Friday update

Today I spoke with the nurse who does the afternoon/evening shift. She told me that yesterday they saw that Dad had not eaten a lot and woke him up at 8 or so, reheated his dinner and he ate it. They are still feeding him most of the time, though. The doctor was in on Friday (Dr. Sheedy) and ordered the surgery staples removed. I also spoke with Kristin, who told me Dad was very sleepy both times that she went to do therapy. He kept his closed most of the time and didn't really talk to her. She discovered that yesterday he didn't actually get the stronger medication. He was given it today, and she thinks it may indeed have made him sleepier. In any case, she wasn't able to get him to do much in terms of moving himself. She says he will start to move his legs, but then stop and not respond when asked to continue. I asked about the next Team conference and she said it is scheduled for Thursday. I do find it rather confusing trying to get a good sense of what is going on, with different people reporting. I know that Dad's state would of course be different at different times of the day - and I guess that can be the difficulty with a facility - there isn't much of a true overview. All they can do is read the reports from others. It's good though that the same PT does see him every day - even though it is only for a short time.

Thursday update

I spoke today with Kristin. She reported that the doctor approved changing Dad's meds to Tylenol with codeine. This did not change Dad's alertness during therapy, but unfortunately it did not seem to make any difference in his willingness to move. She now feels that his cognitive state may be the biggest factor holding him back. She thinks he is afraid perhaps. At the same time, she says he enthusiastically engages in upper body exercise involving throwing/catching a ball, so I wonder if pain is in fact real. She did however raise the issue that they expect patients in this rehab centre to be progressing more quickly in their therapy - the average stay is 10 days. If he is assessed to be 'plateauing' (or not progressing), they will recommend moving him out. She is very sympathetic and wants to keep working with Dad if she can. She hopes the new meds will help in the next few days. She suggested that one of the issues is that the policy about 'plateauing' is governed by the insurance coverage. She suggested talking to the Case Manager (Suzanne - hope that's a good sign) more about this area, when I said I thought Dad's coverage would be better than most. Suzanne will not be available until Monday, however. I also spoke with Haydee tonight. She said Dad was more sleepy today than during her previous visits. He didn't finish all his dinner, and she had to help him eat most of it. She said he did take the ice cream and fed himself to finish it off though. She confirmed that he does not want to move much, and she thinks he may not be able to get back to walking on his own as before. If he does it will take quite a long time of therapy. I know this is not really what we are hoping to hear, and it is still early days yet. I think we need to take one day at a time and continue to work toward full recovery, but may need to accept that Dad could be entering a different stage of ability and consider mainly how to ensure he is as comfortable and happy as possible.

Updates for Tuesday/Wednesday

I wasn't able to call yesterday, so got an update today for both days. According to the nurse, Dad is now able to feed himself and eating 100% of his meals (no surprise there!). They have removed the IV needle, since he is no longer receiving the antibiotics. His blood work showed some improvement in levels of hemoglobin. He was transferred from the bed to chair today for a while. In speaking with the therapist she indicated that she is concerned that his pain meds are not working sufficiently. He is clearly in pain and not wanting to do the therapy because of it (although he does cooperate when asked). She talked to the nurse and suggested we consider something stronger. Dad is now very alert and she said he participates in throwing a ball quite willingly. I told her we had been concerned when he was so knocked out after surgery and receiving morphine, but now that he has become more alert would be willing to have the doctor try something stronger so that he is more comfortable during therapy. There will be a team conference tomorrow where this will be discussed. I will speak with the nurse or with Kristin tomorrow to see what they decide.

Monday

I spoke with Kristin, the physical therapist. She worked with Dad only once, after lunch. She says that Dad still has pain in his hip, notices it primarily when shifting him on the bed to a sitting position. Dad is generally confused and does not know why he is in pain. She thinks this may make him more anxious and resitant to moving. I asked if she knew if he was getting the Tylenol on time, and she said yes. She says he does have the strength, and when finally positioned (sitting or standing) is not in pain. He is unable to take steps, however, so today she put him in a standing frame, rather than go to the gait training area. With the standing frame he can hold himself up and put weight on his feet for several minutes at a time. I spoke as well to Carol again. She reported that he is doing well, eating and having regular BMs. He does sleep a lot of course. Dr. Lai saw him today and ordered an injection to reduce potential for blood clots (as he is lying down so much still). He will get more blood work done on Wednesday.

Sunday

The nurse said that Dad was up sitting in a chair today for a few hours. I asked about alertness and she said he was more awake, but had gone back to bed after lunch and was sleeping. There is no PT on Sundays, so nothing to report there.