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Swoopy:

Here we are on Sunday again.

Because Susan is going back to work in the morning we adapted our schedule some and went to the noon and late afternoon visits.

Because of leakage (of air) around the opening of Derek's trach-tube and simply from the doctor's recommendation in order to keep the number of respirations up, and his blood oxygenation levels up there too, Derek is back on the ventilator. He's getting 45% oxygen, and honestly I'm glad. He's more easily alert with the extra O2, and we saw more signs of life today than yesterday when he was doing all that breathing on his own.

It's hard work to heal, and his lungs are better, but not yet great. More time with extra oxygen will make it easier for him to recover. Although of course this is mostly supposition on my part, and from seeing what a little extra oxygen can do for someone who is fuzzy, groggy, sleepy or hung-over.

I have designs on talking to his doctor in the morning, seeing what the next steps are - if there are any right now. And when I know, so will y'all.

Also because of his troublesome trach tube, they may do some adapting of the way it's inserted, possibly a longer tube into his throat or some other options. And that's something else I'll find out tomorrow. Derek's neck is large and that has presented a challenge from the beginning. Even though his respiration and oxygenation numbers have stayed in good range, and the leakage isn't presenting a problem, they'd still like to stop that air from escaping - a tighter seal is better for him.

Blood pressure is good, he's still receiving medication for that, and his fever has been very low-grade. They are monitoring his kidneys for signs of stress. He's been filtering a lot of medication and junk through those kidneys and while his values are improving they want to keep an eye on that. It's all about maintaining and repairing the body while the brain heals at this point, and that's a special dance in itself.

There were a few lucid moments with Derek today, Susan and I got hand squeezes when requested. There was a lot of rapid eye movement in his sleep today also, so we know he's thinking about a lot of stuff, or dreaming some interesting things.

Beginning tomorrow we're starting a somewhat new schedule. I'll hit the hospital in the early morning, and Susan will hope to get off work late afternoons (if she can manage) and we'll do the 4-6pm hour visit instead of the late evening, so that our nights will have a little de-stress time built in to them and everyone gets plenty of rest.

So it was a pretty quiet weekend for us, hope it was for the rest of you. Best to everyone, and continued thanks.

- Swoopy

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Swoopy:

Monday Monday....la la...la lala....

Susan went back to work today, and as expected was greeted with plenty of heartfelt condolences and curious questions. It's a big help to work with such nice people.

We did well with our schedule today, and Susan and I both got to "see" Derek see us today. Little flickers of recognition. A little spontaneous coughing, a couple of yawns. Some sleep, and some activity too.

In doing Derek's bathing and clean up today the nurse, Courtney whom we like very much, said that Derek was reaching to stop her from some of the things she was doing. Another good sign for us...a surprise for Courtney too I suspect. She is pleased by the amount of movement he spontaneously does. So are we.

Mostly fever free, blood pressure up a bit in the evening, but oxygen saturation very good, despite the gurgling that his trach tube makes. It's merely a function of his lungs getting better, and all the stuff that we constantly blow from our nose, cough up and swallow when we're sick. Only Derek can't do all of that stuff as spontaneously as we can, yet. It's not fun to listen to, but his numbers indicate that his lungs are getting better. The respiratory therapist thinks so too.

Another mostly quiet day. And that's what we're expecting for awhile, and very grateful for.

And lastly, as if he didn't have enough to worry about, Derek's got pressure from Satan to get better:
http://www.thesatancast.com/digicasts/tSC20050923.mp3

- Swoopy

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Swoopy:

It was a pretty slow day, until right here at the end. Morning visit had a sleepy Derek, with little alertness. Mostly I stayed hoping to catch the doctor, who didn't do rounds when I was there and was likely in surgery this morning. Foiled again. Word was that at some point in the day Derek would get his trach tube adjusted so that it wouldn't continue to leak air around it. Even though it wasn't affecting his oxygen saturation numbers, a tight seal around that opening will be much better for him.

