Bob has now been discharged from cardiac rehab. He is doing well. The only pending issue is what to do about his flutter. In 2-3 months his cardiologist will again attempt to cardiovert him--during this procedure electrical current is applied to his chest in an attempt to reset his heart rhythm. If cardioversion is not successful, he may have an ablation where the cardiologist places a catheter in one of his blood vessels and then guides it into his heart where he tries to cut the abnormal electrical pathway.

Mom is doing well. This will be the final blog entry.

Bob continues to have episodes of atrial flutter. He had an MRI earlier this week. He has not been told the final results yet. Evidently these results will help his physicians to determine whether he will need a pacemaker or a defibrillator. These devices are implanted in patients in order to provide a way to restore a normal heart rhythm quickly when things like flutter are detected.

Mom is doing well. She survived a day at the funeral of my grandfather on the 12th. This was her first husband's father.

Bob is home! He will go to outpatient cardiac rehab tomorrow at the Utah Valley Regional Medical Center. He will be assessed as to whether he needs the more intense rehab at this cardiac rehab center or whether he is ready for a home program. If he needs to go to the cardiac rehab center he will travel there from home probably five times each week for the next several weeks.

Bob and Ann Marie found out today that Bob will be discharged from the rehab facility on Thursday, October 1st. They are excited. Mom is nervous. Bob will continue to get therapy through home health care. They appreciate every one's help and prayers.

During his visit to the cardiologist's office yesterday, Bob was found to be doing better than expected. He is off oxygen during the day, but still needs it at night. He will meet with his surgeon in a couple of weeks. The surgeon will determine when Bob will be able to leave rehab and go home.

Bob is doing well in rehab. He says they have to hold him back so he does not try to hard. Mom reports that he looks better. He does like his naps after therapy. The therapy sessions wear him out a little. He will see his regular cardiologist tomorrow. He is in a different room, so ask at the front desk when visiting him. He would also like people to call the cell number because he keeps the cell phone close to him.

Overnight Bob's heart rhythm returned to normal. He has been transferred to Stonehenge. His private number is 801-850-5421. Visitors are welcome anytime. He will be at this rehab center for up to 30 days. His duration of stay will depend on his improvement.

Bob is still at the Utah Valley Regional Medical Center. He saw his surgeon and two cardiologists today to review what to do about his ongoing atrial flutter. They tried to cardiovert him three times today but were not successful. During cardioversion paddles are used to send an impulse of electricity through his heart in order to hopefully reset the electrical activity so that the heart can resume its normal function. They feel that post-operative inflammation is either causing the flutter, preventing them from correcting the flutter or both. For now they will wait 4-6 weeks to see in the flutter goes away as his inflammation heals. If the flutter remains, they will likely try to cardiovert him again. If they are not successful, a pacemaker will be placed.

While Bob has flutter his atria or the small chambers of the heart do not empty as they should. This dramatically increases the risk that a blood clot will form in the atria. Such clots can dislodge and travel to other parts of the body. If a clot forms in his right atria and then dislodges, it will go to his lung and cause a pulmonary embolism which is a life threatening condition. If the clot forms in this left atrium and then dislodges, it can go to his brain and cause a stroke. In order to prevent these serious complications, Bob has been placed on a blood thinner called Coumadin. This is the same chemical that is found in some types of mouse and rat poison. Bob will have blood tests periodically to make sure his coumadin levels are therapeutic (at the right level).

Lastly, while Esther was visiting today, one of the cardiologists told them that Bob's risk of heart attack would be higher if he were to go home now and that his risk will be lower in the hospital or rehab center. This news helped mom and Bob feel better about their decision to have Bob go to a rehab center for a few weeks.

Bob had good weekend and plans had been made to transfer him today to a rehab facility near their home called Stonehenge of Orem. However, he is either having more flutter, a third degree heart block or both--I am getting mixed reports on this from Mom and Bob. Flutter is when the atria or small chambers of the heart beats very rapidly. A third degree heart block means there is a complete disconnection between the electrical activity of the atria or small chamber of the heart and the ventricles or large chambers of the heart. Bob's surgeon has consulted Bob's cardiologist to help decide what to do about these issues.

Bob had some more tubes removed today. He now had no chest tubes to the pericardial sac (the sac where the heart rests). He continues to have tubes in both pleural spaces (the space between the lungs and chest wall). His physicians are increasing his diuretics (water pills) in an effort to get rid of the excess fluid more quickly.

Bob cannot yet get himself in or out of bed by himself. He is using a walker when he walks. He also continues to fall asleep a lot during the day. Because of these and other challenges, he will likely be transitioned to a rehab facility before he is able to return home. He needs to be fairly "tuned up" before going home because mom cannot lift him due to the injuries she suffered in their car accident.

Bob is having one of his chest tubes removed today. He also ate a full breakfast and a full lunch. He walked 300 feet twice today. Lastly, they are beginning to plan how to transition him to rehab. All in all, he continues to show slow, gradual improvement.

Bob has improved enough to be moved out of the ICU to room 561. He is sitting up more and says he feels "a little better." He will have a new appreciation for the nursery rhyme "The Tortoise and the Hare" in that his recovery will be more like the tortoise. 3 IV's have been removed. However, he still has a central line (big IV in his neck) and all the chest tubes are still in place. Children can visit him in his new "tiny" room. Shift change for the nurses is between 6-7 am and pm so we cannot visit during these times.

I am now back in Boise. Mom tells me that Bob sat up in a chair this afternoon for the first time since his surgery. Here are some photos I took yesterday.

Bob feels better this morning. He walked further than he did yesterday. He ate without indigestion. His heart is back in sinus rhythm (normal rhythm). However, his chest tube drainage continues and his overall recovery is taking longer than is usual.

Mom and I met with the social worker today. After Bob is discharged from the hospital he will need to go to cardiac rehab 24 times for about an hour a day. I do not anticipate that he will be discharged for at least 10-14 days. The timing for the cardiac rehab is from 8:45 to 11:00 am daily Monday to Friday (possibly Saturday). He must arrive no later than 10:00 am on those days. If anyone is interested in helping them drive to these appointments let them know. Mom cannot drive and Bob will not be allowed to drive for about 8 weeks.

Bob was more awake and alert during our afternoon visit. He really enjoyed the call from his son Michael who is in Dallas to visit friends.

As a reminder, while Bob is in the ICU visitors are not welcome between 5-7 pm and 5-7 am while the nurses have shift change.

I arrived in Orem late last night and then visited Bob this morning. I will take a photograph and post it when I return to Boise tomorrow. Seeing Bob in the ICU reminded me of all the visits to the Eastern Idaho Regional Medical Center to visit mom in that ICU. Although he is not in a coma like mom was, Bob is still quite sick. His post operative recovery is progressing as expected. The third day is often the worst and that seems to be the case with Bob. He is quite sleepy today and had some syncope (passing out) this morning. He was not able to walk as much this morning but was able to get himself to the commode.

He continues to receive hydration through an IV. He has four chest tubes draining fluid from the chest cavity. He is receiving medication to help his heart contract more strongly and a medication to prevent atrial fibrillation--a common post operative heart arrhythmia that is different from flutter. He has not yet regained his appetite.

