Some more slow progress

My Dad removed his own tracheostomy the other night (ouch!) and the doctors decided to leave it out at this point. He is breathing, eating and speaking pretty well now on his own so there isn't any real reason to leave it in. Thank goodness because that's one less thing for him to tug and yank at.
He seems to be doing well when he receives his pain meds at regular intervals. When they're late however, things get rough. He becomes increasingly agitated and angry, sometimes even violent. He isn't comfortable or happy with his current living quarters and wants to go home. He still doesn't really grasp what's going on around him and why he can't go home. Unfortunately, it isn't likely that he'll be able to go home until he has a better cognative ability to grasp his situation. At this time, he's still very baffled and speaks nonsense most of the time.
On that note, I know many of you would like to call him and wish him a speedy recovery. Since he doesn't have the mental awareness to carry on any sort of conversation in person, much less over the phone, they don't have a telephone connected in his room. If they did, it would only sit there and ring, he would realize that it his phone ringing. In addition, unfortunately it is unlikely that he'd even know who he's speaking to. He really only seems to recognize his family at this point and sometimes still confuses Linda and my mom even though my mom hasn't visited him yet. He will even refer to me as though I'm not there when he is speaking directly to him.
I will make sure that I post as soon as he is mentally able to have visitors outside of his family. It may not be until he is at home.
Our pending family/physician meeting has been delayed for another couple of weeks because they feel that it is still too early to give us any real answers. So, for the time being, we continue to carry on business as usual and take turns sitting at his bedside and helping him sift through the madness.

A Long Over Due Update

I haven't seen my Dad for the past week, so I haven't had a lot to post about. I probably should have told you all that he was finally transferred to an acute rehab facility on Tuesday evening. They have spent the last several days evaluating his mental capacity and condition and will be determining a plan of treatment early next week.
Linda is working on scheduling a family meeting with his physicians there for mid next week. At this meeting, they should be able to prepare us for what to expect over the next several weeks as well as answer any questions that we all may have for them. We have been told that we can expect as long as two years before his brain heals from the trauma.
He has been having many types of therapy. Speach, physical and occupational from my understanding. Initially, his pain medication wasn't actually helping to relieve much of his pain, however they have now doubled his dose. The medication that they are giving him for pain is Oxycodone.
He is able to eat solid food that has been chopped finely, similar to my one year old daughter. His dinner tonight consisted of mashed potatos, chopped up green beans and a pile of ground beef. Mmmmmmmmmmmmmm. Then some applesauce for desert and 'nector' to drink. The nector is a juice, but it's thickened with electrolytes. He ate about 1/2-2/3 of his dinner, although he gave my Grandmother and myself quite a lot of crap about it. He kept wanting to leave, and we kept telling him we couldn't leave until after he finished his food. We knew he had had enough when he started spitting his applesauce back at us.
He has this tent like apparatus over his bed that they keep closed when he doesn't have visitors or caregivers in his room. This prevents him from getting out of bed on his own, or trying to get out of bed and actually falling out. He tell him that they knows he likes to camp, so he got a special tent bed. It may seem silly, but I think it helps him justify why he is in there and why he can't get out so easily.
Here is a picture:

