April 30, 2005

Hokey-Pokey Progress

Riza made a significant step last night, as she performed the "put your right foot in" maneuver for the first time since the stroke. They will work on "shake it all about" in Occupational Therapy today and she'll be on her way.

Okay, I'll be serious -- this is great news. Riza was able to pick up her right (weak) leg at the hip and kick it forward with her knee. This is A LOT more motion than I have seen from this side before. She can also shrug her shoulder on the right side.

I'm so happy to see this, I've no doubt that the motion will intensify in force and control, but the complete lack was a little worrying. But she's moving her right side now, and that's what it's all about.

Posted by John Kranz at 7:57 AM | Comments (5)

April 28, 2005

it's riza again

hi everyone. Welcome to my speech therapy session.
after this i have occupatioal therapy/ physycal thereapy. that is where I how to stand and walk. that tahes it out of me faster than using the eilliptical trainer
for two houres.

Posted by Riza Rivera at 2:25 PM | Comments (2)

April 27, 2005

;life is good

life is good!!

I'm relearning to walk. I'm relearning to dress myself. `i'm relearning everything.

jk is the best. he brings me jamba juice and he comes everday. he's my goal. my goal is to go home

Posted by Riza Rivera at 11:54 AM | Comments (2)

April 26, 2005

my second entry

welcome to my speech therepy session with juli.

i cant be an atheist any more. i met god. i even talked to him and everything.

Posted by Riza Rivera at 2:10 PM | Comments (2)

April 24, 2005

it's me again

hi everyone!
don't send me flowers get me jammbajuice ;)
the drugs are great but i would not recommand getting a stroke to get good drugs just go to the dentist and ask for the nitrous oxide.

Posted by Riza Rivera at 10:16 AM | Comments (6)

April 21, 2005

Walkin' Blues

Or Not. Riza wanted me to post that she walked seven steps forward and seven steps backward in PT yesterday.

She continues to improve very quickly. I cannot imagine that she was, for all intents and purposes, bedridden last week. Today she fights the good fight: many therapy sessions, feeding herself, brushing her teeth, and participating substantively in dressing and grooming.

She's also reading the blog, so I have to be on my best behavior -- LOVE YOU SWEETNESS! You're doing great!

Posted by John Kranz at 10:30 AM | Comments (1)

April 20, 2005

Laughter

Big News, indeed. Riza laughed today; that was music to me.

Her voice strengthens every day but has been low and husky. Last night, I could hear that lilt of Riza's high voice sneaking in. Today at breakfast a couple of things made her laugh out loud. "You found your laugh!" I said, "it sounds sweet."

"Riza laughs," she said. "That's so you know it's me. You have found me in here"

Yup.

Posted by John Kranz at 10:23 AM | Comments (4)

April 16, 2005

Dining in the hall

Riza requested that I share this latest update.

We had two meals in the dining hall today. It has a great view and good facilities, but it makes a third-grade recess look tame by comparison. Riza is in with some rowdy folks. (That seems an explosive combination!)

Riza asked Phyllis, who had been there for a month "Does it get easier?" Phyllis said "yes," which seemed to put Riza at ease.

Sharing meals is great, and she continues to improve every day. Her therapy sessions are difficult and she is extremely fatigued most of the day. She is nervous but still in pretty high spirits.

In tube news, she lost the catheter and IV this week. All that's left is the stomach feeding tube. She knows that she loses that as soon as her calorie count goes up. She had a cake-and-milkshake lunch today to try and hit her numbers, but she is still about half of her required intake.

I tell her, this isn't going to last forever, hon -- people begging you to eat more calories. She gets the joke but still eats pretty lackadaisically. Janelle, her speech therapist says that that is common.

Posted by John Kranz at 8:58 PM

April 14, 2005

Dinner Date

I said that I would post on big news.

Riza had a video-esophogram today to evaluate her swallowing. I asked a couple of people if they knew the results but nobody had any news.

When I came back from the office, Riza said that she was having Chicken, masked potatoes and gravy. I suspected that some of her therapy work with the menus had inspired a little wishful thinking. And I hoped that she would not be too disappointed to discover the misunderstanding.