One thing that is common after these types of procedures is depression. Bob would enjoy visits from family and friends. While in the ICU he can receive visits from family, close personal friends and ecclesiastical leaders. He is in the Cardiac ICU on the second floor of the west tower at the Utah Valley Regional Medical Center.

Bob and mom appreciate every one's thoughts and prayers. We especially appreciate members of the Suncrest 10th Ward who have been very helpful with food and transportation (Mom has not been cleared to drive again).

Bob had a good day. He sat up and ate breakfast this morning. Later today he walked twice and planned to watch the BYU football game. Mom and Bob discovered today that instead of a porcine or pig valve, Bob actually received a bovine or cow valve. He says he is wearing a "moo-moo."

I just spoke to Ann Marie who is at Bob's bedside in the ICU. They have told her that Bob's surgery went well. He is not yet awake but is starting to act like he is waking. He has four chest tubes which drain his chest cavity. He is on several medications. Ann Marie has been told to expect him to be in the ICU for several days.

I am resurrecting this blog in order for people to have updates on Bob's condition. As I write this Bob is having open heart surgery to repair Aortic Stenosis, 4 blocked coronary arteries and his atrial flutter. Aortic Stenosis is a narrowing of the valve which lies between the heart and aorta. The aorta is the main vessel that supplies blood to the body. He has had this condition for years. People can be born with Aortic Stenois or it can occur as a result of acute rheumatic fever--I don't know which is the case with Bob. He will have a porcine (pig) valve placed to repair this defect.

During his evaluation he was also found to have 4 blocked coronary arteries. These are the arteries which supply blood to the heart itself. Bob will have 4 bypasses done. During this part of the procedure, the surgeon takes a section of veins from his leg. One end of this transplanted leg vein is attached to the coronary artery in an area before the blockage and then the other end of the leg vein is connected to the coronary artery in an area after the blockage. This reestablishes blood flow to the heart muscle. We have been told this has probably been present for awhile is unlikely to be related to their accident. These types of blockages are what cause myocardial infarctions or heart attacks.

Lastly, the electrical activity in the small chambers of Bob's heart is causing a condition called atrial flutter. This means that the contractions of this chamber are to rapid to be effective. He will also have this problem repaired today. Each of these three procedures is a significant surgery. His heart is stopped during the procedure while his circulation is supported by a bypass machine (like an artificial heart). He will likely come out of surgery around 3 pm and have his heart restarted at 4 pm today. I would anticipate that he will be in an ICU for several days and the hospital for several weeks.

Earlier this week he had about a liter of fluid removed the spaces between his each lung and chest wall (pleural effusions)--about 1.2 liters from one side and 0.9 liter from the other. This fluid accumulated due to the heart problems discussed above.

All these issues have postponed the care of his bulging discs. These back problems are long standing and are not due to the accident in February. In fact he had these disc problems when he wrecked the Corolla several years ago.

Lastly, Ann Marie is doing quite well. She no longer is receiving care in the home. She can walk short distances without her walker. She can also eat a full diet.

This is the last entry I will make on this blog. Mom is doing well at home. She continues to show slow, gradual improvement; but is not at her pre-accident baseline. Bob continues to struggle with back pain. We have appreciated every one's thoughts prayers during this difficult time.

Mom continues to show slow, gradual improvement. She is walking up and down the stairs once daily as part of physical therapy. She does this with a spotter. She is practicing her swallowing exercises in the hope of passing a future swallow study so she can have a regular diet.

Bob in some ways is having more difficulty. His back pain continues and is due to his bulging discs which were present before the crash but have been exacerbated recently. He was seen by a specialist today and is encouraged by the likelihood of improvement with a cortisone shot. This shot will hopefully provide quick relief. He will likely do physical therapy as well. Surgery is definately the last option.

Mom did not pass her swallow study today. As a result, she will not have her diet advanced to included more textured foods. She was given some exercises which should improve the strength and coordination of her tongue and other swallowing muscles. On a brighter note, she did walk a short distance independently in her living room. In addition she went up and down her stairs just holding the railing (the physical therapist stayed close).

Bob continues to have back pain. He had an MRI recently which showed that he had several herniated discs. He is eager for his appointment next week so he can begin physical therapy for this problem.

Kimberly will be visiting this week.

Mom is evidently eating better. As a result she is scheduled to have a barium swallow study to assess whether she can advance her diet to a normal diet. In addition she had her feeding tube removed today after waiting for 3 hours and getting steamed. Mom even said it was "hell" waiting to get the paperwork done. When the tube finally came out it was easy and only took 5 or 10 minutes. Her other therapies are going well. She is transferring to the car much more easily. Thank you for every one's ongoing concern and prayers.

Mom has done well in her first week at home. There have been some challenges, but on balance she continues to show slow, gradual improvement. She is eating better. She understands that if she eats 75 % of what is recommended then she does not need supplemental nutrition given through her PEG. She eats right up to 75 % then stops. She has had home physical and occupational therapy. The speech therapist has evaluated her and will begin in-home therapy soon. She also get visits from a nurse who assesses her general health and an aide who helps bathe her.

Bob is feeling better after developing some back pain earlier this week as a result of getting out of bed frequently at night to help mom. Next week will present new challenges in that Bob will get to take her to some doctors appointments.

Shawn and mom today.

Sunday morning at the Lawton's. Bob had just returned from his church duties. Mom stayed home--some people will go to great lengths to get out of church.

Arriving at home.

Mom's exodus.

Packing up to leave the hospital for good.

Mom's first night went well. She only got up twice. However, her second night she woke about every hour. As a result Bob is quite tired today and his back is sore. The home health aide came this morning and helped to give mom a bath. Then this afternoon her home health speech therapist made her first visit. Tomorrow home physical therapy will start. Mom is eating somewhat better today but needs lots of encouragement to meet her target intake. We are thrilled with mom's progress. Andrea and I have returned to Boise. Today Shawn is in Orem. Tomorrow Shawn and Katya will help. Bob appreciates all the help. We appreciate his good care.

Mom came home today! Andrea and I arrived last night to help. I had not seen mom since the first weekend in April. It is amazing to see how much progress she has made. She communicates well. She seems to be confused less often. We took some photos which we will post after we return to Boise. Bob and mom met with the home health service who will begin her home therapies on Monday the 11th.

Mom had her her PEG replaced in a different location today. The site is leaking a little, so she will stay overnight and hopefully go home tomorrow. Her medications have been simplified. She continues to show improvement in all her therapies.

Mom had her highest score yet on her cognitive testing. Her care team is still working on resolving her feeding tube issues. Unfortunately she is not eating enough to maintain the nutritional levels she needs.

The discharge plan remains the same. Mom is being discharged on Friday, May 8th. Bob is in the process of finding a home health company to provide in-home physical, occupational and speech therapy for the next 2 or 3 weeks. After which mom will get her therapies at an outpatient rehab clinic. I have asked her care team to review mom's medications in order to simplify her regimen. Both her physician and pharmacist will do this.

Bob and Kim report that mom did better than expected Saturday night when she was able to spend time at her home. Bob got a little sleep. The feeding tube has been bothering mom but it was adjusted today and it does not seem to be causing as much irritation. We are hopeful that mom will begin to eat enough by mouth that she will no longer need the supplemental nutrition through the tube. She continues to do better with her therapies but she is quite anxious about falling. We will likely need to encourage her a lot after she goes home so she does not become too sedentary. Her care team meets again tomorrow then Bob will get a report.

