More Steps

forward in cognition. It's still the right direction. Now that Mom is finally able to have some therapy, she is improving. She is walking about 100' at this time.

I should mention that, a couple of weeks back, Lindsey Goins visited Mom all the way from "The Valley" outside of Los Angeles, CA. That's right, Lindsey is a Valley Girl. I believe Lindsey holds the record for person traveling the farthest to visit Mom.

Today was Party Day in Mom's room, and included these visitors:

Gurvis Post
Bradley Cotharn
Kris Cotharn
Austin Cotharn
Kacy Cotharn
Ronda Pippen
Jane Grismer
Jerry Grismer
Bruce Cotharn
Lisa Cotharn
Courtney Cotharn
Baron Cotharn
Greg Cotharn
Vachel Cotharn

In addition to all the visitors, Mom maintained her schedule with these therapies:

• Occupational Therapy: today = dressing and bath activities
  
• Physical Therapy: today = walking
  
• Neuro-Psychology: "plays a critical role in planning cognitive rehabilitation activities with the treatment team members."
  
• Speech Therapy: Mom's actual speech is good. Speech therapy focuses in on areas where Mom has difficulty with cognition: such as short-term memory. Today's session included working with calendars and dates. The therapist would point to significant dates on the calendar. Mom would later try to remember those dates, and why they were significant.

This has been the most fun day of Mom's entire recovery period. She is further along than she has ever been, and she greatly enjoyed all the visitors. Thank you, Nancy Beth and Todd, for scheduling a wedding.

Tiny Steps

forward in cognition. It's the right direction.

Abby + Progress

Flirting through Bossier City since 2005.

Progress! The shunt is working. Today, Mom recalls: where she is; where all her grandkids are; that Courtney attends Louisiana Tech, where: "The sign always said "Louisiana Polytechnic". Mom did not remember this info on Friday. It's obvious that excess cerebro-spinal fluid is draining out of her ventricles.

Mom started Physical Therapy today, which included a walk of about 50'. This means, if Mom received an accurate outlet pass, she could dribble from midcourt to the basket, then shoot a lay-up: if all opposition players suffered simultaneous catatonic episodes, and if Mom's teammates picked up her errant dribbles, and returned the ball to her. I doubt she would double-dribble, because:

1. She'd need to keep one hand on her walker, and
2. For gosh sakes - she knows the rules.

Where Are We?

--Drunk on anaesthesia. After hip surgery, it took maybe 6 days to become undrunk. It took maybe 10 days for most all effects of anaesthesia to dissipate.

--Excess cerebro-spinal fluid (hopefully) being shunted into stomach cavity. Vital signs are good. The way to know everything is good is for 1) Mom's cognition to return to where it was before, and 2) CAT scans to show reduced ventricle size.

--Hip replacement looks good. Mom still must be careful not to cross her legs, turn her left foot inwards, or (when sitting) raise her left knee towards her stomach and above a 90 degree angle. Otherwise, she could dislocate/mess up her new hip, and require a second hip surgery. This is worrisome to me. I keep a sponge wedge placed between her lower legs, to prevent crossover. The rehab nurses are much more relaxed than a wacked out family member. They keep a pillow between her legs - or not, saying "Oh, let her relax a while - she'll be okay."

--Ready to return to therapy on Monday, even though might still be somewhat anaesthesia hung-over.

--Mom is happy, vibrant, and alert. She has trouble concentrating on reading, writing, or doing artwork. She needs something to do with her hands. Doing something with her hands makes her happy. I will ask if we can give her knitting needles. Other suggestions are appreciated.

Annika

I take exception to previous characterizations about my fashion sense, and about the fashion sense of designers and photographers in my city, and in my state. The fashion community of Ogden, and of Utah in general, blends and matches colors with tasteful verve and whimsy. When you are operating on the hip edge of style, you cannot please everyone, and I/we do not expect to do so. But, I want this known: I am a good girl, and I luv my grandma.

