Philip Michael Erb Sr. (Oct 01, 1944 - Aug 26, 2009)

It is with tremendous regret that I must write that Philip Michael Erb Sr. passed away sometime this morning, August 26th, 2009 following complications from his stroke 2 weeks prior.

Around 2:30am he had some seizure activity on EEG and shortly thereafter had a major spike in his body temperature. Around this time his EEG signals began to flatten out and his brain stem reflexes began to become compromised. It is believed that the highly labile blood pressure he has had for the past 2 weeks contributed to injuring the brain matter in both hemispheres leading to diffuse malignant edema. This swelling began to shut down cortical function, and eventually press on his brain stem leading to herniation and a rapid decline in Phil's health. By the time the family arrived around 6am his EEG showed only trace marks and his posturing and neurological exams were suggesting the worst. Within a few hours his prognosis became so poor and his EEG so faint that he was pronounced brain dead and final arrangements were made. These, as per Phil's wishes, included donation of organs so that the lives of others may be spared.

To anyone that knew Phil, or has been a friend to the family, I'm sure you can understand what a loss this is for us all. His ever-friendly and tirelessly giving personality won so many over, and his wit will be remembered down the ages. While shy, my father had an endearing charm that spoke of comfort, ease, mirth, and security. I'm sure each of you who knew my father can easily think of a well timed pun you can blame him for. But more than anything, to his family, my Dad was our rock. I'm sure my brother and sister will agree with my saying that whenever we needed advice or help with anything, Dad was there for us with well thought out suggestions. Whenever anything went wrong, Dad was there. And whenever something truly great has happened in my life, invariably a large part of the thanks belongs to him.

My father raised me to love technology, to love understanding how things work, but more than anything, he raised me to love learning. It sometimes feels like Dad taught me everything I know, but I realize it's more that he encouraged me to learn everything I have with his support and adoration. Between him and Mom, I do not feel I could be blessed with any better parents, and I will remember and remain grateful to him always. I would only ask that those of you who knew him continue to treasure him in your hearts so that his legacy might live on and flourish.

A memorial service will be held, and when the specifics have been determined I will post them here. Thank you everyone for your support and love in this trying time. Our world has lost one of its treasures, and I'm sure you will all not only join me in grieving for him, but also in remembering and emulating his kindness and humor.

The memorial service will be at 3pm on October 3rd, 2009 at Mills Riverside Park in Jericho, VT. The service will be a potluck, so if you can bring any food that would be appreciated.

Tuesday Afternoon 8/25

I got to meet with Dr. Wayman this afternoon, and to spend a little time with Dad before that. The big news actually has nothing to do with his MRI, but rather my encounter with Dad. He woke when I spoke to him, and then reached out and physically took my hand in a coordinated movement. I waited a couple minutes and then asked him if he'd squeeze my hand, and he gave me a good grasp with the hand. While he's squeezed other family members hands in the past few days, I've been of the opinion that it was a reflexive response, but I was careful to be sure I'd not trigger a grip response while holding his hand. This was very encouraging, and he generally seemed a little more with it today.

Also, I got a chance to view dad's MRI. On one hand, its very scary, as I know what all the structures are, and what's supposed to be there that has been obliterated by the stroke... but it's also encouraging because it doesn't show major changes in areas you wouldn't expect them. For examble, his left hemisphere looks pretty good, and his brainstem is in very good shape. There's a very good chance that Dad could recover a lot of function, so we're still very hopeful.

Also, the 24 Hour EEG is a great thing; if they can identify any seizure activity they can add more anti-epileptic drugs to his regimen and hopefully prevent the seizures. Consequently, this is a situation we can actively combat to help his recovery, where most other options that may be keeping him asleep we have no control over.

Tuesday 8/25/09

I've not yet had a chance to see Dad since getting out of work yesterday (and then the nurses tried to take me out as they were prepping Dad to go for his MRI - well not really, but it was a bit of humor in an otherwise humorless situation).

Although Dad was moved to a new room, he is still in a corner room with a nice view, and now on the floor he should have been on all along. So that is not a bad thing.

