Thursday PM, April 30

Apologies for the delayed update; busy couple of days.

Walter is responding well to the various therapists. He's receiving physical, occupational and speech therapy and likes to show off for his favorites. The doctors removed the NG-tube from his nose and throat and put in the "peg", which will deliver nutritition directly to his stomach. Dad noticed him swallowing today, which is a wonderful sign. Removal of the tube likely made it easier for him to swallow and allowed his throat to recover from being raw from the tube.

At around 6 AM yesterday, the doctors clamped of the "external ventricular drain", or "EVD", the tube that is in place to relieve excess pressure from the ventricles within the brain. The pressure has since then maintained itself within a normal range. If it continues to do that through this weekend, the doctors will remove the EVD and Walter likely will not require a permanent shunt to relieve pressure. Also, once that drain is removed, someone from Shepherd's Spinal Center will evaluate him to determine if he's ready for acute in-patient rehabilitation, lovingly referred to as "bootcamp": 3 hours per day, consisting of 1 1/2 hours in the morning and 1 1/2 hours in the afternoon; 1/2 hour each of occupational therapy, physical therapy and speech therapy.

The most recent CT scans indicate a significant decrease in swelling, so the doctors have stopped the concentrated saline.

Bottom line of all this: the various systems of Walter's body are increasingly working on their own again. His left side continues to be weak, but Lyn even got him to squeeze her hand lightly with his left one today.

Lyn and I recently read about the benefits of music for stroke victims, so Lyn has been playing music for Walter the last couple of days. Lyn says that, in addition to some of the more recent music, he enjoys some Mozart.

As prayer suggestions, please continue to pray for complete healing for Walter; for strength, rest, patience and perseverance for the family and others who are with him; wisdom for the doctors, nurses, therapists and other professionals; and that God be glorified in all.

Love to all.

Wednesday AM, April 29

Walter's CATscan yesterday showed substantial reduction in the brain swelling. The doctors plan to try to wean him off the drain (which relieves pressure around the brain) and see if he can tolerate being totally off of it in the next day or two. They also plan to put the "peg" in his abdomen today, which will allow introduction of nutrition directly into the stomach and removal of the NG tube from his nose. Two intravenous lines were removed from his left arm yesterday, so the peg will be the only external connection. Assuming all continues to go well, the doctors want to move him to Shepherd's as soon as possible; possibly this weekend. Then will start what the doctors call "bootcamp". The prayer there will be for strength and perseverence.

All say that Walter's eyes were much improved yesterday. They seemed more engaged, and, at least at times, tracking better. He's not speaking yet (although, as I mentioned in an earlier post, the speech therapist did get a "yes" out of him), but he increasingly grunts, perhaps (this is just a guess) indicating that, with the reduced brain swelling, he's becoming more aware and trying to communicate.

As a suggestion, pray that the pressure around the brain will moderate itself once the drain is clamped off. If it does not, the doctors will likely implant a shunt to relieve the pressure on an ongoing basis. A shunt would be permanent and would require ongoing maintenance.

Also continue to pray for encouragement and strength for Jessica, Mom, Dad, Lyn and Pat. They have been working the schedule to keep someone with Walter 24/7, and it makes for quite a tiring schedule. Some folks have offered to pitch in on that, and we may very well take you up on it.

Thanks to all.

Tuesday, April 28

A few have asked about visiting Walter. Visitors are pretty much limited to family while he's in acute intensive care. Hopefully he'll move to intermediate care within the next couple of weeks, at which point that may change. I'll keep everyone updated.


Therapy picked up yesterday. Occupational, physical and speech therapists evaluated him. I did not hear any feedback from the occupational and physical therapists, but the speech therapist was encouraged. She said his tongue movement is good and she got him to say "yes". Again, a suggestion for prayer direction: pray that Walter will not succumb to discouragement. Lyn sensed yesterday that he stopped responding after a while with the speech therapist, as if he became frustrated at his inability to do formerly simple things. Or it may just be that he gets tired.

The speech therapist recommended that the doctors remove the nasogastric tube from his nose and throat and install a "peg" directly into his stomach for nourishment. Removing the NG tube should make speaking easier and allow his throat to recover; he has indicated that his throat is sore. We expect that to happen today. The doctors are also beginning to wean him off the tube that relieves that vetricle pressure in the brain. That process takes a few days. Again, one of the current goals is to remove all tubes and get his body working on its own again.

