Dad returns home to Emerald Isle

I spoke with Barb and got an update on how Dad is doing. Barb saw Dad on Sunday, and saw that there did not seem to be significant progress in his recovery. On Monday, the doctor at TCU recommended discharging Dad from their care and Barb agreed. It just seemed that Dad was very unhappy and confused there. He was not able to understand what was happening so seemed to be resisting any attempt at therapy. Barb reports that since his return to Emerald Isle, things are looking up considerably! The home is more familiar and much calmer than the rehab centre. When they arrived in the evening, they had saved dinner and he quickly dug in to the meal when seated at the table. The caregivers are adjusting to his new needs but still able to manage getting Dad to the toilet and to shower for cleaning. When Barb visited on Tuesday he was sitting in his wheelchair and looked much fresher and responding to her. She worked with the new homecare physical therapist, who reported after the first visit that she was confident that Dad will be able to progress and eventually walk (with assistance). The PT will visit 3 x a week for the time being. She said when she visited this morning he was even more alert. Barb will post more details later. She is very busy right now, not only with getting Dad settled, but with finishing off his taxes, and attending to other business after her holiday. She certainly enjoyed the vacation, but sadly had her computer stolen which has added more tasks to her 'todo' list the past few days!

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.

Saturday

I called the nurse station and spoke to Amena (sp?). There is nothing unusually to report on Dad's status. Vitals are fine, he is eating (but still needs assistance to do so. I couldn't get much on his mental state or alertness. He is still on oxygen as well. She transferred me to the therapy office, where I spoke with Abby. Although Abby had not worked with Dad, she read the report to me, which indicated he still required 2 people to assist him to get to the edge of the bed and to stand and transfer. They took him to the gym to the gait trainer (parallel bars) where they did some 'pre-gait' exercises, which seem to involved stepping forward and back. The report indicated that he is confused but cooperative, and that he does exhibit signs of pain still. Ken was to visit this afternoon, so I look forward to his report.

Friday

Saw Dad today from around 10:30 to Noon. He was more alert today. Nurse said he ate all of his breakfast. When I arrived, PT was just about to start therapy. Dad still cries out a bit with moving...we moved him to the edge of the bed, then we helped move him into a wheelchair. We headed to the "gym" area...we discovered Dad had not yet received any pain meds (new medication nurse had not gotten to him yet, even though his order says he should get Tylenol at 8am and 1pm). She came to give him the meds and PT suggested I walk Dad around a bit and then return for the therapy. He seemed to enjoy the stroll around the place--kept his eyes open. I left him with the therapist to begin therapy, but I had to leave (kids have short day today.)

When strolling we saw the Doctor who was pleased with Dad's alertness. On my way out I asked her if she had any medical concerns (reminding her I was leaving for the week.) She said not anymore having seen him more awake today. Said Dad would be in good hands while I was gone.

I brought in our family beach photo to leave by Dad's bedside.

Thursday

Went to Transition Care Unit at 11am today. There was a planned "team meeting" that the doctor had mentioned yesterday. Each therapist (speech, Physical, Occupational) provided some status on where Dad was with respect to therapies. I had not yet met the OT so I had the opportunity to speak up about Dad's pre-fall capabilities (e.g., could feed himself). Goals were discussed, and doctor (not the same one Justine and I had met the day before) indicated that Dad seemed to have a ways to go, so would definitely not be leaving before Monday the 12th, though they will re-assess at next week's meeting. PT mentioned that she had been unable to arouse Dad earlier in the morning to perform any therapy.

After meeting I went and checked in on Dad and he was sleeping. I tried rousing a few times, got an occasional verbal nod or response with eyes closed, or he would open his eyes for a moment or two...he was definitely not as alert as he had been the morning before when Justine and I were there. I inquired about how he had slept the night before. The nurse said there weren't any notes to say he had been awake in the night. I spoke to the bedside nurse who reported that Dad ate breakfast well. Note that they had removed the catheter, apparently earlier in the day.

Occupational Therapist (not same one who was at meeting) came in a little later and I went over Dad's history with her. She tried doing some grooming with Dad...handed him a wet washcloth and prompted him to wash his face, which he did. Speech therapist arrived shortly after, and lunch arrived. OT left and I worked with Speech to help Dad eat lunch. When Dad knew lunch was in front of him, he did perk up enough, to indicate readiness to eat. Most of the meal though, his eyes were slit and he only opened to find the food. Like the night before last, we would give him the spoon and he would fill the spoon, needing help to ensure spoon was loaded properly, and he also needed help guiding spoon to mouth (he would get it just shy of his mouth.) Towards the end, he was doing better with his aim and was pretty persistent to work through his entire meal.

Dad was doing a lot of complaining when being moved in the bed today...after lunch the bedside nurses needed to change the sheets and with each roll, Dad cried out...not sure how much is pain or just irritation with the process, though I'm sure there is some pain. Today, the dressing had been removed and I could see his sutures on his left thigh. Another odd thing was it appeared he had a bruise on the top of the penis....perhaps from the catheter?

I left around 1:40pm. Around 4pm I got a call from the PT (who offered to call me after doing the therapy)...she was able to move (with help) Dad to the edge of the bed like the day before, and said he stood again a few times, also taking a step to one side. She also mentioned that he was standing straighter than the day before.

At 4:30pm I returned to meet Haydee and show her the place and see Dad. Had Dylan with me so could only stay for a short time, but left Haydee there who was going to stay for a couple of hours. I had brought some magazines and cards as options for her to engage with Dad, when he gets to that point. Spoke to Haydee later this evening who said Dad did eat all his dinner, though still not overly alert. Note that while there, I discussed with Haydee the need to ensure Dad is adequately swallowing with each bite per the instructions from the Speech Therapist.

I will return again tomorow. Spoke with Ken who plans to visit the next two Saturdays. Haydee will be able to spend a few hours with Dad Tu/Th/Fri, and perhaps Mon and Wed as well (if she's not too tired from other job, said she would stop by.)

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.