Simon has had another good week at Craig Hospital. I was on clinic duty at the vet hospital this week, but thanks to my colleagues, I was able to break away and go to Craig on Wednesday and Friday.
Simon is more mobile now, though still mostly in a wheelchair, and he constantly asks to go outside!! He has to be accompanied by a "trained" assistant (usually one of the technicians), and fortunately this week I had time to get "checked out" (after completing training on how to handle seizures [he hasn't had any yet, knock on wood!], how to maneuver a wheelchair up and down slopes and curbs, etc.), so now I can take Simon outside myself. So that gives us a bit of freedom! There is a nice flower garden right outside, currently full of daffodils, tulips, hyacinths, and pansies - very colorful!!
He has done a little bit of walking, only in parallel bars, or with a walker and a therapist holding his belt, but did pretty well. He'll be doing more work on balancing, navigating his own path, etc. over the next month. As his physical therapist says, "Walking is the ultimate multi-tasking!" Something most of us take for granted, of course . . . .
His trach tube was removed on Monday, his urinary catheter was removed on Wednesday, and hopefully his feeding tube will be removed next week. He's eating meals pretty well, but still gets some medications through the tube.
He's able to comprehend a lot of things much better than a week or two ago, but still has a long way to go with improving short-term memory, retaining concepts, planning, focusing, and avoiding distractions. The speech therapists and neuropsychologist will have him doing lots of exercises to help with those mental chores.
Today the neurologist told us some sobering facts: someone who has had a traumatic brain injury (TBI) has 2X greater risk of incurring a second TBI; someone who has had TWO TBIs (like Simon!) has a 5x greater risk of incurring a third TBI!! So Simon will need to take great care NOT to hit his head ever again!!!!!
Ann
Friday, April 30, 2010
Sunday, April 25, 2010
Sun 25-Apr
I was at Craig Hospital with Simon on Saturday and Sunday. He is continuing to improve. He's able to stay awake for much of the day, with only short naps occasionally. He had several sets of visitors, and seemed quite engaged in conversations, etc.; however, a little while later, he did not remember who had visited him!
We've been going over the current date, the date of his bike accident, and where he's been since then. He is starting to understand what has happened, but it's still hard for him to remember anything new for more than a few minutes.
I'll have a busy week this coming week, trying to help out in anesthesia at the vet hospital but also planning to go to Craig a couple of the days. So I probably won't take time to write another update until next week. Hopefully we'll have more good progress to report by then!
Thanks for all the emails, cards, and visits!!
Ann
We've been going over the current date, the date of his bike accident, and where he's been since then. He is starting to understand what has happened, but it's still hard for him to remember anything new for more than a few minutes.
I'll have a busy week this coming week, trying to help out in anesthesia at the vet hospital but also planning to go to Craig a couple of the days. So I probably won't take time to write another update until next week. Hopefully we'll have more good progress to report by then!
Thanks for all the emails, cards, and visits!!
Ann
Thursday, April 22, 2010
Thu 22-Apr PM
What a difference a week makes (that is, a week at Craig Hospital)!!!
I went down to Craig Hospital on Tuesday and Thursday (today).
On Tuesday, Simon was speaking!!! He still has a tracheostomy tube, but they've put a valve on the end of it so he can talk, and his voice sounds almost normal. He was asking questions and answering some, albeit not always correctly. He definitely has no memory of anything since his accident, and perhaps even longer - for instance, he keeps thinking it's January. He needs frequent reminders that he was hurt in an accident, that he's at Craig Hospital, that he needs to do what the therapists say, and that he can't get up, or go walking, or go home, as he'd like to. He seems to understand all of that, but just can't keep it in his head for long, so a lot of time is spent re-explaining what happened and why he's there. This is typical of head injury patients, and the staff is very accustomed to repetition!
On Thursday (today), Simon made huge progress. He was allowed to start eating small meals (he still has a feeding tube in his stomach) - but only under direct supervision, as he tends to eat too fast and then starts coughing! If he does well and can take in enough calories, he won't need the feeding tube much longer. His nurse said, "Most people recover from an illness 'day by day', but here at Craig, people recover 'tube by tube' - the fewer tubes you have, the better off you are!!!" Simon arrived at Craig with 4 tubes (IV catheter, urinary catheter, feeding tube, tracheostomy tube); he's still got 3 tubes (only the IV has been removed); but hopefully before too much longer, he'll have none!
He was fitted to a smaller wheelchair than his original one - he can propel the smaller one on his own, by moving his feet or using his hands on the wheel rims. (The techs and nurses groaned when they saw how quickly he can move in it . . . !)
He is being asked to do a lot of different exercises to improve his strength (especially that of his left arm and hand), and his balance. The therapist helped him stand and walk in the parallel bars this afternoon. She commented that, a week ago, he couldn't even stay awake or follow instructions from her during his therapy session - and then today, he was able to walk (with assistance, of course)!
I think the highlight of the day for Simon was that he got a real shower - lying down on a cart, admittedly, but a real shower instead of just a "bed bath". (He is not allowed to sit upright or stand without wearing a back brace to support his fractured vertebra and ribs, and he can't wear the brace in the shower.) After all of today's exercise, and a hot shower, I'm sure he will sleep well tonight!!
One of the many "Turner-isms" that Simon is known for is: "Cooperate, and graduate" . . . meaning: go with the flow, do as you're told, and things will go more smoothly. Well, I've been reminding him of that saying ever since he got to Craig. Even though he forgets why he's there and why he needs to stay for awhile, I tell him he needs to "cooperate" (follow instructions), so he can go home ("graduate") as soon as possible!! He's definitely trying.
Ann
I went down to Craig Hospital on Tuesday and Thursday (today).
