Wednesday Update

Barb and I got to the rehab centre around 9 this morning. Dad was being evaluated by a speech therapist, who identifies any issues with eating and swallowing. Dad does have a little difficulty still, so he is on a chopped food diet for now, and an eating assistant will be with him for meals to prompt him, or help with feeding and drinking if needed. She mentioned that Dad's CT scan had shown some evidence of 'hematoma' or bleeding. We hadn't read the report yet, but the doctors had never mentioned this. Later the rehab doctor came by and we discusssed Dad's conditions in more detail. He said it is possible that the fall could have caused some temporary brain issues that are affecting Dad's speech and coordination, though it could also still be the after effects of surgery and anesthesia. (FYI - the scan report also mentioned evidence of chronic small bleeds, not unusual in the elderly). Dr. Sheedy went over medications with us, and also the expected course of therapy. Generally, patients with hip surgery take 2 weeks in the rehab centre. Dad's morning medications came around 10:15. He takes pills with a little applesauce, one at a time. There are a couple of medications that were ordered from the hospital, but mainly just the ones he has been taking before. The doctor agreed that he will not get any sedating medications unless we are called. He will get tylenol twice a day to manage pain. If this is deemed not sufficient, they will call us. After the meds and finishing off a dish of applesauce, Dad went to sleep. When the PT came for evaluation at around 11:15, it was difficult to get him to wake up. Nonetheless, we did get him to sit at the edge of the bed and even stand up. He had had another bowel movement as well. The PT felt that Dad was too sleepy for more work, so he was put back to bed. The CNA came to help clean him up. Barb and I left around noon. I will be returning to Vancouver tonight. Barb will visit again tomorrow, as well as Friday morning. We decided to see if Haydee might be able to come by a few times while Barb is in Costa Rica (for a week starting Saturday). While his care is fine, when he is awake he does like to have company and interaction. The staffing at the nursing centre does not allow the caregivers to spend much time with anyone. I plan to be in touch with the centre on the phone daily to get a report of progress and can continue to post any news. Please let us know if you have any specific questions to ask the doctor or therapists.

Dad moves to Transition Care Unit

Dad continues to make slow but steady progress. He is eating more, even though he is still not very wakeful most of the time. He seems to have difficulty talking (very soft and not clear) when he is awake. He is on Tylenol for pain now, no narcotics. He was able to work with the PT a bit more (moving his legs), but still cannot sit up long without support. He was also repositioning himself on his own though. He was given a suppository and successfully had a bowel movement, which is why the doctor said he was ready to be released from the hospital to the rehab centre in the afternoon. During his 2nd PT session at the hospital, he was helped to a standing position. He didn't seem to experience as much pain during this, but couldn't yet stand on his own. He was transferred around 4:30pm. The new facility is just a couple of blocks from the hospital. Barb obtained copies of all the hospital reports so that we have a complete record for the future.

At the new centre, we began the process of helping the new staff get to know Dad. We made sure to review the medications as it seems his record includes quite a long list of things which we are not sure when they were ordered (many are just 'as needed', but even so we want to minimize the different drugs if possible). His vital signs are all very good. He is on oxygen for the moment, and was diagnosed with pneumonia so he is receiving antibiotics. At dinnertime, we tried to get Dad to feed himself for the first time. He was as usual VERY hungry. He held the fork/spoon and tried to feed himself, but is not able to lift it all the way to his mouth. Barb and I helped him with each forkful and he ate 100% of his dinner: beef/vegetable stew, lentil soup, pears, chocolate pudding.

We will return this morning, hoping to catch the therapists when they come to do his initial evaluation. I will be returning to Vancouver this evening.

