August 10, 2006 (a quickly written entry)
Today started out with a Life Training session: the OT came over to the apartment at 9 am (Gary liked that part, since he got to stay in bed longer and be served breakfast in bed), and she observed various parts of our routine. First she watched and offered suggestions as Gary practiced padding himself off and getting in prone and side-lying positions – he is getting better at that. Next came a shower, and she had him do more than what he had done when the two of us went through a shower practice on Tuesday. For one thing, she had him try to get his own legs in and out of the tub, with the unfortunate result that in the small space he had to work in he really banged a leg on the cabinet in both getting it in and taking it out, causing all three of us to groan in sympathy with it.
One new tip he picked up concerning taking a shower was how he could wash and dry his lower legs and feet himself by doing something similar to what she had taught him to get his own shoes on and off – namely, get closer to the edge of the shower bench (but not too close, especially since the bench is wet and slippery), grab a leg and bring it up as he leaned back on the bench, then put the ankle over the opposite knee. Because of the extra danger of sliding on the wet bench, she told him to do this only if I’d wrapped the gait belt around his chest and the shower bench. She also said that as long as he had the gait belt around him, I didn’t have to stand right there while he took a shower but could be off somewhere within calling distance.
Once he’d dried off, he did another practice run at dressing in the chair. After he worked at that a while, she concluded it is still the case that he’ll have to hold off on getting his pants up all the way (by himself, I mean – he won’t be wheeling around with his pants around his thighs :-)) until after his flap restrictions are lifted.
After this, she left, telling us we were to finish getting ready and then go to Shepherd. Naturally after she left was when the real life training session began: after we’d gotten him back on the bed and I’d put xenaderm on his flap, we discovered his condom catheter had become disconnected, the result being I had to change his pants, his t.e.d. hose, and the sheets. Then when we got to Shepherd, he tried placing his feet slightly differently for his transfer out of the car and his feet got kind of stuck between the wheelchair and the car door and it took us much longer than usual to get him out of the car.
Once back in the building, we went through the discharge procedure with our case manager. She made sure we knew how to contact our Bridge Coordinator, when Gary’s follow-up visits were scheduled for, who our external case manager is and how to contact her, reminders about his personal care, things like that. She also told Gary she had scheduled an outpatient occupational therapy appointment for him with Rehab Works on August 14th (Gary was a little dismayed by the appointment being that soon, saying he was eager to get to the university on Monday, so I don’t know if he’ll try to change the appointment).
After this, the OT who had talked to him yesterday about vans versus mini-vans brought Gary a ton of brochures about the various models. While Gary looked through those, she ran off a copy of his home exercise routine, the exercises to be done in his chair with either an exercise band or dumbbells. He is supposed to do the exercises once a day, two to three sets of fifteen. I didn’t see the ones like pushups and dips on the list, so I’ll have to give him another exercise routine of my own ;-) (actually, he knows those are good for developing his strength, so I would think he’d stay motivated to do those).
She’d also found an article on the web about wheelchair maintenance, listing what should be checked daily, weekly, and monthly. He and I were both glad to see this, because this hadn’t been laid out so clearly in the wheelchair maintenance class.
After this Gary proned for a while, and I went to find the guy we’d been told knew about travel shower chairs. I asked in the seating clinic room if the guy was in, and one of the other persons there went and checked the various rooms then told me he wasn’t. “He’s in a wheelchair,” she added helpfully. I gave her a look.
I went down to the gym to look for the other person who I’d been told knew about these shower chairs. I found him and he took me to a Bridge person who had a catalogue with such equipment in it. They ran off copies for me of information about two different such chairs.
Next Gary had a group weight training session, but it was on a different floor than usual and with a different person. Plus there was only one other patient in the group, which usually lends to efficiency ;-). The leader was pretty good, I thought, going through the exercises without taking excessive rests, though she did go through the exercises too fast, of course. (Early on, Gary got bold and asked if they could slow down, which worked temporarily until the exercise leader noted that slowing down made the exercises harder (peg rolls her eyes ;-)); Gary wondered where these people got their training, as any weight training book will tell you not to be flinging the weights about.) One nice thing was she also had copies of all the exercises she went through, so now Gary has a good selection of home exercises (plus I can always look back on the blog and see if there are any that he has done in the past that didn’t make it onto the lists we got today; I’m sure he’ll be thrilled to have even more exercises to do ;-)).
