This Really Is the Last One

It didn't scan so good but you can just see the hole that was drilled in the skull.  This was the top right front.
Progress continues, a little each day.  She is in good spirits.  It's just going to take a little time, 1 - 2 years, so if you see her be patient.  We are grateful that we have the time to be talking about.
Thank you all for your love and continued support.  PH

Hole In The Head

Sorry for posting late: usually do it on Monday.
Last week she had a follow up CT Scan and visit to the surgeon.  Everything looks good.  What he was looking for was pressure buildup in the head.  No pressure build up.  We could see the hole in her head where the drain was placed.  No jokes about having a hole in your head in our house any more.  I'll see if I can scan the scan and post so you can see the hole in the head.
Today was another therapy visit.  A lot of the therapy is around energy management.  Things are moving well as she is adjusting back in to life.  Another little piece of information.  It typically takes 1 - 2 years to make a full physical recovery from this type of injury (they call it an injury).

Looking Better Each Day

Last Wednesday they gave her the go-ahead to start driving.  So we will be working in to the driving a little more.  She was also given several evaluation tests.  They we all around average.  However, they could tell that before the bleed she was above average in many areas.  Now she is more like me!
An interesting number was given to us: for every day you lay in a hospital bed it takes 3 days to physically recover.  This means that it will take her approx. 45 days to physically recoup.  I think that will be about right.  However, no one will give any number on neurological recovery times.  Apparently there are no exercises to stimulate neurological growth, they can only provided techniques to compensated.
We had a followup appointment today with the attending physician in the ICU.   Blood pressure and pulse were looking really good.  The doctor reiterated how lucky she is to 1. be alive and 2. to be in such good shape after such an event.  He also said: "Be patient. It's going to take time. Your brain just took a beating.  And you are doing great."

We have a CT scan tomorrow and a visit with the neurosurgeon.  So we will see what tomorrow brings.

Driving Miss Daisy

Not anymore.  Today was her first day behind the steering wheel.  Went for a little drive around the neighborhood.  So, that's the goal for this week - driving.  Part of this goal involves a cognitive evaluation on Wednesday.
Next week is her visit she has another CT Scan and visit with the neurosurgeon.

Another Trip to Therapy

She continues to improve.  We went to occupational therapy again today.  They retested her upper body strength.  Improved from last week: she back in normal range.  More complex dexterity tests this week .  She finished well within normal times.
Waiting for appointments now with Neuro surgeon and physician.  She is still getting pressure behind right eye which gives constant headache.  Still some control issue with upper lip, has a mind of it's own.  Lip issues seems to be diminishing with time.  Still struggling with short term memory although this is improving.  It is still better than mine.  I thought we were going to be equals for a while, but not so.
Leg pain reducing, agility returning slowly.

Will add one more update next Monday.

Almost the Last Post

For those who have come back just a quick update after being home for a week.  Today we went for her Neuro evaluation.  She has lost very little overall.  These a little facial movement and her hand writing in not as fluid.  However, I have seen improvements in the last week.  She is walking about a mile at a time now.  Has stopped the pain killers.  Big improvements this week.  She is practicing the harp, fingers not as fluid at the moment but improving.  The routine at the moment is: sleep, eat, walk. 
Will make another post in a week.

Last Post

Thank you, thank you, thank you, for your thoughts, prayers, fasting, and interest.  There has been a tremendous out pouring. 
She is home and recovering.  Today we have been on 2 walks in the neighborhood.  She walked a lot further than I thought she would, 10 minutes each.  So far her temperature has behaved itself today. She is taking naps with some good deep sleep.  We are managing the pain in her back and legs.  The pain is subsiding, all be it very slowly.  She still has no recollection of the first week in ICU starting from the point she was wheeled in to the ER.
We feel fortunate and blessed to be walking away from this relatively unscathed.  This could have played out so very different.

• That Friday she had returned from a week in Indiana. 
• The following week she was scheduled to work in Ohio.
• She was loosing her vision as I was talking her through pulling off the freeway. Had it been 10 minutes later I would have been on my way to California and she would have been driving on the freeway alone.  
• We were at the hospital within about 25 minutes.
• The medical staff were right there.
• It was not a massive bleed.
• We had some great nurses who were on the ball when life threatening events happened and the physicians and surgeon were there to take care of the necessary procedures and adjust treatment plans.
• She was not willing to give up even when things get really tough with all the ups and downs.
• We had tremendous support from all of you.