Mom is walking more with a walker and spotters. The therapists no longer have to hold her while she walks but they do follow closely in case she falls. The home visit from occupational therapy went well--they just need to get a raised toilet seat and safety railings for the bathroom. They will also have to store all the throw rugs.

Mom is starting to read magazines and asked for a newspaper. She again did better on cognitive testing (thinking) today. She is starting to remember the accident. My sister Kim will be visiting this weekend to both see mom and to help Bob when mom is at home for her one-day pass on Saturday.

Mom continues to show improvement. She went up and down 4 stairs with assistance. In addition, she walked farther today than she has since the injury--again with assistance. She is scoring better on her daily mental status exam. She is more alert and aware, but is still confused about certain things.

Bob learned today that mom will be allowed to go home on a pass for one night this weekend. The occupational therapist will visit their home before the pass is granted to assess what needs to be done before mom goes home. Her tentative discharge date is still 5/8.

Mom continues to get speech, occupational and physical therapy twice daily from 9-11 AM and from 1-3 PM. She takes a short nap and has lunch between these sessions.

Mom is gradually eating more and taking some medications by mouth. She went up one step then stepped back down. Bob will be meeting with the social worker tomorrow to learn how the care team thinks she is improving and whether they will amend her planned discharge date.

Mom walked so much yesterday that she irritated her knee and did not walk today. However, Bob reports that she is becoming more aware. Two visitors who had not seen mom for a week were surprised by how much she had improved in her mental status.

Mom did well enough with her swallow evaluation today to start trying to eat thickened liquids and softened solids. She did a little better on her mental status testings today. I spoke with her social worker who will arrange to have an occupational therapist evaluate their home in anticipation of mom's discharge.

My sister Kimberly and her husband Michael found a resource on traumatic brain injury which may be helpful not only in understanding what mom is going through but also how it affects her family and friends. The link is http://tbiguide.com/index.html.

Mom did start bolus feedings today as I described yesterday. So instead of receiving a continuous rate of feeding she gets 400 ml of formula 4 times each day. She took two walks today. She seems more alert during the day. However, she continues to struggle with her swallow studies.

Each Tuesday mom's care team meets to assess her progress and to revise her care plan. They also try to give a tentative discharge date when they meet. Currently mom's target date for discharge is May 8th. This is subject to change depending on how she improves. It is entirely likely that she could go home earlier or later than this tentative date. The care team will revise this target date if needed. Bob now must get their home ready since it will be quite some time before she will be able to negotiate stairs and accomplish other activities of daily living.

Much happened today. Mom only has one tube now--her PEG feeding tube which is well hidden. Today her PIC line (IV line) and catheter were removed. She walked about 78 feet with a walker and two assistants. In the afternoon she only had one assistant and did not go quite as far. She does about 25 % of the work to dress herself. She is still only allowed to have water and ice chips based on how she is doing with her swallow studies.

One of her big challenges is that her days and nights are mixed up. She stays awake much of the night and is often sleepy during the day. They are making some changes to her medications in an effort to correct this problem.

They are changing her formula to a formula which is higher in protein and fiber. The type of formula that is given through her PEG tube varies in order to meet her nutritional needs. In other words, her nutrition needs vary based on her condition. For example, during the early time in the ICU she needed one type of formula and needs a different one now that she is in rehab. In the next several days, they will likely change her from continuous feeds (getting a certain amount every hour) to bolus feeds (getting larger amounts at a time to mimic a meal schedule).

Lastly, I should mention that mom's current challenges are quite typical of someone who has suffered a traumatic brain injury. However, her MS may cause her to take longer to recover.

Mom's care team will have their weekly meeting tomorrow after which the social worker will give a report to Bob. They will assess her progress and Bob hopes they can give some sort of prediction for how long mom will need to be in rehab. However, it is notoriously difficult to make such predictions. Mom tried a walker twice today taking 15 steps with the first attempt and 22 steps on the second. She continues to struggle with her swallow.

Mom came off oxygen today and was taken on a walk outside (she was in a wheelchair). She is now off all narcotics (fentanyl and Lortab) and as a result she enjoys being regular again. She was able to take a shower. The nurse feels like mom is easier to transfer from the bed to other activities which indicates that she is getting stronger. I was able to speak to her on the phone while she was in the cafeteria with Bob practicing her swallow with ice chips. I habitually said "How are you?" She replied "fine" and then said "lie, lie, lie, ..." Her voice seems to be returning to normal as the inflammation from the breathing tube slowly resolves. She overall seems to be less confused but still has some issues. However, she did remember to tell me to say hi to Evelyn, my mother-in-law.

Bob reports that mom is more mentally alert today. She was able to place Uno cards in numerical order while only having trouble with the number 7. She is now allowed to have ice chips without the speech therapist being present. There was some concern among visitors that the staff at UVRMC did not know about all her injuries. I spoke to the bedside nurse yesterday evening. This nurse was aware of both mom's past medical history and all the injuries she sustained in the accident.

Mom in physical therapy today.

Mom had a good day today. She road a stationary bike in therapy and they dress her each morning. She did better with her ice chips but not with crackers during her swallow study. She is no longer on a medication called Zyprexa and will soon be taken off Seroquel. A different medicine was started today to help her brain. Bob asked me to tell people that they can visit anytime on Sundays.

Bob reports that mom showed some improvement today. First, she did better but not perfect on her mental status exam. Her short term recall was better. She was able to write her name. Lastly, she showed improvement on her swallow study--she only had trouble with one ice chip. The physicians are trying to change her medications and medication schedule so she will be less sleepy during the day when she needs to do her therapies.

There were big changes today. Mom was transferred to the Utah Valley Regional Medical Center (UVRMC) Inpatient Rehabilitation Unit today. She is in room 2671 and visiting hours are 5 pm to 9 pm. This unit is on the south side of the UVRMC in Provo. This is a big step forward. She will receive two sessions per day of physical therapy, occupational therapy and speech therapy. This is a significant increase over what she could get at the Utah Valley Specialty Hospital (UVSH). She needed to be at this the UVSH during the time between when she came out of the ICU and when she was well enough to go to rehab.

The pins were taken out of her right hand. She is now off Fentanyl and is being weaning off Lortab. I don't know whether she is being weaned off any other meds. Once she passes a swallow study, she will be taken to a dining room to eat. For now she will continue to get gastrostomy tube feedings. Furthermore, once she is well enough, she can have day and night passes to leave the hospital. That is the great news. The bad news is that she continues to be somewhat confused. Hopefully the combination of weaning the medications and giving her brain time to heal will help her become less confused.

Bob is happier than he has been for quite some time. As stated above, this is a big step for mom. As of tomorrow it will be two months since her accident and she will likely be hospitalized for more weeks or months.

Bob reports that mom's short term memory seems to be somewhat better. She is remembering explanations for why she cannot do certain things. She continues to do her physical therapy. Lastly, when Bob showed mom the photos of Shawn's and Julie's new baby, she told Bob to make sure he did not lose them--perhaps this suggests that she in becoming less confused.

