From mom:
You are having a breathing treatment through your mouth rather than your trach. You are doing well. Your trach has been capped off for 26 hours! No lungDoctor yet to remove trach. Here's the plan:
Thurs 10/8 Go to UT Southwest for Baclofen trial with Dr. Brian Bruel.
Spend the night for observation.
Note: after the meds wear off for the trial the spasticity will return...you'll go
back to the way you were.
Friday 10/9 to a skilled nursing facility...yet to be determined.
Tuesday 10/13 scheduled for surgery at UT Southwest for baclofen pump at 2pm
PRAY THERE IS NO INFECTION!!!
Wednesday 10/14 hopefully he sill go into UT Southwest Rehab with Dr. Benjamin Nguyen, if not, back to skilled nursing.
Buddy, Tammy and their kids came by. You gave Buddy high fives, shook hands, threw the ball and told him bye when he left. I'd say you had a pretty good visit.
Jackie called mom while she was in your room and mom put the phone up to your ear. Jackie said hi and you said hi back. WOW!! That really made her day!
Psalm 98:6
With trumpets and sound of cornet make a joyful noise before the Lord, the King.
Love you Johnny!! XO Jen
Wednesday, October 7, 2009
Friday, October 2, 2009
Botox
Botox Reduces Spasticity And Tone, Improves Function
Published in UAB Insight, Winter 2007
Self-care, self-esteem, and caregiver burden benefit
The same neurotoxin used to diminish the appearance of wrinkles may now help smooth the frustration of patients with upper motor neuron syndrome-related spasticity following stroke, spinal cord injury, traumatic brain injury, cerebral palsy, or multiple sclerosis.
“Spasticity is characterized by a velocity-dependent increase in tonic stretch reflexes, or muscle tone, with exaggerated tendon jerks. It may lead to chronically flexed elbows or wrists, clenched fists, thumb-in-palm, adducted and internally rotated shoulders, or pronated forearms, all of which dramatically diminish quality of life and the ability of patients and caregivers to perform daily routines of hygiene, dressing, and eating,” says UAB physiatrist Robert C. Brunner, MD, medical director of the Spain Rehabilitation Center. “Lower-limb positions, such as flexed hips or knees, adducted thighs, striatal toes, or equinus foot, may interfere with seating, gait, or patient transfer or transport. Botox relaxes affected muscles, reducing spasticity and pain and improving function.”
Temporary Treatment
All botulinum toxins (A-G) are powerful neurotoxins that temporarily weaken muscles by inhibiting acetylcholine release, which signals muscles to contract. In clinical trials, potential side effects of prepared Botox A doses (5 ng per 100 units) have ranged from injection-site pain to headache, dry mouth, muscle weakness, and dysphagia.
“Spasticity can affect mood, mobility, fatigue, sexuality, self-esteem, and self-care,” Brunner says. “Contractures can develop and may lead to pain, poor orthotic fit, disfigurement, and increased risk of falls. Our strategy when injecting Botox is to relieve tone and improve function, position, posture, and personal care, as well as to reduce pain, pressure sores, and caregiver burden. We look at individual limitations and identify functional goals; for example, loosening fingers enough to grasp an object, such as a spoon, or improve gait by ‘Botoxing’ toe-curl flexors in patients with focal foot dystonias.”
Brunner emphasizes treatments take 2 to 3 days to become effective, with efficacy peaking at 2 weeks and lasting for up to 3 months. He introduces physical or occupational therapy 1 week post-injection and, when necessary, offers serial casting every 3 to 5 days until contractures resolve.
The longer a patient lives with spasticity, the greater the risk of increased hospital costs, skin problems due to pressure sores, and physical and emotional burdens of pain and limited function. Brunner encourages early intervention, when spastic joints are most amenable to treatment. He evaluates tone; assesses clonus, spasms, gait, and disfigurement; reviews comorbidities; and studies optimal treatment options, including drugs, such as oral or intrathecal baclofen, surgical referral, or chemodenervation, such as Botox. He notes Botox benefits focal spastic joints, not diffuse spasticity, which responds better to other options.
“Botox is excellent for focal spasticity and muscle overactivity in patients with upper motor neuron syndrome. It avoids central side effects of systemic oral medication, can engineer a targeted response when aimed at specific muscles, does not cause sedation, requires no recovery period or activity restrictions, and significantly improves quality of life.”
