Great News!

Kevin had another CT scan on Friday morning. The previous one was 2 weeks ago and the subdural hematoma had dissolved completely back then - this was the area on the opposite side of the head from the impact that had not bled very much but was most concerning because subdural means between the brain and the leather casing that surrrounds it. So that was good news. The epidural hematoma was still there but looked like it was dissolving. This is on the right side of the head where the impact was and epidural means between the leather casing and the skull. After reviewing the latest images, the neurosurgeons office called to say that it has completely dissolved! So they are finished with Kevin - don't need to see him back. Kevin now needs to proceed with the rehab doctor and therapists (which we are doing). Great news!

It’s been a busy week and there was no new information until now, so I have not updated this blog in a while. Now I have a slew of info so this is going to be long. Kevin has been doing pretty well – but his activities are certainly curtailed compared to what he was up to before his accident. He has not felt like he can return to work yet. He does see friends every day. He either gets rides from them or us or he takes the bus; however, he tends to come home early and he is sleeping pretty late each morning.

I finally connected with the Mapleton Rehab center at the end of last week and they set up a series of 12 appointments over the course of June. In each of 3 categories, occupational therapy, physical therapy and cognitive therapy, they set up one appt for evaluation and then 3 appts for treatment. They do this just to get us in the schedule for now and then after each evaluation the therapist will determine what and how many treatments Kevin needs and then we’ll adjust the schedule. The first evaluation will be physical therapy this Thursday which is good because he continues to have a lot of pain and discomfort around his shoulders and broken clavicle.

Kevin had his first visit to Dr. Julie Stapleton on Monday. She has practiced “Physical Medicine” and “Neurotrauma Rehabilitation” for many years and works closely with the Mapleton rehab center where he will be going. We both liked her very much – she spent a good 45 minutes with Kevin and was mostly assessing where he is 3+ weeks after the accident. She asked him a whole bunch of questions and performed a few cognitive and physical evaluations and really looked at and talked to him about his shoulder/upper chest area where he is having a lot of pain. She works closely with Brandi, the PT that he will be seeing and will wait for Brandi’s evaluation. I took a lot of notes. I will type these below for those of you who really want to know all of these details, but the bottom line is that he should not return to his dishwashing job until the broken clavicle heals – 6 to 8 weeks. She said that it is a hidden blessing when a brain injury is accompanied by a broken bone because the broken bone dictates that a person curtail their activities for that time period and really that is when the brain is JUST becoming ready to resume normal activities. She is very pleased with Kevin’s progress and says that the trajectory of his recovery is very steep, he’s made great progress just being 3 weeks out. This is where I get a little confused – but I think she said that based on where he’s at right now she would label it more mild concussive. He definitely has a brain injury, but it is more moderate than traumatic. He has a head injury (which describes the blow to the head) and he has a brain injury; however, she thinks that he will experience mild/short consequences of the brain injury IF he takes care of himself the best that he can. She sympathized with my frustrations in getting in the rehab center, but said that it is actually good that rehab is delayed this long. The first few weeks out of the hospital should be minimal activity and lots of rest and it isn’t until now that rehab will provide the most benefit – so we’re on a perfect schedule. When Kevin left the appointment, he said that he was so glad that the doctor validated the feelings and symptoms that he HAS been experiencing and also helped him understand what he needs to do to take care of himself (now we’ll see if he really follows through…)

Here are the notes I took on the questions she asked:

What residual symptoms are you experiencing since the accident? Kevin told her that he gets dizzy if he puts his head back and brings it forward or gets up too fast from laying down. He sometimes can’t handle loud, noisy, social events like the graduation party he went to last weekend. He says he can’t describe it, but his brain just shuts down and he has to get out of there. In this case he left the party, went up to his friend’s room and took a nap. The doc said this is exactly what he needs to do. This happened Monday night at a restaurant where he, Steve and I had gone to eat. As the restaurant filled, it got incredibly loud and we could tell Kevin was getting very irritated and then before the entrees arrived, he snapped. Got up and left – had to go to the car and read his book.