That was the end of the therapy day, and Gary and I went by car first to CVS for some supplies then back to the apartment. Unfortunately, when he transferred out of the car, he again slid forward too much on his transfer board, as he tends to do with this new technique he’s come up with, and I was a tad too slow or too weak in stopping his movement and he ended up laying across the passenger seat with his legs stuck between the wheelchair and under the car door. We tried various things, but he wasn’t budging, and when he heard a car start up he told me to ask the person for help. Fortunately the person was a young man, and he was able to pull Gary upright in the seat, and from there Gary and I were able to complete the transfer. I apologized to him for not pulling him back onto the transfer board strongly enough, and he said he should have been aware where his butt was heading. I said maybe we should ask the OT to go over car transfers again with us tomorrow, but he said that we had the principles down, but that no doubt we’d occasionally make mistakes like this one and we’d learn from them.
Back in the apartment, I spent time trying to get through the list of things I’m supposed to do for checkout (cleaning the fridge and stove and bathroom, mopping floors, etc. – the main cleaning things left for tomorrow morning will be laundering and folding all the sheets, pillowcases, towels, and washcloths, and vacuuming the entire apartment – but the vacuum is a heavy one and the apartment is carpeted, so I am hoping to pawn off this job on someone else ;-)).
Gary found blood in his catheter during his 6pm IC, so now we have to ask the nurse about that – I sure wish these extra complications would just go away . . . . Did I say I was ready to go home? (Ironic grin)
Before Gary’s transfer back to bed in the evening, because I could tell he was tired, I asked him if he wanted me to have my hands on him to help, but he said no, just to put a pillow over the tire as extra cushioning as the OT this morning had suggested we do when Gary wasn’t feeling 100% confident. He should have taken my help ;-) – in his transfer he didn’t get enough lift, and he ended up briefly landing on the frame of his chair (which wasn’t covered by the pillow) before I could give him the extra push off it. His first transfer this morning was also one where he hadn’t quite made his target, landing slightly on the wheel before I could help him over it, so we have decided that, for now, on his first and last transfers of the day I will give him more help, either holding him under his thighs or if need be going back to where I held his hips or even to where I had my hands under his sitting bones. Transfers still take him quite a bit of concentration, him trying to get his timing and technique down, and he finds it hard to keep his concentration on those first and last transfers of the day.
Well, tomorrow is our big day of coming home. My understanding is there is some chance that our cable may be out (evidently having accidently been cut by some construction crew), in which case I may not be on the internet until it’s fixed – I’m letting you know so family members and so forth don’t get worried if they don’t get an email or see a new blog entry.
Today started out with a Life Training session: the OT came over to the apartment at 9 am (Gary liked that part, since he got to stay in bed longer and be served breakfast in bed), and she observed various parts of our routine. First she watched and offered suggestions as Gary practiced padding himself off and getting in prone and side-lying positions – he is getting better at that. Next came a shower, and she had him do more than what he had done when the two of us went through a shower practice on Tuesday. For one thing, she had him try to get his own legs in and out of the tub, with the unfortunate result that in the small space he had to work in he really banged a leg on the cabinet in both getting it in and taking it out, causing all three of us to groan in sympathy with it.
One new tip he picked up concerning taking a shower was how he could wash and dry his lower legs and feet himself by doing something similar to what she had taught him to get his own shoes on and off – namely, get closer to the edge of the shower bench (but not too close, especially since the bench is wet and slippery), grab a leg and bring it up as he leaned back on the bench, then put the ankle over the opposite knee. Because of the extra danger of sliding on the wet bench, she told him to do this only if I’d wrapped the gait belt around his chest and the shower bench. She also said that as long as he had the gait belt around him, I didn’t have to stand right there while he took a shower but could be off somewhere within calling distance.
Once he’d dried off, he did another practice run at dressing in the chair. After he worked at that a while, she concluded it is still the case that he’ll have to hold off on getting his pants up all the way (by himself, I mean – he won’t be wheeling around with his pants around his thighs :-)) until after his flap restrictions are lifted.
After this, she left, telling us we were to finish getting ready and then go to Shepherd. Naturally after she left was when the real life training session began: after we’d gotten him back on the bed and I’d put xenaderm on his flap, we discovered his condom catheter had become disconnected, the result being I had to change his pants, his t.e.d. hose, and the sheets. Then when we got to Shepherd, he tried placing his feet slightly differently for his transfer out of the car and his feet got kind of stuck between the wheelchair and the car door and it took us much longer than usual to get him out of the car.
Once back in the building, we went through the discharge procedure with our case manager. She made sure we knew how to contact our Bridge Coordinator, when Gary’s follow-up visits were scheduled for, who our external case manager is and how to contact her, reminders about his personal care, things like that. She also told Gary she had scheduled an outpatient occupational therapy appointment for him with Rehab Works on August 14th (Gary was a little dismayed by the appointment being that soon, saying he was eager to get to the university on Monday, so I don’t know if he’ll try to change the appointment).
