Sunday, April 30, 2006
Tube Out! Vital Signs Stable!
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
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
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.
Saturday, April 29, 2006
No News - Day 4
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 :)
Friday, April 28, 2006
A Lack of News Might Be Good News - Day 3
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...
Lindsey is steering the vehicle!
Thursday, April 27, 2006
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)
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.
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.
Wednesday, April 26, 2006
No News is Good News: Day 2
Tuesday, April 25, 2006
A Lack of News Might Be Good News
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.
Monday, April 24, 2006
One Ginormous Step Forward; One Shuffle to the Side
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!
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.
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.
Sunday, April 23, 2006
Responding to More Verbal Commands
- 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
Responding to Verbal Commands
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 the head is a marker which Doctors and Nurses have been watching for.
Saturday, April 22, 2006
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.
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.