The results of Dad's MRI do not show anything alarming - though we hope to learn more after Larson meets with Dad's doctor this afternoon at 1:30. Otherwise the latest is that they have moved his procedure for placing the stomach tube until Thursday.

And today they will run a 24 hour EEG to get a much more complete picture of what is going on with Dad BEFORE they do the tracheostomy tomorrow. Dad is also on another breathing trial like before, where they reduce the amount of assistance the ventilator gives him to breath, forcing his lungs to do more of the work. This is a good thing as it keeps those muscles from getting too lazy, and demonstrates that Dad may be getting closer to no longer needing the ventilator (though there is no guessing as to when that will be). The other day he did so well on the trial that instead of the two hours they pushed him to four - and he did great. So Sunday/Monday they were going for a 12 hour trial, which must have done well for them to do yet another one today.

Mom says that Dad is resting comfortably, and seemed a tiny bit more responsive - but we are talking baby steps here - which is all well and good since they are steps forward rather than back. And you all know Dad - Gold Medalist in Olympic Napping for the past eight Olympics - ever since they made it an Olympic sport. And I am working under the assumption that Dad is simply in training for the upcoming winter Olympics - he has to be in top form to keep his title and the gold!!

I plan on going to see him straight after work (as I do everyday, since I am lucky enough to work across the street from the hospital and live only blocks away - and the kitties are willing to wait [impatiently at best] to get fed for a bit longer than usual). If there is more to share I will post an update or share it with someone near a computer to post for me.

Once again thank you all so much for your incredible support. It really has helped all of us keep our heads and hearts above water - you are all amazing and we love you.

Monday AM 8/24

Dad has been fully transferred to the MICU and now has a bed on McClure 409. This is kind of unfortunate as his last room was on a corner and had a great view, but it will be good to have him on the same floor as the doctors who are in charge of his care. I'm hoping this will allow more contact with his physicians.

Update 12:20pm: I just spoke with one of the medical students following dad's case closely. He will be having an MRI done this afternoon, and is also having a workup done for a Pheochromocytoma. The theory is that dad may have had this tumor which is releasing massive spikes of adrenaline leading to the lability of his blood pressure. Speaking of his bloodpressure, he is back on Esmolol and his BP is now about 150/60, but last night his systolic pressure exceeded 200 for a short while. Early this morning it was down around 120/50.

Dad's condition still remains critical and he's unresponsive, but I've seen a couple new things today. For one, he picked up and drew his left arm to his chest. While I'm not sure what this means (good or bad), it still strikes me as encouraging to see him move it. He has been asleep for the bulk of the time I have been here, but his neurologic responses are perhaps a bit better regarding withdrawal from pain.

Update 2:20pm: Dad is having a PICC line placed. Not a big deal really, but one more little procedure for him.

Sunday Afternoon 8/23

Just got home after spending a little time with Dad. Unfortunately, I didn't see any of his doctors, so don't have any real information to update with. He did have a CT yesterday, and general consensus of people who saw him this morning is that he was a bit more responsive. My brother and I saw him for a little over an hour, but he appeared to be sleeping the whole time. At one point he did squeeze my brother's hand following a request, but we're not sure if it was a concious response or not.

Saturday Evening

Meredith spent all day with Dad today. Some good things have happened today, but things are still not overwhelmingly good. The good news is that they did a breathing trial with dad where they took him partially off the vent for 2 hours, and he did so well that they extended it to 4 hours. Also, Mom says that he really squeezed her hand hard today, which he hasn't done for a few days. He still won't respond to commands, but he does appear to be looking around a little more perhaps.

Also, his left side is more tense and rigid than before, mostly from lack of use. They have told us that we need to move his arm and leg for him throughout the day to help with that.

The neurologists have ordered another CT scan for tonight, but we're not sure exactly why they want to do that. The MRI is still pending, and may get cancelled entirely as they're quite difficult to do with patients like Dad.

Finally, Dad continues to choke on his intubation periodically, so we're eager for him to have the tracheotomy next week. It should help him relax more comfortably. Also, today we were given some very yummy food by kind friends, which is an awesome improvement over take out!