Mom and Bob have a new granddaughter who was born yesterday in Denver to Shawn and Julie. She was delivered at 36 weeks and her name is Kennedy Ava. She is healthy and well.

Mom continues to get physical therapy. She has not yet been cleared to eat by mouth. The current plan is for her to be ready for transfer to a rehab facility by the end of the month.

Mom had her first shower since the accident today. She is slowly getting better with sitting and standing. Her progress is slow but it is nevertheless progress.

Mom's grandson Garrett (the tall one) takes second place in the pinewood derby. He designed his car, painted it and helped to apply the stickers. He also helped to prepare the axels and wheels. His brother Jake (the one without the scout uniform) missed participating by a few days. He is eager for his first derby next year.

Bob reports that mom tolerated 2 1/2 hours of physical therapy today, but this caused her to be very sleepy this afternoon. She has an improving swallow but has not yet passed her swallow study. As a result she continues to get all her nutrition through her gastrostomy tube (tube across her abdomen into her stomach) with occasional IV fluids. Lastly, she is answering questions better.

Over past few days mom has been able to use the toilet with assistance. This is a big step forward for mom. She is too prim and proper to use a bed pan. She has been getting a lot of physical therapy which wears her out. Bob reports that mom was more lucid today during a visit from a friend who had been part of the same social group at BYU. We appreciate all those who have visited both mom and Bob. Thank you also for you ongoing prayers.

I just returned to Boise after spending the weekend with mom and Bob. Bob is doing well. He diligently completes his physical therapy to rehab his shoulder. I was able to get some tickets to the Priesthood Session of General Conference. Bob attended with his sons Michael and Jonathon along with two of Jonathon's brothers in law. I attend with two friends from high school--Ken Carabello and Allen Morris. It was fun to hear about how Allen just won the world Elk Bugling Championship and about Ken's work with the mentally ill in prision. We all had a great time.

Mom has had an eventful few days. When Bob and I arrived yesterday morning mom was back on oxygen and was hypotensive (low blood pressure). By the time I left this afternoon her oxygen requirement had decreased and her blood pressure had increased. The exact cause for each problem is not certain, although the care team has some theories.

The most interesting thing is that she is more alert which is making her confusion more apparent. Her long term memory is okay but her short term memory is not functioning well. For example she thought she was in Chicago yesterday and Spanish Fork today. She repeats herself frequently and does not remember instructions well. She sometimes says inappropriate things. For those of you who visit, please remember that most of these types of comments are the brain injury talking and not mom's true nature. Sometimes she has an irritable mood (yesterday) but at other times she is happy (today).

She received another priesthood blessing today. Bob and I feel confident that although she may not completely return to her baseline, she will continue to improve. Thank you for every one's thoughts and prayers. Thank you also to everyone who visits both Bob and mom.

Much has happened since my last entry. First of all, mom has been transferred to a new room. She is now in room 202. The reason for her transfer is that she is requiring less acute care. This is a sign that she is improving.

A second major development was the consultation from the neurologist. He explained that mom's MS will cause her recovery to be slower than in someone without MS. He changed her medications so she will be less sedated. She has been taken off trazadone, promethazine and clonazepam. She is now on seroquel and zyprexa. Furthermore, she continues to be weaned off her fentanyl.

A plastic surgeon was also consulted. He found that mom's skin graft on her left arm was healing nicely. He also evaluated her right hand fractures. As you may remember, mom pulled one of the pins out of this hand. The bone that was supported by this pin is healing well. The other two bones are not healing as quickly. I believe that they have asked an orthopedic surgeon to evaluate her left arm fractures to see how these are healing. I am not aware about whether this has occurred.

A rehab physician began to assess whether mom is ready to be transferred to a facility where she can receive more therapy. Mom mostly gets therapy once a day on weekdays when she is awake enough. She is not receiving therapy on the weekends or when she is too sedated and sleepy. Her therapy consists of physical therapy and speech therapy (for swallowing). She has not been doing as well with her swallow. Hopefully as she is more awake, she will be able to pass all her swallow studies.

Bob is doing well. He is now using resistance with his physical therapy in order to rehabilitate his shoulder injury. He took the attached photo of mom today as she sat up in a wheel chair in her new room. I am visiting for the weekend and am eager to see mom tomorrow.

Curtis and Marina Loosli called today to check up on mom and Bob. Curtis is mom's first cousin and lives in Idaho Falls. They opened their home to all of us while mom was hospitalized at EIRMC. We will forever be grateful for their hospitality and generosity. I particular enjoyed meeting Marina and hearing Curtis tell the stories about the family that Grandma did tell us.

We are thankful for all the friends and family who have been so kind and helpful while mom is recovering. It is impossible for me to keep abreast of everything and everyone. If I don't mention you on the blog it is out of ignorance.

Joyce is helping Bob through the bills. Her experience in this area will be quite helpful. She will likely help Bob review and visit the next facility to which mom will be transferred. We don't have a time table for this, but as mom improves she will likely be transferred to a facility where she can get more aggressive therapy.

Today mom sat up in a wheel chair for 75 minutes which is a great improvement and demonstrates more trunk strength that other sitting maneuvers. She also stood for awhile. She was not given anything by mouth to eat or drink because she coughed a lot with ice chips yesterday. They will continue to evaluate this daily.

Mom passed her swallow study today and was allowed to have ice chips. Hopefully she will do well and have her diet advanced soon.

Dena Kimber and Dona Coats posing with mom to show the final product. It was great for them to do this. We really appreciate it.

We appreciate everyone who is visiting mom and helping Bob. I am no longer in Utah so I am not aware of everyone who comes to visit. If you come, please sign the book in her room.

Dena Kimber cutting mom's hair while a physical therapist helps mom sit up.

Mom has had a good day today. Bob reports that she was off the supplemental oxygen from 9 am to 5 pm. After 5 pm her oxygen level fell a little below 90 % so they restarted the nasal canula. She evidently talked a lot today. Her long term memory seemed intact. For example, she was able to converse freely about Harmon Killebrew (Hall of Fame baseball player from Idaho) and how much Shawn loves the Vikings. She even asked about the accident for the first time. Lastly, she got a haircut and Bob said she looks great. He will be sending photos for me to post. We are still awaiting the neurology and orthopedic consultations.

This is a photo of mom from today. As you can see she no longer has the nasogastric feeding tube, trach or rigid neck brace. She currently only has a small tube in her nose called a nasal canula. Nasal canulas provide patients with extra oxygen.

Mom is still not very alert. People who sustain traumatic brain injuries have injury at the microscopic level in addition to what is seen on CT scans. Although her CT scan earlier this week showed significant improvement in both her subdural hematoma (bleeding between the brain and its covering) and in her excess collection of cerebral spinal fluid (fluid that cushions the brain); she also has injury at the cellular level which can take weeks to months to heal. Time, rest and avoiding further head trauma are the main treatments for these traumatic brain injuries. The extent to which she will recover from these injuries is difficult to predict. We will have see how she progresses in order to answer this question. It is also hoped that increased physical therapy and sitting up more might also help. Mom evidently sat up for fifteen minutes today. This physical therapy will certainly help her bones to begin to heal better.

Kim has returned home to North Carolina. Bob reports that Dena Kimber will come in on Monday to do mom's hair. Bob continues to improve and does his physical therapy religiously. Don't forget that he needs visitors as much as mom.

