Keep On Keepin' On

Judi had her follow-up appointment with her neurosurgeon today and received a clean bill of health. The CT scan showed no issues and her shunt is performing as designed. This is very good news and she will just have routine checks from here on out. I did ask him to give us a referral to a neurologist to ensure that we had all aspects of Judi's recovery covered. He agreed it was a good time to integrate this into her care to ensure we maximize her recovery.

We are hot and heavy into the out-patient rehab program now. Judi is doing great and they are all very high on their expectations for her. She is currently getting all three disciplines (speech, OT, and PT) three times a week. We will have to monitor her energy level to make sure she can keep up at this pace. We plan to have her take a shot at walking (with mechanical assistance) this week or early next week. As I have said before, I have a lot riding on the psychological impact of this for her. Once Judi knows that she will ultimately be free of the wheelchair, I suspect she will tap into that considerable inner strength that we all know she possesses.

Judi continues to work on her speech and we have come back to the physical limitations imposed by the weak neck muscles she has. The lack of strength makes it difficult for her to coordinate all the muscles necessary to accurately form the words. We will continue to work on developing the muscles and her words. I still love to hear the words and the wonderful laugh. She is eating well and becoming more and more aware of what goes on around her.

I want to wish all of you a very Merry Christmas and a Happy New Year. Please enjoy time with family and friends, but don't forget the reason for the season. There are a lot of people around us that are struggling this year. The economy has hit many very hard and the continued deployments have had a huge impact on our military families. If you have the opportunity and the means, please reach out to those in need. A little kindness can go a very long way. I will never be able to repay the kindness we have received from so many, but I will do my best to try! I will continue to keep all of you in my prayers and hope that you will continue to do the same.

Merry Christmas
Steve

Chatterbox

Judi has finally started to talk!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

I am trying not to get too pumped, but I have waited a long time to hear her speaking voice again and I can't describe the impact this has had on Jessica and me. Before everyone gets too excited, the words she is saying are not understandable so we still have a long way to go. I can tell what she is saying in many cases based on what we are talking about and her response when I repeat it back to her. The key here is that she is mastering the mechanics of talking as opposed to speaking specific words. I have been in full cheerleader mode the last couple of weeks in this area. It appears that the BOTOX shots are helping a great deal with her neck control and very possibly in this area as well. She talks more when she is in bed than in her wheelchair which I believe is related to the strain (or lack of) on the muscles in her neck/jaw. We have been spending an hour or so each night with her in bed and talking about the tremendous accomplishments she has made. I usually walk away with a smile on my face and tears in my eyes.

We have still not started outpatient rehab yet, but it typically takes a couple of weeks I have learned before things really get rolling in earnest. I hate waiting, but I have her in the Steve rehab program to prevent her from losing ground from where she was when the home health program came to a conclusion. We actually have a lot of fun doing these things together. The key thing I am looking for here is getting her up and walking with the necessary support equipment as soon as possible. I told her that what I wanted for Christmas was a walking and talking wife and I am holding out hope that we can get there.

The other areas are continuing to improve as previously discussed. She is eating great and continues to improve from an awarenes perspective. Yes/no response is still an area we are struggling in, but is getting better. She had a routine CT scan Tuesday and we have a follow up appointment with her neurosurgeon in a couple weeks to evaluate her progress to date. I suspect he will be surprised at where she is today compared to the last time he saw her.

I'll follow up as soon as we transition to outpatient rehab and the Dr. weighs in. I hate to keep asking, but please keep praying for us. I am convinced more and more every day that God has his hand on Judi's shoulder as a result of all the prayers she is receiving.

Thank you all again!
Steve

Hustle and Bustle

I hope that everyone had a great Thanksgiving and that you gave some thought to the list I mentioned in the last post. I must admit that it was a difficult time for our family. Judi obviously recognized what was going on and she was "off" as we prepared for and had our Thanksgiving dinner. Jessica and I tried to carry on as if nothing significant had changed, but neither of us was totally successful. This time of year is full of family traditions for us and it is going to be an up and down time of year for us. Although this sounds a bit negative, we are EXTREMELY thankful to have our little family together with a future that looks very bright. Or said in Steve's terms, it could have been a lot worse.

Judi continues to grow stronger mentally and physically. We took our first big outing since the accident last Friday and took her to Cirque du Soleil. She did very well and it was great to do something like this as a family again. She did check out a few times during some of the louder/fast paced scenes, but overall followed the show pretty well. It was an awesome show and a great boost for us after struggling through turkey day. The trip to the Columbia Zoo is next and I am sure she will enjoy it as well.

Judi was evaluated for her outpatient therapy program at Walton today. Overall, everything was very positive. All disciplines felt she was doing very well and that they could make some significant progress with her. As a group, they also felt that it was time to give her some intense and aggressive therapy based on what she had accomplished so far in such a short period of time. I think most of you know that I have always thought this would be the most beneficial therapy environment for her and I am excited to see her finally reach this stage. She is strong enough mentally and physically to participate now and I am confident that Judi will show her true strength now. My hope is that each success along the way will provide the motivation to keep pushing to accept the next challenge.

Judi also got BOTOX injections in her neck today to aid in her recovery from wearing the cervical collar (neck brace) for so long. The goal is to relax some of the muscles that have contracted and allow her to continue recovering strength in this area. This continues to be one of the key issues in Judi's ability to perform some of the routine tasks we take for granted. If you think about the things that would be complicated if your head was down (chin on your chest), you have an idea of what she is faced with the majority of the time. She has compensated pretty well for it to date, but she is at the point now where it is limiting her recovery. We will have to watch her close to insure it does not impact her ability to swallow and the impact to her muscle freedom will take a couple of weeks to see.

I thank all of you again for your continued well wishes and prayers. We are building some momentum and I continue to hold out for a full recovery for my girl!

Steve

The Next Phase Begins

Judi continues to advance physically and mentally. Progress is slow, but steady.

Based on her mental and physical health, we will be transitioning from Home Health to Outpatient Therapy at the end of this week. I suspect we will utilize the Walton Rehab Outpatient program for this phase. The facility is very nice and provides easy access to the other physical needs she may have (her brain injury doctor is in the same building). We are pretty excited about getting her back in this environment. It provides her access to a wide array of equipment to focus on her specific needs and it provides a good social environment as well. Those of you that know Judi also know she loves to socialize. I personally believe it will do her good to be around others who are also recovering. She is also a VERY competitive lady and I am hopeful she will "kick it up a notch" to show others what she can do.

Still working on yes/no responses. She is getting better there, but still a long way to go. She is keenly aware of everything going on around her and clearly understands even subtle comments/humor.

She continues to do everything necessary to talk (vocalize, move lips, whispers at times, etc.) and just needs to do it. Pulsing several doctors and speech professionals, the belief is that she just needs to make that last connection and then will step out of there with her bad self. There is nothing indicating that this connection won't ultimately occur.

As previously noted, she shows the most gains in the physical arena. She is beginning to move her left leg under her control (as opposed to some spontaneous movement). This is excellent news and is what we hoped the standing frame would stimulate. Hopefully we will get her walking in a harness in outpatient therapy soon. This will be awesome physical and mental therapy for her (and for me). I suspect it will be excellent mental medicine to know that she will indeed be able to get out of the wheelchair.

Judi continues to eat well and I am sure she will enjoy our traditional Thanksgiving Day feast. I have already factored her needs into our menu and it should be gastronomical treat for all.

I have been getting Judi out of the house every day I am off and taking her somewhere. This past weekend we finally got to the park at the lake and it did both of us a lot of good. We spent an hour just talking (still difficult for me to do all the talking and her listening) and enjoying the awesome weather. She clearly recognized the location and remembered the things I talked about. We are going to make the trip to the Columbia Zoo for the Christmas lights after turkey day. She had a blast there the last time we went and the trip is short enough for her to be able to tolerate it. If you have never been, it is worth the trip.

I have tried not to get philosophical on the blog, but I have a few things that I think need to be said as we approach Thanksgiving. First and foremost I am eternally grateful to each and every one of you that have lifted Judi and/or our family up in prayer this year. I have been blessed to see God's work up close and personal. I have watched the love of my life go from fighting for her very survival to a very real possibility of a full recovery. If that's not a miracle, I don't know what one could be. THANK YOU ALL Second I would ask that all of you step back and take a close look at your lives and what is truly important to you and your family. There is no guarantee that any of us will be here tomorrow and there are some things that we should simply just "do it" and quit coming up with reasons it can wait. I will tell you that if I had generated a list of the top 10 things most important to me the day before Judi was injured and compared it to what is important to me today, they would be VERY different lists. I encourage each of you as a family make that list and DO IT! And last, but not least by any means, there are a lot of people around us that are in desperate need this year. The wars and the economy have brought many families to a point where they too have the same lost feeling I have faced this year (and many of you have as well). If you can, reach out and help them as well.

Soooooooooo.... HAPPY THANKSGIVING

Steve

Making Progress Slow and Steady

Judi continues to grow stronger physically and mentally.