About that time, a tray of food showed up. Chicken. Masked Potatoes. Gravy. Riza asked for dessert and her nurse, Sharon, found her some chocolate ice cream.

I guess the test went okay, then. She shared a bit of her roll and some corn chowder with me. And for some reason, there were two cups of coffee. Hospital coffee never tasted so good as sharing it with Riza at dinner tonight.

She got too sleepy before dessert and went to sleep before ice cream (obviously, serious issues remain). But she looks great, is doing well with a grueling daily schedule, and is enthusiastic at her newfound capabilities.

Posted by John Kranz at 8:09 PM | Comments (3)

April 12, 2005

Inflection Point

Intensive Care, by definition, is forced to be cautious and patient in its treatment. I know and respect that, but I was continually pushing them to give Riza a chance and move a little more quickly. Today at the rehab center I was worried that they were expecting too much on the first day. In addition to her busy therapy schedule, there is an underlying assumption that the patients are self-directed and responsible for their own care in many ways.

My fears were groundless as Riza flourished in this atmosphere. She recognizes what this is about and is very excited about her new independence. I attended a few sessions today; I saw her sitting up, speaking lucidly, and, in speech therapy, reading writing, and performing addition. They gave her a Denny’s menu with a list of items to find and price. En route to Apple Pie a’la mode, she stopped to point out Key Lime Pie. She knew that wasn’t the answer, she just likes Key Lime Pie. She added the .75 ice cream to the 1.75 pie and came up with a total price.

She said “I like this place. I needed to be at the hospital but now I need to be here.” With her new self-assured whisper and the aid of a small amplifier the speech therapist set her up with, she, her brother Mario, his wife Barbara, and I had a long, normal conversation. She really is playing up.

Her busy schedule will also enable me to return to work and annoy people there (it is still very close to my office) and still come back to see her amazing progress.

With these changes, friends, I think the blog will change as well. With her life on the line, I had tried to be open and honest with all of you who love her. Now, at this inflection point, I will honor her privacy and our natural stoicism. I will update anytime there is big news – and I hope to post some of her writing soon. But the diurnal reports are not needed. She is doing well and she or I will update this blog when there’s news.

Thanks to all for the kind words about the blog. Keep it on your bookmarks, or syndicate the RSS feed if you do that sort of thing.

Cheers,
jk

Posted by John Kranz at 8:50 PM | Comments (4)

Busy Schedule

7:30 ADL (Grooming and Dressing)
9:30 Speech
10:30 Occupational Therapy / Physical Therapy
1:00 Speech
2:00 Audiologist
3:00 Physical Therapy

Again, visitors are encouraged to schedule visits. She is generally done at 4PM. You can call the center at (303) 441-0458.

Posted by John Kranz at 9:41 AM | Comments (3)

April 11, 2005

Movin' On Up!

At 4:30, Riza left her ICU home for inpatient rehab at Mapleton Center.

Riza seems very excited (as am I). They had been talking for a few days that she might skip the step of a standard hospital room. L'Audace!

Riza will have three to four hours of scheduled rehab every day. Visitors can call the center at (303) 441-0458 to get her daily schedule and plan for visits in the breaks.

I think another couple of days in ICU would have been very difficult. Riza's trying to come out now. She told me that "I needed to be in ICU, but now I need to be here."

Posted by John Kranz at 9:37 PM | Comments (3)

Disapprobation

A heapin' helpin' from two of the nurses when they heard about the cappuccino.

As the speech therapist had not "cleared" Riza for swallowing, there is great risk of aspiration into the lungs.

Riza is not contrite. She was glad she did. But I am now on the husband black list. Tomorrow: Marlboros and Jell-O shots...

Posted by John Kranz at 9:33 PM | Comments (4)

Cappuccino

Okay, that's a breakthrough.

Riza had a good night last night, and was sitting squarely in her chair this morning. We spoke awhile, and I reminded her that yesterday we had some coffee and she enjoyed a couple of swabs. The coffee cart is open today, sez I, would you like a cappuccino?

Well yeah -- what're you doing here? So I buy us a breve cap and start looking for the swabs on my return...