Monday

When we arrived this morning (after 9), the physical therapist was just finishing with Dad. He wasn't responding very much. They said they would be back later. Dad actually started to wake more a bit later, so we were very relieved. He was able to eat some oatmeal and drink some juice. He responded with nods or yes when asked if hungry, and started opening his eyes much more. Both Dr. Park (ortho surgeon) and Dr. Lai came by. Dr. Park said that his leg was fine to stand on and from that point of view he was ready to leave the hospital for intensive therapy. Dr. Lai told us his blood count was still a little low. During his exam, Dad cried out when the doctor was palpating his stomach area. Not sure what the reason for that was. Dr. Lai came by after we had seen Dad waking, so he said he would come back later and maybe he would be able to be released to the transition care unit (therapy). PT returned around 11:30, and saw that Dad was now more alert. They began with leg exercise and noted that he was resisting (flexing muscles) and responding to commands to move sometimes. Unfortunately, not having had any pain meds for over 24 hours, when they moved him to the side of the bed to sit up, he cried out quite a bit. He remained sitting for a while, but he was looking down and it was difficult to get him to hold his head straight. After they finished, we asked the nurse to get him some pain meds. we decided on vicodin instead of morphine and gave it to him crushed in applesauce. He finished the applesauce, but after that became quite sleepy. Barb and I left to have lunch, and when we returned he was quite sleepy still. We could get him to rouse a bit, but not really eat or drink much. Clearly the drugs were making him sleepy, plus perhaps the effort of sitting up. Barb had to return home for Dylan, but I stayed through the afternoon until after dinner. He was mainly sleepy all day. He would occasionally rouse (I would talk to him and gently shake him every 15min or so). By 5 he was a bit more awake and I fed him some more applesauce which he took well. At dinner, he ate several bites of pulled pork, some cheddar potato soup, and mashed potatoes. We discussed with the nurse to admnister tylenol for pain instead of vicodin if he requires it, and we will ask that he get some before the next PT. We are hoping he can move to the transition care unit tomorrow.

Sunday Update

Barb and I visited Dad around 5pm, Sunday. He was still sleeping, and the nurses said he had not really woken, although when moved he did sometimes groan or grunt. They were giving him blood, due to readings from a blood test earlier, and his face was flushed. He also still had a small fever (99). Barb and I tried to get him to wake by talking, gently shaking or rubbing him, even using a cold compress on his forehead and neck. We gave him oral swabs with water to help relieve his dry mouth, and with some prompting, he did suck on it. He seemed to rouse slightly sometimes, making facial expressions or moving his mouth, but did not open his eyes. We will visit again later this morning, hoping that he is beginning to rouse more.

Post-surgery update

Barb and I visited Dad yesterday around 11am. He had been moved from the recovery area to his regular room. He was having an ultrasound to look at his heart. Apparently there were some possible indications of an enlarged heart which the internal medicine doctor wanted to get more details on, to see if there may have been some congested heart failure. We spoke to Dr. Lai that morning as well and he explained what he was looking for. It appeared that there wasn't anything seriously concerning after the ultrasound. Dad came in and out of sleep while we were visiting over the next 3 hours. He was given some morphine to control pain, and seemed to be relatively comfortable and not complaining too much - although a couple of times when asked how he felt or was doing - he replied 'pretty bad'.

There is concern after surgery about digestion, so we first fed Dad a cup of ice chips to make sure he could swallow properly and that his stomach would tolerate intake. He was then only allowed to have a clear liquid diet, so lunch consisted of chicken broth, juice, jello, and sherbet. He was quite hungry and especially thirsty. Even though he was sometimes half-asleep, we could rouse him and he would usually respond yes when asked if he was still hungry, so he went through most of what was provided. He occasionally had some difficulty with sucking on the straw (chewing instead of sucking), but still managed several cups of juice/water. In fact he downed almost a whole can of Gatorade in one go (resulting later in quite a large belch!). Even though he was responding to us, it wasn't clear if he recognized us at all.

We asked about probable timeline of recovery care and were told that once the surgeon assessed him post-op, he would determine when PT would try to get him up and assess a course of rehab. Assuming all is well, he would likely be transferred to a transition care unit for PT/OT work. Difficult to know how long that would last until they see how he proceeds, and therefore when he might be released back to the care home (where he could still get some in-home therapy). We'll get more details as we see how he does.

We left around 2:30 or so, and then returned at 7:30, hoping that he would be able to eat more. However, at that point he was so soundly asleep that we really couldn't rouse him. The nurse said that they had been able to get him to eat some of his dinner (full liquid style - which means still all liquid but with cream soup and milk, instead of broth and juice). We don't know how much he took though. We stayed for about two hours, and although he opened his eyes once or twice, never roused sufficiently to respond much and so we didn't try to give him any more food. He had not had any further pain medication since the morning, so the nurse administered another dose of morphine. We assumed he needed to rest, being so tired from the surgery. Before we left, the assistant was taking the routine vitals (temp, pulse, oxygen, bp) and discovered he had developed a fever (101.6). He didn't feel exceptionally hot, but the temp was retested and he clearly had elevated temp.

We returned this morning just before 8, hoping that we might see the doctor doing rounds, and also assuming he would be more alert after the night and ready to eat breakfast (now a 'soft' diet, including oatmeal and custard). He was in pretty much the same state as he had been when we left - soundly asleep and we were unable to rouse him with talking and gentle shaking. We inquired if he had roused at all during the night and were told no. All of his other signs remained good (bp, pulse, etc.). His fever had continued, but just before we left when it was tested, it had reduced to 99.4. Because he has not shown any further signs of pain (even when his position is shifted by the nurses), no further pain medication has been given. The doctor had prescribed a single dose of vancomycin (1000mg) earlier in the evening for the fever. We decided to return home and asked the nurse to call us if he showed signs of being more alert, and also if either of the doctors visited.