When we visited early evening, Derek was prepped for the procedure and laying flat and propped up on pillows, sleeping pretty soundly. He did wake up some and we had a lot half alertness, and some arm and leg movement. His day nurse also reported that he was pretty active, especially on his left side, which is great to hear. His blood pressure was good and he was fever free.

The long promised tracheotomy adjustment did come to pass this evening while we were having dinner, in fact Susan just got off the phone with Dr. Akarino.

The trach procedure took longer than expected, and the doctor wasn't pleased with the way Derek's trachea looked, namely red and irritated with more bleeding than he would have wished for. But the longer trach tube is in place now, and Derek was sedated so he felt no discomfort during the procedure.

The doctor will do an endoscopy tomorrow to get a better look at Derek's throat and see what the cause of the irritation is, perhaps it was just the ill fitting trach tube. I suspect more respiratory therapy is in the immediate future.

We also requested to see Derek's most recent CT scan so that we can compare to the first one we saw, and see how the clot has progressed for ourselves. We're certainly not doctors or trained to read the films, but knowing what the clot looked like before, it will be interesting to compare even with our untrained eyes.

More tomorrow, and hopefully better news about his respiratory situation. Derek was still on the ventilator and was up to 65% oxygen, up from 45% the past few days. The body and especially the brain, likes lots of oxygen, so bring it on.

- Swoopy

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Swoopy:

We had a phone call this morning, the first in quite awhile and so of course very unsettling.

The planned adjustment of Derek's trach tube that took place last night, wasn't the fix the doctor's were hoping for. So the trach was removed and he was intubated through the nose. His numbers stayed strong, he was just coughing and very uncomfortable with the trach and it hadn't solved the problem, so it was better at this time to remove it and let him and his agitated throat, rest some. He was sedated then, and is still on a drip this morning and resting peacefully. He is on the respirator with 60% oxygen but is breathing on his own, the respirator is just there to make sure he's taking enough breaths.

His blood pressure, oxygen saturation level and respirations are actually all pretty much the same. He was running a temperature of 102, but this is what happens when the body is fighting infection. After speaking to the doctor who is everything BUT neurology, they've determined that the best fix is a rigid trach tube. Initially the best approach to a tracheosotomy is the least invasive, and the flexible tube that Derek got initially would have been the easiest and best thing at the time. Because of the size of his neck, getting a tube that fits properly is very difficult and keeping the tube in place to reduce any erosion of his trachea while the tube is in, is critical, especially as he's trying to recover from his lung issues.

This tube will do the job, but it's insertion is more difficult and is actually surgery where they will need to anesthetize Derek, and everything that goes along with this kind of procedure. They were hoping the wouldn't need to do this, but now it seems like the best option and they'll do it as soon as possible. They'll need to order the specialized tube, and schedule the operating room and all that stuff, so as soon as possible would probably be tomorrow at the earliest.

They want to not have him intubated through the nose for any long period of time, as it makes the drainage from his sinus and lungs more difficult. All in all, the best way to look at it, is just a necessary equipment change. The computer works fine, but the mouse is broken. Nothing wrong with the computer, you just need a new mouse. So this new tube is the mouse we're looking for.

Now..in cool news..cause there IS some.

Not only did I get to discuss Derek with Dr. Akarino (everything but the brain doctor) and his team, and the night doctors who were coming off shift who had been with Derek all evening, but I got to see and talk to Dr. Weaver (brains) too. Derek was scheduled for a CT scan this morning before all the fun happened. But, because he was sedated, and resting comfortably and there really wasn't a reason not to, Dr. Weaver decided to let him get the CT anyway.

Susan had really wanted to see the films of his more recent scan, as we had seen the initial ones and were hoping to see what the progress was looking like. I mentioned to the nurse that if he could let Dr. Weaver know we were wanting to see those films, that would be great. Before I knew it, Dr. Weaver had been paged, he's a busy guy and I really didn't want to bug him. But not only did he come back to the room, he went and picked up the films of the CT they had just done and let me see them. He had the first CT (from just after the "event") and today's. The word of the day is ...wow.

