Dustin LaFortune

Archive for the ‘Health Updates’ Category

About Dustin’s proposed Rehab program

• Very soon, Dustin will be medically stable enough to participate in rehab.
• The ABI (Acquired Brain Injury) team does not anticipate problems except in areas of stamina and tiredness.
• Dustin’s therapy programs will focus on functional goals, practical skills, activities of daily living, cognition and problem solving.  A section of time will be blocked off so that Dustin can have regular counselling sessions to address psychological and emotional issues.
• Dustin’s schedule will include cognition, memory and safe judgment training & exercises.
• Some of the goals can be met within Dustin’s program, particularly related to ADL’s (Activities of Daily Living) but the cognitive recovery is long term and will continue while Dustin is in the community.
• Dustin will need to stay in rehab until he is safe to return to a more normal life so in terms of mobility Dustin is doing amazingly well and it is expected that he will continue to recover as he gains weight and gets his strength back – he will hopefully be able to do most of the activities of daily living fairly independently.
• Cognitively what is necessary is to hopefully have safe judgment – he is going to need to the help of family and friends for this longer term recovery. The Dr’s experience of 20 years in rehabilitation medicine is that people get better in the real world rather than an institution. It is important to begin to think about planning for what is next and where it is going to take place.
• It may take longer for the cognitive piece; the remembering, thinking and emotional part will take longer but Dustin will not be in rehabilitation for the long term recovery of those aspects. Community and family support will be key.
• The doctors believe Dustin will become independent in dressing, eating and personal care. The key issues will be that of judgment, safety and complex social things.
• The family will need some professional support once Dustin is out of rehabilitation; living with and supporting Dustin 24 hours a day will be the real challenge.
• There is only so much professionals can and will do in these situations – the remainder of the role and support will fall upon Dustin’s informal support network being his family and friends to assist him with his day-to-day living.

Dustin spent time with his counsellor today. She brought him to the Wasakaw Pisim Centre on the first floor of the hospital where he was able to smudge and speak with an Elder.

• The NG tube is out (no more supplemental calories or vitamins) and Dustin is eating double portions of pureed and minced food. Liquids still have to be thickened. Eating is an all day affair because Dustin still can’t open or close his mouth more than one ‘knuckle/tongue depressor’ width. Occupational therapy is working on exercises to strengthen damaged facial muscles and ligaments.
• Dustin is off isolation restriction. The VRE still shows positive in his blood but he is asymptomatic.
• Dustin is standing and walking several steps at a time (with assistance from two people). His balance is still off.
• He sits for longer and longer periods of time

Dustin now weighs 52.3 kg (115.3lbs)!

Renee had a 2-hour phone call with a team of medical professionals helping Dustin recover. There was a LOT of ground covered. The only thing “missing” from these updates are the neurologists’ reports – those are to follow as Renee is meeting them in person in Regina.

WHO was on the call:

• The Unit Manager via proxy by the neuropsych nurse
• Physiotherapist
• Occupational therapist
• Social worker
• Client rep
• Renee

First, we have the medical report that was requisitioned from Calgary:

CALGARY CHART (what we were told was a work accident – this happened back in late Fall 2009. No work accident reports found on record.)

Dustin was admitted to ICU, unconscious and treated for POLYTRAUMA and diffuse brain injury.

List of injuries on admission:

• lacerated bowel from stab wounds
• lacerated liver from stab wounds
• blowout fracture of left cheek bone and frontal sinus
• bilateral multiple rib fractures
• collapsed lung with blood and fluid
• fractures of T-9, T-10, T-11 and T-12
• fractures of L-1 and L-2
• ligament damage and fractures to C-6 and C-7
• open wounds and lacerations
• acquired VRE in the hospital
• toxicology – not on the chart info to follow
• no damage to lips, teeth, mouth

REGINA CHART

Dustin was admitted to ICU semi-conscious (level 12) and then went into a coma.

