Wednesday, November 30, 2011
Wednesday, Nov. 30th
Friends, you have a new writer for the blogspot. This is Mary, Margaret's sister. We visited with Margaret during the 2 daily timeperiods when we're allowed to see her. She's holding her own. The neurosurgeon spoke with us today and said she's made remarkable progress during this short time period. As you can imagine, that was very good news for us to hear. Will you join with me in prayer for her? Dear Jesus, We thank you for Margaret. She is a wonderful, loving mom and friend. We have seen how you have provided for her - we have so many things to thank you for; for Margaret being in a public place when she had her stroke where she could receive immediate help, for the excellent care she's receiving, for her dear friends Kim and Juan in Madrid and their family, for workplaces that are so willing to allow her siblings to drop everything to come to Madrid and be with her. Tonight, may you fill Margaret with your peace which exceeds anything we can understand. Amen.
Tuesday, November 29, 2011
Tuesday Nov 29 update
Tonight will be again a single update for the day because we picked up Margaret's sister from the airport between visiting times.
Today we were one of the first people called for the information updates. Her doctor is one of the directors of the ICU and has his own office so we had our consult in his office with I think was a student doctor. Basically everything is going well was what the student doctor said. They spoke Spanish so we got the translation from Kim and Juan (Margaret's friends that live in Madrid). They said they were going to keep her in the ICU for a few more days. They have also been unable to adequately evaluate her condition for a variety of reasons. The first and obvious is the language barrier. Margaret has not opened her eyes so they are unable to know if she is unresponsive to them because she is asleep or not. She also has not talked so this makes it impossible for them to make an accurate assessment of her condition. The doctors do not want to move her from the ICU without an accurate assessment of her condition and being sure that her recovery will continue to progress when she is moved to a regular room. We were given instructions to try to get her to talk and open her eyes. No new bad news, and that was good.
Margaret was as awake and as responsive as she has been for us. We did ask several questions and were able to get responses from her by asking yes and no questions. The doctors like that we were stimulating her and let us stay longer. Actually insisted that we stay longer. We were able to keep her thinking and stimulated in a way that the hospital staff has not been able to do because of the language barrier. We told her about everyone that obviously cares about her and about the comments that you have left. I should mention that she did say 2 words, quietly but she said them. She did not open her eyes but we did see her eyelids move as she was trying to open them. We did see her move her left arm and legs a little.
We picked up Margaret's sister at the airport and headed back for the evening visiting hour. Margaret was quite calm and not very responsive. It seemed that she was sleeping or resting. I guess we tired her out earlier. She would squeeze our hand but not much else. She had the pressure monitor removed that was monitoring the pressure in the left side of her brain removed. The pressure has been normal and decreasing and apparently they felt it was no longer needed. After about 30 minutes another patient in the ICU was having problems as evidenced by the steady alarm tone. There was a lot of commotion and we were told to leave. We were hoping that we might be able to go back and see Margaret but after a half an hour they said that we could not.
Basically it was a good day. Progress will be slow at times.
I want to tell you a little bit about the hospital she is in. Spain has socialized medicine. Yesterday was the first time that any mention of insurance or repayment was mentioned. The hospital is different that what we are used to in the states. They spend their money on treatment and not so much on the facility. The ICU is nice and we like her there. The regular patient rooms have 2 beds, 2 chairs, and a dividing curtain. Nothing else and there really isn't room for anything else. There is no television or phone or dresser. The waiting rooms are sparse with only chairs. The care is very good and Margaret is in one of the best hospitals in Madrid. We have heard even the King goes there. We have had requests for the hospital address for cards and such. The hospital I don't think is set up for that. The best way is to send cards to her friend at the embassy (a US address so normal postage):
Kim DeBlauw
PSC 61, Box 2503
APO AE 09642
Basically it was a good day
Today we were one of the first people called for the information updates. Her doctor is one of the directors of the ICU and has his own office so we had our consult in his office with I think was a student doctor. Basically everything is going well was what the student doctor said. They spoke Spanish so we got the translation from Kim and Juan (Margaret's friends that live in Madrid). They said they were going to keep her in the ICU for a few more days. They have also been unable to adequately evaluate her condition for a variety of reasons. The first and obvious is the language barrier. Margaret has not opened her eyes so they are unable to know if she is unresponsive to them because she is asleep or not. She also has not talked so this makes it impossible for them to make an accurate assessment of her condition. The doctors do not want to move her from the ICU without an accurate assessment of her condition and being sure that her recovery will continue to progress when she is moved to a regular room. We were given instructions to try to get her to talk and open her eyes. No new bad news, and that was good.