If you imagine the image of Derek's had as a cantaloupe, and you can see the rind and then the melony insides floating in the juice. On his first scan the clot(s) appear on the scan as solid white spots, in this case it looks somewhat like someone had put a chili pepper (the big ones) across one side of the melon. On today's scan. There's no pepper at all.

Dr. Weaver noted that there is some ventricular swelling left, but not much, and also that there isn't any excessive intracranial pressure or excess fluid on the brain. All fantastic stuff to hear.

So once we get the rest of the body recovering, the head is coming right along. The films are staying with Derek for now, and Susan will get to see them this afternoon. But of course I called her right away when I saw them. The signs that his head is doing exactly what it should, and a little ahead of schedule, is exactly what we needed on a day that had a slightly shaky start.

- swoopy (see part II for evening report)

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Swoopy:

It seems either there is NOTHING to report, or everything to report. I'm not sure which I like better.

Susan and I showed up at five and that pesky intubation tube in Derek's nose, gone. I honestly hadn't noticed, and Susan said.."look!" And I was ..spaced out and not paying attention..and then I noticed that the tube wasn't in his face, but there in his throat was a very substantial trach tube. The tracheosotomy fairy had apparently been there.

The neuro unit has emptied about four beds today, and honestly the ward was a little like a ghost town. Our afternoon nurse had gone early because they were over staffed. Luckily the respiratory therapists who have been working on the trach issue, and who are very nice guys as well as uber smart and stuff, were sitting together taking a short break and so we got the scoop.

It seems that Derek was leaking air through the hole left by his trach, which is somewhat of an abnormality, it's meant to close. So they were giving him air, only to be losing some of it through the hole. With the assistance of the whole team and Dr. Akarino (everything but brain doctor) they were able to properly place the longer trach they had trouble with last night. The very long tube that goes down Derek's throat ends up just before the bronchioles divide to the lungs, which is just perfect. The big stiff tube is formidable looking, and his throat is stitched some around it, but it's obviously a very good fit.

Since this was the same procedure that we'd already signed off on, additional consent wasn't required, and also since we had consented to the bigger procedure involving the rigid trach tube, unless there had been a complication we really didn't need to be called. It was a weird, but nice surprise.

They'll monitor this new tube very very closely, but all indications are good. Whereas last evening the insertion was difficult and his trachea was irritated. Today his chest x-ray looked much better, getting the tube out of his nose so quickly further reduces the chance of further sinus infection and his breathing was very stable and quiet. Their hope is that this will also allow them to continue to back off of the oxygen he's getting, and they have already reduced from 65% this morning to 50% this evening. He's still doing his own breathing, and if this tube continues to do well, they won't need to do the surgical trach. We're very hopeful.

Derek, still sedated, had the same pressure and oxygen saturation numbers as earlier in the day - which were all fine, and it seemed that he was barely feverish if at all. His tube fed dinner was being monitored, and getting a drink of water through it as well. Some of a paralytic drugs can slow down the metabolism

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Swoopy:

There was no early morning phone call today, and that always makes for a good start to the day.

Derek's trach tube is still doing well, his fever was down and all of his numbers were good. My morning visit was short, because even though he was just off of the sedation drip, he was sleeping pretty soundly. We have the good fortune of having our favorite day nurse, Kim, back with us (at least for part of today) and she had designs to give Derek a good bath and shave, and I didn't want to keep her from it.

She also let me know that Derek could get the staples removed from his head today, and when Susan and I visited in the evening they were in fact gone. Derek was, as promised, neatly shaved and was somewhat but not a lot more, awake.

Reports from the nurse, one of our other angels of mercy Courtney, were that Dr. Weaver (brains) had been giving him verbal commands for left and right side activities, and that Derek's strongest response today was on the left side. This of course impressed everyone, who expected that initially his left side might be weak and compromised do to the clot being on the right side of his brain. While of course it's too soon to know what and where there may be damage and weaknesses, this is certainly a good sign.