The standing frame is already paying benefits. She enjoys standing and is able to work on other skills at the work table simultaneously. I think this allows her to stand longer since she is focused on other things and her body goes to its natural position.

Judi's awareness level continues to improve as evidenced by her reaction to things that go on and/or are said around her. We are also starting to have some success with yes/no responses using the new switch system with audible feedback. We still have a long way to go there, but we are encouraged by what we are seeing.

Judi is eating well and she has no difficulty swallowing or managing what she is eating now. I suspect we will do another swallow study in the next week or so and I believe the restriction on having to thicken her liquids will be removed. I think she will also be able to begin eating foods that have not been "chopped up" quite so much. She does a good job feeding herself and the independence is obviously good for her. We'll also evaluate what to do with the PEG after the next study. There are some distinct advantages to keeping it, but it does present a source of infection still and she has become increasingly interested in pulling on it.

Thanx to everyone for the continued support and prayers.

Steve

Steady Improvemnt (Part 2)

I will keep this post short since it is nearly identical to the last. Please don't mistake this for a plateau, she IS steadily improving.

Getting physically stronger every day. We do have her standing frame (finally) and hope this will have a big impact on restoring strength to her left leg.

Mentally she continues to become more aware, but the consistent "yes/no" response continues to elude us. We will continue to focus a lot of attention here.

Speech - any minute. She is becoming increasingly vocal and experimenting with sounds. It won't be long.

She continues to eat well and is enjoying many of her old favorites.

Although Judi is doing better every day, she still has a long way to go. Please continue to keep us in your prayers as we take on new challenges. I am convinced that Judi's recovery so far is nothing short of a miracle and that the power of prayer from people all over the world has made the difference.

Steve

Steady Improvement

This will be short and sweet so that I don't just repeat what was in last weeks update.

Judi continues to show progress on a slow and steady basis. She is visibly stronger physically and this is probably her area of greatest improvement. She is able to sit with minimal assistance for several minutes (sounds small, but is a huge accomplishment from where she was just a few weeks ago). We are still waiting to get the standing frame (long saga), but we continue to stand her up with assistance from 2-3 of us and she tolerates it well.

Mentally she continues to become more aware of what goes on around her. She clearly understands most of it, but still struggles with the "yes/no" responses. I did get her an electronic switch setup that provides audible feedback and we will continue to work with her on this front. Her laughter is still the best medicine for us and I can tell it does her good as well. We did take her back to her old office at Augusta Oncology Associates this weekend and she clearly recognized the surroundings and several memories were obviously stirred (thanx Jules for your support). We will continue to expose her to these types of things to help her "snap back," but in a controlled fashion.

Speech - any minute.

She is eating well and for all practical purposes is off the tube feedings. We do still supplement her when we are concerned whether or not she is getting enough calories based on "what" she eats as opposed to "how much." Please don't tell her!

Thanx again for all the prayers and support. Don't hesitate to call and visit. The only reason I ask that you coordinate with me on them is to ensure there is no conflict and that she is physically ready for a visit (she still gets tired easy).

Steve

Slow and Steady

Judi continues to improve at a slow and steady pace. My world on the other hand seems to constantly pick up speed. I just realized last night that I had missed a week on updating the blog. It just seems like I run out of hours before I run out of things on my "to do" list, so bear with me as I try to establish a new routine.

Judi continues to grow measurably stronger on almost a daily basis. PT/OT continues to focus on her core and she is visibly more comfortable and confident during these sessions. We have a standing frame coming in from Louisiana this week and we are looking forward to getting this therapy back in her routine. Having one here will allow her to spend as much time standing as she can tolerate while doing other things as well (TV, eye/hand coordination activities, etc.).

Speech - any minute!

Mentally, she is still coming back to us slowly. She obviously understands most of what goes on around her and we are able to get her laughing on a fairly frequent basis. This can be in response to sounds, comments and even spelled words. As I said before, hearing her laugh does all of us a lot of good. We have still been unable to establish a reliable yes/no response system with her. We are wondering if Judi needs some specific auditory feedback when she answers to help her become consistent. What I mean by this is the use of a switch that when she presses it responds audibly "yes" or "no." If anyone knows where I can get a system that does this, please let me know ASAP. If not, I am going to try and build one myself (ideas are welcome).

She is eating well and is helping a great deal in the routine daily tasks (getting dressed, brushing teeth, etc.). We did get a van and she has enjoyed getting out of the house. We planned to have a picnic this weekend, but the weather has not cooperated. She has enjoyed visits from many of you and she always seems to improve a little after spending time with her friends. Just drop me a line if you want to come by and we'll figure out a way to make it happen.

I did go back to work this week and it was one of the most difficult things I have had to do in a very long time. Both of us had some adjusting to do, but it is working out fine. She has a huge smile waiting for me when I walk in the door and I can't describe how much that touches me. She has bonded well with the lady that stays with her so we are considering it a "win-win" for now. I want to thank everyone for the continued prayers and well wishes. I know we wouldn't be this far along without you!

Steve

Things Are Moving Fast

Just a short post this week.

Judi's therapy sessions are going well and we continue to make progress. We were able to get a mat table where she can do a huge number of exercises focused on strengthening her "core." Thanx to Michelle Jones for allowing us to borrow one for a while. We are in the process of getting her a standing frame to use at home. Hopefully we can find one to rent since they are so expensive, but the benefit is potentially so great for her we will buy one if necessary. These two pieces allow us to focus a lot of "load bearing" exercises to her left side which is the traditional therapy to activate the nerves in these extremities.

Judi continues to eat well and improve at eating on her own (most days). We hope to have her off the tube feeding next week. We will probably keep the PEG in until she is capable of eating/drinking all consistencies. This provides a reliable method to ensure she gets her medications and a backup to feed her if necessary.

I think we have figured out why she isn't talking. She has difficulty opening her mouth when you ask her to (e.g. to brush teeth). When it is a reflex (e.g. yawning), she opens it fine so we know there is no mechanical reason. She is very vocal, but most of the time she keeps her mouth closed. We'll keep working here to help her restore that control and maybe that will open the "flood gates."

Mentally Judi continues to grow. She clearly understands most of what goes on around her and memories are returning at an increased pace. We have started looking at picture albums from way back to the time when we started dating. She stays totally focused on these and there are tears at times as well. I'll admit it brings back some emotional memories for me as well. We continue to work numbers, colors, shapes and letters and she is doing very good in this area. We have still not been able to establish a consistent "yes/no" system where she can communicate with us.

I plan on going back to work the week of 10/12 unless something new comes up. That is going to be very hard for me to do for many reasons. I am eternally grateful for all of the support from my bosses and co-workers over the last several months. We have identified a wonderful lady to take care of Judi during the day while I am away. She is very experienced and will be able to help Judi a great deal. I'll also admit that I need to get some balance back in my life as well. If you want to visit, just drop me an e-mail so I can coordinate it. Most people tend to come at the end of the day, but if you can come during the day, she usually has more energy.

Thanx again everyone,
Steve

Busy Busy Busy

Well, we have been home for a little over a week and things are continuing to evolve on a daily basis. I didn't think I could be any busier than I was before, but I am busier than a three legged cat in a litter box (you'll have to use your imagination to get the picture).

We have completed the initial Home Health speech, occupational and physical therapy evaluations. We tried as much as possible to pick up where we left off at Walton. In some cases it was not possible to continue specific therapies at home (e.g. standing frame), but we were able to come up with activities that accomplish essentially the same goal. The Home Health program will continue until she is strong enough to participate in an outpatient therapy program. I suspect that will be 4-6 weeks and we'll keep the same focus areas that we had at Walton.

Judi is eating very well and hopefully the next swallow study will show some significant improvements. She is feeding herself, but the technique needs a lot of work. Meal time is a true test of patience, but you have to let her do it if she is going to learn. Much of it is continuing to develop her eye/hand coordination again.

We have made significant gains on the mental front since being home. Judi will essentially follow any command that she understands. She has become very inquisitive in many areas, but anything mechanical in nature totally intrigues her and she has to figure out how it works. As you can guess, she usually figures it out pretty quickly. She is very good picking colors and now we are working on numbers and letters. She is also starting to recall memories from the past. I talk to her almost constantly when we are together and as mentioned before, I believe she understands all of it. Today I asked her if she remembered what she did to me the first time we went to the beach together (that was 30 years ago), and she busted out laughing. As previously stated, I won't tell you all our secrets, but that was clearly the right response. I can't tell you how uplifting it is to hear her laugh. Jessica also comes running when she hears her because it just validates to us that Judi is there and we just need to help her come back.

We have had some very emotional days as she continues to absorb what is around her and where she is physically/mentally. I don't think she remembers what happened to her, but I think she realizes that she has a serious brain injury and some associated physical limitations. She gets very frustrated at times when she is not able to get her body/mind to do what she knows it should do. I will admit we have had some good cries together and it usually does both of us good. Those are usually followed by a little quiet time holding her close and praying with all the energy I have for the strength to carry on. Those prayers have been answered every time and it seems that the spark in those brown eyes of hers gets a little brighter when we work through these. Although these are emotionally draining, they are all good signs that her cognitive side is returning.