Are you having headaches? Hardly at all – maybe one or two in the last week. Doc says this is EXCELLENT – sometimes brain injuries can result in lifelong headaches that are hard to treat.

Change in vision? None

Reading? Yes. Back to normal amount? Yes. For as long as you want? Yes. At your normal comprehension level? Yes. So you’re reading for pleasure? Yes – a lot. Can you come back to the book the next day and pick up where you left off, know the characters, the plot? Yes. EXCELLENT

Change in sense of smell or taste? No. Food tastes the same, like you expect it to? Yes.

Difficulty swallowing? No.

Neck pain? Yes – associated with messed up shoulders, etc. and a lot of bed rest. PT will address.

Trouble finding words when speaking? No more than I used to.

Trouble following directions? No more than I used to.

Sleeping okay? He’s restless late at night and can’t go to sleep very early, comes home knowing he should rest and then can’t – then sleeps all morning. Doc says that’s okay – sometimes brain injuries mess with your sleep cycle. Just SLEEP, SLEEP, SLEEP when you can. Later on they will work with Kevin in therapy to readjust his schedule, but for now – don’t interrupt his sleep if you don’t have to. Are you napping? Not so much anymore, although it does feel good to lay down in the middle of the afternoon.

Moods? Kevin says that he has been pretty irritable lately – says things to friends that he wouldn’t normally say out loud. He’s always been a pretty laid back guy and now he finds that things people do bug him a lot more. Doc says this is classic head injury behavior, should diminish over time.

Do you remember the fall? He has this tunnel vision like memory of going down the hill and skateboard starting to wobble, but can’t remember anything after that.

What’s the first thing you remember in the hospital? Doesn’t remember much about the hospital, kind of remembers ICU but not really. Bad memories? Not really.

Are you having flashbacks of the accident? Are you having any weird dreams of being in danger? Are you experiencing anxiety on any level about anything? (She was probing for post-traumatic syndrome). Kevin said he’s not really experiencing any of this. She asked if he’s anxious while driving. He has driven his friend’s car a few times and wasn’t at all anxious or fearful. She’s glad that he doesn’t seem to have PTS.

She then checked out some physical stuff – balance, etc. and that was fine.

She gave him a few cognitive test:

1. She tapped with her pen on the desk and he had to respond. If she tapped once, he had to tap twice and vice versa. He did this with no problems.

2. She drew a big circle on a piece of paper and told him to draw the face of the clock and put the hands at 11:10. He had done this the last day of the hospital and didn’t do a very good job. This day he drew it just fine and put the hands at 11:05 – but realized his mistake. She said that he was a little slow to do all of this – cognitive therapy will address this.

3. She had him recite the alphabet and count at the same time: A1, B2, C3… He skipped E so said F5, then got mixed up went back tried to correct it, got to G and said he was finished with that activity. Again, some cognitive issues that will be worked on in therapy.

Then she gave him some suggestions of what he can do for himself:

1. SLEEP – the #1 thing you can do for brain injuries

2. While healing (3-6 months) NO activity that would bump his head, even with a helmet. No bike riding, no rough housing with friends, no mosh pits, no contact sports, NOTHING. Another bump would not be good.

3. Instead of 3 big meals, eat lots of little meals high in protein and healthy in nature. This will help healing process and will also help even out moods and fatigue.

4. Take fish oil capsules, Vitamin E and a multi-vitamin every day to aid in the healing process.

Busy Weekend!

