Saturday, April 28, 2007

Visiting

One and all, please come visit M especially between 12-1 and 4:30-6 pm weekdays, and anytime 9-6 Sat and Sunday. Sadly, he's not getting many visitors. Thanks to those who do come, though.

His verbal skills remain excellent and he loves company even more than before. Nothing else suits as well to while away the hours. M can read, but lacks the attention span to find it of value right now. Staring at the walls or watching TV doesn't nearly compare for stimulation to support his brain in healing. As much as I feel compelled to be with M to provide stimulation and company, I do have other things take me away (paying bills for one, taking care of the children is another, though parents of their friends have supplanted me there to a large extent.) Be aware that he is confused, so take much of what he says about his activities with a grain of salt. If something concerns you, check with me (for example, he'll talk about the kids getting physical therapy or other family members in the hospital, they aren't and nobody else is). His memory of things past is jumbled, but intact, so you can reminisce about past events or talk about things today, especially politics or whatever.

HOWEVER, there are some caveats to know. M is buckled into his wheelchair with a safety belt for a reason: he thinks he can get out of the chair and safely move about from place to place. He cannot. This morning, he managed to unbuckle the belt and fell. He didn't hit his head, thank God, but did scrape his back. So, please make sure he doesn't unbuckle the selt belt. Also, it's best that Mark and visitors stay in the day room, rather than in his room. He will talk sometimes about going to lie down. It's a bit of an obsession, so just talk around it. Thanks!

Wednesday, April 25, 2007

A little "toodle-loo"

Let me hasten to say we are not bidding all adieu, but I can imagine M brightly chirping in one of his fake Brit accents, "toodle-loo," as he wiggles the fingers of his left hand. Yes, he can move, even if just barely, all the fingers on his weak side and he can flex his left biceps to oh-so-slowly move his right hand up. It was the week of April 2nd that I first noted M could move his left thumb. As slow as this seems, apparently this is rapid progress in the world of injured brains.

Cognitively, M progresses rather rapidly too. He's been reading the blog at a computer in the hospital for a couple of days and even made a comment yesterday. We can get conversations going either through comments or through an email account newly set up for him. Please do write. He enjoys conversation more than anything, I think, and he is touched by expressions of concern. Bless you all.

Monday, April 23, 2007

Another sharp upswing

What a sweet weekend we had. We celebrated our son's birthday at the hospital with relatives and M joked around and laughed. Later that evening, M on his own started reflecting about the future. He wants to work, to teach others. When he returns to work, he said, he wants to serve others, especially the disabled.

I've mentioned previously the possible consequences of frontal lobe damage: the loss of insight, planning ability, self awareness and awareness of others. Over the past few days, M has been demonstrating a remarkable insight and an ability to empathize. He's projecting himself into the future, showing some of the executive functions so necessary for taking charge of one'e own life.

Later Sunday evening, he transferred himself (with my help) from the wheelchair to a low couch and we sat together for a bible study our church is doing. For twenty minutes, we read the Bible and reflected on answers asked in the study. How sweet to commune with my husband. He reached sometimes in his reflections, was not either as facile or as intense as he could have been three months ago, but he was fully present -- such a gift. A week ago, ten minutes without a non sequiter would have been impossible.

God continues to be so good. We prayed so hard at church Sunday for Ms memory to improve. On a whim, one therapist decided today to test his immediate memory. He amazed all of us by making an almost perfect score. With the immediate memory (remembering things within minutes, such as when you look a phone number up, then turn to dial it), he can use aids to assist his memory. It also shows that healing proceeds.

And today he started reading the blog. A half hour later, he forgot he read the parts he had read, but he was so absorbed while reading, he sat straight up in the wheelchair for half an hour.

Late in the afternoon, we spoke with his doctor. She too is encouraged by his progress, stating she expected his recovery to continue at a rapid pace.

Bless you all. This weekend saw lots of activity at the house, too, with the rooms totally rearranged and most of the boxes of stuff put away. Today dear friends started redoing our entry floor, with stunning results. Soon we'll have a refreshing garden entrance, one that M can negotiate in a wheelchair. It reminds me of an old-fashioned conservatory, just the place for a convalescent to bask in the sun.

Saturday, April 21, 2007

Still making progress

In every session of physical therapy, M walks. He requires assistance, mostly with the left leg, but even the assistance required is lessening. Though progress is achingly slow, M's left arm slowly is regaining strength. The left hand remains mostly unresponsive, but M does have a small amount of control over shoulder and upper arm muscles, which tire easily.