As far as talking, I expect her to start at any minute.

I need to thank all of you for your continued support and prayers. I need to give special thanx to my brother and some very generous members of his church. They are all builders by trade and are providing the labor to build a sun room on the back of our house to give Judi a wonderful place to recover since all of our bedrooms are upstairs. I also need to give a special thanx to Mary Ellen and Christine from Judi's Weight Watcher's group for the wonderful meals they brought for us last week. The food was awesome and I am signing up for the program if this what they get to eat!

Steve

Home Again!

Well, after almost 5 months, Judi is back at home!!!!

I know that both of us are tired of staring at hospital walls and dealing with the routines inherent to those types of facilities. Although Judi was doing very well in rehab, she had reached the point where it was no longer necessary to be in the hospital environment while receiving therapy.

She will continue to receive therapy in our home until she is strong enough to participate in an outpatient rehab program. We still have a long way to go, but she continues to make steady progress and we want her to keep that momentum. We will continue to focus on the same core areas since they open so many other doors for her. Hopefully I can get her to eat more with some home cooking and finally transition from the feeding tube.

The biggest thing we hope to achieve with bringing her home is to allow her time to heal mentally in a familiar environment. She had a difficult time yesterday as we went around the house. She was constantly rubbing her head and very agitated. I suspect that it was just a huge rush of electrical energy in her brain as everything came rushing in. I did remove all the things that would make her think of motorcycles before she came home. I really want to be able to talk with her and understand how she feels before she gets exposed to those things. We'll continue to take it slow and easy and give her plenty of time to heal. I continue to remind people that Judi's last brain surgery (bone flap ) was just a month ago and she has made huge progress since then. Once she begins to talk, I suspect we can make a lot of additional progress. She has already shown the ability to "learn" things that she is exposed to. I continue to have faith that she will recover fully in this area.

If you would like to come and visit, just let me know before hand. She still tires easily (physically and mentally), but the visits are great for her. I am finally starting to put our house back together after five months of leaving things where they landed. Hopefully Judi won't remember the mess when she comes around or I'll be in deep trouble.

Several people have asked what our plans are now that Judi is at home. I plan to stay at home with her for the next couple of weeks as we get all of the home health and other logistics in place and running. I also want to be with her to ensure that she gets the "TLC" she needs as she deals with being home and the rush of old memories she may have to deal with initially. I have hired an agency (Right at Home) to take care of her during the day when I go back to work. They will provide Certified Nursing Assistants (CNAs) who are experienced with people in her condition and have the medical knowledge to monitor for problems and deal with emergencies. It will be the same couple of people so that they can build a relationship with us. I believe this is critical for Judi so that there is a stable environment instead of sea of constantly changing faces. I'll stick with the weekly updates unless something dramatic occurs.

Thanx again for all the prayers and support,
Steve

Rehab Update

Judi continues to get better day by day. She will be staying at least another week due to the progress she is making.

She is still struggling with talking where we can understand her, but she is very vocal and has started laughing at times as well. I can't tell you what it does to my spirits to hear her laugh after all we have been through. I can also tell you that without a doubt, Judi understands at least part of what we are telling her. I won't tell you what I said to her, but it was an old joke between us and she started laughing when I said it. Just another reminder she is in there and ready to come back to us.

She is following commands much better and has become VERY active in exploring things around her. I made a mistake and showed her how to unbuckle her wheel chair seat belt (What was I thinking????). I have to keep a close eye on it now because she can do it pretty quickly. She is also intrigued with different textures and loves to touch everything that comes within reach. These are all good signs.

She continues to have difficulty processing information that requires multiple brain functions and being able to establish a clear method to communicate "yes/no" responses. This has us a little perplexed because she is doing so well in other areas. We continue to believe this is just going to take time. Unfortunately, this is one of the most critical areas since it inhibits our ability to really communicate with Judi and start focusing on specific issues that she can tell us about.

PT continues to go well. We continue to focus on standing in the "standing frame" and sitting up without support. You can tell this causes her a great deal of discomfort, but she does her best to "suck it up" and get stronger. Sometimes though, she just needs to lay down and take a rest. Her left side is still very weak, but seems to be getting slightly more responsive. We'll keep working on this as well. My admiration for Judi continues to grow as I watch her fight her way through these things.

Eye hand coordination (right side) getting much better. We believe she is having some trouble with her vision field which may be contributing to some of her difficulties. This is not uncommon and often resolves itself by getting her to look away from her "strong view" and the recognition by the brain that she can see over there as well (that may not be the anatomically correct description, but you get the picture).

Swallow study today went OK. Still struggling with regular liquids, but did fine with a cookie (go figure). This will allow her to eat ground meats/veggies instead of pureed and hopefully they will retain a little more flavor. She is not eating as well as I hoped she would, but we believe it will just take time since it has been so long and she had already become a pretty small portion eater as part of her weight loss program prior to the accident. It is kind of a "Catch 22" because if she doesn't eat, we have to feed her through the PEG to ensure she doesn't become malnourished which causes her to be full when the next meal rolls around. I am working with the dietitian to come up with a plan to get her on a path where she can be successful.

We had her follow up doctors visit at MCG yesterday and all was well. CT scan shows things heading in the right direction. She got all of her sutures removed and now we'll be able to let her head heal (it has been through a lot!). We have our next follow up in three months. It dawned on me as we drove from Walton to MCG with her in a wheelchair, this was the first time since her accident that she had been able to sit up and see the world around her. She was taking it all in as we passed many familiar landmarks in the area and just the amount of motion she could view was almost overloading her senses.

Several of you have been to visit and she seems to enjoy it very much. It seems to be good for the visitor(s) as well. Just shoot me an e-mail if you would like to come so I can make sure you don't waste a trip (in rehab, asleep, etc.). If you want to wait until we are back home, that's OK too. I already promised her she could have "girl's night" anytime she wanted when we got back home and catch up on all the news. Thanx again for all of the prayers and support.

Steve

Getting Better Every Day

A quick update on where we are.

Judi continues to do very well in rehab. Her trach is out and the stoma is already closed off and healing well. She is still struggling with talking on a regular basis. She will say a few words very softly, or mouth them, but has yet to master the Judi voice of old. She is very close though and we will continue to push her in this area. I am sure there is a flood ready to come when those gates open!

She is eating well and swallowing normally with the pureed foods and thickened liquids. She will have another swallow study on Wednesday of next week which will hopefully allow her to move into more food consistency options. I will tell you that thickened decaf coffee was NOT a hit. She is holding out for the real McCoy I think.

PT continues to go well and she is getting stronger every day. She is starting to push her wheelchair with her right hand in addition to her right foot. Her left side is still very weak, but we believe that with time she will grow stronger there as well. Her neck is getting much stronger and we continue to work on the "core" muscles to aid in sitting unassisted. We still have a ways to go here, but she is heading in right direction.

OT is going much better. Judi is recognizing colors and working some simple shape puzzles. The eye hand coordination continues to be the focus area since it requires a lot of processing to perform.

We are still not certain about Judi's schedule over the next few weeks. She has done so well that we want to make sure she stays long enough to maximize her benefits, but not too long that she becomes frustrated because she just plain can't do it yet. I still believe we will be home in a week or two to allow her an opportunity to heal and continue to get stronger. She will continue to get therapy there as well. If you would like to come and visit, please send me an e-mail at swilk@knology.net and we will try and coordinate it. She enjoys having visitors, but I need to make sure we don't get too many (she still overloads easily) and that her rehab schedule accommodates it. Once she is home, it will be easier to come and visit.

I have to continually thank everyone for their continued support and prayers. I continue to find it in many unanticipated places. One of my co-workers has a loved one in the room next to Judi and she stopped by and provided me with a tremendous boost with her caring words and prayer. I went to the dentist this week to get some work done that I had put off because of Judi's injury and he took time out of his hectic day to stop and pray with me for our family (Dr. David Reid in case you need a good dentist who is also a good man). I hope this is not inappropriate for our blog, but I am also looking for a wheelchair accessible van. Ideally I would like to lease one for a few months because I am confident Judi will only be in a chair temporarily, but I will buy one if that is the only option. I don't plan on letting Judi stare at the walls. You all know how much we like to go and we are not going to let this stop us. If anyone has one or a possible contact, please send it to my e-mail above. We would greatly appreciate it.

Thanx again,
Steve

Rehab Update - What a Woman!

What can I say? Judi has exceeded all of the therapists' expectations this week. I, of course was not surprised and did resist the urge to yell out "I told you so!" She has worked so hard that it is truly inspiring to see.

She is eating again and has progressed to the point where she can start eating enough to be part of her overall nutrition instead of just therapy. Hopefully she will tolerate this well and we can drive towards removing the feeding tube and a normal diet.