Pump It Up

Toria Post created an artwork of a little girl, with the caption: "Pump it up."

Mom: They (Baylor Rehab people) confuse me. They tell me to be careful with my movements. Then they put up a sign saying "Pump it up."

Baylor Rehab, Room 209

Returned to same room at Baylor Rehab. Never had to remove crayoned pictures from the walls. Link for Directions. Mom is happy and alert.

Roberts Hospital; Room 1604

At Baylor Hospital complex. Link for Directions.

Update: Mom is no longer at Roberts Hospital.

Surgery Went Good

Mom is in recovery. Hooray!

VPS Surgery Scheduled

to start approx. 7:30 - 8:00 AM Thursday (tomorrow).

Ventricular Peritoneal Shunt (VPS)

(Bumped to top)

Since Thursday, Mom has experienced increasing cognition difficulty. This is likely due to hydro cephalus, which is a fancy name for having excess cerebro-spinal fluid in your ventricles. The fluid has possibly been accumulating since Mom's shunt was removed - approximately one month ago. She will have a VPS procedure this week, in hopes of curing the problem. Here's how it works:

A shunt will be inserted into her brain. The shunt will not be visible from outside her body. A tube will run from her shunt, through her body, and will empty excess cerebro spinal fluid into her Peritoneal Cavity (her stomach). Scroll to the middle of this web page for info and pictures about VPS.

Side effects include maybe a 25% chance the shunt will become plugged up and blocked. I assume, in that case, the shunt can be replaced. Blockage is more likely to occur in the initial weeks after VPS implantation. Sometimes, after a couple of years, during a routine examination, a shunt is found to be blocked. In this case, where the patient has shown no external symptoms of a problem, the patient's body will have been removing sufficient amounts of cerebro spinal fluid on it's own. This is another example of the body healing itself - on it's own schedule.Other side effects include about a 5% chance of infection, and about at 10% chance the shunt will cause further bleeding in the brain, i.e. subdural hematoma.

It's not a sure thing that her cognition problem is due to hydro cephalus. However, Doctors cannot find another problem. Doctors do believe they see increasing size in her ventricles, which would indicate accumulating cerebro spinal fluid. Hopefully, the shunt will reduce ventricle size, and return cognition to where it was before. I'll update, if and when the surgery occurs.

Workin It

Abby: Hi! Good to see you guys! Especially since I love everybody!

Annika: Hush it, toots. Let's be serious. How come we haven't appeared on Nancy Update in forever? And how'd those cats get bumped to the top two times? We are waay cuter than those cats. Was it affirmative action?

Kendyl and Shelby: We heard his computer was down, and he lost access to his picture files. Also, Nancy Update doesn't do affirmative action. Those cats must've been bumped to the top on merit. They were workin it. Look at us - this is how you work it! We are adorable!

Austin, Max, and Kacy: This is how you work it when you are kids from the Midwest - you do wholesome. We are so wholesome, we sweat whole milk! Also, animals help - woos the PETA crowd - and all the grandparents who love cute.

Annika: (grumble, grumble) You think that's workin it? I'll show you workin it... umph... puff... give me a minute...

Lindsey: Work it with a sexy vehicle. Readers love a hot woman posing with a sexy vehicle!

Jenny and Ling: We are adorable. No one can work it better than us. Your only hope of getting more pictures is affirmative action - oh, so sorry - Nancy Update doesn't do affirmative action. Ha ha ha ha ha ha ha! Cats rule! Jenny and Ling rule! We rule!

Annika: Ta da! THIS is workin it! All y'all can eat your hearts out. We're playin' Ogden Rules, suckahs. Y'all cain't hang in the Mormon hood! Shout out to mah homeys, an mah unc Aaron. AAAROONN!!

Lindsey: omg - you are mixing cool colors, with hot colors, with medium colors. That is so slut!