Saturday Morning

Pauline and I went and saw Dad last night. He was pretty well unconcious, though he did wake when I came in and spoke to him (he did not speak to me, sorry for the confusion). He of course then started to gag and cough on the intubation tube, which looks beyond miserable. I can't wait for Wednesday, when he should be getting the tube surgically placed in his trachea. He will also have his feeding tube surgically placed so that he doesn't feel like he's choking on stuff all the time. This will be a wonderful change as he will not require sedation to tolerate the assisted breathing anymore. Dad seems to focus and respond to changes around him, but as of now doesn't respond to direct comands like to blink his eyes or squeeze your hand.

From what I understand Dad had a fairly normal night last night, resting peacefully. His blood pressure remains under better control which is a nice change (around 120-130/80-90). I'm also told the nurses have discontinued his arterial line as they didn't trust the pressures it was reading. Thank you all for your kind thoughts and wishes, we all hope he wakes up soon.

This is the first time I have had a chance to post on this blog before, so I first want to express my deep appreciation to Larson and Isis for the posts they have made so far. I have been at the hospital most of the time that I am not sleeping or trying to keep our house running minimally, so I really haven't had time to do much else.

It has been a real journey the last ten days.....most of it pretty hard, but overlaid with hope and optimism. We have been lucky in so many ways: having our family all live in the area to support each other, great nursing and doctor staff, wonderful support from friends, and many other blessings along the way.

I am personally learning that I actually can use the left side of my brain more than the right at times, and that I can clearly focus my attention for a sustained time on what needs to be done, and what I need to learn in order for that to happen. My goal right now is to support Phil in whatever way he needs it, and advocate for him, and of course to let my love for him pour gently over him. I am so proud of our kids and how we have all pulled together to get through this. I am so glad that it turned out that Larson is both in medical school and is at school at UVM. And I am grateful that he is living with us right now. Phil and Shanin and the girls have been super helpful with meals and house and yard maintance, and Isis is an incredibly nurturing caregiver and supportive daughter.

Yesterday was a really difficult day, for the reasons that Larson wrote about. It was very hard to watch Phil suffer while he was struggling so hard to breathe. I could see that he was very scared, even though he wasn't responsive mostly. Today he is re-intubated and sedated, which is a relief to be around, but the pulmonary doctor just came in and said they were going to take him off the constant sedation, and give something as needed, because the outcome is better with patients who aren't constantly sedated when intubated. It makes me feel nervous that he will start to suffer again, or that he will be scared, but I also want to think long term. I am hoping and hoping that he won't remember any of this after he comes back to us in full. I have heard that he won't,and that's reassuring.

Again, our thanks to all of you who are sending us such positive and loving energy.

Thursday PM

Pauline and I visited Dad again around 9pm tonight. He was much more peaceful due to the propofol, but it was necessary he be resedated. He has been transferred from the SICU team to the MICU (Medicine) team this afternoon, which makes sense as they're usually the ones who take cases like Dad. After some time wasted getting him reintubated, he had a CT scan and an ultrasound of his kidneys. Pauline and I met with the new medicine resident and went to look at the images in radiology with him. The CT showed Dad's hemorrhage as being unchanged, and the ultrasound showed no renal artery stenosis, a possible cause of his unexplained refractory hypertension. All in all, today was a hard day as Dad wouldn't wake up from the sedation, and nobody knows why. We're all hoping that with a few more days rest and recovery he'll be more aware of his surroundings.

Thursday

Some great news today hopefully. They have weaned Dad's ventilator PEEP down to 5 and plan to very quickly extubate him this morning. With some luck he'll breathe on his own and can come off the propofol sedative. This would be great!

Also, Mom says he has been stirring this morning and in the process really moving his left leg a good bit, stretching it and such. This is very encouraging to hear!

Update 12pm: Dad has been extubated, and is off the sedative, but still will not wake. This is very concerning to us as he should have awoken by now. His breathing is a bit labored and his sat is dipping a little last I heard.

