Bump In the Road

The respiratory numbers didn't stay stable for very long after visiting hours ended. About 3 hours after the tube was removed, Mom's breathing became labored. The Respiratory Therapist put on a C-PAP(constant air pressure) to push some air closer to her lungs. The Respiratory Therapist said Mom's lungs need to build up some strength. The hope is they can remove the C-PAP for longer and longer periods of time, until, eventually, hopefully, she will not need the C-PAP at all. Lung strength sometimes does become an issue, and there's a good chance things will work out. If things do not work out, the next step would be a tracheotomy to ease her breathing. It would, hopefully, be temporary, and allow her lungs to build up strength over a longer period of time. As I left tonight, Mom was drunk on Atavan, on a C-PAP, and sporting somewhat tenuous respiratory numbers.

Tube Out! Vital Signs Stable!

Big news!

When Mom's tube came out last Monday, she was not able to maintain stable vital signs for even an hour.

When her tube came out today, she was able to maintain stable vital signs for the remaining 2 1/2 hours of the visiting period. This is a big step forward. Every hour going forward, with stable vital signs, is a further good sign.

When the tube came out, Mom was a bit goofy. Her doctor and nurse also noticed this yesterday. They attribute the goofiness to Atavan, and it's effects on older patients. Accordingly, they are taking her off Atavan. This means Mom will be somewhat uncomfortable and edgy over the next couple of days. Though uncomfortable for her, it will be reassuring for me to again see her mentally sharp, as she was last Monday.

Beyond Most Dangerous Stroke Risk Period; TCDs Cancelled

Saturday night made for a full twelve days since the incident. No Vaso Spasm is present. The most dangerous period has passed. TCDs are typically cancelled after 14 days. Doctors cancelled Mom's TCDs after 12 days.

Mom remains at increased risk of Vaso Spasm for an additional 9 days, or until late in the evening of Monday, May 8. This risk is not as high as the risk has been the last 9 days. Going forward, doctors and nurses will monitor her neurology through questions, requests, and physical movements. These will indicate if she is having a problem with blood flow in her brain. I will question her doctor further about this on Monday morning.

This is another important marker which Mom has passed by.
Her outlook brightens.

Ventricle Size Returned to Normal

I forgot to report this a couple of days ago:

The CT showed the ventricles have returned to normal size.

Also, somewhat related, the brain drain has been out for several days, and no additional brain swelling has occurred.

No News - Day 4

Tube's still in. Dang it. No one seems concerned. They say they are being intentionally overcautious. I am now intentionally impatient.

Abby

Abby is opening her second set of Easter gifts! And why not? Abby has never met a stranger. She is, possibly, the happiest child ever to drag stuffed animals around Bossier City, Louisiana. Great- grandmother Pat Caggiola claims Abby has never cried - and who would argue with a great-grandmother?!

Abby is the Granddaughter of Jim and Martha, daughter of Leslie and Jason, niece of Lindsey Ruth, Lacy, and Laura. I'm guessing Abby could spare a stuffed carrot (or three!) as a gift during Nancy's recovery.

On the next major holiday, maybe Abby should ask for a backyard playhouse/storage room :)

A Lack of News Might Be Good News - Day 3

Doctors are relaxed. Nurses and Doctors are mightily pleased with the ongoing recovery. No one seems the least bit worried.

The tube stays in.

I'm ready for it to come out.

Separated at Birth

Can you tell which is Charlize Theron, and which is Lindsey: stunner from Robinson, TX; daughter of Mike and Kerry; sister of Kendyl and Shelby?

If I didn't know already, I don't know how I could tell them apart...

(answer below)
















Lindsey is steering the vehicle!

Drain Out

The drainage tube was removed from Mom's brain some hours ago. She shows no additional swelling since the removal. Very nice. This reduces the threat of infection which was associated with the tube; and reduces a larger threat that Mom might need a permanent shunt to drain her brain.

Mom's sedation has been reduced. Nurses are monitoring how her vital signs respond to less sedation, in anticipation of removing her intubation tube. This afternoon Mom was alert and aware, yet could not speak, due to the tube. That must be frustrating. The good news is - it might only be frustrating for a short time more!

Blood Velocity (Warning: there will be math)

I should comment about the blood velocity in Mom's brain. The velocity is currently acceptable. Her blood velocity is measured every day via a Transcranial Doppler Scan, which is variously shorthanded as a "the TCD", or "the Doppler." If the TCD shows her blood velocity going faster, her vessels are constricting, which usually happens over a period of days.

Each TCD produces a range of numbers, each of which represents a different artery. According to the scale used, the best numbers would fall in a midrange between 0 - 100(maybe from 30 to 50, as a guess). If the numbers go past 100, she will be experiencing Vaso Spasm, and medication dosages to counteract Vaso Spasm will be increased. The medication usually works. If it does not work, Mom could suffer a stroke.