Elliot graduated from high school this past weekend and we had family in town, so things were a little too hectic to post anything to the blog. Kevin had another CT scan last Thursday and we met with the neurosurgeon's PA on Friday. Things are still looking good. The small area of subdural bleeding (on the upper left side of the head) is gone completely - no evidence of left over blood, the body has reabsorbed it. On the right side area of impact is where his skull is cracked and where he had epidural bleeding. The PA showed us the CT scan images on his computer and compared them to the CT scan taken the morning after his accident. The old scan shows that there are pockets of air around the fracture and the new scan shows no evidence of air anymore, so that's good. There is still a pool of blood, but it is not new blood - it is changing in characteristic and looks different between the two images so that means that it is breaking down and the body is reabsorbing it as well. He also showed us that the mid-line of the brain is intact, so this pocket of blood isn't putting any undue pressure on the brain, or pushing it aside, which is good. He gave Kevin a few quick gross-motor skill tests and said that he is doing very well and is very stable. He said that Kevin can return to work whenever he feels like he can handle it. Should avoid ANY activity that might cause a bump to the head for 3 months and then, of course, gave Kevin the helmet lecture. We had a small list of questions that he answered and then he said he wanted to see Kevin in a month, with a CT scan done the day before he comes in. Later, the doc office called back and left a message that they changed their minds and want to see Kevin in 2 weeks, not a month. Don't know why.

Kevin continues to improve every day. He sleeps late into the morning, but then seems to stay awake most of the day. Might go lay down for an hour or 2 in the afternoon - and some days doesn't even do that. Went out with friends to do low key things (movies at their apartment) several of these nights and did just fine. Did get a little worn out by the time they brought him home, but no major problems. I still have not noticed any short-term or long-term memory problems nor any cognitive problems. Can still get a little irritated or out of sorts at times, but not very badly. I haven't asked him about his hearing in a few days, if that has completely cleared up or if it's still bothering him a little. He's still having a lot of pain around his shoulders - I don't know if it's the small break in the tip of the clavicle or if it's just because the whole area is tweaked. I'm still waiting for the rehab place to call, maybe he can do some physical therapy for that. He had hurt his right shoulder last year at school in Durango and had never completely felt back to normal from that, so I think this injury compounded the old one. Otherwise, my dad and sister were amazed at how well he is doing - they were expecting a lot worse. He see a doctor next week that specializes in TBI (traumatic brain injury) so we will get a lot greater insight into what he can do to heal completely and what we can expect in the coming year. She'll be the one to guide him through evaluations and rehab if he nees it.

Tues & Wed

Steve & I have gone to work both of these mornings and Kevin is doing just fine until I get home at 1pm. He doesn't seem unstable at all, is acting so normally that it seems like a dream that he was in ICU 2 weekends ago. On Wed when I got home I took he and a friend (& Lizzie the dog) on a few errands and then for a drive in the mountains. We went to a little town just up a canyon from Boulder to visit some friends of theirs. I walked the dog while they hung out - they even walked a bit, we were there about 30 minutes. We returned home and Kevin crashed for 2 hours in the evening. He was up at 9 and I drove him to rent movies and his head was really hurting. The left front temple, which which was new so I was concerned and asked him over and over for a while. It didn't get worse - he stayed up and watched movies. On Wed, he took a few tylenol in the morning and none the rest of the day. Had a really good day. When I got home I took him to eat lunch and then to visit the restaurant where he works. He said they were glad to see him - and I know Kevin enjoyed stopping by. He had a whole group of friends in the afternoon, then another couple in the evening and never slept or lay down even until he went to bed for the night. He looked really good - is moving a little slowly, but otherwise looks and acts just like the old Kevin in that he can listen to music and talk to 5 friends and make a phone call - which many times is impossible for a TBI (traumatic brain injury) patient. His right ear is still bothering him and isn't quite back to normal and loud, banging noises are not good for his head - will set off a headache. His neck and shoulder areas are really bothering him - need to figure that out. He has a follow-up CT scan this morning and an appt with neurosurgeons tomorrow afternoon. I finally have a scipt for out-patient rehab in the hands of the rehab center and am waiting for the in-take person to call me.

