Sunday, June 28, 2009

Rehabilitation Is the Goal!

The key difference between Sharp and Kindred is that Sharp is a short-term care facility and Kindred is long-term. Kindred is a rehabilitation facility. The pulminologist, Dr. Clark, believes in aggressive treatment. He is also an internest and critical care specialist. With an interdisciplinary perspective he is able to treat Daniel with the big picture always in mind.

The immediate goal for Daniel is decanulation within 8 to 10 days.. Decanulation means that the trach-tube comes off completely. In order for this to happen Daniel must pass several tests. First, he must be able to breathe on his own without ventilator assist. Next, the RT would attach a one-way valve (known as a pmv or "speaking valve" because it permits patients to speak) that would allow Daniel to exhale through his nose and mouth. If Daniel passes this test, that is if he is able to exhale through nose and mouth, the next step would be to plug the trach entirely to see if Daniel can both inhale and exhale through nose and mouth.

The final most critical test is the swallow test. This test inolves the use of ice chips with food coloring. Daniel is given ice chips through his mouth (I'll bet he would love to taste ice once again, think of how refreshed he will feel) with the hope that Daniel will SWALLOW these into his belly via his esophogus. If, after suctioning his lungs, there is any evidence of food coloring or dye, then the ice has gone down the proverbial "wrong pipe." If this is the case then Daniel will have to practice swallowing--a skill we take for granted and do automatically.

The RT points out that youth is again on Daniel's side. However, because he isn't as "awake" and "alert" as we'd like he cannot consciously correct his swallowing as we do when we begin to choke. So when Daniel finally passes the swallow test and he has been breathing independently then the trach has served its purpose and can be removed. The hole, in his throat, once healed, will hardly be noticed.

Kindred has a very high success rate with this kind of rehabilitation. Then what? Well, Daniel will be evaluated for occupational, physical or speech therapy. Kindred has all of these specialists "in-house." My hope is we'll be able to access these resources for Daniel for some time. Kindred's multi-prong approach to acute care and rehabilitation is perfect for my perfect brother!

Thanks again and with Love,


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