Tuesday, August 12, 2014

Stroke Rehab

Today I recorded a full session of my father going through a therapy session for his right arm. After two weeks since his stroke, he's come a long way. Initially he couldn't move his arm at all. He know has full range of motion and is starting to work on his fine movements. The video captures where he's at. Cristian, his therapist, is patient, encouraging, and humorous. Either way, my father is really putting in the effort to get better.  Proud of the old guy.

Monday, August 11, 2014

Pasando Cuentas

I'm still in Pirque, Chile. My father's recovery is still showing great progress. We're all working overtime to help him along. He's never been a very chatty person but now he's even more silent. A life-long smoker and stubbornly independent, I think giving these habits up has a lot to do with it. My young half-brother, Ryan, at only 4 years of age has had the best luck at getting him to engage. Ryan is witty, energetic, and insistent so it's near imposible to ignore the little guy.  

In my case, I've had to take a different approach. My father's right arm mobility is on track to a full recovery, so I've been focusing on helping rehabilitate his cognitive injury. Since he's one of the smartest, most well read people I know, finding conversations to engage him with has been tough. Let me explain. All too often, my father is more informed on stuff than me so just talking to him is like asking for a lesson. The stroke seems to have made these teachings harder than their worth. In several occasions recently he's avoided them entirely with an irritating "never mind" or "just trust me" after he's corrected some bonehead statement I've made. I needed to find a topic that would offer him something more.

My father works as a consultant for the mining industry in Chile. A few months ago he wrote a book on operational productivity meant as a wake up call to the specialized community that delivers over 60% of the country's exports. Consisting of over 150 pages of densely packed technical jargon, I set out to read it, learn it, critique it. 

Like my father, I'm an engineer by trade. However unlike him, I was trained in English. I speak Spanish but technical Spanish is a whole other language. Here's the books' abstract to get an idea:
La industria minera nacional enfrenta desafíos de productividad y competitividad, ante escenarios de caída de leyes, normalización de super-ciclos de “commodities”, baja efectividad de factores productivos, altos costos y márgenes de rentabilidad en franca degradación. En los últimos años, las empresas mineras han implantado diversas prácticas de trabajo planificado, análisis de desempeño, gestión operativa, y mejoramiento continuo dirigidas a regularizar el proceso de negocio de faena; aún cuando estas prácticas constituyen claro avance en la gestión, no han logrado revertir las tendencias citadas. Se requiere así un re-enfoque más radical, un repensar los fundamentos de las prácticas aplicadas, que conduzca a plantear nuevas formas de hacer las cosas, un nuevo modelo global que mitigue interferencias, pérdidas productivas, y costos, y oriente las actividades a maximizar el resultado de negocio general. Este texto busca llenar este espacio vía el análisis de causales de pérdidas en la operación y la propuesta derivada de estrategias y tácticas para controlarlas.
It took me a about 40 hours to get through it all. Equations, charts, methods, strategies... you name it, it was there. Even obscure quotes from Einstein and Shakespeare's Hamlet. I took notes, listed typos, and organized my thoughts into effective nuggets of controversial feedback. 

Today I unleashed the first wave of my planned mental assault. I think it went well. He was surprised by my effort and engaged in a passionate discussion like many we've had before. He struggled in drafting some of his arguments, often going with a simplistic choice of words to avoid stalling. This is in stark contrast to his debate style in the past and his writings in the book. That being said his points were strong and after close to 2 hours of going at it, I felt he had persuaded me. He was visibly tired and we talked about how he felt. Unlike working at regaining motion in his right arm, he explained how the cognitive effort was much more draining. It's interesting because his knowledge base, understanding, and intuition are all intact. The effort is simply trying to generate the expression of the content, albeit in English or Spanish.

The other piece of news worth sharing is the hospital bill.  Roughly 7 days in the hospital, over half a dozen tests, and a bunch of prescriptions came out to about USD$9200.  My father's insurance will cover most of it, but we all thought it was reasonable given all the fuss.

Thursday, August 07, 2014

Throw'em Up!

Settling in at home has it's advantages. While my father gets acclimated with current events, I get a chance to work on my stuff. It's colder than I expected so stacking the fire place is a round the clock endeavor. Not a lot of dialog from him yet, but we did cover some ground on short term goals.

With a need to move into the city we agreed that the area of Parque Forestal would be convenient enough. Close to the clinic and several modes of transportation, it will be a good location to be accessible and cut costs. The house he's in now if paid up until December so it'll be a move for next year. A condo with an elevator and less than a couple blocks from a metro station is what we agreed would be good. In preparation for that we'll be working to sell a lot of the furniture and things that he could do without. My father's spent a life time collecting books. Most are in english so I'm not too sure they'll go for much in a spanish speaking country. Either way, we'll be working on putting things for sale on ebay equivalents remate.com and mercadolibre.com.  If you're interested in anything, send me an email (shipping not included).