The thing his leg is resting in is a CPM machine. CPM stands for Continuous Passive Motion, and it bends his knee in order to keep his joints from stiffening up, without him having to use his muscles to do so. It has a faux sheep skin lining and he was sure that he had a cat laying on his leg. He wanted to kick it off and go lock it in the car.
He is still very confused. He was talking a lot about going up to the "Res" which we believe meant the Reservation. He was talking about the Lakota Souix and peyote ceremonies. He said he'd been a member of the church since 1972 and that my Grandfather and I were also practicing. I have no idea what he is talking about, maybe some of you do. He also thought that my Mom, Theresa, and Linda were there and would talk to them from time to time, although neither of them were there at the time.
He did laugh when I told him about the dude with the super mullet outside the window of his room. He couldn't see him, but he laughed when I told him about the guy.
The Rehabilitation Therapy Doctor has told us to expect him to be an inpatient there for 3-4 weeks at this point and then he can be changed to an outpatient. I guess it all depends on the workers comp insurance and his condition.
Your continued prayers are much appreciated. Those of you who have sent cards, thank you. My Grandmother takes them in and reads them to him and he has expressed a desire to respond to all of them. So, on his behalf, he is thanking everybody for their prayers and loving support and the kind words that you have all spoken and writted to him and also to us.
Tomorrow we celebrate my youngest daughters first birthday. It will be another bittersweet day for us. I know that when my Dad is coherent enough to understand that he wasn't able to be there for that, it will break his heart. He loves his Grandchildren so much and I know that he'll be sad to know that he wasn't able to be there on her first birthday like he was for the others. We are just grateful that he will be able to be here to celebrate future birthdays.

July 18th

I made it in for a short visit yesterday and found out that my Dad had moved rooms because of staffing reasons and his need for a 1:1 ratio. When they finally buzzed Ted and I through and we went looking for him in his room, all of the nurses called to us at the nurses station because, there he was! Sitting up in a modified bed/chair thing right there at the nurses station with his foot up on the desk!
We were so excited to see him up and about. He was there keeping them all company and entertaining the crowd. He seemed very happy to see us. After some small talk, his back started to really bother him so he decided it was time to get back in bed.
Once they helped him back into bed, we were allowed in to see him for a short time before he fell asleep. He was exhausted from being up and interacting so much, but hopefully the change of scenery helped him out a little bit. He keeps trying to get out of bed and saying "Let's go, let's get out of here", so hopefully it felt like he had a chance to go and get out a little bit.
At this point, his confusion is primarily due to his brain damage. He is hardly on any medications anymore. He has been on a diet consisting of pureed food the consistancy of honey. He seems to be doing well with that and even was encouraged to feed himself with a spoon that had a special attachment to help him grip it better. He was able to successfully feed himself for a short time before he got tired and had to be fed the remainder of his meal.
He still has the PEG tube in that is feeding him through his stomach as well. I am not sure when they intend to remove that, but it is likely not going to be until he is able to eat more solid foods on his own.
I am going to post a picture of him with Ted and I from yesterday that his nurse took for us. I have not posted pictures before this due to my concern for his privacy and the possibility that he may not want people to see him in his condition.
The reason I have decided to post this picture is because he is looking so much better. He was up and alert and smiling and this is the first time that I've seen him so with us. I also want everybody who has been following so closely to be able to see for themselves some of his facial damage. It looks 150% better than it has looked over the past few weeks even though there is quite a bit of drooping on his left side. He will have to undergo more surgeries to position his eye back up where it belongs and hopefully diminish some of the scarring as well.

Friday, July 16th

My Dad's recovery is like that old song... "Slow and steady, steady and slow, that's the way we always go". It's maddening. But, as I've said before, at least he is progressing.
He is still at RCH awaiting transfer to acute rehab due to some lag in final paperwork/insurance red tape, etc. I think we are somewhat anxious for his transfer because as of right now, there isn't much more they can do for him in the hospital. He needs acute rehab in order to really start gaining back so much of what he's lost.
I did get to speak to him over the phone today. That was nice. He was carrying on good conversation and following the topics pretty well. Then I put him on the phone with my two oldest daughters so that they could say hi and he could hear their voices. They miss their Grandpa so much and they are anxious for the day to come when he can sit and read books with them, or take them out in the back crime and go rock hunting again. They decided to sing him a song, so they sang 'Itsy Bitsy Spider' and my Dad chimed in to sing along. Just recalling it puts a smile on my face.
He also got to speak with Josh for a bit as well. Josh was so pleased to find Dad so coherent. He was not expecting him to be able to carry on a sensible conversation at this point so I think that helped make his day.