On Tuesday, Simon was speaking!!! He still has a tracheostomy tube, but they've put a valve on the end of it so he can talk, and his voice sounds almost normal. He was asking questions and answering some, albeit not always correctly. He definitely has no memory of anything since his accident, and perhaps even longer - for instance, he keeps thinking it's January. He needs frequent reminders that he was hurt in an accident, that he's at Craig Hospital, that he needs to do what the therapists say, and that he can't get up, or go walking, or go home, as he'd like to. He seems to understand all of that, but just can't keep it in his head for long, so a lot of time is spent re-explaining what happened and why he's there. This is typical of head injury patients, and the staff is very accustomed to repetition!
On Thursday (today), Simon made huge progress. He was allowed to start eating small meals (he still has a feeding tube in his stomach) - but only under direct supervision, as he tends to eat too fast and then starts coughing! If he does well and can take in enough calories, he won't need the feeding tube much longer. His nurse said, "Most people recover from an illness 'day by day', but here at Craig, people recover 'tube by tube' - the fewer tubes you have, the better off you are!!!" Simon arrived at Craig with 4 tubes (IV catheter, urinary catheter, feeding tube, tracheostomy tube); he's still got 3 tubes (only the IV has been removed); but hopefully before too much longer, he'll have none!
He was fitted to a smaller wheelchair than his original one - he can propel the smaller one on his own, by moving his feet or using his hands on the wheel rims. (The techs and nurses groaned when they saw how quickly he can move in it . . . !)
He is being asked to do a lot of different exercises to improve his strength (especially that of his left arm and hand), and his balance. The therapist helped him stand and walk in the parallel bars this afternoon. She commented that, a week ago, he couldn't even stay awake or follow instructions from her during his therapy session - and then today, he was able to walk (with assistance, of course)!
I think the highlight of the day for Simon was that he got a real shower - lying down on a cart, admittedly, but a real shower instead of just a "bed bath". (He is not allowed to sit upright or stand without wearing a back brace to support his fractured vertebra and ribs, and he can't wear the brace in the shower.) After all of today's exercise, and a hot shower, I'm sure he will sleep well tonight!!
One of the many "Turner-isms" that Simon is known for is: "Cooperate, and graduate" . . . meaning: go with the flow, do as you're told, and things will go more smoothly. Well, I've been reminding him of that saying ever since he got to Craig. Even though he forgets why he's there and why he needs to stay for awhile, I tell him he needs to "cooperate" (follow instructions), so he can go home ("graduate") as soon as possible!! He's definitely trying.
Ann
Monday, April 19, 2010
Sun 19-Apr
I am back at home in Fort Collins, but drove down to Craig Hospital in Denver to spend some time with Simon, on Saturday and Sunday. Fortunately it is only about 1 hour and 15-25 minutes, each way (if I can avoid Denver's rush hour!!). I feel very lucky to be able to "commute"; I've met many other patients' family members who've had to leave their homes (Florida, Oklahoma, Nevada, New Mexico, Idaho, etc.) and stay at Craig for months at a time.
Simon is making progress. He is upright, in a wheelchair, for much of the day; his periods of awareness are getting a bit longer; he's trying to mouth words to communicate (he won't be able to talk until his tracheostomy is closed); and he is a bit more interactive. He still has plenty of times when he can't focus or respond appropriately, and he's still quite restless. He is just aware enough to know that he wants to go home, but not aware enough to understand why he can't!! But overall, he is heading in the right direction.
Continued thanks for all your emails, cards, and comments on the blog!!
Ann
Simon is making progress. He is upright, in a wheelchair, for much of the day; his periods of awareness are getting a bit longer; he's trying to mouth words to communicate (he won't be able to talk until his tracheostomy is closed); and he is a bit more interactive. He still has plenty of times when he can't focus or respond appropriately, and he's still quite restless. He is just aware enough to know that he wants to go home, but not aware enough to understand why he can't!! But overall, he is heading in the right direction.
Continued thanks for all your emails, cards, and comments on the blog!!
Ann
Friday, April 16, 2010
Thu 15-Apr PM
Today (Thursday) was Simon's 3rd full day at Craig Hospital, having arrived there at midday Monday. I have to admit to a bit of culture shock, going from one-on-one attention in an intensive care unit at a brand-new hospital (Medical Center of the Rockies), to sharing nurses and aides at a rehab center in an older, more urban setting. At Craig, the staff wear street clothes, not scrub or uniforms, so it's sometimes difficult to tell who's who!! But I'm learning firsthand what a fantastic place it really is.
Simon was very restless before and during the drive to Craig, and has continued to be so; he hasn't really slept much in the past few days. However, the staff all say that the first few days always seem chaotic, with meeting everyone and having diagnostic tests and all sorts of evaluations. Once all of that is over, he will have a pretty consistent routine. Although he is still being treated for some medical problems (which are getting under control), he has started some preliminary rehabilitation. The past 2 days, he has been upright in a wheelchair for long periods, going to physical, occupational, and speech therapy. He has periods of responsiveness, but still "zones out" a lot of the time, which is typical after brain injuries. He can't speak yet, because he still has a tracheostomy, but hopefully next week they will start "weaning" him off that. Overall, he is going in the right direction, albeit slowly!
A lot of friends have asked about visiting. Right now, Simon is so tired that he needs to rest whenever he can, and whatever energy and focus he has, needs to be reserved for therapy. I hope that before too long, he will be able to receive visitors, particularly on Saturdays and Sundays, when there is no therapy scheduled. So - those of you in our area - stay tuned!!
Thanks again for all your good wishes and encouragement. I do save every card and email, so that Simon will eventually be able to peruse them himself!!
Ann
Simon was very restless before and during the drive to Craig, and has continued to be so; he hasn't really slept much in the past few days. However, the staff all say that the first few days always seem chaotic, with meeting everyone and having diagnostic tests and all sorts of evaluations. Once all of that is over, he will have a pretty consistent routine. Although he is still being treated for some medical problems (which are getting under control), he has started some preliminary rehabilitation. The past 2 days, he has been upright in a wheelchair for long periods, going to physical, occupational, and speech therapy. He has periods of responsiveness, but still "zones out" a lot of the time, which is typical after brain injuries. He can't speak yet, because he still has a tracheostomy, but hopefully next week they will start "weaning" him off that. Overall, he is going in the right direction, albeit slowly!
