Lokomat

Bob had another good day. He had his three therapies and an extra group therapy today. In this group therapy he sat around a table in the dinning room of his floor with other patients.

During his physical therapy Bob used the lokomat - not locomat as I previously thought. The lokomat is a machine that suspends the patient while he walks on a treadmill. Here is a picture of it that I found online:

When asked by my mom if he liked using it he gave her an enthusiastic "yes". She also asked Bob if it hurts and he shook his head "no". Bob will use this machine again on friday morning and my mom is planning on going to the hospital early to see it in action. If we are lucky, we'll get some pictures.

One of Bob's daughters who lives in California came to visit with her daughter. Elizabeth and Emma came to the East Coast to drop off Kyle, the eldest son at his new school. They took advantage of being so close to Bob and swung north on their way back home. Elizabeth and Emma spent some time at the hospital and were able to see Bob in between his many therapy sessions. Bob enjoyed their visit and was happy to see them.

I was planning on going to see him after picking up my daughter from school, she was sad that she didn't get to go with me and my son on Monday. Unfortunately, due to a snow storm, I had to postpone the trip. It was hard to stay away, but I will try again tomorrow. That's all for today. Thanks for reading and keep the positive thoughts and prayers coming.

Bob is doing fine

Bob had a good day today. He participated in a copper rubbing activity and had good therapy sessions.

During physical therapy, Bob worked on moving on the bed and practiced transfers (bed to chair and sit to stand). He kicked the ball and practiced moving around on his wheelchair, forward direction only. Yesterday during physical therapy, Bob was evaluated on a machine called locomat. I'm not sure what it does. When I find out I'll post about it.

Bob trained copying words during speech therapy today. He did well with 80% of them. The therapist also practiced one step commands with cues and demonstration. She did not rate him on this in her report. She will be out on vacation for the rest of the week so another speech and language pathologist will work with Bob while she is gone.

My mom submitted a form to the team which included all the measurements of her house. The team will provide suggestions for modifying their living conditions to better accommodate Bob's new life. This won't be done for a while, as a lot can change from now until he is able to come home. (I feel like I wrote this line once before...) My mom did not meet with the case worker after all today so we will have to wait until tomorrow to get the team's most current report.

That's all for now. Bob is settling into the hospital, establishing bonds with the staff and making good progress every day. Thanks for reading and keep the positive thoughts and prayers coming.

Huge Food News

Today Bob's speech therapist, Marianne, upgraded his diet from "advanced soft" solids to "regular" solids: Bob can eat regular foods. That is a significant advance in his recovery. It is hard to believe that one month ago he was eating through a feeding tube. This means we can bring food from outside the hospital as a treat. Another bonus: Bob can now have a bite of my mom's doughnut when they visit the Dunkin Donuts in the lobby. But just a bite, he still must eat the diet of a heart attack survivor: low in salt and fat.

Marianne loved the tablet that my cousin Cecilia brought last saturday. Marianne thought it was a great present and it will be very useful in Bob's rehabilitation. Bob likes having it by his bedside. Today he used it to write a word to answer a question I had asked him. I didn't understand the word, although it was legible, it was nonsensical.

Bob's occupational therapist suggested he wear a watch again. This could help direct his attention to his right arm. It seems he is more aware of his right leg, than his right arm. When Bob rides the wheel chair without the foot support, he uses his left foot hook under this right to support it. This prevents the right foot from dragging on the ground.

I helped Bob tie his shoe today. I held one lace, he held the other and together we did a pretty nice job.

My mom brought Bob a mirror that stands alone so that he can shave without help. She also brought Bob his nook and he remembered how to unlock the screen and navigate through the menu. Bob didn't want to keep it around because the amount of words was overwhelming. So my mom will bring it back home and try again another time. Bob was an avid reader and I can't wait for him to devour books again.

Bob's doctor said he is doing very well. The team will meet again tomorrow. We are not sure if they will give him a whole new assessment. That's all for today. Thanks for reading and keep the positive thoughts and prayers coming.

A Day Off

Today Bob was happy to have a day off from all three therapies. They are very tiring for him. It is a lot of work to rewire the brain! Bob did have dog therapy today, which he enjoyed very much. He went up to a room on the eighth floor where a few times a week there are dogs for the patients to interact with. I wonder if Bob thought of Candy, his last dog.

My mom spent most of the day with him and they watched shows on the ipad, read emails and magazines and ate meals together. Tonight she will sleep at their house, but tomorrow she will be back at our house.

My parents' friends Bruce and Simone went to visit in the afternoon. They brought pictures from their trip to Brasil, which Bob enjoyed looking at. Bob went on another stroll that lead him to the lobby where he had a dunkin donuts latte once again. Decaf of course...

That's all for today, thanks for reading and keep the positive thoughts and prayers coming.

First Outing

Bob had a large cheering section today. Besides our family of four, my cousin Cecilia, her husband Claudio and their two girls drove up from New York just to see him. They went back the same day. They brought Bob a great present: a tablet from Brookstone to help him write. A sort of electronic dry-erase board.  Bob liked it a lot. The grandkids enjoyed it as well and had to be reminded several times that it wasn't a toy...