As time passes and we understand more about what, how, when this happened, and how it impacted our life and others we will see our Heavenly Father's hand at work.  Having spent a week in the ICU with my niece from Scotland who was in a fatal car accident in California this February and now living this experience with my wife, life is different.  I've read about this type of difference before but now I feel it.

I am so grateful she is alive. 

I'm sure you will start seeing her and hearing from her within next few weeks or months as she recovers and is more active.

Here's a few blog stats:

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Pageviews by Countries

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HOME AT LAST

She was discharged from hospital this afternoon about 2pm.  She has a little anxiety not having the medical staff around after everything that she has been through the last two weeks.  The fever came again late this afternoon.  I asked about this before she was discharged.  The fevers are not unusual for this type of injury.  The brain decides it should have a fever, so it does.  We keep her cool and give her some Tylenol and her temperature is down within a couple of hours.

Here are the discharge orders:

• Low water intake and salt tablets for the next two weeks (helps the brain heal)
• No driving for two weeks
• Outpatient therapy for speech and short-term memory (I think it is coming back fast. Big improvements today.  Helps when they let you sleep)
• Limited visitors for the next two weeks and absolutely no group visits (sorry people)
• Continue to exercise lungs for next four weeks
• Follow up visit in four weeks
• Start building up stamina - slowly

Will make a final posting tomorrow when I'm a little more alert.  The blog has been viewed from 9 different countries.  Will post more details tomorrow.

Good Day Yesterday and Looking Better

Yesterday was an up day and today she is up and walking.  Appetite is coming back.  Another fever during the night.  Fevers are getting shorter, just a couple of hours now.  Her temperature rises to 101 and then drops again.  She is staying awake for longer periods of time.

They will be assessing outpatient therapy needs today.  They are looking at speech and short term memory.  I see just small changes here.  For me it is hard to tell. With the sleep deprivation, meds and constant headache it's hard to tell if these are masking any real changes to her speech or memory.

Calum

Many have had concern for Calum and wanted to know how he is doing.  I talked to Calum about 8 days ago and have emailed him since.  He is naturally concerned for his mother but very calm and has great faith. He is working hard and can not believe how fast the time is going. He was telling me how much he loves it in Chile and being with the people there.

Fever Pattern

It appears she is in a fever pattern.  Her temperature rises in the afternoon until the early morning hours although the amount of time it lasts seems to be reducing, i.e., midnight last night .  Some of the lab results are coming back and all have been negative for infections.  There is still one more lab result to come back tomorrow.  She is still on a fluid restriction of 2 litres per day.  This is to keep the sodium levels up to help the brain heal.
Think we may get to go home this week, a little earlier than originally thought.  She really has done well.  Would just like to get rid of the daily fever.  Will let you know when they give her a discharge date.  A little nervous about going home after such a traumatic event.

Saturday Night Fever

I decided to stayed overnight as she was still running a fever. The nurses we threatening to ice her down if the fever did not break. The fever broke around midnight :) . She was able to settle down and get some sleep.  She was looking much better this morning, eating much of her breakfast.  They are running more lab tests to find he site of infection.  Would like to stop this recurring fever.

Fever is Back

Last night she had double vision and nausea for a while.  This is not a good sign as it is a symptom of pressure build up in the head.  The results from the CT Scan were negative: no sign of pressure, vessels look good and amount of blood from bleed reducing.

However, the fever is back.  They are sending samples to the lab to try and determine where the infection is.
Seems like we just go back and forth.  Two steps forward one step back.

Out of ICU

She is out of ICU now. A big step forward.

However, we ask the you not visit just yet. 

We still have family and grandchildren that have not been able to she her while in the ICU.  She is still very fragile and not really up to visits.  I know it is hard not to visit and you would like to come cheer her up and make her feel better. Right now it is rest that is going to help the most.  It is just going to take time, more than any of us would like.  I will keep you posted on her ability to take visitors.

Rough Night

Did not sleep well at all last night so very tired today and sleeping.
They took her for another CT Scan this morning, have not go the results back.