Her trach is capped and we plan to leave it that way through the weekend. As long as she has no issues, we will remove it on Monday. We have been a little surprised that she hasn't started talking yet, but she is VERY close and it may take the trach removal to push her over the edge. She makes a lot of sounds and routinely mouths words. She also had a laugh during one of her therapies that was wonderful to hear. Just a good reminder that she is in there and we just need to help her come back to us.

She is doing well in Physical Therapy (PT) and getting stronger every day. She is standing up in the "standing machine" for about 30 mins at a time. This helps her in many ways. We continue to work on strengthening her abdominal muscles to provide support for her when she sits without something behind her. Once she can sit unsupported it makes moving her to/from a wheel chair much easier (and comfortable). Her neck muscles are also a focus area. The neck brace always creates an issue with weakening muscles from lack of use and Judi had to wear one for a long time. We need her to get that strength so she can safely ride in a car or something similar that does not have a specific support. All of you know that Judi loves to be "on the go" so both of these areas are important to her physically as well as from a quality of life perspective. Just to make sure everyone understands, the wheelchair is an interim step while Judi recovers her muscle strength and coordination. I fully expect her to be walking and throwing a bowling ball in the future.

Occupational Therapy (OT) continues to be the biggest challenge for her. This deals a lot with doing tasks that we take for granted in our everyday lives like brushing your teeth, feeding yourself, etc. These present the most difficulty at this point due to the fact it requires a lot of eye hand coordination, fine motor skills, etc. that just take time to get back. Judi is chipping away at these, but the going is slow due to the combined effects of the brain injury and muscle recovery. I have no doubt that she will continue to pick up momentum here as well.

Judi is following commands better and I have her counting with her fingers as well. She is still working on yes/no type responses which continue to be impacted by her limited ability to process information at multiple level of the brain. I continue to believe she just needs time here since she has steadily improved.

I am getting everything ready for her to come home soon. We are still not sure how long she will stay in rehab this time. That will be determined by what is right for her from the big picture. We have no desire to force her through therapy that doesn't truly provide value for her at this time. At some point we need to let her mental state recover sufficiently so that she can understand what she is being asked to do and not be presented with a bunch of tasks that only serve to frustrate her. A familiar environment, some quality social time and my cooking are sure to bring her up to speed in a hurry. Many of you have offered to help with some tasks along the way and I may need a little help once I get her home initially. With Jessica working full time at school, it will only be me for a while and I will have to stay with her at all times.

Thanx again for the prayers (they are working) and all the other support as well,
Steve

Busy Days

Judi continues to work her butt off to get stronger and recover.

She went about eight hours with her trach capped and had no issues keeping her O2 levels up. By the end of that period though, she was tired from the combination of breathing normally and rehab activities. We'll keep letting her grow stronger until she goes about 48 hours with no issues and then remove the trach. Should be on track for late this week or early next week.

She goes for a swallow study tomorrow which evaluates how well she manages to swallow different consistencies of food. After the study, we'll know what types of foods she can handle and let her start eating regularly. At first, it will be small amounts primarily for therapy and then build up to the point where she gets her nutrition from what she eats. Once she is eating and drinking well enough, we can remove the feeding tube from her stomach. That will be another big day for us. I was joking with a nurse the other day that Judi would pitch a fit if she knew that you were giving her 500 calories in an 8 oz can of anything. Those of you in her Weight Watchers group know how far she (you) can make 500 calories go. I was always impressed with her discipline in this area. That same discipline is already paying dividends for her today.

Physical therapy continues to go well and she is obviously getting stronger. She stood up today with the aid of a machine that slowly lifts her and shifts the weight to her legs/feet. She was pretty excited and VERY tired after that. This is intended to provide feedback from the nerves in her legs/feet/joints to the brain to stimulate the process associated with controlling them. Although this sounds like a simple evolution, it took five people (me included) to get her in position and then support her. This is why I wanted to get her in a REAL rehab facility so bad. It takes a lot of people that know what they are doing to provide this type of therapy.

I continue to be humbled and eternally grateful for all of the support we have received from so many. The prayers and well wishes keep us strong spiritually. Many of my co-workers at SRS have even donated their precious vacation time to me so that I could stay by Judi's side and not worry about how I would pay the bills. We have received "care packages" from numerous folks and organizations. The list goes on and on and I could never list all of the things people have done for us.

Thanx for the continued support,
Steve, Judi and Jess

Back in Rehab

Well, we moved back to Walton Rehab late Thursday and got Judi all settled in. Today was a big day since it was the first time she was able to participate without all of the "gadgets" we had to contend with the last time. Gone is the hated back brace. Gone is the hated neck brace. Gone is the hated helmet as well. Judi is a totally different patient this time and she seems to be picking up where she left off as opposed to starting all over.

I believe she will be talking very soon. She is working on making sounds and she mouths words at times. Her vocal chords are weak from lack of use (never thought that would be an issue for my girl) and she needs to regain strength in her diaphragm. She is also trying to figure out how to manage all the aspects of actually speaking (air flow, tongue, lips, etc.). We were able to give her some applesauce and "honey thick" cranberry juice today and she thoroughly enjoyed that. As you may recall, she had just been able to start eating a little the day before we had to go back to MCG. I can only imagine how good it tasted to have something that wasn't antiseptic tasting in her mouth for a change. At this point, it is more for speech therapy than for nutritional purposes, but it won't take too long before she can begin eating regularly again.

She spent a couple of hours in the wheel chair today and was very comfortable. This is where the lack of gadgets really paid off. She never got hot and her heart rate stayed steady throughout. We are building slowly here since we still need to develop her muscle strength to support her in the sitting position, allow her to get acclimated to the difference in her back from the surgery and allow her neck muscles to strengthen from having the neck brace on for so long. She is doing awesome as anticipated.

We have already begun trials with "capping" her trach for short periods of time and she tolerated that very well. I suspect that we will finally have the trach out next week sometime. Again, you may recall we were going to remove her trach the morning we had to go back to MCG. I will be VERY happy to see this source of infection eliminated and it greatly simplifies many of her rehab activities as well.

Judi also has a new doctor that recently joined Walton Rehab (Andrew Dennison) who is a brain injury specialist. In just a few conversations with him it is obvious he has his act together and is already evaluating some different treatment options for Judi's mental recovery.

I continue to have faith that we will be able to get Judi back to her old self, but I also realize that it is going to take some time for that process to occur. The next week or so will determine if we continue down the high intensity rehab path or bring Judi home for a while to allow her to get stronger (mentally and physically). There are merits to both and we'll make the decision that is best for Judi. She can have visitors here, but the hours are limited and must be integrated into her rehab schedule. Give us a few days to get in the groove and see how tired she is at the end of the day. After that, we'll see what we can fit in. Thanx for being patient.

Hopefully this gives everyone a good feel for where we are. Keep praying for us and you never know when you might get a phone call from Judi.

Steve

Out of ICU

A quick update.
Judi was discharged from the ICU today and transferred to the Neuro floor unit. Everything is looking good from the surgery so far. Her awareness level has increased significantly and she is moving around much more than she has in the past. We hope to be moving to rehab soon and see how she does. I'll do a better update once we have a clearer picture.

Steve

Last Surgery in the Books

Judi had her surgery today to replace the bone flap removed back in April. Her surgeon said all went well and there were no surprises. Using his words: "It was a boring surgery." She was placed on the ventilator long enough to perform the surgery and then immediately taken off after she was stable. She never missed a beat and has been breathing on her own every since. Over the next few days we will be monitoring the fluid restoration to the new cavity and the brain position as it is allowed to return to its natural position. The possibility exists that we may have to close off the shunt for a period of time to allow the fluid to buildup in her head, but that does not involve another head surgery if it becomes necessary.

Hopefully this is the last surgery Judi will have to go through. I have been reminded countless times throughout this journey what a truly special lady I am married to. She has been through more than we could ever describe in words here and has consistently shown she is made of the "right stuff." Unfortunately, she has a lot of work in front of her to complete her recovery. We'll have a better idea of what's next over the next few days and weeks as she recovers from the last couple of surgeries. The initial focus will be to get her off the trach completely and back to eating/drinking normally. During this process, we will be able to see if she is ready for acute rehab (traditionally defined as three hours per day) or if she just needs to come home and rest for a while.

Once we have her out of ICU here and on the way to recovery, I know she would love to visit with the members of "Team Judi." We'll have to make sure we don't overload her so I'll come up with some way to make sure we have the appropriate controls for visiting in place. Please keep us in your prayers as we head down the next leg of the recovery path and thanx again for the tremendous support you have already given us.

Steve

Not Yet

Just a quick update since I know many are anxiously awaiting news. Judi is still waiting for surgery. We had two false starts, but we knew this was a possibility and we'll just have to remain patient a bit longer. I'll update again as soon as there is any new news.

Looking Up!

Jessica is wide open getting ready to embark on her new career as a school teacher (teaching eighth grade math at Grovetown Middle School) so I am going to do my best to keep the blog updated for a while. This post will be a little longer than usual as I try and bring you up to date with all that has happened this week.

