Tuesday, October 06, 2009

Update On Mr. AOW (updated intermittently)

Previous posts about Mr. AOW's stroke are here and here.

Recent information below the fold. Click "Turn the page."

October 6: Arriving around 7:30 AM and leaving around 7:30 PM, I spent all day yesterday at the rehab hospital with Mr. AOW. I had the opportunity to confer with both his doctors and all three of the therapists (physical, occupational, speech) and observed all the therapy sessions.

In a some situations, I gave the therapists some hints as to how better to work with Mr. AOW. For example, the occupational therapist didn't want to challenge him enough with a poster she uses to have patients identify common objects; she thought he was too tired and incapable of the task. I held up the poster and asked Mr. AOW what the pictures represented, and he got all but one correct. I also indicated to the therapists a better way for Mr. AOW to work with the mirrors so that Mr. AOW would cooperate better.

I was very proactive with all the medical personnel I met. I think they were happy to see me leave!

Before lunch and after lunch, I took Mr. AOW outside the center to the "garden" so that he could sit in the sun and, as Mr. AOW said, "touch something besides bed sheets."

Now for some medical information....Mr. AOW had a large hemorrhagic stroke on the right side of the thalamic region. Read a little about the thalamus HERE and detailed medical information HERE (Type in "thalamic stroke" with the quotes in the search box in the upper left corner, and read the article entitled "Thalamic Hemorrhage"). A detailed diagram and more explanation are HERE.

According to Wiki (not cited above):
The thalamus (from Greek θάλαμος = room, chamber, IPA= /ˈθæləməs/) is a midline paired symmetrical structure within the brain of vertebrate animals, including humans. It is between the cerebral cortex and the midbrain, both in terms of its location and its neurological connections. Its function includes relaying sensation, special sense and motor signals to the cerebral cortex, along with the regulation of consciousness, sleep and alertness. The thalamus surrounds the third ventricle.


The thalamus is known to have multiple functions. Deduced from the layout of the isothalamus, it is generally believed to act as a translator for which various "prethalamic" inputs are processed into a form readable by the cerebral cortex. The thalamus is believed to both process and relay sensory information selectively to various parts of the cerebral cortex, as one thalamic point may reach one or several regions in the cortex.


Many different functions are linked to various regions of the thalamus. This is the case for many of the sensory systems (except for the olfactory system), such as the auditory, somatic, visceral, gustatory and visual systems where localized lesions provoke specific sensory deficits. A major role of the thalamus is devoted to "motor" systems....
We don't yet know the extent of any permanent damage. Typically, hemorrhagic strokes result in less permanent damage than blockage strokes.

At this point, Mr. AOW has left side paralysis and left neglect, the latter meaning that he doesn't know that he has a left arm. As of last night when I left, he was getting "reacquainted" with his left arm. Balance is an issue with left neglect. Another issue: he's unable to turn his eyes upward; however, the first several days after the stroke, he couldn't open his eyes at all or bring them both center, so some progress is evident. The nystagmus has nearly resolved.

Complicating Mr. AOW's recovery is the brain surgery Mr. AOW had in 1993 for acoustic neuroma, left side; the nerves on the left side of his face and mouth have been compromised every since that surgery. Furthermore, he has no left-side vestibular nerve, complicating even more Mr. AOW's trouble with body balance and correct head position.

When Mr. AOW is released from the rehab center, he will require around-the-clock supervision. Therefore, he'll be released to a skilled nursing facility. The insurance policy will allow for 60 days in that kind of facility.

October 7 @ 7:36 AM:
This morning, Mr. AOW had the nurse call me twice so that he could speak to me. He also called once on his own.
He's having a pity party right now and called to say, "Goodbye." Years ago, my grandmother after a series of strokes said similar things.
Anyway, here's another roller-coaster ride.

October 10 @ 11:40 AM:
Mr. AOW is making significant progress: fewer mood swings, some trunk-muscles activity, a bit of movement in the left leg. His vision has improved somewhat, but still leaves much to be desired. He does get disoriented; for example, on Wednesday, he said, "I feel like I'm in California." Yesterday, he felt as if he were in one of the outbuildings on our property.
Mr. loves to visit the garden area at the hospital. I am encouraging all visitors to take him outside when the weather is nice.
The left arm and hand remain useless. As he is left-handed, the left neglect is a serious issue. To sign the application for Social Security Disability yesterday, Mr. AOW could merely "make his mark" with his right hand and have witnesses certify.
According to the doctors, nurses, and therapists, Mr. AOW is making excellent progress, particularly with regard to speech and swallowing. Clearly, however, he is not yet able to come home and will not be able to do so for some time.

October 12 @ 9:20 AM:
Mr. AOW complained yesterday of pain in his left leg. Read about pain after a thalamic stroke HERE. The information is stomach churning! I myself suffer from nerve pain ever since the car accident I had in 2005, so I know how debilitating such pain is.
I plan to ask the care team today as to how they plan to manage this new development with Mr. AOW and will update this post later today or early tomorrow morning.

Note to friends and family: Additional updates on Mr. AOW will be added to this post.

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posted by Always On Watch @ 10/06/2009 07:31:00 AM