Big Improvements

Big improvements today.  Can see her improving by the hour.  Therapist wants to come back and check her eye sight one more time.

After the Shampoo

Site of Drain - Lower Mark

Cooling Off

Temperature is down this morning, almost normal.  Getting some color (colour) back in her face. Will be going for her first shower in a few minutes.  First order of business - wash out the GREEN, no rinse, hair shampoo. 
She said: "this is a drag, 2 hours seems like 2 weeks."

End of a Long Day

Big day today, lot of things removed from her body.  Up for several hours.  She is very tired but it's a good tired.  Back of legs still very painful. Does not have appetite back yet.  Have to force feed a little until I get that look.  The goal for tomorrow is to be up out of bed and in a chair for one hour six times.  This is going to be a stretch.  She has really had to fight to get this far, it has been tough and there's still a long road ahead.

Neurologically we are not seeing any signs of loss.  She could be that 1 in 5 that get to walk (crawl) away from a Subarachnoid Hemorrhage with minimal or no damage.

Goal for tomorrow:
Stay up for six hours
Consume more food

Monumental Events

1. The central line was taken out
2. The catheter in the head (drain) removed, 3 staples in
3. The other catheter (they were draining both ends) removed. This should help with the UTI.

With the head dressing gone we can now see the shaved part of her head with the green hair streak.  She is one styling woman.  Said she thinking of being the bride of Frankenstein for Halloween.  Yes I know.  When the nurses heard that they turned looked at me and smiled.
She has been up for 2 hours straight and is now sound asleep.  It's nice to she her sleeping and with no tubes or wires coming out of her - it's been 10 days.
Is it safe to hope?

Leg Cramps

The cramps are painful, but we know the cause.  Apparently, some of the dead blood cells from the bleed migrate down the spinal cord to the base of the spin and irritate the nerves causing sever pain in the back and back of the legs.  They gave a strong medication that seems to have taken the edge off the pain.  Time will take care of the rest, until then it's hard to watch.

A Down Day But Progessing

Very tired this morning.
Cramping in the legs. Think this may be a side effect of one the medications she has taken.  The medication had already been stopped so looking to see if cramps subside.
Neck very tender this morning.  Suspect that the meninges are inflamed or irritated.  Do not think it is meningitis but watching. Think it may be an irritation from the catheter (drain) in the head.

On the up side:
Oxygen tube is gone :)
CT Scan at 5am this morning looks good, doing testing cranial fluid and pressure before making final decision to remove drain.

Better Day

More active today.  Did three little walks today.  Sat in a chair to eat all her meals.  Working hard on her breating exercises - to get off the oxygen.  The drain has been clamped off all day and no headaches.  Will be going for a CT Scan early in the morning to check if body is handling the fluid.  If it all looks good the drain comes out!!!

Still has a temperature and infection: the UTI is back.  Her hamstrings and muscles have shortened and are causing some pain at this point.  In a way it is nice to be worrying about things that are non life threatening.

She did manage to get some good naps today.  I can tell that these are making a difference and the rate of recovery seems to be increasing.

Thank you again for all your thoughts and prayers.

Some Stats

Just to put things in perspective, here are some stats for Subarachnoid Hemorrhage.  These are the most consistent numbers I have found from reading but mostly from the doctors and nurses.


Subarachnoid Hemorrhage

10 - 15% die before they can get to a hospital
50% die within 30 days

Of the 50% that survive 60% will have some level disability


These are some difficult numbers to live with, especially when it's a loved one.
At this point we are cautiously optimistic.

Sitting Up

She ate breakfast sitting up in a chair this morning. I have been concerned about her appetite as she has been eating very little of her meals.  Nurse was looking at putting her on a calorie count to make sure she is getting enough. This morning she ate most of her breakfast.

They just clamped off her drain.  So we will see how her body reacts.
Oxygen is still on.

They are planning on lots of evaluations today to test her motor skills and coordination, i.e., test her brain functions.  She's looking good so far, all things considered.

Still has a slight temperature and infection somewhere. They have taken a blood sample to try and figure what and where. 

Yesterday was a real down day.  Today is much better.  Just have to make sure she does not over do.

Day 10 is a watch day (today and tomorrow).  Apparently, the brain can take a nose dive and do strange things to the body.  Not sure what on this go around. 