Margaret was as awake and as responsive as she has been for us. We did ask several questions and were able to get responses from her by asking yes and no questions. The doctors like that we were stimulating her and let us stay longer. Actually insisted that we stay longer. We were able to keep her thinking and stimulated in a way that the hospital staff has not been able to do because of the language barrier. We told her about everyone that obviously cares about her and about the comments that you have left. I should mention that she did say 2 words, quietly but she said them. She did not open her eyes but we did see her eyelids move as she was trying to open them. We did see her move her left arm and legs a little.
We picked up Margaret's sister at the airport and headed back for the evening visiting hour. Margaret was quite calm and not very responsive. It seemed that she was sleeping or resting. I guess we tired her out earlier. She would squeeze our hand but not much else. She had the pressure monitor removed that was monitoring the pressure in the left side of her brain removed. The pressure has been normal and decreasing and apparently they felt it was no longer needed. After about 30 minutes another patient in the ICU was having problems as evidenced by the steady alarm tone. There was a lot of commotion and we were told to leave. We were hoping that we might be able to go back and see Margaret but after a half an hour they said that we could not.
Basically it was a good day. Progress will be slow at times.
I want to tell you a little bit about the hospital she is in. Spain has socialized medicine. Yesterday was the first time that any mention of insurance or repayment was mentioned. The hospital is different that what we are used to in the states. They spend their money on treatment and not so much on the facility. The ICU is nice and we like her there. The regular patient rooms have 2 beds, 2 chairs, and a dividing curtain. Nothing else and there really isn't room for anything else. There is no television or phone or dresser. The waiting rooms are sparse with only chairs. The care is very good and Margaret is in one of the best hospitals in Madrid. We have heard even the King goes there. We have had requests for the hospital address for cards and such. The hospital I don't think is set up for that. The best way is to send cards to her friend at the embassy (a US address so normal postage):
Kim DeBlauw
PSC 61, Box 2503
APO AE 09642
Basically it was a good day
Monday, November 28, 2011
Monday Nov 28 Update
Today will be one long post because we were not by a computer to make an update after the morning visit and update.
This morning we were one of the first people called to have an update from the doctor. As you know if you have to wait it cuts into visiting time. The doctor spoke very good English which is good so we heard everything without translation. Basically he said everything was going well. She is making good progress and she was off sedation and while in theory it should be out of her system in 10 minutes it realistically takes 5-6 hours. He told us she was off of the respirator but they are waiting for 24 hours of her off of the respirator before taking out the breathing tube. They want to make sure she has the strength to breath on her own and be able to cough and do everything we don't even think we are doing while breathing. She was responding to commands for them.
We then went to see her and she was "awake" meaning she was aware we were there but she did not open her eyes. She squeezed her right hand when we asked her questions. Then she tried to write words on our palm. We finally figured out that she was spelling "pain" and she pointed to her throat. We knew what was causing the pain, it was the breathing tube. They were already giving her pain medication but it was good to know that she was able to have this new form of communication. We explained the situation that they would take it out as soon as they could but it wouldn't be until tomorrow. Frustration was felt by all including Margaret. Before we knew it they came by and said visitation time was over. Amazing how fast an hour can go. We walked out of the hospital feeling pretty good.
After seeing sights of old Madrid, eating some lunch, and some time at the "Catedral de la Almudena" we went back to the hospital for the evening visiting hour. They call you in by patient name and make sure there are only 2 people heading to the ICU. There are 2 ICU wards with 11 "rooms" each. Margaret is in room 3 so we were called pretty early. "Room" is a bed with a partial glass divider open to where the nurses are. It is pretty open so the nurses can see all of the patients in the ward. The first surprise we saw when walking into the ward was that she only had an oxygen mask and no breathing tube. We were not prepared for that. The next surprise was when she was able to hold a pen and do some writing. After a little trial and error on how to hold and move the paper plus some deciphering we were able to get what she was trying to say. "Yes Margaret we have your iPhone" was one answer to what she wrote. After a couple of minutes she was getting tired. We spent the next hour or so just talking to her. Fortunately, they gave us some extra time, maybe because we don't speak Spanish or because we were so elated with how she was responding and the medical staff was happy with Margaret's positive interaction with us. She was able to move her right leg and arm and it made it look like she was uncomfortable. She did not move her left leg and and only a slight twitch of her left arm. We left after an hour and a half visit.