She waves off the swabs and reaches for the cup. I warn her to go easy, remember you can't swallow. O yeah? She's been holding out on the speech therapy folks. Give her a cappuccino and she can miraculously handle it!

As I left, I asked her if she wanted the rest, and yes, I was hoping she'd say no. Yup, she nods -- leave that baby right there. She's back.

Posted by John Kranz at 9:53 AM | Comments (5)

Mystery Solved

One of the first things that Riza wrote was "Becky Kranz came by the other day to take care of me." That's our niece and I called her to see if she had visited when I was gone.

Many members of the nursing staff have names that match family members: Diane, Lisa, Becky, Paul, Paula -- even a Risa. I wondered if she had confused the nurse Becky with our niece. She told me that Rebecca had given her a bath (that might make for an uncomfortable moment at Thanksgiving) and when I asked if it wasn't the nurse Becky, she emphatically said no.

This morning we figured it out. Deborah, who has had her a few nights last week, looks quite a bit like my niece Rebecca. Riza said "That's our niece!"

She hears voices and names and sometimes thinks that people are in the hallway. She knows at some level that they are not there, that's why she tells me. All the names and all the voices are probably very confusing -- I know I have learned more new names in the last two weeks than all of last year.

Posted by John Kranz at 9:50 AM

April 10, 2005

Conversation

I never listen to or trust the weather folks on the teevee news. But I got caught this time -- this was the big bad. Two feet of snow between Cheyenne and Raton -- more near the foothills.

Well, Boulder is damp. To be fair, there are some good drifts in my backyard. But it never stuck to the streets in Boulder, and my plans for being snowbound all day fell through.

So I went back in tonight for a short visit, and it was a true joy. Riza's speech has improved quite a bit, and she was really in focus. We had a long talk, speculating on the difficulties that lay ahead for us, our sources of strength, and quite a bit of what we mean to each other. From the mundane to the metaphysical, just a couple of married folks talking.

Here's the hits:
I bought her a stuffed dog to keep her company if I were snowed in today. I suggested a few names for the little guy and she said "No. Johnny." I said that was my favorite word when she said it. And she said "it's my favorite word, too."

She asked "How many bodies do I have?" Did I hear that right? Yes. Well, dear, you have one beautiful body. She said "I had a stroke -- it feels like I have two bodies." Then she drew a line down the center. Left side, right side. So that's what it feels like.

The nurse, Holly, asked me to start sitting on her "Bad" side to force her to look that way. As it became later and she was showing some fatigue, I suggested that I could move to the left. No, she pointed to her right. I said "You choose the right way, even when it's hard -- I have to learn that from you. Sometimes I do the wrong thing because it's easy." She said that she learned that from my mother. And she said "Mom loved me."

Doing genealogy, Riza gets occasional visits from dead people. I asked if my Mom had visited her. She said "She's dead." I told her I knew that but that sometimes she visits her in her dreams. "Oh yeah," she said, "she has. She told me to be very strong." She said that she sees people in the hallway, who are alive but that she knows they're not really there.

She said that I will have to be strong, but that we always do all right with whatever hand we're dealt. She didn't know what life would be like (amen to that!) but she seemed ready for the adventure.

She asked about a long list of people. "How's so-and-so?" "How's somebody else?" These were not people that she sees every day, she was digging through to some obscure people.

Holly's grandfather had a stroke. When she walked in, Riza asked "How's your grandpa?"

It was a magical evening.

Posted by John Kranz at 9:47 PM | Comments (1)

Coffee!

Riza was up in the chair working with the PT and OT folks. She sits up well and holds herself up squarely. Two days ago she could not do that.

She was in good spirits, enjoying sitting up even though this chair is the most horrible, uncomfortable, Frankenstein-movie-prop contraption. She wrote "I will get out of this chair!"

She asked for my cane and was checking it out. I said, "if you end up needing a cane, we'll get you a cool one with diamonds." She motioned me to come in close to hear her speak, and said "and rubies!"

A nurse, Pam, who is always nice, came over to ask if she could bring me something to drink. I said "a triple-cappuccino for the lovely lady," and Riza gave her famed thumbs-up. I asked if she'd like some coffee on a swab. She can't swallow yet, but they have these little sponge-on-a-stick guys to moisten her mouth. I said I would bring her a coffee when I came back. But then Pam got us a machine-mocha, and Riza enjoyed a few swabs full.