Smokie: Yes, I think that is slut. What about you, Sassy?
Sassy: Hmmm. Yes. Slut. I concur. Very definitely. Quite unfair to the rest of us.

Kendyl:
Shelby: We say slut! Totally. What are you people in Utah thinking?! That color mix is totally unacceptable.

Abby: Can't we all get along? I love everybody. Let's be... um... nice... - is that fruit on that bikini?

Slut.

Baylor's Colorful Rehab Lineup

From a web page for Baylor Institute of Rehabilitation:

Baylor Institute of Rehabilitation (BIR) has been named seven times in U.S. News and World Report as one of the top rehabilitation hospitals in the U.S. BIR's Traumatic Brain Injury program has earned the rare distinction of being one of 16 federally designated "model systems" of care, in the country, for the treatment of persons with brain injuries.

From a Web Page for the Traumatic Brain Injury Program Treatment:

Brain injuries and the disabilities they cause are extremely complex. Often, patients with seemingly similar injuries do not have the same level of disability. Therefore, each patient is provided with an individualized treatment plan, based on an evaluation performed by members of the interdisciplinary treatment team and the goals of the patient and family.
[...]
A variety of specialists comprise the treatment team. Each specialist brings to the team an expertise in a specific area of neurological rehabilitation, and the team is assembled based on each patient's individual needs and may consist of all or some of the following:

(From the same web page) Mom meets with all of the following types of rehab professionals:

Physiatrist
The physiatrist is a medical doctor who specializes in physical medicine and rehabilitation. The physiatrist manages the patient's medical needs, calling in appropriate physician specialists when necessary and leads the team in treatment planning to accomplish unified goals.

Neuropsychologist/Neuropsychology Therapist
The neuropsychologist is a PhD. level psychologist while the neuropsychology therapist is a Master's degree level psychologist with expertise in the area of brain/behavior relationships. Specialized testing is used to determine cognitive, intellectual and behavioral changes that may have resulted from the brain injury. The neuropsychologist/ neuropsychology therapist plays a critical role in planning cognitive rehabilitation activities with the treatment team members. They conduct preliminary testing for possible return to work or school and provide counseling and support for patients and family members.

Speech-Language Pathologist
These clinicians evaluate and treat difficulties in the areas of speech, language, thinking and swallowing. They coordinate each patient's treatment program to help ensure that cognitive and communication deficits are identified for maximizing participation in the program, so that patients have the opportunity for achieving outcome goals.

Occupational Therapist
This therapist's role is to assist in promoting independence and safety with activities of daily living through self-care skills and management of home activities. They evaluate the motor, sensory, visual, perceptual and cognitive deficits which may interfere with independent living skills. They assess and work to improve upper extremity (arm) weakness and spasticity, and evaluate the use of casting and splinting. The occupational therapist implements a treatment plan to teach self-care and activities of daily living. Adaptive devices may be recommended for the patient to achieve a greater level of independence in the home and community.

Physical Therapist
Physical therapy focuses on improving motor function, minimizing physical disabilities, and restoring normal movement patterns. The physical therapist assesses and treats the areas of strength, joint range of motion, balance, endurance, motor planning, gait, transfers and mobility. They will work to help the patient improve lower extremity (leg) weakness, muscle tone and spasticity.

Therapeutic Recreation Specialist
These clinicians evaluate past leisure pursuits and help develop skills necessary for successful return to an active and healthy lifestyle. They act as a resource to the patient and family in identifying activities within the community that the whole family can continue to participate in after discharge.

Clinical Nurse Coordinator
The clinical nurse coordinator coordinates with all the people involved in planning and implementing the patient's treatment program. The coordinator will help with issues related to financial resources and be the primary contact and source of information about the patient's progress achieved in the treatment program.

Social Worker
The social worker works with the family to address issues related to discharge planning. She provides the family with information on follow-up therapy providers and community resources and makes referrals for continued services upon discharge from the hospital.