A lot of friends have asked about visiting. Right now, Simon is so tired that he needs to rest whenever he can, and whatever energy and focus he has, needs to be reserved for therapy. I hope that before too long, he will be able to receive visitors, particularly on Saturdays and Sundays, when there is no therapy scheduled. So - those of you in our area - stay tuned!!
Thanks again for all your good wishes and encouragement. I do save every card and email, so that Simon will eventually be able to peruse them himself!!
Ann
Monday, April 12, 2010
Mon 12-Apr-10 PM
Simon was transported by ambulance to Craig Hospital today (Monday).
It will take several days for him to get settled in. The staff at Craig cautioned that he will be very tired with the schedule of therapy here, and they discourage visitors, at least initially.
I will let friends know if and when he can start to have visitors.
I won't be providing daily reports anymore, but will send an update now and then. Your cards and emails are much appreciated, but please do not send flowers, as there is very little room here (none!) to display them.
Please know that I really appreciate your continuing encouragement and support!
Ann
It will take several days for him to get settled in. The staff at Craig cautioned that he will be very tired with the schedule of therapy here, and they discourage visitors, at least initially.
I will let friends know if and when he can start to have visitors.
I won't be providing daily reports anymore, but will send an update now and then. Your cards and emails are much appreciated, but please do not send flowers, as there is very little room here (none!) to display them.
Please know that I really appreciate your continuing encouragement and support!
Ann
Saturday, April 10, 2010
Sat 10-Apr-10
Great news to report . . . just now, Simon spontaneously opened his right eye, started looking all around, as though he's really noticing his surroundings for the first time. He seemed to be checking out his legs and other appendages - I kept reassuring him that everything is still intact and will be okay. He nodded or shook his head in response to a bunch of questions, and tried to mouth some words, which unfortunately I could not decipher. When I told him I loved him, he made a funny face like he always does when I say that!!!
I think he's on his way back - not that he won't have problems and obstacles - but this was the first time I think he really recognized me, and his surroundings.
This was too good to save until tomorrow!
Ann
I think he's on his way back - not that he won't have problems and obstacles - but this was the first time I think he really recognized me, and his surroundings.
This was too good to save until tomorrow!
Ann
Friday, April 9, 2010
Fri 10-Apr-10
After much confusion back and forth, it has been decided that Simon will be moved to Craig Hospital in Denver on Monday, for a rehabilitation course that will last 6 weeks. Craig is a very highly-regarded hospital that specializes only in traumatic brain and spinal cord injuries, so we are lucky that we live relatively close to such a facility. (According to Mapquest, it is 72 miles from our house in Fort Collins to Craig.) I will probably stay down there at least some of the time, as they encourage family involvement in the rehab process; I should learn more about that on Monday. At least for now it is nice to know what the immediate future holds for us! If you want to know more about Craig, check out: www.craighospital.org/
Simon was pretty tired yesterday (from all the previous day's activities), but he rallied in the afternoon and was using his "thumbs-up" signal to answer a few simple questions from the nurse. He sat up for awhile in his bed, and also in a huge wheelchair (called an "ortho chair"), and the physical therapists worked with him. He seems to be emerging very gradually from his fog, but his responsiveness is still intermittent, and he tires or "zones out" frequently. I am sure he will start to regain his stamina now that he is able to do more.
(I asked one of our anesthesia staff to bring me a horse endotracheal tube and breathing bag, because I have been telling the nurses and respiratory therapists here at Medical Center of the Rockies about anesthesia and critical care for animals. The 30-mm diameter tube and 30-L breathing bag were a great hit - they are so much bigger than anything these folks have ever seen!)
So, soon we'll be moving on, from the lifesaving acute care, to the longer term work of rehab. I will likely stop sending these daily updates, and perhaps write an update every other day, or whenever there is a major development. Thanks again to EVERYONE for their support and positive thoughts - we appreciate all of it!
Ann
Simon was pretty tired yesterday (from all the previous day's activities), but he rallied in the afternoon and was using his "thumbs-up" signal to answer a few simple questions from the nurse. He sat up for awhile in his bed, and also in a huge wheelchair (called an "ortho chair"), and the physical therapists worked with him. He seems to be emerging very gradually from his fog, but his responsiveness is still intermittent, and he tires or "zones out" frequently. I am sure he will start to regain his stamina now that he is able to do more.
(I asked one of our anesthesia staff to bring me a horse endotracheal tube and breathing bag, because I have been telling the nurses and respiratory therapists here at Medical Center of the Rockies about anesthesia and critical care for animals. The 30-mm diameter tube and 30-L breathing bag were a great hit - they are so much bigger than anything these folks have ever seen!)
So, soon we'll be moving on, from the lifesaving acute care, to the longer term work of rehab. I will likely stop sending these daily updates, and perhaps write an update every other day, or whenever there is a major development. Thanks again to EVERYONE for their support and positive thoughts - we appreciate all of it!
Ann
Thursday, April 8, 2010
Thu 9-Apr-10
Simon apparently did well through the night - no need to use the mechanical ventilator; pneumonia under control, blood pressure under control. His nurse reduced the fentanyl (pain medication) this morning because he seems pretty comfortable and doesn't resist any manipulations. Yesterday he was placed in a near sitting position for several hours and handled it fine.
Today he is supposed to be evaluated by the neurologist and by a representative from Craig Hospital, a major brain-spinal cord injury rehab facility in Denver. Hopefully we will figure out where he needs to go for rehab, in the next day or so.
POTENTIAL VISITORS PLEASE READ:
I received an email from a research colleague of Simon's, who experienced surgery for a brain tumor, herself. She made the following comments:
"I am writing because you are allowing visits...that is great...BUT...when I was still in hospital and then the first few weeks at home it was very very exhausting to see people. Just getting up and doing the physio, bathing and getting dressed was enough almost for the whole day!
