Day 10: A better day today. March 23, 2012

We are glad to report that today is a better day. The team has responded promptly and well to our concerns. Communication has improved and we see active problem solving for his "issues". We have a better grasp of what to expect and a better sense that they are acting in a pro-active manner. The nurse last night, took good care of him. His pulse rate has been really high, generally 100 to 113. We have been told that it would be expected, but it is hard to see as a constant, knowing that his normal pulse rate is 56. And... I don't know if it is due to pain, due to neuro issues, etc. he nurse last night did some problem solving, which we appreciated. She asked him through hand squeezes if he was in pain, further assessed the accuracy of his responses and reliability of his responses. She gave him a some pain meds, then his pulse rate decreased to 78 from 120 plus. So I guess we have our answer. I can only imagine that he has a ton of pain with all of his fractures, surgeries, and head trauma. The trick is making him comfortable at night so he can rest and recover, but not over medicating him so he can't participate with therapies during the day or progress his awareness. Such a trick. It would really help to Assess him and help him if he was awake! A different doc came in today. We liked him much better. Much more pro- active, much better communicator. We are glad to have him for the weekend. We asked to have him routinely. Not sure that will happen, though. He did say that he would like to have Physiatrist from Barrows come over and consult on Scott's case. We loved that recommendation,even though the MD today gave us great confidence. We have a ton of questions for that barrows guy! Here's what's new for today:

1. Speech therapy placed a one way valve (speaking valve) in today to test him out. This allows him to breath through the trach and out through his mouth. She left it in for 5 minutes and he did perfectly well. Soooo next week when they are able to place the smaller tracheostomy tube in, they will be able to place a speaking valve in it. They also mentioned that he isn't able to smell right now because there is no air passing through his nasal passages, but once they put the speaking valve in, he will be able to smell and we will be able to start stimulating his brain through smell. Oh... The one way valve allows him to breathe in through the trach tube and out through his nose.

 2. They have taken out the central IV line and have replaced it with a peripheral IV line.

 3. They took out the Foley catheter and put a condom catheter on. They may still have to straight cath him due to neurogenic bladder,but it will decrease the risk for infection. His bladder muscles will have to be re-trained along with everything else.

 4. They just did a follow up CAT scan. We will get the report tomorrow.

 5. Scott's dad, Mickey, brought in a fan today to help keep his temperature under control. They had one in the ICUS, but they don't have them here. They allowed us to bring one in. He seems to be more settled and no longer sweating.

 6. They will remove the trach as soon as he is safe to do so. He needs to be able to swallow and manage his secretions. They will test his swallowing once he gets the speaking valve in.

 7. He has lost 12 pounds, so they are increasing his calories.

 8. His wounds are progressing quite well. Once the staples begin to "float", they will remove them. 

9. Rehab placed boots on him today and will alternate them on and off every 2 hours to protect his heels from pressure sores and to protect him from "drop foot". PT and OT will be here M-F and will focus on increasing his awareness with his environment, strengthening extremities and core, and building his activity tolerance. Today, he was able to sit unsupported. He fatigues very quickly and begins drifting to the right. He is responding better to commands today, including visual tracking and mouth movements. They had me kneel next to Scott while he was sitting on the edge of the bed, and talk to him. He turned his eyes toward me. Yeah! I then placed my hand next to him, and asked him to touch my hand. Nothing. They then brought Ashley in to repeat the same instructions. He immediately reached for her hand and followed her commands. Ashley is worried that Scott may not remember who she is, so this was a bit encouraging. We are taking it that he knows and remembers that she is special to him.

 They told us today that he may have to go to a sub-acute setting for 2-3 weeks before going to Barrows, if he improves medically but is not able to tolerate 3 hours of therapy per day. Whatever is the most successful course is good with us. They will begin sitting him up in a chair daily increasing his tolerances to a maximum of 2 hours. 2 hours is the bed sore limit. They will put him in a Barton chair, which has an incline backward, in order to keep him from falling forward out of the chair and it will provide support for his head. He gets exhausted very easily, but he seems to be resting much better today. They also said it is time to begin sensory stimulation. Phone calls to hear familiar voices, talking to him about things that might agitate him a little (in order to get a stronger response), music, photos, etc. Things that are familiar to him.

 In my exhaustion and frustration yesterday, I forgot to thank Bishop King, Bishop Matthews, Scott Smith, President Forsberg, and Melynda King for coming by to give Scott and Ashley a blessing. We are beyond grateful! Also, we are very grateful for Mickey And Carol Moore, Scott's dad and step mom, who have been working tirelessly a and fervently to get all of the logistic things taken care of (police reports, insurance issues, etc.), thus allowing Ashley and I to focus on Scott himself and his medical needs. It has been a huge relief and blessing! Oh... I almost forgot.... When he was being transferred back to his bed after having his CAT scan done, he rolled himself over onto his side! It was so cool to see! So... all in all a much better day today! Yeah! "Talk to you again tomorrow!" Patti