already know, my husband Mr. AOW had a hemorrhagic stroke on September 15. See this previous post.

Recent information, including updates, below the fold. Click "Turn the page."

I want to thank The Merry Widow for posting the announcement on September 15. I also want to thank all the supportive commenters for their concern and their encouragement. Nearly a week after the event, I've finally had time to read each and every comment.

I am not putting this blog on official hiatus. Of course, I may have to do so at some point. But not yet! This blog is one of my support systems!

For now, I will occasionally post Twitter updates. See the top of the right sidebar.

The last update to the previous post about Mr. AOW's medical condition was on September 20 @ 10:20 PM.

TMW or I will update this post after I speak to Mr. AOW's night nurse and at least once a day for an indefinite period. Mr. AOW's recovery will be a long haul, and I simply won't usually have enough time to blog as usual.

Update from AOW (September 21 @ 5:30 AM):
Mr. AOW doesn't sleep much at night. Instead, he sleeps all day. In other words, he has his days and nights turned around.
He remains in ICU but very alert. In fact, he now wants the nurse to phone me at all hours so that he can talk to me. Two things concern him at the moment: (1) what I'm doing with his "nest" in the shed, and (2) how much he wants ice and ice water. Right now, he has restrictions as to how much he can receive by mouth, the concern being aspiration into the lungs. His begging is disconcerting for me as meeting his requests is medically unwise.
Mr. AOW's blood pressure is finally stabilizing. Once stabilization occurs, he'll be moved to a regular room. The sooner he begins physical therapy and occupational therapy, the better!

Update from AOW (September 22 @ 6:28 AM):
Mr. AOW passed his swallowing and memory tests yesterday as he wants milk to drink. He's a big milk-drinker. He got milk and a pureed meal yesterday.
I was present for the memory test. In some ways, his memory is better than mine right now. LOL. In fact, the other day I asked him for the combination to the safe because I cannot ever remember those numbers in order. He knew the combination!
Once the medical team can get him off the pain medications for his headache, Mr. AOW should be able to stay awake better and longer so that he can begin some physical therapy and occupational therapy.
He remains in ICU and will remain there until his blood pressure in consistently where the docs want that upper number to be. The bottom number is fine.
Mr. AOW is on antibiotics, and his temperature is normal or nearly so. Overnight, the lab ran a urine culture because of the cloudiness of output. The fever of a few days ago is likely due to a urinary tract infection.
Overnight he got some sleep. Finally some sleep at night! Mr. AOW didn't sleep all night, however, and gave the nurse a rough time about the nasogastric feeding tube. He was also somewhat agitated, to the point that the nurse sedated him. Despite the agitation, he was oriented.
I learned last night that Mr. AOW repeatedly told one of the family members who saw him on Sunday afternoon that his left arm is "useless, useless, useless." Several times he picked up his paralyzed left arm with his right hand and dropped the arm over and over again, repeating "Useless!" He hasn't made any such complaint to me.
His case worker consulted with me yesterday. We went over several things: what kind of medical hardware we have at home, the layout of the house here, various health-insurance matters (private catastrophic policy went into effect on June 1), an outline of the course of recovery (residential rehab when he's ready to move to another facility if the health plan covers such a program and home care), household income, the possibility of Social Security disability, household income, and my work schedule. The case worker and others at the hospital take care of a lot of paperwork, thus relieving me of that chore!

Update from AOW (September 23 @ 6:14 AM):
Mr. AOW's blood pressure has come down, and he's now off the drip which keeps him in intensive care. If he can maintain this lower pressure - I don't know for how long - he'll be transferred to a regular room. He remains on a nasogastric feeding tube to facilitate giving medications by mouth.
Unfortunately, when I visited last night, Mr. AOW was irate about "how awful this place is." He even demanded to call an attorney to get him released. Mr. AOW was very angry with me last night because, in his words, "You are keeping me here." He said, "I want my wallet and a key to the shed. I want to go anywhere else but here." The shed has a couple of walkers in it (Mr. AOW the Packrat), so the request for the shed key actually makes sense. But, of course, he doesn't realize that he's incapable of using a walker as the left arm and left leg remain completely paralyzed.
I got Mr. AOW calmed down after a few minutes of reasoning from me, and he dozed off. He had a less hostile overnight than the night before - no Haldol required.
On the very positive side, the paralysis involving the mouth is much improved. In fact, his mouth looks nearly normal now, and his speech is not slurred much. Also, his eyes aren't rolling and turning downward nearly as much now.
Mr. AOW could be transferred to a regular room as early as today. Once he gets access to a telephone, no telling whom he'll call!

UPDATE(Sept. 23, 1:10 pm)
Just got a call from, AOW, Mr. AOW had 2 sessions with the physical therapist this morning, he fell asleep after both. But he also slept through the night.
His left arm was swollen from the sodium drip(to keep his brain from swelling so much), he has been getting massages to reduce the swelling. It's working.
His ire seems to have cooled...he MAY have thought that he was in a more permanent institution...he could use prayer to reduce his feeling of abandonment.

