Day 61 - Monday February 13, 2012

Today was a good and busy day.  In the morning I called all around about the peg tube removal.  I finally talked to the nurse of the doctor that placed the tube.  She explained that the tube is meant to be removed by traction.  It is much more dangerous to do it endoscopically because of the sedation and because of the endoscopy.  She said it will hurt--more than a bee sting but less than having a tooth pulled.  The pain will only be for about 10 seconds she said.  Since I already have lidocaine that we are using on the site, she said to put it on just before we come in (it will be done at the hospital) and then again just before they do the procedure.  This will numb it and hopefully help with the pain.  She said the pain that Bridgett has been feeling is related to the tube not being used.  Right away after the tube is removed, the site will start healing and the pain will start getting less.  As an added bonus (making me glad that I called the doctor that placed the tube) they will remove the tube free of charge.  If we had used the doctor they had scheduled, then we would have had to pay for the removal.  So, all good.  The tube will be removed Thursday instead of Wednesday.  One draw back--no eating or drinking the day of removal and it won't be until 3:00.  However, we had not received these instructions from the other doctor, so we would have showed up on Wednesday without fasting and had to reschedule.   We had speech therapy and occupational therapy today (at the low vision clinic), so we drove to Salt Lake.  Note to self--the drive gives Bridgett a headache and neck ache.  So, take Tylenol before we leave and take the soft neck collar just in case.  Anyway, we showed up to the Sugarhouse rehab and there were problems with insurance right off the bat.  However, Bridgett was able to see the speech therapist anyway for this appointment.  Lisa has over 20 years experience as a speech therapist and many years with TBI patients.  I especially requested that she work with Bridgett.  One thing--most of these people seem to have students doing their internship.  That can be frustrating to me--I want the best for Bridgett. However, Lisa sat in on the appointment and gave direction as needed.  At the end she took over.  If I feel that Bridgett  is not getting the help needed, I will address that later on.  The appointment went well I thought.  We discussed the vision problems.  Lisa said she has a great understanding of TBI and the challenges faced with language, but has not had to deal with many vision problems.  So told us to be sure to let her know if she asks Bridgett to do anything that she is unable to do.  However, the evaluation went well and she knew just how to have things presented so that vision was not an issue.  She was asked yes and no questions, sequencing, identifying pictures (they used very large pictures) and writing down words (they gave a description of an item and she wrote the name of that item).   I thought Bridgett did amazing. Of course, she used many of her own words, but when cued, she remembered the correct words.  We have our second appointment on Wednesday. Next we headed to occupational therapy, stopping for a hamburger in between.  Actually I brought Bridgett some yogurt and a banana, but a hamburger sounded better.  She hasn't had one yet since the accident.  She had  a Wendy's cheeseburger and ate about 2/3 of it.  Occupational therapy went well.  First Kasey checked her strength (with instruments).  He checked range of motion with both arms, hand strength, finger strength and thumb strength.  Then he did some assessment on identification of objects that he showed her and then placed in her hand under the table.  He had cards to point to so that she could identify without remembering the right word.  The key she just told him the word.  The marble and the dice she pointed to the card, after first using a word we don't know.  The screw she couldn't identify with the right word, and couldn't find the picture (it was on the far left).  So, he substituted a clothes pin and the card was still on the left and she couldn't find it.  I said, is it a brain problem or a vision problem.  He said he wasn't sure at that point.  But, the next test I think told us for sure.  He had large print words for her to read.  So, picture this--four large print, three letter words (with only four to a line, you can guess how big they were.  He asked her to read the first line.  She skipped the word to the far left, even though he was pointing at it and read the letters of the second word.  Then when he pointed to the second word, she again read those letters.  OK on the 3rd and 4th word.  Same thing happened on the second and third line.  So, he tried drawing a dark red line down the left edge of the paper to have her look at that first then try the word.  In the end, he realized that by moving the paper to the right of her vision, she was able to read the 1st word.  However, she couldn't read the 4th word.  So, this confirms the fact that her field of vision is very narrow.  She can get three of four large print words without moving the paper to see the other words.  And the thing is, she wouldn't know to move the paper.  So, right now, we know her field of vision is limited on both the left and right.  She needs to slightly move her head, but it's hard for her to tell how much to move her head.  It's something we can work on in any case.  Oh, by the way, when I pointed to each word while Kasey watched, she read each word in her field of vision. Then we discussed this with Kasey: it seems to us that her left eye is slightly more to center than last week.  He said this confirms their belief that the cranial nerve is trying to heal and that hopefully it will continue to heal.  Please continue your prayers for Bridgett and continue putting her name of the prayer rolls for us!  We appreciate so much every one's prayers in her behalf and KNOW that this makes a huge difference in her healing.  By the way, I was able to finally sort out all of the insurance problems (at this point) and so we will be able to schedule more therapy for her.  Bridgett's new policy has unlimited out patient rehab benefits so that's a big plus.  Otherwise, she has the same coverage that she had on our policy, and seamless conversion, with no lapse in coverage and no pre-existing condition exclusion.  This way though she has a Utah policy so that their are providers that are in network.