Then she grabbed for the cup. I inquired whether this was a really good idea, and we settled on a small sip with my holding the cup. She liked it but that seemed to be enough. (Maybe a real one would hold her attention longer. Coffee snobs we be.)

I told her that I would leave early today because of the snow, and that she can't forget. She promised that she wouldn't.

She wrote "Give Skylark lots of love from me (and that includes plenty of treats)!!!"

Posted by John Kranz at 9:52 AM | Comments (1)

April 9, 2005

Good Enough To Worry

The bright side of Saturday evening is that Riza continues to improve and think on a very high level. She made a few more jokes with hand gestures, executing a perfect "whoop-de-do" for the royal wedding. (For being something of anglophiles, neither of us get into the trappings of the monarchy much.)

Her speech improves, and her writing is still there. She spoke quite a bit with her sister, Rika, yesterday, and made some jokes as well. Those who know me will not be surprised that I think of jokes as the highest mental activity. It was without question a day of distinct improvements, both in mental acuity and physical progress with occupational, speech, and physical therapists.

The dark side is that she knows enough to be scared. She asked me a few questions about my grandmother. My maternal grandmother has a bad reaction to some anti-coagulants after a successful hip surgery. I was just twelve or so, but for three years she hung on in a near-vegetative state.

She asked a few questions about my grandmother, and mentioned Becky's grandmother. I know that these questions reflect her seeing herself as a burden, and I have tried my best to make it clear how well she is doing. I say "You had a stroke and it was very bad, but you have done well every day since then."

Good to have her back so far so quickly, but there is a long road ahead.

Posted by John Kranz at 11:37 PM

Good day

Riza had a good night and seemed in pretty good spirits this morning.

The nurse had the news on (well, CNN...) this morning so Riza recognizes the world out there and knows what day it is. She showed no discernable response to the wedding of "Wales & Pahker-Bowles," but there is the chance she was too overtaken with emotion...

Speech therapy today. If she continues on her same rate of progress, she'll likely be riffing some Shakespeare tonight.

Posted by John Kranz at 9:28 AM | Comments (1)

April 8, 2005

Read 'em and Weep

No, I mean it. Go get a Kleenex(r) I'll wait.

Back? Good. Riza was whispering to me this evening and I was having a difficult time understanding. I asked Diane, the nurse, if she had a suggestion. She grabbed a clipboard and some pens and said "try this, but if it doesn't work, don't get frustrated."

Riza clumsily picked up the pen at first and I thought that this might be a bad idea. Then she just started writing: quickly and determinedly. She wrote "Thanks for everything" and put a heart around it. That's for the nursing staff. The next was for me.

jk_iloveyou.jpg

What a great night.

Posted by John Kranz at 9:56 PM | Comments (1)

A Joke

Excited with Riza's writing skills, I suggested that I could come back late tonight after I let Skylark out.

The nurse said "She has a big day tomorrow, I think you'd better let her sleep." Riza and I caught eyes, then looked at the nurse and Riza made a "crack the whip" gesture with her left hand.

Good night.

Posted by John Kranz at 9:50 PM

Reunion

That was pretty fun. Diane wheeled Riza outside in front of the hospital, where she could get a little sun and some time with a furry little dog.

I was trying to look closely and see how much Riza recognized Skylark. I couldn't really tell. But she was enthralled and did not want to stop petting her. I asked "do you want to give her at treat?" Riza nodded yes, stuck out her hand, and gently held it out for Sky.

We asked if the sun was too much. It was also very windy. No she was quite happy to stay out. I think she really did have fun.

We will discover what she keeps and what she does not, but I have hope. Troy, one of the nurses who helped bring her out, is a jazz fan so I told him that Skylark was named after the song. He mentioned Django Reinhart and Riza threw a big thumbs-up sign. As long as she remembers the gypsy great, we'll be okay.

I am not always sure she remembers me but, then again, Django was a much better guitar player...

Posted by John Kranz at 2:23 PM

Stroke Prevention

Riza's brother sends a link to another web page. Start With Your Heart gives pointers for prevention of stroke and heart attack.

