The Road to Recovery - week 19

I walk slowly, but I never walk backward. 

(Abraham Lincoln)

Our sweet cherished Alysha Rose Smith is recovering from a post surgical complication that put her into cardiac arrest and into a coma for 7 days.  She emerged from the coma with severe brain damage.  This website was created to update friends and family of Alysha's progress along the road to recovery.  Please join us as we support Alysha on her journey.  (For earlier details, like the history behind this medical nightmare scroll to the bottom of the blog and click "older posts.")

December 3/12
The feeding tube remains out.
     After an eventful weekend at home, Alysha returned to the Rehab Center in time to start her daily therapy sessions.  Lisa, Justin and Nana joined her on her return trip and stayed the day with her.  Justin bugged Alysha all day long like brothers do.  Alysha responded by telling him off like sisters do.
     Late in the afternoon the doctor came in to talk about the feeding tube.  At this time they are going to leave it out.  They will monitor what Alysha is eating, count calories, increase her oral intake of water and fluid and they ordered 1 serving of the liquid meal Ensure for each day (to replace the 4 cans of food she used to receive through her feeding tube.) They will also run blood tests every week to make sure it is fine for Alysha to proceed without the feeding tube.
     This is a side note.  On the weekend, Alysha watched some movies on her large screen TV at home.   She had some snacks to go with her TV watching.  One of the snacks that she really enjoyed was Cheesies.   Cheesies tend to melt in your mouth making them a fairly easy snack to eat.  Doreeto's on the other hand are a more difficult snack to consume.  Justin shared some Cool Ranch Doreeto's with Alysha.  She enjoyed these.

Nana King and Alysha back at Rehab.

December 2/12
The feeding tube falls out.
     There was a small glitch last night.  After a busy day and a wonderful homecoming complete with her favourite meal (spaghetti), Lisa tucked Alysha into her own bed, put a movie on the television and set up, connected and started Alysha's feeding pump.  Shortly after her gastric tube feed had been initiated, the tube that was surgically placed to deliver liquid nutrition, water and medication, directly into her bowel came out!!
     Lisa was alerted to this by Alysha calling for her. "Mom," "Mom!" Lisa headed into the room to see what Alysha wanted.  Alysha was smiling and pointing at her belly.  It took a few seconds for Lisa to realize what she was seeing.  There was Alysha's belly freed from the last remaining tube, with the feeding tube lying on the ground at the foot of the pump + pole.  Alysha didn't seem to have found the extubation process painful.  In fact she spent the next half hour giggling as Lisa and Rich organized medical follow up.
     A quick google search and a phone conversation with a friend who has knowledge of these things helped Lisa to decide to bring Alysha to Emerge at the Barrie Hospital (RVH).  The aim is to replace the tube as soon as possible to avoid the hole closing up.  Well, add the wait-time in Emerge onto the 40 minute drive to Barrie and you can guess what happened next.  They were unable to replace the feeding tube.  They did make sure the site was cleaned and bandaged.  They told Lisa to come back and have it placed on Monday.  Lisa's plan is to head back down to the Rehab centre on Monday and speak to the doctors there.
     Without the feeding tube Alysha worked hard at drinking more water to replace the water flushes she normally receives each day.  Lisa went out and purchased some Ensure (liquid meal replacement) and Alysha drank a can of that in addition to eating the meals that Lisa prepared for her.  Alysha usually receives her vitamin and muscle relaxant pills dissolved in water through her tube.  Instead, Lisa ground them up and mixed them in with her meals.  Alysha had no problem taking her medication like this.  Alysha has told her mother she doesn't want the tube to be replaced. In fact she readily adopted the necessary changes in her eating and drinking habits to compensate for the tube remaining discontinued.
   

December 1/12
Alysha goes home for the weekend.
     What an exciting day.  As a reward for working so hard in her therapy sessions, Alysha spent time with the therapy dog today at the rehab institute.  I was surprised to see that Alysha's supported walking now only requires the support of 2 staff members.  When I saw her walk 2 weeks ago it took the support of 3 staff.  Below you will find a video of Alysha walking.  After a full morning of physio and occupational therapy.  Alysha, Lisa and the staff were all abuzz with the excitement of Alysha going home to spend Saturday and Sunday night at home. Alysha hasn't slept at her home since July 23/12.  Marcia and Abby were down in Toronto to participate in Alysha's send off.

November 29/12
Initiation of an Incentive program.
Alysha ate half her oatmeal this morning and half her carrot spice pudding.  At 11 am she did her physiotherapy starting with a new stair climbing exercise.  For this exercise Alysha holds onto 2 railings, one in each hand and alternates lifting her left and right feet up, placing them on a stair and then placing them back down again.  She did this 4 times with each foot.  She doesn't put weight on her raised foot or lift herself up onto the stair yet. Alysha went on to practice standing for 5 minutes supported by holding onto a railing with her left arm for balance.  She concluded the session by walking back to her bedroom.  She cried a bit on the walk back. Frustration?, effort?, pain? hard work?
     At noon Alysha had lunch Alysha consumed an entire serving of minced chicken and mashed potatoes. She also ate half a serving of of mashed peas.  At 1:30 the occupational therapist brought Alysha to the gym for more range of motion and conditioning exercises.  They asked Alysha what she wanted to do first and she chose the hardest task.  This exercise involved leaning forward and reaching up for an object 4 times and reaching down for an object 4 times then repeating the other exercise with her other hand and arm for a total of 16 stretches.  The therapist remarked to Ron that on Tuesday, Alysha could only manage this exercise 1 time on the left side.  She is showing fantastic progress.  The next exercises involved stretching out her arms, and again Ron commented that there has been a noticeable improvement in her ability to straighten her arms.  Ron told Alysha that he is amazed by her display of heart and determination.
  For dinner Alysha had 1 serving of minced oriental ground beef and 1 serving of mashed potatoes and half a serving of mixed vegetables.
     Alysha struggles with her therapy sessions.  She often breaks down and cries.  If Lisa or Ron aren't right there to reassure her Alysha can sometimes become unconsolable for the therapists.  After consulting with Lisa the previous day, the therapists implemented an incentive program with Alysha that capitalized on her love of animals.  Together, Alysha and the therapists come up with therapy goals.  When she achieves each goal, she gets rewarded with a sticker and when she has accumulated 5 stickers she gets a visit with a therapy dog.  Once she gets 10 stickers she gets a visit with Chocolate her horse.  Unlike the mascot for the Calgary Stampeders that made an appearance in the Royal York Hotel, Alysha's visit with her horse will be at home on the farm, not in the lobby or halls of the Rehab Institute.   Alysha seems to be responding well to the incentive program and completed her exercises today with minimal crying.