Judi is off the ventilator! The standard protocols were just not working for her and it did not appear that she was having any real trouble breathing on her own. We finally just took her off the ventilator (under intense observation) and she never missed a beat. I will admit that it took a couple of days before I could relax and not count every breath she took.

We were also able to get her cleared from the neck brace after all. Kudos to the MCG team for that! They kept evaluating her condition and determined it was safe and beneficial for her to start regaining strength in her neck muscles. She is still exploring that new freedom and we are watching her closely to ensure she doesn't over do it.

Judi's movement of her hands and feet continue to improve as well. She is strongest on her right side which is expected since the majority of her brain injury manifested itself on the right side. Most of you know that the right side of the body is controlled by the left side of the brain and vice versa. This was the reason we were so concerned that the shunt had to be installed in the left side of her brain since there had not been any visible damage there.

We have made the decision to put the bone flap back in that was removed during her craniotomy back in April. We believe this will allow her brain to move back to its "natural" orientation and provide the best environment for it to continue to heal. It will also be much safer for Judi as she continues the recovery process. This will be a long surgery for Judi and we anticipate that there will be some issues restoring the fluid balance in her head following the replacement. This could require additional surgery and/or manipulation of the shunt that was installed, but we'll deal with that as necessary. I also anticipate that this will be one of those emotional roller coasters from a scheduling perspective in the Operating Room. Since it will be a long surgery, it will be difficult to get and maintain an open window due to all of the critical cases that come to MCG. We will also have to put Judi back on the ventilator for the surgery. I am confident though that she will continue to be the fighter she has been from the start and continue to step up when she needs to.

There has been a lot of good news this week, but we have a long way to go. Judi is still in the ICU and needs all of your prayers. I don't have the words to describe how critical they have been to our family. I can say that there have been several days that I only made it by drawing on the strength of those prayers and it is obvious that God is watching over Judi as she recovers.

Thanx for the continued support,
Steve

Puzzling Days

Judi is continuing to struggle with the ventilator, which is puzzling the doctors. They said it is not neurological, which is a relief. Still, we are a little frustrated that she is having so much trouble. This may not seem like that big of a deal, but it is holding her back in her recovery, because she gets completely focused on the ventilator and can't get past it. (Much like when she was at MCG the first time around.)

Fortunately, she was approved to not have to wear her back brace in bed anymore, which is a huge relief for us. Putting the brace on is a big task, and it causes enough discomfort sometimes that it defeats the purpose of sitting up in bed. We are not having as much luck getting the neck brace cleared, but you can't win them all, I guess.

We are a little concerned right now with the site of her craniotomy. Since the installation of the drain, the skin has really drawn in. The neurosurgeon is considering putting her bone flap back soon, which would be another good thing for her, we think. While there are some health advantages to having it out, it will be safer for her when it's back in.

Despite the apparent doom and gloom, she is showing some progress. The surgery set her back a bit, but she's starting moving her hands and feet around again. So, as always, we are trying to take things one day at a time.

Judi's surgery Friday went very well. The drain is 'perfectly placed,' to quote one of the neurosurgeons, and seems to be performing its job. We've peeked under her bandages and were startled by how different her head looks. This led to some speculation that she might have been dealing with some of this fluid buildup for quite a while. The doctors agreed that she might have.

I bring this up because one of the issues that arises from hydrocephalus (fluid building up in the head) is that it can negatively affect cognition. We're hoping that she will come back better than before when she's fully recovered.

Right now she is still pretty tired and probably very confused. The doctors had to paralyze her for part of the surgery, as well as reopen her trach and put her back on the ventilator. We think she is really focused on the ventilator again and probably wondering why in the world she's attached to it again after being without it for so long. Also, we were laughing a little to think that for the last few weeks we've been telling her to breathe through her nose and mouth, and now she can't because of the vent. They are weaning her back off it again, though, and she should be back on her own soon.

So that's where we are right now. We're not sure what will happen in the next few days - if she will go back to Walton or go out onto the floor or what. We will keep you posted. Thanks for your prayers and support!

A Bump In The Road

Well, they told us we'd have those setbacks, and so we have. Judi was readmitted to the hospital yesterday due to swelling in her head. Steve noticed the swelling and asked for a consult, and the decision was made quickly to take her to MCG to find out what was going on.

The CT scan showed significant hydrocephalus - which is fluid on the brain. This happens when cerebrospinal fluid is not reabsorbed into the brain, and instead collects in the head. Because her bone flap is still out from her craniotomy, there is plenty of room right now. For you and I, this would be a serious crisis. For her, it's still a big deal but she has the room to swell.

She is currently in the Neuro ICU back at MCG and will be going into surgery tomorrow morning at 11:00. That's hospital time, of course, so it could be 11:00 or it could be 4:00, so who knows. One of the neurosurgeons who saw her when she first had her accident will be performing the procedure. He will be installing a shunt, which is essentially a drain that vents internally. It will run under the skin, from the head down into the abdominal cavity where the fluid can be reabsorbed.

We are hopeful that this is just a minor bump in the road, and that she can get back to rehab next week. Please keep her in your thoughts tomorrow.

More New Places and New Faces

Well, after some calling around and more deliberation, we ended up taking Judi to Walton. Most of the recommended nursing facilities would not accept Judi with a trach, which made us a little leery about them being able to deal with her other issues. Though she is not ready for the full program at Walton, they are more experienced at dealing with complications like her back brace or helmet. They can give her the appropriate care and help her work up to the full therapy. (Hopefully.)

Judi moved to Walton on Tuesday. She had been displaying a low-grade fever over the last few days at Select, and some tests Friday confirmed that she has developed pneumonia. Her lungs sound clear, so hopefully the antibiotics will knock it out without causing her any major issues. She seems to be feeling a lot better already, but best to be safe. Send some healing thoughts her way, and hopefully she can get through it quickly and focus on her therapy.

The environment here is another step in the right direction for healing. Most of the nursing visits into the room are visual checks, rather than poking and prodding every couple of hours. There's not a lot of hospital noise, and she's been able to wear some normal clothes finally. All those little things add up after a while! Today, she got to go on a ride around the hospital - even outside in the sun - in a wheelchair. She was very alert and seemed to enjoy looking at the fish in the lobby. Now she's resting up for occupational therapy in a little while.

So we're headed in the right direction. There should be a lot more happening next week, since we came here right on the cusp of the weekend. Hopefully we'll have some exciting news to post soon.

A Change of Plans

We have received some messages asking if Judi has made it to Shepherd and how she is doing there. Unfortunately, a great number of things have changed since our good news was posted, and were changing right up through yesterday afternoon.

Because of where Judi is on the cognitive scale, she is deemed to be unprepared for the level of rehabilitation at an acute rehab facility like Shepherd or Walton. We believe she is very close, but there is a big delta between "not ready" and "ready." After a lot of deliberation, we have come to realize in our own hearts that she just isn't ready. We very badly wanted her to be - wanted her to head right up to Atlanta and have them work their miracles. But the bottom line is that she is not consistently aware enough to handle the strenous therapy she would receive in an acute rehab facility.

Unfortunately (or not, depending on your view), she also cannot continue to stay at the hospital. With the level of care she still needs, we are not able to safely care for her at home. We are currently looking for a skilled nursing facility for her to get strong enough to go to Shepherd. Some of the ones we have been recommended are Kentwood, Westwood, and Windemere. If anyone has experience with these places or has any contacts there, please comment or email Steve at swilk@knology.net.

So, it's been a disheartening week on that front. We had a lot of hope pinned on that little journey west to Atlanta. But going now would probably have set everyone up for failure. Better to wait a little longer until she is going to have the best chances for success. Judi herself is doing great. She wears the trach cap for most of the day now, though it is opened up at night. She is getting close to having the thing taken out entirely. She is really vocalizing now and testing out those tired vocal cords. And she has been increasingly aware and responsive over the last week. So her recovery is continuing, even if our hearts and hopes are a little worn right now.

Thanks for your continued concern and prayers, and let us know what you know about those places. :)

Good News

Judi will be heading up to Shepherd on Thursday to begin rehabilitation. There was a little doubt today as to whether that would happen sooner rather than later. However, late this afternoon they confirmed that there was a bed for her starting Thursday. We have heard great things about Shepherd and are hoping that this is going to be the start of a whole new era, so to speak.

Also, Judi's tracheostomy was capped off Sunday night, meaning that she is breathing entirely on her own through her upper airway. She was 'snoring' most of yesterday because she was only breathing through her nose for some reason. If she can manage breathing on her own for 72 hours, the doctor will give the go-ahead to pull the trach out. One less piece of hardware to worry about!

This also opens the possibility to start eating again. She will have to do what is called a swallow test, to ensure that she is swallowing and not aspirating. I believe she will be very happy indeed to have something yummy in her mouth after all this time.

Anyway, the next few days may be a little hectic but when she is moved and settled, we will update to let you know how things are up there!

