Waltraut Giesela Kairies

Val-trout

My grandma Vee (My dads mom) is now further from me than she has been in a long time……..ever,really…..she is closer though to her daughter Dorothy, in Yorktown VA also there is my dad and his wife Mary.  For me it’s bitter sweet that at least she will be closer to her children but the distance for me is almost too great it seems like visits will be few and far between. She was at my celebration of life so I think that means the most.

Grandma if you are reading this or it’s being read to you, I miss you already.  Hopefully soon we will get to come down there. Also please know that of course, I am wearing my jacket.  I do hope your enjoying your new place

awareness

Quick update… we were thrilled to meet Michael’s case manager Chris with Brain Injury Services.  The first visit was an informal “get to know ya” but I think the first impression was shared by all – this is the perfect match for Mike.  He was open to working with Mike’s Neuropsychologist, I would actually say he was delighted to work in partnership with her. Mike’s team will now include two people who specialize in helping brain injury survivors find their way.  YEAH!!!!

March is Brain Injury Awareness Month – to bring attention to the seriousness of brain injury, their focus varies each year. Ironically, 2009 is to raise awareness of sports related brain injury.

I’m sure everyone has heard of the recent untimely death of Natasha Richardson during a skiing lesson on a beginner’s slope.  Her death caused by an injury to her brain.  By all accounts, her injury was a mild head injury much less severe than the injury Michael sustained to his brain. Her death was an accident, a sports related head injury. The doctors said she might have survived if she had received immediate treatment. However, nearly four hours elapsed between her fall and the time she was seen at the hospital. She suffered from an epidural hematoma, which is often caused by a skull fracture. It can quickly produce a blood clot that puts pressure on the brain. That pressure can force the brain downward, pressing on the brain stem that controls breathing and other vital functions that keep us alive. The scary thing is you might feel fine immediately afterward because symptoms from the bleeding may take time to emerge.

For Michael – an auto accident. He suffered blunt head trauma and multiple lacerations to his head while driving home intoxicated on Interstate 66 at exit 66. The vehicle left the road at a speed in excess of 60 miles an hour, hit a guard rail at the exit, the impact propelled the Jeep forward with it’s rear flipping over the front. It landed headlights up on the right rear side, the sudden deceleration threw the Jeep forward again hitting a tree headlights down and one more bounce back to all four tires.

There were many forces that caused traumatic damage to his brain. He had three large lacerations; the temporal areas of both sides and the occipital area of the back of his head. The cerebral cortex was bruised (contused), the deep white matter suffered diffuse axonal injury when his head whip-lashed without necessarily hitting a hard object, the axons stretched so much that they were torn and damaged (sheered). Cerebral contusions at the tips of the frontal and temporal lobes where they banged up against the interior of his skull. Diffuse axonal injury occurred more toward the center of his brain where the axons were subjected to the most stretching. His brain was swelling from bruising and pooling of blood. Michael’s injuries were so severe, he was non-responsive and Code Blue upon arrival in the ER.

The outward injuries to his body were obvious but the injuries to his brain although assumed, were invisible. We were fortunate that a cab driver witnessed the accident and called for help. Blessed that the ambulance responded quickly and Fairfax Hospital was within minutes of Exit 66. Within those first critical hours, he received brain injury specific medical treatment including a craniotomy that allowed his brain to decompress. Swelling of the brain becomes dangerous when the swelling causes a rise in intracranial pressure which prevents blood from entering the skull to deliver oxygen to the brain. Because of immediate medical attention, Michael survived. It could have been so different. Worse yet, it could have been prevented.

Sports injuries however may not be as clear cut, not as easy to identify as Michael’s. Many times head injuries are very treatable if you’re aware of what the problem is and you quickly receive medical attention. Would it be horrible to think the injury to your/his/her brain could have been prevented? If only I/he/she had worn a helmet. If only he hadn’t gotten behind the wheel. I speak from my heart when unequivocally I answer, yes. Yes, it is horrible to know it could have been prevented.