I'd never tell you what to do but maybe if there's some family history or other risk factors, you might wanna check it out...

Posted by John Kranz at 2:21 PM

Z-z-z-z-z-z-z-z-z-z-z-z

Riza slept through our morning visit today. I did a nice disquisition on Hayekian distributed authority and -- even when I got to the really good parts -- she slept right through.

The nurse said she had had a good night and that she was up all morning.

Sleep is good. Everything else seems to be holding up. Dr. (Pulmonary) is concerned about possible ulcers, and has stepped up some medication. The GI doc will also look for ulcer when she gets her "little procedure" (feeding tube) done.

Possible items on today's agenda:

  • A visit from Skylark

  • An evaluation from the Rehab folks at Mapleton

  • Feeding tube

The rest of us will have to hang in there. Thanks for all the kind words and kindnesses shown to me.

UPDATE: All tasks have been completed -- Steven Covey has nothing on Riza!

Posted by John Kranz at 9:48 AM | Comments (2)

April 7, 2005

Better day

Her additional forays into the chair went quite a bit better. She got better than two hours in tonight and was very communicative all the way through it. It is great to talk with her again. I will accept no jokes about my doing most of the talking...

The hard part is to see her realize what's up. She squeezes her dormant right hand. I tell her that there is still some swelling and that the doctors expect this to get better when it recedes, but she knows enough to be scared.

She is handling it, of course, with fortitude and courage. I said "we always get through everything, don't we?" and got a thumbs-up. She continues to be my inspiration.

Posted by John Kranz at 9:21 PM | Comments (2)

Self-directed health care

Riza took matters into her own hands today and removed her feeding tube. Don't look at me I was gone -- and no, I did not give her the idea.

Diane started to replace it, and suggested that Riza could also get a plug straight into her stomach, and not need the nose-tube. It seemed like a little more freedom to me, I asked Riza, who had heard the entire exchange if that's what she wanted -- she gave a big thumbs-up sign.

Diane removed the half-inserted feeding tube and took off the oxygen, which was down to one liter. In short, Riza has no more tubes on her head, which I think will be a big plus in rehab as well as a huge moral boost to both of us.

Posted by John Kranz at 9:11 PM

Sitting in a chair

Riza was sitting up in a chair today. That was good to see, but I have to admit that she did not look comfortable. She was sleepy and that could have been it.

Nice that she is off the ventalator and not nailed down to the bed, though. And I'm sure it will help with circulation and stength recovery.

Posted by John Kranz at 9:49 AM | Comments (3)

April 6, 2005

Riza Speaks!

During her exam this afternoon Riza attempted some speech when asked questions by Dr. Nelson (what's the square root of 87,500? What year was Marbury v. Madison adjudicated? Kidding, it was what is your name? and What year is this?) She tried but had a difficult time. Her tongue and throat are still badly swollen.

Tonight at about eight, though, she asked the nurse in a whisper where the bathroom was. Becky, her nurse, explained the exigencies of her situation, and the asked: "Who's that guy sitting there?"

"John." A good stage whisper you could hear in the back row. She processes speech and seems to have the facility to generate it. I told her to rest up tonight and that we'll talk tomorrow. April 6.

Posted by John Kranz at 9:23 PM

Good Day

Of course, the speech is the high point of the day. But there were several others.


  • There is a dentists' suction tube to clean her mouth after coughing. The nurse showed me how to use it. I did a couple of times and asked once "More suction?" She waved her hand in a "no-more" gesture as if I were offering somebody a third piece of cake.

  • Very distinct nods for yes and no, clearly making her self known

  • The third time I was suctioning, she reached up with her hand to do it herself. (That's Riza!) Every time after I would grab it and she would do it herself.

  • She waved goodbye to people leaving today, and flashed "I love you" signs many times. She sees my sign and returns it. I was not sure about her vision before seeing this

  • She was looking at me intently. I offered suction? Move your pillow? (I really don't have a big arsenal here...) Then I said "How about I just love you forever?" To which she gave a thumbs-up sign.

Did I mention that I had a pretty good day? April 6, 2005.