Rough Day

Today was a rough day: aching and exhausted.  She still got up twice and walked, did her breathing exercises.  She is working hard to get better.  Her temperature was up a little today.

Still making progress.  The CT Scan showed the blood from the bleed is reducing in size.  Tomorrow morning they plan to take her off the oxygen and clamp the drain.  They will then wait one day to see if the body is processing the fluid and then remove the drain.

The occupational therapist came back and did a more thorough test this afternoon to evaluate her neurologically abilities.  She did great despite the headache and exhaustion. 

They are checking her every 4 hours now during the night instead of every 2 :)

Restless in ICU

Restless night plus a 2am trip to radiology for a CT Scan. So very tired today. CT Scan looks good.  This scan is in preparation for removing the drain.  As they reduce the amount of fluid the drain takes off the head they want to make sure the body is taking over and starting to absorb the fluid.  Do not want to have to reopen a hole in her head.

Occupational therapist paid a visit.  Balance looks good, walking well, still a little slow with the speech.  If she continues to progress at this rate she will be able to skip the rehab center and be discharged from the hospital to home.  We like that.

Slow But Sure

Getting some sleep here and there.  Still very vary tired, but then there's a lot going off in the body.  Still on very low dose of oxygen, although was off the oxygen for a while today.  Still has low fever.  This is due to the UTI which she has had for a couple of days but this has seemed insignificant compared to everything else.  Some of the dead blood is moving down from the head to the back of the neck and in to the upper part of the back causing tenderness.

We must not forget that the really good news is, no vasospams.  This we are grateful for, very grateful.

Here are the goals:

Off the oxygen tomorrow
Remove the drain Wednesday, then remove the catheter :)
Turn in bed and get up and go to the bathroom without the aid of nurses - the simple pleasured in life

Tired But Good

Did not get a lot of sleep last night so trying to get some sleep this morning. She did eat breakfast in a chair which is a first.  A lot of staff in and out doing tests and evaluations.  They just finished testing (TCD) the blood flow of in the vessels of the brain. It all looks good :).  No signs of any vasospams.  They are going to start removing some of the wires and lines used to monitor her vitals.  They feel she is past the high risk area of vasospams and backing off the vasospam preventative measures that tends to be hard on the body (fluid, heart and lungs).  They have just taken out the art line, central line still in.  Oxygen volume turned down a little more this morning.

Oh for few hours deep sleep.

Stable

Things have been stable today.  The nurses promised to let her sleep longer tonight.  They typically wake her every 1 - 2 hours to check her vitals and brain functions.

Thank you for all the words of encouragement, concern, thoughts, prayers and fast that have been offered today.

Oops

It was kindly pointed out that in the FAQ I had written "conscientiousness' instead of "consciousness."  The humor of fatigue, my spelling and spell checkers.  Given the situation and person I'm going leave it as is.  Just thought it very funny.  Hope you enjoyed it too.

She is sleeping :)

Green Hair

Her hair has a green streak from the procedure of replacing the drain yesterday.  She was excited to have her hair washed yesterday. Just that they left the green as it is near the drain site.  Think we are good for Halloween.

Very tired this morning.  Went for a walk this morning despite the tiredness - she's a trooper.  Oxygen mask has been replaced with the tube.  They are cutting back on the O2 with the intent of having her completely off by the end of the day.  Much of the fluid has gone from the body and skin is looking normal (not puffy and tight).  Fluid from her head is starting to clear again.  Plan is to start weening her off the drain tomorrow.  She has not shown any signs of being able to tolerate not having the drain so I am little nervous about this.

Doctors are encouraged.  Neurologically see looks really good.  Pulse and blood pressure looking good. After today the probability of a vasospasm starts to decline.

Yo-yo

Feeling much better now the fluid is draining from her head.  Double vision has gone :).  However, the fever is back, fluid back on the lungs and oxygen mask is back on -  80%.  The saline drip is gone.  Taking fluid and food by mouth.  Fluid intake by mouth is restricted to prevent dilution of sodium levels which is detrimental to the brain in this situation.  We are now down to just 2 IV's.  I think we had 5 IV's at the start.  She just told me that her pain levels are down.  This is the first that it has not been bad and worse.  Still no pain meds permitted.

So some gains some loss.  Kind of back on forth.