The ten of us hung out in the sunny room at the end of the hallway and then took Bob for a stroll outside. It was quite windy, but Bob enjoyed the sunshine and the new sights. Here is a picture of the crowd taken by my mom:

Even though it was saturday, Bob had all three types of therapies today. I believe tomorrow he will have a day off. His physical therapist told my mom that Bob kicked a ball in front of him with his right leg twenty times. Yes, I meant right leg!

There is a blue binder in Bob's room that is his Program Therapy Manual. In it are his therapy goals, some personal information and notes from the therapists. The therapists have been updating it almost daily. It is very nice to have this record book because it helps inform the family of Bob's progress. It will also be a chronicle of his improvements. I have started to take pictures of the pages where the therapists take notes so that I can relate the information on this blog.

Yesterday, his speech therapist wrote that Bob did well in therapy. She wrote: "He correctly pointed to 10 out of 15 objects named by Marianne [the therapist] (better than yesterday). He correctly answered 9 out of 10 pairs of yes/no questions (better than yesterday). He copied 10 simple words with very rare mistakes in letter choice. He matched written words to objects in 5 of 10 attempts. We also worked on saying "ah", "oh", and "m"." It is nice to get this kind of insight into his sessions.

Bob was in good spirits today and appreciated seeing his fan club. I know not everyone that reads this can come see him at Spaulding, but if you can, you should. If you can't, Bob continues to enjoy the emails he receives through my mom. Thanks for reading and keep the thoughts, (emails!) and prayers coming.

Initial assessment by the team

Yesterday my mom got the first report from Bob's case manager. It includes goals set by the doctor and therapists as well as expectations of what Bob can recover. It is accompanied by a disclaimer: this can change weekly and it is not written in stone. Bob's team will meet at least once a week to discuss his progress. They will make the appropriate changes in his plan as he improves and meets or exceeds their expectations. Yes, I have high expectations...

The target date for Bob to leave Spaulding is April 5th. Here are some of his team's goals:

• Bob will leave Spaulding requiring a contact guard. That is a person who will help him transition from one place to another. Bob will always need supervision, he may never be left alone. 
• Bob will have minimal assistance for washing and dressing. That means he does 75% and someone else does 25%. 
• Bob will be able to groom himself (shave, comb, brush teeth) independently while sitting down.
• Bob will have a normal diet. That means he can come to restaurants with the family and eat anything he wants from the menu. 
• Bob will use a wheel chair independently. Not an electric wheel chair, but one which can be maneuvered with just his left hand.
• Bob will understand basic information given a cue. 
• Bob will speak eight to ten basic words that will help him express his needs such as "yes", "no", "hungry" and "toilet". 

Bob might not go home after he leaves Spaulding. After Spaulding (which is considered an acute therapy rehabilitation center) he may go to a skilled nursing facility (which is different from a nursing home because it provides physical, speech and occupational therapy). From there he can then go home and receive in home care, and then finally attend an outpatient rehabilitation facility.

Today I took the kids to see vovô again and picked up my husband at work so he could join us during his lunch hour. We found him in good spirits again. The grandkids enjoyed hanging out with Bob and he even helped Zoe color the book she had brought. The four of us went to have lunch at the cafeteria while Bob had physical therapy at one o'clock. After lunch we met him in his room and Bob was very tired. He napped before his three o'clock occupational therapy session. We went home while he was napping and left him a note saying we will be back tomorrow. My mom said he understood it.

Below is a picture of Bob in the dinning room of his floor during his occupational therapy session. He is wearing a special glove that stimulates his right arm. It was opening and closing his hands for him. Bob was quite mesmerized by it.

During the weekend the therapies aren't as frequent, but Bob will have a ton of visitors. Besides my mom who has been there daily, the four of us will be back along with my cousin Cecilia and her whole family. They are coming to spend the day from New York to see Bob.

Thanks for reading and keep the positive thoughts and prayers coming.

Assessment from the psychologist

Today Bob was seen by the psychologist on staff and I am told he was impressed by Bob. He said Bob is doing very well and that he is not depressed. He said Bob is a strong man. Bob is aware of the fact he had a stroke. He also knows where he is. The doctor said Bob's biggest obstacle is his aphasia. What is aphasia? I went to aphasia.org and found this definition:


Aphasia is an acquired communication disorder that impairs a person's ability to process language, but does not affect intelligence. Aphasia impairs the ability to speak and understand others, and most people with aphasia experience difficulty reading and writing. 

After a few more clicks online I discovered that it can take a few years for a patient to recover some or part of their communication skills. It is too soon to tell what Bob will regain. My mom pushed the speech therapist to make a non-binding prediction yesterday and she thinks Bob will interface using many forms of communication such as gestures, sounds and writing. The psychologist today used a series of multiple choice questions to talk to Bob. So when presented with choices, not just "yes" or "no", Bob is capable of selecting the one that best answers a question. This was evident yesterday when he chose his food for today from the menu that was dropped off in his room. 

My husband, Jason, went to see Bob for lunch and brought him the newspaper. When Jason arrived Bob was almost done seeing his psychologist. Jason found Bob in good spirits and happy to see him. Once the session was over the psychologist asked Jason to answer some questions about Bob's background and fill in some blanks. Bob giggled and was amused by the fact that Jason couldn't remember Bob's mom's name. Jason of course remembered "Jean" as he was telling me about his visit. This tale demonstrates that Bob is aware of what is going on around him and is participating in the way he can right now - always with a sense of humor. It is incredible that he hasn't lost his sense of humor.