Update from AOW (September 24 @ 6:35 AM):
Mr. AOW wasn't angry when I visited him yesterday. I was at the hospital for hours yesterday because I had to wait a long time for him to wake up. When he finally did wake up, he made perfect sense. He stayed awake for about 45 minutes, then dozed back off.
He's been off the IV drip for blood pressure for nearly 24 hours, but his blood pressure overnight varied too much for immediate transfer to intermediate care.
The other problem yesterday: Mr. AOW's glucose was way up, at one point to 360. He is now on an insulin drip, and glucose levels are improved.
Once his blood pressure stabilizes, Mr. AOW will be transferred to intermediate care.
I spoke by phone with Mr. AOW a few minutes ago. He was too sleepy to make much sense, however. Mostly, I got snoring from the other end of the line.

UPDATE (Sept. 25, 7:25 am);
Mr. AOW is making more forward progress, his left leg has moved twice, he is starting to crack jokes instead of getting angry, he remembered what he was doing when he had the stroke AND has started noticing how wiped out AOW is. He is starting to get outside his own head.
He needs his teeth for speech therapy, but his blood pressure still creeps up at night, it needs to stay under 150, before he can be moved. Also, since he cannot have solid food yet, his glucose levels sky rocket. He also asked the nurse what time it was last night and decided it was too late to call AOW. He is going nuts without someone to talk to.
So, there are some prayer needs right there.

UPDATE(9-25, 2:36 pm)
More good news. AOW was present at Mr. AOW's PT, this morning. His stroke was in the sensory area of the brain, so his memory is intact. He still cannot feel his left hand or foot, but if he looks at his quadricep, he can move it. His eyes are centering more(focusing issue), he is cracking jokes with the nurses and PT people.
He now has an irregular heartbeat, unknown cause, but it has occurred since he's been hospitalized.
The doctor told AOW not to get rid of the SUV...hmmmmm?!?!
The PT folks say he will probably be in live in rehab for up to 6 months, but as long as he makes progress, they won't toss him out.
He did want to go to work at the VFW tonight(his regular shift)...I don't think so! LOL!
The ministry has started to step up to speed, now that the needs are more clearly known...AOW now has more saucepans than she knows what to do with. She is also working on a home made chicken pot she is eating better herself.

Mr. AOW's bp went down to 140/71, and he has been moved to an Intermediate Care Unit! He is in with 3 other men and 2 nurses...he can have cards, balloons, whatever. Anyone can go visit him and he is getting thickened foods. He does have a problem with silent aspirations, that is where he doesn't cough if something, "goes down the wrong chute".

Update from AOW (September 26 @ 7:30 AM):
I had to go back to the hospital for the third time last night (only two trips had been planned) as Mr. AOW got confused. He knew that he was confused, however. He wanted a couple of dollars, his little book of phone numbers (Yikes!), and some reassurance that I hadn't abandoned him. They do keep moving him around while he's dozing, so the confusion clearly isn't dementia of any sort. He remains oriented as to time and space and all other essential neurological signs. His speech continues to improve as the paralysis around the mouth is gradually resolving.
His vision is not clear as his eye muscles aren't working properly. This trouble with his vision is part of the cause of his confusion.
He nearly got out of bed on his own this morning! The nurses cannot allow him to be up and about, of course.
Mr. AOW will have more PT today. Let's hope that he cooperates.
I'll be at the hospital for much of the day but won't get there in time to observe today's PT as I want to get my flu shot at today's flu clinic at the hospital. I have some 21 essays by students to grade and will tote those essays and the corresponding grade sheets with me. Whenever I get home today, I still have some chicken pot pie to eat. I'm so grateful for the food drop-offs. I don't have time to cook anything but my own breakfast right now.

Update from AOW (September 26 @ 9:33 PM):
Mr. AOW missed his PT today as he was sedated so as to calm down his anger and relieve his headache.
That said, everything else today was good! He had several visitors from the VFW, and their presence and cards really cheered him up. A guy thing, no doubt.
Tonight, Mr. AOW ate at least half of his pureed dinner of beef, mashed potatoes, and corn. All those particular foods are among his favorites.
I will also say that this evening is the best I've seen Mr. AOW since he had the stroke on September 15. Of course, there is no way of knowing whether he'll have as good a day tomorrow. If he can have several good days in a row, he will have turned a corner!

Update from AOW (September 27 @ 7:40 AM):
Mr. AOW had a good night in that he slept straight through and showed no signs of agitation. His blood pressure went up to the 190's for the top number, but only briefly while the nurse waited for him to respond to the medication administered. His last pressure was 144/82.
He is resting comfortably and snoozing, so I won't go over to the hospital till later today.
Updates to this post will not be as frequent now that Mr. AOW is relatively stable.