In his cognitive therapies, M's powers of concentration have improved daily. A favorite of the therapists in group therapy, M encourages the other patients, laughs and jokes. Most frustrating, I think, for all of us is how poorly his short term memory operates right now.

Discharge from TIRR is now expected to be May 17th and the recommendation is for M to continue in the day program at TIRR. This means that his schedule would remain the same, but he would stay home nights and we would be responsible for providing personal care during the day while he is at TIRR.

We're making progress at home, too. In a few days, we'll have a new floor in another room and all the boxes will be put away in another week or so.

Bless you all and please pray for progress, strength, and wisdom for us.

Sunday, April 15, 2007

Thanks for the works of art

I have had so much help from so many. Gal pals have piled out of their minivans (and trucks) to freshen up my yard for spring. Barbara has spent two Saturdays in a row moving furniture with me. Ashlyn showed up with fresh fruit and veggie from her co-op, food she and another member, Tina, have pitched in to provide for us.

Still more friends spent all Saturday ripping up the carpet in our bedroom, then sanding and refinishing the hardwood floor. Though the plywood patch (a full sheet of plywood) was an unpleasant surprise that we weren't able to alleviate for now, the concrete patching and other interesting "repairs" were removed nicely. Plus, I can no longer see down to the dirt under the house, thanks!

Thanks especially to Nathan and Darrin, who stayed until 11 p.m. working on the floor. And to Debby, who makes a mean chili cheese dog, times ten or so. And to Kristen, who left at 8:30 only to give our kids a quiet place to sleep, her house.

On Sunday, a bunch a guys we've known from our kids' school showed up to rip and pound the lumber Jim already had delivered earlier, all to make a beautiful ramp. Thanks Jim, Scott, Bill, and Wolfgang. Thanks too to your families who gave up a good part of the weekend with hubby or dad.

I should have jumped up and down at the results of your time and knowledge (and/or brute force). As gorgeous as the ramp is -- fitting perfectly in style with our house and deck -- it hurts to see it out my kitchen window. It's such a present reminder of things having changed. M said it perfectly today when I told him what was going on at the house today (he remembers all you guys). He said he thought you wouldn't mind if he doesn't use the ramp. I agree; I don't think you will.

Any Questions? Any Comments?

Let me know. Thanks to those who have commented. Otherwise, it's lonely lobbing thoughts into the vastness of the web.....

In turn, I should acknowledge my indebtedness to others who have trod this road before me. M is one of the three M's at church. Margaret's emotional honesty touched me deeply and inspires me. I feel for Rita in her role as mother, wife, and chief cheerleader for her husband Mike. As you check on M, please also pray for Mike and Margaret and their families. ...

Friday, April 13, 2007

Caregiving

About half the time now, I hang out in Mark's speech sessions. He speaks very well, but the therapist also helps with cognitive issues such as organization and impulse control, all encompassed within the general term of "executive control." Mark almost entirely lacks these critical skills now and is constantly coached, when in therapy.

I'm glad to be able to participate and am grateful the therapist spoke at length with me about the value of my being there, not just as a caregiver, but actually helping with therapy.

The caregiver role has its own burdens and rewards. Tricia, who used to work with Mark, sent me this.

DEAR LORD, I THANK YOU!

By M. Lemmons

Dear LORD, when you chose me to be a caregiver, I doubted YOU had the right person for the job. I have since learned that YOU have bestowed many blessings on me, and I Thank YOU!

YOU blessed me by giving me the strength to face the challenges each new day brings. YOU blessed me by giving me each new day, and I thank YOU!

YOU blessed me by giving me the patience to be a caregiver, and I thank YOU!

YOU blessed me by showing me how to smile when I wanted to cry and didn't have the time, or the time was inappropriate, and I thank YOU!

YOU blessed me by teaching me to be tolerant of others weaknesses, and I thank YOU!

YOU blessed me by giving me a sense of humor to laugh at myself when I get confused, forgetful, or do something really dumb, and I thank YOU!

YOU blessed me by giving me the determination to do my best for the person I am caring for, and I thank YOU!

YOU blessed me by showing me the intensity of the love I have for the person I am caring for, and I thank YOU!

But most of all, YOU have blessed me by allowing the person I am caring for to stay in my life, and I thank YOU!