After 5 days of so little to have so much even though it seems like not much otherwise made this a GREAT day. We hope and expect to see continued improvement. This is around the time of maximum swelling of her brain. It seems that she is making very good progress compared to what we are told to expect.
It is amazing the number of requests for help that we are getting. I think we have things covered and will certainly let any of you know if there is anything you can do. What you are doing now, praying and hoping for Margaret I think is helping. Trust me we are letting her know during the 2 hours we are able to see her 2 at a time of everyone that is hoping for a speedy recovery.
This morning we were one of the first people called to have an update from the doctor. As you know if you have to wait it cuts into visiting time. The doctor spoke very good English which is good so we heard everything without translation. Basically he said everything was going well. She is making good progress and she was off sedation and while in theory it should be out of her system in 10 minutes it realistically takes 5-6 hours. He told us she was off of the respirator but they are waiting for 24 hours of her off of the respirator before taking out the breathing tube. They want to make sure she has the strength to breath on her own and be able to cough and do everything we don't even think we are doing while breathing. She was responding to commands for them.
We then went to see her and she was "awake" meaning she was aware we were there but she did not open her eyes. She squeezed her right hand when we asked her questions. Then she tried to write words on our palm. We finally figured out that she was spelling "pain" and she pointed to her throat. We knew what was causing the pain, it was the breathing tube. They were already giving her pain medication but it was good to know that she was able to have this new form of communication. We explained the situation that they would take it out as soon as they could but it wouldn't be until tomorrow. Frustration was felt by all including Margaret. Before we knew it they came by and said visitation time was over. Amazing how fast an hour can go. We walked out of the hospital feeling pretty good.
After seeing sights of old Madrid, eating some lunch, and some time at the "Catedral de la Almudena" we went back to the hospital for the evening visiting hour. They call you in by patient name and make sure there are only 2 people heading to the ICU. There are 2 ICU wards with 11 "rooms" each. Margaret is in room 3 so we were called pretty early. "Room" is a bed with a partial glass divider open to where the nurses are. It is pretty open so the nurses can see all of the patients in the ward. The first surprise we saw when walking into the ward was that she only had an oxygen mask and no breathing tube. We were not prepared for that. The next surprise was when she was able to hold a pen and do some writing. After a little trial and error on how to hold and move the paper plus some deciphering we were able to get what she was trying to say. "Yes Margaret we have your iPhone" was one answer to what she wrote. After a couple of minutes she was getting tired. We spent the next hour or so just talking to her. Fortunately, they gave us some extra time, maybe because we don't speak Spanish or because we were so elated with how she was responding and the medical staff was happy with Margaret's positive interaction with us. She was able to move her right leg and arm and it made it look like she was uncomfortable. She did not move her left leg and and only a slight twitch of her left arm. We left after an hour and a half visit.
After 5 days of so little to have so much even though it seems like not much otherwise made this a GREAT day. We hope and expect to see continued improvement. This is around the time of maximum swelling of her brain. It seems that she is making very good progress compared to what we are told to expect.
It is amazing the number of requests for help that we are getting. I think we have things covered and will certainly let any of you know if there is anything you can do. What you are doing now, praying and hoping for Margaret I think is helping. Trust me we are letting her know during the 2 hours we are able to see her 2 at a time of everyone that is hoping for a speedy recovery.
Sunday, November 27, 2011
Sunday Night, Nov 27 Update
Tonight we received an update from the same doctor that was in her room during the morning visiting half hour. We were the first to be called in so that also gave us a full hour or more to be with Margaret. Basically the update from the doctor was that they did work with her some while she was awake. She is able to respond to commands and while she cannot talk because of the breathing tube in her throat, she can squeeze your hand. The doctor said she was very responsive. She is able to move her right side very well (that is controlled by the left hemisphere and was not affected by the stroke). She is able to move her left leg some but no really her left arm if at all. That right hemisphere is the side she had the stroke so the left side of her body is affected. It is still very early and her brain may still be swelling still though it should be close to being done swelling. It usually swells for 5-7 days after the stroke and we are only on day 5. There should be improvement as the swelling decreases which could take several weeks to months. Everything else is going well. There are no sign of infections or other problems, though she is a bit anemic.
