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.