Published in UAB Insight, Winter 2007
Self-care, self-esteem, and caregiver burden benefit
The same neurotoxin used to diminish the appearance of wrinkles may now help smooth the frustration of patients with upper motor neuron syndrome-related spasticity following stroke, spinal cord injury, traumatic brain injury, cerebral palsy, or multiple sclerosis.
“Spasticity is characterized by a velocity-dependent increase in tonic stretch reflexes, or muscle tone, with exaggerated tendon jerks. It may lead to chronically flexed elbows or wrists, clenched fists, thumb-in-palm, adducted and internally rotated shoulders, or pronated forearms, all of which dramatically diminish quality of life and the ability of patients and caregivers to perform daily routines of hygiene, dressing, and eating,” says UAB physiatrist Robert C. Brunner, MD, medical director of the Spain Rehabilitation Center. “Lower-limb positions, such as flexed hips or knees, adducted thighs, striatal toes, or equinus foot, may interfere with seating, gait, or patient transfer or transport. Botox relaxes affected muscles, reducing spasticity and pain and improving function.”
Temporary Treatment
All botulinum toxins (A-G) are powerful neurotoxins that temporarily weaken muscles by inhibiting acetylcholine release, which signals muscles to contract. In clinical trials, potential side effects of prepared Botox A doses (5 ng per 100 units) have ranged from injection-site pain to headache, dry mouth, muscle weakness, and dysphagia.
“Spasticity can affect mood, mobility, fatigue, sexuality, self-esteem, and self-care,” Brunner says. “Contractures can develop and may lead to pain, poor orthotic fit, disfigurement, and increased risk of falls. Our strategy when injecting Botox is to relieve tone and improve function, position, posture, and personal care, as well as to reduce pain, pressure sores, and caregiver burden. We look at individual limitations and identify functional goals; for example, loosening fingers enough to grasp an object, such as a spoon, or improve gait by ‘Botoxing’ toe-curl flexors in patients with focal foot dystonias.”
Brunner emphasizes treatments take 2 to 3 days to become effective, with efficacy peaking at 2 weeks and lasting for up to 3 months. He introduces physical or occupational therapy 1 week post-injection and, when necessary, offers serial casting every 3 to 5 days until contractures resolve.
The longer a patient lives with spasticity, the greater the risk of increased hospital costs, skin problems due to pressure sores, and physical and emotional burdens of pain and limited function. Brunner encourages early intervention, when spastic joints are most amenable to treatment. He evaluates tone; assesses clonus, spasms, gait, and disfigurement; reviews comorbidities; and studies optimal treatment options, including drugs, such as oral or intrathecal baclofen, surgical referral, or chemodenervation, such as Botox. He notes Botox benefits focal spastic joints, not diffuse spasticity, which responds better to other options.
“Botox is excellent for focal spasticity and muscle overactivity in patients with upper motor neuron syndrome. It avoids central side effects of systemic oral medication, can engineer a targeted response when aimed at specific muscles, does not cause sedation, requires no recovery period or activity restrictions, and significantly improves quality of life.”
Intrathecal Baclofen Therapy
ITB TherapySM (Intrathecal Baclofen Therapy), or the Medtronic baclofen pump, is a treatment that may relieve some of the symptoms of your severe spasticity. Since
1992, more than 50,000 Medtronic baclofen pumps have been used worldwide to manage severe spasticity related to a variety of conditions.
Depending on your specific condition, ITB Therapy may impact your severe spasticity in different ways. Treatment may be even more effective when used in combination with physical, occupational, or speech therapy.
Detail - Pump and catheter placement
How ITB Therapy Treats Severe Spasticity
ITB Therapy uses a surgically implanted programmable pump and catheter that delivers medication which helps relieve severe spasticity. This medication is a liquid form of baclofen called Lioresal® Intrathecal (baclofen injection), that goes directly into the intrathecal space where fluid flows around the spinal cord.
Because Lioresal Intrathecal is delivered directly to where it’s needed most in the spinal fluid, it relieves spasticity with smaller amounts of medication than when baclofen is taken orally. This method of delivery may help minimize side effects that can result from oral baclofen.
Therapy Components
The ITB Therapy system consists of:
Pump – a surgically placed, battery-powered programmable pump with a reservoir infuses the drug at a programmed rate via the catheter
Catheter – a flexible silicone tube delivers medication from the pump to your body
Lioresal Intrathecal – a liquid form of the medication baclofen
Although Medtronic ITB TherapySM (Intrathecal Baclofen Therapy) won’t eliminate the primary source of your condition or severe spasticity, it may help you manage the tight, stiff muscles that make daily living more difficult for you.