Posted by John Kranz at 9:21 PM | Comments (1)

Medication

A little change to Riza's medication today. She is weaning off morphine, but having some Breve-cappuccino withdrawals...

IV.jpg
(Thanks to Mario and Barb)

Posted by John Kranz at 9:00 PM

EXTUBATION!

I prepared myself for disappointment after the breathing tube was pulled. Maybe it wasn't such a big milestone, maybe she'd need a tracheotomy, it'd still be a long road, yadda yadda.

Naaaah! It's great. They pulled the tube at 10 this morning. I just left a little after one pm and she is doing very well.

She looks better, is obviously more comfortable, and seems less tied down to the bed and to ICU. She's nodding her head clearly, waving at family when they leave, and has kept her oxygen up al by herself.

April 6, 2005. Pretty much the best day ever. Write it down.

Posted by John Kranz at 2:17 PM | Comments (7)

She gets her shot!

I did a Jedi mind trick on Riza's Pulmonary guy today. He said that he was going to wait a day or two before pulling the tube, and we talked over the reasons. I asked a few questions but I was pretty agreeable -- I didn't really lobby.

When I left, he said "we'll try her without the tube this morning and see how she does." (These aren't the droids we're looking for, they can go...)

So, she gets her shot at freedom. I mentioned -- after the decision was made -- that she has exceeded expectations every time. Let's hope she does it again. To have her this alert and free would be great! She is down to only IV. That's pretty manageable. I saw a guy last night had wheeled his IV out front with him to have a smoke.

Posted by John Kranz at 9:37 AM | Comments (2)

Wide Awake

Riza was wide awake when I came in this morning. She raised her hand for me to hold and also did an "I love you" hand sign.

It is a joy for hubby to see, but I do worry about her comfort; sedation has its advantages.

Posted by John Kranz at 9:31 AM

April 5, 2005

Awake

They are weaning Riza off of sedation, both to ensure good readings in neuro tests and to prepare her for breathing on her own.

It is great to se open eyes, feel a hand squeeze, and know that she is aware of my presence. Yet I become aware of her discomfort and fear. She nods "no" to the nurses that she is not in pain, but she doesn't look like somebody having a lot of fun.

Tomorrow I will stalk the physicians in the hallways to lobby for extubation. (And, perhaps sneak in a pair of pliers...) I think she is ready.

While getting a mouth suction (like the dentist without nitrous) she pushed the suction tube out with her tongue. Besides proving to me that that is Riza in there, it is a good sign that she might have tongue and throat control to handle breathing. Dr. Nelson prepared me for a possible tracheotomy if her tube is pulled and she lacks the control to open her throat and tongue.

Still, we have lost the ventric, the cooling blanket, temperature probe, and most of the IVs. Her room looks less like the Monty Python "Meaning of Life" sketch all the time.

She'll need her trademark toughness over the next few days, I think. But I think that we could also see a blossoming when she is freed.

Posted by John Kranz at 9:38 PM

L'audace! L'audace!

I've a meeting and am out of the conference, but some docs will be discussing the infamous breathing tube. I think they all know where I stand.

CT-Scan was good. It is stable, not getting worse in shift or size and there are no real signs of troubles without the ventric.

If not today, I bet we are looking good for tomorrow -- I'll let y'all know.

Posted by John Kranz at 12:28 PM

A Restful Night

Riza did well and continues to follow commands -- all and all a very good night.

She had a CT-Scan this morning but I don't know if Dr. Nelson has read it yet. She also did a 2+ hour breathing test. She did well but they did some blood work after. It will be important to see how well she did, not just breathing but processing. Hope springs eternal!

Posted by John Kranz at 9:05 AM

April 4, 2005

Ventriclessness

I had a good talk with Dr. Nelson this evening. He had come out to replace the ventric. I was disappointed, feeling that she was pretty close to having it out and I hated to go back.

Dr. Nelson agreed to wait a little longer. Because she is able to follow commands, which shows very high-order thinking, the staff will go back to hourly tests. Presuming those continue well, we will be able to keep the ventric out and perhaps remove the breathing tube tomorrow. She will also get a new CT-Scan in the morning as Dr. Nelson has lost visibility of what's going on.