Next things I need to look into is claiming his social security benefits. Well past retirement age, this isn't something he ever paid much attention to. Having lived many years in USA and Chile, it'll be an aggregation of each. Finally, we found a neurological therapy center, Clínica Los Coihues, which offers mobility and expression rehabilitation. His right arm mobility is improving gradually and he keeps working at it on his own.  Here he is raising it all the way up. Finger agility is still limited although he can move all his digits. 

Tuesday, August 05, 2014

Bye Bye Clinic, Hello Pirque

Today my father was released from the Clinica Santa Maria. I expected it to be a happy day but the 2 hours we had to wait to get all the papers signed and collect all his items had him on edge. The final interview with Dr. Bustamante wasn't too eventful. He prescribed what sounded like a life time of pills, specifically:

Xavelto - 20mg once a day - blood thinner
Atorvastatina - 40mg at night - for cholesterol - to work plaque of ateromatosis (stroke blockage)
Omeprasol - 20mg every 12hrs for 2 weeks
Lactuloas - 20ml every 12hrs for constapation
Nicotinel - 30mg patch a day

My primary goal was to get all the exams he had been subjected to on soft copy.  Mainly the CatScans and AngioTac results. I plan on showing these to friends in the medical profession back home in an effort to learn more about his condition. 

Long trip out to Pirque was quiet given my father wasn't in great spirits. Actually the whole day he's been more silent than ever. He was pretty tired since he knocked out for a few hours as soon as we arrived. The peace of being out of the city is definitely calming. Luckily the house had an upgraded WiFi connection from the last time I was here so I'll be able to get some work done.

I feel myself growing frustrated from not being able to do more. His right arm -although he's able to move it- mostly dangles by his side as he moves around. I mentioned it might be best to put it into a sling so as to not throw his balance off but he felt it was better in free motion. Since I don't make it out here often, people naturally want to cater to my needs. I made it clear to Maggi and my father that I didn't want that. My sole purpose was to help him recover, not to hang out. I asked them for direct tasks that I could work on that would make life easier. My father's laptop needed it's keyboard replaced so I started on that. Pretty easy fix though since the part was readily available.

Towards the end of the day I mentioned it again, how I wanted to do more. My father seemed troubled at figuring out how I could help. He told me "I'm trying to correlate my thoughts and figuring out something you can help me with is a distraction at this point." So I guess I'll have to focus on my own stuff until he can formulate a plan. I wish we could do it collaboratively, but then again he's never done it that way before.

Monday, August 04, 2014

Where's the Red Ball?

Today was a good day.  My father was much more upbeat and in good spirits compared to yesterday. He says it has something to do with the fact that they let him sleep until 7am for the first time since he arrived. His right arm continues to gain mobility and strength. A few days ago he asked me to get a squishy ball so he can test out his grip with. I went to a couple quickie marts on my path to and from the hospital from my grandmother's house but with no luck. Since these balls are typically free promotional items, I took a chance at asking my grandmother for one.  Sure enough, this produced an assortment of balls, all different colors. I delivered this red one yesterday morning, when he was all grumps.

It wasn't the reaction I expected given *he* asked me for it to begin with. So I took it upon myself to recommend playing with the red ball whenever he would complain about one thing or another. What can I say, humor is the best cure. Turns out he must have been squeezing the ball last night because today he was able to open a pack of salt on his own using his right hand. He can can even raise his right arm to scratch his face. 

Seems the progress has been noted by the neurologists as well because they lifted his "maximum security prison" sentence to one where visitors can stay the night. Here you see him in all his misery as they have him strapped into all sorts of monitoring machines. 

The new spot grants him freedom from wires, so he can flip around in the bed as he sleeps. I've realized getting on his side or face down lets him sleep much better. He still gets a visit from the nursing staff every couple hours for food, drugs, or a checkup. But at least he's cooperative with them now (as opposed to yesterday). 

After the move I realized the red ball had gone missing. I asked about it and a few hours later it turned up. Knowing how he likes messing with me, he might have stuffed it somewhere in his bed. No matter, it's here now and get to keep reminding him to squeeze it.

The best news today is that we will be released tomorrow.  Woot!  The doctor will roll through for a final review at 2pm and then we get to head out to Pirque. The internet connection is a bit flakey out there so not sure when I'll get my next post out, but I'll be working on it.

Sunday, August 03, 2014

Sunday wasn't a Fun Day

Today was not as good of a day as yesterday.  My father's progress is still good but his patience has been reached with some of the hospital staff. He's not as cooperative as he's been. For instance, at one point a nurse came in to give him a pill while he was sleeping. I was working and saw her having difficulty waking him. I got up to help but no dice. All his vital signs were good and I could see him breathing but calling his name or tapping his shoulder had no effect. I couldn't help but wonder if something may be wrong. I shook his ass hard. Nothing. Then I grabbed a bottle of water, filled a cap and poured it down his face. He wiped it off and muttered "por el carajo". No pill was taken.