Quick Update

Mark continues to progress cognitively and physically, with an edge to the latter. He's been working more on supported walking, using the Robomedica treadmill for the first time yesterday. Because of the specific nature of his injuries (mainly to frontal and temporal lobes), Mark is largely unaware of the severity of his injuries (for example, he does not understand that he cannot walk without assistance and has not for two months). Therefore, he doesn't feel any great need or desire to work on using his left side. Please pray for improvement in his immediate memory and organization skills, areas where his spectacular improvement lags. Please pray also for continued reduction in perseveration.

More good news came in the results of tests this week. His cat scan this week shows all the bleeding and pooled blood in Mark's brain has been resolved. Another vision screening indicated his left neglect has improved greatly.

Today some of his family members and I will tour the Transitional Learning Center in Galveston. The latest recommendation from his doctor at TIRR, though, is for Mark to be discharged in early May, come home, and continue on in the TIRR day program. That means his days will remain the same, except he'll be sleeping at home and I will be responsible for his care, feeding, and transport. I'm eager for continued progress, but wondering how I will juggle work and staying with Mark at TIRR all day. Discharge planning on the institutional end and on mine will come more clear in the next week or so.

It's been explained to me that because Mark has not plateaued in his physical rehab, he would best benefit from continued intensive physical therapy. (This is his doctor's opinion.) When improvement in walking, for example, slows, or if healing leads to accelerated cognitive abilities (and better orientation), a program specializing in cognitive therapy would be most appropriate.

Blessings all.



Author: Elisabeth Elliot
Source: A Lamp For My Feet
Scripture: Exodus 13
Detours

When Pharaoh let the people go, "God did not guide them by the road towards the Philistines, though that way was the shortest.... God made them go round by way of the wilderness towards the Red Sea" (Ex 13: 17, 18 NEB).
The direct route would save time as well as wear and tear on the people, but God had something infinitely more important than economics in mind--He wanted the people to be able to sing the song of praise of chapter 15--"The Lord is my refuge and my defence...my deliverer. He is my God and I will glorify Him; He is my father's God and I will exalt Him" (Ex 15:2 NEB). They sang this song because they had firsthand experience of God's power and deliverance. Pursued by all the chariots and horses, cavalry and infantry of Egypt, they had passed through the Red Sea in safety and seen the enemy drowned. They would have missed this glorious lesson if they had taken the short road.
When we are puzzled by delays and detours, let us think about the great purpose of life: to glorify God. The lessons He wants to teach us "in the wilderness" are priceless means of providing us with a song we could not otherwise have sung: "In Thy constant love Thou hast led the people!" (Ex 15:13).

Friday, April 6, 2007

TWO Thumbs up

I jumped up and down this week at the news that M was able to lift the thumb of his left hand in therapy. His therapist told me, not M, who had forgotten and/or not held this accomplishment in mind as anything special, one little incident indicating how profound and total brain injury can be. The emotional response most of us feel to events, the ability to reflect on experience and recognize its relevance to our lives, M lacks for the most part for the time being. I can say "for the most part" because M is still making progress in leaps and bounds.

Flashes of self-awareness, that the brain injury has affected the survivor's abilities, indicate a big milestone in the recovery process. And M has started saying things such as his memory isn't working very well and that his body is in terrible shape, showing that he is becoming aware of himself. Even further, he is showing an awareness of others' feelings. He turned to me a few nights ago and asked me if I loved him. When I answered yes, of course, why would he ask, he answered that I deserved to be protected and cared for. I was stunned, but able to answer in all truth that we both are sheltered by God.

M's memory, both of events before the accident and since, is returning. He consistently remembers, for example, that he is in TIRR to recover from a traffic accident and that he is right now working on making a pizza with a couple of his therapists. Some have asked about his recognition of people. From the beginning of his ability to let me know, he has always recognized his family members and always has known he has two children, even in the early days when he thought he was still 24 years old. He also recognizes people he had gotten to know just a few years ago and those he has met since being at TIRR.

Others have wondered about our financial circumstances and what lies ahead. M has health insurance, but his group coverage will end before the end of the year. At that point, though I don't have the details, our only option will be to join the state's high-risk pool. I will try to find individual insurance for the children and myself. My office does not offer health insurance as a benefit.

Two years from now, M may qualify for Medicare, if he qualifies for social security disability. I've started the application process for the latter. Mark will be deemed to qualify he is judged to be unable to work in any capacity for a year or longer. His doctors have advised me that is their prognosis for M. But the ss administration will keep a medical hold on M's file for at least several months as he continues to recover.