Fingers Crossed

Judi has spent the last week getting stronger, and we're hoping to see a positive result from it this next week. The liasion from Shepherd came to visit on Thursday to assess her. Initially, she did not seem positive, but Steve started coaching Judi and got her responding very well. The liasion seemed very positive when she left. We hope to hear on Monday if they will be able to take her. After a lot of discussion, research, and consideration, we really feel like Shepherd will be her best chance at recovery if they can accept her.

While there are no clear, tangible milestones to describe to you, she is clearly more alert and strong this week than ever before. Her recovery continues in the right direction. There are times when it seems she is just about to snap out of entirely. I

This was a somewhat hard week for all of us. Some of you may know that July 2nd is Steve and Judi's wedding anniversary. The 4th is my (Jessica's) birthday. This was definitely not the circumstances we expected to surround those milestones this year. But it brought into focus the reminder, as ever, of 'what's important?'

So hug those loved ones tight if you're BBQing and watching fireworks tonight. And keep your fingers crossed for us that we are going to hear "Pack up and head to Atlanta" on Monday! :)

Slow Days

I hope you all can forgive the slow updates lately. We've mostly been having slow days with baby steps, so I find myself often saying "well...what am I going to write?" It's become easier to say progress over the span of a few days now as opposed to a day at a time.

Over the last week, Judi has started working her left side more. She had been strongly favoring her right side, which seems consistent with the location of her brain injury. However, she has started to track visually all the way over to her left side, as well as move that foot and hand more than before. She is also continuing to do well with the Passy-Muir valve. We hope to see her off the trach soon!

I also wanted to thank you all for leaving helpful comments and sending cards to Judi. The comments help us a great deal, and the cards are helping her! We frequently get comments about how her room is so full of love and warmth, with pictures and cards plastered everywhere. You all have helped create a great environment of healing.

Looking Forward

Judi has continued to grow healthier and stronger over the last week. She has really been working her arms and legs, and has developed quite a grip on our hands when she wants to. Her periods of awareness come at about the same frequency and length. During these periods, she obeys commands and really focuses, but we are still looking for this to be the rule rather than the exception.

The big update is that yesterday, her trachea tube was replaced with the smallest size. This means that the next step will be capping it off and having her breathe through her upper airway. Changing it was not fun for anyone involved, but she has tolerated it well and is maintaining her oxygen saturation. She has also been doing well with the Passy-Muir valve. This is the one-way valve that allows her to breathe in through the tracheostomy but forces her to breathe out through her upper airway. It takes time for patients to build up the strength to tolerate it, but she has really been doing well with it, keeping it on all day sometimes.

Right now, we are starting to weigh our different options for rehabilitation facilities. I know that some of you have helped loved ones through a similar injury, so if you have any insight, we would appreciate it. We are considering Walton and Shepherd, and trying to discern the real differences between the two. Thanks in advance for any insight you have there. :)

Where We Are

I realized that over the last few weeks, we’ve done mostly sporadic updates. I see Judi almost every day, so it occurred to me that the picture might not be so clear to all the wonderful folks who are sharing our concern and supporting Judi through this struggle. So today I’m going to do a little ‘State of the Union’ post to get everyone up to speed.

Physically, Judi is strong. The swelling in her head from the brain injury has obviously been down for a long time. The incision in her head has healed well. The bone flap is still out, but it is a low-priority issue. Her back incision is also healing nicely.

She is no longer on the ventilator, but she still breathes through the tracheostomy. When she first went off the ventilator, she was receiving extra oxygen through a respirator collar. However, she now goes all day on room air, with just a little extra moisture added to it. She also spends progressively longer periods with the speaking valve, and she is able to maintain oxygen saturation all day with it. She still has some lung secretions that have to be suctioned, but this is an ordeal that only occurs a couple times a day now, instead of every ten minutes. (We’re all VERY happy about that.)

When this first started, I would need both hands and at least one foot to count all the tubes and wires coming off of her. Now, she only has her PEG (feeding tube) and the PIC line in her left arm. She receives various drugs through these tubes and a constant feed of some delightful (sarcasm) looking stuff called Jevity. This week, she should be doing the swallow test. If she passes, she can start having some liquids orally.

She is not on any sedation. She gets pain medication as needed, but she is not on a constant drip. She is receiving several drugs that increase awareness and should help her along in the healing process. She is currently on a drip of antibiotics to take care of some minor infection. Nothing serious – just the natural consequences of being in the hospital for so long.

Neurologically, she has also made a lot of progress. One thing that has been hard to explain has been her level of awareness. She has been ‘awake’ off and on since a few days after the accident. However, at first, she was only awake in the sense that her eyes were open and she wasn’t quite asleep.

Now, she has two main states. One is her ‘chilled’ mode. She is in this state most of the time when she is awake. She watches TV, checks out pictures, tests her toes, and generally pays attention to what interests her. She responds to stimuli, but only for a short time before going back to what she was focusing on before. Dad and I have learned to put on our thick skins, because she will sometimes ‘play possum’ and close her eyes until people go away. We think this is a good healing time for her – she’s relaxed and doing what her brain needs to do for a while.

The other mode is her ‘connected’ mode. These phases usually last from 15-30 minutes. During these times, she responds to commands, listens to what we say, and really focuses on things visually. When she has these times, we try to stimulate her and test what she can do. As I mentioned once before, we hope that this will make her more confident and hopefully encourage her to tune in with us more often.

She is visited by occupational therapy (OT), physical therapy (PT), and speech therapy several times a week. OT focuses on the upper body and also applies various stimuli like light touch and sound. PT focuses on the lower body. Both of them focus on preserving her range of motion. Now that she is more aware, they are trying to get her to do the movement on her own.

So I think I’ve covered everything – I hope this is enough info without being too much! If you have questions, please feel free to ask. We are so grateful for all the support and prayers you have given us. We are all going to see this through!

The Right Direction

I think the generally positive trend of this week made time go by in sort of a blur! All of a sudden it's Saturday...how did that happen?

Judi is continuing to 'dial back in' as we say. When she is one of her alert periods, she tracks very well (following movement with her eyes), follows commands, and becomes intently focused on us when we talk to her. Then there are those other times when she is ready to have some down time. But we are getting more of the alert time each day, and it is so good to see.

This week, she finally got a helmet, which allows for more therapy options like getting into a chair, and eventually walking around. The helmet protects her head, since her brain is still vulnerable without the bone flap in place. Steve wasted no time getting her into a cardiac chair, and taking her on a little trip around the hospital floor. She definitely enjoyed that!

We are hoping to see a sort of 'snowball' effect over the next stretch of her recovery. Just like anyone learning to do something, I think that maybe making these small gains will give her the confidence and strength to keep pushing her way through.

From Baby Steps to Big Steps

We have seen Judi take a lot of baby steps over the last weeks. Late last night and this morning, she took a large step. She is beginning to respond to commands. Last night, she was moving her hands on command for Steve. This morning, she raised her arm on command for her nurse, and later was 'pinching' her fingers on command for me. This is a great sign, and it's one of the indicators that her cognitive function is healing.

Also, part of her therapy now is using a speaking valve. This is a little plastic cap that is attached to the trachea tube opening, which allows her to breathe in, but not out. It forces her to breathe out through her mouth. This allows her to speak because the air is going out the body as intended, rather than through the trach tube. Her nurse said that this morning, she was managing to say the word 'water.' Wow! I thought she was pulling my leg at first! Since then she hasn't been talking (imagine that, with Judi!) but we have a feeling that before too much longer, she will be talking all our ears off.

She is definitely on her way up, and we are glad to see it.

Coming Up

Judi has continued to make progress over her first week in her new room. She has become markedly more aware of what is going on, and is starting to localize pain. Though we don't like to know that she is hurting, it is definitely a sign of progress that she can move her hands to show where her discomfort is. This makes it a little easier for us to react and make sure she either gets moved or receives some pain medication to make her comfortable.

Her Weight Watchers group did a 5k this morning and dedicated their participation to Judi. They brought us a t-shirt for her on a special gold hanger, which is an award they give at their WW group. We took it in to show her this morning, and she had a very strong reaction to it, like she was trying to really take in what it was. Now it's hanging up where she can check it out, and maybe it will help remind her to keep taking those steps! Thanks so much for bringing to us.

In any case, she is continuing to take those little steps forward. Steve has been looking into some doctors who are highly experienced in Judi's type of injury, and one of them will be coming to check on her next week. We are hoping they can help come up with a game plan that will get her trucking on down the road to recovery. :)

In the meantime, just keep those prayers going. Every little bit counts!

Hand Jive

An odd title - but fitting for today. Judi has decided it's time to give her limbs some exercise, and was showing a lot of movement with her hands today. It takes a great deal of concentration and effort for her, but she was managing to move both arms and hands with a fair range of motion.

Being out of the ICU has definitely been a culture shock, but it has been a good move. We are still adjusting to not having people in the room constantly, and are making an effort to not be high-maintenance. But it has been a peaceful environment for her, and she is getting some good rest time, even if it's just watching TV and testing out her toes.

I would like to also use this post to ask for a few favors!