Tuesday, July 13th... Hard evening for us

Tonight was a little bit bittersweet. We celebrated Cody's (my daughter, Dave's Grandaughter) 3rd birthday this evening with my Grandparents and Linda. I'm sure that I'm not the only one who missed my Dad's presence there. Ted and my Grandpa watched the all star game, and I k ow my dad would have been right there with them.
Cody got a big bouncy ball and her first big girl bicycle tonight. She rode her first bike along the same stretch that I learned to ride my first bicycle on. No doubt, the same stretch of sidewalk that my Dad learned to ride his bicycle on as well.
I haven't been able to go and see my Dad since my last posts over the weekend and I miss him. My Grandparents and Linda say that not much has changed since then. He is still making progress, it's just very slow.
He was evaluated by two different intensive rehab centers today and yesterday. Tomorrow, Linda and my Grandparents will visit both of them in person to tour the facilities. He may be transferred to the facility that they choose as early as Friday.
It is likely that once he's transferred, visiting hours will be very limited because he will be in some extensive rehab and therapy sessions for the better part of the day.
From my understanding, he's still very confused. He doesn't remember from day to day what has happened to him or where he is. Sometimes he is in Germany or the coast of Scotland, other days he is at the alpha beta on California. That alpha beta closed down about 20 years ago. He also sees his old best friend who died 20 years ago from liver disease.
He knows who people are and what they're relationship to him is, but he doesn't seem to really know where everything belongs in relation to time and everyday occurrences.
I really miss him and I still have very high hopes for his recovery. I'm terrified that this mental confusion could be permanent but I continue to pray that he will return to us whole and the same as he was before.

Speech Therapy Update

I didn't get a chance to update last night after my Dad had his speech therapy session. Actually, the therapist wasn't planning on returning because she had gotten so busy, but the nurse paged her because we wanted to have her at least put in the passy muir valve, which amplifies his voice and allows us to hear him speak.
She came in, and as soon as she put the valve in and asked him a question, he was very responsive. He answered really well and enthusiastically. He is still on some pretty dopey medications and the part of his brain that's damaged is the part that controls his inhibitions, so it was a little like talking to somebody who had been drinking...a lot. But, it was soooooo good to hear his voice.
The therapist was so impressed with his willingness to interact with us that she decided to give him some ice to see how he'd do with swallowing. He did so well chewing and swallowing the ice, that she decided to try actual food. He had a choice between..jello, applesauce, or (drumroll please) chocolate pudding. Naturally, the choice was chocolate pudding. I helped him make the decision, mostly because I know he's not a big fan of jello since he sees so much of it at work. :)
He did remarkably well with the pudding also. He was able to have about four bites of pudding. Considering that he hasn't eaten in three weeks, that was really impressive. He thought it was the most amazing thing he'd ever eaten, next to the ice that he had eaten a few minutes before.
Keep up the prayers, they are working. The doctors and nurses have high hopes for his progress because he's been so agitated and aggressive. They say when a patient is a fighter, they heal faster than the patients that just sit there quietly and obediently. Anybody who knows my Dad, knows that obedient and quiet are not words that describe him.