Update 2:10pm: Dad still is not arousable. Dr. Bender suggested that it may be partly due to the clonidine he is on... but it could also be a result of the stroke. The latter there is a much scarier concept.

Update 3pm: Dad's breathing is quite poor and irregular, so they are sending him in for another CT as I write this. Things are not looking very optimistic at this point. I will update as soon as I have more information.

Wednesday

I just came from meeting with Dad's doctors. We missed rounds, but they were kind enough to fill us in on their plan. Dad still gained fluids yesterday due to his nicardipine drip, despite the lasix he was given, so they are planning to try to make him lose 2L of fluid today.

Once again, Dad seems to have taken a bit of a turn for the worse. Every day seems to flip between good and bad things, and today appears to be one of the latter so far. Neurology had a dificult time arousing him after taking him off his propofol drip for 10-15 min and are questioning if he had a seizure last night. They are repeating his CT scan as I write this, and will be doing another EEG to look for any seizure activity.

Additionally, he is not responding well to oral antihypertensive therapy, as the 150 of metoprolol tid was insufficient and he had to resume nicardipine. They are changing up his medications some and adding in more oral medications to try to get him back off the nicardipine to keep his fluids level going down. It's likely there are many factors contributing to his current hypertension, not the least of which being his longstanding history of it. Moreover, his brain has suffered trauma from the stroke, and is likely demanding a bit higher BP to maintain perfusion. He is also loaded up with excess fluid, which will drive his BP up, and he is in a stressful setting, despite the propofol hypnotic sedative.

His lungs are doing pretty well now, but he still isn't quite breathing strongly enough to be weaned off the mechanical ventillation just yet, which is unfortunate as we'd love to take him off the propofol at this point. It would be much easier to assess his neurologic status if he was not always coming off sedation.

Like always, thank you all for the love and support.

Update 11:35am: Good news, Dad's most recent CT scan shows no changes or evidence of rebleeding.

Update 7pm: Dad had his EEG done, but the results have not yet been analyzed. Also, he has had more lasix (furosemide) given to help shed some water. The nephrologists came by and are changing his anit-hypertensive drugs around a bit, but I'm not yet sure of the specifics. Hopefully they will come up with an entirely oral regimen that keeps Dad's pressure well controlled. At this time he remains intubated and sedated, and will likely be so for a few more days while they wean him off the ventilator. I for one am eager to have him breathing independently, and unsedated so that we can talk to him once more.

Update 11:59pm: It's clear that Abbey really misses her Dad. She keeps barking all day and insisting on going outside the bedroom at night, presumably to look for Dad. I really hope there's some way we can bring her to visit him in the nearish future (once he's out of the SICU and mobile in a wheelchair perhaps).

Also, success! I just hacked into my Dad's MedCo account and was able to get his current medication lists for the doctors. There has been much trouble getting the right lists to them for whatever reason, so this should be useful. I found that he was on one more anti-hypertensive than I thought; enalapril, an ACE inhibitor.

Tuesday PM

Evergreen and I stayed with dad until about 4:15 today; we would have liked to stay longer, but I had to pick something up by 4:30 and we had shared a ride in.  Dad's condition is about the same as it was in the morning, which is hopefully steadily improving.  I'd love to see him off the vent sooner rather than later, and when I listened to his lungs they didn't sound half bad; just some wheezing in the upper left lobe.  Dad is now entirely off of IV anti-hypertensives, which is also good news.  His edema seems a little better after his dose of Lasix today.  All in all, today was a pretty good day and we hope he continues on this trend of improvement and good news.

Thanks to everyone who has both helped us in any way and or offered to do so.  It is overwhelmingly kind and we really appreciate the support from you all.

Tuesday AM

Mom has been back in Dad's room in ICU since early this morning, and told me that Dad is much the same; he seems to be resting much more comfortably than before he was intubated. He is still sedated and intubated, but Mom was told that he seemed to be doing a bit better in regards to his breathing and the amount of mucus etc. in his lungs and airways.

