Author Archives: Family

Off with his vent!

Ansel had a good, solid night. A little arm and leg thrashing due to some indigestion, but as soon as he ‘expels’, he’s quite calm. The movement is good, because it demonstrates muscle control — now that the sensors are gone, this muscle control and ability to respond to questioning is one way to inform us of his progress.

So there are three exciting things to report today:

1) Ansel’s off the Versed drip.

This is the sedative that was used initially to keep him in the medical coma, then to keep him calm as his brain starts the beginning stages of ‘waking up’. He may still receive an injection or so depending on whether he cooperates with the CT scans.

2) Today marks the beginning of the process of removing the ventilator from the equation.

There are essentially three modes of this ventilator: I’ll call them ‘mode 0’ (the vent does all the breathing), ‘mode 1’ (the vent pushes a constant amount of oxygen over time, but allows Ansel to breath over it) and ‘mode 2’ (no constant, Ansel does his own breathing, but the vent will kick in if he’s not taking full breaths).

As of approximately 11am this morning, Ansel was switched to mode 1. Today’s awesome nurse, Heidie, would like to be aggressive with this process, because Ansel is young and still has great respiratory system. About 20 minutes ago, Ansel was switched to mode 2!

It’s too early still to speculate anything beyond this, but it’s interesting to note that once he’s done with the vent, he’ll get a trachea collar, which is essentially a tube with humidified enhanced oxygen — but he’ll be breathing on his own. With positive results, this gets swapped with a smaller tube, and eventually no enhanced oxygen. Once we’re there, Ansel will get a temporary voice-box. With some time and training, this will enable Ansel to communicate with us! And with even more time, the trach-tube and voice box can be completely removed.

3) Ansel met his physical therapists for the first time today.

Today’s session was just about identifying a baseline. Not much to report at this point, but the physical progression will be a very interesting measure of his overall progress in the future.

Just gotta ask the right questions …

Some days are better than others.

This morning, Ansel did the whole ‘raise two fingers’ thing, then a few hours later just completely refused. This cycle is to be expected.

So Uncle Rich shows up, taps on the medical restraints, and says ‘hey Ans, I’m gonna bust ya outta here!’. Ansel cracks a smile. Then he says ‘well, maybe later. How about a cold beer eh?’. Ansel nods. I guess he was just bored of the standard survey!

Hydawhodawhaty?

If Memorial Day was ‘Day 0’, we’re on Day 16. Liz and I got back into town last night, and visited Ansel before catching some zzz’s.

I was able to meet Nurse Madeleine last night, who continues to expertly manage Ansel’s respiratory and ICP. He was in the middle of another Versed dosage, but these doses are more about keeping him calm, as opposed to keeping him ‘under’. Ansel seemed curious of his surroundings, looking around the room and intermittently tracking my presence.

Today has been nothing short of fantastic news.

After some successful basic motor/cognitive testing (asking Ansel to hold up two fingers, stick out his tongue, nod his head, etc), Ansel continued to want to move! Again, we love that he’s doing so well, but the movement presented an issue when Dr. Morgan wanted to do another CT scan. So they gave him another dose of Versed to get him calmed down, to take the scan. The scan was primarily to identify Hydrocephalus (an overabundance of CSF in the ventricles of the brain).

The results are, in a word, clean! So clean, in fact, that Dr. Morgan decided it was time to ‘unplug’ the Ventricle Catheter, and the ICP monitor. In other words, the combination of Ansel’s ability to regulate his own ICP, and his ability to demonstrate basic cognitive and motor control negates the necessity of any further measurement of ICP. The pressure may indeed continue to fluctuate, but since he’s now strong enough to regulate this on his own, the change will be within a healthy range.

Since it will take weeks (even after he’s awake) to metabolize all of the sedatives he’s using, Ansel probably won’t be able to remember any of this part of the healing process. Luckily, I’m not taking the sedative, so it’ll take a lot more than a bonk on the head for me to forget the wave he gave me before drifting back to sleep.

-Marcial

6/12/12

Very early this morning, Ansel’s nurse made a second attempt at weening him from sedatives .  This time she gave him a medication for anxiety, to keep him calm as he woke up.  By 8am he was completely without versed, however, his heart rate and cranial pressure began to spike.  We gave him several hours, hoping he would slowly calm down.  At about 130pm he was given Manitol (diuretic) to help with ICP.  This is the first time in 3 days that diuretics were needed. Then at about 215pm his nurse had to give him a small dose of Versed (sedative) to calm him down.  Again, we may see this cycle a few times, but not to be discouraged, he is putting up a strong fight which is exactly what we hope to see. 