Day 21...He's much more awake today

I am here with my Dad and he's very awake today. He has been answering questions by nodding his head or shaking it and he is also mouthing words and occasionally can make some sounds through his trach. I believe later that his speech therapist will be showing Linda how to deflate the trach and add a valve that will allow him to speak as he needs to.
He didn't remember Josh being here, but I was able to call him and put him on speaker phone so that he could speak to him and my Dad could hear him. I could tell that he was very happy to hear Josh's voice. He tried to speak to him, but mostly I had to translate to Josh what he was mouthing. He did make a cheer in the air with his right arm when Josh said he would be coming back soon to see him.
His face is healing more and more each day. He kept trying to feel his scars and wounds on his face, he seemed curious about the damage. I asked him if he'd like to see a mirror and he nodded. So, I told him that I would bring one in next time I came. He nodded again in agreement.
He laughed at a few jokes too. He laughed when I said that my husband calls me bossy and he laughed at a couple of lame jokes or comments that I made.
It feels soooo good to have him coming back to us. Today I really feel like he's coming around. His body has been healing well, but we have still been left with the question of his mind and where his brain damage would leave him.
While he still forgets where he is and why he's here, he recognizes all of us and knows who we are to him. I know that his memory will be patchy for awhile, as that is common with head injuries. My Mother had an accident nearly fifteen years ago and head some brain damage. It took her about three years to get back a lot of the things that she lost, but she did eventually get everything back. She still forgets things from time to time, or thinks that things happened differently than they did in the past, but that could be an age thing too.. (no offense, Mom). It's nice to know that my Dad still possesses his sense of humor and his love for his family. The rest is gravy.
Speaking of gravy, he did ask me for something to eat. He brought his hand to his mouth and made eating gestures. I asked him if he was hungry and he nodded yes. I explained to him that he was being fed through the PEG tube but told him that I was sure he'd much rather have a cheeseburger or a burrito, and he gave me a big nod to that one.
The best part of my visit,has without a doubt, been when he pulls my hand to his mouth and kisses it. The first time he did it, I thought he might try to bite me. But, then I saw him pucker his lips to give me a kiss and I willingly gave him my hand. He also reached up to me and my Grandmother and held his hand against our faces and patted gently. I think I can speak for both of us when I say that it was very rewarding to finally have him acknowledge us and show a gesture of love.
Linda and I are now waiting for his speech and occupational therapy sessions. I really look forward to that because I am the only one who hasn't had the chance to actually hear him speak through the valve when he has therapy. I will update again after he has his therapy.

July 8th

I received an email today from one of my Dad's Union colleagues with a link to the Healing Drum Ceremony on YouTube. I've embedded it here on the blog so that you can see it if you'd like. You may notice that my brother and I were absent at the ceremony. We had decided to go up to my Dad's room and spend some time with him while it was going on.
Things are still progressing slowly, but at least they are progressing. His Orthopedic Surgeon has ordered physical therapy for him, so that will more than likely begin tomorrow. My Grandmother was told that they planned to get him up and sitting in a chair tomorrow. We're not too sure how they plan to go about it, but that's their goal. I also spoke with Linda, and they told her that they'd like to get him to 'toe stand' tomorrow. I believe that may mean standing with his weight on his right leg and just using his left toes to balance.
His speech therapy session went well today from what I was told. He did well with the newer voice valve, it was much easier to understand him. He was asked several questions and was able to give the correct responses and answer if he was in pain or not.
He has been assigned a 'babysitter' in the form of a CNA (Certified Nurses Assistant). Her job is to basically sit in his room with him and make sure that he doesn't try to get out of bed or get too agitated since his nurse is assigned another patient besides him, plus at some point, they have to use the restroom and go to lunch. Interestingly enough, his CNA happens to be an extended family member of sorts.
We have been pretty lucky with regards to his caregivers. Most of them know him in some capacity outside of being a patient at the hospital. He has worked with many of them, from his nurses, to respiratory therapists, all the way to some of his doctors and speech therapists.
Early next week, he will be evaluated by three different Therapy facilities for transfer. His doctors would like to be able to transfer him into a rehab facility as soon as late next week. In order to do so, he will have to withstand three hours of therapy first. We aren't sure if that means three hours at a time or just three hours intermittently throughout the day.
His medications are being limited in order to get him fully awake, but his disorientation and agitation gets pretty bad, so ultimately, they end up medicating him again to keep him calm. I guess they are trying to find a happy medium so that we can get him up and going, but keep him comfortable also.