So we are still in a "holding pattern", but that is not necessarily a bad thing. It is allowing Dad some much needed solid rest to just do nothing but heal himself with the assistance of the wonderful team in the ICU.

Having this private room is a blessing of vast proportions - both for Dad and for Mom and others when we are quietly sitting in there - just sharing calm and positive energy with Dad. We are trying to keep all conversation to a bare minimum to reduce the external stimulus for Dad as much as possible and yet still be there for him. We figure the less stimulus he has to respond to the more deeply he will sleep and the better his healing will progress.

Once again thank you all for your continued support in this difficult time. We appreciate it, even if we have not yet had a chance to thank you personally.

Tuesday Morning

Today I was able to make it to the SICU in time for rounds with the SICU team.  This was particularly good as I got an opportunity to discuss all the aspects of my dad's healthcare.  I won't go into all the details here, but the bottom line is that his pneumonia seems to be clearing up nicely, and he is being put on a lighter antibiotic for that.  He still is very waterlogged from all the fluids he has recieved, but they will continue to diurese him with a goal of removing 1L of excess fluid per day.  Also, he will remain on propofol and intubated until his lungs have more or less fully cleared up.  This has several advantages in that he may be more comfortable sedated, he cannot aspirate anything into his lungs while intubated, and he can't knock off the intubation tube like he was his oxygen canulas and masks every 10 seconds.  His blood pressure remains poorly controlled, but they are increasing his metoprolol to the maximum dose which should bring it under better control.  Thank you everyone for all the love and support.

Monday AM (also)

So, unfortunately, it now appears that Dad definitely has aspirated pneumonia, which is quite common in stroke victims.  However, despite being common, it is also a very serious complication, and has resulted in his being intubated as he was nearing a point where he would no longer be able to sufficiently breathe on his own.  The hope is now that in a couple days the antibiotics will clear up his pneumonia and he can come off mechanical ventillation at that time.  I suppose the one good thing about this is that in order to be intubated, one also needs to be sedated, so Dad is finally resting and getting much needed sleep.  He still responds to verbal commands, despite being unable to speak due to the intubation, so that is also encouraging from a neurologic standpoint.

Update 2pm: I just came from seeing Dad in the SICU.  Some really good news is that a good friend of mine is now one of the residents on his service, which gives me much more direct access to his care providers.  This is a huge relief after never even knowing who his doctor was during his time in the PSCU with various Neurology teams coming through.  He remains intubated on propofol, a hypnotic sedative to help him tolerate the intubation.  The sedative is probably for the best as he finally appears at peace and is resting.  My hope is that his body will fight off the pneumonia while his psyche heals some with sleep.

Update 9pm: I stayed with Dad in the SICU for as long as I was allowed tonight, and his condition remains largely unchanged.  He has some PVC's on his EKG, but that's not a very big concern.  His blood pressure was under much better control this evening, and was down to around 120/60 which is where I'd like to see it stay (earlier in the day it was up around 160 systolic, and as high as 190 when he gagged on the intubation tube at one point).  It's my sincere hope that Dad remembers none of his ICU stay, as I'm sure it is very uncomfortable and downright painful for him.

Monday Morning, August 17th

I spoke with Dad's nurse this morning and unfortunately they had to preform a tracheal intubation on him early this morning to help with his breathing as he was laboring too hard. (I assume it is a tracheal intubation - but he is definitely intubated.) While this means he will not be able to speak until they can remove the tube, it does mean that they can help him with his breathing, making sure he gets enough oxygen and also help by suctioning clear his airways and helping to clear his lungs of all the accumulated liquids/gunk.

His nurse did say that he was still able to follow commands, so that is a good sign from a neurologic standpoint - though Larson can do a much better job of explaining all this when he is able to post. I just wanted to get the latest info out to everyone who has been so wonderfully supportive to us all. While we may not say so directly just now, it means a great deal to us to have such a supportive and loving community surrounding us.