The doctor said that she was being sedated so that she could rest from her earlier awake time. She was quiet and seemed asleep for most of the hour we were with her. She started to stir after Liz quietly hummed a tune. Her blood pressure increased and so did her heart rate (we have become "experts" at reading all of the monitors attached to her). Margaret moved and responded with hand squeezes to questions. She knew who was with her and could respond to other questions. It may seem small and not very encouraging but it made our day. Then visiting time was over and we had to leave.
We will be back tomorrow morning at 11am when the information session will be before visiting time. Only 1 hour and only 2 people at a time.
The doctor said that she was being sedated so that she could rest from her earlier awake time. She was quiet and seemed asleep for most of the hour we were with her. She started to stir after Liz quietly hummed a tune. Her blood pressure increased and so did her heart rate (we have become "experts" at reading all of the monitors attached to her). Margaret moved and responded with hand squeezes to questions. She knew who was with her and could respond to other questions. It may seem small and not very encouraging but it made our day. Then visiting time was over and we had to leave.
We will be back tomorrow morning at 11am when the information session will be before visiting time. Only 1 hour and only 2 people at a time.
Sunday Morning Nov 27 Visit
This morning's visiting hours were from 11:30 to Noon. We were lucky in that a doctor was in her room to talk to us because this was just visiting hours and the information session is during tonights visiting hours. Margaret was sedated and on the respirator. The doctor said that this was normal as they are trying to wean her off of the sedation and respirator but it is a long process. They take her off for a few hours and then back on. She was sedated so she could get some rest. She was quite active last night and they want her to rest. This is going to be a long process and in today's instant gratification society we are impatient and expect fast results and all the answers now. We are not going to get that instant gratification with Margaret. Progress is normal and she is doing well even though at times nothing seems to change or even seems to be going backwards. The good news is nothing out of the normal (ie bad) has happened. The doctor today explained as the other doctors had that the medication they give to ischemic stroke victims (blockage as opposed to hemorrhage stroke) was not effective with Margaret. The medication is given immediately after the stroke and needs to be administered within 3 hours to be effective. We believe she received immediate medical attention but she was alone visiting a museum that day and was on her way to meet her friend Kim. The medication given was supposed to dissolve the blockage and reduce damage to the brain. Unfortunately, the extent of damage caused to her brain will not be known for weeks. They are saying that it was a big stroke so there will most likely be permanent impairment affecting her left side mobility, strength and coordination. On the positive side her left hemisphere pressure is normal and seems to have no damage and that is the side that controls speech.
We will be going again tonight for the information session and visitation. We will post another update tonight. Please remember that this will be a long recovery time and progress will seem incredibly slow. But there is progress.
We will be going again tonight for the information session and visitation. We will post another update tonight. Please remember that this will be a long recovery time and progress will seem incredibly slow. But there is progress.
Saturday, November 26, 2011
Saturday Nov 25 Update
Today's visiting hours were from 1130-1200 and 6-7pm. This morning there was not much change. Margaret did squeeze our hand a couple of times but for the most part she was sedate. The positive side is that there was no problems over night and the pressure in her brain remained normal. She has a pressure monitor installed on the left side and the readings were and have been normal since the surgery (when they installed the monitor).
The evening we had to wait until about 6:45pm to get an update from the doctor. This doctor was very nice and recapped what had happened. We liked her manner as she seemed more compassionate and understanding. She had a nice way of recapping what had happened and what they had done. She explained again to us that a large part of the right side of her skull was removed to allow room for her brain to swell. The swelling should stop in a couple of days. They have said it usually continues to swell for 5-7 days after the stroke. And it will take weeks or more for the her brain to recover from the swelling. They are still trying to determine a cause for the stroke and want to find the cause to prevent any future problems. There is not an apparent and obvious cause.
We then visited with her. She was not responsive at first until the doctor came in and woke her up. Then she did respond by squeezing her right hand in response to specific questions. It was reassuring. They allowed us extra time after 7pm since we had to wait so long to see the doctor. Just before we left she did get quite agitated and moved quite a bit. She still has the breathing tube in but the ventilator is disconnected so she is breathing on her own. The doctors just need to make sure she can cough and has the proper respiratory responses before they remove the tube. Hopefully they will remove the tube tomorrow. She was able to move her body (the right side) and did lift up both her right and left knees. She was agitated and probably frustrated because her blood pressure did increase and the doctor said she was crying. The lifting of the left knee was encouraging because they were saying she may not have movement on the left side for a while and likely may not return to normal ever. While her condition still is not good it has not worsened. We see little signs of improvement and that is giving us hope and helping to keep us positive.
