Update and Goals

Thanks to Marc for today's wonderful post!


Natalie had another minor setback this week when her feeding tube got blocked on Thursday evening. The tube had clogged up before, but this time the nurses could not get it unblocked. Nat missed all her meds that day and the tube feeding as well. On Friday she was taken over to Ellis hospital, a general hospital right next door to Sunnyview. There they x-rayed the tube with dye in it and found that it had pulled out of her jejunum, and had kinked. They straightened out the kink but could not re-insert it into the jejunum because her intestines were in spasms. However the x-rays showed that the blockage between her stomach and her jejunum seemed to have resolved in the last few weeks. It was decided to convert the tube back to a G-tube, in her stomach instead of in the jejunum, and see if she could tolerate that over the weekend. So far so good!

When Natalie is feeling unwell or tired she stops talking, or talks much less. Between her C-diff infection last week and the tube problems and procedure this week she has been very tired, and has not talked as much as before, but when she does talk her voice is now louder and clearer.



The therapists recently gave Natalie a new set of goals for the next 3-4 weeks. The most important of the goals are:

1) Orientation to “people, place and time”: People emerging from a coma have very little short term memory, and can typically remember some information from several years ago much better than they can remember information from a few hours ago. For this reason they have trouble recognizing people, understanding what time, date or year it is, or remembering where they are. Natalie is fairly well oriented to people, she knows each of us and generally remembers her therapists. She is somewhat oriented to place, she usually remembers that she is in hospital, and can pick the right hospital name if given a couple of options. She has more trouble with time, even though we go through the calendar several times a day.

2) Following commands consistently: Natalie can follow simple commands, but is not yet 100% consistent in doing so.

3) Discontinue the feeding tube: Natalie is beginning to eat a few small spoonfuls of soft foods by mouth in the morning, and drinking a little with a straw. Gradually she will be encouraged to eat and drink more with the goal of establishing 3 meals a day and phasing out the feeding tube.

4) Switch to a regular wheelchair and learn to wheel it around herself: One of the goals of her physical therapy is to strengthen and tone her back and stomach muscles so that she can sit without full support. She can then switch from her special wheelchair, which has wrap around support and a neck brace, to a regular wheelchair.

5) Family training for bed to wheelchair transfers: We have a goal too! We are learning how to safely transfer her to a wheelchair, and will learn how to transfer her from a wheelchair to a car, so that we will be ready when the time comes for her to make short trips out of the hospital. Natalie will also be taught to help with the transfers by taking some weight on one leg.



There has been some confusion over the posting about Nat walking. To be clear, she was held upright for a few minutes, without taking any of her own weight on her feet, and was encouraged and helped to move her legs in a walking motion. It took 4 people to do this and by no means was she actually walking. She was practicing movements only. We do hope that she will walk again eventually, but that will not happen until she can straighten her right leg and regain more strength and feeling in her left side.