ICU Soccer!

Hello Friends & Family!  I am back in Reno with my take on Ansel’s update!
First everyone keeps telling me how good Ansel looks. Well, as his mom, I’ve always known I have 2 of the best looking boys around….(ok, Monzo are doing pretty good at bumping the top 2!) However, I just had concerns about how anyone who had just spent over 3 weekes in a trauma icu could look good.
Gratefully, all things considered….he does look pretty good …..save for his funky haircut!;).
In an effort to clean him up “for his mom”, Val gave him what turned out to be a partial haircut. He has some resemblence to a Polish rooster right about now (sorry Ans!) So I tried to get the job further along, and now have even a greater respect for Val’s brave effort to shave him while he shook around in resistance!! I did manage to trim more off, but somehow……what seemed like minor trimming has turned his room into a wooly mammoth cave….that kid has hair!
So meanwhile back to how Ansel is doing…well, I don’t have all the medical verbage, but here we go…. All his vitals are good (pulse pressure, temperature). His chest xray is ok, his blood work shows that he is still have difficulty retaining sodium so they are keeping that in his iv solution. Progress was held up yesterday (Wednesday) due to staffing issues at the hopital, so no voicebox session, no walks thru the garden (or anywhere). We did manage to highjack a wheelchair and took Ansel for a short stroll out the back door where he got to spend a few minutes breathing in freash Reno sunshine!! yipppeee. It was sure the highlight of MY day. He also manage to sit up for several hours in the reclining chair next to his bed. All this was enough to wear us both out, and think we both manage to get a bit more sleep than the night before. This morning, it is back to our continuing battle to keep the air/humidifier on the trach, Ansel’s continued resistance and pulling at his feeding tube, which results in having to change his smock 3 times because he pulls the cap off, turns the valve on, and then his “food” drains oll over him….over and over again.
A highlight today has been the 5 minute voicebox session…..I felt so bad for him because it caused him to cough horribly, but hearing him speak did wonders for me….even if much of it didn’t make sense, such as: Where are you Ansel?….Ansel: Phoenix;
Do you know why you are here Ansel?….because of the dentist…..and other such ???
Still, it did my heart good to hear him:).
Oh, so my sister Tammy suggested we pick up some squishy toys for him to play with, in an attempt to keep his hand busy doing something besides pulling on tubes. He now has a squishy football, spikey ball, and large squishy soccer ball!  Ok, so what is he suppose to do with these you ask…..well, our hope was that he would lay there and squish these to build muscle and stay occupied……BUT they are balls after all, so of course he has been throwing these things across the room, at me, at nurses……I go retrieve, give back, and then process is repeated. Hmmmm, great idea Tammy;).
Love & Light to all, keep those prayer coming!
Jas

Amigos!

First, A huge shout out to everyone who came out for spaghetti last Tuesday!!  What a great turn out!  Was so nice to see you all.  Sending a special thank you to everyone who helped organize the event, cooked the food, donated raffle and auction prizes, and much more.  Thank you to the Eagles Nest for providing us with such a beautiful location.  Thank you to all Ansel’s friends and family who showed up to support him, and to those who couldn’t show up but supported him anyways.  Thank You All!

It has been a few days now since anyone has updated us on Ansel’s progress.  Sorry, I think this is mostly due to his demanding every waking moment of attention.  There are many more waking moments than sleeping ones.  Ansel is very restless and spends most of the night tossing around in bed pulling the oxygen tubing out of his trache and pulling at every IV he can find.  After he tires himself out and takes a power nap, he is usually up for a small chat, some tv, magazine, or other type of mental stimulation. 

Ansel is more consistantly and quickly recognizing his family and friends.  He isn’t always able to vocalize it because he must take a lot of breaks from his voice valve as it makes breathing a bit more difficult.  When he can’t say hello he does wave, or smile to acknowledge us.  Saturday he made his Aunt Tammy’s day when he grabbed her hand and pulled it in for a kiss.  When Ansel’s stepmom Chris, and his son Monte arrived yesterday, he immediately recognized them both.  He gave Monte high fives and even thanked Chris for coming to see him. 

Today, Ansel took a little walk with the physical therapist to the door of his room, then back to a chair where he spent about an hour sitting up.  We took advantage of the sitting up possition and washed his hair for the first time in 27 days.  Im sure that felt refreshing. 

  Last night, Ansel’s nurse Gary informed us that Ansel is at about level 4 out of 10 on the “Rancho Los Amigos Cognitive Scale.”  You can visit www.northeastcenter.com and search Rancho Los Amigos for more info, but here is the outline of level 4;

Level IV – Confused/Agitated: Maximal Assistance                                                        

-Alert and in heightened state of activity.

-Purposeful attempts to remove restraints or tubes or crawl out of bed

-May perform motor activities such as sitting, reaching and walking but without any apparent purpose or upon another’s request.

-Very brief and usually non-purposeful moments of sustained alternatives and divided attention

-Absent short-term memory.

-May cry out or scream out of proportion to stimulus even after its removal.

-May exhibit aggressive or flight behavior.

-Mood may swing from euphoric to hostile with no apparent relationship to environmental events.

