Monday, March 23, 2009- FAMILY MEETING DAY

Today was filled with a lot of information.  The family gathered by phone in a conference call.  Alan, Luis, Don & Chsristy were meeting with Dr. Ripley, the rehab doctor, Dr. Shraa- Psychology, PT, OT, Speech, Nursing, & Family Service to discuss Christy's rehab plan.

Dr. Ripley began by showing the MRI done at Craig.  He explained that a MRI is a 3D picture that they can cut into slices.  He said a lot of things that we had heard before  but it was good to hear them again, explained a little differently.  Dr. Ripley told us that Christy suffered from hypoxic (lack of oxygen) Ischemic (lack of blood) Encephalopathy (disease of the brain).  He explained that with this injury you can have subtle or no injury noted on the MRI.... Christy has 

some differences.  There are areas of her Cerebellum (part of the brain nearer to the neck) that have grey areas where a clot prevented the tissue from getting oxygen.  We're concerned about the lack of blood flow here. Higher in the "Occipital lobe" where the vision center is also had damage from lack of oxygen.    Christy is having problems with her vision.  Dr. Ripley explained what he thought was missing.  The eyes are receiving the information but the screen is missing to project the picture on.  The picture can not be realized by the brain.  Also, they feel that

 Chrsity is having trouble controlling her eye movements to focus on one thing.  She's having a hard time seeing the whole environment around her.  Dr. Ripley things that if Christy could hold her eyes focusing on one object she would see holes in the picture, like Swiss Cheese.  Christy will be seen by two eye doctors that specialize in two specific parts of vision and the brain.  On Wednesday, Christy has an appointment with the rehab optometrist Dr. Pauletzer (not sure I have these names right) Dr. Peltz will also see her soon.  He is a Neuro-Opthomologist (brain eye doctor).  

Dr. Ripley continued past the Occipital lobe to the Hippocampus which looked a little different color but very subtle.  He did say there was any specific injury.

Further up from there he pointed out some lesions in the Basal Ganglia and Thalamus.  These parts affect feeling and sensation.  This is why they are doing all of those sensation tests on Chris with the safety pins.  Christy's sensation seems to be pretty intact for the most part.  

Dr. Ripley also noted that Christy's blood vessels delivering blood to the brain didn't look damaged.  This is good.  He didn't feel that the blood clots that damaged the brain came from damaged vessels.  

Dr. Ripley then stopped talking about medical anatomy and said to us that Christy's Memory is MUCH better than other patients who have come through with this same injury in previous years!! Having a good memory is going to help her rehab better because she can remember the rehab techniques and learn the theory.  Dr. Ripley also made it very clear not to compare Christy to the other brain injury patients on the floor- there isn't a fair comparison.  He explained that the progress is slower with Ischemic Brain Injury (what Chris has) verses traumatic brain injury (most other patients on Christy's floor have traumatic injury).  He also explained, although slower, the progress can continue for a longer amount of time.  He said there is a misconception that recovery will be finished after 6 months to a year-- with anoxic injury it can stretch out much longer.

Dr. Ripley explained that right now there are drugs that we will wait one year to give.  They help with the ataxia (the lack of coordination of muscle movements)  This Ataxia is probably from cerebellum damage.  They are not useful yet because they are known to inhibit Dendritic sprouting.  This is when the nerve cells put out fibers to other nerve cells to reconnect.  The benefits do not outweigh the risks, so it's  can wait. They have other drugs they can try to get her in the best shape possible, but one step at a time right now.

Each member representing their specialty spoke at their turn:

Nursing (Karen) spoke about Christy's positivity and pleasant sense of humor.  The entire team feels that this is helping Christy's recovery.  She talked about getting Christy on a good day and night schedule as a priority.  She wants her to have lots of rest so she doesn't use up the energy that could go into therapy for too much socializing.   

PT spoke about Christy's wheelchairs.  They need to problem solve with the upright chair to 

get is all just right.  They will continue stretching and the standing frame which she does 3-5 times a week.  Stretching on the side works best for Christy & Once she's on the mat, she moves well!  Christy is going to the spasticity clinic next week.  This was the first appointment available for her.  She will get an evaluation and they will address loosening her up!  Christy is doing well with transferring & Don too!  She no longer uses a sliding board, but does a pivot.  Christy is doing really well with the standing and squatting exercises.  The PTs are planning to trial Christy on a wheelchair bike to go to the gym! Fun!  Christy is just faking her "pain face" as a joke! Alan just took the picture right before she laughed at her own joke!

Malea from speech commented on what a hard worker Christy is, even when things are uncomfortable and not fun.  Christy bit her tongue recently and it's been really soar.  Christy had to go back to a puree diet while this is healing.  Malea talked about how Christy has a hard time planing the movements of the muscles used for annunciation and resonance.  This is part of her challenge with her brain injury.  She did say that Christy is able to put her tongue in the right place with verbal cues and sometimes with using a mirror, so that's great!  The Apraxia (not being able to carry out muscle movements) is affecting her breathing at times as well, she notices.  Her memory is SO much better than they had expected and Christy passed one of the milestones on Monday dealing with memory.  Christy has learned all of her therapists and their names! AWESOME!  On Thursday they plan to do a video swallow.  They go to the radiology suite and use a dye called Barrium, and take a moving video of her swallowing!  This will help them learn more about what's going on inside!!

Occupational therapy stated that their goal was to help Christy be as independent as possible.  They help rehab the vision as well as the upper body.  They have been dressing Christy daily in the AM.   They also talked about Praxis which is described as slow motor planning. Christy does better with automatic things to get the hang of how to do things again verses verbal directions.  So while getting dressed, asking her to put her arm in the hole might trigger her to use the wrong arm or put the arm in the wrong hole, etc.  Things like drinking her diet coke is automatic... pick it up, drink it, and put it back down!  As far as the eyes go, they found that she is moving her eyes much better since admission, but looking up makes her sick!  Eye movements are linked to the ear, so hat could make her dizzy.  They sat Christy in a rocking chair to take advantage of the movement to rehab the eye. They also talked about maybe using "rolling stimulation" to help her!  Very cool!  I never would have know this stuff! It also seems like her vision is inconsistent.  What  helps sometimes is for Christy to touch something so she can focus on what she wants to see.  They need to assess what Christy sees more, and continue working on the eye movements and getting a clearer picture of what's around her.  

The other big issue for them is that Christy is getting Tired.  Her energy reserves are low.  Christy becomes emotional- mad and frustrated- with therapist, Don or herself.  They are going to work on signals that tell them Christy has had too much.  They don't want to tire her out too much!

Dr. Shraa wanted Christy to slow down a little and try to relax.  Try not to hurry to each appointment too fast.  Being 5 minutes late is OK.  He was very complimentary of Christy's personality and the support and love of the family.  He said Christy's personality is helping her do better.  Christy has a good "personal style" that's getting her ahead!

Melissa of family services said that the rehab is right on schedule.  For now Christy's "last day at Craig" date is May 13th.  They also explained that Hawaii does not have NEURO-REHAB, which is what Chris is getting and needs.  They will have to continue rehab at a regular basic rehab area.  They may keep Christy till May 26th when insurance covers till, just so Christy can benefit from the full neuro rehab advantage.  They talked about video taping the therapy sessions to give the therapist that follow a better idea of what Craig was working on and the Theory of the rehab.  

We love you Christy and are all behind you every step of the way!!!