At the advice of a family friend, we purchased a digital picture frame for Judi and loaded it up with pictures. If you have pictures of yourself that you would like for her to see, even if they are not pictures WITH her, I invite you to send those to me to add to the slideshow. Thanks to a computer crash and not knowing her password, I can't get all of her pictures. So if you have any you think she'd like, please send them my way by sending them to teamjudi@gmail.com. For the lovely Weight Watchers bunch who are walking in honor of her this weekend, please get a picture of yourselves and send it to the email! I will make sure she gets it.

While searching for information about the after-effects of a craniotomy, I stumbled upon the blog of a lovely lady named Jodi. (Not to be confused with Judi!) She is suffering from a brain tumor and has been through a great deal. The last few days have been especially hard for her, because she had to have a second surgery and is experiencing tremendously painful headaches.

It was humbling to read her story, because it reminded me that no matter how huge and life-encompassing this event has been to our little family, there are people dealing with their own traumas all over the world. I would like to ask you to keep her in your thoughts and prayers. Her story is here, if you would like to let her know that you are praying for her.

As always, thank you for your continued support and love.

As of yesterday evening, Judi has moved out of the ICU - a big step in the right direction!

We cannot express just how amazing the care was at the Shock Trauma unit, and we definitely miss a lot of the faces over there. There are some angels walking around over there, no doubt about it. However, it was definitely a good move for her. She was no longer in need of the high maintenance care given in that unit, and with summer coming up, there will probably be some folks needing that space and the excellent care the trauma unit gives. Things are much quieter now, and the environment is a little more conducive to rest for her.

Physically, she is doing very well. She is still breathing with the trach collar, but is getting stronger with it all the time. She is sitting up for longer periods and tolerating it fairly well. Her awareness level is also continuing to creep up. All baby steps in the right direction.

Even with the move, for right now, we are still asking for everyone to wait on visiting. While I don't want to sensationalize or paint a grimmer picture than is real, she is not at her very best right now. All the choices we make right now are to see that she has a comfortable, restful healing time. When she is more aware and ready to enjoy your company, we will let everyone know.

Slow Days

Right now, no news is...well, no news.

The last few days have been pretty slow, and I would imagine that the next few days will also be slow. Judi continues to improve in small increments, regaining her strength after her surgery. She seems to be a little bit more aware of what's going on around her every day, although she is still not responding to commands or showing some of the signs we would like to see.

Today, she did make a big step physically, however. She is no longer on the ventilator, not even with pressure support. In a rather symbolic gesture, the RT actually took the machine out of her room today. She does have what they call the trach collar, which is a little oxygen mask that's placed loosely over her tracheostomy, giving her some extra oxygen. But she does all the breathing on her own, both initiating the breath and filling up her lungs.

Keep those prayers up for a big step soon.

A New View

Quick update for today:

Judi was able to spend some time sitting up today. Her whole view of the world has changed! She has been moving her hands some, which she didn't do before. She also seems to be more alert already. We are continuing to be hopeful for some big steps forward soon.

Surgery Update - (Finally)

Well, a month after entering the hospital, Judi went into back surgery around 12:30 this afternoon. She held up very well, and the team experienced no surprises as they did the procedure. They came up around 5:30 to let us know they were done and that she was fine.

This procedure stabilized the broken thoracic vertebrae with screws and rods. The injured area will grow much stronger over time as the bones fuse together. She should be able to sit up as early as tomorrow, which we are hoping will be accompanied by a huge step forward in her level of awareness.

Thanks for your prayers and support over this last month. I know we are all happy to see her get past this surgery, and are ready to see her take the next steps in her recovery.

What's Important

What’s important?

The last few weeks have made the two of us rather philosophical. One of the positive things to come from this whole experience is the reduction and simplification of life. So many of the things that concerned us and worried us before have become unimportant. Priorities have become simpler and more clear.

I will admit that for quite a while, I’ve been harboring a little bit of doubt, maybe even a little anger, about this whole incident. As logical and pragmatic as I try to be, there’s that little sliver of doubt that remains.

If Mom had never gotten on a motorcycle, this wouldn’t have happened. She wouldn’t have been on that road on that day to hit that specific car. Motorcycles are dangerous. Everyone knows that, right? What was she thinking? I’m sure I’m not the only one who’s thought that, and it’s okay to think that. It’s a normal, human thought. We hate to admit that we’re not utterly unshakable, but I’ll go ahead and tell you that I am fallible and shakable.

I was angry.

And then I read this on Mom’s Facebook. I saw it in the first few days after the accident, but it only upset me then. When I read this again last night, it hit me in a much different way:

Watch out cuz here I come.

Took my first ride on the road today...what a liberating
feeling. It was so awesome.

Everyone who knows Judi knows how much she loved her motorcycle, being around motorcycles, and being around other people who loved motorcycles. She and Steve have spent many a weekend tearing up the road both on their own and riding with the local Harley Owners’ Group.

When she talked about their experiences, there was a glow about her that made it abundantly clear how much she loved every moment of it. Her pride when she passed her test, her excitement over the weekend rides all over the state, her absolute joy at the freedom of the ride – no one could doubt how important riding was to her.

While it’s true that this very accident would not have happened if Mom was not on a motorcycle, she could have easily been in a dangerous car accident. After all, car accidents happen every day, and people can be badly injured or even killed in a car accident. We’ve seen a few victims of car accidents come up here to the trauma unit, some worse off than Judi.

So what’s the solution? Do we refuse to drive our cars, because people can die in cars? No, we take measures to offset the risk. We obey traffic laws (more or less), wear seatbelts, drive cars with safety features to protect us in the event of an accident. We drive our cars because we’ve done what we can to make it safe, and so made the risk acceptable.

Judi did all the right things. She took the motorcycle safety course. She spent many hours on the weekends practicing with Steve in parking lots. She even watched videos on safe driving. She wore a helmet. She wore protective clothing. She did far more than many motorcycle riders out there do.

And yet fate had it that this was how a traumatic event would happen. In spite of the precautions, something bad happened. Sometimes, you can do everything right, and things will still go wrong. So it goes with any undertaking. We consider the risk, take what precautions we can, and we hope for the best.

I am still angry, but I’m no longer angry at her choice to ride. How could I be when I look back on the joy it brought her? How could any of us who love and care for her be angry at her choice, seeing that exuberance? I’m still angry that it happened. I would be a liar if I said I wasn’t. But sometimes fate is cruel and ironic and just deals an ugly hand.

I’ll throw out a scenario that may sound grim or depressing, but it’s a reality, and one that only reinforces my point. Judi could have chosen not to ride, and might have been in a terrible car accident on that very same day. She might have been just as badly injured, or even worse. She might have lost everything and never even had the chance to do something she desperately longed to do.

Life is full of risks. We take risks every day. The very act of living life is a risk. But what is the alternative? Living in fear, never doing those things we long to do because of that fear, and looking back at the end of a long, safe life and saying “I wish I would have…” Do any of us want that?

So what’s important?

Joy is important. Riding free down the highway, relishing the wind in your hair and the trees rushing by; that’s important. Living life while you have it is important.

Postponement

Well, sometimes the best-laid plans are set aside. Judi's surgery has been postponed until Monday due to instrument problems in the OR. She is in great health, but they need to have the right tools for the job.

While we'd certainly prefer that the surgery get done earlier rather than later, we want it done right the first time. We will let you know about the new time when we do.

Big Day Ahead

Well, by the time most of you read this, Judi will be on her way to or already in surgery. She originally had a mid afternoon slot, but some things opened up and she will be heading in for surgery around 7:30 am.

Please 'kick it up' a notch tomorrow for her and send some extra prayers up the line. We are very positive about how strong she has gotten over these few weeks of resting, and think she is going to do great tomorrow. The surgery should take about three hours. We will update after surgery with results.

Baby steps has been the name of the game til now. Tomorrow will be a big step forward, and I think we are all ready to see it come. :)

Inching Forward

More good rest today, and another little step forward.

Judi spent a while today breathing entirely on her own, with no ventilator support at all. It was a little surprising to walk in and see the machine on 'Standby.' But the RT (respiratory therapist) came in to assure me that she was breathing fine on her own. It was turned back on later on, but she did great on her own.

Now we have our sights on Friday, when she will have her back surgery. I'm not yet sure of the time. They tell us it will be about a three hour procedure, and while it is definitely a major surgery, it is not quite as invasive as we were expecting it to be. As mentioned before, we think this is going to be a major turning point for her. So now we are just hoping she will continue to rest and get strong for her surgery.

As always, thank you for your continued support and prayers. We are encouraged every day by them. :)

This Old House

This morning, Judi seemed much more aware, to the point of paying rapt attention to the TV show "This Old House."

It has been a quiet few days, with Judi just continuing to get stronger and rest up. While she is still not following commands, she has been much more alert in the last few days. She fixes her attention on people in the room, the cards on the wall, and the TV when it is turned on.