My mom went to Spaulding in the afternoon after spending the morning at her house taking care of finances and organizing the huge to-do list. She will have to take on all of Bob's responsibilities for now.


Bob had visits from Bruce and Simone, the couple that my parents were traveling with in Brasil. They talked a lot and Bob enjoyed the visit.


My mom met with the case worker today and they discussed Bob's initial assessment. I will talk about this with my mom and husband this evening and will report back in tomorrow's blog. Thanks for reading and keep the positive thoughts and prayers coming. 

Family Visit

Bob had physical therapy this morning and he stood up holding two parallel bars. He practiced taking steps by moving his left foot forward while the physical therapist moved his right foot forward. My mom arrived at the end of the physical therapy session. She did not witness the other therapy sessions as they happened in the morning. Visiting hours start at one in the afternoon.

My husband and I took our two children to see Bob for the first time today. We met him and my mom in a sunny room at the end of the hallway. My daughter read to vovô, my son put together a puzzle with him and they all played tic-tac-toe. Bob and my daughter tied, but Bob won when he played my son (he doesn't really know the rules and preferred making squares instead of circles...) The children behaved well at the hospital and acted naturally around Bob. I was apprehensive at first. This isn't a setting that my children are used to and it could have been intimidating or even scary. But they were genuinely happy to see Bob and my daughter didn't want to leave at the end of the day. On the drive home my son expressed the same feeling saying "I love vovô so much, I wish I could spend the whole day with him."

My husband and the children broke up the visit by leaving on a hunt for an electric shaver. The hospital staff is against shaving with a razor due to the blood thinners that Bob is taking. The nurse mentioned Bob will continue to take these blood thinners until he no longer sitting or lying down for such long periods of time. They help minimize the risk of clots, which is higher when a person can't move much.

While they were gone, my mom met with Bob's case worker for the first time. She coordinates the team of three therapists and doctor and acts as a liaison between the family and the team. The case worker will meet with the team by the end of the week to discuss Bob's progress and set goals for his stay at the hospital. These goals may change every time they meet, depending on how Bob improves.

Bob had to move to another room after all. It is on the same floor. Bob was moved closer to the nurses' station as he requires to be checked in on every fifteen minutes. This is due to his inability to ask for assistance. I hung family pictures on the wall as well as some drawings that my kids made for vovô. Bob has a nice view of the science museum and the water.

There are lots of aspects about Spaulding that are different from the hospital in Rio. The most noticeable one is the fact that my mom was with Bob all the time in Brasil. This meant being present for all the therapies and taking an active role in them. My mom helped translate the portuguese, fed Bob in the beginning, held him and exercised with him during physical therapy. She also slept at the hospital nearly every night. At Spaulding she has a less active role. On Bob's first day my mom was told to be his advocate. The director has told me that my mom should rest while Bob is at the rehabilitation hospital because once he is discharged, she will be the full time care giver. So now my mom is fulfilling her role and advocating on his behalf: Insisting that he get checked upon every fifteen minutes, ensuring that he has a bath everyday, asking that his bed is by the window, making sure he receives the bracelet that signals he is a fall risk... She has found that no place is infallible.

Taking care of someone has many forms. As Bob relearns to be independent and take care of his needs, we are all adjusting and learning how to best serve him. Last time I fought back the urge to open his milk carton for him. Today I helped him take the plastic wrap off his slice of cake at dinner time. He asked for help, I quite literally jumped at the chance. My husband got him the electric razor and held up the mirror while Bob used it. The grandkids showed their love in ways that grown ups can't. Relatives called to check how Bob is doing. Friends and family have left sweet and encouraging comments on the blog (thanks, Diane!) And so it goes, one day at a time.

Thanks for reading and keep the positive thoughts and prayers coming.

First full day at Spaulding

Bob's doctor will be the same woman that saw him yesterday. He will remain on the third floor after all. Good. He has done enough moving lately. Bob met with all of his therapists. His occupational therapist is called Amanda, his physical therapist is called Dan, and his speech therapist is called Katlyn. I don't have their evaluations of him, so I can't answer the most anticipated questions such as how long will he stay at the rehabilitation hospital or what can we anticipate from his recovery. I hope to know more by the end of the week to set realistic expectations of what Bob's future holds.

Bob's food has now been upgraded to "advanced soft thin with closed supervision". Yesterday it was "soft thin with one to one supervision." Bob has already improved in less than a day! He continues to eat well and tonight's dinner was linguini with clam sauce. Yum! Bob was able to swallow a whole soft pill today. He dreaded taking medicine by crushing the pills. The speech therapist predicts that within one week Bob will be eating normally.

Dan, the physical therapist, said Bob looked better in person than on paper and put him in a wheel chair to teach him how to get around in one. Tomorrow Bob will get a wheel chair that can be maneuvered with just one hand. My mom took him for a ride around the sixth floor and showed him the gym facility.

Bob is happy to be there, relieved to be home and in a hospital that is devoted to rehabilitation. We are all happy to have you back, too.

Thanks for reading and keep the positive thoughts and prayers coming.