Several people have asked about bringing food. Some wonderful friends have us covered for about the next week-and-a-half, I believe. I'll update as we go.

Best to all.

Sunday PM, April 26

The routine is beginning to come together. We've worked out schedules for folks to stay at the hospital. Everyone is having to fold, drape and bend. For example, it looks like Lyn will initially take the early shift that starts at 5:30 or 6 in the morning. Those of you who know her understand the irony of that. Lyn's "musical girls" -- the team that she works with producing musicals in our area-- are scheduled to bring meals over the next couple of weeks, bless them. We're settlin' in.

Walter had the hiccups today, sometimes for extended periods. Mom and Dad were with him much of today. Jessica's parents, Brenda and Bobby, are here through tomorrow. They will spend the night at the hospital with Jessica tonight. Jessica finally took some time today to leave the hospital, go to her and Walter's townhouse and take care of things like washing some clothes. etc. She has to go back to work tomorrow, so the next stage of our routine will kick in then. Life continues.

Here's the address for cards (I recall that flowers are prohibited):

Walter Romine, Patient

Emory University Hospital

Neuro ICU

1364 Clifton Road

Atlanta, GA 30322

Remember Jessica's earlier suggestion about contributions to Shepherd's Center. You can check out the earlier post with the information on that.

A visual

I thought you might like to get a view of the set-up at Emory. Here's are a picture of Dad and Walter watching the NFL draft yesterday.

John Taylor

Settlin' into Patience

The title of this post comes from the book "Jayber Crow" by Wendell Berry. Wonderful book, in many ways. Highly recommend it.

We seem be moving from constant drama into a routine, however long it might last. The medical staff tells us that the goal for the stay at Emory is to stabilize, to gradually wean Walter from the various tubes and get his body to working on its own. More visible progress should come once he moves to Shepherd's and begins the various therapies. We are prayerfully settlin' in.

The staff encourages us that Walter is not evidencing anything right now that is out of the ordinary under these circumstances. His eyes are open much more, but he does not seem to have control over them and they're not tracking. He indicates in answer to questions that he's seeing double. He has a patch over his right eye right now, in an effort to strengthen the left one. A nurse said that the eye situation may also be addressed later, if needed, by surgery. In a swallow test last night he was unable to fully swallow ice chips, so he's not at the point of handling real food yet. Since he still needs nourishment through a tube for now, the plan is to remove the tube from his nose and install a tube directly into the stomach. That arrangement should be more comfortable; Walter has indicated that his throat is sore.

Dad shaved him again this morning and massaged his feet. We received an email earlier suggesting that stroke patients enjoy having their feet held; gives them a sense of grounding. Walter's response seems to bear that out.

Love to all.

What a Day!

The day started in the wee hours getting Walter to Emory via helicopter and ambulance. It ends with much-needed encouragement.

Two developments today, both the subject of much prayer. First, Walter had an angiogram (a test that uses a special dye and camera to take pictures of the blood flow in the blood vessels of, in this case, the brain). Dad explained to me that an angiogram can discern things like aneurysms, tumors or narrowing or blockage in blood vessels. Walter's angiogram showed no such thing! It was normal. All the doctors detected was high blood pressure.

Second, the doctors discovered that Walter's sodium level was low, so they've started to treat that. The nurses told Lyn and Pat today that they have seen this treatment work extremely well in reducing swelling. Let me know if you want an explanation of the chemistry behind it and I'll have Dad write a guest post. In any event, once the swelling is reduced sufficiently the doctors will then be able to get a better look at the source of the bleeding. It is possible that the bleeding resulted from a leak from a blood vessel caused by, or at least exacerbated by, high blood pressure. If that's the case, then the only thing to treat is the high blood pressure, although physical therapy will still be required. This may be getting a little ahead of ourselves, but the prognosis may be much better than feared. Not out of the woods, but grateful for answered prayer and good news!

Transition

As it turned out, the call from Emory was the beginning of a dramatic night. No ambulance service was available--or willing-- to take him to Emory, but Emory said that he'd lose the bed if he did not arrive shortly. We were finally able to engage a medical air service to take him by helicopter. Weather forced a landing in Columbus. An ambulance took him the rest of the way to Emory. Allow me to say that's the short version.