There is some risk with this, but Dr. Nelson is comfortable with it and agrees that it could speed up recovery.

She was doing very well and managing her ICP pretty well yesterday, now she has to. Kind thoughts, prayers, fingers crossed and shaking of voodoo talismans are appreciated.

Posted by John Kranz at 10:24 PM

Luck Comes in Funny Packages

During her morning CT-Scan, Riza's "ventric" was slightly dislodged. The ventric is also known as "the tube sticking out the top of your head."

As it was no longer functioning, they have removed it. It might be a hair early, as now they cannot monitor ICP nor alter it by draining. Yet yesterday, she was doing very well regulating it herself and they seem content to leave it be.

To ensure that new pressure doesn't build up, she is sedated a little more today and they will hold back a little on the breathing tests. On the other hand, the ventric could have become and excuse to keep the breathing tube in.

Posted by John Kranz at 1:13 PM

Hanging in...

Riza had a good night, hanging on to her gains from yesterday.

She had a CT-Scan this morning but the doctor has not read it. I will advise when I hear something.

Her breathing has seemed to impress the Pulmonary folks enough to extubate, providing they get a signoff from Neurosurgery. There is concern that without the tube, they are more limited on the amount of sedation. So, if Dr. Nelson is comfy, we might get it today or tomorrow.

Riza was awake and responsive this morning and managing pretty well in spite of the CT-Scan, which requires her to be disconnected from the room and travel to the machine. As soon as Apple is done with the new 80GB CT-Scan iPod, it will be easier.

Posted by John Kranz at 9:38 AM

April 3, 2005

Two Hours!

Great day today! Riza had several tests of breathing without the machine: 30 minutes, 45 minutes, one hour. She passed them all with flying colors.

On the one hour, she was doing so well they just let it go. Jan, the Respiratory Therapist finally put her back on after more than two hours. There is talk of extubating tomorrow.

The whole day was good. Besides breathing, she now seems to be regulating her blood pressure, temperature, and ICP on her own. All week the ICP would build, and the nurses would drain fluid to get it down. Today, it would build but she would be able to reaccept enough of the fluid to bring it down. The drainings were far less frequent and less severe.

There is a belief that both tubes have to come out at the same time. I wouldn’t complain.

Also, today was full of eyes opening and hand squeezing without the increased pressure that typically accompanies them. A very good day.

Posted by John Kranz at 7:52 PM

Language Notes

You keep using that word,” Inigo Montoya famously says in The Princess Bride, “I do not think it means what you think it means."

I have corrected two posts which featured calls for "extirpation," Merriam Webster definitions for which include "to pull out by the root" or "to remove surgically." The word I was aiming for was "extubation," or ummm well "to remove a tube."

The posts have been corrected and Tat Ergo Sum regrets the error.

Posted by John Kranz at 7:41 PM

Good Morning, Bright Eyes

It's hard to beat this morning. Riza opened her eyes widely when I walked in and squeezed my hand firmly.

She had a very good night last night and her solo-flight-breathing tests all went very well. (Two, Four, Six Eight! Now it's time to Extubate!). Her temp is down a degree and her ICP was good. They still give her Tylenol as they would like the temp down another degree. Brain metabolism and chemical changes are accelerated at higher temperatures, so they want it down. Yet, Emily, her nurse overnight. was very pleased.

The clot is worrisome. Real bad but real common. They will likely just wait it out and hope she breaks it down naturally before it breaks up.

Posted by John Kranz at 9:39 AM

The Country Springs Forward

-- and jk falls back. I showed up to the hospital at 7:50 this morning, and rang to be let in, as I must always do on the ICU wing. "Well, okay," they said, "but make it short, we have a shift change coming up."

These people think I don't know how it works. Shift change is at nine. What's the matter with these people?

Welcome to Daylight Savings time, Americans (the UK changed last week). Arizona readers: as you were...

Posted by John Kranz at 9:21 AM

April 2, 2005

Breathing Without Training Wheels!

Some very very good news today. They turned off the respirator and Riza breathed on her own for 30 minutes. They will likely do this a couple more times overnight.

