Monday, March 25, 2019

Keith at UNMH, Week 4

(This first said Friday, but it was Monday; I had cut and pasted from elsewhere and not corrected.)

Last updated 3:00 PM Tuesday (March 26, 2019)
Keith is still in room 560, 5 West

9:25 AM Monday (March 25, 2019)

It was a Sunday afternoon when Keith came here (May 3). It's a Monday, so Week Four is on, for sure.

Keith ate lunch! Really ate. Drank all his chicken noodle soup. Ate almost all of a fair-sized piece of chicken breast with some sauce on it (and Mrs. Dash on all that), and some cooked carrots. Drank milk. Ate yogurt I had brought in.

He's able to rearrange himself in the bed really well. The only thing he's hooked to is oxygen, and that's an option. The machine is quieter with the little bit of extra oxygen. But if Keith wants to take that off, nobody will complain.

From the morning, I hoped I'd get to talk to the discharge counselor, and we waited a few hours, but at that time we thought it would be about Keith moving out to a rehab facility in a few days. Since then, some things have been learned.

A physical therapist came to work with him. He stood up and walked to the wall and back a couple of times, but he was dizzy, and so that's all they did. Because of this, the recommendation will be a skilled nursing facility when he leaves, and not rehab. She said inpatient rehab costs five times as much as skilled nursing, and the insurance companies don't like that. (And Ashlee pointed out later that the co-pays might be considerable.) Also the PT said that if Keith were to go prematurely to rehab, he could be "demoted" to skilled nursing, which would be another ambulance transfer, or if he got hurt or medically affected by the rehab, he might end up back here at UNMH. There is a possibility (likelihood?) of being at skilled nursing for a while and then transferring to inpatient rehab from there. She said I should advocate for that.

What we already did know about the difference between skilled nursing and rehab was that rehab expects one to have the stamina to do three hours of PT a day. Skilled nursing might only have one or two hours of physical therapy. When that was first said, it went with the idea that Keith might have to go to skilled nursing first if he still had any tubes in him (feeding, or drainage). With tubes gone, we thought rehab was a default, but he's dizzy.

The internal medicine lead came to talk to him and said that after he's out of the hospital, and out of rehab, there will still be at least three months of follow-up appointments with EP (Electro physiology), Cardiac, and his primary care physician.

Someone came by from cardiology to say that it will be Wednesday afternoon before they can implant the ICD, so his nothing-by-mouth starts tomorrow night, not tonight. (And he might still be bumped from the line, but she didn't say that this time. The last time she said if more pressing cases come along, he might be bumped.)

So at the moment, the vague plan is:
  • Tuesday: More sitting up, maybe sitting to eat (though he's not eating much).
  • Wednesday, no eating at all, surgery in the afternoon (with light sedation and local anesthesia)
  • Thursday... maybe (MAYbe) moving to a skilled nursing facility, or not... or having surgery, or not...

I told Keith I'm hoping we will look back and say that he was in the hospital for nearly a month. Not "for a month."

9:25 AM Tuesday (March 26, 2019)

I forgot to say yesterday that Keith reported to the internal medicine doctor that he felt weaker in the left arm than the right, and that he's a lefty. The doctor jumped at that, and started having Keith squeeze, push, pull, with both sides, both hands, arms, feet, and legs. It was perceptible, the doctor said, but minor, and might be from being in bed. Sensation seemed to be good on both sides, and Keith's face ("Smile big, raise your eyebrows, close your eyes, open your eyes") was still symmetrical, so no stroke symptoms.

Also, from yesterday, the nurse had said that if Keith wanted, after the physical therapist left, he could have pain meds—either oxycodone or Tylenol. Keith, after standing, stretching, taking a few steps to the wall and back, twice, and lying down for being light-headed and tired, said his pain level from down from a 3 to a 2, because he had stretched his back and it felt better. Nice.

Today I'm babysitting (a bit later), and was here to meet an electrician, so I'm home, but here's info from today (per Keith by phone) is that he sat up for dinner, sat up for breakfast, but standing up is still difficult. They wanted to do a shower, but it's down the hall and around, and would involve some standing, and it seems too much for now.

That was all written this morning, but I didn't post it. The electrician came by, I went to print out some articles about cardiac arrest and an ICD, and the baby showed up. P.S. from 3:00 p.m. on Tuesday

The thing I was looking up was about Keith driving. The cardiologist who is doing the procedure tomorrow visited him, with the resident who had talked to us before. The doctor said it wans't true, that Keith couldn't drive. He would be safer driving than before. That goes against everything I've been told, and read, including the dumbed-down-for-patients printout from last week. So I was printing out studies, and didn't get back here.

Week 4 continues here

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