She is stronger on her legs again today and much more alert.  Starting to remember more of what happened.  Can now remember pulling in to the ER but nothing between that and waking up in the ICU room.  Before this she could not remember anything past the initial pain while driving on I215.

Thank you again for all your thoughts, prayers and fast (I know some are fasting for her tomorrow).  It means a lot.  I really just can not thank you enough.

Life can change in the blink of an eye.
Don't think it can't happen to you.
Be grateful for the things you have and be grateful now.

Clogged Drain

At 6am this morning they replaced the drain that had become clogged and would not clear with saline.  It had clogged at the point of entry.  We had hoped to ween her off the drain this weekend.  The clogging caused enough discomfort that I think they will postpone trying to ween.  While ever she has the drain she can not move her head much which means she can not move her body, i.e., rollover, slide up and down without a nurse.  Laying still for 5 plus days now is causing significant body aches. The drain can be closed for about 30 mins which they do to get her up for a little walk which wears her out.  We really would like to get off the drain but her body has to start processing the fluid first.

Progress But a Rough Day

Another angiogram today.  Results still negative - not able to locate the bleed site. 

Tough day: hurting all over, throbbing head, nauseated, just uncomfortable and nowhere to go.  We are going to have some up and down days - up day tomorrow.  The physio came and took her for another little walk today.  She was stronger on her legs and walked a little faster.  There were five of us walking around.  Eilene, myself and 3 nurses: wheeling oxygen, IV's and the drain from her head - what a sight.

Lungs doing much better today; most of the fluid seems to have gone and the O2 mask has gone and back to a tube.

Fluid from her head was a little pink again today due to her activity, this is to be expected.  Apparently, blood sediments and starts to breakdown to be dissolved by the body.  When you're active it stirs the blood cells up and they mix with the fluid.

Correction

Didn't quite state what I meant to on the vasospam last night.  They generally start to occur on day 4 and 5.  There is then about a 2 week window that they have a tendency to occur.  I wish it was just a 2 day window.  Yesterday the TDC showed no signs of vasospam and that's the way we want it to stay.  This is were your thoughts and prayers would be greatly appreciated.  There are many other reactions that the body can have to a subarachnoid hemorrhage that are not desirable but it's the vasospam we really do not want.  So it's no vasospams the next 2 weeks and then start getting back to life.  That's the plan.

End of Day and What Lies Ahead

Quick summary for today:

• They got her up twice today for a little walk, which pretty much exhausted her but really helps with the body fluids and recovery.  She is not as puffy today.
• Oxygen levels continue to improve and they started to reduce the amount of oxygen she is on: started out the day at 70% and now at 40% (the air we breath is 21% if you were wondering). 
• Has developed phlebitis in left arm unfortunately which is causing some discomfort.  
• The fluid draining from her head has been pink up until today.  It is almost clear now :).

What's Next
Days 4 and 5 are the days that vasospasms generally occur.  That's tomorrow and Saturday.  To prevent this: body fluid levels have been kept high, medication given, constant monitoring of blood flow in main vessels in brain (transcranial doppler) amongst other things.  Why so concerned about vasospasms?  They cause strokes.  Please keep her in your prayers and thoughts.

vasospasm:
an abnormal narrowing or constriction of arteries due to irritation by blood in the subarachnoid space.

transcranial doppler (TCD):
an ultrasound device used to measure blood flow through an artery in the brain.

Oxygen

Oxygen levels better this morning.  Still has a mask. There is some fluid on the lung.  They want to keep a high level of fluids in the upper body (head) as it helps prevent vascular spasms occurring in the head.  The problem is it can push fluid on to the lungs resulting on respiratory issues, ie. low oxygen.  It's a trade off.  The doctor on call last night when the O2 dropped happened to be a respiratory specialist.

She is looking better today than yesterday.  Woke up hungry.  Neurologically she is sound and doing great.  So right now for me it's do everything to protect the brain.

End of Day Wednesday

Lot of progress in the afternoon.  Up on her feet and a little walk around.  Voice much stronger and laughing.  Current challenges: low oxygen level, fluid retention and a slight fever.  Taking steps to manage.  Oxygen level up a little by end of day :).  Given medication to dispell fluids.  Hands a little puffy.  Medication worked fast.  Now I know where the term peeing up a storm could have come from.  Didn't know a body could dispell that much in less than an hour.  She has a cathater so didn't have to go anywhere.