List of injuries on admission:

• severe bilateral pneumonia
• fractures of right and left cheek bones over partly and badly healed fractures (since Calgary)
• fracture of C-6
• badly damaged thyroid cartilage
• multiple bilateral fractures of all ribs (over partly healed and old fractures since Calgary)
• acute brain injury over diffuse with bleeding and swelling
• severe malnutrition and dehydration
• heart arrhythmia
• damage to upper hard palate
• lower lip severed
• tongue cut
• blowout fracture of eye orbit and attached muscles
• bilateral bleeding, hematoma, scar tissue, swelling, cuts and damaged cartilage – both ears (new wounds over old wounds since Calgary)
• “2nd degree trauma” (?) to penis
• toxicology report:  negative for Hep & HIV, no drugs or alcohol of any kind
• multiple wounds and lacerations in various stages of healing from new to scar tissue (since Calgary)
• No rape kit was done on admission

SURGERIES REQUIRED (eventually)

Facial reconstruction, ears, mouth and extensive dental work.  Maybe more.

EARS

• Dustin will eventually need reconstructive surgery
• there is damage to the auditory canal in both ears
• there is some evidence of hearing loss but only in the higher ranges
• Dustin does not yet have the cognitive capacity to participate in the necessary tests to accurately determine the degree of hearing loss.

EYES

• the uneven and wandering eye is a result of the facial/orbital fractures and damage to the ligaments that connect the eye to the face
• Dustin does not yet have the cognitive capacity to participate in the necessary tests to accurately determine the degree of vision loss.
• he will need glasses

MOUTH

An application has been submitted by the Social Worker to Victim Services for Compensation.  Dustin is pre-approved up to $1000 in dental work plus another $1000 if the actual costs exceed their limit.

The plastic surgeons noted in the chart that Dustin will require extensive reconstruction on his face, lips and inside his mouth before dental work can even be contemplated.

BRAIN INJURY

Dustin’s head trauma occurred over a long period of time so the ‘first 90 day rule’ does not apply.  Dustin is still considered to be in the ACUTE phase.  The inflammation of his brain is still evident although the bleeding has stopped.  Progress has been slow but steady.  Most of the severe deficits are in short term memory.  There may be some retrograde amnesia. Dustin is in the repetitive stage.  His agitation may be caused by the brain injury or by his inability to process PTSD.

• Once the swelling is reduced, some of the neurons may start firing again by themselves and Dustin may begin to remember, understand and retain new information.
• Dustin is ‘covering’ deficits.  Apparently this is normal because Dustin does not understand the gravity of his injuries on any level.  He probably knows that ’something’ is not right or normal.
• Dustin cannot transfer or generalize information.  To accomplish this he must engage is stimulating and repetitive tasks.  According to the Rehab people….life is rehab.  Dustin must engage in ordinary activities over and over and over again so he can re-learn old skills.
• Progress will be slow.  Dustin is still in the very early stages of ABI recovery.  Dustin may never recover complete brain function but the end prognosis so far (subject to change):  Mild ABI
• Dustin may never remember all the details, the sequence etc…It depends on the level of consciousness and unconsciousness at the times of the assaults.  Partial Retrograde Amnesia is the rule, not the exception.  It is very, very common.
• The ABI neuro team assessed Dustin with moderate ABI with the possibility of achieving MILD ABI after rehab….maybe.
• The hospital has put in a request for a specialized neuropsych consult.

PHYSIO

• The physio therapist works with Dustin for at least two hours, Monday to Friday.
• Currently she and Dustin are working on ‘Stepping’, ‘Standing’, ‘Walking’, and ‘Balance’.
• Dustin cannot ‘balance’ his trunk and is very weak.  He requires two person supports on either side to hold him up. The therapists have experimented with a walker but Dustin is too wobbly.
• Strengthening exercises and muscle building exercises are built into every activity or task.
• Dustin has a very positive attitude.  He’s pleasant and cooperative most of the time.  Dustin is also trying really hard to perform the exercises.  He follows instructions but sometimes has a difficult time remembering.
• Dustin spends most of his day in the wheelchair.  It is important to improve trunk balance and abdominal muscles.