Benefits of ITB Therapy
ITB Therapy, also called the baclofen pump, has been shown to benefit people who have been affected by brain injury, stroke, cerebral palsy, multiple sclerosis, and spinal cord injury in the following ways:
Multiple studies show it significantly reduces spasticity and spasms.1-9
In at least seven studies the therapy has helped people become more independent, allowing them to perform activities of daily living including feeding or dressing themselves, sitting more comfortably, or transferring more easily.10-16
Some studies have reported caregiver satisfaction with ITB Therapy.13-17
For people whose spasticity is of cerebral origin (cerebral palsy, brain injury, or stroke):
A study found that ITB Therapy may provide long-term control of spasticity in people living with cerebral palsy or brain injury.6
A number of studies have determined ITB Therapy reduces spasticity in both the upper and lower limbs of those living with cerebral palsy,
brain injury and stroke.2,3,18-20
In another study, ITB Therapy was shown to improve hygiene and transfer scores in patients living with brain injury.21
1992, more than 50,000 Medtronic baclofen pumps have been used worldwide to manage severe spasticity related to a variety of conditions.
Depending on your specific condition, ITB Therapy may impact your severe spasticity in different ways. Treatment may be even more effective when used in combination with physical, occupational, or speech therapy.
Detail - Pump and catheter placement
How ITB Therapy Treats Severe Spasticity
ITB Therapy uses a surgically implanted programmable pump and catheter that delivers medication which helps relieve severe spasticity. This medication is a liquid form of baclofen called Lioresal® Intrathecal (baclofen injection), that goes directly into the intrathecal space where fluid flows around the spinal cord.
Because Lioresal Intrathecal is delivered directly to where it’s needed most in the spinal fluid, it relieves spasticity with smaller amounts of medication than when baclofen is taken orally. This method of delivery may help minimize side effects that can result from oral baclofen.
Therapy Components
The ITB Therapy system consists of:
Pump – a surgically placed, battery-powered programmable pump with a reservoir infuses the drug at a programmed rate via the catheter
Catheter – a flexible silicone tube delivers medication from the pump to your body
Lioresal Intrathecal – a liquid form of the medication baclofen
Although Medtronic ITB TherapySM (Intrathecal Baclofen Therapy) won’t eliminate the primary source of your condition or severe spasticity, it may help you manage the tight, stiff muscles that make daily living more difficult for you.
Benefits of ITB Therapy
ITB Therapy, also called the baclofen pump, has been shown to benefit people who have been affected by brain injury, stroke, cerebral palsy, multiple sclerosis, and spinal cord injury in the following ways:
Multiple studies show it significantly reduces spasticity and spasms.1-9
In at least seven studies the therapy has helped people become more independent, allowing them to perform activities of daily living including feeding or dressing themselves, sitting more comfortably, or transferring more easily.10-16
Some studies have reported caregiver satisfaction with ITB Therapy.13-17
For people whose spasticity is of cerebral origin (cerebral palsy, brain injury, or stroke):
A study found that ITB Therapy may provide long-term control of spasticity in people living with cerebral palsy or brain injury.6
A number of studies have determined ITB Therapy reduces spasticity in both the upper and lower limbs of those living with cerebral palsy,
brain injury and stroke.2,3,18-20
In another study, ITB Therapy was shown to improve hygiene and transfer scores in patients living with brain injury.21
October 2, 2009
Johnny,
Mom said she came to visit you tonight and she was about to leave and said, "Johnny I'm going to go, bye" and you said "bye". Mom said well crap...I can't go now, you might say something else. So she said, "Johnny do you know who Jackie is?" and you said, "yeah". Then she said, "Johnny do you want me to tell Jackie hi for you?" and you said, "yeah". Then mom said, "Johnny, do you want me to tell Jackie you love her?" and you said, "yeah". Mom said, "what's your name?" and you said, "Joh". Mom said, "I love you!" and you said, "I looo". She said you lost interest after that.
I am so proud of you!!! You are one of the toughest people I know!!! Keep pushing Johnny!
Last night, the nurse said that your heart rate when up some so they took the plug off of your trach and gave you some oxygen. Mom told her that your heart rate tended to go up and down and that she didn't feel like it was because of the trach plug. The nurse told mom that the doctor was still planning on taking the trach out this weekend.