Ya know, I’ve been thinking. Wearing a helmet may be like wearing a condom. Nobody “wants” to wear one but each will save your life. Put helmets on those heads.

xxoo

hear ye, hear ye

The best therapist/mother I’ve had, my own mother, has released a new video. If you will direct your attention toward the video section, you may notice the newest addition.Carry on.

today – the next step

I considered purchasing a tin sign, complete with instructions that I saw in a store the other day. There was a circle in the center and “Bang Head Here” written in bold lettering. Resistance personified.  Resistance? OMG! You don’t even know but we’ll get to that later…

The next step… Michael’s intelligence still fully intact (thank you God) scoring with an above average intelligence, which is awesome but unfortunately also leads to a large measure of his frustration and honestly adds to much confusion with family and friends. Traumatic brain injury is so complicated. When your brain stores so much of the same pre-injury information how could he see the variety of cognitive impairments? How would he acknowledge the impaired memory ability, the compromised executive functioning, and decreased fine motor speed? The brain controls everything – and self assessment or the lack of, is a part of the injury.

But if we’re talking about Michael’s desire to move forward, his primary focus of going back to school, his determination to stop this “busy work” and get back to business then we should probably start at the beginning.  You see Michael is tired of this rehab stuff with me – TI ERD (that’s country for really tired).  He’s impatient, antsy, ready to move on.  He just doesn’t realize how far he’s come, or what a short distance we’ve traveled on this road to recovery. 

Remember the Glascow Coma Scale and the Rancho Los Amigos?
Glascow Coma Scale
Eye opening
4 = Spontaneously
3 = To voice
2 = To pain
1 = None

Verbal response
5 = Oriented
4 = Confused
3 = Inappropriate words
2 = Incomprehensible sounds
1 = None

Motor Response
6 = Follows commands
5 = Localizes pain
4 = Withdrawal to pain
3 = Abnormal flexion
2 = Abnormal extension
1 = None

The scale is also used to determine chances of recovery from head injury:
Mild (GCS 13-15)
Moderate (GCS 9-12)
Severe (GCS 3-8)

The Glasgow Coma Scale is the most widely used method of defining a patient’s level of consciousness and neurological status, or brain health. Michael was Code Blue on arrival with no movement, eye opening or verbal response to pain – his GCS of 3 was the lowest it could be without being dead.  He remained at a GCS of 3 for a month.  We believe that prayer and the grace of God were responsible for the miraculous healing and this second chance to live. 

During the year following his decision to get behind the wheel after drinking with friends, Michael moved his way up the GCS and on to the Rancho Los Amigos measure.  After 17 exhausting months of daily physical and cognitive training, I would love to say to Michael that he doesn’t have to work at this anymore, that I won’t push him to be everything that God intends him to be, but I can’t. A traumatic injury to the brain changes your life forever.  I won’t ever be able to say to my son “you’re healed”, “it’s done, you can relax now”.  BUT what I can say is with persistence and dedication every single day for the rest of his life, his brain can be re-trained, it can and will learn new pathways. But it will NEVER, EVER be the same.
 

Rancho Los Amigos

Today Michael probably sits between and Level VII and Level VIII

Rancho Los Amigos
Level VII
Automatic, Appropriate: Minimal Assistance for Daily Living Skills
* Consistently oriented to person and place, within highly familiar environments.      
* Moderate assistance for orientation to time.
* Able to attend to highly familiar tasks in a non-distraction environment for at least 30 minutes with minimal assist to complete tasks.
* Minimal supervision for new learning.
* Demonstrates carry over of new learning.
* Initiates and carries out steps to complete familiar personal and household routine but has shallow recall of what he/she has been doing.
* Able to monitor accuracy and completeness of each step in routine personal and household ADLs and modify plan with minimal assistance.
* Superficial awareness of his/her condition but unaware of specific impairments and disabilities and the limits they place on his/her ability to safely, accurately and completely carry out his/her household, community, work and leisure ADLs.
* Minimal supervision for safety in routine home and community activities.
* Unrealistic planning for the future.
* Unable to think about consequences of a decision or action.
* Overestimates abilities.
* Unaware of others’ needs and feelings.
* Oppositional/uncooperative.
* Unable to recognize inappropriate social interaction behavior.