Life at the moment is monitor and test all day all night.

FAQ

From the time of the hemorrhage (haemorrhage - UK) to the hospital was about 20 minutes and less than 45 mins to the scan and diagnosis. 

There was no loss of conscientiousness (this should have read "consciousness" but I like it the way I originally wrote it) although there was loss of peripheral vision and blurred vision for about 30 minutes. This started about 5 minutes after the hemorrhage.

We live 5 minutes from the hospital which has been nice.

How And When This All Happened

We were on our usual Monday morning trip to the airport to drop me off.  We had been chatting away.  We were at I215 north bound and Califonia Ave when she suddenly stopped talking and complained about a sharp severe pain in the back of her neck (that could have be me) but then it shot up in to the back of her head and over the top.  We were in the middle lane of the freeway doing 70.  I'm now looking for ways to get off to the side of the road should she pass out.  I could see that it was taking everything she had to manage the pain.  Once we got on to I80 I had her pull over (I had to order her to pull over).  We switched places and I drove to the airport which was the next place to turn around.  I stopped at the airport to she how she was doing (worse or beater) at which point she said she felt like throwing up.  This she did.  Once she stopped we headed for the ER.  When I pulled up outside the ER she threw up again.  I had a nurse wheelchair her in.  I parked the car, which was only 50 yds away and by the time I got in to the ER she was registered and off to an examination room.  Shortly after it was off for a CT scan.  The scan showed the bleeding - fortunately it was not a large amount (the ones that kill you almost instantly).  Then it was off for an angiogram to look for an aneurysm to determine if it was surgery next or the ICU.  No aneurysm could be found.  It is possible they may never find an aneurysm of site of the bleed.  She remembers parts of what happened, i.e., the immense pain, but not a lot more after that.  So some of this may be news to her when she reads it.  She is remembering more each time we talk.

A Little More Awake

More awake today, about 50/50 can talk for a little while.  Oxygen level is a little low so have moved from tube to a mask with a humidifier.  Her nose was starting to dry out. They are also planning to get her standing on her feet today which should help with the oxygen and aching body.  Getting restless from laying still on her back.  Has started eating small amounts at meals.

Overall she is improving steadily and the medical staff and all of us are pleased with the progress.

More Tests

Yesterday was very busy and I didn't get everything posted.  More tests were done yesterday to baseline the health condition of the heart, lungs and blood vessels (9) in the brain.  This was in addition to the other tests mentioned.  They will continue to monitor the heart, lungs and vessels at least daily.

Racing Heart

This evening her heart rate became erratic, bouncing around between 86 to 104 bpm in a matter of seconds.  Along with this there was a drop in blood pressure.  This is one of the adverse side effects of a subarachnoid hemorrhage.  She was given an EKG to check things out.  A short time after her heart rate and blood pressure returned to normal and stable levels without and intervention.  The EKG results look good.   :)

This could have been an existing undetected heart condition, but is also common with a subarachnoid hemorrhage.

Length of Stay

Given her current condition she will be in the ICU for about 21 days.  The next 7 days will be the most critical as she is treated for the adverse effects of there being blood around the brain, prevention of a second bleed and the body healing: requiring lots of sleep.  After this first week she will likely start feeling herself and will be sitting around in ICU just in case there's an adverse reaction: seizure, vascular spasm, sudden fluid lose ...

Once she gets back to feeling herself she will really like having visitors, she will be feeling good and will not be able to go anywhere - boredom. 

Drain

Early this morning fluid pressure was building around the brain.  A drain was placed in the head to siphon off excess fluid.  This has helped her condition noticeably.  The plan is to leave the drain in for approx. one week and then see if the body can self regulate the fluid again.

MRI

She slept a lot today, waking for about 10 minutes every couple of hours.  Her pain levels are down from yesterday :).

MRI's were performed this afternoon to look for possible sites of bleeding.  Non were found :).  They will be performing another angiogram in a couple of days to check again, sometimes the blood can mask the aneurysm.  Until then they are monitoring and regulating her body to minimize the possibility of a second bleed.


Thanks again for all your thoughts and prayers.