Jerry said that he asked you, "what do you want Johnny?" and you said, "water". Oh man! You know, that's one thing I've been wondering about...it's been so long since you had anything to drink.
Your case worker at Texas Specialty told mom that your Dr., Dr. Goff, said that he will have no problem getting you in to UT Southwest to get the pump and then they will transfer you to rehab. Mom said that she swears when she went over your benefits book that UT Southwest wasn't covered. But, when she looked them up again recently, they were there and they are covered...I told her it's God's time. He wasn't ready for you to go to UT Southwest so He took care of that, now he is : )
***Update***
You are approved to stay at Texas Specialty until 10/7. On the morning of 10/8, you will be sent to UT Southwest for the trial pump. It's the first step in getting your pump. You will stay there over night and they will make sure that it works on you. You will also be tested for infection in your blood and urine. If the trial pump works and you are found to have an infection, you will still be able to get the pump but it'll have to be after your totally infection free. If you are infection free, you are already scheduled to get the pump on 10/13. On 10/9, you will go from UT Southwest to skilled nursing until your 10/13 appointment. After you receive your pump, you will be moved straight to a rehab facility to start therapy.
As far as botox goes, the pump is first priority. You can't get both the pump and the botox at the same time because you can't have anesthetic and botox at the same time so you'll get the pump first and within days, you'll get botox.
***specific prayers for Johnny***
It is so important that Johnny stays infection free.
Please pray that Johnny stays infection free, that he tolerates the pump during the trial and that he has a successful surgery while the pump is being installed. Pray that the pump is all that it promises. Johnny has come so far and I know that it's because of your continued faithful prayers. Johnny's family can't thank you enough for lifting him up!
Love you Johnny! xo Jen
Mom said she came to visit you tonight and she was about to leave and said, "Johnny I'm going to go, bye" and you said "bye". Mom said well crap...I can't go now, you might say something else. So she said, "Johnny do you know who Jackie is?" and you said, "yeah". Then she said, "Johnny do you want me to tell Jackie hi for you?" and you said, "yeah". Then mom said, "Johnny, do you want me to tell Jackie you love her?" and you said, "yeah". Mom said, "what's your name?" and you said, "Joh". Mom said, "I love you!" and you said, "I looo". She said you lost interest after that.
I am so proud of you!!! You are one of the toughest people I know!!! Keep pushing Johnny!
Last night, the nurse said that your heart rate when up some so they took the plug off of your trach and gave you some oxygen. Mom told her that your heart rate tended to go up and down and that she didn't feel like it was because of the trach plug. The nurse told mom that the doctor was still planning on taking the trach out this weekend.
Jerry said that he asked you, "what do you want Johnny?" and you said, "water". Oh man! You know, that's one thing I've been wondering about...it's been so long since you had anything to drink.
Your case worker at Texas Specialty told mom that your Dr., Dr. Goff, said that he will have no problem getting you in to UT Southwest to get the pump and then they will transfer you to rehab. Mom said that she swears when she went over your benefits book that UT Southwest wasn't covered. But, when she looked them up again recently, they were there and they are covered...I told her it's God's time. He wasn't ready for you to go to UT Southwest so He took care of that, now he is : )
***Update***
You are approved to stay at Texas Specialty until 10/7. On the morning of 10/8, you will be sent to UT Southwest for the trial pump. It's the first step in getting your pump. You will stay there over night and they will make sure that it works on you. You will also be tested for infection in your blood and urine. If the trial pump works and you are found to have an infection, you will still be able to get the pump but it'll have to be after your totally infection free. If you are infection free, you are already scheduled to get the pump on 10/13. On 10/9, you will go from UT Southwest to skilled nursing until your 10/13 appointment. After you receive your pump, you will be moved straight to a rehab facility to start therapy.
As far as botox goes, the pump is first priority. You can't get both the pump and the botox at the same time because you can't have anesthetic and botox at the same time so you'll get the pump first and within days, you'll get botox.
***specific prayers for Johnny***
It is so important that Johnny stays infection free.
Please pray that Johnny stays infection free, that he tolerates the pump during the trial and that he has a successful surgery while the pump is being installed. Pray that the pump is all that it promises. Johnny has come so far and I know that it's because of your continued faithful prayers. Johnny's family can't thank you enough for lifting him up!