Sunday Night

I spent the evening tonight with Dad in his new ICU room.  I think its the best room in the SICU, which is awesome.  It has a nice view out the windows, and its a corner room.  He has it all to himself, and it's nice and quiet.  Sadly, he's not really in a position to enjoy the view or the space, but what I'm sincerely hoping is that it affords him the opportunity to sleep longer and better, something I believe his brain desperately needs.  He remains delirious, but he has lucid periods where he appears to be cognizant of what is going on around him.  Today was particularly sad, as when Mom and I said goodbye and that we'd be back in the morning some tears formed in his eyes.  I badly miss my father and eagerly hope he makes a speedy recovery.

Dad had another CT scan, chest xray, and had a nasal gastric feeding tube placed today to make sure he doesn't aspirate any food.  The CT shows no further bleeding, which once again is a good thing.  His CXR shows something going on in his left lower lobe, but its tricky to say if its pneumonia or atelectasis apparently.  He still has no fever, which is a good sign.

On our way out we met with Dr. Applebee, who gets props from me for being very kind and taking the time to inform us about Dad's situation.  It is so very different for me to be in the families role; while I would never wish this kind of tragedy upon my peers, I think it's a very valuable experience to gain.  Dr. Applebee spent time telling us about Dad's possible pneumonia, his delirium, and his CT Scan.  Overall, she sounded very optimistic, and said that despite the setbacks of pneumonia (potentially) and the delirium, with some rest and time he should get over both of those and is looking good for making some recovery.  I really hope she turns out to be right, we could use some lucky breaks.

Edit:  I forgot to mention, Dad's left arm and both legs are very edematous now.  I suspect this is mostly from not moving them at all for the past few days combined with lots of IV fluids.

Sunday AM

The nurse said Dad had a rough night last night.  He has a lot of mucous in his lungs and throat, and is getting an NT Suction right now to try to clear a little bit of it up.  They're also taking him off eating food or ice chips as they are concerned he may be aspirating into his lungs.  Worse yet, Dad seems to have gotten more pronounced Intensive Care Delirium.  He doesn't appear to be very with it, asking about random things like sled dogs and former vice presidents.  This is generally very concerning, however 50-70% of medical ICU patients do experience delirium in their stay.  Last night he was oriented x3, but that no longer appears to be the case.  Hopefully he will be transferred to his own room today, and perhaps that will improve things some.

Update: Dad is having a feeding tube placed now.

Update 2: Dad finally has his own ICU room, in which Mom can use her cell phone.  General consensus is this is a big improvement, but he remains very agitated and told mom that he "hurts everywhere".  As long as she stays with him to keep him from removing his oxygen mask he doesn't need to have his hands tied down.  Mom met with the neurologists, but was very unimpressed.  One seemed incompetent, and the other two didn't seem overly concerned about Dad's pneumonia, stating that he's on abx and it will resolve in a couple days.

Saturday Night

I just left the PSCU(SICU) where my father is after spending about 4 hours with him this afternoon.  First the bad news (and it's very bad news)... he appears to have developed pneumonia after all.  The doctors looked at the chest xray again, and decided that yes, maybe it was an infiltrate.  And oh yes, he's coughing a lot and his lungs sound like jumbo sponges.  He has begun antibiotics, and I'm hoping he will quickly recover from the infection.  For the meantime he's sating low, and his pulseox crashes pretty fast if you remove his oxygen mask (which he hates wearing).

And for the good news, he was much more alert today when I visited with him.  He ate some ice cream, spoke with me a little, and at times was aware that he was at FAHC in the hospital.  This is very encouraging, because it is very scary when he is delusional about things.  I suspect some of yesterdays delusions may have been the pain meds talking, but he is no longer on those.  

Dad remains the same nice and funny guy as ever, and in the time I was there he made a few jokes, but largely complained about the "sadists" trying to make him suffer.  I couldn't agree with him more, the ICU is a horribly horribly uncomfortable place to be.  With some luck he will at least be transferred to his own ICU room tonight or tomorrow, which should be a nice relief.

Thank you again for everyone extending their best wishes, it's very nice to have the support.  I would ask that people not call for updates at this time though as it is a bit overwhelming.  Please feel free to leave comments here though.  Thank you everyone!