This is a resting day, with little to be concerned about as Derek is under excellent care, and presently appears to be doing much better with his breathing. The noisy respiration and the large amount of sinus drainage he was having previously, wasn't in evidence today at all. Coupled with an improved chest X-ray result, it looks like his lungs might be on the mend as well.

Kim also said that soon she hoped, even if he wasn't really awake, to try and get him up and into a chair and out of bed for short periods of time. That would of course, be fantastic.

When the sedation clears, and he rests up from all of the fun of the last couple of days, we're hoping we might begin to see a return to some of the heightened awareness Derek has shown at times.

Our thanks for everyone's continued care and concern, it keeps us afloat through the scary moments. There WILL be a new show this weekend..as soon as...I get..some...zzzzzzz.....

- Swoopy

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Not much to report. And that's good

I did sleep in and go at noon today, and then Susan and I returned at the evening visit. Sleepy Derek pretty much most of the time. Good blood pressure, good oxygen saturation, good respiratory rate and oxygen being given is 40%, so they are slowly cutting that back. Another good sign.

His respiratory illness seems to be really quite a lot better, as the rate of coughing, necessary suction to clear his trach, and runny nose are all much less frequent. All biological functions working well, and fever was low grade.

Susan and I went with a large contingent of friends to see Serenity tonight (late show), and it was even more awesome than the pre-screenings that we all saw earlier in the year. I can't wait for Derek to see it, though I suspect it will be long out on DVD before that happens. Although by then maybe there will some deleted scenes and stuff for him to enjoy.

And speaking of good friends, because of the concern of the people Derek works with at Brown and Caldwell, and the people he works for, we found out some very important information today regarding his health insurance. We have been going with the knowledge that Derek's coverage would take care of 90% of medical expenses. And 90% is good...but 10% of probably an astronomical number before we're through, is quite a lot to be concerned about.

Today we were told that there is a cap to the out of pocket amount, including deductibles. This will widdle down that astronomical number by a huge margin. We're all breathing easier ourselves for having that news.

And lastly, in the cool department, the podcast that Derek and I do was in our local entertainment guide called Creative Loafing this week. It's their Best of Atlanta 2005 issue, and Skepticality was listed as best podcast. Derek would be so jazzed, I'll have to tell him tomorrow.

Have a good weekend yourselves, and not that I'm biased or anything but DO go and see Serenity. Even if you don't like space movies. It has a great message, fantastic effects and wonderful performances. Derek would SO want you to go

- Swoopy

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Swoopy:

Derek had a pretty quiet weekend, much more sleepy on Saturday with a few wakeful moments. But Sunday, both early afternoon and late evening visits, we had a pretty alert guy on our hands.

Arm and leg movement on both sides, head movement too. Facial expressions as well, furrowing brow when something is uncomfortable or there is an unexpected noise. Slight smile when he's fussed over - which is constantly. His eyes move from person to person in the room, and when we change sides of the bed, he almost always moves his gaze to wherever Susan is. Some hand squeezes on command too.

Also Sunday morning Derek was off the respirator and breathing completely on his own for ten minutes. This is something they will step up over time to help his lungs get stronger. His trach still looks good, so for the time being there hasn't been further talk of switching to the rigid tube. He's down to getting 30% oxygen, which is another step in the right direction.

Fever is barely existent, and Derek runs hot as a rule, so 99 is not something we're concerned about. Good blood pressure numbers, mild rise at night still, but not nearly as much as before.

They're really making a point to tilt his bed and raise his legs, and put him in a different position every few hours so that he doesn't develop any sores on his back or hips; the pressure points that he rests on in bed. Even though his bed turns him, they continue to do everything they can to keep him comfortable, and it's really nice to see that they pamper him as much as we would at home - except that they have all the cool toys and a tireless staff.

