Hi Crew,

Sam, Bridie and myself went and visited Mike again today to check status, and he was jumping out of his skin. His improvement has been unexpectedly good in the last 48 hours, largely due to his excellent respiratory function. So good that he’ll be moving to the spinal ward tomorrow, with plans to remove his tracheostomy on Monday or Tuesday next week.

Physical

Mike’s breathing is the best it’s been since he had his accident. He’s blowing numbers for the physio in the mid 2000’s, which is about 1L better than when he was a bit under the weather last week. The physio is also being tested to the limit by Mike’s well hardened work ethic, plus the recent addition of trash-talking added to his armoury! He has a fenestrated tracheostomy tube, which is supposed to be open for 45min or so (so he can talk), then closed to give him a rest. When the nurses tried to change it back to silent mode, he put the foot down (metaphorically) and has been yapping ever since. He has become the biggest talker of anyone in the ICU- well of the patients anyhow! This augmented communication has buoyed his spirits tremendously, plus the fact that he no longer requires the ventilator to assist his breathing. His large breaths are about 50-60% the size of our big breaths, so he still has to complete regular physio to prevent infection and strengthen the breathing muscles he has left (essentially the diaphragm).

Mikes back and neck pain have eased considerably, so he is able to sit up for longer periods. This has the added benefit of protecting his skin from pressure sores, and allowing his lungs to be filled more efficiently by his diaphragm. He’s wearing a rigid collar about his neck still, which is allowing any unfixed ligamentous and bony damage to heal with some support.

His neurological state has also improved In the last 24 hours- he was barely moving his arms, other than shoulder shrugging late last week. But today he was able to move his arms from the pillows beside him, using his deltoid muscles. The biceps muscle may yet returned, though nothing is certain when there has been damage to the spinal cord. It’s difficult to explain in summary, but the nerves in the spinal cord are unable to regenerate in the same manner as a nerve could if it were cut in an arm. Essentially there’s no breadcrumbs (myelin sheath) for the nerves (axons) to follow in the ncentral nervous system, so the nerve cannot reform it’s connections to the peripheries.

Mental

The last couple of days has seen a vast improvement in Mikes outlook on his short and long term future. This has been helped a lot by being able to share his thoughts and feelings with Mon and Ash and all his visitors. He is loving the messages of support, and he is busy making plans for the future- like being able to walk/wheel Ash to school when he gets back home. Luckily she’s not due at school for a bit, so he has time to get his act together.

Visiting

Keep the trickle going folks- he’s loving it. Try to get out during the week if you’re able, as most people have spare time to visit on the weekends. His family are proving steadfast, and Mon is getting booted to the outside world for a break from time to time!

Overall

He gets an A for being a good physio student and getting his act together so quickly to get out onto the ward. This is the Acute spinal ward, where he will stay until he has no pressing issues which prevent him from getting to Royal Talbot for rehab. The sorts of things that are required prior to being allowed to move include: remaining temperature normal (don’t visit if you have a bad cold/flu!); tolerating sitting for extended periods in a chair and getting his lung function as premium as possible.

Cheers

Mitch