When Therapy Runs Out

We have almost exhausted my father’s allotment of therapy for his stroke. Will supplemental insurance make a difference? For now he is seeing an acpuncturist twice a week.

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Sometimes it feels like we are going in circles.

In order to get better after his most recent stroke, my father needed therapy. He could only tolerate so much therapy when we started. And then when he could tolerate more, and was starting to make progress, we had to decide how much therapy and which therapy to keep.

As you may have guessed, Medicare will only provide a certain amount of money for therapy. To complicate matters, speech and physical therapy funds come from the same bucket. And speech and physical therapy are what he needed the most.

We have already seen a difference in how easily he is able to sit up once he is moved from a wheelchair to a bed at therapy. When he was attending weekly, not surprisingly, it was easier for him.

If he needs therapy to get better, goes to therapy, then tolerates more therapy and makes progress, but then has to stop, how will he get better?

If he needs therapy to get better, goes to therapy, then tolerates more therapy and makes progress, but then has to stop, how will he get better?

I have looked into supplemental Medicare plans, but that will not help his current situation and get him addditional therapy.

A family member might be able to add him to his insurance, but that might not happen until next year. Which means my father, who is still making an effort to get better, will go half a year without therapy.

I asked what it costs to pay out of pocket for therapy, and it is not cheap.

The good news is he makes progress with mental stimulation exercises, particularly math and multiplication tables. He is now up to the “6” times tables and one of the activities persons at the skilled nursing facilty is supposed to review them with him (in addition to being mentally sitmulating, it is something he enjoys). For some reason his mind remembers addition and subtraction easily, but multiplication has become a challenge.

He continues to move his left arm slightly during occupational therapy exercises. The left side of his body was paralyzed whe he had his stroke last March.

And he recenlty moved his left thumb.

While these are all minor improvements, they are still cause for celebrating. I remind him that each small improvement will lead to more, and the more he is able to move, the easier it will become.

Acupuncture is going well, and his traditional Chinese acpuncturist immediately recommended herbs that have helped with his circulation. His skin color looks healthier, he is more alert and he is holding his head up better.

He is now tolerating twice-a-week appointments.

It is slightly easier for him to close his mouth, which is important for swallowing. Swallowing is still difficult, but when he closes his mouth and then “chews”, it is a little easier for him to swallow. But oftentimes he must be prompted verbally to do so, and sometimes verbally as well as physically (tactile sensation on his chin and tongue are usually the triggers to get him to swallow).

It is slightly easier for him to close his mouth, which is important for swallowing. Swallowing is still difficult, but when he closes his mouth and then “chews”, it is a little easier for him to swallow. But he must be prompted verbally to do so, and sometimes physically and verbally (tactile sensation on his chin and tongue are usually the triggers to get him to swallow).

We have our light moments.

My significant other, who is fluent in Mandarin, taught me to say, “I speak a little Chinese.”

Like an eager tourist, I tried out my Mandarin on a native speaker. My father listened, and then he started to laugh. I asked if my Chinese was OK — I wasn’t sure if he knew it was Chinese — and he nodded. Then I asked him to tell me if it was good (thumbs up), so-so (rotating hand side to side), or bad (thumbs down).

He graciously said it was so-so.

It reminded me of the time I called him several years ago to tell him I was taking a Mandarin class. He said to tell him something in Mandarin. I did. But he had trouble understanding me, so I repeated it a few times.  Then he said to just tell him in English.

His acupuncturist helps me translate and speaks a few words of Spanish to me sometimes because she knows I am part Mexican. A few times she has teased him, in Mandarin, for not teaching me to speak his language.

 

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My father, at acupuncture last week. Electric pulses course through some of his nerves when small clips at the end of the different colored cables attach to some of the needles in his face and body. Acupuncture has helped his paralyzed side move a little, improved his flexibility, and given him more energy and strength to participate in physical and occupational therapy. By being better able to participate in therapy, he has gotten stronger, and able to sit with little or no assistance at times.