Her back surgery is scheduled for this week. We think that this is going to be a huge step in letting her regain full awareness. Because of her back injury, she cannot sit up. If you think about trying to get a sleeping person awake (I am laughing at thinking about some of my kindergarteners after nap time), one of the first things you would want to do is get them vertical, right? When her back is fixed, she will be able to sit up with her brace on. This is going to also just help her general health, since she can move around much more than she can now.

As soon as we have a definite date for surgery, we will let you know. It was set for Friday, but Dad is doing his best to get it a little earlier if there is time available. In the meantime, keep on sending those positive thoughts our way.

Another quiet day - just taking baby steps forward.

One good step was that the respiratory therapists adjusted her ventilator so that she is now initiating all her own breaths. The machine still gives her pressure support and some extra oxygen, but it doesn't force her to breathe at all. She was managing quite well all day long, which seemed a little surprising. The nurses said she might be able to do it for a few hours and then need the regulated breathing again when she got tired. But she did it for upwards of 12 hours on her own!

Baby steps. :)

On Moving Mountains

While driving down Washington Road this morning, I saw a sign on a church marquee. If I were slightly more egocentric, I might say someone had posted it just for our family, knowing exactly how impatient Dad and I are. A gentle reminder, if you will.

"God can move mountains, but sometimes He moves them one shovel full at a time."

Today was a pretty sleepy day. More of those baby steps forward, inching toward recovery. We appreciate all the comments and cards - we are accumulating quite a collection in the room. I know that the brightness and the positive energy is doing her good.

One recent change (since Monday, I believe) that's got us tickled is that she is now yawning every so often. It's the most wonderfully normal thing we've seen yet. The first time she did it, we freaked out, not realizing what she was doing. It's become pretty habitual for her now, and it's so completely normal it makes you think she's just waking up from a nap. These little things make us think (in our amateur medical sort of way) that her brain is getting back into some of its normal processes. Yawning, for instance, to get a little more oxygen when she's getting tired.

We'll take it one shovel full, one little yawn at a time. Keep that good energy coming.

A Little Reminder

Well, I'm back from my trip! Sometimes, I think that life shows us little signs, little reminders of just how amazing it can be.

When I arrived back at Charlotte-Douglass International, I was sort of down in the dumps. It was Sunday, and the parting words from the flight crew was a perfectly cheerful "Happy Mother's Day." Quite honestly, I felt a little jealous of those other people walking around the airport with their mothers or calling them to wish them well that day.

When all of this started, I sort of predicted my own timeline. In my prediction, Mom would be back with us, almost back to normal by the time Mother's Day rolled around. That obviously didn't quite work out, and as I was walking out of the airport, reality was coming crashing back in.

After lugging all my stuff back out to the remotest of the remote parking, I saw one of those strangely beautiful things that we often overlook.

This little plant was growing in the pavement right in front of the nose of my car. Perfectly ordinary, yet miraculous, all wrapped up in the same little leafy plant. There was pavement and parking lot as far as the eye could see, and yet here was this little piece of life. It had found some miniscule opening, and it had shoved through. It fought against the tough asphalt, pushing its leaves up into the sun and growing ever skyward.

It has been a tough two weeks and change, for everyone involved. Right now, we are sitting in what we've taken to calling our 'holding pattern.' Mom has recovered well from the procedures on her brain, and has had many of the invasive tubes and devices removed. She is still on the ventilator, although she is getting stronger. Her blood pressure and heart rate are strong, although they are still not quite consistent enough for the surgeons to feel confident about doing her back surgery.

Many people have asked us if she is awake yet. This is kind of a hard question to answer, and I often find myself stumped as to how to answer. She is awake - as in, not sleeping - for a good portion of the day now, but perhaps the better question now is how aware she is. She seems to latch on to things visually - when her nurses are close by, or Dad and I are standing next to her, she seems to watch us. But she is not yet following commands, such as squeezing our hands or blinking her eyes. This is one of the major stepping stones for patients with traumatic brain injuries, and we haven't quite reached it yet.

We think she is doing what we are calling 'reconnecting.' After being unconscious for a good bit of time and being in a pretty good haze of painkillers and sedation, we think her brain is figuring things back out. As we have mentioned, her doctors assure us that she is recovering well. While we want her to instantly wake up and start talking to us, the brain simply does not work that way. It's a slow and steady push toward recovery.

Like the little plant in the middle of the parking lot, she is going to push through to the sunlight again. Life will find a way through.

Monday Evening News

It was a long week today for Jessica and me. I was reminded again of how much I hate to wait and my internal need to be doing something at all times to correct an existing issue. I was also reminded how much my daughter is like me in those regards. Judi continues to take baby steps in the forward direction. Every single one of the medical team members (from the top to the bottom) continues to tell us it will take time and we have to be patient. We continue to talk with her, read to her, play her favorite music, read her your comments from the blog, etc. to help her focus her mind and heal. I know in my heart that this is the right therapy, but both of us are struggling with the desire to do something that physically helps speed her recovery.

An ultrasound was performed on her legs to ensure there were no blood clots forming - all clear there. A PIC line (peripherally inserted catheter) was inserted in her left arm which will provide longer term access for drugs and testing and minimize the need for multiple "sticks."

Her back surgery continues to be driven by the concern over the strength of her heart. Her blood pressure and heart rate will be fine for 24-48 hrs and then have a transient. Some of you probably know she had problems in this arena prior to the accident and her present condition only aggravates the condition. Jessica and I are faced with some fairly simple realities here. The back surgery is a major surgery in and of itself. She will definitely lose blood as part of the surgery. If her heart is not strong enough to support her under these abnormal conditions, she could have another brain impacting event (or worse) that she would most likely not recover from. Although all of us want to see her back stabilized, in her current physical and mental state the existing condition presents a much lower risk to her long term recovery than going to surgery unless we are confident she is ready. We will continue to evaluate on a daily basis and go when the time is right.

Steve

PS - Jessica was tired from her trip and being with Judi and me most of the day and will take over tomorrow.

Mother's Day 2009, aka Chillin' III

First, on Judi's behalf I would like to thank all of you from the bottom of my heart for the well wishes for Mother's Day. I read all of them to her and I am sure they made her day. Once she is well, I am sure this will be her second most memorable Mother's Day (the first being her first as a Mom).

Not much to write about tonight. A little lighter again today . She stayed awake for a significant portion of the day which must have wore her out because she was sleeping like a baby when I left tonight. I believe we will have to get the surgery behind us before she makes much more progress. Her back obviously makes her uncomfortable as her awareness level increases and I suspect she may be retreating a bit to make it stop. I'm certainly no medical expert, but as many of you know I have a lot of experience with a back that hurts to the point you would try anything to make it stop. We should be able to nail down a date for her surgery tomorrow and hopefully put this one behind us soon.

You'll also be glad to know that Jessica is back in charge of the blog and will keep everyone up to date as we move forward. This will be a critical week in Judi's recovery so please continue to keep her in your thoughts and prayers.

Thanx again to everyone for the tremendous support you have given us, I am not sure what we would have done without you.

Steve

Chillin' Part II

Rest and recuperation was the game plan and Judi was right on target. She continues to grow stronger and to use my term again, "lighter" as well. She is beginning to establish a sleep/awake cycle and I can predict her alertness level pretty accurately by her vital signs. She will focus on me and pulls my hand close to her chest when I talk to her. She still tires quickly. Slow, but steady progress from my perspective.

On a different note, tomorrow is Mother's Day and I want to say a special thank you to all the Moms out there for all you do. This experience has reminded me how quickly life can change and all of us should make a special effort to spend time with those that are special to us. You never know what tomorrow will bring.

Chillin'

A short post tonight.
Resting and getting stronger was the regimen for today. Judi is clearly much "lighter" from an awareness perspective now that her mouth and nose are tube free and she is only on a low dose of pain medicine. That's a Steve term , not a medical term. She responds to various things around her by opening her eyes and looking around, heart rate goes up, etc. She REALLY gets mad when they suction out the breathing tube because it makes her cough. Again, baby steps, but in the right direction. Hopefully this will continue throughout the weekend and we can get her ready for back surgery next week.

Baby Steps, But Steps They Be

Judi continued to rest and grow stronger today. We did make progress on several fronts though. The drain (EVD) was removed early this morning which indicates there is no longer a significant concern with pressure building up in her head due to swelling of the brain tissue. The PEG (stands for a long name meaning feeding tube in the stomach) was inserted and the final tubes were removed from her mouth and nose. Unfortunately, to perform the procedure they had to paralyze her again and administer a fairly healthy dose of drugs to ensure that she was comfortable throughout the procedure. It will take some time to work those out of her system again. Her alertness level continues to increase slowly, but it is clearly increasing. I have suspected that the tubes frightened her as they tried to reduce her sedation because she would become very agitated once she reached a certain point and would have to be sedated again to keep her key vitals (heart rate, blood pressure, breathing, etc.) under control. I am anxious to see how she responds as the drugs from today are eliminated from her system.

So, several small steps in the right direction and with your continued prayers and support I am sure her recovery will continue. Hang in there with us, there are still several large hurdles for her to cross, but those of you that know Judi well, also know she is not afraid of a challenge!