Lauren visiting her Grandma Ann last week. She enjoyed reading Princess stories to grandma.

Bob and the Aguilar's visiting mom last week.

Mom has had an eventful couple of days. Yesterday morning she had her nasal feeding tube removed and had a gastrostomy tube or PEG placed. The gastrostromy tube is a feeding tube that goes across the abdominal wall and empties into the stomach. She tolerated this procedure well and seems to be happy that the feeding tube is no longer in her nose. Until she is less confused and can eat on her own, she will require that much of her nutrition be provided via this tube.

The physician on service this week finally received the x-rays of mom's neck from the Portneuf Medical Center. He found that the neck fracture was indeed stable initially and that she has likely had the rigid neck collar on long enough. As a result, he removed the neck collar today.

Lastly the Ear, Nose and Throat specialist came this evening. He evidently found no obstruction. Instead, it looked like mom had a smaller than expected windpipe or trachea. After trying to find a smaller trach tube to replace the larger one that mom had in place, he decided to simply remove the trach to see how mom did. So far mom is doing well and is maintaining her oxygenation.

All of this is great news and indicates ongoing improvement. These are clearly important steps in her healing process. However, all of this is tempered by the fact that mom is still quite confused at times and struggles with her short term memory. Hopefully as her traumatic brain injury continues to heal, these problems will resolve. Also, she is still quite weak and will require long term therapy to regain her function. Assuming that she passes her swallow studies with the trach out, it will take some time before she is strong enough to adequately maintain her nutrition without the supplemental nutrition provided by the feeding tube.

I have returned to Boise and Kimberly is now in Utah.

Mom is about the same today. We continue to await consultations from the ENT and the neurologist. As a result we do not yet know why it has been difficult to wean mom off the trach and to try the speaking valve. We also do not know why she is so much more sleepy than she was in Idaho Falls. We have heard from the nurse that the head CT showed continuing improvement. I am not accustomed to waiting this long for consultations on patients. It is difficult to be on the patient side of this equation.

Mom is scheduled to have a PEG placed tomorrow morning. This is the feeding tube that goes directly across the abdomen into her stomach. This will allow us to not have a nasal tube. The nasal feeding tube is an ongoing frustration for mom. She continually asks for it to be removed and has to be restrained to prevent her from removing it.

Mom told Bob that she would like people to wake her when they visit. Yesterday evening, I discovered that the physicians in Utah did not know that mom has MS. This information will likely help them plan her recovery. Two consultations have been requested. The first will be from a neurologists to assess, if possible, what part of her sleepiness is related to medication, what part is related to her injury and what part is from her MS. Part of this evaluation will include a repeat head CT. She has not had one of these since her transfer from Idaho Falls. The second will be from an Ear, Nose and Throat doctor who will evaluate mom's airway to determine why she is so slow to wean off the trach. This will likely occur on Wednesday. Lastly, she continues to pull her feeding tube out occasionally. However, the PT accidentally pulled it out today. I have asked the care team to consider placing a PEG which is a feeding tube across the abdominal wall directly into the stomach. We think this will be a less irritating alternative for her.

We are visiting Grandma Ann and Grandpa Bob for part of our spring break. I had not seen her in about 10 days days. I was struck by how much better she looked generally. Her swelling has decreased significantly. She is moving her left arm much more than in Idaho Falls. She is in a nice new facility near the mouth of Provo Canyon. I am sure Mom and Bob appreciate all the visitors. Just yesterday Joyce, the Price's, the Aguilar's, and the Kadomsev's (I hope I spelled this correctly) all visited. My kids all read to her. We brought a guest book that we left in her room--we invite all visitors to sign it.

The pending medical issues are several. First she is still quite sleepy. This is likely due to several factors; including her head injury, not being on methylphenidate for about a week (this medication stimulates her neurotransmitters to hopefully wake up her brain) and continuing on the fentanyl patch (this is a morphine like derivative for pain which is also somewhat sedating). The second issue is her trach and her airway swelling. According the her respiratory therapist, they may change to a smaller sized trach. This might allow her to breath on her own better. The third issue is that because of her airway swelling they cannot trust the results of her swallow studies. As a result she is not eating by mouth. Rather she continues to get nutrition through a feeding tube. The medication she is getting for this airway swelling will hopefully work soon. The fourth issue is her overall strength. She is slowly improving with her physical and occupational therapy. Lastly, she is interactive when awake. We are all eager to see how she is when she can talk.

It may seem like she is not improving quickly. This is true, but she is improving. At her age and with the type of injuries she has sustained it will take weeks, if not months, for her to heal. It is really a lesson in patience. We appreciate every one's thoughts and prayers.

Bob learned today that mom will have the neck collar for another month and will have the pins removed from her hand in another 2 weeks. Her tracheal (airway) swelling has not yet decreased enough to try the speaking valve or to trust the results of the swallow study. As a result mom is still getting most of her nutrition through the nasogastric (nose to stomach) feeding tube. She again removed this tube last night and it took much of today to replace it. She let the nurses know she was hungry by trying to eat the TV remote.

Bob had his first physical therapy visit today and is eager to work on his exercises. He continues to heal well.

I spoke with mom's nurse today. Evidently mom is now having more alert episodes. There is a scoring system called the Glascow Coma Score which attempts to quantify a patients level of alertness. Previously mom was having variable scores but now is scoring more consistently higher. The maximum score is 15. Mom was ranging from scores of 10-11 to scores of 14-15. She is now more consistently in the 14-15 range. This is a good trend but does not completely answer how her head injury has affected her communication, personality and memory. We will have to wait for her to speech to make this determination.

She continues to do well with her therapies. One of the pins from her right hand spontaneously fell out today. I do not know when they plan to remove the other two pins. She continues to wear the neck collar for her cervical spine fracture. I also do not know how long she will need to wear this device. She is now starting to raise her left arm slightly.

Mom passed her second swallow study on Monday 3/16. She sat up longer without support. She is now receiving medicine for restless leg syndrome at night. She does not take this medicine during the day because it is too sedating. Lastly, her trachea or windpipe has become swollen due to the trach tube. She is receiving steroids (not the ones football players take) to decrease this swelling. Hopefully this will allow her to come off the trach sooner.

Mom began to move her left arm more today. According to Bob, she is moving it as much as she was moving her right arm in Idaho Falls--meaning that she is wiggling and moving the fingers and thumb but not raising the arm. This has been a concern because one of the main nerves that controls the movements of her left arm travels dangerously close to the site of her left humerus (upper arm) fracture. This leaves one unknown--albeit a big unknown. We won't know how much mom's head injury has effected her day to day communication, personality and memory until she has the speaking valve on her trach or has the trach out. For now it seems that she has episodes of confusion alternating with episodes of being more lucid and alert. We will continue to pray for her and appreciate every one's thoughts and prayers on her behalf.

Mom passed her first swallow study in Utah today. She will have the next one on Monday. When she tried the speaking value on the fenestrated trach, her oxygen level dropped to 85 % (should be > 90 % at Utah's altitude). As a result they will wait to try this again in a few days. Mom continues to have aggressive physical, occupational and speech therapy. She is improving in each area. In fact she stood today--twice with assistance and once without.