OCCUPATIONAL THERAPY

• The Occupational Therapist works with Dustin for two hours every day from Monday to Friday.
• She administers cognitive assessments and provides Dustin with stimulating tasks and exercises.
• Dustin’s short term memory is severely impaired.
• He can repeat sentences and instructions immediately but not after one of five minutes.
• Dustin can choose between 3 options.  This is consistent so she knows that the CHOICE is actually Dustin’s preference and not random.
• Dustin seems to be oriented in time and space.
• The Occupational Therapist administered a ‘Safety and Judgment’ test. Dustin’s answers were ‘vaguely’ correct.
• The therapist is noticing a very slow but steady improvement.

NURSING/HEALTH (no nurses, other than the psych nurse participated in the teleconference.  He was there as a replacement for the Unit Mgr., not as a nurse)

• Dustin is able to focus on immediate needs and wants
• He is in hand restraints for impulsive behaviours (in bed or in the chair)
• Dustin receives multivitamins and T3s every 6 hours.
• Dustin ‘calls out’ frequently.  This might be OCD, the brain injury or flashbacks.
• Dustin was scheduled for another swallowing test TODAY.  If he passes, Dustin will be put on a very high calorie, dental soft diet.
• If Dustin passes the video test (thyroid cartilege damage plus brain injury responsible for the difficulty swallowing), we will be allowed to feed him (bring treats) pudding, ice cream, cream soups etc… (No pizza or hamburgers yet).  It will take months of practice before Dustin can swallow properly and before he can chew more solid foods (damage to palate, teeth and tongue).
• C-diff swabs still negative
• VRE still positive.  Dustin is not being treated.  It is hoped that as he gets stronger, his body will be able to fight it off without more antibiotics.
• the nurses are applying topical cortisone ointment to Dustin’s wounds and lacerations.  There is some improvement but it’s slow.

Dustin is still in Depends.  He will be able (if he’s able) to go to the bathroom with assistance within 2 or 3 weeks.  The problem right now is that he is too weak, cannot walk and cannot support his weight while standing, moving or sitting.  Dustin knows when ‘he has to go’ but does not have sufficient control to ‘hold it’ until he can be physically transported to the bathroom. It takes 2 people.

Dustin moves limbs automatically (unconscious reflex which is normal at this stage of Brain injury) and independently on command.  The left side works better than the right side.

PSYCHOLOGICAL AND EMOTIONAL

The Social Worker got ‘pre-approval’ for EMERGENCY PTSD counseling.  It takes a minimum of 3 – 4 weeks of bureaucratic wrangling to have the emergency service implemented.

Ms. F from _____ Counseling has five (5) psychologists available, including herself, to provide URGENT support to Dustin….which will take at least 3 – 4 weeks.  Victim Services has authorized the standard amount of $1000 or four appts to provide crime related support for PTSD which includes the initial assessment.  The Social Worker is trying to arrange for Ms. F to come to the hospital to do the assessment.  Four (4) of the five psychologists have agreed to go to the hospital to provide one-hour counseling sessions…after the assessment and when everything is set up in 3 – 4 weeks.

In the meantime, the Social Worker has been given permission by her supervisor to provide ‘listening and emotional’ support to Dustin if he discloses and requires assistance to process.  The Social Worker said the she cannot help him process.  The police have instructed everybody NOT to ask leading questions.

Dustin will not be given sedatives.  The neurology department prefers not to administer certain drugs to patients with brain injuries.  There is one compound approved to stop the repetitive loops which has sedative effects.  This has already been prescribed and Dustin will continue to get it as necessary.

MISCELLANEOUS

Dustin’s body will be okay.  He will recover and with surgery(s), he will return to normal with normal function and abilities.  It will take a long time.  Dustin may walk with a slight limp (from spinal fractures).

Dustin’s brain injury is forever.  With extensive rehab he may be able to ‘pass for normal’ but will always require some kind of practical and functional support.  The hospital is very pleased with his progress, his personality and his attitude. It is too early to tell how far Dustin will go – but everyone seems optimistic.