Saturday Morning

Finally some good news.  First, the infiltrate that had been suspected in Dad's left lower lobe appears to not be anything.  This is a huge relief as pneumonia is a very dangerous complication for stroke victims.  Secondly, Dad was more alert and awake this morning, even going so far as to make a dirty joke.  He was awake enough to eat some cream of wheat, a popsicle, and most importantly of all, his oral medications.  This is great news, as the sooner he is off IV medications, the sooner he can be transferred to the wards from the ICU.  Additionally, they are trying to find him a more private, quiet ICU room than the PSCU, as it tends to be very loud there.  This is important as he really requires a lot of good sleep for a strong recovery.

Brenda and Bob have once again been saints and come out to our home to help clean and get things in order.  I don't know what we'd do without them.

Friday Afternoon

Evergreen and I just left the PSCU.  Dad was quite lethargic, but wasn't completely out of it.  The poor guy is just being constantly poked and prodded and yelled at because everyone wants to do something to him.  In the 90 minutes or so I was there he had 25 wires glued to his head for an EEG, then removed with acetone.  He had blood cultures drawn from two sites.  He had his teeth brushed and mouth vacuumed.  He had a neuro exam.  And he had me shoving pudding down his throat.  (It's good that he was able to swallow and eat though, as this gives an avenue for delivering oral medications in the near future).

The nurses say he is slightly less out of it this afternoon than he was in the morning, but its clear that he's extremely lethargic and sleepy.  He's at the point where he can just about fall asleep mid sentence.

His SpO2 and BP are looking a little better, though I'd still like to see his blood pressure down a little more.

Thanks again to everyone for the kind wishes for his speedy recovery.

Friday Morning

This morning Phil has been very lethargic and difficult to awaken.  The nurse informed me that if she really yells at him he will mumble something along the lines of "go away, let me sleep", and it is our hopes that he is just very exhausted from his stay in the ICU, but there is the risk that this lethargy may indicate a worsening of his stroke.  He went in for a CT this morning around 8am, and we are still awaiting the results.  I will update when I know the results.

Update: CT Scan looks the same as before (which is very good).  An EEG is going to be done to rule out any seizure activity.

Background

On Tuesday, August 11th, 2009 around 8pm my father, Phil, suffered a stroke. After having had headaches for several days, his symptoms suddenly became worse and he felt like he needed to vomit. Evergreen became very concerned and had me, Larson, come look at him. Thankfully I knew what to look for from my previous year in medical school and was able to identify that he was having a stroke and dialed 911. Essex Rescue responded quickly and rushed him to the ER where a CT scan was taken and the stroke was identified as an intraparenchymal hemorrhagic stroke. There are two main types of strokes, ischemic ones where blood is cut off to part of the brain, and hemorrhagic strokes, where there is a bleed in the brain. The latter, which my father suffered, can be more severe acutely, but we hope affords a greater chance for recovery.

He spent the next two days in the ICU under careful blood pressure control, and a further CT scan showed that there had not been any more bleeding. He's currently in moderately stable condition, but remains in the ICU under careful attention. It is our hope that he will be well enough to leave the ICU in the next 24 hours, but everything must be played by ear.

His current status is that he is unable to feel or largely move the left side of his body, and doesn't recognize his left arm as being his own. Tonight, he was also unaware that he was in a hospital, however his personality seems largely intact. He is as stubborn as ever, and also has a great sense of humor. Throughout the ordeal he has remained responsive and capable of speech. He recognizes family members immediatly and correctly, and is sharp as a tack in some ways. Whenever a physician asks me about his home medications, even if you thought he was sleeping, he's quick to chime in "I'm taking metformin, 2500mg daily". I don't know about you, but I don't know that many patients who are so good with their medication lists and dosing even in their normal state.

The staff at the hospital has been exceptionally good, and the support from family and friends has been an overwhelmingly positive influence. Feel free to leave any comments or well wishes here as they will be read by the whole family. Additionally, more posts will follow with updates to his status. Thank you all for your love and support.

Larson (and Evergreen, Isis, and Phil Jr.)