It is important to remember that this process will take a long time. She has a dozen or so injuries. Each injury alone would cause someone her age to have a significant recovery time. When taken together, the combination of all her injuries will result in a prolonged recovery.

Thanks for every one's ongoing thoughts and prayers.

Mom had a fenestrated trach placed today. This will allow her her to try a speaking valve tomorrow. They have not had her eat in Utah because of concern about aspiration. This concern bore out in that there was dye on the old trach when it was removed. This means that she is a high risk for aspiration. As a result the speech therapists in Utah will re-evaluate her swallow tomorrow. Mom will need to pass 3 swallow tests in order to begin taking food by mouth again.

Shawn took this photo yesterday. They are being aggressive with mom's physical therapy. Also, as she becomes more consistently interactive, they will work to get the trach out. She has also figured out how to give Bob orders. She shakes her leg to get his attention. He then asks yes or no questions until he finds the right question she can answer with either a yes or no. This puts an entire new meaning to the phrase "shake a leg"--she shakes her leg so Bob can move quickly.

Evidently mom is feeling better over the last several days. As a result, Bob has asked that we let people know that they can visit anytime. Remember that the Utah Valley Specialty Hospital does not allow flowers. Visiting hours are 0900 to 2100. Bob needs visitors too!

Mom and Bob arrived safely in Utah. Shawn was also there on a business trip and took this photo of her in her new room. The Suncrest 10th Ward is taking good care of them with both food and transportation.

A gentle reminder--Mom can get overwhelmed by too much commotion and too many visitors. We do not yet know the visiting hours at her new hospital. Please speak to Bob about visiting.

Grandpa Bob and Grandma Ann

Garrett reading to grandma.

I returned to Boise today. It is nice to be back in the warm part of Idaho. I forgot to mention that mom's skin graft is healing nicely and that the staples were removed from this site as well. Today mom had her inferior vena cava filter removed by an interventional radiologist. As a reminder, this was placed in the major vein which drains the lower part of her body in order to prevent clots from traveling to the lungs. She is now on a medication to prevent clot formation. She is all tuned up and ready for her transfer tomorrow.

Garrett and I visited Idaho Falls this weekend. The staff at Eastern Idaho Regional Medical Center have been great. They are getting mom tuned up for her transfer Monday morning. Mom will leave here at around 0900. She will be taken to the Utah Valley Specialty Hospital in Provo (UVSH.ernesthealth.com). Bob will get to ride in the ambulance with her. Dimitri will fly to Pocatello and drive Bob's car back to Utah.

Today mom ate much better. She had a few bites of pureed pork cops, mashed potatoes and green beans. She then ate an entire cup of desert. It looks like her sweet tooth has not been injured. She is progressing well enough will her eating that the physicians are hoping not to place a PEG (feeding tube across the skin which directly enters the stomach). She does not take enough nutrition by mouth yet, so she still gets much of her nutrition through a feeding tube (NG--from nose through esophagus and into the stomach).

Her sense of humor seems intact. Garrett was reading to her this afternoon and said his voice was getting tired. He asked Grandma Ann if he could stop reading and she said no with gestures. After a few seconds she started to laugh and let him take a break.

Her head CT showed continued resolution of her subdural hematoma (bleeding between brain and its covering). The excess of CSF (fluid the brain makes to cushion itself) is now staring to return to normal. Her neck fracture seemed stable enough for transfer. All of her staples have been removed. She continues to get physical therapy which wears her out. Today she increased the tilt table angle to 55 degrees. She is starting to be able to move her left thumb and some of her left fingers.

We appreciate every one's thoughts and prayers. Carol and Bart have visited often as have Portia and her family. Curtis and Marina have been so kind in opening their home to us. Bob's son Michael and his wife Esther also visited this weekend. It was good to see them.

Sorry about not entering anything yesterday. As things stabilize, I will probably give several updates each week. Mom continues to improve slowly. She is tolerating physical therapy. She is off the breathing machine most of the time. The current plan is for her to transfer to a rehab hospital in Utah on Monday, March 9 at 0900. Tomorrow she will get a CT of her neck to make sure her neck injury is stable enough for transfer. She will also have her skin graft evaluated by the plastic surgeon tomorrow.

Bob is doing well. His scalp injuries have healed nicely. His shoulder is becoming more mobile and his lower leg is much less swollen.

I am in Boise for a few days so my information is less detailed. Although mom's surgery went well yesterday, she has required the ventilator (breathing machine) post-operatively. She is slowly being weaned off the ventilator and hopefully will be off by tomorrow.

On a more positive note, her diet has been advanced from thickened liquids to solids.

This waxing and waning course is typical for someone mom's age with the types of injuries she has sustained.

The tentative plan is to have her ready for transfer to a rehab facility in Utah sometime early next week.

Mom returned to the operating room today for two procedures. First, she had a skin graft to cover the wound on her left forearm that was left open to prevent a compartment syndrome (i.e. to prevent excess swelling within a closed space which wound have damaged her arm further). Secondly, the plastic surgeon pinned some of the fractures in her right hand so these bones wound heal in better alignment. She did well with both procedures. When she wakes up, her diet will be advanced.

Many things happened today. A repeat head CT showed that the subdural hematoma (bleeding between the brain and its covering) is decreasing. There is still a lot of extra CSF (fluid that the brain makes to protect itself). The good news is that the amount of this extra CSF is not increasing.

Mom passed her first swallow study today. This is done to make sure she will not aspirate or breath in any food when she eats. She is now able to eat liquids thickened to a nectar consistency.

Her physical therapy increased today. She was placed on a tilt table at about a 40 degree angle. She did some knee bends.

She has been off the ventilator or breathing machine for more that 24 hours. She will need to keep the trach tube in until her mental status is more stable.

She is getting tuned up for transfer to a rehab facility in the next week or so. Tomorrow she will have a plastic surgeon do a skin graft to cover the wound on her left forearm. Either tomorrow or Wednesday she will have a neck CT to assess her neck fracture and how it is healing.

Overall, she continues to improve. She is having more wakeful and alert periods while having fewer periods of confusion and sleepiness.

2/28 mom smiled on command.

3/2 Mom's first food by mouth in 2 weeks--yummy pudding. She took 4 bites!

Jake reading to his Grandma Ann on 3/2

Mom on 2/28.

Mom continues to make slow but real progress. Today she was awake much of the afternoon. She listened intently as we spoke to her. She tried to mouth answers to our questions. It must be frustrating for her not to be able to speak.

She spent much of the day off the ventilator (breathing machine). In fact, her care team does not plan to resume the ventilator unless mom fatigues.

Some other small changes were noted today. First, her scalp staples have been removed. These were placed to repair lacerations or cuts. She no longer has dressings on her left arm. We can now see a long row of staples which were used to close her skin after her humerus (upper arm) fracture was repaired surgically. There is a small area on her upper forearm which will likely require a skin graft. This area was left open during surgery due to the risk of swelling.

Overall, she is doing quite well. We should not forget Bob. He looks great. He is walking everywhere now and we are no longer using the wheelchair to help him get to mom's room. His cuts and scrapes are healing nicely.

Mom spent 9 hours today on a trach mask. This means that she breathed on her own without the assistance of the ventilator (breathing machine) for 9 hours. At about 10 pm she grew fatigued and her trach was reattached to the ventilator so she could rest overnight.