Day 18, July 7th

My Dad is pretty sedated today. They removed his NG tube that went from his nose, down his esophagus and into his stomach for feeding purposes and placed a PEG tube in through his stomach. Here is some information on what a PEG tube is:
Percutaneous endoscopic gastrostomy tubes (PEG tube)
A percutaneous endoscopic gastrostomy tube (PEG tube) goes into your stomach through an opening made on the outside of your abdomen. This procudure is done under sedation. To put a PEG tube in you have an endoscopy. This means the doctor puts a tube with a camera on the end through your mouth, down your food pipe and into your stomach. They can then see where to place the PEG tube, which is put in through the skin of your abdomen. This type of tube is used for people who have long term problems with eating and swallowing. The feeds usually run for most of the day through a pump, with a break of a few hours to give the stomach a rest. But sometimes feeds can go in over 24 hours at a low rate. If you are having feeds at home, your dietician will guide you about how much feed you need and the timings.
He had to be sedated for the PEG tube so he's been really groggy all day. The advantage to the PEG tube is that it is much more comfortable than the NG tube. They had sutured his NG tube into his nose and he kept trying to pull it out, so you can imagine that it was pretty uncomfortable for him.
I'm not sure how his speech therapy session went, but I will try to get details and post about it.

Day 17...update...Today Was a Good Day

So, surgery went well. They didn't end up taking skin grafts to close the wounds on his leg. The plastic surgeon was able to repair them with "extensive suturing". I'm not even sure that he had to go under anesthesia for it.
When I got back after his surgery, he was no longer on the CPAP or Ventilator. He was breathing on his own with only oxygen streaming to him. His breathing was much calmer than it had been the last time. Before, he seemed to be struggling to breathe on his own. Today, he had a more normal respiratory rate.
He was able to wake up somewhat while I was there. I had really been hoping that I could see him awake and I wasn't dissapointed. He repeatedly attempted to 'get out of bed'. At least that's what it seemed like he was trying to do. He did open his good eye and look directly at me. He seemed somewhat scared and confused, like he didn't understand quite what was going on.
My Grandmother and I explained to him again that he had an accident and had several broken bones, but that he was going to be o.k. He tried to talk, but we still can't hear him because of his tracheostomy. We are hoping that he will be able to stay off of the ventilator so that they can add the part to his trach that will allow him to speak through it. At this point, it is very hard to determine how much he knows or remembers about what is going on because he can't speak to us.
For the most part, today was a pretty good day for him. He had the c-spine collar removed, avoided a skin graft with extensive suturing, and got off the ventilator. All positive steps in the right direction, steps toward recovery.

Day 17, another surgery

Updates have been less frequent because his progress has slowed somewhat. Day by day, he looks a little better, gets a few sutures and staples removed and is able to wake up from time to time. He is reminded daily of where he is and why he is there.
Today, he is on CPAP, which is a slightly less intrusive version of the ventilator. It allows him to initiate breaths on his own, but assists him and provides a higher level of O2. According to the Pulmonologists orders, they plan to see how he does on that for a couple of hours and then draw blood gasses to see how his body is responding. He will remain on the ventilator through surgery, however, if his gases come back well, then they will eventually disconnect it.
He is scheduled to have his skin graft surgery today at noon. They plan to 'steal some skin' from somewhere on his left leg to use in closing the remaining open wounds left from his femur fracture. It is a fairly simple procedure and shouldn't take too long.
His blood pressure is pretty low today without any BP meds. His nurse said that some of the other medications that he is on could be causing it to be so low and because of the reading, he won't be getting any BP meds at this time.
He looks more like himself today than he has throughout this entire ordeal. They took his C-Spine collar off today and he's had a recent shave. His left ear has healed pretty nicely. You can hardly notice the part that's missing at first glance. The plastic surgeon did a remarkable job on his face, and his scars aren't nearly as bad as we had expected them to be.
He still has a huge goose egg on his forehead, but it's a little less prominent now. Most of the swelling has gone down. The only realy swelling that I can notice is in his left leg. It is still about twice it's normal size. He briefly peeped his right eye open when the respiratory therapist was giving him a breathing treatment. I also got to see him smile a little in his sleep.
Overall, he is making progress, even if it seems to be slow. He sustained so many horrible injuries, it's unrealistic for me to expect that he could be awake and aware and able to fully communicate by now. I know it's wishful thinking on my part and he needs to heal at his own pace. I'm sure I'm not alone in feeling this way and I know that we'll all sleep a little better once he is out of the ICU.