The only bad thing about when Derek is awake, is that it's harder to leave when visiting hours are over. We have a little separation anxiety.

We'll be interested to see, when Monday morning rolls around, what the doctors have to say - if anything, about how he's progressing and if there is a next step to think about, or just more of the same. Slow and stable is fine with us.

Hope everyone had a nice weekend, fall is definitely here.

- Swoopy

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Swoopy:

More face time with the man today, as well as a short confab with the doctor (filling in for Dr. Acarino, everything but brains)who says Derek's chest x-ray looks better and better, and that from all the reports and from what he can see, Derek is doing awesome. I know that the doctors know more than us, but...we knew that already.

The morning visit was about to be cut short as Derek seemed to be sleeping, but then he woke up quite a bit, and was quite alert. He turned his head some from side to side, noticing me, noticing the tv (which we keep with the sound low on CNN) and noticing the doctor when he made rounds.

The best of all though was the smiling. Since his bed was set to turn him side to side slowly, I would stand on the side he was tilted toward, and when the bed shifted, move to the other side. When I would leave one side for the other, Derek would smile when he turned his head to my direction. It was like he didn't expect there to be someone on the other side, and he was surprised, but glad. It was really neat.

Lots of glowing reports from all of the nursing staff who are just really excited to see all of Derek's alertness and improvement over the past few days too. Make no mistake, he's not talking or evening trying to. Nor do we know if he knows or remembers or thinks a thing, but all signs point to recognition of a sort. He also does follow simple commands most of the time such as, squeeze this hand, now squeeze that hand, look at me, look over there. I couldn't be more impressed if he was reciting soliloquys.

Yesterday Derek was breathing on his own for ten minutes. Today he was off the respirator for nearly two hours. This is a sign that his lungs really are in good shape. After the workout though, our evening visit was mostly quiet, though he had a rough coughing spell that woke him up and so we all got a little bit of seeing him, and him seeing us. And then he drifted off comfortably to resting again.

Slow and steady, but good. Can I tell you some of the cool things that we've received? Derek's office in Walnut Creek sent....a penguin! A big stuffed one. We told Derek about it, but Susan also explained that he's going to have to share it. Our friend Mur sent Susan and I a care package that contained the world's softest and fuzziest socks. And..some sinfully good bread. Warm, soft, fuzzy feet..when you're weary, are just the best. We agree. The cards, the phone calls, the well-wishes. They mean a lot to us.

So thank you, everyone, for the kindness and the offers of everything under the sun. I have EVERY email tucked away, and every everything else. The man is going to have some serious catching up to do, when the day comes.

- Swoopy

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Swoopy:

As expected, Derek had the BB in his brow removed and now has just two small stitches next to his left eyebrow. This clears the way for the MRI that Dr. Weaver (neurologist) has been hoping to do. And in fact Derek is scheduled for the MRI tomorrow. We're all looking forward to seeing..what there is to see.

Derek trach looks somewhat irritated and the possibility still exists that they may need to use the more heavy duty tube on him, so we'll see then too if that comes to pass.

The coolest news of today was that Derek spent over four hours off of the respirator, breathing on his own. He was actually off of it when I was there this morning and sleeping very peacefully too.

He woke up some for the evening visit and that gave Susan some nice time with him. The goal in the evenings is having him wakeful enough to notice people but then sleepy enough that he's no longer awake when we leave. We have a little separation anxiety, so it's hard when visiting hours are over, when he's still got his eyes open. Our plan was successful though, and after some soothing from Susan, Derek drifted back off just before we had to go. Being off the vent is good for his lungs, but is of course a tiring exercise. It's a tradeoff we'll take.

Good movement from hands and feet today, head turning too. And I managed to catch him yawning while I had one of those Oral B brush up, fingertip toothbrush mouth freshening thingies on my finger. He doesn't like opening his mouth, because usually it means someone is going to use suction, so just getting in there to clean his tongue is nearly impossible. I let him bite my finger pretty substantially yesterday, trying. But today I caught the mouth open wide, and I was able to get some of the stuff that collects in there, out. He does get really good oral care from the nurses, but we're a little obsessive Susan and I, and we were dying to get in there. Think about your worst case of morning mouth, and then multiply it by a few weeks. Not pretty.

