Quit

Well, Dad officially quit speech therapy yesterday. He had reached a point that many in therapy reach where they just don’t want to do it anymore. I was told this is quite common. And if you aren’t showing improvement, Medicare will stop paying for services. Dad’s speech still presents a hurdle (specifically with yes and no still) and speech therapy had wanted to start him on augmentative and alternative communication. This begins to teach an individual how to use other forms of communication (i.e. pictures and hand gestures, computers), anything other than oral speech. Like older people whose licenses are taken away, because they pose a danger to themselves and others on the road, asking someone to essentially give up something they have done practically their whole life is a lot to ask. Asking them to begin communicating in ways they never imagined is even more to ask. Many feel a choice, speech in this instance, is being taken away from them, that they have no say in anything, no pun intended. Dad did not want to learn augmentative and alternative communication at this time. You can’t make someone do something they do not want to do. So he quit. What can I say? That I was disappointed? Part of me was. I want to see Dad succeed. It’s one thing to raise your children, it’s quite another to take care of your parents, yet the sentiment involved in caring for both is the same or should be.
In the end he was told to take a month or so off and see how he feels. If he wants to begin speech therapy again he will have to go to his PCP for a new referral. I joked with Dad last night, remembering he was a teacher, “You just wanted to have the summer off didn’t you.” He laughed. I still have a few tricks up my sleeve and I'm not giving up yet. And we continue on…

Addendum

Dad is not going on blood thinners yet. We saw Dr. Biswas for our bi-monthly visit and even though the neurologist Dr. Hajjar okayed him to go back on blood thinners for his Afib, Dr. Biswas, as mentioned, doesn't want to rush into anything. Originally he was going to put Dad on them. Friday he discussed with us the risks involved with going back on blood thinners, the dosage Dad was to go on, with now weekly followups to monitor everything. While Dad may not remember the disastrous results, the rest of us very clearly remember the hemorrhagic stroke Dad had about a week or so after his initial infarction, most likely a result from the blood thinners he was on at that time.
Dr. Biswas checked Dad's pulse and asked if we could stay a little longer. He wanted Dad to have an EKG. Ok I thought. Meanwhile, inside I began to have anxiety about Dad going back on blood thinners. Dad was slightly hesitant too. The nurse came in and administered the EKG. The nice thing about this test is that the results print out immediately. Within moments Dr. Biswas came back in the room and changed his mind. When he had checked Dad's pulse he did not feel the irregular heartbeat. In fact he hasn't in months. Dad is currently not in Afib and as a result doesn't need to be on blood thinners at this moment. Both Dad and I breathed a sigh of relief. We are still very much aware of the reason he was on them and the reason he may one day have to go back on them. But for the moment he doesn't need the blood thinners. The less pills you have to take the better you are. Dr. Biswas joked that he changes his mind a lot and was going to have to do an addendum to his dictation for this office visit. I'm ok with that because I trust him with the care of my father immensely.
And that is the word from Maine on this Sunday, July 28, 2013, day 207.  

The Gardens

If you click on the photo it will take you to the album.

This is an early shot taken about a week or so after Dad returned home in April. The big joke was he missed the entire winter but was home in time to enjoy seeing spring blossom. Mom and Dad have lived in the Bucksport house (as I call it) since the fall of 2004. Prior to that they lived in the middle of nowhere, or what's called Sebec Maine. In the almost nine years they have been in Bucksport Dad has tinkered with his front and back yards. He's added this, taken away that, expanded upon a little bit of everything and designed the whole feel and shape of the outside. Not one to travel outside of Maine, this was retirement living for Dad and something he enjoyed immensely as I've already written about. I thought I would share photos of the yard to highlight how it changes from spring to summer and through to the fall. The album will continue to grow as the seasons change so I urge you to check this entry for photo updates. I hope you enjoy!

*The pictures are taken with my Sony DSC-R1 and Samsung Galaxy S3 using an HDR app by Almalence.

The Neurologist

Last week Dad saw Dr. Hajjar, the neurologist. While I knew he had been seen by neurologists in the hospital and Stillwater, this was the first appointment I took him to and the first visit he’s had since he’s been home. As we slowly followed Dr. Hajjar into the office she asked Dad, “I remember you Rudolf from the emergency room, do you remember me?” He didn’t. He doesn’t remember much about the stroke itself and that’s a good thing. I; however, remembered her. Dr. Hajjar was called in for a consult the morning Dad had his stroke. She carried with her a plastic flip book listing different criteria for determining the acuteness of a stroke in patients, questions to ask, things to notice etc. To be honest, it’s so long ago I forgot where Dad was on the scale of stroke severity that morning. All I remember is thinking there was still hope. Neither of it is here nor there now, but seeing her brought back that morning in the emergency room with such vivid clarity that save for the time of year, I would have sworn I was back there watching Dad spastically try to get off the table they had him lying on, while she tried to talk to him.

The good news is (for there is always good news) Dad’s latest CT scan revealed nothing new, which I had been anticipating. It’s nice when things out of your control work out in your favor. She emphasized to Dad how he didn’t just have a “little stroke”, but rather such a really massive stroke, he was lucky to be alive. It reminded me of the pulmonologist in Portland who played bad cop, telling us Dad wasn’t going to improve beyond the way he was in intensive care. Everyone has been right and wrong with much of what’s happened. She also mentioned that the type of stroke Dad had was unusual because, as I like to say it, it’s more a young person’s stroke, affecting people around 35-45 years old. I guess Dad is young at heart, no pun intended. She couldn’t give an opinion on the cause of Dad’s stroke, just the damage that had been done. And the damage was pretty extensive. Dissections, like the one he had, are either traumatic or spontaneous.