Rehabilitation Nurse
The responsibilities and involvement of the rehabilitation nurse vary, depending on the stage of recovery and level of care required by the patient. The nurse will monitor the patient's medical condition, level of alertness, nutrition, bowel and bladder function, response to medications and vital signs. The nurse also provides patient/family education.

Rehabilitation Assistant (RA)
Like the nurse, the rehab assistant provides varying degrees of support based on the patient's level of independence. The RA's primary role is to assist the patient with self-care activities in the patient's room. As the patient progresses in the treatment program and becomes capable of performing these activities more independently, the rehab assistant provides less hands-on care.

Moved to Room 209

A private room, fit for a queen.

Directions to Baylor Rehab can be found here.

Swallowing = Good; Taste Buds = Discriminating

Mom eats 3 or 4 bites of each meal. She then pronounces the meal a distasteful mess, and does not eat more. She is skinny. I'm hoping exercise will increase her appetite. Doctors have threatened to resume feeding her through her still-in-place stomach tube. She says that is fine, adding defiantly:
"I'd rather you do that than force me to eat this food."

Mom can only eat soft food. I've brought in food from the outside, then mashed it up. She didn't like that,either. I brought in a milk shake. She didn't like that. Maybe her taste buds need an adjustment period. Or, maybe she's become a food snob late in life, and will only eat 5-star cuisine. Calling Grady Spears.

Rehabbing the Brain

One method is through the resumption of physical activity. Myriad parts of the brain are called to perform during physical activity.

Mom, for the first time ever, underwent a full day of therapy on Monday (3 hours minimum). She pronounced it a difficult day to get through, and had no trouble falling asleep.

Speech therapists ask questions which force patients to call upon different parts of the brain in order to answer. They zero in on the types of questions the patient has the most trouble answering. They put greater focus on those questions.

The brain will repair itself in many instances. When parts of the brain are called upon, the brain will create denser connectivity in those areas. Over time, the brain will adapt to what its user calls upon it to do. Through encouraging patients to use the damaged areas of their brains, speech therapists help patients create healing in their brains. It's just a theory, but everyone believes it works - including the ultimate skeptics: insurance companies.

Mom is quite good at listening to stories and recalling details. She is less good, but improving, at creating lists out of thin air, such as lists of animals, plants, trees, words that start with particular letters, etc. Speech therapists at Harris have already been working with Mom in this area. She has shown good improvement in the last 4 to 5 days.

Baylor Rehab Location

Find Us

Baylor Institute for Rehabilitation
3505 Gaston Ave.
Dallas, TX 75246
(214) 820-9300

Directions, parking information and phone numbers

Mom is in Room 209 (Room 209 is Mom's new location, as of Monday, June 12).

Baylor Institute for Rehabilitation is a free standing, 4 story building. It is located on the north side of Gaston Ave, and directly across Gaston Ave. from Wadley Towers.

Thanks to the lovely Kathy Helgason: bank officer extraordinaire,
at Comerica Bank.

Swallow Follow Up

It appears Mom's body healed itself. This was possibly due to finally having sufficient rest for her throat muscles, or due to some undetectable neurologic progress, or due to some combination of the two.

When Mom broke her hip, on May 28, all therapy designed to improve her swallowing stopped, and remained stopped right up to her second Barium swallow test, on approximately June 4. That swallow test revealed her to be swallowing everything perfectly. The doctor reading it said
"I don't know who had a bug up their behind about her swallowing, but she is fine."

Yet Mom had not been fine in her previous swallow tests. In addition, one speech therapist after another, upon examining Mom, had cluck clucked about her apparent swallowing problems, and about the likelihood of aspiration. In the one or two days before the second Barium swallow test, Mom's voice volume suddenly increased a good bit. I suspect this was an indication that the strength of her throat muscles had imperceptibly taken a step forward.

