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Yesterday mom only had to be suctioned down through the trach a couple of times in the evening. Mostly she coughs it up and is learning how to suction herself at the top of the trach tube. There has been some small traces of blood in the secretions yesterday, but the doctor last night said this is very minimal and normal, resulting from irritation in her throat from the tubing and the coughing. She got out of bed 3 times yesterday with the help of the nurse. She didn't do too much walking but sat in the chair for over an hour each time. She is still anxious when getting up and out of bed but will now allow one person to help, even if it is a woman. :) When I came in today the nurse said she had already been up once and walked into the lobby of the ICU again, and sat in the chair as well. She is still shaking today, and we are expecting Neurology to pay a visit to her today to discuss this. Mom says this shaking is a pre-existing condition that has worsened since the accident. I did not notice it until a few days ago. Sometimes it is really bad and sometimes it is subtle. The anxiety meds did not decrease the shaking, so the staff thinks it is not anxiety related. Parkinson's is one possibility...something I am hoping they will rule out today!

On a positive note, the ICU has put in the official request to move mom to the first floor, trauma level. I am told there is a bed ready, and that they are waiting for an official ok from that department and the doctors. Since mom's secretions are diminishing and the need for constant suctioning down the trach by the staff has also decreased, mom no longer needs constant attention and care. I am told that on the first floor the ratio is 5 patients to 1 nurse. The doctor last night also said that they will only be allowed to suction her every 4 hours (if needed), and if that need were to increase, she would be moved back up to the ICU. She will also be required to do more of her own suctioning when she coughs it up, and start learning to do more of her own personal hygiene, but will also have more consistent visits by the physical therapist. I am looking around her room now, and wondering how I will get all her stuff downstairs!!! If she moves today it will be bittersweet. She has been here in the ICU for exactly 7 weeks today, and we have made a lot of friends here. Mom is well-loved by all the staff so it will be sad to say goodbye, even though it is time. We are going to watch the last of the Planet Earth series and wait for the word...

Neurology came by and did some simple tests with mom. The doctor's preliminary conclusion is that mom's trembling is not neurological. The doctor feels it is definitely related to depression and anxiety. She is recommending anti-depressants and possibly more or different anxiety meds. Mom said she has struggled with depression for a while, and admits to having anxiety in the past as well. She seems to be unsure about taking any meds for this; is worried about side effects and addictive properties of the meds. Perhaps she will change her mind after talking to more doctors. I am also hoping we will see the psychologist again. Initially the psychologist was visiting mom fairly regularly, but I haven't seen her for a couple of weeks.

One of the chaplains is visiting mom right now. He seems like a nice guy. Mom likes to press buttons by bringing up her favorite controversial issues like birth control. :)

BIG NEWS TODAY...It finally happened! Mom is now in the Trauma Nursing Unit on the first floor, Room 1013. We had to take down her wall of stuff in the ICU and pack up all her other things, which got piled into her bed with her (My worries about "how" to get all her stuff down to the first floor were unnecessary!) Everyone in the ICU came out of their rooms to wave and say good-bye. They all want her to come walking back in one day, in her regular attire, so they can see and hear the real Lorraine. Mom started to cry, and I had to resist the urge myself. After 7 weeks, I myself have gotten used to her staff and her surroundings. The new room is half the size of her old room, and she shares that space with a roommate, separated by a curtain. She has her own T.V., but cannot watch videos or DVD's anymore, as there are no hook-ups for it. There is also no cork board or really any wall space to hang all her posters and cards. Bummer! I am lucky I can still use my laptop and get an internet connection down here. Mom was very anxious about her move. She felt like she was not really ready, but I assured her that this was not an arbitrary decision. We met her new nurse, Morgan, who gave us an overview of this new area and how things work. Mom still has a call button, but will need to be patient, as Morgan has 4 other patients besides mom. Mom immediately began writing to Morgan about all the things she needs help with, and Morgan assured her she would be just fine. About a half hour later, mom fell asleep! The room is definitely quieter, and mom can no longer see into the lobby, which is the ONLY plus so far, in my opinion. Hopefully she will be able to get a good night's sleep for once! Visiting hours are from 12-9 p.m. for all future guests. The unit is located on the first floor, sort of behind emergency. You do not need to buzz to come in, and children are allowed. Once mom can talk, we can also post the phone number to her room, as she now has her own phone line!

I just want to say THANK YOU again to the SICU1 staff, who have taken care of mom for sooooo long. You are all so terrific, and will be sorely missed (Kelli, Guinevere, Marcia, and the rest!). Please come down and visit mom ANY time, as I know she would love that. One day she will come up there and say hello all on her own, thanks to your loving care!

Mom has had a busy day already! She had one visit from Physical Therapy before I arrived. They got her up and walked a short distance. They made a second visit after I got there and she walked out into the lobby and back, and is now sitting in her chair. A doctor came by and talked to mom about the trembling again, and did some more informal assessments with her. He also feels they are not neurological, but said he would be coming back with his boss, another doctor, later today. Currently the Speech Therapist, Matt is here, doing preliminary swallowing trials. He has been feeding mom some applesauce dyed green and also some ice chips. If this comes up green through the trach when she coughs, then he knows that she is having trouble passing things down the esophagus normally. He explained that these swallowing muscles can atrophy, and patients can lose the sensation of being able to distinguish when they are swallowing normally. A regular person would naturally cough when choking on something, but mom might not be able to distinguish where food is going. Matt said there was only a slight tinge of green in his trials. He is going to recommend a "Modified Barium Swallow Study," which is a 2D contrast method and she would have to be taken out of her room for that to the radiology department and she would have to sit up for about an hour to an hour and a half. The other method he is also recommending is a 3D picture from the top of the neck down, using a camera and a dye. This is called the fiber optic endoscopic evaluation of swallow, which would also take place in the room with the assistance of a speech pathologist, and a fiber optic camera through the nose. These studies will allow them to determine what consistency of food is appropriate, and what strategies to use in order to help compensate for her swallowing troubles. These evaluations could happen as soon as Wed. of this week, and the doctors on mom's team will decide which study will be done and when.