 

And at a recent acupuncture visit he moved his left arm. He lifted it when I asked. It was a very natural movement, immediate and deliberate. For a second or two I forgot the left arm has not moved since the stroke last year. Then the realization hit me.

“Hun hao (very good),” I exclaimed. “You raised your arm, that’s great!”

And at a recent acupuncture visit he moved his left arm. He lifted it when I asked. It was a very natural movement, immediate and deliberate. For a second or two I forgot the left arm has not moved since the stroke last year. Then the realization hit me.

He could only do it once, and knows whether he can or cannot move it. It fascinates me to hear his occupational therapist ask him in Mandarin if he can move his arm or if he can move it again after an exercise. He answers honestly, and immediately.

Our trips to USC Keck Medical Center for outpatient rehab have become less frequent for the moment, which is why I increased his acupuncture treatments. It seems to me it is a little easier for him to close his mouth, and I wanted to get his feedback. So I asked.

Google translated for me and when I played the question for him in Mandarin, he listened. Then he nodded.

 

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Google translated my question to my father into Mandarin, and then I played the translation for him to hear. My father has shared with me that my Mandarin is so-so (which is generous of him) and I translate and play back questions or phrases whenever possible.

 

This might sound like a simple question. Or an odd question. But for a person recovering from a massive stroke — who cannot eat and has difficulty swallowing, closing his mouth and being able to keep it closed, and command the muscles to obey and move and swallow — the ability to answer that question affirmatively is quite a feat.

Practice makes it easier. And having someone help him practice when he is not at USC for therapy, or with his acupuncturist or with me, is a challenge. We will soon see if with some additional training the staff at the skilled nursing facillity will be up to the challenge of helping him perform some basic exercises to trigger a swallow.

 

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I recently provided this list of common words the staff at the skilled nursing facility can use with my dad. At least one nurse expressed interested in learning Mandarin when I mentioned during a training session I translate words to Mandarin to make it easier for him to understand what I am asking. 

 

He is scheduled for a visit with my acupuncturist later in July. Some readers of this blog may recall I had a complicated ankle injury that involved damaged nerves, a sprain and a minor fracture. I had difficulty moving my toes, could not move my foot to the left and was on crutches for half the year.

My official diagnosis was Chronic Regional Pain Syndrome (CRPS) which in severe cases make life extremely painful and dibilitating. Not to say that my time on crutches was a pleasure. I rarely take medication, I prefer the natural route. But the pain was so severe at times I had to take pain meds, and then suffered the side effects.

The CRPS was causing false pain messages to be sent to my brain and with physical therapy and acupuncture, I was eventually able to walk and run again. My acupuncturist essentially “rewired” me so that messages would no longer travel on the paths that were sending the pain message to my brain.

I am curious how this will help my father after a stroke. I know that it will, that has already been made clear. But with her particular bag of tricks, things will get very interesting.

 

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My father, after an acupuncture treatment. 

Connecting with Connect Four

It was Sunday, and I thought I’d pay my father a visit at the skilled nursing facility. A caretaker who accompanied him to acupuncture the day before said his left arm was very active and that the acupuncturist was working to awaken his throat muscles and improve his ability to swallow.

I was curious if I’d notice a difference in his appearance or demeanor after my 10-day trip to Chicago.

He was awake when I came in, not quite laying down and leaning to his left. He didn’t look very comfortable. Despite knowing how to call for the nurse, he does not use his call button. I snagged two nurses from the hallway and asked that they kindly sit him up.

His most recent stroke was in March 2015, and he has been living at a skilled nursing facility in the Highland Park neighborhood of Los Angeles (northeast of downtown) since last May.

The stroke left him paralyzed on the left side of his body and he cannot yet speak. A few times he’s managed to say a word loud enough for me to hear. He swallows more than before, but it is still not enough and he remains at risk for pneumonia if his saliva goes to his lungs.