Mom is at especial risk of Vaso Spasm for 3-12 days post-incident(until 5/2). She is at somewhat raised risk of Vaso Spasm during the 13th-21st days post-incident(5/2-5/11). After 5/11, her prognosis brightens considerably.

Mom's grouping of TCD numbers have bumped up, but nurses say that is normal for anyone in her circumstance. A week ago, her numbers were in the upper 30's to the upper 40's. Her numbers have steadily ticked up, and now are mostly in the upper 50's to upper 60's, with a couple of arteries each day ticking into the 70's, and a different artery each of the last two days ticking into the low 80's. This is amongst a grouping of approx. 16-20 numbers. Maybe only three numbers a day have topped 70.

I've tried to become alarmed about these numbers, only to be shot down by nurses, sort of like this:

We're not going to worry about these numbers. We're not going to worry about anything until she gets above 100, and even then she will only have mild Vaso Spasm. If she moves beyond mild Vaso Spasm(a good distance past 100), then we'll think about if we are going to worry.

So, now you know everything I know. It's about 55 hours until Mom will be a full 12 days beyond the incident - at approximately 11:30 PM on Saturday.

Max

From the Upper Midwest comes Maxwell Maurice Cotharn, namesake of my father: Maurice Vachel Cotharn. Max watches over Bradley, Kris, and their children.

Max is like an ancient lion - all at once venerable and dignified. He has earned his scars, and his regal bearing. Max loves when Nancy visits. He wishes her a speedy recovery, so she can visit ASAP.

No News is Good News: Day 2

Excellent. Everything is very quiet, and very stable. They are looking to wean Mom off the intubation tube. I will update if it happens today.

Annika

Annika beautifies Ogden, Utah. She is the daughter of Nancy's grandnephew - Paul, and his wife - Mikelle.

The cuteness standards - high as they are - are in no danger of kicking in.

A Lack of News Might Be Good News

This is a "no news is good news" day, and I am glad to see it. Now that we know Mom's cognition is so good, I'm happy to see a day of neurologic rest. I'd be happy to see a string of such days, in fact.

Smokie and Sassi

Smokie and Sassi live in Helena, MT; with Nancy's nephew-Bob, and his wife- Peggy. Smokie is 12 and Sassi is 4! They are wishing Aunt Nancy well, as are Bob and Peggy.

Smokie and Sassi crack me. They look contemplative - as if they are working out math theorems in their heads. Smokie's math theorem might be slowly putting him to sleep. Maybe they are intensely focusing on what time dinner will be ready.

One Ginormous Step Forward; One Shuffle to the Side

First, the shuffle:

Dr. Treadwell eliminated Mom's sedation; and took her off the intubation tube. As the sedation reduced, Mom began to better understand her circumstances. Her heart rate and blood pressure went very high. We were not able to have her relax in a way which reduced her heart rate and blood pressure to acceptable levels. Therefore, Dr. Treadwell had the intubation tube re-inserted, and re-started sedation. Dr. Treadwell expects the tube to come out in a couple of days. His goal is to provide some "neurologic rest", thus allowing her neurology to become a bit stronger. He says this is no big deal at all, and he expects her to come off the tube after a bit more rest.

Second, the ginormous (love that [non] word!) step:

Mom's mental capacity is outstanding! - as evidenced by her conversation while she was off the intubation tube:

• Where is your father?
• How is he doing?
• Cancel my beauty shop appointment at Plaza Beauty Shop. Me: Rosie already cancelled the appointment at Plaza Beauty School. She: No, it's not a beauty school!
• Am I in ICU?
• How long have I been here?
• What did they do? (Arteriogram to solve the bleeding aneurysm problem - but no actual surgery)
• That's amazing!
• What are my dosages?
• Bruce, help me up, and get me out of this bed right now!

Various nurses came down the hall to meet the awakened Nancy. She said hello to each, and used each nurse's name. Eventually, she announced: "That's too many names to remember!"

Mom overtly refused to be a good patient. I can guarantee she is tremendously angry with everyone who came into her room, then allowed her to be re-intubated. Our only hope is she might forget some of us were there...
If she remembers I was there, I plan to blame the whole thing on Bruce.

Overview:

Mom faced a not insignificant danger that her brain function might not return to normal. This morning Dr. Treadwell, in speaking with Dad about another matter, offhandedly mentioned "her brain function has returned to normal." I was not there to question exactly what he meant by that. I find it unlikely that he was making an absolute statement about her mental acuity. I can say, in a lay person's opinion, she was very sharp mentally. Very. Hopefully, the dangers in this area have been largely eliminated.