So tomorrow looks to be a busy day, with finding out about the future of his trach tube and his MRI. I'm not sure if they'll sedate him for that, or just hope for him being sleepy, because as far as I know you have to stay really still while they scan you.

We have the BB in a container that the hospital gave us. It's about the size of a ..BB. It has a place of honor on the table next to the many many cards and stuff that are waiting for him.

- Swoopy

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Swoopy:

Very quick..late night, but not much to report. So late night, not fun
Not much to say - okay.

Derek was awake both this morning and this evening for a stretch and spent more of today off of the respirator breathing on his own, than not. His numbers were good all around, and he went for his MRI at 9 this morning.

No report yet from the doctor about what there was to see there, but we're expecting to hear more tomorrow.

Reports from Steve, Derek's day nurse today - I think he's secretly Reggie's twin, he's so cool - were that Derek was in pretty good shape. This is an impression from a nurse who hasn't had him before, so we were impressed. Steve said that Derek followed a few commands for him, including one I've not been able to manage yet - to open his mouth and stick out his tongue. The man NEEDS his tongue cleaned. And Steve got it done, and with Derek's help no less. I guess it's that male bonding thing.

Also today came the first mumblings that Derek may be headed to a new facility in the near future. His stay at the hospital is guaranteed through Sunday, but after that he's up for evaluation of his status. It's common for long term patients who need a lot of respiratory therapy to go to a facility that has expertise in weaning people off of a ventilator. Such a place had a representative in hospital today evaluating someone else, and they looked in on Derek while they were there.

Further discussion with his nurses and respiratory therapist though, lead us to believe that since he's doing so well only having started to get off the vent this week, and is already up to being off of it for many hours at a time, that moving him might be unnecessary and not beneficial in the long run. When he's ready to participate more in rehabilitative therapy, more alert, more awake, following more commands and such, then he'll be ready to move to a facility that specializes in that kind of care.

We're looking into all the options, and of course what we can do within the constraints of his insurance plan. But we're looking at him going to The Shepherd Center. It's ranked number 17 on a list of Best Rehabilitation hospitals in the country for 2005 by US News and World Report. They have a great brain injury center, so hopefully they'll be able to offer Derek some excellent post hospital care to get him home and functioning eventually. The only downside is of course, it's downtown on Peachtree Road. We've been a little spoiled with his hospital being so close to home.

Okay, so did I say not much to report? I guess I fibbed. In any case, the discussion about if and when and where Derek will be going is something we'll be doing more of in the coming days, and we'll definitely let everyone know what's going on with that, when we know.

Thanks for hanging in there with us,

- Swoopy

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Quiet day really, so I'll keep it very short.

Tomorrow they will be finally putting in Derek's rigid trach tube. They are thinking that since the tube they have been using is so well placed (but not a permanent fixture by design) they will insert a guide down the current tube and use it to place the new one. In theory they should be able to do it bedside and it won't be the difficult procedure they first thought. Also his lungs are in better shape than when it was first proposed, so all around it should go well.

Dr. Weaver talked to us a little about the results of Derek's MRI. The scan showed no evidence of aneurysm, tumor or AVM. This means he doesn't have an ongoing issue in the brain, and that his bleed was very likely due to hypertension causing a small vessel to burst and bleed. There is still some old blood left from the initial bleed that is reabsorbing and dissolving that didn't show up as well on the CT scan as it did on the MRI. But there is no evidence of any additional or ongoing bleed of any kind. These are all good things. It's likely he'll have another MRI in three to six months. Where we'll be or what we'll be doing then, is pretty much anyone's guess. Mostly likely rehab of some sort.