The evening we had to wait until about 6:45pm to get an update from the doctor. This doctor was very nice and recapped what had happened. We liked her manner as she seemed more compassionate and understanding. She had a nice way of recapping what had happened and what they had done. She explained again to us that a large part of the right side of her skull was removed to allow room for her brain to swell. The swelling should stop in a couple of days. They have said it usually continues to swell for 5-7 days after the stroke. And it will take weeks or more for the her brain to recover from the swelling. They are still trying to determine a cause for the stroke and want to find the cause to prevent any future problems. There is not an apparent and obvious cause.
We then visited with her. She was not responsive at first until the doctor came in and woke her up. Then she did respond by squeezing her right hand in response to specific questions. It was reassuring. They allowed us extra time after 7pm since we had to wait so long to see the doctor. Just before we left she did get quite agitated and moved quite a bit. She still has the breathing tube in but the ventilator is disconnected so she is breathing on her own. The doctors just need to make sure she can cough and has the proper respiratory responses before they remove the tube. Hopefully they will remove the tube tomorrow. She was able to move her body (the right side) and did lift up both her right and left knees. She was agitated and probably frustrated because her blood pressure did increase and the doctor said she was crying. The lifting of the left knee was encouraging because they were saying she may not have movement on the left side for a while and likely may not return to normal ever. While her condition still is not good it has not worsened. We see little signs of improvement and that is giving us hope and helping to keep us positive.
Friday November 25
We are just trying to get caught up with daily updates so this is what happened yesterday. We are allowed to visit her twice a day at 11am and 6pm. Updates from the doctors are only once a day at 11am during the week and 6pm on weekends. We will try to make updates after each visit. Madrid is 6 hours later than Eastern time zone.
Margaret was still under sedation in the morning visit. Her color had returned and she was looking better. She was on a ventilator and did seem to move her head once and face while we were talking to her. During the day the sedation was stopped. She responded to requests to squeeze her hands. She was able to squeeze her right hand but not her left. That is to be expected with the stroke she experienced. She also moved and lifted her right leg. It was comforting to have her respond to us. She is not able to open her eyes, though it a result of the stroke and brain swelling.
It is frustrating that while she is in the ICU we are only allowed to visit at those specific times. They are quite strict with the visitation rules. Once she is moved out of the ICU, visitation will be much more liberal.
We have learned that brain injuries have no defined time lines as each person is different and recovers at a different rate. The positive side is that she is young and otherwise healthy, and it was the right hemisphere of the brain. All of the doctors say it will take time for her to heal.
Margaret was still under sedation in the morning visit. Her color had returned and she was looking better. She was on a ventilator and did seem to move her head once and face while we were talking to her. During the day the sedation was stopped. She responded to requests to squeeze her hands. She was able to squeeze her right hand but not her left. That is to be expected with the stroke she experienced. She also moved and lifted her right leg. It was comforting to have her respond to us. She is not able to open her eyes, though it a result of the stroke and brain swelling.
It is frustrating that while she is in the ICU we are only allowed to visit at those specific times. They are quite strict with the visitation rules. Once she is moved out of the ICU, visitation will be much more liberal.
We have learned that brain injuries have no defined time lines as each person is different and recovers at a different rate. The positive side is that she is young and otherwise healthy, and it was the right hemisphere of the brain. All of the doctors say it will take time for her to heal.
Margaret's Stroke
Margaret suffered a pretty bad stroke on Tuesday, November 22nd while on vacation in Madrid, Spain. She was taken to a very good teaching hospital in Madrid. The stroke was a blockage of the vessels as opposed to the rupture of a blood vessel type. The stroke occurred in the right hemisphere which is the better side as her speech was not affected. She was awake and could talk though she weakness to paralysis on her left side. She received immediate medical treatment but the drugs used to treat this type of stroke were not effective. The brain tends to swell after a stroke for several days. On Thursday the doctors determined that the swelling in her brain was starting to affect the left hemisphere and brain stem. There is no extra room in the skull for the brain to expand so surgery was performed to remove part of her skull to allow the brain room to expand. The skull is being well kept by her in her abdomen for replacement after her brain in no longer swollen. The surgery has been successful in it has reduced the pressure on the left hemisphere and brain stem to normal levels.
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