Bob arrived at Spaulding Rehabilitation Center Today

The trip home was not without stress and controversy. The take-charge nurse turned out to be quite overbearing and rude. The plane that brought my parents to Boston left from JFK after all. It was also much smaller than anticipated making it an uncomfortable hour ride for Bob and my mom. Two planes and three ambulances later, they made it to Spaulding by eleven in the morning. I arrived at room 307 to meet them shortly after. This room is a total departure from the room he was in during the last month. He has no private shower and has a roomate. My mom is obviously not allowed to stay overnight. She is staying at out house tonight and most nights while Bob is at Spaulding.

Today is a holiday so Bob's team of physical therapist and doctors will come meet him tomorrow. We did meet his nurses who were very nice and got along well with Bob. He will be assesed by his team tomorrow. Bob will also have physical therapy, occupational therapy and speech therapy tomorrow.

It was great to see him and my mom. I will never forget the hug Bob gave me and how he rubbed my pregnant belly. It is heartbreaking not hearing his voice speak words. This will be a big adjustment for my children as well. I understand why my mom did not want to assign a percentage to his understanding. It is not always clear if Bob comprehends what you say to him. He is not consistent with his replies yet so a nod of yes may not mean yes.

When the doctor came to examine Bob he did most of the movements she asked him to do such as move his left arm out to the side or push against her hand with his arm or squeeze her hand. I was surprised to see his body's reflexes. I was even more stunned when I saw his right foot move while he slept. My mom assured me they were not voluntary movements, but I was still stunned. It was like a puppy's legs when he's dreaming of chasing cats. It was like he was making up for lost time, for all the times he had told his foot to move and it didn't obey. This movement meant to me that the capacity for full recovery is there.

I saw Bob eat his lunch independently and I was extremely impressed with how he opened the milk carton with only one hand. I wanted to help him initially but was told to hold back and let him do it on his own. As a mom of small kids my urge is to swoop in and help (read: do it for them...) But you should see how proud Bob was when he was sipping milk through the straw he himself had inserted into the opening he created. Bob chuckled, smirked and drank that milk with satisfaction. I saw that it pays to not interfere. Bob has to do things on his own to relearn how to do them, to feel accomplished and to succeed outside the hospital.

On the way to the hospital the radio played a song that I found described this new chapter very well. It was Natasha Bedingfield's "Unwritten". Blank pages before us, we are reaching for something in the distance. Bob spent a month in a hospital in Rio and we don't yet know how long he will be at Spaulding. There is a lot that we don't know about Bob's future right now. But if we stop and think about it, there is a lot that we don't know about our own lives either. Thanks for reading and keep the positive thoughts and prayers coming.

They are on their way home

I last spoke with my mom about an hour ago. She was inside the American Airlines lounge at Galeão airport with Bob and the two nurses. They arrived by ambulance after all, not a limo as I was told. The transportation company must have found an ambulance large enough to accommodate everyone and the small pieces of carry-on luggage my mom will be allowed to have aboard. All their regular luggage had to travel separately, with my cousin Juliana who as luck would have it, traveled to the United States yesterday and could do my parents this favor. Their bags would not have fit into the jet they are taking to Boston from New York. We will have to figure out a way to get their luggage from New York to Boston sometime this coming week. But of course, that's not the main concern now.

They still have a long trip ahead of them. My parents' flight should be leaving within minutes. They arrive in New York's JFK airport around six thirty on monday morning. After a thirty five minute trip to Farmingdale's Republic airport, they will board a small jet to Logan airport. From there, they will go directly to Spaulding Rehabilitation Hospital. I will meet them there in the morning.

This morning we saw my parents on face-time and the kids had a blast making faces at vovô and vovó and showing them some toys. We saw Bob eating independently again. When my mom asked him if he wanted his banana cut into small pieces, he said an emphatic "NO". I heard it! We all celebrated. Bob is a tenacious man, I am certain he will make great strides towards recovery at his new hospital.

I look forward to writing tomorrow night. Lots of new developments lie ahead and this reporter (thanks Janice, I proudly accept that moniker!) can't wait to share them all with you. Thanks for reading and keep the positive thoughts and prayers coming.

The day before the return to the United States

Today was a busy day at the hospital as my parents prepared for the return home tomorrow.

Bob had visits from my uncle Roberto, my grandmother and my mom's friend, Dora. He had his usual physical therapy and speech therapy sessions, they all went fine. Bob ate well.

The two nurses that are accompanying my parents back to the US arrived in Rio and spent about three hours at the hospital with them. The nurses participated in the therapy sessions and got acquainted with Bob. One of them is Australian and my mom likes her because she is a fast talker and a take-charge kind of person. The other nurse is Brasilian, I imagine it will be nice for my mom to have someone that speaks Portuguese along for the ride.

They all leave in a limousine - not an ambulance as was first thought - tomorrow night at six thirty in the evening. Everyone wouldn't fit in an ambulance, hence the limo. As long as Bob can stretch out his legs, he should be fine, my mom reasoned.

I'll write again tomorrow after they have boarded. Thanks for reading and keep the positive thoughts and prayers coming.

19, 19, 19

Today my mom noted that they left the United States on December 19th, Bob had the stroke on January 19th, and they are leaving Rio on the 19th of February. Weird coincidences!