Derek was off of the respirator for over six hours today, but was somewhat alert and not too sleepy at the either morning or evening visit for someone who had been working that hard all day. However, we're pretty tired and going to rest up for tomorrow. Every day brings a little something new, but every day also seems to show us some improvement, even if very small. We'll take the small stuff.


- Swoopy

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Derek's new trach wasn't able to be scheduled today, so it's been rescheduled for Monday. It really isn't a pressing matter, so the fact that the other doctors were too busy with more critical matters to get to it, isn't a problem at all. He's breathing very well, and his lungs are getting to be in pretty good shape after his bout with pneumonia.

Derek was off of the ventilator again for most of the day, which is the new regimen, to be off the vent during the daytime and then back on at night to rest. He's doing really well in that regard.

Many periods of wakefulness today, coupled with a lot of body movement. Moving both of his legs a lot, and at times reaching with his hands. The nurse said he responded to commands like simultaneous right and left hand squeezes, and again he would open his mouth and stick out his tongue - for her. Not us yet. I guess he just knows that we're pushovers, and nurses are not to be messed with - which is true.

We hope to have a quiet weekend, visiting and resting and doing research into rehab facilities and such. Very rainy here, which is nice, the plants are happy. Derek really likes rain, and they've had the blinds open in his room. He actually has a very lovely view of a courtyard with lots of plants and trees.

Our best to everyone, we hope you have a peaceful weekend too.

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Monday, as always, a busy day somehow. Derek was literally bouncing today, his typical leg bounce that all who know him have felt and seen, that restless leg. Just a lot of movement in general.

Since Saturday morning Derek has been off of the ventilator entirely, and breathes on his own. He has what is called a "T" piece attached to his trach tube that administers some oxygen, but he does all of the work. He's doing really well, which means he won't need a facility to wean him off of the respirator, he's pretty much done that work on his own, in very good time.

He's very into turning his head to look at people now, even though his bed still turns from side to side, he'll turn his head to look over if you say his name. He almost always does respond to his name, and has begun (as of today) opening his mouth a little, as if he's thinking he might say something but isn't sure what it is. His amount of awake time is longer.

So they did schedule, and successfully put in place his new rigid trach tube this afternoon. It did turn out to be a bedside procedure that only took minutes. They also got a lot of good junk out of his esophagus when they pulled it out, and may, if necessary do a bronchoscopy tomorrow in case anything got loose when they did it. But he seems pretty comfortable with it.

The really good part about the new trach is now that it's stable and in place (the old one was a very long tube, held in place with sutures), Derek could finally get out of bed.

The staff uses a hoyer lift that is a body sling of sorts, that has hydraulics to lift the patient out of the bed in a somewhat sitting position. He got to sit in a chair for two hours.

After awhile though, he was tired of sitting and started shifting around in the chair. The nurse at one point asked if he was ready to get back in bed, and Derek nodded yes. To confirm that he had in fact responded, she asked him again, and got the same response. That was a pretty cool moment.

It made for a great visit for Susan (the report is secondhand, as I was there this morning but couldn't go this afternoon), and it's really really good for his back and body to get out of the bed. It has, after all, been a month that he's been in it.

Derek has now been evaluated by two rehab facilities, and tomorrow he should be evaluated by a third. That will be the evaluation we're looking for, from The Shepherd Center in Atlanta. This place is rated number 17 in the country for rehab, and they have an excellent brain injury and coma stimulation program that is just what Derek needs.

Since he's off of the respirator and on the cusp of being able to participate in therapy, as well as following some commands, it looks like he'll be transferring to whichever facility suits his needs (and ours) the best, probably sometime this week.

This is the beginning of a new phase in Derek's recovery, and the one that will probably prove for him and for us to be the most challenging. We got through the survival phase, onto the road toward stability, and now - heading towards rehabilitation. Every day brings a little improvement, and gives us something to look forward to, wondering what new thing Derek will be doing today.

More reports as they come. Thanks for sticking with us through this last month. We've got a lot way yet to go, but every day is a little brighter.

- Swoopy

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