An update on my father's stroke

In a follow up to this post, James writes:

I am pleased to report that my father continues to improve in his alertness and articulation. I am attaching a photo I took of him over the weekend that well reflects his determined spirit. He still shows signs of confusion. He remains weak. He is also far from the point of being able to make the daily decisions that are necessary to live on one's own. I am very happy, however, that he is now able to hold small conversations, and to express his state of mind. This means that he can consider what he wants to do after he completes ‘sub acute’ rehabilitation (which still won’t be for several weeks).

I thought I would attach in this update a report from my mother, who was able to sit in on a therapist meeting yesterday morning at the rehabilitation center. Here is her report:

I went up today for the 9 AM team meeting. Carl seemed pretty alert – he was in the dining room having breakfast and saw me from afar and waved. He wheeled himself back to the room after breakfast. I mentioned how much I enjoyed seeing Christine [Panero] on Sunday, that it had been so long since I had seen her. And he said “over 20 years”, The speech therapist said his talking is so much better although he still gets confused sometimes with answering questions.

The team said they were delighted with his progress but thought there was still much more to be made – that he was nowhere near plateauing out. But we all did talk about where to go next. Everyone—including Carl—agreed that going back to Block Island to live was out of the question – he would need to drive etc. etc., and he will need assistance. So we all agreed we would shoot for Assisted Living—and their goal is to help him (and us) get him prepared for that. He said he “has a lot to think about”. He did not seem interested in a place in NYC. He seems to treasure his visits from his BI friends. He had gotten a card from a whole bunch of them and a gardenia plant. He was obviously touched. I said I did not know them and he said “that is because you do not hang around the Beachhead”. Tell everyone how much Carl enjoys visitors, that he is very touched by everyone’s concern, and that he also loves cards, that he can read them.

Who is Baby Carl?

James writes:

After the difficulties of the past few weeks, I thought we could all use a break. Since this is a family blog, it occurred to me that it might be fun to introduce our extended kin to this forum. I couldn't think of a better place to start than with my most interesting relative, Baby Carl.

Baby Carl is my father's half brother. He is so named bacause my father is also Carl, and my father's father was also a Carl. So in my family you have Big Carl (my grandfather), Little Carl (my father), and Baby Carl (my half uncle). Baby Carl wasn't raised by my grandfather, who suffered from wanderlust and nearly died trying to build a hunting lodge in Somalia. (You can read a little about that episode here.) So Baby Carl goes by another last name--Cestari.

If this wasn't interesting enough, Baby Carl has distingished himself in his profession by becoming a master teacher of something called 'gutterfighting.' This is a philosophy of hand-to-hand combat that combines martial art dicipline and dirty tricks to deliver the greatest and swiftest lethality, should you really need to kill someone in a fight. Baby Carl can explain it much better than I can. You can read one of his manifestos here, including these short-cut tips to mortal combat:

*Attack the throat with the INTENTION of crushing it! No brainer.

*Attack the anterior/lateral carotid triangle. One of TWO primary KO points. Kyusho/Dim Mak this *AIN'T! Just "hammer" the bastard. Fast, hard and often is the key phrase!

*Attack the cervical spine/C-1 - dens bone attachment.

*Attack the head/brain case. Now here we get interesting. The goal in attacking the head should be, in my opinion, to cause ACUTE TRAUMATIC BRAIN INJURY. Other possible injuries are secondary. *Attack with the intention of causing massive "coup contra coup" brain trauma, either through translational or rotational impact. Cause severe "kinking" of the brain stem, either by hyper flexion or extension. Forget the "death touch" stuff. THIS IS HOW people in the real world get Fucked up.

What does this all mean? Baby Carl has starred in a series of videos demonstrating his fighting techniques that have become the rage of the underground extreme-fighting types. The videos now retail for hundreds of dollars. Fortunately, a few choice clips are available on You Tube. You will recognize Baby Carl by his missing his ring finger on his right hand. You will also notice that we Paneros fight dirty.

My father's stroke

James writes:

I never thought this would be a medical blog, but the events of the New Year have changed that for me and Dara.

On December 30, 2006, at around 6:30 pm, my father, Carl Panero, suffered a stroke while dining at a restaurant on Block Island, Rhode Island, where he lives. Friends immediately noticed unusual behavior--an inability to communicate, and confusion. The Island police and doctor were summoned. They diagnosed stroke-like symptoms and readied the local airline for a medial evacuation. My father was off-island within an hour, and admitted to Westerly Hospital. Once stable, within the evening doctors transferred my father to the ICU at Rhode Island Hospital in Providence.

An MRI scan has revealed that my father either suffered a hemorrhagic stroke or a more unusual type of stroke called an amyloid angiopathy. Both concern bleedings into the brain. Amyloid is not your typical stroke that is brought on by high blood pressure and high cholesterol; my father was remarkably healthy in those two areas. His stroke was rather the result of weakened blood vessels in the brain, most likely caused by age, and of blood leaking into the brain from these weakened vessels.

A sizeable amount of blood was discharged into the left front side of his brain. This could have caused permanent damage to his faculties of speech, reason, and some motor coordination. We will be able to determine the extent of this damage within the next several days, as the blood is broken down naturally. In the meantime, my father is being monitored for seizures and other complications caused by the swelling of these blood deposits. Doctors report that he had a number of small seizures on the evening he was admitted, and two large seizures the morning of 1/2. Although they have been unpleasant for him, these events most likely have not caused additional long-term damage. My father continues to be on anti-seizure medication to reduce the chance of their reoccurrence.

Aside from the seizures, my father appears to be in stable condition. He is generally aware of his surroundings, able to move--in a weakened state--with some encouragement, able to nod, able to communicate through facial expressions, able to understand basic commands, able to digest food. He is also able to say a few basic words--yes, no, hello--but not able to speak or write beyond that.

My father has been improving at a good rate and has been evaluated to be eligible for acute rehabilitation. This means that his evaluators believe he will be receptive to 3 hours a day of physical, occupational, and speech therapy--the highest level. Within a week of the stroke he was transferred to a nearby rehab center. Here he can continue to be monitored by the doctors who admitted him at the time of his stroke. The average rehab time is two to three weeks.

Unless there are complications to his condition, the worst stage of my father's stroke is now behind us. He will only improve from here. How much he improves, however, is an inexact science and varies greatly patient to patient. Physical therapy will work to strengthen his body to the point that he can move again on his own. While no part of his body became immobile by the stroke, the right side of his body is noticeably weak.

My father has been impaired mainly by what doctors call expressive aphasia. This means that while he is able to understand many of the words spoken to him, he is not able to process the language and grammar to respond. This affects both his power of speech and writing. The hope is that as the blood drains out from the stroke area within the next couple months, and the nerve endings damaged by the blood begin to function again, through rehabilitation he can regain some expressive capabilities. He is already able to walk on his own, with supervision. Memory, reason, speech, and other cognitive functions are still noticeably impaired, although also improving. While he is responsive to the therapists, and seems to understand the need to engage in his own recovery, his attention can flag. He is also prone to confusion.

Now the puzzle for Dara and I--we are his 'health care proxies'--is where my father should go next. He lived on his own on Block Island. Now that's no longer an option.

No one is ever fully prepared for these scenarios, but we have been fortunate in the support and advice we have received from friends and family. My hope is that through this weblog, we can also at times share some of the things we've learned in helping out my father's recovery.