Love You Mom! Goodbye!

Mom, enjoying a rare patch of sunshine, just one week ago.

She died this morning at 8:40AM. Sometime after 4AM she had a massive bleed in her brain. We got the call from the nursing home at 5:35AM that she was on her way to the hospital. She was found in a non-responsive state and never regained consciousness. We were with her right until the end. I held her and kissed her, Mike holding her hand, and we told her we loved her so much and that she shouldn't be afraid that we were there for her as long as she needed us. Words. Only words. Maybe she heard us. Maybe she didn't.

One thing she knew well, and I will apparently never learn, is how to live in the present. Live and love like it's the last day you have together.

We saw her last night only briefly. Normally we'd stay longer, or take her out of there for a few hours on the weekend, but yesterday I was pretty sick and needed to go back home. I told her I felt badly about it. She told me not to and hoped I felt better.

Oh, had I only known.

Love you Mom! Goodbye!!

I miss you! You're a special lady. I only hope you knew that, too.

Fixin' A Hole

So, Mom no longer has an open PFO, or hole in her heart. Last Wednesday she had the device closure procedure at Munroe Regional. The cardiologist used a Helex device, and everything went well. Mom said the procedure went fine, but that afterwards was not so fine. She was very uncomfortable, I think. And she doesn't seem to agree with the Versed and whatever else they gave her. At any rate, one more stroke-causing issue has been struck from the list.

Small Rewards

Mom got a cookie on Monday. Wait, let me back up a bit. I've got a little catching up to do.

On July 26, Mom had yet another stroke- her third this year. She hadn't even finished her home health care from the last one. She spent most of the next week in ICU again. The first 2 days were rough- she was quite agitated the second night, ripping out her IVs and trying to leave. I'm sure that was due to disorientation brought on by the stroke itself. They gave her Haldol to calm her down, which made her a zombie for the next week or so. Finally, she was discharged to another skilled nursing facility, and is still there. Since I figured it would be demoralizing for her to be back in the same place as before, I pushed to get her to a different (and better) one. It worked, and we're all happy about it.

This time we weren't as lucky as the last 2 strokes, where she was able to move her left side fairly quickly. Her left side is only very slowly coming back. She can move her leg a bit and walks quite a ways with assistance, but now has foot drop. She's been fitted for a brace, which helps tremendously with walking. Her left arm/hand may only come back later.

She had escaped aphasia for the most part the previous times, but not so this round. It's such a struggle for her to speak at times, that unless she's well rested and energetic, I don't know what she's trying to say. She's improving, as ever, though. Dysphagia is also something she'll probably always have to deal with, which is where I come back to the cookie. On Monday she was able to pronounce the word cookie, and so was given a cookie for reward- her first cookie, I might add, since July 26th. Yesterday the word 'excellent' was the accomplishment. She may come off the puree diet very soon.

Though her memory is affected somewhat, her sense of humor is quite lively- always cutting up with the nurses and CNA's. They all seem fond of her. This means a lot to me, and not only for the obvious reasons. Whenever I go see her, I am deeply affected by the faces of the other residents there, especially when they're gathered in the dining room. I can't help but wonder what stories they might have to tell; where are their families, or if they have any. I just can't imagine what how they feel or what they're thinking.

Today we took Mom to a cardiologist in Ocala to discuss the closure of the PFO (patent foramen ovale) in her heart, which could be responsible for passing clots. The best option for her is what is called a device closure, which she's opted for. The benefits far outweigh the risks for her and would reduce the likelihood of another event like she's been having. All 3 MRI's following each stroke have shown no change, nothing new.

Home

Finally, Mom came home a week ago today. She gets around okay with her walker, but her left side, especially her leg, still is an issue. She once again gets physical therapy for six weeks, and so hopefully more progress will be made. This last stroke knocked the wind out of her sails, for sure.

The road is rocky this time around, and we're doing our best to hang in there together.

No News...

is good news. Though Mom is still in the 'joint', as I call it (skilled nursing facility), she's hanging in there and doing okay. My brother sent her a lovely bouquet for Mother's Day, which I captured on my new (for me) Pentax ME Super. Not bad for a 25 year-old camera.

The visit to the vascular neuro-surgeon resulted in his stating that she did not have an aneurysm in the basal artery in the pons or stem area of her brain. Instead, it is a diseased (enlarged) vessel, perhaps from her past uncontrolled hypertension. At any rate, it is not operable. We got up before dawn for this appointment, so I documented it. You'd better believe it. If I'm up in time to greet Father Sun, I'm getting proof!

Accomplishments

TX3A.4.08-5
Originally uploaded by Madrigalrose

Baby steps, as they say. Hearing that repeatedly can get annoying after a while, but sometimes it's all too true.

Mom is, as ever, very lucky. Many people wouldn't have use of the side affected by so many strokes, but she still does. It's weak, but she's working on it.

Stroke Awareness Month

May is National Stroke Awareness Month

In honor of this I am going to be getting Mark McEwen's book Change in the Weather: Life after Stroke. He has a very positive attitude, which Mom needs right now. Come to think of it, so do I.