My focus is set on removal of this tube, so it stands to reason that if she can prove she does not need it, we're on the way. (What do we want? Extubation! When do we want it? Now!) I heard a hundred good reasons to leave it in, but I still can’t wait 'till it comes out.

Riza was more awake today and the swelling had subsided enough that she opened her eyes frequently. This was exciting, but I was not allowed to jump up and down and talk to her when she did it.

Of course, after a great day, they have to hit you on the way out. The new worry is a blood clot in her left arm. It's not too bad and it is very common, but it poses a conundrum: you fight a clot with anticoagulants, but those are clearly at cross purpose with a recovery from hemorrhage.

The radiologist will read the ultrasounds and confer with the Pulmonary Docs. She's in good hands.

Yet another thanks to everybody helping me out. I went to friends’ for dinner (Thanks Lou and Marykay!) and later came home, once again, to food in the 'fridge (Thanks, Brooke & Tania!) Jk’s law: make sure a lot of people have a key to your house. It helps when you’re locked out and it allows magical people to do magical things.

Posted by John Kranz at 9:33 PM

Restful, restful...

Saturday morning finds a restful and stable Riza. She had a good night, was moved off the cooling blanket and most of her numbers look good.

ICP is a bit higher than they'd like, but when the others are okay, that doesn't seem such a big deal. I know it concerns them, but it also seems the most manageable of the monitored parameters. They can send it to zero by opening a tap, versus the blood and medication she received for blood pressure and the ice packs, Tylenol and evil cooling blanket to control temperature. They, of course, want her to manage the pressure like the rest of us do.

Her eyes are now un-swollen enough that she opened them today for the nurse, hubby got a big hand squeeze in response to a verbal request, and toes were wiggled.

Posted by John Kranz at 9:32 AM

Friday Ends Well

I was a little down earlier today. I know it's a long road and I know there will be ups and downs but I feared that Riza was becoming a little more distant.

I talked to Dr. Nelson tonight. (You know, it's a small sample, but I am starting to think there is some truth in that old "Brain Surgeons are smart" folklore...) He assured me that what I am seeing is additional sedation to keep her comfortable and to allow her to forget this part of her life. The good things I saw early in the week are still there, and he continues to be amazed how well she is doing.

It was great to hear that.

Another good thing is how much better she looks. She has always been the most beautiful to me, but even I questioned the giant white head bandage fashion accessory. After that came off, she had a lot of swelling around her eyes and face. Today, the swelling has gone way down and she looks really good. Lisa brushed and braided her hair and she looks like Riza again.

I'm a big fan of Virginia Postrel. She is a libertarian economist, Buffy fan, and frequent contributor to the New York Times. Her beat is to highlight the importance of aesthetics and design, and to quantity economic advantages. To see Riza looking so good cheered me up enormously.

Posted by John Kranz at 12:07 AM

April 1, 2005

Stroke Prevention

Brother Mario just sent me this link to the Colorado Department of Public Health and Environment Cardiovascular Disease and Stroke Prevention. Worth a look-see, especially for some of you who may have family history...

Ric-I mean Mario works of the State Stroke Task Force with Pam, who directs training and education for the nursing staff on Riza's wing.

Posted by John Kranz at 10:00 AM

Thought for the Day

...comes from Jacquelyn, her nurse for the last few nights. She says these things usually get a lot worse before they get better.

As she has been in more sedation, she has seemed less responsive and there have been fewer of the moments that I know she's there. Earlier in the week she would squeeze my hand when I spoke or if something was bothering her.

I asked how much of this was more medication ("better living through chemistry" as Riza would say) and how much was deterioration. Jacquelyn said that she still does very well in her evaluations, and that the doctors and staff are confident that she still has what she has. "Hold up two fingers." "Three fingers," "point to the ceiling," "wiggle your toes" these all still work. And that is a good sign that she has them and has held on.

Patience was never my long suit but that's what's required here. The news really is still better than any would have expected; better than I expected last week.

Temperature and ICP are still problematic. They have stopped her rotation so as to not exacerbate the ICP, but that delays progress with her lungs. Always this vs. that. But I have absolute confidence in the staff and physicians over there.

And, yes, I am fine. Thanks for all the kind thoughts and deeds.

Posted by John Kranz at 9:35 AM