Blood Drive Still Going..code to give lifestream

Lifestream is still accepting donations in my Dad's name and will continue as long as he is hospitalized. I copied addresses and phone numbers to the Southern California Donation Centers in an ealier post.
When you go to donate, give them the code: REPLVAD3
This will ensure that he gets credits for the units that are donated in his name.
Thank you all for your donations.

July 4th

He has been switched from Ativan to Xanax for anxiety. He's still on the Ventilatory, but his peep is at 4.7 which is good. We don't know exactly what that means, but we've been told that anything above 5 isn't good. His chest tube was removed yesterday, so that means that they don't believe his lung is in danger of collapsing again at this point.
He is still heavily sedated, so he hasn't been able to fully wake up yet. His Neurologist would like the sedation stopped so that he can fully assess the damage to his brain, but his Trauma Surgeon has ordered it to continue. Once again, as much as we'd all like him to be awake and responsive, if he would be in pain, we all agree that it's better that he sleep and get as much rest as possible while his body heals.
I am sad that my Dad will miss July 4th this year. I have fond memories of our Independance Day celebrations in the past. My Dad has always been a fan of M80's. We have never blown up a toilet together, (I wouldn't doubt he has on his own at some point in his youth), but we've blown many tuna cans sky high with them.
I'll leave you all with that, hopefully it puts a smile on your face. It does mine.

Not too many changes

For those who are keeping track on a daily basis, There hasn't been much change in his condition over the past couple of days. They have had him on Ativan which is a tranquilizer, so he really hasn't had too many conscious moments.
He's still on the ventilator and it seems like he probably will be until the other pulmonologist takes over next week, maybe tomorrow. His peep level was a 5 yesterday, which is really good. They told me that he would more than likely be on the ventilator until he was at a 5 or lower for awhile.
It seems like things have stalled a little as far as progress, but I suppose that's somewhat normal. I've been warned that it could be that way by a friend who's Father had similar injuries.
At least all of the rest will help him heal faster. It's astonishing to me that it has already been 2 weeks since his accident. The days are all blurring together.

Some more good news

My Dad had a CAT Scan tonight to see how the bleeding on his brain was. The results were good, so he got to have the Intracranial Pressure Monitor removed tonight. For those that don't know what that is, it was this strange probe thing that was inserted into the top of his skull. It stuck straight up and had a wire attached to it that led to the machine that would show the pressure. It was bizzare.
The Speech Therapist said that once he had that removed, she would be able to use a different type of voice box on his tracheostomy so that we could hear him more clearly when he tries to talk.
Next big step I think, is to get him off the ventilator asap, so long as he can breathe on his own. He did several days ago, but the Pulmonologist on his case this week is pretty conservative and wanted to put him back on it. I am hopeful that he will be able to be off of it within the next day or two.
Another big step would be for him to be able to open his eyes. He is able to follow simple commands and speak from time to time, but try as he might, he can't get that darn eye open.

Information about the infection that Dave has...

I asked if they knew what type of infection my Dad has the other day, and I was told it was acinetobacter. I, being the curious person that I am, had to come home and google it of course, and here is the article I found by the CDC.
(you may have to copy and paste it into your url bar)

http://www.cdc.gov/ncidod/dhqp/ar_acinetobacter.html

I suppose it's fairly common, however, I don't like the part where it says "Acinetobacter causes a variety of diseases, ranging from pneumonia to serious blood or wound infections and the symptoms vary depending on the disease."
He has been doing so well and I think it would be a real bummer if this infection turns into more than a mild fever and cough. I guess that the good news was that his fever was down a little bit yesterday.
Let's all just keep praying that he continues to recover without his infection getting worse.