Traumatic dissection is the result of either external mechanical injury, such as a penetrating or blunt trauma, or trivial trauma that is related to a movement or abrupt change in head position. Examples of such movements include rapid turning of the head, flexion or extension of the head and neck, and strenuous physical exertion.

Spontaneous dissections are those in which no definitive precipitating factor is recognized. However, spontaneous dissections may be associated with predisposing factors, such as connective tissue disorders, systemic hypertension, smoking, diabetes mellitus, a history of cerebral infarction, hyperlipidemia, cerebral and abdominal aortic aneurysms, use of oral contraceptives, and a family history of arterial dissection.

At the end of the appointment she ok'd Dad to go back on blood thinners because of his Afib. We are working with his PCP Dr. Biswas to determine when that is to take place. What I like about Dad's PCP is he isn't looking to rush into anything and prefers Dad not take any medication. His philosophy is if you don't have to take a pill, then why would you? I like that about him.  

And we continue on...

No News Is Good News

Things have been all quiet on the western front the last couple of weeks. I’m not going to lie, it’s been nice to say the least. They say no news is good news and that has certainly been the case since Dad’s been home, with regards to his health. I am hoping that trend continues after he sees the neurologist this Wednesday for his first post Stillwater head exam. Other than baby aspirin, he has not been on blood thinners since he had the hemorrhagic stroke in mid-January. Part of this week’s visit is to determine if he is to go back on them and what level he will be on. As I wrote previously, it’s a tricky situation because while he needs to be on blood thinners for his atrial fibrillation they aren’t necessarily good because of the dissected artery in his head. The dissected artery can’t be repaired and the afib will never go away. Both these issues will continue to be at odds with one another for the rest of his life. Needless to say it will be interesting to see what the neurologist has to say and what her course of action will be.
In other news around the Villa Walter, Dad has been bored. Never one to just sit around he has been bored out of his mind lately. I’ve started giving him little jobs to do around the house though and that seems to be working out nicely. Yesterday he was pointing to the glass sliding doors. After a moment or so I figured out he wanted it cleaned (darn dog nose prints). I was in the middle of something but assured him I would get to it. He shook his head and said he would do it. I love his can do attitude. However, the previous weekend he had almost fallen backwards, when he stood up from his chair in the backyard. The chair had tipped back and he almost went with it, but caught himself with his improved balance. The incident still made me a little nervous though and I was not comfortable with him bending down that far to try and clean some glass so I said to him, “Tell you what, I will clean the glass, why don’t you make your own lunch today.” He was having soup and toast. He looked at me, said OK and immediately got up, glad to have something to do. Now, the only thing I did to help him was open the can of soup, otherwise he was on his own and did everything himself. I write about this like it’s some monumental task he accomplished and you know what? It kind of is and it may seem like a little thing to you and me but for him, it’s huge. This entailed, getting the pot to heat the soup up, the bowl to eat the soup, the plate for the toast, the knife to butter the toast, the spoon to stir the soup, all while maneuvering without his hemi-cane in the kitchen. I know people that can’t boil an egg (they exist) and there was Dad, getting everything together to heat up some soup and toast a piece of bread, without burning either of them. Piece of cake. The other day I came in from outside and I heard him in the kitchen. He was trying to grab some paper towels. I got out of him that he wanted to clean the countertops. So, I handed him the cleaning wipes and told him to have at it. He proceeded to clean all the kitchen counters, clean the toaster and change out the garbage. The only thing he couldn’t do yet was carry the garbage into the garage. I say yet because he isn’t quite at the point where he doesn’t need his hemi-cane. He will be though, he will be.

Monday July 1, 2013, Day 180

Tomorrow is 7 months since Dad’s initial stroke. I cannot believe we are more than halfway through this incredible year of change. It doesn’t feel like it, that’s for sure. Last Friday I put my old dog Kane down, a difficult decision I knew I was going to have to make, yet not an easy situation to go through. The best dog I could have ever asked to be graced with, I had Kane for just over 11 years. I thought about the decade plus he was in my life. How it had changed, the things I had done, the places I had been, the people I had met. All gone now and in the past. Even last year is so long forgotten I can barely remember what it, life, was like.

Kane was to stay with Dad, when I was initialing planning my escape of Maine. It would have been easier on me with moving and I knew he loved Kane and loved having a dog to take care of, despite what he would tell you in person. Kane grew very close to Dad and Dad to Kane. They had a very clear understanding who gave out the treats. It was Dad.

Someone related a conversation they had regarding the loss of a loved one. This loved one hadn’t passed yet, but it was looming on the horizon and so the question arose, “I don’t know how I’m going to deal with the loss. How will I get through it?” The advice given was as each new day rises, so too do you rise. At first it may be difficult, unbearable and possibly heart wrenching. But you go through the day and then the next day and the next day and the next day. Before you realize it, life is happening. It had never really stopped, even though you may have thought it did. Life continues to happen for all of us.



Kane and Dad 2/7/2012