Thanks to Dustin’s cousin, who is also one of his best friends, we have a wonderful video update to how Dustin is progressing! There is still a long road ahead of him, but now we can share in his first steps.

Thank YOU, Dustin; keep getting better.

Link to source at YouTube

Dustin’s YouTube Channel

Dustin’s cousin Marcel, brother Rogi, best friend Lynn and “Cousin-in-law” Shileen (Marcel’s wife)  were able to visit Dustin this past weekend. They gave Dustin a new baseball cap and looks like he gets some stuffed animals to keep him company

To see the new photos, go to the Gallery.

I called the hospital tonight as I have every single night since Dustin was admitted (save for the precious few days that I was in Regina).

Tonight, a nurse answered (she only said the name of the unit), I went through the whole routine of saying my name, giving my password and waiting five minutes for the nurse to go get the chart to check my password. Once that was over, I asked how Dustin was and what kind of day he’s had etc…

The anonymous nurse answered: “…he’s good, no change, we gave him a bath tonight. Bye.”

Before she had the chance to hang up on me, I tried again and said that I call every night at the same time so I can get info from the day and night shifts and asked if there was anything written on the chart about test results.

She said: I have nothing to tell you. He’s good, no change, we gave him a bath tonight. There is nothing more I want to tell you.

I asked her name and she refused to tell me, then said good bye and hung up.

Of course it is Friday of the long weekend and nobody will be in until Tuesday but I called and left messages for:

The Unit Manager, the Client Rep and the Social Worker.

NOW THE HOSPITAL IS WITHHOLDING INFORMATION ABOUT DUSTIN. I SUSPECT THIS IS FALLOUT FROM THE SECURITY BREACH – perhaps some of the staff from that rotation are back on shift.

**Update May 22**

This morning, the Client Rep. from the hospital called me to say that she would look into the matter and gave the name of a nurse on Dustin’s unit that I could speak with about updates. All I want is to know how my son is doing from day to day. Every little improvement and every ache or pain means something to us!

I have sent an email to Dwight Nelson, the CEO of the Saskatchewan Health Region. My email will be followed by a phone call on Tuesday.

- Dustin stayed up a little later than usual tonight. He was watching hockey and something else on TV.

- Dustin was weighed this morning. 111.39 lbs or 50.5 kg. (approx) He’s gained about one pound since May 11th..

- Dustin spent time in the special reclining wheelchair again today but was not allowed to leave his room (somebody ‘remembered’ the isolation restrictions so from now on, or until infectious disease says otherwise, Dustin must remain in his room)

- Dustin asked for painkillers several times in a row. Even after he’d been given meds and enough time passed for them to kick in, Dustin asked again. This continued for quite a while so the nurses asked him if it hurt anywhere and Dustin said NO. Then Dustin started repeating other things…

The nurses think ‘the recording in his brain’ just got stuck….he’s repeating and repeating everything. I was told this was normal for this stage of recovery.

- a consult was submitted to psychiatry re: trauma, depression etc…but then withdrawn after a preliminary assessment. It seems that Dustin has not yet reached that stage of self-awareness and processing.

- If Dustin is given photos of family, he looks at them and names the person in the picture. He has not identified himself in any of the photos. (for example: I wrote the word “YOU” on top of a picture of Dustin and the word Marcel on top of the picture of Marcel – both Dustin and Marcel are in the picture. Dustin says “thats YOU and Marcel”)

May 15, 2010

Here is the update for today and yesterday….

- Dustin is the talk of the critical care unit. The nurses keep telling him that he was on TV. Dustin said “cool”
- Dustin was pretty tired today. Between sleeps the nurse put him the the chair for about an hour
- The latest C-diff test came back NEGATIVE. When the VRE results are back, if the Infectious Disease dept. says it’s okay, Dustin will not be in isolation anymore. This means no gloves or gowns necessary – and Dustin can have stuff in his room.
- WEIGHT: May 04 48.9 kg., May 11 50 kg.
- the nurse said Dustin looks better and more at ease since Court’s visit.