Level VIII Purposeful, Appropriate: Stand-By Assistance
* Consistently oriented to person, place and time.
* Independently attends to and completes familiar tasks for 1 hour in distracting environments.
* Able to recall and integrate past and recent events.
* Uses assistive memory devices to recall daily schedule, “to do” lists and record critical information for later use with stand-by assistance.
* Initiates and carries out steps to complete familiar personal, household, community, work and leisure routines with stand-by assistance and can modify the plan when needed with minimal assistance.
* Requires no assistance once new tasks/activities are learned.
* Aware of and acknowledges impairments and disabilities when they interfere with task completion but requires stand-by assistance to take appropriate corrective action.
* Thinks about consequences of a decision or action with minimal assistance.
* Overestimates or underestimates abilities.
* Acknowledges others’ needs and feelings and responds appropriately with minimal assistance.
* Depressed.
* Irritable.
* Low frustration tolerance/easily angered.
* Argumentative.
* Self-centered.
* Uncharacteristically dependent/independent.
* Able to recognize and acknowledge inappropriate social interaction behavior while it is occurring and takes corrective action with minimal assistance.

The next step is to continue training, continue rebuilding, continue setting daily goals that lead to achieving weekly goals that build the new foundation for the future. Michael’s hopes and dreams for his future are not so different than they were pre-accident.  But the road he’ll travel to get there is profoundly different. He wants to be a leader, he wants to have a lifetime of learning which equates to getting back into the class room every now and then, he dreams of having someone by his side for love and companionship, he hopes to have children, he wants a life. He wants to be the driver of that life, not the passenger. 

The only limitation I see for Michael is him getting in the way of himself; concrete rigid thinking and stubborness.  And Michael knows that no matter how difficult it gets, I am there to push him through the concrete. He will not have an easy time of getting in the way of himself.  My prayer is that his and all of our hopes and dreams come true. This is what we’re doing to get there:

Michael is rebuilding with tools for life after and with a brain injury.  He meets with a neuro-pyschologist on a weekly basis and together they are developing plans for Michael to take control of his own recovery.  Does that mean he does it alone?  No, it means ultimately he is in control with the understanding that needing help, doesn’t mean you are helpless. Together they are building a base of strategies for success to compensate for cognitive losses that may or may not return.  A very positive hour that also allows Michael to share and to work through his frustrations and concerns with a professional. Someone outside the family who has the knowledge and experience to light the way when all we see is darkness.

Michael’s application has been accepted and he has been assigned a case manager through Brain Injury Services.  The first official meeting is this coming Tuesday (St. Patty’s Day) when we will learn about social activities, cognitive therapy and perhaps even vocational training.  We are looking forward to opening many more doors with BIS and hopeful that this will assist Michael in his journey forward. We welcome their assistance.

We greatly appreciate the recent order for physical therapy from Michael’s primary care physician.  She will work with him to improve his gait and to strengthen his prior dominant right side so it will take over for his now dominant left side. 

From my perspective, as his mother and TBI caregiver this is more than a bumpy ride. It is emotionally draining, physically exhausting and (remember the tin sign?) often times very frustrating. The bridge connecting my relevance to Michael’s rehabilitation efforts are increasingly lost with him. Each day he is less likely to actively participate in our cognitive exercises and some days refusing to participate altogether. It’s a very tough place to be emotionally even for him, but we’ll get through it.  I do respect the fact that Michael is exerting his independence again and I am thrilled that he has reached this level of recovery.  I understand that I am the constant reminder (the general he jokes) and sometimes he just doesn’t want to be reminded of what needs to be done. Sometimes he just want to be a normal twenty six year old guy, wanting to get on with his “normal” life. 

The next step… one foot in front of the other,  breathing in, breathing out, one step at a time, one day at a time.  We persist. 

LIVESTRONG Michael

xxoo

purpose?

Now being that this is “Mike Rosner’s blog” I figured this question might be better off asked here

ok………now I have always believed things happen for a reason; my accident included, realistically it was the best thing that has happened…….the coma sucked,the therapy sucked, and now the solitude sucks. I really do believe things happen for a reason (that readon?)  Question is what is the reason?  what now?

For me I feel like theres a chance to continue building my life…….school. I’m very ambitious and would like to see MY next steps as an opportunity to further my education. I am unsure as to which schools would be appropriate or even if there is much difference in which school to choose.  I need to get my bachelors in order to finally go for a phd so thats’s where I start.  So Bachelors-any help?