Monday

Kevin had a really good day yesterday - he ran out of vicodin (narcotic pain med) and switched to tylenol which is working just fine. Without the vicodin he isn't sleepy, nauseous or slightly off-balance so I think he actually feels better overall. He took the dog for a short walk around noon and then I whisked him off to the mall to the one-hour optical place to get glasses. He survivied that 2 hour excursion and came home and DIDN'T go straight to bed. Then 5 friends showed up and hung out with him for a few hours and he STILL didn't go to sleep after that. Hung out with us and watched tv in the evening and then about 9pm said he was wiped out. He looked so good and acted so normal that I was afraid he would take off with his friends. Steve really needed to go into work this morning, so we decided to leave him at home alone until I get off at 1pm. He usually sleeps until 10 or 11, so we figured he won't be awake and alone for too long. I'm typing this on my lunch break and am anxious to get home to see how he is.

Saturday and Sunday

Kevin has had a good couple of days. I'm not really checking on him in the middle of the night - he says he gets a little restless, alternates between his bed and the recliner in the living room. Slept or dozed most of the morning both Sat and Sun and then got up mid-day and had a different group of friends over each day for a few hours. Saturday they sat on the sunny back patio and played cards and even took a short walk to the Elks club and back. Sunday they watched a movie and played video games on the x-box. Both days Kevin moved a little slowly, but had the energy and concentration for those types of activities. I even played cribbage with him and he wasn't slow at all - counting cards, knowing which cards to keep, what hand to play. He moved the little pegging counters without trouble. He really seems to be doing quite well these past few days. However, after a few hours of being up, he needs to go lay down again for a while. His headaches haven't disappeared completely, but I think they've gotten milder. He was on his laptop for a while yesterday, chatted with a friend, but then his head started to hurt. Could be the convergence problem with his right eye that they identified in the hosp. OT exercises will help correct that, if it is still a problem. The late afternoon/evening finds him up for a while and then resting for a while. He's well enough to be bored but still feeling crappy and unenergetic enough to stay put. He's eating pretty well and easing off of the pain meds - I'm going to call the doc's office today and see if we should try over the counter stuff. I think Steve will work from home in the mornings again this week while I work my usual 8-1 so that we're around if he needs anything.

Friday Doc Appt

The other day I had scheduled Kevin's follow-up CT scan and appt with Neurosurgeon's office for next week per hosp discharge instructions, but yesterday morning I called them back to ask about the staples in Kevin's head (he has a small gash that was tended to by someone in ER). They decided to have Kevin come in at 1pm. Steve met Kevin and I there, which was good because poor K had finally given in and taken a pain pill (he's trying to lenghten the time in between) and was really naseous cuz he hadn't eaten any food. We had to get a wheelchair and puke bag for him to make the trip to the office. We saw one of Dr. V's physician assts (PA) who removed the staples and talked to K about how he was feeling and what to expect. Talked to him about pros and cons of using narcotics for pain mgmt - they mess with you, from constipation to nausea to being a little off balance. Asked him about his headaches and the intensity of them. Reminded us to keep watching for any sudden changes - come straight to ER for CT scan. Alex, the PA, also told Kevin that some people recover from this type of injury very quickly and others very slowly - each case is variable. He thinks that overall Kevin is doing well and decided to take him off of the seizure medicine. He wants to keep next Fri's appt and have Kevin do the CT scan day before.

Meanwhile, it's been the worst trying to sort out his out-patient rehab. I guess I'm fortunate that I'm not well versed in the post-accient red-tape nightmare, but you can waste days before finding out that you need a prescription from a doctor before they can start K's rehab. The hosp did all these evals, a doc from rehab checked him out and wrote a report the last day - I thought the rehab center would know all about him. And - I have tried to call them for the last 2 days, left messages, etc with no call back. It took Steve driving over there and walking in to find out we need a script from a doc. Now when I call the doc's office Friday afternoon, she doesn't have an opening until June 1. What! I will be working on this Monday as well, I thought he would begin this out-patient therapy a little sooner than middle of June.