Bob had another good day. His core and neck are strong. This is crucial for his ability to ride on a wheel chair, something he will be doing a lot of during his trip home. Bob sat at a table and ate unassisted for the first time. The table made it possible for him do eat independently because it kept the plate still, so all he needed was his left hand to get the food. As a departure from his usual blended, pureed or overcooked food, Bob had a piece of soft bread. He didn't like it very much. It wasn't the usual Brasilian pãozinho he loves to eat for breakfast when he stays in Brasil. Still, it is another milestone to celebrate.

Here is a picture of him sitting for his meal, the man sitting on the couch is my mom's brother, Roberto:

My uncle Roberto kept my mom company today. She also had visits from aunts and calls from cousins. Thanks to all of you that have shown your support by visiting, calling and sending emails from the very beginning. I apologize for not mentioning everyone of you by name, but know that my mom and Bob really appreciate it.

Tomorrow the two medics that will accompany my parents on their trip home should arrive in Rio. It is another step towards home! Thanks for reading and keep the positive thoughts and prayers coming.

Trip Home - Take Two

So it seems everything is really set for my parents to leave Rio on Sunday night. There will be two medics traveling with them and they will arrive in Rio on Saturday. My parents and the medics will reach New York early on Monday morning and then take an ambulance to a smaller airport in Farmingdale, Long Island - a familiar destination. From there, they will all take a private ambulance jet to an airport in or around Boston. We don't know where they will finally land, it might not be Logan International. I will meet them at Spaulding. I don't want to get my hopes up so I will only breathe a sigh of relief when I know they are on a plane.

Bob did well today, he was very tired so he napped a few times. He ate well, he is enjoying the bounty of fresh fruits Brasil has to offer. He had his usual physical therapy and continues to gain strength. The speech therapist is working on the words "Yes" and "No" with him.

Bob has been ordered by his doctor to spend three hours sitting down in the morning and then three hours sitting down at night to minimize his chances of getting fluid in his lungs. Two days ago Bob was coughing and the doctor found him to be a bit congested. Today Bob is better. He is doing breathing exercises as part of his daily routine. Bob does not enjoy those.

My uncle Roberto came to visit from São Paulo and will come again tomorrow for lunch. Oddly, my grandmother had told my mom's aunts, uncles and cousins that my mom did not want to be disturbed with calls or visits. This could not be further from the truth. My mom never asked my grandmother to do such a thing and she was starting to wonder where all the family support had gone. So if you are reading this and are in a position to visit or call, please do so. You can make up for the lost time in these last few days in Rio!

Thanks for reading and keep the positive thoughts and prayers coming.

A good day

My cousin Pedro wisely said that a problem that has just one solution is not a problem, because it is already solved. My parents have made peace with the fact that they are staying longer. My mom said they were both more relaxed today. When your circumstances are out of your control, you can either fight in vain, or accept it. My parents have chosen to accept their predicament.

Bob had a good day. He ate well and continues to surpass everyone's expectations with his continued progress. He moved his right leg with the support of the physical therapist. His right foot is improving and the physical therapist said he doesn't have to ice it any longer. Bob did not like icing his foot.

Here's hoping tomorrow brings some news about their return home. Thanks for reading and keep the positive thoughts and prayers coming.

PS: I'd like to make a correction: Yesterday Bob did not go to the hospital's cafe or have juice there. My mom had mentioned that as a possibility when we spoke in the morning and I assumed it happened. He was not allowed to go to the cafe. He can and has had juice, just not at the cafe.

An Unexpected Delay

The day started with happy news of the trip home: Bob and my mom would be on a flight from Rio to New York City on wednesday night accompanied by two medics from the US. From New York, they would all take an ambulance flight to Boston. Once they arrived in Boston, Bob would go straight to Spaulding Rehabilitation Hospital. In the afternoon my mom rushed to get all the bags packed, said her goodbyes to family, friends and the hospital staff... But at 8:30 pm, I got a call from her to say they would not be returning tomorrow. The organization in charge of Bob's transportation failed to realize that Americans entering Brasil need a visa and the two medics they were sending from the US to fly back with my parents are going to need five days to get visas. Sunday night is the earliest they can return home. Yet this is not set in stone. Plans are still being made.

This travel day change is beyond anticlimactic, it's a huge source of anxiety that just keeps on getting larger and larger. We are hoping that Spaulding will hold a room for Bob. We are hoping the transportation organization can get a visa in such little time. We are hoping they can find tickets for everyone for Sunday.

So now we wait. Again. More frustrated than before, more stressed than before.

Regardless of the bad news that came at night, Bob had a good day. He went for a ride on a wheel chair and left his room to visit other parts of the hospital. He went to the cafe and had a juice. Bob went to the wing where he stayed when he first arrived at the hospital and posed with the nurses that took care of him there. Here is a picture:

Everyone at the hospital in Rio really cares about Bob. Many members of the staff have asked my mom to send them emails with updates on how Bob's recovery is coming along. There is no doubt that he will be well taken care of these extra unexpected days.

Well, at least it isn't a medical issue that will be keeping Bob in Rio longer. It's time to put on the Pollyanna glasses. Thanks for reading and keep the positive thoughts and prayers coming.