It’s not all bad: my father recently moved his left arm, and indicated he’d like to walk. He is aware he must strengthen his upper body, and has been an active participant in physical and occupational therapy since we confirmed he was indeed moving his left arm at will. At a recent occupational therapy visit he sat with zero to minimal support for several minutes. When asked, he nodded that he wanted to try and stand. Assisted, of course.

We reviewed my Chicago photos, which included food, and various buildings around the city that were part of the “L” train tour I created (I have a fascination with architecture and building design) and the gorgeous views from my boyfriend’s family’s cottage near a lake in Hastings, Michigan. The photos also included the murals that dot the area around Chicago’s Columbia College and Wabash Arts Corridor.

I noticed he was very alert and he seemed curious about what I would show him. He was happy to view the photos on my tablet and when we were done, he watched carefully as I closed the tablet and set it aside.

To transition to physical activity, I asked about his right hand and how much he is able to open it. I then asked about his arm, and more questions led to a mini physical therapy session, where he had to touch the top of his head or his left shoulder. A few more minutes of this continued with head, mouth and leg exercises. I reminded him how important it is for him to move, even while he is in bed.

I asked if he wanted to play Connect Four. He did not say no, so I walked over to the closet and pulled out the box. I showed it to him and asked if he remembered playing with his therapist at USC Keck Medical Center. He quickly nodded.

For those of you born after 1974 when the game was first sold, small, round, plastic discs are inserted into a frame and the first person with four discs in a row, either horizontally, vertically or diagonally, wins the game. Think Tic-Tac-Toe, but instead of an “X” or “O”, each person picks a round, colored disc.

Our game features yellow and red discs.

While he cannot speak yet, my father is completely aware of what is going on. His addition and subtraction skills are still intact, although multiplication is giving him problems and he usually has homework that involves reviewing multiplication tables (he’s on the 4’s at the moment).

He also still likes to read. Like my grandfather who had his own printing company in China, my father had his own printing business. He greatly enjoyed or was greatly intrigued by a recent story about meat turning fluorescent blue in China. It was under investigation the last time I checked, but government officials warned people not to eat any blue meat.

I set up the game, and on this day I was red, he was yellow.

I knew I had to pay attention during our game, and I had no intention of letting him win. Now, before you start to feel that I am a cold-hearted daughter, you should keep reading. Yes, I blocked his moves a few times and to my surprise, he got a BIG kick out of blocking me.

I knew I had to pay attention during our game, and I had no intention of letting him win. Now, before you start to feel that I am a cold-hearted daughter, you should keep reading.

You can see from the photo below that I was making my way across diagonally, and his yellow disc stopped me from winning the game.

“Hey, you just blocked me!” I said in surprise. He started laughing and I started laughing. We laughed for a while. Sometimes his laughter is silent, and I only see his mouth open and his body shake. But on this day, I could actually hear noise as he laughed.

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During a game of Connect Four, I attempted to win the game with a horizontal line of four red pieces. My father blocked my move with his yellow disc. We both laughed after I was surprised by his move.

We carried on with our game. At one point I asked if he wanted to continue playing because it didn’t seem anyone was going to win.

He ignored me, so we continued to play.

I thought I might have some luck on the right side of the board, and wasn’t really paying attention to what he was doing.

On his next move, I saw he was more eager than usual to get a disc in to the frame.

I saw where he might be placing it.

“Where are you putting that piece?” I asked, hoping he was not doing what I thought he was doing.

He focused on what he was doing, ignoring me again, and finally dropped the disc in.

I didn’t say anything.

Then he raised his arm again, and motioned to the four yellow discs that appeared horizontally on the frame.

In case I wasn’t paying attention, he was letting me know the obvious: he just won the game.

Then he raised his arm again, and motioned to the four yellow discs that appeared horizontally on the frame. In case I wasn’t paying attention, he was letting me know the obvious: he just won the game.

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My father recently beat me at a game of Connect Four, and made sure to point to the four yellow discs making a horizontal line across the center of the board.