This is a micro example of the unknowableness, and the unpredictability, of Mom's recovery. Every brain patient recovers at their own rate. It's possible that different parts of the brain, and even different tiny bits of the brain, recover somewhat independently from each other. If neuro-surgeons understand it, they refuse to admit so. They refuse to predict the speed, or the eventual degree, of any recovery.

As a family member, or as a friend, we are left in a state of "not knowing." This is so frustrating. As humans, we want to know. We really, really want to know. Yet we are denied. Personally, I at least want to know odds of various recovery scenarios. I really, really want to know. Yet I am denied.

The only peace I can find is to look upon "not knowing" as a sign of God's all-knowingness, and as a reminder of my place in His universe. God knows and understands far beyond my capabilities. I can only look upon His creations with wonder. I can only look upon the human brain, and upon the body's ability to heal itself, with wonder. Some things cannot be understood. They are wonders.

Guest blogger Bradley for a PC detached Greg:

Mom has been at Harris Hospital in Ft. Worth for the last several days, recovering from her hip surgery. She has recovered very well, even walking on it, and they are confident she can move out of Harris Hospital to refocus on her neurological rehabilitation.

Baylor Rehabilitation Center in Dallas has won the battle for Mom's business. We are told by the healthcare professionals that it is considered the best neurological rehabilitation center in North Texas. The location is next to Baylor Hospital, but I don't have an address. She is to be moved tomorrow morning, Friday, June 9. We anticipate she will be there for a few weeks.

Less Drunk on Anaesthesia

And more ready for visitors. Mom may be leaving Harris in a couple of days, for a not-yet-determined destination. If you've been thinking of visiting, there may be no time like the present.

Swallowing: Good News

Early results from a barium swallow test show that Mom is swallowing liquid into her stomach, and not into her lungs. Therefore, her Doctor has ordered a simple diet for her, which she can ingest by mouth. !! This is very big news indeed, as Mom was a serious candidate to have a stomach tube for life. This has all happened within the last two hours. This info comes second hand, from Dad. I will try to find more detail, and first hand detail, for a future update.

Hip Recovery More Complicated Than I Thought

Update Note: My previous understanding of "6 months" was likely incorrect. Mom goes back to the hip surgeon approx. 8 weeks after her surgery. Some movement restrictions may be eliminated at that time.

The recovery from the broken hip will be more complicated than I thought on Tuesday. For six months, Mom must not rotate her left foot inwards, or she runs a real risk of dislodging, or otherwise messing up, her new hip socket. For six months, Mom must not raise her left knee at more than a ninety degree angle - as you might do if you were raising your knee to your chest, or she runs a real risk of damaging her new hip socket. There's something else to be wary of, but I cannot remember it at this time. And I'm neither on anaesthesia, nor narcotics!

Not Returning to Harris Rehab

Harris Rehabilitation says they do not have the capability to do the intensive neurologic therapy Mom needs, and they will not be taking her back.

Only two local facilities are capable of providing what Mom needs: Baylor in Dallas, and HealthSouth. As of now, the leading contender for the honor of treating Mom is Baylor. I've spoken to four medical professionals I trust, and they all say Baylor provides the best neuro rehabilitation in this area.

Still Drunk on Anaesthesia

Mom's surgery was Tuesday afternoon, and today she is still drunk, on some combination of lingering anaesthesia + current narcotics. Older patients have a harder time recovering from anaesthetic. Mom is saying plenty of cute/funny things. From Bruce:

[Mom asked] about clothes for Baron..after I told her she couldn't leave the hospital, she asked the nurse, "I have vacation time, I can leave and take my grandson shopping tomorrow, can't I?"

Last night, Mom asked for the phone.
Me: Who do you want to call?
Mom: Margaret.
Me: (laughing) Well, you don't need a phone to call her. She is dead.
Mom: (instantly distraught) Wha? You tell me she is dead, and you are laughing?!
Me: Mom, she's been dead for 10 years.
Mom: Well, I never. I don't know what's wrong with me sometimes.
(Note to self: next time, MaMa's on the roof, and we can't get her down.)