Missing info

Sorry...realized I left out some stuff. Yes, discovered yesterday following x-rays that Dad had indeed broken his hip. He was referred to an Ortho Surgeon and an Internal Medicine Doc, with the expectation that he would need surgery. They withheld any food for the rest of the day with the possible expectation of surgery, perhaps by the evening. Ortho Doc didn't see him until close to 9 and scheduled the surgery for 7:30am today. After picking up Justine from the airport, we headed to the hospital and arrived about 9:45--the nurse had already tried to find some snacks, and I had a banana in my car, so we helped him drink and eat. We stayed until after 11 and he seemed to be resting comfortably.

Surgery today

Quick update...Dad had surgery this morning. It was to repair the fracture with a pin. He is still in recovery. Justine are heading over there right now and hope to speak to the doctor to get more information.

Saw him several times yesterday and he was mostly staying comfortable...he was receiving pain meds when needed.

Heading to hospital

Got a call from Chris around 7:15 this morning at Emerald Isle. Al had heard a loud thud around 5:30am and found Dad on the floor in his room. Dad was complaining about his leg/hip area. Chris had contacted an ambulance service who was to pick him up and take him to the emergency room at 8:30am. I went over after getting kids off to school. When I arrived shortly after 8am, Dad was sitting in his wheelchair and Al was in the room with him watching TV. He was calm and responsive, but occasinally complained of the "constant pain" and was mentioning he had never broken his leg before. He was leaking through his pants, so Al, Anna and I worked together to lift/shift him to another wheelchair with a fresh diaper. He complained when being moved, and we also discovered an abrasion above his left elbow. The ambulance arrived around 8:50...they checked his BP (136/58) and he had a low pulse (58). They moved him to a gurney and loaded him in the ambulance. I had to take care of a couple of things at home, and now I will head over to the hospital where I assume they will take some x-rays. Will keep you all posted. Note that Justine is scheduled to arrive tonight...had planned to come in for the weekend to help me with Dad's taxes.

FYI...Al had reported that Dad had been sleeping very well and they had not administered the Haldol since the last time I reported it.

Kenny visit to Dad at Emerald Isle

I visited Dad last Saturday (3-20-10) at his new home. Dad was half sleeping and half awake, and switched between sleeping and awake every minute. He was in the living room. I asked him is he wanted to walk around and he said yes. We walked outside to the front of the house, to my car. He walked very slowly, and wanted to sit down after we got outside. He sat on the front wall and talked to Judy and the kids. Al also joined us. We went back inside, and Judy talked to Al and Anna in filipino language. I walked with Dad to his room, and looked around. I stayed there about 45 minutes, then Al walked Dad back to the TV room.

VIsits with Dad

I visited with Dad last Thursday, and also today. On both occasions he was less sleepy than on previous visits. Today the house was celebrating Mamie's 105th birthday. so they had pizza and cake. I got to meet Mamie's son Harry (former Marine) who I had previously reported enjoys talking to Dad on his visits. The three of us chatted a bit and Dad definitely seemed to acknowledge his company, with friendly, polite statements. Janice was there and I asked her how things have been gong from her perspective. She said Dad has been sleepy on the past few Bingo occasions, but said she thought he seemed content.

I brought over some rice pudding that I had made on Saturday night for a dinner party...hopefully Dad will enjoy it later.

Visit with Dad

Yesterday I went for a visit with Dad. When I arrived, he was in his recliner...I asked him if he wanted to go for a walk with me and he said yes. We walked around the house (very cold yesterday)...he knew his way around without my direction. After circling the hall and coming back through the kitchen/dining area, I asked him if he wanted to go to his room and we did. He was able to sit in his chair on his own, moving very slowly and cautiously. I reviewed some photos with him. I asked him if he was comfortable here and he said yes. I asked him if he liked living in this new house and he said "is this the new house?" to which I responded yes. I then asked him if he wanted to toss the ball and he said yes so we did. He threw it back and forth quite forcefully and with strength. After awhile it was time for lunch so we walked back to the dining room to join the ladies for lunch (green salad with tomato and grilled cheese.)

Juana reported to me that the night before Dad did get up around 10:30 or 11 to walk around. They gave him the Haldol and he slept the rest of the night.

Today, Laura stopped by and wanted to go visit Dad...I sent her with some oatmeal choc chip cookies I had made to give him. She reported that she had a nice visit and Dad was energetic...they walked as well.