Love you Johnny! xo Jen
Thursday, October 1, 2009
October 1, 2009
Johnny,
I spoke to mom this morning on my way to see you. Mickey took off work today and planned on spending some time with you during therapy. I called to tell mom that and she said that she had heard from Baylor. The doctors at Baylor said yes, they would accept you. Baylor said yes, they would accept you. Insurance said no! WHAT?? They would rather put you in skilled nursing and tote you back and forth by ambulance at $1,000 a pop rather then put you where the surgery can be done and then put you in skilled nursing. That just totally doesn't make sense and it doesn't seem like they are putting the patient (you) first. Well, Mom is waiting to hear from the appeals and denial of your insurance. She is protesting it! Go mom!
****Specific Prayer****
Pray that Johnny gets approved to go to Baylor Rehab, stays infection free, is able to get and tolerate the pump and that the botox works like it's suppose to. Pray that the insurance company puts some heart into their work and puts Johnny first...above the bottom line!
In the mean time, Mom is looking into a skilled nursing facility that takes trachs but also has rehab therapy. We definitely don't want another Manor Care and that's going to be one of her arguments...if you had stayed in that place any longer, we are sure you would not have survived it! They did not know how to care for you! Praise God you got out when you did because you have improved 100%!!
When Mickey and I got to your room, you did not look like you felt good. I straightened you up in the bed, cleaned your face, hands and mouth. I rubbed lotion on your feet. You so owe me! By the time Jerry got there to do therapy, you seemed more alert and ready to work. Jerry put you in the chair and had you shave a little and brush your teeth. You did really good. He worked on stretching you out. Jerry also had you stand for about two minutes and he stretched your back out. You didn't seem to mind it. Mickey and I had to leave right after your therapy, we headed to AAC (American Airlines Center) we met with Leroy to get your stuff. I got to talk to Susie. She's really missing you. She speaks so highly of you Johnny. You've got a lot of good people that work there that call you friend! I can't wait for you to realize! I also met Scott. He's a really nice guy!
Mom called me just a little while ago...around 5:30ish. She's visiting you. I think she was mad that I didn't tell her of the change they made to you but honestly, they made it after I left because I didn't know anything about it! She was crying, I know, I know...hard to believe! Ha! Sorry mom! I am kidding! She said that they had a red cap on your trach. You had no oxygen hooked up to it and you were breathing at 100%....ON YOUR OWN!!! Did you get that....you still had the trach but it is capped off...your breathing on your own oxygen and your doing it 100%! AWESOME!!! The Respiratory guy told mom that you would be TRACH FREE by the weekend! Mom said that you were raising up your head and looking around. She said that you were fully awake. I guess your feeling better! PRAISE GOD!!!
You will have a whole array of skilled nursing facilities to choose from if you don't have a trach. That's such a relief! We still need you to go to Baylor first to get the botox and pump and then to skilled nursing. That's still what we are praying for!!
Love you Johnny!! XO Jen
You seem more alert
Jerry working on head control
You shaving
I spoke to mom this morning on my way to see you. Mickey took off work today and planned on spending some time with you during therapy. I called to tell mom that and she said that she had heard from Baylor. The doctors at Baylor said yes, they would accept you. Baylor said yes, they would accept you. Insurance said no! WHAT?? They would rather put you in skilled nursing and tote you back and forth by ambulance at $1,000 a pop rather then put you where the surgery can be done and then put you in skilled nursing. That just totally doesn't make sense and it doesn't seem like they are putting the patient (you) first. Well, Mom is waiting to hear from the appeals and denial of your insurance. She is protesting it! Go mom!
****Specific Prayer****
Pray that Johnny gets approved to go to Baylor Rehab, stays infection free, is able to get and tolerate the pump and that the botox works like it's suppose to. Pray that the insurance company puts some heart into their work and puts Johnny first...above the bottom line!
In the mean time, Mom is looking into a skilled nursing facility that takes trachs but also has rehab therapy. We definitely don't want another Manor Care and that's going to be one of her arguments...if you had stayed in that place any longer, we are sure you would not have survived it! They did not know how to care for you! Praise God you got out when you did because you have improved 100%!!
When Mickey and I got to your room, you did not look like you felt good. I straightened you up in the bed, cleaned your face, hands and mouth. I rubbed lotion on your feet. You so owe me! By the time Jerry got there to do therapy, you seemed more alert and ready to work. Jerry put you in the chair and had you shave a little and brush your teeth. You did really good. He worked on stretching you out. Jerry also had you stand for about two minutes and he stretched your back out. You didn't seem to mind it. Mickey and I had to leave right after your therapy, we headed to AAC (American Airlines Center) we met with Leroy to get your stuff. I got to talk to Susie. She's really missing you. She speaks so highly of you Johnny. You've got a lot of good people that work there that call you friend! I can't wait for you to realize! I also met Scott. He's a really nice guy!