-Unable to cooperate with treatment efforts.

-Verbalizations are frequently incoherent and/or inappropriate to activity or environment.

 

-val

 

 

Another ICU Thursday…Not!

I was going to write about how well Ansel slept last night. I was going to share the fact that he only got one hit off the Fentonal 1 ml dispenser. My plan was to ask the question; how many nurses does it take to give Ansel a walk? Then, I was planning to share the sentiments of Ansels doctor. Then last but not least the news of leaving the ICU.
The good news is that all the above happened! Last night Ansel slept pretty well, except for the occasional rolling, tossing and flinging off his bootiesocks. The inflatable calf devices didn’t make it through the night either, however a 4 hour sleep session was welcomed. Hardly needed the fentonal, infact one shot was what it took to get it done.
The good news came from Dr Watson. After his morning assessments, Dr Watson told me he was planning to release Ansel from the ICU and get him a room at the Neuro ward. Same floor, same quality care nurses, just not as clinical. Ansel was on his way out of here!
However, before his mass exodus from this fine ICU brain trauma room 113, Ansel had a date with a couple of nurses ready for rumbling! So, how many Intensive care RNs does it take it to walk Ansel? Four! Ansel was coaxed, disassembled then reassembled by, Nurse Allison, Nurse Charlie, Nurse Tiffiny and Nurse Katharine. Ansels allstar team. The stroll was more like torchering a young kid at his first goat roping contest. Ansel was insisting to sit and not walk and actually being quite vocal. Charlie and Katharine kept the air assist canister from topping! RN Allison tried to steer the industrial grade wheel chair and RN Tiffany orchestrated the cheering squad! I ended up pushing equipment out of the way here and rolling pumps there. Couldn’t believe a hallway could be so cluttered! By the time this circus circumvented the ICU , the attending nurses with their patients all stepped out of their rooms to cheer Ansel on! This wasn’t a stroll, it was a race. Way to go Ansel, theyre already cheering for you!

Straps to Laps!

I arrived here at Renown at 1830 this evening. Ansel was sound asleep. Nurse Jenna, commented that Ansel had a very stimulating day. Ansel was assisted with two strolls around the ICU this morning. The walk/about were done at separate times today. Since his leg muscles need exercising, the walking helped arouse his awareness and therefore this stimulus exhausted him. The “out n about” put him out in bed. Its amazing how much progress Ansel shows in just 3 days. Ansel saw sunlight for the first time on Sunday, albet strapped to an up right hospital bed/seat. Today he’s doing laps around the ICU. Ansels progressive recovery is quite inspiring. At the moment he is enjoying a 3% drip, fentonal button request and 28% oxygen through his trachea. No fever and beat pneumonia to a pulp. We are planning another tour around the ward at 0100. Can you just imagine Ansel strolling with the balancing help of two strong nurses wearing a blue h/gown humming to “Story of my Life” ? -Steve

Bad Medicine is what he needs!

Good Morning friends and family,

Pretty sure Ansel has become knocked-turnal, haha!  He was up all night, thrashing around in his bed.  I just didn’t have the heart to keep him in his restrants.  At times, I leave him unrestrained for as long as I can bare, but this means I have to wrestle him as he pulls at his oxygen mask, feeding tube, catheter, and tangles himself in a mess of IVs, wires and tubes.  He is showing more and more of his ornery self, and he’s getting stronger and stronger with each wrestling match.  I, however, am getting weaker and weaker the less I sleep.  Nurse Dawn suggested Ansel needed to go for a long walk — more for me than him.  Thank you!  With Dawn and Scott helping to hold up his weight, Ansel took a walk all the way around the ICU unit.  Fantastic progress!

After his long walk, Ansel was tired but still fighting.  After trying everything I know to calm him down, I asked him if maybe some music would help him sleep.  Here is how the converstion went……

Me: Ansel, would music help you sleep?
Ansel:  Yes, music would be good.
Me:  Okay, what would you like to listen to?
Ansel:  Bon Jovi.
Me: haha, thats funny, you dont like Bon Jovi.
Ansel:  I want some fuckin Bon Jovi!
Me:  Okay, Bon Jovi it is, whatever helps you sleep
Ansel:  Thank you Val.

Believe it or not, he is now sleeping.  So, now I have a Bon Jovi station saved on my Pandora.

-Val

Do I gnome you?

Ansel spent the last two days learning to speak using his new voice valve which connects directly to his trache.  He’s asked many basic questions several times a day:

What is your name?  Who are your children?  How old are they?  Where do you live?

Ansel is gradually answering these questions correctly.  Yesterday, Ansel was having trouble with face recognition, but by 11pm he was able to tell me who I was, and even asked for a hug.  At 11am today, nurse Dawn got Ansel out of bed, and with two people holding him up attempted walking for about 20 min.  In this time, he walked about 30 feet but the nurses did most of the work for him.  At 4pm, he made his second attempt to walk.  This time he walked about 100 feet in less than 5 minutes, with two nurses holding him up, but with less verbal direction (left foot forward, right foot forward, head up).  Today, we read some hot rod magazine, and Ansel even did a little of the reading.