The rest of his day was just okay - had a visitor for a while - watched a low-key movie. He's so frustrated because he just can't do much, is still hurting a lot, head hurts most of the time, needs to sleep - can't even sleep on his side, head won't let him, so tired of being on his back. Is bored out of his mind but any stimulation (reading, tv, music, visitors) hurts his head pretty soon. He talks about his job so often - he was really loving it and wants so badly just to get back to it and he's not sure when he'll be able to. He really cares about the restaurant and the owners and feels he's part of their team and is letting them down, wanted to go visit Pi yesterday but then knew he wasn't up to it. It's hard to see your child knocked backwards when his life was moving in such a positive direction, but we'll just do all we can to help him make a full and speedy recovery.

Thurday Doc Appts

When Kevin woke up yesterday morning he said that he felt much better than the previous few mornings, so I'm encouraged that he seems to feel a little better each day. I was correct in saying that the doctor appointments would be all he could handle yesterday. The 1st was at 9am at one location and the 2nd at 3pm at a different. He slept in between and then after for 5 hours straight after the 2nd one. Also, he's exhibiting symptoms of a head trauma victim which is that bright lights, loud shrill voices, too many inputs at once annoy him and after a time he just wants out of there. It's tough - but he did pretty well, I must say.

The ENT doc looked at Kevin's right ear which he had been complaining about, but has actually gotten steadily better. I brought the packet of written reports from the hosp, with descriptions of the findings from the CT scans so he looked at those (Kevin's skull fracture is right above that ear). He cleaned out a little wax to get a good look at the ear drum and Kevin could hear a little better already. The ear drum looks just fine. There's a little bit of dried blood and debris on the ear drum which he said would be painful if he tried to clean, so he wants us to put drops of hydrogen peroxide in it twice a day for a week. Then he sent Kevin off with an audiologist to test his inner ear. She put him in a sound proof room and tested both ears. We then spoke with the doc who said that those came out great! Both ears are hearing at the same level which is in the normal range for a 20 year old male. When she spoke words for Kevin to repeat he heard her at 0 decibles and with 100% accuracy which is excellent. So doc expects Kevin to fully recover - NO DAMAGE TO INNER OR OUTER RIGHT EAR!

The Orthopedic doc looked at his clavicle in the afternoon. He had all of the CT scan images on his computer right there in the office and scanned the written reports that I had brought in. We were looking at the area on Kevin's upper left chest, right under his chin. It had been very painful the night he came home from the hosp, but was feeling better by Thurs. The doc showed us that there is only a separation of where clavicle meets breast bone - the ligaments are stretched, but it will just heal like that. Kevin will have a little bump or rise, no big deal - it won't bother him at all in the future and there's nothing to worry about there. The doc then noticed on the CT images another area on his right clavicle that wasn't mentioned in the reports. The tip where it attaches out near the shoulder socket was chipped a little and it, too, has a separation. Kevin doesn't feel any pain there at all, couldn't tell that it's also damaged. The doc sent him off for x-rays - 2 standing up, one with a weight in that hand gently pulling downward and one without the weight. He wanted to know if the separation gets worse with the weight - but it doesn't at all! So he said that's good. Kevin doesn't need to do anything with that except not lift anything over 10 pounds (25 with both hands) for 6 weeks till bone heals.
LEFT AND RIGHT CLAVICLES SLIGHTLY INJURED

