Mike Day 20 Moving Forward: Medical Updates

June 16, 2011

Family, Health, Mike

Yesterday I met with the various therapies working with Mike.  PT tells me he is pretty high functioning actually, in the physical department.  And they tested his balance and he passed the balance test with flying colors…which surprised them because in the gym he is oblivious to what is around him which makes it throw off his balance when he encounters obstacles which makes it look like he needs increased balance.  Sigh.  The cognitive issues that remain before they can take him further physically are things like attention, focus etc.  Frankly, I fear those may be permanent souvenirs of Mike’s venture through the cardiac arrest/stroke maze.  Aspects of his intellect that my never return regardless of the amount of cognitive or speech therapy he receives.  OT tells me he seems to lack motor planning capabilities…and speech tells me his diagnosis is mild receptive aphasia, expressive aphasia, and, of course, lest we forget, he doesn’t use his voice above a whisper.  With no real reason for that.  The current plan is for him to start receiving speech at least one more time a week starting Friday…we hope.  And PT, rather than discharging him Tuesday, wanted to know if it would be possible for me to spend 2 weeks of therapy sessions with him to learn his PT routines.  I don’t quite know what this will accomplish…teaching me to help him with it at home?  Getting me to see what they go through?  I know what they go through.  For the most part, I do at home.  Redirection is a biggie.  Seems like maybe they want to multi-task through multiple patients simultaneously and he still requires too much one on one handling.  I don’t know.  I’m disenchanted with all things medical any more.  To me it seems medical science hit this high in what it is they can achieve, they’ve plateaued…and now the associated, peripheral medical folk who must sustain the high achievements of science are petering out and the trend is on a steep decline.  Doesn’t seem they are able to sustain it entirely.    Well, progress and research and discovery is great…as long as the ancillary systems can keep up.  Not sure actually that is happening in every case.  

Anyway, as we drove home from therapy, we were on MacArthur Road where all the shopping is…a road we’ve driven on a gazillion times.  Mike has not recognized where we are when we are on it.  Until yesterday.  He looked up, looked around and incredulously said, “Hey!  This is Lehigh!”  I asked if he recognized where he was and he excitedly told me yes.  It WAS Lehigh County…and we were directly in front of the Lehigh Valley Mall.  He has started to remember the dogs names and can differentiate which is which.  I who had such faith and never gave up believing when Mike faced down death three times is not about to be discouraged now.  Getting back this intellect, whatever of it we can retrieve, is nothing compared to what he’s already faced. 

Last night Mike was trying to move around in bed and get himself in a position that he wanted to be in to watch TV.  The floundering around he was doing was totally unnecessary…but he seemed unable to do the necessary motor planning to make it an elegant move from one side of the bed to the other.  I was across the room on a chair, tapping away on the keyboard as usual.  I heard him call (whisper) my name.  I looked up and he was hanging backwards, partially off the bed.  He needed me to “pull his legs” to pull him back on the bed.  I looked down at his spindly little calves and thought…uuuuuhhhhh no.  I hollered for Mikey who came down, re-situated him and tried to talk to him.  When the talking didn’t go so well because Mike was insistent on whatever misguided approach he was on, Mikey informed him he was “rolling around like a turtle on its shell.  You’ve got the remote.  Why are you watching National Geographic.  The Phillies are playing.  Let’s find it.  Now roll on your side.”  When Mike declined to roll on his side, his son informed him he’d fix that since he was tired of arguing.  He said “”I’m putting the TV back facing straight ahead so if you want to see it you’ll need to lay on your side.  I’ve had enough arguing with you about this.  Back went the TV and poof…over on his side went Mike.  Unfortunately he had a moment of anger and lashing out…I asked if he was angry and he said yes, I asked at what and he told me “the whole damn situation.”  He settled…but had tears in his eyes.  I held him and told him it would be OK, that I loved him more than anything and he settled in to watch the game.  More and more he seems to realize his status is altered and how, he is more aware of what’s around him.  I think there is some cognition returning…but it is pretty spotty.   When he got up to go to the bathroom I slid into bed on the new “my side” and asked him to do me a favor and sleep on the other side.  Amenably, he crawled in and  covered up.  He turned to look at me and with that same old boyish Mike grin he asked, “So does this mean you’ve decided to sleep on that side from now on?”  YESSSS!