The return home is in sight

We received news from Spaulding Rehabilitation hospital that they will have a bed for Bob on Wednesday or Thursday. So now the ball is passed over to the people in charge of arranging Bob's trip home. It is an organization that will provide his ambulance to the airport, the plane ticket and then his ride from Logan airport directly to Spaulding. It will take a lot of coordinating between the hospital in Rio, the transportation folks and Spaulding. And it all out of my mom's hands. This lack of control is stressful. She could leave as early as tomorrow night and have to tie up all the loose ends with not much notice. So now we are waiting to hear from the people in charge of the transportation. We are hoping they can book tickets on such short notice. Fingers crossed again.

Bob had a good day today. He stood next to the window and saw the outside world. He ate well and had good physical therapy sessions.

We used face-time early in the morning and the grandkids loved seeing vovô and vovó. Bob even gave us laughs, which I don't remember seeing or hearing before. I thought his lips looked normal when he smiled, not like what I had seen earlier when Bob's smile was turned up just on one side.

My mom said Bob said the word "No." Then she joked that "of course his first word would be 'No'!" Bob was in a playful mood today, rolling his eyes while Juliana and my mom were talking, poking fun at the two of them. He really likes it when Juliana visits. She will stay with him when my mom has to leave to get their luggage sometime this week.

Bob played tic-tac-toe on the ipad screen and won fair and square. My mom said she didn't have to explain the rules, he just remembered - and then beat her!

Bob practiced writing some short words today and did great. Here is a picture of the board he has been using to practice. Note how he wrote "Zoe" and "Shella" perfectly! The larger words were written by my mom.

That's all for now. I plan on writing this blog even after my parents return home. Bob's recovery will be a long journey that won't end with his homecoming. The blog has recently celebrated it's one thousandth page view and that's proof that it is doing its job at keeping friends and family informed. I want to continue fulfilling that mission. I don't know if I will be able to still write every night as I have been, especially as my delivery date gets near... But maybe by then I can turn the reigns over to someone else for a bit. Thanks for reading and keep the positive thoughts and prayers coming.

Good Sunday

Bob had a good day today. Tia Rita helped with Bob's daily activities and went back to São Paulo in the evening.

Bob had physical therapy twice and no speech therapy as the therapist does not work on Sundays. Bob sat and stood without assistance on his left side, only his right side for the first time. This shows how strong he is getting.

Bob continues to eat well. I saw what he ate over face-time and was surprised to see large pieces of fruit. He is chewing soft foods well. Bob ate chicken with yucca for dinner, the fruit was dessert. Yesterday he ate an apple to practice chewing pieces of meat.

Bob had lots of visitors today including Tehti, her husband Carlos, and my aunt Victória and uncle Zé.

I can't wait for tomorrow when we hope to find out if there is a bed available at the rehabilitation hospital in Boston. Thanks for reading and keep the positive thoughts and prayers coming.

A bit blue

Bob had a bit of a blue day, my mom said. Bob still worked really hard on his physical therapy and speech therapy, even though he was more sad than usual. I suppose days like this are to be expected. When we are healthy and lead relatively normal lives, we all have days in which we are discouraged or sad. Imagine what it must be like to have been in a hospital room for three weeks, unable to do the things you used to do, or to communicate your needs. It is such a cruel predicament.

As Bob continues to make progress physically, he is also progressing mentally. I imagine it is more difficult to see the kinds of improvements he is making in that area. I wonder how the physicians are assessing that. I am curious about what Bob's treatment will be like when he is back in the United States. I am hoping that being immersed in his own language again will make things easier for him.

Tia Rita spent the day helping Bob and my mom again today, she will return to São Paulo tomorrow. Maybe this will be the last weekend she comes to help? We will know more on Monday. Fingers crossed.

Thanks for reading and keep the positive thoughts and prayers coming.

Vovô Bob

Bob had a good day. He did well at physical therapy and took some steps forward again.

Bob ate salmon with mushrooms and has taken the initiative to feed himself on several occasions. He has a healthy appetite. Bob drank water through a straw and will continue to practice drinking liquids.

Bob saw the East coast grandkids on face-time today. He smiled and laughed at my son who loves to ham it up for vovô Bob. It is great to see Bob's reaction to our faces and our voices. It is really sweet when he reaches to touch his screen as if to touch the kids' faces. One of the things that the kids are struggling with is the fact that vovô can't talk back when they ask him questions. Today my son was happily surprised when Bob responded to one of his questions with a sound, like a grunt. My son smiled and said to me "He made a noise!" It's hard to imagine what is in the head of a three year old, let alone what kind of expectations he has for his interactions with his "new" vovô. But whatever they are, my son was really pleased with Bob's noise and his smile couldn't be bigger. I look forward to seeing Bob's progress through the eyes of my son in the weeks and months ahead.

Tia Rita is back from São Paulo so my mom can have a break from the hospital. My mom's guardian angel came straight from work! My mom is going to try to get some longer stretches of sleep at my grandmother's house both nights this weekend while Tia Rita is there. Tonight, Ana Beatriz was going to take my mom for some chopp and then take her to my grandmother's house.

Another slow news day, but what matters is that Bob continues to progress. Thanks for reading and keep the positive thoughts and prayers coming.

