Hi All,Naant and I saw Michael, Mon, Lesley and Bruce yesterday on the spinal ward. Overall, my impression is that Forbesy is actually doing quite well. His mood seemed high and he was having increasing awareness of which muscles and skin areas had retained function.

Physically, he has had a roughish week with a few minor setbacks. The metabolism of a young, super-fit male is not something that is easy to estimate and Forbesy has probably not been getting quite enough fluid and nasogastric foods for the first few days on the spinal unit. Consequently, he was fatigued, somewhat light headed when he sat up, and felt generally sub-par. This has been corrected and he was actually a lot better yesterday.

The tracheostomy is out and Michael is talking freely. His swallowing however, is not yet safe. We all “micro-aspirate” to some degree, where fluid and even the occasional bit of foodstuff enter the airways during day to day life. This is not a problem when you can cough and clear the fluid/food from your airway, but becomes a problem when either excessive amounts are aspirated, or you are unable to cough it up. Chest infections can result.

At the moment, Forbesy is having some pooling of food and fluid just above his epiglottis, the flap that usually drops down over the entrance to the main bronchus (airway leading into the lung itself). Consequently, some of this food/fluid can enter his lungs and he doesn’t get the sensation that he needs to cough and if he does cough, his cough is not forceful enough to expel it.

The reason food is pooling is probably multifactorial, and relates to the nearby swelling from the injured cervical spine, the plates that have been inserted to stabilise the spine, and the extended period of intubation that will produce some local swelling of the pharynx. Fingers crossed this will improve with time and the natural resolution of the swelling. The time course for this is difficult to predict but is probably days to weeks.

Meanwhile, Michael is being fed by a nasogastric tube which bypasses the obstruction and delivers liquid food into his stomach. He can get all the necessary macro- and micro-nutrients he needs from this, but no taste! He currently craves some wholesome fruit and couldn’t stop talking about the local fruit market and bakery at the end of his street. We joked about the sudden downturn in business for each of these venues in the last 4 weeks – the businesses should now recognise that wheelchair access is a future priority for ensuring a steady income!

Otherwise, Michael is physically doing well with some function of his upper arms including biceps, resolution of an early chest infection and cessation of IV antibiotics, and he is now spending short periods sitting out in a wheelchair. Some retained core strength / abdominal muscles are helping here – an added bonus of his pre-injury fitness.

Mentally, as you might imagine, there are good days and bad days and I can’t pretend to do them justice here. Yesterday, he seemed relatively happy dreaming of pears! His days are filled with activity and visitors – his last physio session each day is at 11pm – cuts in Tour viewing time…

Some special people deserve mention here. Christine Shannahan, a kinesiologist and nurse, and Harriette Collins, a massage therapist, have both been successful in increasing Forbesy’s awareness of his various limbs, improving blood flow, and probably most importantly, giving him something positive to focus on. Great work girls! In fact, the entire nursing staff, allied health staff (special mention to the speechies) and medical staff on the spinal unit have been fantastic and Mon and Michael can’t speak highly enough of their care and compassion. These people make such a positive impact on the lives of their patients every day – if you get the chance, grab a nurse or allied health staff member and say thank you when you’re visiting! The extra effort these people put in makes a huge difference!

Radisson Plaza have chipped in with some complimentary nights to be raffled off and there are actually some amazing offers coming through regarding fund-raising and awareness-raising activities – please keep them coming through, and recognise that the process of deciding on the best way to make use of these offers is currently underway but takes time and organisation! Don’t despair if your offers are yet acted upon, they will be!

Cheers

Sam