"While I was still in hospital I loved to have the visits...but do not touch me...people talking was too much, it was a conflicting time as I wanted the people there but did not want to hear them or be touched...it was too much for me to handle ( too much to take in)...family was fine as long as they were there for short stints and not much talking . I know others are anxious but it is very very tiring and draining to take all that in...let them write cards. Those meant a lot to me as I could go back and see how caring everyone was ( when I was able to take it in)."
Sounds like good advice, from someone with a perspective that few of us could know - so, visitors, please keep her comments in mind when you come - I realize it is a long drive to MRC for a minimal interaction with someone you're very concerned about, but we need to do what's best for Simon!!
Thanks again for all your concern and support -
Ann
Today he is supposed to be evaluated by the neurologist and by a representative from Craig Hospital, a major brain-spinal cord injury rehab facility in Denver. Hopefully we will figure out where he needs to go for rehab, in the next day or so.
POTENTIAL VISITORS PLEASE READ:
I received an email from a research colleague of Simon's, who experienced surgery for a brain tumor, herself. She made the following comments:
"I am writing because you are allowing visits...that is great...BUT...when I was still in hospital and then the first few weeks at home it was very very exhausting to see people. Just getting up and doing the physio, bathing and getting dressed was enough almost for the whole day!
"While I was still in hospital I loved to have the visits...but do not touch me...people talking was too much, it was a conflicting time as I wanted the people there but did not want to hear them or be touched...it was too much for me to handle ( too much to take in)...family was fine as long as they were there for short stints and not much talking . I know others are anxious but it is very very tiring and draining to take all that in...let them write cards. Those meant a lot to me as I could go back and see how caring everyone was ( when I was able to take it in)."
Sounds like good advice, from someone with a perspective that few of us could know - so, visitors, please keep her comments in mind when you come - I realize it is a long drive to MRC for a minimal interaction with someone you're very concerned about, but we need to do what's best for Simon!!
Thanks again for all your concern and support -
Ann
Wednesday, April 7, 2010
Wed 8-Apr-10
Well, a couple of developments this morning:
Simon is OFF propofol (the sedative he has been on), and his wrists are no longer tied in cloth restraints!!! Now he can reach up with his right hand and scratch or rub his face and head - which he does frequently - it must feel good!! (He hasn't been moving his left hand and arm much, although he CAN - they're not sure if the nerves are still weak from the injury, or whether it just hurts him to move that arm.) He also has been breathing on his own most of the time, with just a few hours on ventilator assist overnight.
His head CT scan apparently shows improvement - resolution of the minor bleeding, decreased swelling.
The only bad news is that his chest x-ray shows he's developing some pneumonia now. He's on antibiotics, and they are going to try to get him positioned more upright today, which should help his lungs. Keep your fingers crossed that the pneumonia doesn't turn into a major problem.
The doctors say that, with his CT showing improvement and the propofol off, we may hope to see some improved mentation in the next few days too - another reason to cross fingers!!!
Ann
Simon is OFF propofol (the sedative he has been on), and his wrists are no longer tied in cloth restraints!!! Now he can reach up with his right hand and scratch or rub his face and head - which he does frequently - it must feel good!! (He hasn't been moving his left hand and arm much, although he CAN - they're not sure if the nerves are still weak from the injury, or whether it just hurts him to move that arm.) He also has been breathing on his own most of the time, with just a few hours on ventilator assist overnight.
His head CT scan apparently shows improvement - resolution of the minor bleeding, decreased swelling.
The only bad news is that his chest x-ray shows he's developing some pneumonia now. He's on antibiotics, and they are going to try to get him positioned more upright today, which should help his lungs. Keep your fingers crossed that the pneumonia doesn't turn into a major problem.
The doctors say that, with his CT showing improvement and the propofol off, we may hope to see some improved mentation in the next few days too - another reason to cross fingers!!!
Ann
Tuesday, April 6, 2010
Tue 6-Apr-10 PM
Mostly status quo this morning; the main change is that Simon was breathing completely on his own yesterday for 2 separate four-hour periods, did well, and will probably breathe on his own for even longer today. He still gets a rest between these periods by being back on "ventilator assist" for a couple of hours, but within 2 or 3 days, he should be on his own completely. His high blood pressure is being aggressively treated, and seems to be stabilizing at an acceptable level. He is still on a low dose of the sedative propofol, which is being used mainly to prevent arousal that results in blood pressure spikes. They hope to get even better control of his blood pressure, so the propofol can be discontinued completely.
Yesterday one of the nurses came into his room with a perplexed look on her face and said, "Did you know that some people at the School of Veterinary Medicine in Davis [California] sent the nurses a box of dried fruit and other goodies??" The gift was organized by Lynelle and David Maggs and supported by quite a few other fans of Simon at Davis, and the nurses here were most impressed that Simon has such caring friends even so far away!! One of the nurses said the accompanying card made her tear up!! The entire staff here has become very aware of how well-respected and well-liked Simon is, across the US, Australia, and other places!
Ann
Yesterday one of the nurses came into his room with a perplexed look on her face and said, "Did you know that some people at the School of Veterinary Medicine in Davis [California] sent the nurses a box of dried fruit and other goodies??" The gift was organized by Lynelle and David Maggs and supported by quite a few other fans of Simon at Davis, and the nurses here were most impressed that Simon has such caring friends even so far away!! One of the nurses said the accompanying card made her tear up!! The entire staff here has become very aware of how well-respected and well-liked Simon is, across the US, Australia, and other places!
Ann
Monday, April 5, 2010
Tue 6-Apr-10
Simon had a good night; he was breathing on his own with just a little support from the ventilator, all night, and that means he is close to being off the ventilator entirely. It sounds like he will be weaned off it sometime today. He won't need much, if any, sedation once he's off the ventilator, so let's hope that he will be more alert then. His blood pressure is still being treated to prevent it from getting too high, but it's better than last week.