Three week anniversary

Bob continues to work hard at physical therapy and speech therapy. Like a newborn (being in my third trimester, I've got babies on the brain...) Bob eats, exercises and sleeps and repeats this cycle multiple times a day. My mom even mentioned the word "boring" to describe the routine. It's easy to see how spending three weeks confined to a hospital room can start to have that groundhog day feeling.

Bob ate more over-cooked food cut into small pieces and is doing well with chewing them. My mom is allowed to assist with his food now. Bob's right foot is slowly improving but he hasn't taken any more of those steps forward in a few days.

My uncle Zé visited today and got big smiles from Bob. Tio Zé was keeping my parents company when I called in the evening. He joked that Bob wasn't missing real food because one of his favorite restaurants, Majórica, has recently closed its doors.

Today Bob wrote "Bob" after my mom asked him to. This is significant because it was the first time he wrote a word after hearing a verbal command. Before, Bob had only been copying words that were written down. My mom said that his writing is legible. When Bob copies words, his writing looks just like his usual handwriting.

My mom spoke with the rehabilitation hospital here in Boston this morning. She learned that they might have an open bed by the middle of next week making it possible for Bob to come home around next wednesday. My mom was asked to call again on monday to follow up on this possibility.

Thanks for reading and keep the positive thoughts and prayers coming.

Solid Food

Both my parents slept well last night. From 11 pm to 5 am straight. That hasn't always been the case so it's cause for celebration.

Bob had visitors again today: my cousin Juliana, the doctor who works at the hospital, Ana Beatriz who is Pedro's wife, and helped with the physical therapy, and Tethi, my mom's very good friend.

Bob did not eat pureed food for the first time today. He has started eating small pieces of over-cooked food to practice chewing. He did very well. Here is a picture:

Doesn't he look great?!

Other than the food progress, there isn't much more to report that's new. The routine has been the same and we are still counting the days for Bob's safe return home. Thanks for reading and keep the positive thoughts and prayers coming.

Shave and a hair cut

Two bits! Bob got a shave and a hair cut today. He looks very nice.

Bob is doing well without the feeding tube and drank some liquids again. A nurse unknowingly gave him a pill to swallow with a glass of water and even thought Bob is not at that stage yet, he did fine. It was another one of the hospital's missteps, but it didn't end as badly as it could have.

Bob's physical therapy is now focused on his core, or midsection. Bob is improving his control over his trunk and neck. This will help him use a wheel chair later on.

Bob got visits from my uncle Felipe and my grandmother in the morning. My uncle lives in the United States and brought some clothes from here that I had mailed him. They are comfortable pants to make traveling more bearable. Tio Felipe also brought nice toiletries as a present for Bob and necklace making supplies from Tia Marilu as a present for my mom to help her pass the time. My cousin Pedro visited in the afternoon. Pedro made Bob a daily calendar. It was the therapist's idea to supply Bob with a means of telling the days apart. I think that since it is February, they were hard to find at the store but Pedro came to the rescue!

My mom spoke with the stroke program director at Spaulding Rehabilitation Hospital in Boston today. This is most likely the place where Bob will be for a few weeks once he returns to the United States. I visited the Rehabilitation Hospital last week and was impressed by it.

There is a lot to work out logistically for Bob's transfer home and the process has started. We still don't have a certain date for his return to the United States, but we are hoping for sometime next week.

Thanks for reading and keep the positive thoughts and prayers coming.

Bye Bye Feeding Tube!

The biggest news today is that Bob no longer has a feeding tube! I was surprised to hear this in the middle of the day and didn't get the opportunity to ask how (or why) it happened when I spoke with them again at night. As I explained in the last post, I was under the impression the tube was going to remain in place for a while. I'm curious as to why the hasty removal of the feeding tube but on the other hand, who cares!? This is a huge development because it puts Bob one giant step closer to his trip home. It's as if the shackles that have once literally attached him to the hospital have been broken.

Bob drank plain water today without issues and ate very well again. I've attached a photo of the kind of food he is eating. This photo was taken yesterday. Today, Bob even fed himself his dessert!

Bob was not on his feet today. Unfortunately a few days ago one of the nurses who was helping him take a shower did not realize that Bob's right foot was caught on something and injured it. Since Bob couldn't feel the pain, it is hard to know the extent of the damage his right foot suffered. The orthopedist examined an x-ray this afternoon and said Bob's foot, which is bruised and swollen, is not broken or injured. The orthopedist recommended Bob do as much physical therapy as he can stand. This is a tricky proposition because Bob does not have the ability to feel nor really express when his foot hurts.

Even with a hurt foot, the idea of my parent's homecoming is becoming a reality. My children saw Bob again on face-time and it was pleasure witnessing the joy on everyone's faces, including Bob's. Thanks for reading and keep the positive thoughts and prayers coming.

Feeding Tube News

Bob continues to impress the hospital staff. His doctor, Dr. Achilles, said he has never seen someone with the same size and severity of stroke improve as much as Bob has improved in such little time. Bob applies himself to all the different types of therapies: physical and speech. Bob is admired by the staff who enjoys having a patient who is so involved and invested in his own recovery.

Bob took more steps forward today. He has done this twice a day for the last two days.