At this point, M's lead doctor is recommending that, after TIRR, Mark go on to a residential rehabilitation program in Galveston, the Transitional Learning Center, to learn self-care and cognitive coping skills. As much as I want him home, I am realizing more and more how much M needs to learn, but more positively, how much he can learn. We don't know yet if he would be accepted into the program, if the insurance will pay, and when he might go.

Another resource will be available to us in the fall. M is on the waiting list for comprehensive rehabilitation services through the state's Department of Adult Rehabilitation Services. Knowing the paltry level of social services offered in Texas, I'm surprised that such a program exists, but not surprised to know that it will be six months before the program will have sufficient funds to offer services to M. Of course, any expenditures now will not be reimbursed.

As for expenses, without the bills from the hospitals Memorial Hermann or TIRR (over two months of hospitalization), Aetna's accounting has us owing more than $20,000 to doctors alone. M will have a custom wheelchair that may cost us several thousand dollars out of pocket. And our living expenses, without any medical expenses, exceed my income. I am profoundly grateful for friends and family members who already have given us financial support in so many ways, not just cash, but services and meals and other expenditures. Then there is the Herculean effort BVD is putting into a fundraiser for M. In early days, I thought that would be icing on the cake, but am now realizing how important every dollar will be. Regardless of stories about wild spending sprees at the expense of the poor credit card companies, the majority of U.S. bankrupties are precipitated by an incident of illness or disability. And middle class persons with insurance are more likely than the uninsured to owe more money and go bankrupt in such circumstances. (Maybe it is in all truth because we get more services.) More sad statistics, most persons with severe brain injuries go bankrupt and, if married, have a 75% chance of getting divorced. I resolve that, as much as I have any ability to determine things, we will not add to those statistics.

I'm actually getting excited at the prospect of being the family breadwinner (when I'm not daunted and scared witless). Two books I devoured in the course of two days have helped me immeasureably: Where is the Mango Princess?, by the wife of a brain injury survivor and Over my Head: A Doctor's Own Story. I highly recommend both.

In this season of resurrection and new life, I give thanks for all of you, for your prayers, and the possibility of new life for all of us. I pray for God to be glorified and for the good news to spread far and wide.

And I pray that you, being rooted and established in love, may have power, together with all the saints, to grasp how wide and long and high and deep is the love of Christ, and to know this love that surpasses knowledge—that you may be filled to the measure of all the fullness of God. Ephesians 3:17-19

Your attitude should be the same as that of Christ Jesus: Who, being in very nature God, did not consider equality with God something to be grasped, but made himself nothing, taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself and became obedient to death— even death on a cross! Therefore God exalted him to the highest place and gave him the name that is above every name, that at the name of Jesus every knee should bow, in heaven and on earth and under the earth, and every tongue confess that Jesus Christ is Lord, to the glory of God the Father. Philippians 2:5-11

Monday, April 2, 2007

Nice visits, great progress

We've been blessed with lots of visits this weekend and Monday and M has done much better. Visitors really engage his attention and he'll crack jokes and laugh. Cognitively, M was much better today, including his memory of recent events. With friends, we played Battleship and "Kings in a Corner," a solitaire-type card game.

He’s so much stronger physically that he was able to transfer, with only my help holding on to make sure he kept his balance, from wheelchair to bed and other places a few times today. And he went on a bowling outing with other patients and therapists in the morning. Although his left leg is strong enough to bear his weight, he cannot voluntarily move it yet. He can, for very brief moments and ever so slightly, voluntarily move his left arm. Please pray for peace for me and protection from unecessary pain for M. I qualify it because he needs to feel pain on the left side to protect himself from hurt, but not unremitting pain caused by misfiring of nerve signals.

But because of his great love for us, God, who is rich in mercy, made us alive with Christ even when we were dead in transgressions—it is by grace you have been saved. And God raised us up with Christ and seated us with him in the heavenly realms in Christ Jesus, in order that in the coming ages he might show the incomparable riches of his grace, expressed in his kindness to us in Christ Jesus. For it is by grace you have been saved, through faith—and this not from yourselves, it is the gift of God— not by works, so that no one can boast. For we are God's workmanship, created in Christ Jesus to do good works, which God prepared in advance for us to do. Ephesians 2:5-10 (NIV)