She seems most awake in the evening. When I went back to the hospital after dinner, her eyes were wide open and she tried to mouth words. When I held to phone to her ear for Kimberly to say goodnight, she mouthed the words "I love you." Then when I held the phone to her ear for Shawn and his girls to sign to her, mom really brightened up and got very animated. She tried to say "thank you."

Overall she is still quite sleepy most of the day, but these episodes are encouraging. It will continue to be a long and gradual process for her to recover. It is possible that she will be well enough to transfer to a hospital closer to their home in the next week or so.

My wife Andrea purchased a CD player and some CDs to play in mom's room. Mom got particularly animated during "Clare de Lune" by Debussy. This is evidently a song that anyone who plays the piano knows well. I guess I did not make in far enough in my lessons to learn it. Nevertheless, mom seemed to smile and move her extremities more each time we played this song.

Bob is now back in Idaho and is staying with Anita in Pocatello. She has been quite helpful during this entire saga.

Lastly we got mom to smile on command while taking her photo. When we return to Boise, we will place it on the blog.

Mom had an eventful day. She had her chest tube removed. This was the tube that drained the space between her left lung and chest wall. She is no longer on the sedative (propofol) or the pain reliever (fentanyl).

She is not yet strong enough to breathe on her own so she had a tracheostomy tube (trach) placed today. The breathing tube that entered her mouth was removed and now one is placed through her neck. This may sound like a set back but it is not. This trach allows us to see her face and she can try to mouth words. The trach also will allow her to be more mobile and to do more things as she gets stronger. I have several patients with trachs who go about their daily activities at home.

Kimberly left today and I arrived at mom's bedside late tonight. She looked much better than when I last saw her on Monday the 23rd. The swelling is dramatically decreased. The bruising on her face has resolved. Most surprising to me was that she opened her eyes and smiled. She then started to mouth words. I think she said "thank you." I nearly broke down in tears--I was so happy and grateful. I called Shawn and Kim who spoke to her on the telephone. During these conversations mom smiled and tried to mouth words. I tried to call Bob but he was already asleep. It must be torture for mom not to be able to speak. We will take her photo tomorrow then post in on Monday night when we return to Boise.

The next step will probably be to place a PEG. I will speak to her caregivers tomorrow to see when and if they plan to do this. A PEG is a feeding tube placed across the skin directly into the stomach. After placement of the PEG she will no longer need her current feeding tube which enters her nose and ends in her intestines. It will take some time before she is strong enough to eat on her own.

What a great day!

Mom is more awake today. She nearly had her breathing tube removed. There is a test that the nurses perform that indicates that the patient is ready for extubation. Mom did not pass so they will try tomorrow. They are almost ready to remove the chest tube from her left chest. Kimberly reports that her eyes have been more open today.

Shawn received a copy of the accident report and spoke to a witness today. Evidently this witness was traveling in the opposite direction and saw everything. She remembers that the front wheels seemed to come off the van. Then the van spun and flipped about 3 times before landing in the median. This witness said debris was flying everywhere. The front wheels were evidently still on the interstate. Lastly she said the van was so smashed that it resembled a car rather than a van.

Mom had another day of being challenged off some of her sedation. She also was put in some sort of chair for awhile. Each day brings slow gradual improvement.

Kim decided to stay 2 extra days. She went to a basketball game with Portia and Michelle Loosli. They watched Mark Loosli's North Fremont team.

Mom's physicians are trying a new plan. During the day she is off one of her sedatives (propofol). This will challenge her body to work harder on its own. Then during the night they resume this sedative to let her rest. During both times she continues on the IV pain medication (fentanyl).

She had a central line on the left (think of this as a big IV). This IV site was beginning to look infected so a new central line was started on the right.

Kimberly decided to stay until Friday. I will return to Idaho Falls that day. Curtis and Marina have been kind and generous to let us stay at their lovely home and all they ask is that I bring back a pound of anise seed from the Boise Co-op so Curtis can make some of his famous Biscotti. Curtis has been giving us a lot of family history--many stories that we never heard from Grandma Doty. This has been a real treat. Who knew that Uncle Donald invented the machine that makes tater tots and that his son Todd continues to manufacture the machine that make tots and the hash browns you get at fast food restaurants.

Curtis' sister Carol has been quite attentive to us as well. She checks in nearly every day. We are grateful to be related to the Loosli clan--or better said, we are glad to be Loosli related. Finally it seems that Stuart's son has discovered what happened to Ulrich Loosli's long lost brother. He went to Chile. There is evidently a thriving Loosli clan still living there.

Bob's children have also been great. Anita took great care of Bob while he was in Pocatello and has visited Ann Marie in Idaho Falls. Jonathon and his family spent three days visiting. Marketta (I hope I spelled this correctly) will come tomorrow to take Bob to Orem so he can take care of some business and get some clothes. I think either Katya or Dimitri will bring him back on Saturday.

Lastly, my sister tells be that the Stake Presidency and high counsel from the BYU First Stake called tonight. They sang to mom. We appreciate all the kind thoughts and prayers.

Mom had an eventful day. Overall she continues to improve slowly and gradually. A repeat CT of her head showed that her subdural hematoma (bleeding in the brain) is slightly smaller. The amount of support she gets with each breath is decreasing. Her sedation is also being decreased. This afternoon all sedation was stopped for a short time. During this "vacation" mom responded to verbal commands from her physician. For example she wiggled her toes, blinked her eyes and tried to stick out her tongue. While these are encouraging signs, we won't know how her head injury affected her until she is off sedation.

Bob is healing well. His abrasions and lacerations (cuts and scrapes) are healing well. He says that his head now looks like a road map instead of a train map. His leg is still quite swollen and his shoulder is still quite sore. However, both problems are slowly improving.

This is a photo from the Pocatello paper showing Bob and Mom's van. Bob is on the stretcher.

I need to clarify my entry from Saturday. Mom is initiating her own breaths but the ventilator needs to augment her breathing because Mom is not breathing deeply enough on her own. As such she will need the breathing tube for a while longer.

When she came into the hospital Mom required 90% oxygen but now only requires 40%. Room air is 21% oxygen. This indicates that her lungs are healing.

When the sedation was decrease, Mom became irritable and fought the ventilator. This is actually a good sign indicating that she is responding to pain.

We were worried that Mom's leg was swollen but an x-ray showed that it was not broken.

I had a great time Saturday night and Sunday with Portia and Michelle Loosli. I also enjoyed spending time with Brian's family and seeing his kids for the first time in years.

Ben, Bob, Jonathon, Kim and Shawn with mom. Jonathon's family also visited as did Portia and Michelle Loosli. We enjoyed a trip to Curtis' shop. Carol checks in daily.

Mom has had a good day. She has opened her eyes several times. Her sedation was decreased by 50 %. She has been initiating her own breaths but is still on the ventilator. She now has a splint on her right hand. Overall she is improving slowly.

Bob has also had a good day. His stritches were taken out. He discovered why his ankle is so swollen--he has a small fibula fracture (non weight bearing bone in the lower leg). This will not require casting and should heal nicely.

