It's hard to believe it has been almost 4 weeks since I last wrote an update. In some ways it feels like so much has happened. In other ways, it feels like so little has happened. We traveled back to Seattle on July 20th and have mostly settled back into our life here. We are officially on a Pacific coast sleep schedule at the very least. I started work on July 21st in a new role as a Marketing Operations Manager at Google Cloud, which has been going really well and provided the flexibility that I need to take Jake to doctors appointments, take care of medical and insurance paperwork and phone calls, and just sit with him and rub his back when he's having a hard day. 

Jake has been making amazing progress, even though he doesn't always feel like it from day to day. For example, four weeks out from the accident when we were still in Lancaster, a quarter-mile walk would wipe him out. This past week, which was a little more than five weeks since the accident, he walked 3 miles with no problem. He's still not ready to get back on a mountain bike anytime soon, but I've been very impressed by his growing strength and energy level.

Today was a big day for Jake because it was his first day back at work. Jake loves his job, and since the day he was released from the ICU, he has been anxious to get back to his friends and his valves. Based on a physical exam from his doctor and his own assessment of his abilities, he was cleared to start working again part time from home. He was so excited to dive back into his work and reconnect with his colleagues, but the day didn't go quite as well as he was hoping. It's hard to deduce an exact formula for his fatigue, dizziness, and headaches. I don't know if it was the amount of screen time or the amount of socialization or the fact that he didn't take a nap yesterday, but by this afternoon, he was feeling exhausted and also discouraged. 

One unique challenge of a head injury, as I've written before, is that there aren't obvious external signs of injury. On the one hand, I think Jake wanted to get back to work because he loves it. On the other hand, I think he felt like he needed to go back because he looks and seems fine to most people. He's going to give tomorrow another try and would like to make it through the week, but if work continues to feel like too much of a stretch, he'll go back to full-time leave. 

As far as his physical health, I would say Jake is at about 50% energy level and essentially full strength. He still has some lingering soreness in his back, which he starts physical therapy for this week. He is also still pretty consistently dizzy, mostly when transitioning from standing to sitting. He has driven successfully a handful of times, but I don't think he's ready for any trips on his own yet. His hearing has returned, but only partially. He still has constant ringing (tinnitus) in that ear and has noticeable noise sensitivity and difficulty picking up conversation if there is background noise, like the sound of traffic, chatter in a restaurant, or the sound of a fan. 

During our time in Lancaster, Jake was able to see an Ear Nose and Throat specialist about the hearing loss in his left ear. After a physical exam and a hearing test, the doctor concluded that there is no damage to his ear drum or middle ear. We were happy about this news because it means that he won't need any surgery and that his dizziness is part of his headaches and will resolve over time.

The potentially bad news is that the hearing loss is a result of nerve damage either from pressure put on the nerve because of his brain bleeds or from partial severing. The fact that his hearing has slowly been returning is a good sign and means the nerve was not complete severed. However, the doctor said that with nerve damage, they really can't say how much hearing he will recover. According to the hearing test he completed in mid-July, he has 50% hearing out of his left ear. It's hard to tell, but I think his hearing has improved to some extent since then. 

Jake wanted me to say that he is so appreciative of everyone who has supported us and reached out to us during this time. We've had lots of food, fun phone calls, video chats, and visits from friends and family that have brought a lot of joy to some pretty tough weeks.