The overnight nurse, Seth, said Simon responded really well to his commands, and even nodded his head "yes" in response to a question. The doctors on rounds seemed to think he is making steady progress, although slowly. They cautioned that he could have setbacks, but overall they think he is heading in the right direction! It is possible he'll be ready to move out of ICU to a lower level of care later this week.
I have received direct messages from 315 individuals since this started, and I know even more have been keeping track on the blog or through friends, and have sent positive thoughts our way. Thank you for all the great reminiscences about Simon, and for your reassurances; they are really helpful!!
Ann
The overnight nurse, Seth, said Simon responded really well to his commands, and even nodded his head "yes" in response to a question. The doctors on rounds seemed to think he is making steady progress, although slowly. They cautioned that he could have setbacks, but overall they think he is heading in the right direction! It is possible he'll be ready to move out of ICU to a lower level of care later this week.
I have received direct messages from 315 individuals since this started, and I know even more have been keeping track on the blog or through friends, and have sent positive thoughts our way. Thank you for all the great reminiscences about Simon, and for your reassurances; they are really helpful!!
Ann
Sunday, April 4, 2010
Mon 5-Apr-10
It's now a week since Simon was hit by a car whilst riding his bike. It's been a long week for everyone waiting for positive news on Simon.
For Ann, Andrew and Sally, we can only imagine how difficult, emotional and tiring the week has been.
And for Ann especially, our thoughts are constantly with you through this long and difficult recovery period for Simon.
Ann's report on Simon's condition today reflects Simon's physical situation stabilising, but a sense of frustration and disappointment at the lack of mental response, hopefully due to the heavy sedation Simon has been under.
Gus
"The short-term things are going fine (trach tube, feeding tube, blood pressure not too bad), but I am feeling discouraged about Simon's lack of awareness. All week I've been hoping that all the sedative drugs are a large part of his grogginess - but this morning the propofol (the main sedative) was off for awhile, and although he did follow a few commands, it was very sluggish and inconsistent. Of course, I realize there are probably residual drugs in his system, and that it's only a week since the injury, and so on and so on. But it is still hard to be very optimistic.
Today he is getting a "PICC" line - a peripherally inserted central catheter - which is what they put in patients that might need an IV catheter for a longer period of time.
Ann"
For Ann, Andrew and Sally, we can only imagine how difficult, emotional and tiring the week has been.
And for Ann especially, our thoughts are constantly with you through this long and difficult recovery period for Simon.
Ann's report on Simon's condition today reflects Simon's physical situation stabilising, but a sense of frustration and disappointment at the lack of mental response, hopefully due to the heavy sedation Simon has been under.
Gus
"The short-term things are going fine (trach tube, feeding tube, blood pressure not too bad), but I am feeling discouraged about Simon's lack of awareness. All week I've been hoping that all the sedative drugs are a large part of his grogginess - but this morning the propofol (the main sedative) was off for awhile, and although he did follow a few commands, it was very sluggish and inconsistent. Of course, I realize there are probably residual drugs in his system, and that it's only a week since the injury, and so on and so on. But it is still hard to be very optimistic.
Today he is getting a "PICC" line - a peripherally inserted central catheter - which is what they put in patients that might need an IV catheter for a longer period of time.
Ann"
Saturday, April 3, 2010
Sun 4-Apr-10 AM
Simon had a tracheostomy and a feeding tube (which enters the stomach via the abdominal wall) placed at around noon today. Everything went very well, and he's just sleeping for the rest of the day. His face looks great, now that the tubes are gone from his mouth. His tongue is a bit swollen, but hopefully with the tube gone, that will resolve soon.
No one is making any predictions about how he'll do over the next few days, or how soon he'll be able to breathe for himself, etc. But I talked to one of the nurses about eventual rehab, and she said patients usually go straight from ICU to an in-patient rehab facility. For Simon, most likely that will be Craig Hospital in Denver, which is a world-class rehab facility, for brain and spinal cord injuries only. There is another potential rehab facility not far from here, but it is not as specialized as Craig is.
Of course we are still going day-by-day, but at least it is helpful to me to have an IDEA of what comes next!
Ann
No one is making any predictions about how he'll do over the next few days, or how soon he'll be able to breathe for himself, etc. But I talked to one of the nurses about eventual rehab, and she said patients usually go straight from ICU to an in-patient rehab facility. For Simon, most likely that will be Craig Hospital in Denver, which is a world-class rehab facility, for brain and spinal cord injuries only. There is another potential rehab facility not far from here, but it is not as specialized as Craig is.
Of course we are still going day-by-day, but at least it is helpful to me to have an IDEA of what comes next!
Ann
Sat 3-Apr-10
I realized yesterday that there is no description of Simon’s injuries on it, so for those who don’t already know, they are:
1. Traumatic brain injury (closed head injury)
2. Fractures of left orbit (eye socket) and cheek
3. Fractured left clavicle (collarbone)
4. Fractured ribs x 4
5. Fractured 7th thoracic vertebra
6. Fractured pelvis (pubic bone?)
Despite that list, he actually looks quite good – even his left eye and cheek are almost normal-looking, with only a very slight black eye. And, it appears that no surgeries or other interventions are needed for any of the fractures - just time to heal. However, all of the fractures are going to be painful when he is allowed to awaken more!!
Simon is doing well this morning – still sedated, still on ventilator, but his blood pressure is much more normal with the treatments he’s getting now. Yesterday afternoon they had the ventilator on “assist” mode, so that Simon was setting his own respiratory rate and doing most of the work of breathing, and the ventilator was only supporting him a little bit. He managed to keep this up for about 2 hours without getting too fatigued or having his oxygen level drop. He also seemed to produce more secretions from his airway during this period, as his own exhalations seem to bring up a lot more of them (and the nurses suction his trachea on a regular basis). Hopefully that will help clear things out! Obviously they are watching the secretions carefully, looking for any signs of pneumonia, but his daily chest x-rays continue to look good.
