physical therapy

Progress Report: Week 4 in Rehab

/ Shirleyjdietz / Leave a comment

Last Thursday marked the end of the fourth week in rehab at Miller Dwan, one month of Medicare’s allowed time. My schedule was the same, going up to be with the husband four of the days and at home for the other three. Here’s what happened (in my experience, which is probably much different from the husband’s).

– Shell Lake Health Care Center declined to take Dennis. They felt they didn’t have the needed equipment and the ability to give speech therapy often enough. Back to searching for another facility.

– Gave him a much needed haircut, but there was the part of his head that was hard to move off the headrest of the wheelchair. Tricky and not the best job I’ve ever done.

– He would try to wake up for his therapies but I had a feeling something was “off”. He was looking more like a nursing home patient than a rehab patient. A lot of vacant staring at nothing. Worrisome.

– He kept his ability to sit by himself and correct his leaning. OT and PT did a lot of reaching and grasping exercises. Worked on the steps to roll over in bed.

– My saddest day at the end of this week, I arrived and he told me he was trying to catch up on his sleep and not to talk to him. Granted, he’d had a hard night and he did feel bad about telling me that later.

– Maybe getting over some of his bias against talking to the psychologist assigned to him. Understanding her role better. She’s in a wheelchair too.

Reach Dennis, reach!

Progress Report: Week 3 in Rehab

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– The trach came out on Saturday!! He had no trouble and the hole is healing up with only a bandaid on it.

– Wednesday and Thursday were good days in PT and OT. He’s tossing bean bags in a basket and sitting up by himself for most of the sessions.

His aim could use some work, but they were all close.

– Swallow test on Monday showed he is still not completely safe from aspirating, but he is coughing less during sessions with E-stim. Had his first taste of ice cream on Friday.

Chocolate.  The electrodes on his neck are stimulating his swallow muscles.

– Alert more and engaging others in conversation. Surprised a couple people with phone calls where he did some of the talking.

He stood in the stand-up machine for almost 10 minutes before his blood pressure tanked.

On Tuesday of week three I got a call from the social services gal assigned to Dennis. She reported that the weekly meeting of all therapists, nurses and doctors had resulted in the decision to move him out, maybe by the end of the week. His progress was too slow to warrant the acute rehab aggressive schedule. He was often too tired or unable to focus for the whole sessions in PT. There were often issues with blood pressure and bowel problems this week as well. I understand what they are dealing with, nevertheless the change from 60 days to “out by the end of the week” was a little alarming.

The next day I went around to our local facilities in Hayward and got his name on their lists. There are three of them and they are all full with long wait lists. But since we could be waiting for years yet, it was still worth it to sign up for something in town.

After social services investigated facilities that would offer the needed therapies within reasonable travel distance, I was given the short list to consider. On Thursday I decided to visit the one rehab/nursing home that had an open bed. It was in Shell Lake, 40 miles from home. True, that would cut my travel time in half on most days but still… it makes me sad to be thinking of this level of care.

The building was acceptable and clean. The staff people who gave me a tour and spent time with me were pleasant and seemed candid about the quality of care given there. I felt it was a possibility, but was a little concerned about their ability to meet the needs of someone who can’t even turn himself in bed.

Back at home I happened on a friend whose mom had been in three different facilities as an Alzheimer’s patient. Shell Lake was the worst of the three. It was back in 2014 and things could have gotten better, but it did cool my already lukewarm enthusiasm a bit more.

I am praying that his progress toward the end of the week will cause the rehab team to reconsider and give him more days at Miller Dwan. It could happen, right?

Week One in Rehab

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Occupational Therapy, clothes on, in a chair, ready for work. Thumbs up.

Progress Points: Week One in Rehab

New routines are getting in place at Miller Dwan Rehab Hospital.. OT early in the morning to get dressed, brush teeth, ADLs. Speech therapy. Off to the gym for an hour with PT and then back to rest. OT and Speech again in the afternoon. Evening rest.

Off oxygen and still doing well.

Blood pressure remaining stable.

No more finger pricks for blood sugar testing.

On a new mattress that avoids painful pressure points.

Allowed to sleep at night, undisturbed if he doesn’t need anything.

Beard got trimmed (yay!). Wearing real clothes during day.