One Week Later

It's been a roller coaster of a week. Yesterday Mom was finally discharged from ICU at SRRMC back to the skilled nursing facility she had been in for some 6 weeks until just about a month ago. Though she has been understandably bored the past week, the nurses in ICU were great. Awesome crew. I have to admire and tip my hat to anyone who can do that job and still maintain such a great attitude. Tough job! Mom definitely wasn't as bad off as most anyone else there- no ventilator, no traction.

Monday she had been transferred out of ICU to a regular room, but within a few hours her left side was flacid again, and her speech was seriously affected. I noticed immediately when I came in to see her after work. Apparently, so had her neurologist, who ordered another CT scan when he saw her a few hours earlier. Radiology came in to get her for that minutes later, as it happened. Nothing new showed up from it, so the neurologist ordered an MRI Tues. By Tues morning, she was almost back to where she was Sunday afternoon- she could raise her left arm and leg, and the left side of her face was better. The MRI revealed 2 separate and unrelated issues- an 8mm aneurysm and a stroke- both in the stem area of her brain. We go to a vascular neuro-surgeon the first week of May to see what our options are.

So far, she's been holding since Tues. No new strokes, and her Coumadin INR has been at an acceptable level. Hopefully, the physical therapy dept. will cure her boredom for a while...

I'm really glad I can quit collecting these now-

Set-back

Mom had yet another stroke this morning. I had been at work about an hour when Mike called and said he was taking her to the hospital- she couldn't move her left side and her speech was slurred. They had just returned from a doctor visit for a Coumadin INR check. I told him I would meet them there and left work. It was all I could do to keep it together the 40 minutes drive down there. Seeing fear and disappointment written all over her face when I got there didn't help any.

Again, the CT scan showed no hemorrhaging. But since she'd had a stroke not long ago, and she is on Coumadin, no tPA this time. So, for now she's on a heparin drip. And we wait.

She hasn't responded well when evaluated for swallowing, so to avoid aspiration, no drink or food (or pills for that matter) are allowed. She's hungry, too. Mom has kept her sense of humor up to this point, but she is quite serious about food...

The Irish Half

(I had originally written this on March 1st, 3 weeks after Mom's stroke.)

If there's anything to it, Mom's Irish blood has been living up to what is often called the Luck of the Irish. On Feb 7, at 9:10 AM, I heard two big, loud thunks coming from her room. I called out asking if she was okay- no answer. I ran into her room, where I found her face down on the floor, unable to speak and not moving. Her nose was beginning to bleed. She had landed on her face. I suspected a stroke and yelled for Mike to call 911. In what seemed like a pretty short time- 10 minutes or so- an ambulance was here. The nearest hospital is 10 minutes drive from here. We don't have a lot around here, but we do have a decent hospital. They asked me a few questions before they took her down there, then a few more when we got to the emergency room. Mostly focusing on when I thought she had had the stroke- there is a 3 hour window with the tPA treatment. I could tell she had already been up and gone out for her paper and had her cereal.

The ambulance left first, we followed shortly after. By the time we got there, she was already in getting a (non-contrast) CT scan. Very shortly, she was in the ER and awaiting the results. She was still on a stretcher, with neck brace, too. Her nose was cut and swollen from the fall. I told her they were taking the very best care of her and not to worry. We mothers worry a lot. Often more than necessary.

The ER doc came in and told us the CT scan showed no hemorrhaging, which indicated an ischemic (dry) stroke, which made her a candidate for tPA treatment, aka the clot-buster. I debated for a few minutes, but it really was a no-brainer, if you will. 93% success rate, 7% resulting in worsened symptoms, creating hemorrhaging in the brain. When I gave the okay, they immediately went into action. It was a big room, so Mike and I could sit on the sidelines. The nurse, Rosemarie, or Rosie, was so very good. Mom's left side was affected- left side of her face, left arm and leg. She also couldn't look to the right past center. She couldn't talk- she was still fully awake and observant, but couldn't make more than weak attempt. Once they got the tPA drip going, we waited, though not for long. At 6 minutes: she could move her head to the right again. 15-20 minutes: she could move her left arm and leg. Within an hour she could talk some- she said she was thirsty. Because swallowing is affected, and to avoid a choking hazard, she wasn't allowed anything to drink or eat for 24 hours. She had an IV and that was it. Later that day I learned that this hospital is a certifed Primary Stroke Center. How lucky is that?
She spent 2 days in ICU, 2 more days in the hospital, then she was released to a skilled nursing facility, where she stayed with physical therapy until March 26th. With a nurse visiting a couple of times a week, and continued physical therapy, she's doing quite well, considering how it could have been. She's graduated from wheelchair to a rolling walker with brakes. She may always need one, but who knows? This is the second round of strokes for her- the first was almost 3 years ago, though she wasn't so lucky. No one was around to take her for treatment. She recovered okay, but it took some work.

At the top of everyone's agenda is finding a way to keep Mom busy enough to stay out of trouble... Ha!

So this is my way of sneaking in a PSA. This is serious business, and I'd be willing to bet most of us are at risk here. I know I am. I've decided I must take better care of myself NOW. Regular exercise, eat better, reduce stress and so on.

American Stroke Association.
Interesting article on tPA
End of PSA
Thanks for indulging me.

Nine days after the stroke, with the residual black eyes,
my mother, Mary.


Cheers to Mike- I don't know how I'd manage without his support.