The doctors just came through and they are planning to go ahead and do a tracheostomy (and a feeding tube), today (if they can get all the right people together). It sounds like a week of oral endotracheal intubation is usually the limit (to avoid too much trauma to the larynx and mouth, etc.), and everyone agreed that weaning off the ventilator would be safer and faster with a tracheostomy. Apparently there is a reluctance to do tracheostomies early on in head injury patients, but several people seemed to think they shouldn’t be so reluctant. Anyway, I’m all for it, if it will speed things up!!
Also - good news - his left pupil is coming down in size, and starting to regain its PLR . . . it had been measuring something like 4.90 and 4.88 before and after light (ie, almost NO change), but today it's more like 4.5 and 4.0 before and after. They seemed happy with that improvement. (They have this cool "pupillometer" that automatically records those dimensions and gives them a 3rd number, indicating not only the % change in size, but how rapidly it changed.)
Ann
1. Traumatic brain injury (closed head injury)
2. Fractures of left orbit (eye socket) and cheek
3. Fractured left clavicle (collarbone)
4. Fractured ribs x 4
5. Fractured 7th thoracic vertebra
6. Fractured pelvis (pubic bone?)
Despite that list, he actually looks quite good – even his left eye and cheek are almost normal-looking, with only a very slight black eye. And, it appears that no surgeries or other interventions are needed for any of the fractures - just time to heal. However, all of the fractures are going to be painful when he is allowed to awaken more!!
Simon is doing well this morning – still sedated, still on ventilator, but his blood pressure is much more normal with the treatments he’s getting now. Yesterday afternoon they had the ventilator on “assist” mode, so that Simon was setting his own respiratory rate and doing most of the work of breathing, and the ventilator was only supporting him a little bit. He managed to keep this up for about 2 hours without getting too fatigued or having his oxygen level drop. He also seemed to produce more secretions from his airway during this period, as his own exhalations seem to bring up a lot more of them (and the nurses suction his trachea on a regular basis). Hopefully that will help clear things out! Obviously they are watching the secretions carefully, looking for any signs of pneumonia, but his daily chest x-rays continue to look good.
The doctors just came through and they are planning to go ahead and do a tracheostomy (and a feeding tube), today (if they can get all the right people together). It sounds like a week of oral endotracheal intubation is usually the limit (to avoid too much trauma to the larynx and mouth, etc.), and everyone agreed that weaning off the ventilator would be safer and faster with a tracheostomy. Apparently there is a reluctance to do tracheostomies early on in head injury patients, but several people seemed to think they shouldn’t be so reluctant. Anyway, I’m all for it, if it will speed things up!!
Also - good news - his left pupil is coming down in size, and starting to regain its PLR . . . it had been measuring something like 4.90 and 4.88 before and after light (ie, almost NO change), but today it's more like 4.5 and 4.0 before and after. They seemed happy with that improvement. (They have this cool "pupillometer" that automatically records those dimensions and gives them a 3rd number, indicating not only the % change in size, but how rapidly it changed.)
Ann
Friday, April 2, 2010
Fri 2-Apr-10
Yesterday was kind of scary (for me) because Simon was so gorked with various sedatives that he was basically unresponsive. The doctors told me that it was just too much sedation, but it still worried me that he looked like going backwards. Fortunately, this morning his nurse told me that he has been very responsive all night (one of the sedatives is wearing off, and they just discontinued another one, but started him on propofol along with the fentanyl). Her words were: "I KNOW he's all there!!!" Hopefully her 30+ years of experience count for something!!
Once again he gets very hypertensive and agitated when stimulated; this morning he looked like he was trying to get out of bed! And I thought his right eye was focusing on me, much more, this morning. They are going to get an internal medicine consult about what to do about his blood pressure. I think if they can solve that, he will be close to getting off the ventilator.
How many hospital patients receive get-well wishes and cards from RESTAURANTS?? So far, Simon has received 3 such cards – from Jay’s Bistro, Young’s Café, and Fish!! (all of which will be familiar to Fort Collins residents) He eats at all of them so often that they are probably already noticing a drop in business! The total count of well-wishers is at 228 as of this morning.
Thanks again for all the words of support. I find I'm becoming obsessed with checking email, as new messages pop up so often, but it is a nice way to find out we're NOT alone.
Ann
Once again he gets very hypertensive and agitated when stimulated; this morning he looked like he was trying to get out of bed! And I thought his right eye was focusing on me, much more, this morning. They are going to get an internal medicine consult about what to do about his blood pressure. I think if they can solve that, he will be close to getting off the ventilator.
How many hospital patients receive get-well wishes and cards from RESTAURANTS?? So far, Simon has received 3 such cards – from Jay’s Bistro, Young’s Café, and Fish!! (all of which will be familiar to Fort Collins residents) He eats at all of them so often that they are probably already noticing a drop in business! The total count of well-wishers is at 228 as of this morning.
Thanks again for all the words of support. I find I'm becoming obsessed with checking email, as new messages pop up so often, but it is a nice way to find out we're NOT alone.
Ann
New reports of Simon's accident
Here are some local newspaper reports of the accident:
http://www.coloradoan.com/
http://www.thedenverchannel.com/news/22996756/detail.html
http://www.9news.com/news/article.aspx?storyid=135585&provider=top
http://yourgroupride.com/component/content/article/132-news-and-events-/533-csu-professor-remains-in-critical-condition-following-sunday-bike-crash
and this one:
http://www.coloradoan.com/
http://www.coloradoan.com/
http://www.thedenverchannel.com/news/22996756/detail.html
http://www.9news.com/news/article.aspx?storyid=135585&provider=top
http://yourgroupride.com/component/content/article/132-news-and-events-/533-csu-professor-remains-in-critical-condition-following-sunday-bike-crash
and this one:
http://www.coloradoan.com/
Thu 2-Apr-10 PM
Simon is still being kept sedated and on a ventilator. His responses to commands are still about the same. A problem he has been having is that anytime he starts to awaken a little from his sedation, his blood pressure shoots up tremendously (yesterday his systolic hit 303!!). That makes it hard to lighten his degree of sedation to assess his neurologic status or consider weaning him off the ventilator. So today he is going to be started on a new sedative, Precedex, which I just realized is dexmedetomidine - a drug that we veterinarians are VERY familiar with!!! Hopefully it will help Simon stay calm but allow him to awaken slightly without too much hypertension. IF it does (and I'm not counting on ANYTHING, at this point!!), then perhaps they can try to wean him off the ventilator again sooner rather than later . . .
