November brings us Thanksgiving and this year we have a lot to be thankful for.  Since my last entry, a lot has been happening.

She said she would be walking by the time her wheelchair was delivered and she is.  Christy has made a lot of progress in terms of her ability to walk.  She started off with a platform walker (picture a tall walker with a place for each arm to rest), then a hemi-walker (a triangle shaped cane with 4  legs) to a quad cane (straight cane with 4 feet for stability).  Since last week she has been working on her endurance.  Her custom wheelchair was delivered today and she walked 200 feet with the quad cane before it arrived.  She still needs someone standing at her side in case if she were to lose her balance but she is walking.

About a month ago, Christy had Botox injections for the spasticity (tight muscles) in her left hand, wrist and arm.  It has allowed her to gain more mobility.  She now has a special brace that she applies 3 times a day to stretch her wrist and fingers to combat the spasticity.  Botox last about 3 months, so on the next application, the doctor will likely administer a higher dose to get more relaxation of the muscles.  

A plan to return home - we are starting visits to Christy's house this Friday with hopes to have her moved back home the first weekend in December.  She has a ramp into the house (built by her grandfather and installed with the help of Uncle Donny) if she arrives by wheelchair but I know she hopes to walk over the threshold.  Her grandfather and I also installed a railing for the stepdown into the living room.  Her temporary bedroom next to the more accessible bathroom, has had a makeover and is ready for her arrival. 

The kids will be over the moon to have their Mom back home after 4 months, but we haven't told them any specifics just in case if there are any delays.  While it may mean more work for Rodger and I, getting them all back under one roof will be a huge accomplishment.  

Last week we had a follow-up appointment with the Plastic surgeon from Shock Trauma.  Since there is an area unlikely to heal on the skin graft, she has proposed that we go forward with the procedure to expand the scalp tissue (this was going to be done after the cranioplasty originally).  Once the scalp tissue has stretched enough the skin graft can be removed.  We are hopeful that the neurosurgeon will replace the skull prosthetic (cranioplasty) at the same time.  Since many elective surgeries will likely be delayed with the uptake in COVID cases and the tissue expansion will likely take 3 months, hopefully before spring Christy can have the skull and skin repairs done.  

The kids are doing well.  Most evenings they have a video visit with Mom and love to play with the filters.  The two little ones started daycare in late September and look forward to going each day to play with friends.  Sanibel was so proud that she learned how to write her name and Liam of course is a favorite with the daycare providers.  They all had a good Halloween and are still enjoying their treats every day.  (Thank you Dana, Michael and Elise for letting us tag along).  The first quarter of 8th grade was a struggle for Kira but I think she's getting back into the groove.  She's said she was interested to get back into Girl Scouts, so she just joined a local troop - she is a Cadette.   I bought a kid hauler - its an used GMC Acadia.  Despite my original plan to "downsize" my vehicle this year, we need that 3rd row and the extra space for all of our things.

I am two weeks into orientation for my new job with the University of Maryland Neurocritical Care group.  There have been delays in opening the neuro ICU beds at the Midtown Campus but that will allow me more time to acclimate to my new setting.  The delay also means I will be off for each of the holidays!  Since COVID cases are going up in the Baltimore area, the likelihood is I will spend the winter season caring for COVID patients in the medical ICU at Midtown along with other critically ill adults.  It has been a while since I have practiced in a medical ICU environment (2001-2009) but I am sure I haven't forgotten how (thank you Dr. Selinger).  As is the case with most of my medical colleagues, we go where we are needed. 

We continue to feel the support of family, friends, coworkers present and past, and our neighbors.  When we feel like we cannot go on, you lift us up and we are so grateful.  Keep us in your prayers.

And I almost forgot November brings us Christy's birthday - 34 this year - on November 28th.

Week 2 and we are on a roll.  Outpatient therapies (OT, PT and speech) have started and Christy continues to demonstrate improvements in her arm and leg.  Her strength is steadily improving and she is requiring less and less support for transfers. 

During today's PT session, she was able to walk using a cane and very little support for her knee.  Since the strength has improved, she is now focusing on controlling the movements.  The physical therapist feels confident that she will be able to walk independently using a cane soon.  This provides so much encouragement for Christy to keep working hard.   

The arm is finally starting to move more and we have an ESTIM (electrical stimulation device) to use at home as well as during OT to encourage the hand to open.  The rehab physician plans to administer Botox to some of her arm/hand/wrist muscles as soon as we get insurance approval.  This will help relieve the spasticity and allow her to get better movement.

For cognitive rehab she is starting to take on making her own appointments, keeping the calendar, and paying some bills as well as speech therapy once a week.  

We have an appointment Thursday at UMMS with the plastic surgeon to ensure the skin graft is healing well and  get the OK to proceed with the cranioplasty (replacing the missing skull) on October 28th.  

I took a day off to visit with some Christiana Care colleagues and clean out my office.  There are so many wonderful people there, I will miss them but know they are still there for me if I need them.  Since I've run out of PTO, I am going to try to work a shift a week until I start my new position with University of Maryland in November.  

Christy had a great visit with Mercy High best friends Shannon, Liz and Lindsay on Friday.  I could kick myself for not getting some pictures.  It was great to hear them laughing and having a good time.  

Looking forward to our family crab feast this weekend (a couple of months late).  Her grandfather, uncle, aunt and cousin are so looking forward to seeing her.  

We are blessed in so many ways.