By the time Walter arrived, his ventricular pressure had elevated again and he was not responsive, so the doctors have reinserted the bolt, or valve, to relieve pressure. Lyn just told me that he has now begun to open his eyes again. The doctors continue to evaluate him. I will update as we go.

Wednesday Night, April 22

We just got word that Walter is being transferred to Emory tonight. Wonderful news! Will update as learn more. Thank for continuing prayers!

Wednesday, April 22

Following up on the determination that the pressure within the brain ventricles is regulating itself, the doctors on Tuesday removed the drain (called a "bolt") from Walter's right frontal lobe and replaced it with two staples. That is good news. He sat up in a chair for a couple of hours to give his back a rest from lying down. He received acute therapy on his left side and a little speech therapy. He enjoyed the massage of the acute therapy. He moved his left shoulder a lot and his left leg some. He got pretty frustrated with the speech part because he couldn't do a lot of what the therapist asked him to do; e.g., moving his tongue around, saying "mmmm", etc.

He has tried to communicate by pointing to things and by writing. The writing is illegible. The doctor says that the remaining swelling in the applicable parts of the brain make these attempts at communication difficult. Walter kept his eyes open most of Tuesday but was very agitated, perhaps because he's probably seeing multiples. Therapists administer respiratory therapy every four hours, including through the night. Despite the exhausting day, he had difficulty sleeping last night.

Today, the doctors plan to remove the NG-tube from his nose and throat, through which he's been receiving medication and nourishment, and replace it as a longer-term solution with a gastric feeding tube ("G-tube") that will provide access directly to the stomach. He will be sedated for that procedure, which should take thirty minutes at the most. Removal of the bolt and the NG-tube will remove two connections from his head. If he keeps breathing well and the respiratory treatments do what they're supposed to do, perhaps he can soon come off his oxygen as well. The fewer connections the better. He tried to pull one or two out before and must sometimes be restrained to prevent that.

He has a CT scan scheduled this morning. We believe that the swelling may be continuing to go down because he is becoming more aware of what's going on around him.

His color looks great and of course Walter, Sr. is keeping him well groomed. J

We are doing what we can to expedite Walter's transfer to Emory. The consensus is that it's time to go.

As a suggested point of prayer, please pray that Walter will not be afraid. Jessica senses fear in his eyes as he becomes more aware. Those around him constantly seek to encourage and calm him, but his inability to communicate renders it difficult to know what he's feeling. Jessica prays with him every night and he squeezes her hand to acknowledge "amen".

Monday Evening, April 20

Some progress today on a couple of fronts. First, it appears that Walter will not need a shunt inserted long-term to control the pressure around the brain. His body is handling it. Second, he's keeping his eyes open more and seems to be trying to focus. Third, he's keeping nourishment down and his digestive system is working. All that is progress.

The doctor reports, however, that today's scan, while it showed somewhat of a dissipation of the blood around the brain, did not indicate a reduction in swelling.

We're waiting to receive word that Emory has a bed for him. Hopefully that call will come in the next day or two.

In response to the question of some regarding what they can do, Jessica suggests that anyone desiring to do so may make a contribution on Walter's behalf to The Shepherd Center, where he will be doing his rehab once we get to that point. Below is the link for contributions, which are most appreciated:

http://www.shepherd.org/giving/ways.asp

More later.

John Taylor

Sunday Morning, April 19, 2009

Quick update for this morning: Walter had good night. He's opening his eyes a bit more. The doctors have ordered respiratory therapy to work to keep the lungs clear.



For those of of you who may feel the need for prayer focus, Lyn says that she's praying right now that (1) his eyes will open and be conjugate (which I think means to track together like they're supposed to; they haven't been doing that the little bit that his eyes have been open); (2) he be able to tolerate nourishment; and (3) he speak. May the Spirit otherwise lead.



Here are some emails that we received before the blog went online (I have done some editing on them):



"Thank you for sharing this with us. Will start praying this morning-we have such a mighty God. We have had some dealings with the Shepard Center. As you know, it is an outstanding place-we were very impressed with the staff especially. Please keep us posted-if there is anything else I can do-please holler! Love you all"



"We are praying constantly. The other day a woodworking acquaintance was over to pick up some wood, and it turns out he's a part-time preacher at a little church. A prayer meeting of sorts broke out in the workshop! Another friend who is a very intuitive, alternative 'healer' suggested that someone (jessica?) hold his feet from time to time. Her rationale was that many times people who have had strokes sense a lack of grounding (that part seems reasonable) and contact with the feet apparently helps with this."