Update from AOW (September 27 @ 8:13 PM):
Mr. AOW has some appetite now, but unfortunately, both lunch and dinner today involved foods he prefers not to eat. The docs are concerned that he's not getting enough caloric intake.
He did show interest today in watching television as football games were on. Using his eye muscles has obviously improved, and he is able now to distinguish fantasy from reality on a more consistent basis.
My cousin "L" and I spent two hours with Mr. AOW today, from 11:00 AM and 1:00 PM and fed him his lunch. Decent appetite, but he did complain of the taste of hospital food. His thought processes were fine during the visit, and he's actually quite chatty until he tires. Sense of humor is intact. And he's finally stopped saying, "I know, but...."
Some excellent medical news today! The blood from the brain hemorrhage is resorbing a bit earlier than expected last week! One area of the yesterday's CT scan showed that what the docs originally thought was blood is actually edema, believed more manageable. The specialist today was quite hopeful about Mr. AOW's rehabilitation and told Mr. AOW to quit referring to his left arm as "my dead arm."
So far, I haven't had to make a second trip to the hospital today.
Tomorrow I'll be going to the hospital early to confer with Mr. AOW's case-management team. The team meets at 9:30 AM. I may spend most of tomorrow at the hospital as I work a full day on Tuesday.

Update from AOW (September 29 @ 6:15 AM):
Mr. AOW continues to improve bit by bit.
The hospital is now consulting with me as to which residential acute physical rehab facility he should be discharged to when his medical condition stabilizes and he meets certain benchmarks, including being able to stay awake longer. He tires very easily: a mere 30 minutes of PT exhausts him. His appetite is excellent now, but he has some trouble feeding himself because his left arm remains paralyzed. Mr. AOW is left-handed.
Mr. AOW understands that he won't be coming home as soon as he would like. Either of the two possible acute physical rehab facilities will allow pets to visit outside in a "garden."

UPDATE(9-29) from TMW;
AOW thought that Mr. AOW wouldn't be moved to a residential rehab facility until next week...uh...they are moving him tomorrow!
Are they moving him to the one 10 minutes from home?
He is going to the one an hour away, when the traffic to get there is a nightmare!
Poor, AOW! Her gasoline bill is going to be rather overwhelming!

Update from AOW (September 29 @ 8:50 PM):
He's baaaack! Hard to believe that the man I saw tonight is the same man I saw yesterday!
When I went in to visit Mr. AOW tonight, he was watching television, had his reading glasses on, and was perusing a magazine. His vision isn't very good, but the eye muscles are bringing his eyeballs closer to center now. His speech is much clearer too.
The wonderful difference in 30 hours is astounding!
Please keep praying, especially that he can recover sufficient use of his left arm and left leg.
I'll learn more tomorrow. The standard for this type of residential physical rehab is two weeks, then conversion to outpatient rehab.
I'll be busy over the new few days. I need to get him some items such as shoes with velcro fasteners. I also need to do some laundry for him, then pack his bag to take to the rehab center on Saturday.

Update from AOW (October 1 @ 5:50 AM):
Yesterday Mr. AOW was transferred to another hospital for physical rehab.
The move disoriented him somewhat. The disorientation is primarily one of personality, and he has frustration and anger issues.
At this time and even though I spent all evening with him at the center, Mr. AOW sure that he's not getting enough attention from the nurses. In his own mind, he's certain that he needs to be "somewhere else." This issue, his imagination, had resolved before the transfer but has reappeared.
Also, this time Mr. AOW thinks he's "on a train that keeps moving." Whatever that means!
Today the specialists at the rehab center will do their own evaluation Mr. AOW's condition. I will try to phone his rehab-center case manager this afternoon.

Update from AOW (October 1 @ 5:00 PM):
Mr. AOW began therapy sessions today! He is much more content now that he has something to do and to work toward.
According to his nurse this evening, he is cooperating fully. Mr. AOW is also okay that I'm not visiting tonight but will see him on Friday, Saturday, Sunday, and Monday. In fact, I will spend the entire day there on Monday so as to confer face to face with the appropriate hospital personnel.
Unless I have reason to, I will not be updating these posts as frequently as before.

Update from AOW (October 3 @ 6:50 PM):
I saw Mr. AOW last night. He was exhausted from the three sessions of physical therapy yesterday.
Usually on Saturdays, therapy isn't done. The unit made an exception for Mr. AOW today, however, and he had three sessions. The nurses see improvement!
I didn't go over tonight because Mr. AOW is always exhausted at the end of a day of three sessions of therapy. I will go early tomorrow; there is no therapy on Sundays, family day. I have a heart-shaped "I love you" balloon to take in.

Note added on October 6: Updates on Mr. AOW are now being added to this post.

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posted by Always On Watch @ 9/21/2009 05:21:00 AM