Mom had an eventful day. This morning we found out she has 3 fractures in her right hand. These will either be splinted or casted. She had her left upper arm fracture repaired with metal plates and screws. This fracture had multiple fragments and took several hours to repair. Postoperatively, Mom looks much better with respect to swelling. We don't yet know the results of todays head CT.

Here's Bob. We are grateful Bob is recovering from his injuries.

We learned more about mom's injuries today. She evidently has 6 rib fractures and several vertebral (backbone) fractures. These are quite painful but should heal over time.

When patients are immobile they can develop clots in their legs. These clots can dislodge and travel through the veins. Occassionally they can enter the lungs which is a serious problem. Because of Mom's immobility she is at risk for this to occur. As a result a filter was placed in her inferior vena cava (the vein that enters the heart from the lower body) to prevent this potential complication.

Kim is now in Idaho Falls to help. Mom had several other visitors today. Portia Loosli, Michelle Loosli, Norma Andrus and Todd Loosli all visited. Jonathan and Jenny Lawton along with their children arrived tonight.

Mom with her kids in Glenwood Springs during the summer of 2008.

Mom with Shawn's daughter Hailey.

Mom getting her first physical therapy.

Bob forwarded the following for me to post. "Another miracle was to have Anita and her family so close. Anita was able to be at the emergency department in Pocatello soon after Bob and Ann Marie arrived there. She has been great with helping Bob and getting personal items out of the van and coordinating things. She has been an angel. Also thanks to Alex for his help in getting Bob his new glasses and for transporting Bob from Pocatello to Idaho Falls."

Mom did well overnight. She has no new issues. We won't know how the head injury has truly affected her until she is well enough to come of the ventilator (breathing machine). She will have a repeat head CT tomorrow. Also tomorrow, she will have orthopedic surgery to repair her humerus (upper arm) fracture. She will likely get a new cental line (think of this as a big IV) today or tomorrow. IV sites are hard to find on her arms because of the swelling.

This weekend they will begin passive physical therapy to help her range of motion.

Earlier today the nurse weaned her sedation for a brief time and mom was able to move her right arm and both legs. This is a good sign. However, as mentioned above we will have to wait for awhile to see how she will do neurologically.

Mom had a good day today. Her head CT showed no new bleeding so the subdural hematoma is stable. It will slowly resolve over time. The neurosurgeon was able to repair her two scalp lacerations (cuts) with staples. One was small over the top of her head and required only 3 staples. The other was on the back of her head and required about 20 staples.

She now has a feeding tube. It will be good for her to get the nutrition she needs to heal.

She required two more units of red blood cells today to correct some anemia. She is anemic due to blood loss from her lung and arm fractures.

Bob was discharged and arrived at mom's bedside around 1 or 2 o'clock this afternoon. He is getting around slowly due to a sore ankle. He is in a sling due to his shoulder injury. He has multiple cuts and abrasions (scrapes) on his head and hands. His spirits seem to be good. We were able to give both mom and Bob priesthood blessings today.

I have returned to Boise for a few days. Shawn and Bob are staying with Curtis and Marina Loosli who live just a short drive from the hospital. Kimberly will arrive tomorrow evening.

Carol Jensen again visited today as did Brian Loosli. Mel, Jayne (Loosli), Olivia and Annika Henderson visited on their way back to Colorado. Todd Loosli visited this evening.

Shawn received a call from the women who was first to arrive at the accident scene. Her name is Laurie Bolander. She is a former EMT and lives in Cedar City, Utah. She not only provided first aid but had the presence of mind to ask if there were any priesthood holders present. There were and they gave both mom and Bob blessings at the scene. We are grateful for her selfless service.

Overall, mom's condition has stabilized. We now need to wait for her body to heal the fractures, cuts, bruises and other injuries. Her orthopedic surgeon plans to repair her humerus (left upper arm) fracture on Friday 2/20. The ICU physician is encouraged by her progress and thinks we may be able to remove the breathing tube sometime next week.

This is a picture of Bob and Ann while serving their 2nd mission in Finland.

This is a photo of Mom on 2-17. Hopefull she will forgive us for posting this picture on the blog with her hair messed up. :)

On February 16, 2009 Ann Marie and Bob Lawton were involved in a roll over accident on I-15 near Pocatello, Idaho. They were traveling to attend the funeral of Ann Marie's first cousin Lynn Loosli. Ann Marie was driving and it is unclear what caused the accident. They were taken to the Portneuf Medical Center in Pocatello. Bob sustained some lacerations around his right eye, right side of this head, and both hands which required stitches. He also sustained multiple bruises. He dislocated his right shoulder. The physicians were able to relocate his shoulder without surgery. He will likely be discharge on the 18th.

Ann Marie's injuries were more serious. She was evidently unconscious at the scene. She was intubated (breathing tube was placed) and was taken to Portneuf Medical Center. A head CT showed that she had a subdural hematoma which is bleeding between the skull and brain. Because there is no neurosurgical coverage in Pocatello, Ann Marie was flown by helicopter to the Eastern Idaho Regional Medical Center in Idaho Falls. This subdural hematoma seems to be stable and she did not require surgical intervention to drain it.

She was found to have multiple other injuries, which include the following:

• She has a stable fracture of her second cervical vertebra (neck) which does not appear to have affected her spinal cord. For this injury she is wearing a neck collar.
• She had multiple fractures to her left arm. Her left ulna (forearm) was fractured twice and the left radius (the other forearm bone) was fractured several time. These two injuries were repaired with metal plates and screws on the 16th. The orthopedic surgeon left the incision partly open so that she would not get a compartment syndrome which can occur with excessive swelling.
• She sustained an open fracture to her left humerus which is the bone between the elbow and shoulder. An open fracture means that the broken bone opened the skin. Because the forearm surgery took a long time and she was somewhat unstable, the orthopedic surgeon stabilized this fracture externally (metal rods on the outside of her arm). He plans to repair this fracture on the 20th in the operating room. During this surgery the other orthopedic surgeon will close the incision he left open during her forearm surgery.
• She has a stable pelvic fracture (where the sacrum or lower back joins the hip bones) which should heal without surgical intervention.
• She broke several ribs. This caused her to bleed into the space between her left lung and chest wall (hemothorax). This bleeding caused her left lung to collapse. This problem is being treated with a chest tube which is evacuating the blood thus allowing the lung to re-expand. This tube is placed between her ribs into this space. In addition she has a pulmonary contusion which is a significant bruise to the left lung.
• She has several other minor injuries including bruising and lacerations (cuts).

During resuscitation, she receive 7 units of red blood cells and 4 units of plasma. The plasma contains proteins which are important for clotting. To provide these blood products and to receive the medications she requires, a central line was placed. Due to her injuries, she had consumed much of her own clotting factors.

She is heavily sedated for pain. As such she cannot communicate with us but can probably hear us when we speak to her.

She will be on a ventilator (breathing machine) for some time.

She is currently in stable but critical condition.

We appreciate every one's thoughts and prayers. Her cousins Carol Jensen, Stuart Loosli (and his wife) and Curtus Loosli (and his wife) have all visited. Curtis and Marina have graciously opened their home to us while Ann Marie remains in Idaho Falls. Carol has also kindly offered us a place to stay.

We will update her condition on this blog as we get new information.

From Ben and Shawn Godfrey