Thank you for all the love and continued support.

update.

Ansel had a relatively uneventful night, so doc decided to take him off versed (sedative) at around 11am.  Soon after, he became very responsive.  We saw a lot of eye movement, eye tracking, opening his eyes to sounds, and followed limited verbal commands such as hand squeezing.  As more of the sedative wore off, Ansel became confused, angry, agitated (as we would expect him to be, waking up in an unfamiliar hospital, in restraints, IVs crisscrossing everywhere, tracheotomy, csf drain, neck immobilizer, etc.)  We tried to calm him, and explain where and why he was here, but this only put him in more of a panic.  He began pulling on his restraints and tossing his head and body from side to side, which in turn made his heart rate too high.  Nurse, Alison, decided it would be safest to put Ansel back on Versed and try slowly weening him at another time.  This reaction is seen in most patients with head injuries, as they have no recollection of the events leading up to the accident.  Right now, 4pm, Ansel’s fever is a very low 100.4 with no medication to manage it.  His ICP has been in the teens and low 20’s all day, no medication to manage it, even when he was off the sedatives.  His vitals are within safe limits, with the exception of the high heart rate during his panic episode.  There was improvement seen in his chest x-ray.   We will most likely attempt sedative weening again tomorrow, after a good night’s rest.  Overall, we consider all of his reactions, including his anger, coughing, and panic attack to be good signs.  He is responding to pain, verbal stimulus, and emotions.  This is a huge step.  Yay Ansel!

Second Sunday Stats

Happy Sunday everyone! Ansel slept well last night. Some coughing and slight head turning. He seems to want to stretch his arms. I held his hands tightly during one of his stretches. I must report; he still has good grip. I was explained this stretching and squeezing of my hand is involuntary and cannot be construed as a voluntary demand move. Ansels nurse, Robin, did start some cognitive exercises, though. These exercises include pinching of his chest areas to detect reaction from his face, fingers and arms. Other tests include squeezing of different areas on his legs to detect reaction. Due to this early stage of his recovery, Ansel could only twitch portions of his face and momentarily twitch his right hand. He has quite a bit slower movement on his left side. This paralysis is quite concerning and due to his serious head trauma, expected. As we all await Ansel to wake up, we should also understand this process is very slow and deceivingly emotional. Stats as of 0700 Sunday: ICPs@6, MAPs@91, CPP@85, 133/72, 02@40% sat, Versed @ 5ml. Thank you for all of your prayers. Steve

Here today gone Tomaui

This is my last Saturday night here with Ansel, by my side…till next weekend. Its odd but I’m starting to get separation anxiety! At 2300 ICPs @ 18, temp @101.5, MAPs (mean arterial pressure) @73 (kinda low), CPP @53 (due to low bps), O2 @40%. Todays recap reads like this: Ansels nurse, Robin, lowered his Versed to an amazingly low 5 mgs. Astounding job Ansel! He still coughs in a very difficult manner. Sometimes during a coughing episode his anguish squeezes a tear from his eyes. Hey I don’t know about you all but, yours truely can’t hold back the tears either. However, when he does open his eyes he seem to mesmerize me in an odd form of ESP. I tend to talk to him slowly as if he were back in Dottys arms as a baby. The very slow cadence, simple low volume words and uncomplicated thoughts expressed with unconditional love. The last two weeks here at Renown Hospital ICU has been a blur, but I’m savoring this evening in a higher regard than any E-ticket ride Disneyland could ever sell me at a discount. The staff here are the best. Period. Thank you so much for reading my words. Thank you so much for your kind words of support, your precious feelings shared in e-mails, your constant reminder of prayers to the one and only and the Angels that visit us at the oddest times. Thank you for being Ansel’s friend.
Steve

Mr. Personality

Ansel had a rough night, after his ventric drain clogged yesterday.  Nurses tried trouble shooting the problem throughout the night, but by morning it was out of their hands and into the hands of neurosurgeon Dr. Morgan.  Dr. Morgan arrived around 8am this morning, read CT, found that there was a blood clot stuck in the ventric tubing and fixed it.  Thank you Dr. Morgan!  Ansel’s ICP levels immediately stabilized.  With his pressures at normal levels, nurse Alison decided it was time for some teeth brushing (his breath was gnarly).  For the first time since the accident, I saw a little bit of Ansel’s ornery personality.  As Alison was brushing, Ansel bit down on the tooth brush with all his strength, as if he was taking everything out on that toothbrush.  She asked him kindly to give it back, nope, then asked more firmly, then it turned to a command, and finally I had to intervene with a little jaw thrust maneuver.  Bingo!  As usual, I won that that argument.  Praying for more personality today and every day thereafter. 