Mom called me just a little while ago...around 5:30ish. She's visiting you. I think she was mad that I didn't tell her of the change they made to you but honestly, they made it after I left because I didn't know anything about it! She was crying, I know, I know...hard to believe! Ha! Sorry mom! I am kidding! She said that they had a red cap on your trach. You had no oxygen hooked up to it and you were breathing at 100%....ON YOUR OWN!!! Did you get that....you still had the trach but it is capped off...your breathing on your own oxygen and your doing it 100%! AWESOME!!! The Respiratory guy told mom that you would be TRACH FREE by the weekend! Mom said that you were raising up your head and looking around. She said that you were fully awake. I guess your feeling better! PRAISE GOD!!!
You will have a whole array of skilled nursing facilities to choose from if you don't have a trach. That's such a relief! We still need you to go to Baylor first to get the botox and pump and then to skilled nursing. That's still what we are praying for!!
Love you Johnny!! XO Jen
You seem more alert
Jerry working on head control
You shaving
September 30, 2009
Johnny,
Mom said during therapy they had you standing on the board. They worked on stretching with you. Mom said that you really didn't do anything new. Your respiratory doctor came by and took your trach out and replaced it with a different one. He said that it should help with your secretions.
****Specific Prayer for Johnny****
Pray that Johnny stays infection free. It's a matter of him getting the pump or not. Baylor rehab called today about the botox injections and the pump, it looks like it's going to be a go but Johnny has to stay infection free.
Mom said this evening she was visiting you and her phone rang and you put one of your "toys" up to your ear. I hate calling it a toy but it is...it's for therapy purposes but I know how prideful you are and I don't want that to embarrass you!! It's not my intentions! It does, however, show us that you know what a phone sounds like and what to do with one. Mom said that you were sitting up in bed when she walked in. Y'all spent some time looking at the electronic pictures. She said that you seemed fascinated...until you fell asleep. She also put aspercream on your knees, feet and left hand. You seemed to like that.
Love you Johnny!! XO Jen
Mom said during therapy they had you standing on the board. They worked on stretching with you. Mom said that you really didn't do anything new. Your respiratory doctor came by and took your trach out and replaced it with a different one. He said that it should help with your secretions.
****Specific Prayer for Johnny****
Pray that Johnny stays infection free. It's a matter of him getting the pump or not. Baylor rehab called today about the botox injections and the pump, it looks like it's going to be a go but Johnny has to stay infection free.
Mom said this evening she was visiting you and her phone rang and you put one of your "toys" up to your ear. I hate calling it a toy but it is...it's for therapy purposes but I know how prideful you are and I don't want that to embarrass you!! It's not my intentions! It does, however, show us that you know what a phone sounds like and what to do with one. Mom said that you were sitting up in bed when she walked in. Y'all spent some time looking at the electronic pictures. She said that you seemed fascinated...until you fell asleep. She also put aspercream on your knees, feet and left hand. You seemed to like that.
Love you Johnny!! XO Jen
September 29, 2009
Johnny,
I know I've said it before but Tuesday's are hard! Today is week 15 and it's still so hard to believe! I came to visit you and you just really seemed like you didn't feel good. You had a touch of diarrhea and it really wiped you out. Jerry came to do therapy and put you in the chair but you were not at all interested. He left me alone with you to work on some things and you would not even keep your eyes open. When Jerry came back to check on us, we decided that you had enough and put you back in bed. You were sound asleep just about as soon as your head hit the pillow.
On my way home, I stopped by Michaels to get stuff to make Jackie a mum. Mom is going to spend the night after she visits with you and we are going to work on it. Well, it turned out good.... here's a picture:
I know I've said it before but Tuesday's are hard! Today is week 15 and it's still so hard to believe! I came to visit you and you just really seemed like you didn't feel good. You had a touch of diarrhea and it really wiped you out. Jerry came to do therapy and put you in the chair but you were not at all interested. He left me alone with you to work on some things and you would not even keep your eyes open. When Jerry came back to check on us, we decided that you had enough and put you back in bed. You were sound asleep just about as soon as your head hit the pillow.
On my way home, I stopped by Michaels to get stuff to make Jackie a mum. Mom is going to spend the night after she visits with you and we are going to work on it. Well, it turned out good.... here's a picture:
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