Mom still faces a not insignificant danger of stroke. Anyone who suffers this type of blood on the brain finds their brain arteries(?) constricting over the ensuing 21 days. If the constriction becomes severe enough, it is called Vaso Spasm. The danger of Vaso Spasm is especially high during the 3 - 12 days after the incident; and is lower during the 13th - 21st days after. If Mom makes it past 21 days, her prognosis becomes - I can't seem to find an appropriate adjective, which does not overstate - but her prognosis becomes pretty doggone good.

Intubation/schmintubation. This has been a fantabulous day.

Kendyl and Shelby

Received a fun dog pic, yet must save it for another day, as cannot pass up this pic of Kendyl (2 1/2), and Shelby (5), of Robinson, TX. Kendyl and Shelby run the household of Nancy's niece - Kerry; and her husband - Mike.

Kendyl and Shelby flew right by the Nancy Cotharn Update's high child cuteness standards.

Responding to More Verbal Commands

It's been a wonderful 24 hours for Mom. She clearly understands verbal instruction, and responds to a larger grouping of verbal commands. When her sedation is reduced, she will do all the following if she is asked:

• Wiggle your left foot. Wiggle your right foot (that she remembers left from right is amazing to me).
• Lift your head.
• Nod your head.
• Show two fingers.
• Raise your hand.
• Raise your elbow.
• Move your elbow up beside your head.
• Lift your leg.

It's unlikely that she is able to put a person's history together with their face or their voice. She does, however, recognize familiar voices. She will sometimes turn toward the person speaking, open her eyes, and smile at them.

It's been a wonderful 24 hours. Blessed.

Also, the outpouring of support and love for Mom has been wonderful and moving. I'm trying to keep a record of it, and to keep all the notes and cards, so she can see the record, and read through all the notes and cards when she is able. You all are wonderful. I will speak for her, and thank you very, very much.

Sam and Rohan

It is the official policy of the Nancy Cotharn Update to publish pet pictures from friends of Nancy. Just send them to my email: gcotharn [at] yahoo.com

We will also publish child pictures - if the child makes the cut by being sufficiently adorable :)

Today: Sam(above), and four month old Rohan(below), of Flagstaff, AZ. They live with Nancy's nephew Joe, his wife Lynn, and their daughter Rachel.

Brain Swelling Reducing

via CAT scan. Thursday's CAT scan showed reduced ventricle swelling. No CAT scan on Friday. Saturday's CAT scan showed that ventricle swelling is continuing to reduce.

Responding to Verbal Commands

Mom understands at least some verbal commands. She can respond to some simple requests, such as to wiggle toes, or to open eyes (raising lids from 1/8 to 1/2 way open), or to blink.

Responding to verbal commands is a marker which Doctors and Nurses are looking for. When she can respond to a larger number of commands, she will have reached a notable mark along the path to recovery.

Lifting Head

Because of tubes and sensor cords, Mom can only lift her head a couple of inches, at maximum. She has lifted her head at least a half dozen times; has held it suspended in mid-air for about 5 or 6 seconds at a time; and has turned it slightly side to side while she held it suspended.

Lifting the head is a marker which Doctors and Nurses have been watching for.

No Signs of Paralysis

Everything moves. Mom sometimes makes big movements with her legs and arms.

Purposeful Movements

Purposeful movements are a good sign, as they represent complex brain activity. If Mom is pushed on the chest, she will move her hands toward the area being pushed. At least once, when she was turned, she shifted her legs into a more comfortable position.

Responding to Stimulus

Mom responds to stimulus. She will pull a limb away from pain.

Off Ventilator

Mom is breathing on her own! Since about 9:00 AM on 4/21.

She remains intibated, just in case. Because it is difficult to pull air through the hose which is attached to her tube, the Respiratory Therapist has C-PAP (constant air pressure) running through the hose and tube, to ease getting air close to her lungs. However, he said she is breathing completely on her own, and he only runs the C-PAP because she is pulling her air through a hose.

Definitions

Aneurysm - "Aneurysm is a bulge in a blood vessel, much like a bulge on an over-inflated innertube. Aneurysms are dangerous because they may burst."


Subarachnoid Hemorrhage (SAH) [1, 2, 3, 4] -

"Subarachnoid hemorrhage occurs when a blood vessel just outside the brain ruptures. The area of the skull surrounding the brain (the subarachnoid space) rapidly fills with blood."

"SAH is responsible for the death and/or disability of 18,000 persons each year in North America alone. Unfortunately, the difficulties in detecting unruptured aneurysms in asymptomatic patients practically preclude the possibility of preventing most SAH."

Cerebrospinal Fluid(CSF) - the subarachnoid space is filled with cerebrospinal fluid. Our bodies constantly absorb CSF out of the subarachnoid space. Our bodies simultaneously infuse the subarachnoid space with new CSF, to balance for the CSF which is absorbed.

>>When blood hemorrhages into the subarachnoid space, it must be broken down, by natural cellular process, until it has morphed into a substance which can be absorbed out of the subarachnoid space.