The doctors and nurses here have been just fantastic. Medical Center of the Rockies is a "level 2 trauma center", which means they handle all the most critical cases from around our area. But what really impresses me is how much of a team effort they make - for instance, every morning they do rounds here in the surgical intensive care unit, and a group of about a dozen doctors, nurses, respiratory therapists, pharmacists, etc., all come together and discuss the cases. I get to stay in the room and listen in, and this morning they even asked me about dexmedetomidine, since we vets use it a lot. The nurses in particular are just wonderful - so compassionate, so competent, and so good at answering my questions and including me in Simon's care. (Seems there are a lot of MEN who are intensive care nurses, and one of them said it's because males are drawn to the stress and excitement of emergency and critical care!)
As of this morning, we have heard from nearly 190 individuals around the world, and it is wonderful to see how many people care about Simon and have been impacted by him. The ones that get to me the most are the testamonials from former students who say, "I wouldn't be where I am today, if it hadn't been for Dr. T." There are a LOT of those!
It is still to early for visitors or flowers, but thanks again for all your messages - they are really helping me, and I know Simon will eventually appreciate them, too!!
Ann
The doctors and nurses here have been just fantastic. Medical Center of the Rockies is a "level 2 trauma center", which means they handle all the most critical cases from around our area. But what really impresses me is how much of a team effort they make - for instance, every morning they do rounds here in the surgical intensive care unit, and a group of about a dozen doctors, nurses, respiratory therapists, pharmacists, etc., all come together and discuss the cases. I get to stay in the room and listen in, and this morning they even asked me about dexmedetomidine, since we vets use it a lot. The nurses in particular are just wonderful - so compassionate, so competent, and so good at answering my questions and including me in Simon's care. (Seems there are a lot of MEN who are intensive care nurses, and one of them said it's because males are drawn to the stress and excitement of emergency and critical care!)
As of this morning, we have heard from nearly 190 individuals around the world, and it is wonderful to see how many people care about Simon and have been impacted by him. The ones that get to me the most are the testamonials from former students who say, "I wouldn't be where I am today, if it hadn't been for Dr. T." There are a LOT of those!
It is still to early for visitors or flowers, but thanks again for all your messages - they are really helping me, and I know Simon will eventually appreciate them, too!!
Ann
Thu 2-Apr-10 AM
Not a whole lot to report since yesterday . . . it is 72 hours since the accident now, and I guess I was hoping things would start to improve by now, but then I am impatient!! I was told from the beginning that the worst swelling / inflammation would occur at 48 to 72 hours, so hopefully we are about to get past that time and then see something change. At least things are NOT deteriorating!
Simon is still heavily sedated and on a ventilator. He responds to some commands, but the doctors want him to rest for at least another day before trying to wake him up. Yesterday he had an MRI which did not show any damage to the nerves of his left arm, or to the ligaments of his neck. So the cervical collar was removed, which is more comfortable for him. His face looks amazingly good! - only a slight black eye, very little other bruising - considering the broken bones of the left cheek and orbit.
To date, we have received messages from over 140 individuals, all over the US, Canada, Switzerland, and Australia. These are much appreciated. Please do not send flowers at this time. I know you all would like to help us in any way you can, but at present, there is nothing we need. Please keep those good intentions for later, as there will be a long road ahead, and it is likely that we will need your help at some point in the future, once Simon is out of the hospital and rehabilitating. Thanks for your kind thoughts and good wishes!!
You are welcome (in fact, encouraged!) to forward this to anyone who might want to check on Simon, as I can't keep up with all the inquiries myself. If anyone sends an email to my address, they should get an automatic response, which I will try to update every morning.
Ann
Ann
Wed 1-Apr-10 AM
Kind of status quo. Simon still gets extremely hypertensive (systolic BP > 260) whenever he’s a little light and stimulated. He still follows commands but no better than previous days. The cervical collar was removed last night, which is good. I spoke with Dr. Foster the ophthalmologist (who coinicidentally did my Lasik surgery some years ago!), and he said the left pupil may be dilated because the nerve is “weak” or because the pupil itself is damaged, but the eye itself is okay. He would like to do a couple more tests, but they need to be done after Simon is off sedatives and fentanyl: the “doll’s-eye movement” and a retinal exam. He said that, even if they make a specific diagnosis on why the pupil is dilated, it’s unlikely there will be any treatment necessary, so there isn’t much urgency to make the diagnosis.
I was a bit tired and more emotional today, so I went walking with a friend, and had lunch with her and another friend, which was a nice break.
When I came back after lunch, the nurse told me they had tried to use “pressure support” for awhile – I guess this means setting the ventilator so that Simon triggers his own respiratory rate, and the ventilator delivers a minimal volume so he has to do more of the work. Sounds like this is what they normally try before weaning someone off the ventilator. Well, Simon didn’t handle it well; he got tachycardic (high heart rate), hypertensive, tachypneic (rapid respirations), and his sat (oxygen level) starting dropping. So they put the ventilator back on its regular settings.
The pulmonologist Dr. Wallach came in and told me about it, and said they’d try again tomorrow. When I asked her how long it might be before he could be weaned, she said sometimes a week. Today he is at 72 hours post-trauma, so theoretically this is the peak of inflammation and swelling. I guess we just keep our fingers crossed that he starts to improve over the next 3 or 4 days!