Thursday morning

Although he slept much better at home the first night, when he woke yesterday morning he had an excruciating headache - just like the previous few mornings in the hosp. He says that mornings are when he feels the worst. Luckily, his room is the darkest in the house because bright light really bothers him right now. He himself is keeping track of the two medicines that he's taking. He takes one at 8am, 4pm & 10pm and the other every 3 hours, and he's been letting us know when he's going to take them. He slept most of yesterday until 4 friends came at 4pm. I woke him up to say they were coming and he got up feeling pretty good after resting all morning, went outside and sat in the grass and they sat with him out there. 3 of the kids left after only 15 minutes - so I let the other stay and they kept it low-key for about an hour, Kevin ate something and they watched a little tv. I'm very happy to hear in their conversations Kevin saying that he really can't do this or that - he's not up to it. He needs to be proactive in shutting himself down when his body says it's time and not trying to do too much this coming week or more. After an hour with 1 friend yesterday, another 2 came over and Kevin said he was sorry, he's falling apart fast, and went straight to his room and zonked out. Slept most of the evening and came out around 8:30pm - he was grouchy and out of sorts and really wondering (cussing out loud) just what he did to himself. He's hurting and he's realizing that this is going to take a while. I just keep telling him that, yes it's going to take a while, but he WILL heal, and he just needs to take care of himself. He slept all night as far as I know - I said hi to him and got him water at 1:30am and looked in when I got up and 5:30am and he was okay.

He has 2 appointments today, Ear/Nose/Throat in the morning and Orthopedic in the afternoon which will tax him quite a bit to go out and come back, so I'm keeping visitors at bay. Will post what we learn about his right ear and cracked clavicle.

Thank You

Thank you to all of the well wishers, followers and comments on the blogs, and gifts.

1. Thanks to the Aaron Wildman family. Aaron is a much younger Boy Scout from Kevin's troop. Aaron made a chocolate cake for us and walked it over on Sunday night.
2. Thanks to Nick Dotter and family for making us a casserole. It is amazing how fast you run out of food when there is just no time to make it to the grocery store. Nick is Kevin's friend from birth.
3. Thanks to the Elephant Hut Thai restaurant where Kevin works. They sent flowers and later a nice card from the whole crew (Pi, Chris, D, Rachel, Nate, Tim, Max, Ana, Pick, and Alex) to Kevin while he was in the hospital. Pi, who is the owner and head chef, also called to the hospital. I will shamelessly put in a plug for them. Great restaurant. Recently opened. Try them out. On 30th next to Joe's Espresso shop. Thanks Pi,
   
4. Thanks to Kevin's friends Maya, Scott, Rose, Rosie, Osha, I know, others, for your homemade cards and gifts and for keeping your visits short.
   

wed morning

Just getting him home from the hosp drained him. He went straight out and sat in the sunshine on the patio while we finished his room. Then he went to bed - his shoulder hurts a lot because of a broken or cracked clavicle - we don't even know yet (too worried about his brain). Need to see an Orthopedic doc for that. His right ear is also really bugging him (where he smacked the curb going God knows how fast). Over the weekend it was ringing, but he says that it's gotten steadily better, but still can't hear 100% and says it feels or sounds like it's "clogged". Gotta go see an Ear/Nose/Throat doctor for that. And his head is the biggest concern. He has been and will be on seizure medicine until we see the Neurosurgeons next week. He will be going to out-patient rehab a few times a week for a time. However, he gets up and walks around, albeit very gingerly, and talks to you and seems like the same ole Kevin. And then when you really talk to him for a while you notice (and he's starting to notice) that things aren't quite right and sometimes his thinking and processing speeds aren't what they were last Thurs afternoon, so that's why he needs rehab therapy and lots of rest and over time his brain will heal from this.

All that said...
He had a very restful night in his own bed - so much more comfortable than a hosp bed, and his room is very dark and quiet. He woke and took only one pain pill right before 4am when I looked in on him - asked for the classical radio station turned on low (which he has always listened to - not odd behavior) and I put an icy washrag over his face. He's still asleep at 6 am.
Steve and I will alternate being home with him. Steve can work from home and I have flexibility with my job. More later.

He's Home!

Kevin is home in his own bed now.
This will be very short. I will add more later.