"Thanks John for the update. We will continue to pray and seek God's face about this."



"I am shocked and so sorry to hear this. We will pray for a full recovery. When I see patients in or facility after a neurological event, it is tough. The patients I feel have the greatest struggles are those without faith and those without family. Walter has both. Walter is surrounded by those that believe and those that love him. I will refrain from calling for a few days until you might know more. I know the calls are steady. As you know, Emory and the Sheperd center are the absolute best facilites for him. Please give Walter a hug and love from Alaska. We'll be praying for Walter, Jessica and the family. Thanks for letting us know. If there is thing we can do, we'll do it."



"Thank you so much for including us in these communications. As I've often said when my friends of all religions offer their prayers for my family.... I'll take them and hope someone or everyone has a direct line! I believe you know how much we love your family and hope that this difficult period is as short as possible."



"Yes, I will pray for Walter. There are no coincidences with the Lord. He is in our midst and cares so much for our well being. Emory and Shepherd are wonderful places for him. Let me know what I can do."

Beginning of a Long Road

Walter Romine, 38 years old, had a stroke early Friday morning of last week (a week ago yesterday). He had been exhibiting concerning symptoms (e.g., a drawing up of the fingers on his left hand; numbness on his left side) for some time. He had visited two neurologists and had an MRI scheduled for this past Tuesday. He picked up his wife Jessica (26 years old) at the Atlanta Airport late Thursday evening to drive down to Quitman for the Easter weekend. The stroke occurred on the trip down. They went initially to the emergency room in the Valdosta, GA hospital but shortly transferred to Archbold Hospital in Thomasville. Archbold is a wonderful medical facility, with a strong staff. Walter, Sr., Walter’s father, has strong connections there from his own days of medical practice.

The doctors shortly diagnosed Walter’s condition as resulting from a hemorrhaging hemangioma located in the thalamus, a part of the brain down near the brainstem. They have not been able to discern the precise scope of the lesion because of brain swelling (which has been going down), but they have observed that the lesion is unusually large. They have told us that such a lesion in this part of the brain, especially a bleeding one, is unusual.

Walter has spoken and opened his eyes little since the first few hours after the stroke. He responds readily to requests such as “squeeze my hand” and he can answer questions with hand signals, using his right hand. His left side is compromised. He is receiving nourishment intravenously and through a tube into the stomach. The nourishment directly into the stomach has occasionally caused nausea and vomiting, so the nutrition is being supplemented intravenously.

Peggy (Walter’s mother) called this morning with encouraging news: Walter moved his left arm and left leg for the first time.

For those of you who believe that God cares about, and is involved with, his people (although we do not understand the how or why of things), and that he sometimes speaks in very direct ways from Scripture, I offer this from my discussion with Peggy this morning: This morning she read the prayer of Nehemiah in the face of opposition to his leading the people in the rebuilding of the wall of Jerusalem: “Oh God, strengthen my hands”. (Nehemiah 6:9). On the way to the hospital this morning, she told Walter Sr. about it. When they got to the hospital, the doctor told them that Walter had moved his left arm and left leg, for the first time. Coincidence? Maybe, maybe not.

Walter is on the waiting list for transfer to Emory. The doctors estimate that the transfer will occur early next week. If things progress as expected (although, of course, nothing is certain), that timing should line up well with the resolution of the brain swelling. Emory, as a teaching and academic hospital, appears to be well-equipped to take the lead in the next step of the process, which is determine treatment of the lesion itself. For example, we are told that Emory has an MRI that delivers more detailed imaging. This should enable to doctors to fine-tune prognosis and treatment. We understand that there are various options, all the way from doing nothing to computerized laser procedures.

Longer term, it appears likely that Walter is looking at an extended period of physical therapy and rehabilitation. The Shepherd Center in Atlanta will likely be the provider of those services.

So, it appears that Peggy and Walter, Sr. will pretty much be living here in Atlanta for a prolonged period of time once Walter gets up here.

As you can tell, much is uncertain.

Again, for those of you who believe in prayer, please pray.

John Taylor