This morning I awoke to him balling up his top sheet.  I asked if he was wet and he said yes.  I asked if he was sleeping so soundly he didn’t get up to pee and again he said yes.  (If the tradeoff for sleeping soundly is wet sheets, I’ll take wet sheets and a well rested hubby any day!)   Unfortunately, when I got up to help him I discovered the diaper had been pulled apart into a million little gelled wet puffs.  Ugh.  The Lord gave me patience on this morning.  We got it cleaned up and the bed changed and had a long discussion about strategies he could use henceforth if he wakes up wet.  We also talked of his frustration since he looked saddened by all of this again.  We had a long talk about his cardiac arrest, the subsequent hypo-volemic shock and associated stroke.  The damage to his brain, how it rewires, whether or not it can rewire and the latest in medical science’s thinking on the subject.  He drank it all in.  He understood…and it was a long complex discussion.  But he got it.  He wants to work toward healing.  He knows he needs to be patient too.  He also heard again…how very much I love him, no matter what of his former functions return or don’t return.  I’ve tried to put myself in his shoes…knowing I was different than before, unhappy about it and frustrated, wondering if the people around me would stick by me if the going is tough.  I feel frightened and assume he must feel the same.  Well Mike baby, we’re stuck together like glue.  LOL   

We also visited the wound care center yesterday.  My imagination was not playing tricks on me…the bedsore was three millimeters shorter in length, a few in width and a whopping four or five in depth.  The area of undermining or tunneling was a whopping 5 millimeters smaller.  However,  the speed with which that is closing is outpaced by how quickly the wound itself is closing.  And they can’t let the wound itself close without that undermined area closing first.  Thus, next appointment, in two weeks, Mike will see one of the plastics surgeons that runs the wound care center for evaluation of this undermined area.  He’ll be deciding if they should surgically open the area above the undermining and increasing the overall size of the wound temporarily to allow that area underneath to close.  My mind is racing with all the issues…the whole anesthesia issue…can he withstand anesthesia?  Is it necessary?  Will he be able to sit and walk around afterwards or am I going to be faced with a bedridden Mike for a period and the possibility of some loss of physical/motor gain he has achieved?  What about infection and the MRSA he’s colonized with?  So now will it be even longer to achieve healing and is there any possibility it won’t heal?   I’m feeling kind of overwhelmed by this whole bedsore thing…like we moved forward ten steps with it over a month and now we’re talking about going backward several to begin again.  I wonder when it will end.  On a happier note, all of Mike’s blood work was back and I got copies of the results.  His hemoglobin…which was 9 when discharged…is up to 13.4.  That’s just .4 away from the bottom end of normal and way better than the 7 it was for over a month till they discovered the retro bleed.  His albumin and pre-albumin were great…so we’re doing fine in the protein department for healing.  His cholesterol numbers are improving.  The bad cholesterol up a bit but way below the numbers they look for.   His good cholesterol up from 19 to 38.  Respectable improvement…and so I expect he would no longer be considered malnourished by the cardiologist.  I think the cardiologist would figure Mel and I are feeding him mighty fine.  His total cholesterol looks like 103…up from 77.  I know they want it 70…but they didn’t want to fuss over that until his nutrition improved so I expect that about the time he goes off Amiodorone he’ll get an increase in his statin dose…or a change to a different statin that doesn’t have the Amiodorone interaction that Zocor does.  The higher dose of statin, the way we are feeding him, will definitely keep his cholesterol down.  All his kidney and liver functions looked good.  His fasting glucose was 95…and I’ve worried about that since the arrest.  Subsequent to that and during his illness afterward his blood chemistry was totally out of whack.  Though his sugar was never a problem prior to the arrest, he required regular insulin coverage in the hospitals.  He hasn’t had it since he went to the rehab hospital.  95 is in normal limits…though at the upper end where over 99 is considered diabetes in a fasting blood sugar.  He’s lost a lot of weight, he’s getting reasonably exercise.  He’s getting NO simple carbs.  I think his sugar should be lower.  His TSH test (thyroid) was also 3.04.  That’s getting up to the higher end of normal.  My sister-in-laws endocrinologist would only accept a 1.35 as normal…anything above required thyroid meds.  This, because Mel’s cholesterol was high without reason.  Seems hypo-thyroid may run in his family since his mom ALSO had it.  I’m thinking maybe a little visit to an endocrinologist might be in order.  I’m going to watch his blood work in a month when he has new bloodwork for the cardiologist…and then I’ll decide.  Meanwhile, all the rest of the bloodwork was just great.  

This morning Mike’s looking sad…and he says it’s because he wasn’t able to help me.  He is remembering things.  Short term memory may be increasing somewhat in some areas.  I hate to see him sad and once again reassured him. I’ve noticed that his personality has changed since his arrest.  The areas that he retained are all of his most charming and endearing areas.  The areas that are different changed for the better.  Melanie, his sister, agrees and noticed the same.  Since Mike was a really endearing fellow before, he a big lump of love now.  The sweetest guy in the world if you ask me.  I remember my first posts about his illness…the 55 minute journey to find my husband posts.  I think the journey is a lot longer than 55 minutes.  I think we’re still on it.  And in the meantime, perhaps I’ll find myself too. 

 

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