Mom continued to have a busy day today. She was out of bed 3 times and had a second visit from the doc who is evaluating her trembling. The Nurse changed her dressing and also her tubing for her trach. Her wound site is nearly all closed up now, except for maybe 2 inches, and has healed amazingly well in my opinion. She also had another visit from the first-year resident, Dr. Smith, who we met for the first time last night. They talked about taking her catheter out again and getting her a bedside commode! She has a bathroom but it is on the other side of the room, and she's not quite ready to make that trek every time she needs to go. But she is getting more confident in sitting up and standing with minimal support. She still prefers to hold on to the PT when she walks. I think she could probably get around with a walker right now (at least for short distances) if she had more confidence in herself. I am going to head back to Gram's early in case there is holiday traffic later on. HAPPY NEW YEAR EVERYONE!

It's been a fairly quiet day so far. I am thinking maybe a lot of the staff have the day off today. Apparently RT was here before I got here and told mom she might not need IPV treatments anymore. It was unclear to me what exactly was said. Hopefully I will still be here if they return. When I got here another neurologist was here talking to mom. She said that they cannot completely rule out Parkinson's as the cause of her shaking, and that she should see a specialist for a more formal evaluation when she gets out of the hospital. I didn't quite understand why they couldn't do that while she is here. I guess it's not their main concern. Mom seems to be coughing less than yesterday so far. I am hoping that means her secretions are decreasing. PT is here now, getting her up out of bed for a walk. She asked for pants, so they made her mostly put them on herself! Off she goes now. Wow. I just watched mom walk way down the hall with minimal help. She took a break halfway and sat for about 2 minutes in a chair. She was nervous and said it is hard, but she did fairly well. Now she is sitting in the chair, and RT is here to do the IPV after all. She said when she came by before it wasn't a good time. Apparently treatments will continue after all.

4:30 p.m. Well mom took a little nap and the Nurse Practitioner came in to chat and said there is a good chance they might do her swallowing trials tomorrow. She also said that if mom's secretions keep diminishing, they may take out her trach as soon as the end of the week! She said she doesn't think mom will have much damage to her vocal chords since she has been able to vocalize anyway. She also said that it is really important that mom keeps doing the Physical Therapy, especially sitting up and walking, because it helps move the secretions out. Mom smiled and seemed very excited about the prospect of having the trach out, which made me happy, too. I am going to leave a bit early to do some grocery shopping for grandma. Tomorrow I am going to try and bring Grandma for a visit, so we can discuss some concerns with her in front of mom.

I am here with Grandma and Diane. Spencer and the girls came in to visit for a few minutes also, and now they are going to cafeteria. Mom said that she was up twice today, and she used a walker to go down the hall. Mom also said she used a bedside commode, which was easier than the bedpan. She seems to be in good spirits, but Grandma is not taking it too well, so I will probably drive her back home, soon. Diane will stay a couple hours and then head home.

Our visit yesterday with Grandma improved as Grandma saw all the different people who take care of mom, saw her get up and walk down the hall with me, and saw mom do some exercises. Initially Grandma was very upset and emotional about seeing mom, and said, "She just doesn't look like herself." Grandma stepped into the hall 4 times to cry and let out some of her emotions, but managed to stay and visit for about 3 1/2 hours. It seemed this morning that Grandma remembered the visit, and was thinking a lot about mom's condition. She seems to understand that she is improving and has excellent care.

Today is a quiet day. Mom has been up once and walked, is using the bedside commode, had her IPV treatment, and a visit from the nutritionist who says mom has lost about 5 pounds so far, so they are going to change her liquid diet to something that has a higher calorie content. Other than that, she said mom's numbers look really good. Mom also gets a daily dose of Coumadin/Warfarin, which is a blood thinner, and Lasix, which is a diuretic. They have not down-sized her trach or done the Swallow Study, but the nurse says they don't have a set schedule for those things, and that the specialists do procedures according to their own schedules. It is possible it will get done today or tomorrow.

I am going to be heading to San Jose for the night, then back to San Diego tomorrow. My sister will be here this weekend and I will update the blog when I hear from her. If anyone has been thinking about visiting mom, next week would be an excellent time to do so, as mom will be on her own during the week. Trauma Nursing is located behind the Emergency Room entrance, or you can come in any entrance and follow the signs to Trauma Nursing. Mom is in room 1013 which is on the other side of the Trauma Nursing entrance. I am sure she would love to see some visitors! Flowers are also welcome in this unit! Thank you to all the people who have sent letters and cards, as my mom enjoys reading them very much!

Mom seems stronger today; she was getting up and walking without much help. They told me they moved mom because they were worried about a rash on her roommate; it might be contagious. So her new room is 1015-1.When they moved her into the new room, she walked there using the walker. She was also using the bedside commode pretty independently. The trach and secretions seem a little concerning. When they did the swallowing trial some of the ice and /or applesauce was going down her trach and into her lungs. Also the secretions from her mouth might be going into her lungs. So they are giving her 2 different medicines to reduce and thicken the secretions and then they'll do the swallowing trial again. Alyssa was able visit her awhile and help her move; she helped hang up the pictures in the new room. We'll be back again tomorrow morning.