with love,

-val

Cloggs are not dancing shoes

It was a rough day today.  It all started just after Ansel woke up. Somewhere around 1100, the nursing staff had notified us of a scheduled  CT scan. All was well and looked like Ansel was fighting back in big strides so a CT scan would be a good tool. For instance at 1100 : ICPs = 04 to 10, temp at 102.9 deg, O2 at a very  low 35% and the Versed dosages at an all time low of 8 mgs.WOW,  We were almost dancing in the Healing Garden! Days ago when he was moved to change the bed set, his ICP spikes could reach the 50s and with added doses of Manitol his ICPs would drop. Then a day and a half ago NO Manitol was induced and the control over his Internal Cranial Pressure was just about mastered.

 Then today, Ansels coughs became quite vigorous. With his body now metabolizing the paralytic, shaking and gasping would occur during coughs. One would believe he could hurt himself coughing.. Despite his regained strength and stamina we knew he still has a long way to go for the recovery process to begin. Then it happened, the slight set back.

Remember the Ventriculostomy of June 5th? Unfortunately, today, the catheter that was inserted into Ansels ventricle slowly clogged up. This clogging prevented the CSF from draining out of his brain and resulted a much higher ICP.  After the CT scan, Ansel  was wheeled back into his room. We witnessed an ICP spike of over 50. Quite a surprising number  since our recently found confidence in his slow recovery process.  For the first time in a day and a half Manitol was needed. Manitol is a hyper-tonic sodium that pulls fluids from the brain, therefore lowering the ICPs. The V-drain basically worked, till it clogged.

According to Ansels, neurosurgeons not all is lost. They planned to close off the V-drain anyway.  This unexpected clogging just accelerated the decision making process. We are now treating the high ICPs with Manitol, a 23% hyper-tonic sodium solution and upped the Versed to 15. However, these pharmaceuticals are used only if the ICP values are above 25 for 15 minutes. So far at 2300 I’m happy to report there has not been any Manitol given to Ansel for over six hours and this solution can be administered once every three hours. The CT scans? No problemo, word has it: Ansels brain is healing well.

 Just a slight set back today, rather disappointing though, since we were about to   ” don our gay apperel”  and dance in the Garden.                      Steve

Ansel’s Friends

On behalf of Ansel’s entire famiy, we can’t say thank you enough to……

PAUL, BEN, and JOE for holding down the fort over there at Monzo Speed. Thank you for busting your ass to keep Ansel’s business running smoothly. We all know that Monzo is Ansel’s life long dream, and would fall apart right now without these guys. I know when Ansel wakes up, the next thing he will be worried about after his two handsome children, is his business. It will mean the world to him to know that you guys took care of it for him. Thank you. And thank you to all the guys who have called the shop to offer extra hands.

JAMIE, SAM, and KAILEY for all your hard work planning the spaghetti dinner fundraiser for Ansel. I have posted the flyer to the website. They also put donation Jars at local businesses, Kragen and Napa (please comment if I missed one). Thank you ladies, I know Ansel absolutely adores the three of you and his heart would be overwhelmed with warmth to know you did this for him.

TAHOE DERBY DAMES for all of your hard work putting together an awesome fundraiser for Ansel. Slayer and Scarlet are working on a flyer that I will also post ASAP. They have also designed and ordered very cool coozies to sell with profits going to Ansel. There will be a pic of the coozies on this site later today. I love all of you ladies, and coach Hammer. Thank you.

ESCOBAR TRAINING GROUNDS for putting together a T-shirt fundraiser for Ansel. The Escobar family have been good friends of Ansel’s and mentors for his son Monte. They love Ansel and have offered open arms and a willingness to help in any way possible. They are selling very cool Escobar t-shirts to benefit Ansel. Please stop by Escobar Training at 972 Tallac ave, south lake tahoe for a t-shirt. Thank You.

HOLLIE, for creating a beautiful fundraiser jar for Ansel which is located at Meek’s in Meyers.  Hollie, you have always held Ansel and his family close to your heart, and I love you.  Thank you.

MONTE’S CLASS for making ansel a super awesome poster which hangs in his room here at Renown.  There was a lot of love and creativity put into this poster, and I know Ansel will cherish it forever.

Between Ansel’s friends, family, and community, Ansel will come out of this knowing he is loved and supported unconditionally.  Thank you everybody.  Please continue praying as Ansel makes his next moves to recovery.

-val