A big new development is that Bob now takes all of his nutrition by mouth, not the feeding tube. He ate six times today. Bob has quite an appetite. His diet is varied and consists of soups, thin smoothies and pudim among other things. He didn't care for the spinach at lunch today...

Bob now needs to relearn how to drink liquids. It is counterintuitive to me, but it is harder to take in liquids than the pureed consistency of certain foods. The phono-audiologist will work on that skill with him tomorrow. Bob's feeding tube is still inserted. He gets his medication through it. I was told it will only be removed once the staff is absolutely certain it is no longer needed. So even after some days of him eating and drinking, the tube will remain in place until the doctor is sure that Bob is getting all the nutrition and sustenance he needs by mouth. The process of inserting the tube is uncomfortable and it requires an x-ray to make sure it is in the correct position inside the body. That is why the tube will stay in place until everyone is certain it doesn't need to be there.

We still don't know for certain when my parents are coming back to the United States. Dr Achilles wasn't very receptive of the friday deadline my mom was hoping for, but he said it wouldn't be too long after that. The day can't come soon enough. Thanks for reading and keep the positive thoughts and prayers coming.

Steps forward

Today Bob took a few steps forward! Even better, he moved his right foot all on his own to meet his left foot! I saw it on video. It was incredible. He moved his left foot forward first, then his right foot slid forward to join his left foot. Bob did this at least three times. We are all very proud of him. He truly is a strong man.

Bob saw his East coast grandchildren on face time. My son got more laughs and my daughter, who is five, got Bob to touch the screen at his end to show affection. She is having a harder time than my son accepting vovô's new condition. Although it only hit her after she got off the call with him, she was all smiles while they were talking.

Tia Rita came back from São Paulo and is spending the night so that my mom can start packing my parent's bag's back at my grandmother's house. We are feeling optimistic and are looking forward to the end of next week.

Thanks for reading and keep the positive thoughts and prayers coming. (They are working!!)

Face time

Bob was moved to a new room today. It is much bigger than the others. It is in a different wing, so my parents were assigned a full time nurse for the night.

Bob ate four times yesterday and today. The difference was the amount of food. He ate 200ml twice today. I was told he would eat more if given the chance. The doctor decreased the amount of food being administered through Bob's feeding tube. They are working on increasing the feeding to six times a day and taking away feeding tube.

Bob is very strong and continues to apply himself at his physical therapy session. Bob is working on sitting by himself. My son and I saw Bob on face time this afternoon. He laughed when my son was talking about how he hit his head and had a boo boo on his forehead. My mom explained that while my son had an ouchy on his head, vovô Bob has a boo boo inside his head. Being three, that's about as much information as he needed to justify Bob's stay at the hospital. I was surprised he didn't ask why vovô wasn't saying anything back to him. I think that in the end, my son was just happy to see him and get a sweet smile. I know I was.

Thanks for reading and keep the positive thoughts and prayers coming.

Laugh

Bob slept well last night. It's a sunny day in Rio. My parents are falling into a routine and today marks two weeks of the stroke. There is still something new everyday, I suspect and hope it will be that way for weeks to come. Instead of puréed fruit, Bob had a puréed vegetable soup today. He ate four times. There is hope he will be eating six times a day by monday. This means there is a chance Bob will be traveling back to the US by the end of next week.

Tomorrow Bob will get a haircut. He took another shower in the bathroom today.

I asked my mom about how Bob's writing has been coming along. She said the last time he wrote something was two days ago. Two long nonsensical words. My mom said that now the focus is less on rehabilitating his communication skills but more on building up his physical strength. Bob needs to be strong to travel the long distance home.

Bob continues to apply himself to his physical therapy. He stood up twice today. As my mom read some emails to him, Bob responded with a laugh to two of them. One from his good friend Roger and another from my husband. This was the first time emails have elicited this kind of reaction. I wish I was there to see it. To see a bit of the Bob that is concealed by the stroke.

Tomorrow I will tour the Spaulding rehabilitation hospital in Boston. On Monday I hope to visit another center called Braintree Rehab. The goal is to have a place for Bob lined up before he returns home.

That's all for today. Thanks for reading and keep the positive thoughts and prayers coming.

Food news

Bob got more compliments from his doctor today. Dr. Achilles commented that Bob's improvements are above the average My cousin Juliana said that for how serious Bob's stroke was, he is making remarkable progress.

Today Bob ate pureed food twice. The second time, he was helped by a nurse not the speech therapist. His eating independence is the main concern for now because if achieved, it will allow him to travel back to the US. Tomorrow Bob will eat three times. After a few days of eating three times, he will eat four times for a few days and so on. When the time comes that Bob has been eating six times a day well, the feeding tube can be removed. Without a feeding tube, he can leave the hospital if everything else is well. 

Bob shaved his beard. He also brushed his teeth and took a bath in the bathroom. Bob's routine physical therapy sessions went well. He is happy to do it and continues to apply himself.

Bob was a little blue today, he was disappointed that my mom was unable to understand what he was trying to communicate. It must be incredibly frustrating to be such an eloquent person, and then lose the ability to express yourself. I imagine the speech therapy will intensify when Bob is back in the US. Progress can't be rushed. I'm feeling impatient today.

Thanks for reading. Keep the positive thoughts and prayers coming.