After this, the OT who had talked to him yesterday about vans versus mini-vans brought Gary a ton of brochures about the various models. While Gary looked through those, she ran off a copy of his home exercise routine, the exercises to be done in his chair with either an exercise band or dumbbells. He is supposed to do the exercises once a day, two to three sets of fifteen. I didn’t see the ones like pushups and dips on the list, so I’ll have to give him another exercise routine of my own ;-) (actually, he knows those are good for developing his strength, so I would think he’d stay motivated to do those).
She’d also found an article on the web about wheelchair maintenance, listing what should be checked daily, weekly, and monthly. He and I were both glad to see this, because this hadn’t been laid out so clearly in the wheelchair maintenance class.
After this Gary proned for a while, and I went to find the guy we’d been told knew about travel shower chairs. I asked in the seating clinic room if the guy was in, and one of the other persons there went and checked the various rooms then told me he wasn’t. “He’s in a wheelchair,” she added helpfully. I gave her a look.
I went down to the gym to look for the other person who I’d been told knew about these shower chairs. I found him and he took me to a Bridge person who had a catalogue with such equipment in it. They ran off copies for me of information about two different such chairs.
Next Gary had a group weight training session, but it was on a different floor than usual and with a different person. Plus there was only one other patient in the group, which usually lends to efficiency ;-). The leader was pretty good, I thought, going through the exercises without taking excessive rests, though she did go through the exercises too fast, of course. (Early on, Gary got bold and asked if they could slow down, which worked temporarily until the exercise leader noted that slowing down made the exercises harder (peg rolls her eyes ;-)); Gary wondered where these people got their training, as any weight training book will tell you not to be flinging the weights about.) One nice thing was she also had copies of all the exercises she went through, so now Gary has a good selection of home exercises (plus I can always look back on the blog and see if there are any that he has done in the past that didn’t make it onto the lists we got today; I’m sure he’ll be thrilled to have even more exercises to do ;-)).
That was the end of the therapy day, and Gary and I went by car first to CVS for some supplies then back to the apartment. Unfortunately, when he transferred out of the car, he again slid forward too much on his transfer board, as he tends to do with this new technique he’s come up with, and I was a tad too slow or too weak in stopping his movement and he ended up laying across the passenger seat with his legs stuck between the wheelchair and under the car door. We tried various things, but he wasn’t budging, and when he heard a car start up he told me to ask the person for help. Fortunately the person was a young man, and he was able to pull Gary upright in the seat, and from there Gary and I were able to complete the transfer. I apologized to him for not pulling him back onto the transfer board strongly enough, and he said he should have been aware where his butt was heading. I said maybe we should ask the OT to go over car transfers again with us tomorrow, but he said that we had the principles down, but that no doubt we’d occasionally make mistakes like this one and we’d learn from them.
Back in the apartment, I spent time trying to get through the list of things I’m supposed to do for checkout (cleaning the fridge and stove and bathroom, mopping floors, etc. – the main cleaning things left for tomorrow morning will be laundering and folding all the sheets, pillowcases, towels, and washcloths, and vacuuming the entire apartment – but the vacuum is a heavy one and the apartment is carpeted, so I am hoping to pawn off this job on someone else ;-)).
Gary found blood in his catheter during his 6pm IC, so now we have to ask the nurse about that – I sure wish these extra complications would just go away . . . . Did I say I was ready to go home? (Ironic grin)
Before Gary’s transfer back to bed in the evening, because I could tell he was tired, I asked him if he wanted me to have my hands on him to help, but he said no, just to put a pillow over the tire as extra cushioning as the OT this morning had suggested we do when Gary wasn’t feeling 100% confident. He should have taken my help ;-) – in his transfer he didn’t get enough lift, and he ended up briefly landing on the frame of his chair (which wasn’t covered by the pillow) before I could give him the extra push off it. His first transfer this morning was also one where he hadn’t quite made his target, landing slightly on the wheel before I could help him over it, so we have decided that, for now, on his first and last transfers of the day I will give him more help, either holding him under his thighs or if need be going back to where I held his hips or even to where I had my hands under his sitting bones. Transfers still take him quite a bit of concentration, him trying to get his timing and technique down, and he finds it hard to keep his concentration on those first and last transfers of the day.
Well, tomorrow is our big day of coming home. My understanding is there is some chance that our cable may be out (evidently having accidently been cut by some construction crew), in which case I may not be on the internet until it’s fixed – I’m letting you know so family members and so forth don’t get worried if they don’t get an email or see a new blog entry.
posted by Peg Daniels at 7:42 PM
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