Thursday, November 29, 2012

The Latest



Scott has made much progress since the last post.  He continues to live at home with Jen and Floyd and the help of full-time nursing care.  Since the last post he has begun consistently eating solid foods, especially bacon, the food he eats most consistently.  We are hopeful that, as he continues to make progress with eating and self-feeding, his feeding tube can be removed.  At this time his feeding tube is used for occasional feedings (if he goes for a long period of time without being interested in eating) and for administering his medication.  

Scott has also made great progress in terms of his mobility.  He is able to get up and walk around with minimal assistance.  Yesterday he made two laps around the block with only Jennifer helping him.  His progress presents new challenges in terms of his safety at home.  For example, if he has a desire to leave the house he is now able to do that.  However, cognitively he does not have the ability to keep himself safe and make good decisions so, he has to be watched at all times to ensure that he doesn’t just get up and venture out.  

Cognitively Scott remains in a general state of confusion.  He can recognize familiar faces and can accurately recall some memories and experiences.  However, he is not oriented to current time and space.  For example, during a recent conversation he said he was 29 years old had a blue van and lived in North Carolina.  He doesn’t recognize his current home as his home and is often preoccupied with going home – most likely a home he recalls from a memory.

Scott has also entered a stage of agitation.  His agitation is definitely a sign of progress and is related to his increased awareness of what is going on around him. He has become particularly irritated with nursing and medical staff.  He is understandably annoyed at the poking and prodding because, at this stage, he doesn’t have the ability to understand who they are and what they are doing.  In addition, Scott seems to be experiencing heightened sensitivity to sounds and touch.  So, naturally he is much more sensitive to being touched by nursing staff and reports that just the slightest touching is painful to him.  His agitation peaked about a week and a half ago and he was transferred to the hospital so that doctors could run some tests.  Doctors determined that medically he is doing just fine so it was decided that he should be started on an anti-anxiety medication to help stabilize his mood.  Scott transferred back home again on Monday.  Now starts the process of regulating his medication by trying to strike the right balance between keeping him calm and yet preventing him from being so tired and groggy that his recovery progress is impeded. 

Although Scott’s agitation presents new challenges for his recovery, it is important to keep in mind that it does represent progress.  For reference it is helpful to refer back to the Rancho Scales (http://www.rancho.org/research/bi_cognition.pdf)  Scott is definitely experiencing the agitation described in level IV but, otherwise, falls somewhere in the range of level VI.