Having real conversations with wife. Voice getting stronger.

Getting “known” by staff.

Got to ride stationary bike in PT, with help.

Room got personalized – the “love” poster from family and all the cards are on the wall where they can be seen.

Sayings

When told rehabbing was his new job: “Take this job and shove it.”

Off to Rehab

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I thought the surprises were over, but they were not.

Today when I arrived at Dennis’s bedside I was able to see his face without the NG tube. The nurses had already taken care of that task. A good thing.

Dennis’s face… he has lost weight in his face and looks so tired. The husband has very big eyes, hound dog eyes, you might say. When he looks at me, or other people, with recognition in those eyes, and maybe a lifting of the eyebrows in question mode, he sparkles with personality. When he has his eyes closed, or half closed as they often are, he looks near death. He doesn’t always show a lot of facial expression – it’s one of the parkinsonism traits of Lewy Body dementia. Another feature of his face is the month old beard and mustache. I’ve held off trying to shave him for fear some hair might be sucked into his trach tube.

The next thing we heard from one of the nurses was that he was being transferred to rehab today! Probably this morning! A day earlier than expected! His first feeding in the new gastrostomy tube was started and a few minutes later PT was knocking on the door to work with him. They were all excited and wanted to see if he could stand with their fancy lift machine.

The stand up machine. Took 10 minutes to get in place, 5 seconds to stand up.

The doctor came next, then the social worker who had been helping with placement. It was like a celebration with everyone smiling and congratulating us. It was like having a new baby, or maybe winning the lottery.

I actually felt guilty leaving before the move occurred. I had a much needed massage scheduled and had barely enough time to get home for it. I’ve missed a lot of self care lately (showers, hair cuts, sleep, etc…) and decided that there were competent people who would take good care of Dennis during the transfer. And they did. I called this evening and he was in his new room, doing fine, according to the nurse.

Tomorrow I will have a new adventure, finding my way through a new facility, getting used to new regimens and rules. Dennis has always thought that trying to get well was his new post-retirement job but I have a feeling this will be the most work he has done in a long time. The list of scheduled appointments is long.

A Near Miraculous Turn of Events

/ Shirleyjdietz / 1 Comment

I know enough not to get haughty and demanding with God. On my walk yesterday evening I had asked only for some small encouragement, something to keep us in the game and give us direction, some small arrow to shoot at the complex discouraging problems in view. I felt a plan was in place, even if I didn’t know the details. I trusted we would be helped, based on the character of my God. And now I will acknowledge his actions on our behalf, because that is what is due.

When I arrived at the hospital on Wednesday morning, Dennis was already back from Interventional Radiology and the feeding tube was in place. It had gone perfectly. However the nasogastric tube was still in place also and would have to stay there, hooked to his nose, for another 24 hours before it could be taken out. We decided to allay our disappointment with a little work.

I fed him ice chips and started his exercises, moving every part of him that would move. He was just finishing this when PT came to the room. The day before I had told the attending doctor that he had been alert all day and had scratched his own nose. He had talked to her and remembered her name. She had been impressed and had asked for him to be re-evaluated. The PT girls had him sit up on the side of the bed, and they too were impressed by his responses. Then Occupational Therapy came and had him brush his own teeth with a sponge stick, and a few other small maneuvers. Another point for the man. Speech Therapy came next and had him do a bunch of swallowing exercises. This was a busy morning for someone who had been nearly comatose for several weeks.

First time sitting up in a looooong time. It felt good. Still have a few tubes to get rid of though.

But wow, did it ever pay off! The attending doctor came in the afternoon and said Dennis was going to acute in-patient rehab at Miller Dwan, the best in the area. It’s connected to the hospital via skywalk. He would probably be able to go on Friday. Whereas he had not been a candidate for it previously, they now felt they had something to work with and were going to give him a second chance. I was ecstatic. Dennis was worn out but I think he was catching on that a good thing had happened.

We talked about it (I talked about it) the rest of the afternoon as he practiced swallowing ice chips. So even though he still had the NG tube for another night, it felt like the day had gone gloriously well. He had been a trouper and had worked hard. I had been a good coach and advocate.

I left to stay overnight with a friend who lived a few miles away, feeling oh so grateful and amazed at such a turn of events.