Ann
Thursday, April 1, 2010
Tue 31-Mar-10
MRI showed some swelling / edema around the brachial plexus (nerves) of his left shoulder, but no actual damage to the nerves, so I'm guessing that means whatever weakness he has should resolve gradually, once the swelling goes down. Also, no ligament damage in the cervical area, so the collar can come off tomorrow (for some reason, they have to wait until rounds tomorrow morning to take it off!!).
The case manager answered some of my questions about what to expect from this head injury. The first time (1986), Simon had a discrete hematoma that affected one specific area of his brain, and the doctors were able to predict some of the effects it would have. Although that time he woke up quickly and looked pretty normal, he had a lot of behavioral / emotional abnormalities that were difficult to deal with.
This time, he does NOT have a discrete injury like before, it's more of a diffuse shock to a larger area of brain. She said that often means it takes longer to wake up (as I'm seeing), he may remain groggier and more sluggish for longer, and it's hard to predict what deficits he might have. So that's why the doctors aren't predicting what symptoms he might show. But it sounds like he'll stay in the hospital or in-patient rehab for quite awhile.
Ann
Ann
Mon 29-Mar-10 PM
Simon was just extubated about 45 minutes ago. He is breathing okay but accumulates a lot of blood / mucus etc. in his throat periodically, which he's having difficulty coughing up - maybe because he's not "with it" enough, but also because his ribs hurt when he tries to cough. He goes through periods where he's pretty responsive; for instance, when the nurse asked, after the tube was out, "is that better?" he made the "A-OK" signal with his thumb and forefinger!! But then he goes through periods where he isn't very responsive. There is a chance he will have to be re-intubated, if he can't keep his airway clear enough without it.
Later that day:
Well, Simon had to be re-intubated and put back on the ventilator. His oxygen level started dropping after about an hour of breathing on his own, and he wasn't able to cough well enough to keep his airway clear of blood and mucus. Since he's intubated and ventilated again, he's also heavily sedated again. I think it will be at least 2 more days before they even think about trying to get him off the ventilator again. It will probably be pretty difficult to assess his neurological status during that time.
Ann
Later that day:
Well, Simon had to be re-intubated and put back on the ventilator. His oxygen level started dropping after about an hour of breathing on his own, and he wasn't able to cough well enough to keep his airway clear of blood and mucus. Since he's intubated and ventilated again, he's also heavily sedated again. I think it will be at least 2 more days before they even think about trying to get him off the ventilator again. It will probably be pretty difficult to assess his neurological status during that time.
Ann
Mon 29-Mar-10 AM
Simon was very stable through the night. This morning his sedation was
discontinued briefly, and he got quite active, moving, etc. He was able
to follow a couple of simple commands and open one eye (the other is too
swollen!!), and nearly pulled out his endotracheal tube. So, the plan
is to try to wean him off the mechanical ventilator and get the
endotracheal tube out, in other words, get him breathing on his own.
Hopefully that will happen sometime today.
So, overall, mostly positive and no negatives to report this morning.
Ann
discontinued briefly, and he got quite active, moving, etc. He was able
to follow a couple of simple commands and open one eye (the other is too
swollen!!), and nearly pulled out his endotracheal tube. So, the plan
is to try to wean him off the mechanical ventilator and get the
endotracheal tube out, in other words, get him breathing on his own.
Hopefully that will happen sometime today.
So, overall, mostly positive and no negatives to report this morning.
Ann
Sun 28-Mar-10
Simon had a bike accident - actually, he was hit by a car while on his
bike - Sunday morning, and is in intensive care at the Medical Center of
the Rockies, Loveland, CO. Like last time (1986!), he has a closed head
injury, but he also has a bunch of other fractures. It is going to be
at least a few days before we know how serious the effects of his head
injury are, but for now at least things look fairly positive. He has
responded to commands (squeeze hand, show 2 fingers, etc.), but he's
heavily sedated with midazolam and fentanyl so he's not in any position
to be doing much more than that.
All his other injuries sound reasonably okay: lots of them, but none
too life-altering. He has a bunch of facial fractures, a fractured
clavicle (collarbone), minor pelvic fracture, thoracic vertebral
fracture (neurosurgeon has already said the spine is okay and won't
require surgery), several broken ribs, and tons of bruises. I think
the only things that will definitely need surgery are the facial
fractures, and maybe the clavicle. He has moved all of his extremities,
although the right side is moving a lot more than the left, but he was
evidently hit on the left side, and that's the side the clavicle
fracture is on, so maybe he's just sore on that side - or he may have
injured the nerves to his left arm. He also had a torn artery
associated with the pelvic fracture, which was bleeding and was
embolized after he got to the hospital to control the bleeding. He's
had a couple of units of blood and his blood pressure, etc., seem pretty
stable now.
Ann
bike - Sunday morning, and is in intensive care at the Medical Center of
the Rockies, Loveland, CO. Like last time (1986!), he has a closed head
injury, but he also has a bunch of other fractures. It is going to be
at least a few days before we know how serious the effects of his head
injury are, but for now at least things look fairly positive. He has
responded to commands (squeeze hand, show 2 fingers, etc.), but he's
heavily sedated with midazolam and fentanyl so he's not in any position
to be doing much more than that.
All his other injuries sound reasonably okay: lots of them, but none
too life-altering. He has a bunch of facial fractures, a fractured
clavicle (collarbone), minor pelvic fracture, thoracic vertebral
fracture (neurosurgeon has already said the spine is okay and won't
require surgery), several broken ribs, and tons of bruises. I think
the only things that will definitely need surgery are the facial
fractures, and maybe the clavicle. He has moved all of his extremities,
although the right side is moving a lot more than the left, but he was
evidently hit on the left side, and that's the side the clavicle
fracture is on, so maybe he's just sore on that side - or he may have
injured the nerves to his left arm. He also had a torn artery
associated with the pelvic fracture, which was bleeding and was
embolized after he got to the hospital to control the bleeding. He's
had a couple of units of blood and his blood pressure, etc., seem pretty
stable now.
Ann
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