He is very confused, and most of what he says makes no sense, but talking about anything is an improvement.  Now that he has become pretty proficient with the voice valve, he is working on swallowing.  He was fed blue colored ice chips, and blue colored apple juice.  Then after about an hour, his lungs were suctioned to see if any blue coloring ended up in his lungs.  No blue!  This means Ansel is swollowing properly and he is very close to getting his feeding tube removed.  It is possible that Ansel could be moved out of the trauma ICU tomorrow, and into a standard ICU room.

He has been extremely restless today and ripped through his restraints twice.   Ansel is very anxious to get out of here and is making a strong effort to put all the pieces back together.

-Val

A Distant Sound, Lost and Found

The speaking valve was a success!

This is essentially a little plastic piece that fits over the end of the trache-tube, which allows air to pass by the ‘balloon’ inside the trachea, up to the vocal chords. Since the valve can cause discomfort, it will be installed and removed as Ansel would like to speak.

This is the first step to ditching the tracheostomy tube, and to introducing solid foods.

Our speech pathologist de jour, Nikki, explained that it’s typical of brain injuries to take some time and coaching to get the vocal chords back in full effect. After asking a few basic questions without response, we finally got Ansel to count to four. His voice is extremely quiet and coarse, but that’s to be expected.

The family had pool going for what his first intentional words would be. I think we all lost.
[polldaddy type=”iframe” survey=”41C6AE3568A1A0F5″ height=”auto” domain=”m3tr1k” id=”what-were-ansel-s-first-intentional-words”]

Food shmood

This sweet Cadillac is on display in front of the hospital. I learned on a science-project-like display in the lobby that this Renown center is over 150 years old!

In other news …. Ansel got at his feeding tube once again yesterday. Because the process of re-inserting the feeding tube is so abrasive, nurse Charlie decided it was necessary to install a ‘bridle’ to prevent removal temporarily. This is basically a piece of floss that goes up one nostril, around the septum, and out the other nostril, tied just under his nose to the feeding tube, clamped off with a little plastic lock. It’s quite reminiscent of years ago, when Ansel got such a kick out of displaying his ability to floss his septum with a spaghetti string. To this day, I’ve not been able to perfect the art of nose flossing. Don’t worry — I’ll keep my day job.

Last night went swimmingly — Ansel’s blood-to-oxygen ratio held a healthy 95% for most of the night with no intervention, which means the collective therapists agreed to attempt a few things today:

– A component of the trache-tube has been swapped out with what’s called a ‘trache-mask’. This is basically a small plastic shield that fits over a space above the trache-tube, allowing for quick swapping between the aerosol-enhanced air (humidity and oxygen) and straight-up room air. Without the mask, and with a strong enough cough, Ansel can blast loogies across the room through the trache-tube. He racked up at least 20 points on Thursday. But I won’t bore you with those details. 😉
– Just about an hour ago, Ansel got his first ‘walk in the park’. Well — almost. He was moved to whats called a ‘cardiac chair’ to allow him mobility, while still maintaining a placebo-like saline drip (just to keep the main IV’s open). With this, Val, Ansel and Charlie were able to take a stroll through the healing garden.
– Upon returning to the ICU, the respiratory therapists were so pleased with his vitals that they’ve ordered the speaking valve! They will attempt to install this later today. Pending continued acceptable blood-to-oxygen ratio, this will be a temporary fixture to allow Ansel to speak (with some training), until he’s ready to start eating solid foods!

It’s Friiiidaaaaaay

Big thanks to Wes for this awesome picture! This is Ansel in his element.

Another solid, mostly uneventful night last night. Ansel did manage to remove his feeding tube at one point. I’m sure that felt awesome; but we need him to keep that for now, so nurse Steve had to re-plant it. I’m sure that felt less than awesome. This brand of disorientation is par-for-the-course for these types of head injuries, but Ansel seems to settle immediately after knowing his friends and family have come together so well for him.

This morning, we sync’ed up with nurse Charlie. She mostly reiterated what we’ve already seen — still on the 3% saline, with the salt additive in his food (to help the brain drain that fluid), didn’t need Versed over night, and the aerosol is working very well (95-100% blood:oxygen content — healthy normal numbers). It’s just about 10am here in Reno, which puts Ansel at a grand total of about 19 hours since he swapped from the ventilator to the aerosol. If he continues to do this well, he may be ready for the smaller trache-tube by 48 hours!

 

Breathin’ Easy

I’m happy to report as of about 3.45pm today, the respiratory therapists decided to take Ansel off the ventilator!

This means:

– He’s breathing independently, without a machine to expand his lungs (the ventilator)
– He’s hooked up to what’s called an ‘aerosol’ — basically a humidifier, using the atmosphere’s oxygen supply
– There’s still a suction component, in case those coughs persist

Also, I was able to have the first conversation (albeit, mostly one-sided) with my brother since the accident. He was able to answer yes/no questions by nodding or shaking his head. Naturally, he seemed quite agitated and wanted to sit up. I explained what happened, where he was, and that he was ok — he calmed down and sat back.

I know this level of awareness is pretty transient at this stage, so we’ll probably have to go through this quite a few more times before it really sticks.