Michael is doing good.  He remains stable, all numbers are on track.  Tomorrow I have a "Care Plan Meeting" which take place about every 3 months but it's pretty much the same verbiage over and over.  If it weren't for my constant research and reaching out to RT's and Doctors individually I don't believe anything would get done.   My current focus is always the trachea and getting him off of that.  In tomorrows meeting I will discuss his inner cannula being downsized from an 8 to a 6.  I discussed this with just about every single RT individually on various days and they all agree that he would be able to handle it, any progress is a good thing.  By downsizing the The Inner Cannula it increases air flow through or around the tube. This in turn enables sufficient air flow to permit the external tracheostomy to be capped-off or “corked” and facilitate speech. In other words the speaking valve and then once he is used to that it's the red cap.  So close and yet so tricky. 

Michael does not like the speech therapist and ignores her and pretends to be asleep when he sees her so now she doesn't even come in to see him thinking he is always asleep which is hilarious. I tell him to stop being snobby so he can start the speech therapy, he shrugs. We have a speech therapist friend who wants to try a few things. 

He is still receiving physical therapy but sometimes he is not in the mood and refuses to do it. I have yet to begin stimulators but will go that route in the summer. One of the PT people told me its better to get him to build up more strength naturally before going to the stimulators. Then again none of the PT people knew anything about the benefits.   I had to show them pictures and videos of what I was talking about. I reached out to PT people outside of the facility who stated that I should do it to get those muscles he does not use often back in motion.  I showed Michael the videos and he agreed that he wants to try it.