Sinus rhythm
Heart conduct sinus.gif
Atrial fibrillation
Heart conduct atrialfib.gif

One objective that was achieved was talking openly between Maggi, him and I about his recovery plan. After sending his scans out to Jenny, a friend of mine that's a neurologist, we're pretty certain that atrial fibrillation was the likely cause of my father's stroke. This condition is treatable with improved physical fitness, however exercising is not something he sees himself doing to get his condition under control. He believes that he can just remain calm, make some changes to his diet and habits, and be fine.  Maggi and I agree that this sounds like a minimalistic approach in that it doesn't do enough to show that he wants to recover 100%. We left the discussion unfinished though because the hour long debate really wore him out. What I learned is that it will be a psychological battle to convince him to aggressively take control of his reality. It's not enough to have gone through this near death experience or that his youngest son, Ryan, be traumatized by his poor health, more evidence is needed before he will adopt a radical change.  This troubles me.

A Stroke of Bad Luck.

Last Tuesday, July 29th I was informed that my father, Peter Grundy, suffered a brain stroke and was in the hospital. I was aware that he was going through some stressful times at home with his girlfriend but I never imagined it could escalate to this. I immediately sought to travel to Chile -where he lives- to help him recover. My younger brother, Alan, had enough American Airline Miles (60,000) to get me a flight on Thursday, August 1st. I arrived Friday morning in Santiago and went straight to Clinica Santa Maria where he was in the critical care unit.

He's lost motion in his right arm, has some blind spots in his right eye, and has difficulty verbalizing ideas. The last is the most important to me, although the first two will likely prevent him from driving which translates to him being unable to take care of himself.  His ability to verbalize ideas that he has is not only incapacitating from a work/life perspective but is affecting his psychology. He's frustrated, afraid, and overall feels/looks/acts powerless. Let me elaborate on this point. During the times I had alone with him, I can speak intelligently in either language and his facial expressions, body language, reactions are from the man I've always known.  "Chincol", "no te vaya dar un surmenage", "dejate de hueviar"... all the same quips he would tell me growing up. It's when he wants to express a complex thought or discuss a topic as intertwined as the drama that likely triggered his condition. He will "ummm" and "ahhh" for as long as 45secs at a time and culminate with a deep breadth and a wipe of his face.  In one occasion he muttered a "damn it" as if to release the frustration of not being able to communicate as he once did.

One thing is clear. He needs help. He knows it and is willing to do what's necessary to recover. That includes moving from the remote village where he lives, Pirque, to the city, Santiago, where friends and family can help him. Moving to the USA isn't out of the question but as he sees it "it's impractical and generally an unpleasant place for me".  So the plan for the next 6 months is starting to take form. Once he's released form the hospital on Wednesday, August 6th we'll head to Pirque to work on getting his mobility back. Meanwhile, we'll work on a move to Santiago to allow him easier access to friends and family that can help him get his mind back. That's what he told me today: "where you can help me is to work me through completing my thoughts until I can do so for myself again".   

Medically there are a couple decisions to make. Most pressing is a recommendation to surgically implant a pacemaker. The argument is as follows. Neurologist Dr. Gonzalo Bustamante (head doctor in charge of my father's case) reviewed the scans attached above and hypothesizes that a blockage to the Arteria Central Media caused the stroke.  Limited flow prevented enough blood from reaching the left center and back areas of the brain. They are prescribing blood thinners to try and free up this blockage and avoid more from potentially forming. Dr. Bustamante also requested a cardiologist study to understand what might have pushed a clot up into the brain. Dr. Rubio, the cardiologist, carried out a Holter Exam over a period of 24hrs on Wednesday, July 31st which studies the performance of the heart. He found that there was an arrhythmia which means the heart rate tends to spike and drop. The lowest he recorded was 34 beats/min at one point. Based on this, their recommending implanting a pacemaker. This procedure is only mildly invasive since the device sits just below the skin and electrically triggers the heart to maintain a minimal rate. This is meant to prevent fainting. At my father's age and physical state, his heart rate should be in the 65beats/min zone. The pacemaker would keep the low end from ever dropping below a safe threshold but do nothing for the high end which is believed to have caused the blood clot in the brain. In other words, the high heart frequency can cause moments of blood turbulence that can form clots in the blood pathways.  In my father's case this happened in the pathways to the brain.

My father is not ok with the pacemaker. He's never needed one before and finds that it won't help with preventing further strokes, only from fainting. He thinks the chance of him fainting is too small to warrant something as invasive as a pacemaker. The decision will come to a head on Monday, August 4th when the doctor expects us to have a decision. Maggi is leaning toward putting it in, since it's the doctors recommendation. I'm leaning towards my father's argument but don't want him fainting and possibly hurting himself in the process.  Tough call.

Friday, July 27, 2012

Padres game at PETCO Park...

Sunday was a special day. We had planned to catch the Dodgers vs Padres game in downtown. PETCO Park was a brand new stadium in the sweet spot of the city. The architecture and color scheme of the city breathes contemporary style and dessert tones. Stylish high rises are peppered around the stadium with winding walkways crossing between them. The grass although unnatural to the region, is the greenest and most comfortable to walk/lounge in. The game was a much needed win for the Dodgers who were chasing the wildcard and facing a loosing series against the Padres.