Home… Home at Last!
Oro Valley, Arizona
There wasn’t really much fan fare, but those closest to Lisa from the hospital staff came to say goodbye and expressed their well wishes. Then, the day continued with two paramedics from the Phoenix Paramedic Transport service who brought Lisa, with Richard sitting beside her, home in their ambulance. To make sure we were at the hospital before the 1:00 PM transport to Tucson, Richard and I left for Phoenix at 7:00 AM. Then after loading my vehicle with Lisa's things and her wheelchair I was off to Tucson, and arrived home near 10:30 AM.
The timing of Lisa's move was as close to perfect as one could get. You see Lisa's discharge date and time from Select Specialty Hospital was firm: 1:00 PM, Friday, June 15th. Richard's Jury was still out on Thursday, June 14th, and they had been deliberating since Wednesday the 13th. The jury was deciding the guilt or innocence of a man accused of racketeering, drug dealing, murder and kidnapping, and other felonies. It (the trial) had taken 6-weeks, and now it has come down to the final day and everyone is waiting, and waiting, and waiting, and then at 3:30 PM the jury came with their verdict: GUILTY! And, so it came about the way it ought to... one more bad guy is off the streets of Tucson. There is a coincidence to my way of thinking in that just a year ago Richard tried a case in Ada, Oklahoma that concluded just-about-this-time. A current best seller titled "Innocent Man" was written about the case. I was John Grisham first non-fiction book.
Lisa’s home coming went well; with only a few glitches that were corrected by the time of her arrival. For instance, her specialized hospital bed arrived at 10:30 AM Friday. It was a replacement for the incorrect bed that was delivered a few days earlier. There were other things I could tell you about, but what the heck everything worked out so at this point it really doesn't matter. What does matter is that Lisa is home and loving it!
Michael
mlwintory@msn.com
Saturday, June 16, 2007
Friday, June 08, 2007
Lisa Today - 08 June 2007
Select Specialty Acute Care Hospital
Phoenix, Arizona
Lisa has regain
ed her weight. She has reached 132 lbs, and now is breathing on her own without oxygen assistance; also Lisa’s heart rate is normal. She has begun to vocalize somewhat, and as Ann Peterson would say, “That’s a good thing.” Patrice Mills, Lisa’s Certified Nurse Assistant is completely on board. She is managing the inventory of supplies and equipment that Lisa will need after she arrives in Tucson at Lisa and Richard’s home. I don’t have a picture of Patrice yet, but will include one after Lisa comes home. By-the-way, her discharge is coming up soon, but I do not have an exact date yet because everything must be in-place and at hand for Lisa when she arrives, and that big job is being worked on as we speak by Richard and Patrice here, and others in Phoenix at the insurance company and the hospital. I am happy to report that we have a physician on board with us now in Tucson. His name is Joel Moncizaiz, M.D. I’ll tell you more about Dr. Moncizaiz and how Sherry recruited him later. Understand this, no skilled nursing facility her was willing to take Lisa; therefore homecare was the only option, and further without a physician to supervise her care… well that’s a nightmare thought.
I told you about the Ed Hill and the gang raising $6,000.00 for Lisa’s care and credited everyone who made it possible, well almost everyone except Dennis Frazier. You’d think he’d be first on everyone’s mind… because it was Dennis who provided the lunches for class participants and donated the funds to Lisa and Richard. Please accept our belated thanks to Dennis, and absolutely everyone else who contributed to make the project such a big succes++%26+healing+garden.jpg)
s.
On June 10th, Michael celebrated his 15-month birthday at the doctor’s office. No big deal: a quick height and weight check-a couple of shots and out the door, or so I thought. He contracted some kind of bloody bug that made him quite ill. I’ll spare you the details because most of the people who read this know about from their own experience and for those who may not, sooner or later you-they will. Thank goodness for Huggies.
The rail which will enable Lisa to be comfortably transported (outside of a wheelchair) is up in Richard and Lisa’s home. The track runs from the great room, of their home, up the stairs into the master bedroom and on to the bathroom. There is a spur off of the track leading into what will become Lisa’s therapy room. The workman did a very nice job. The track (rail) is secured with large, long bolts with go through the roof and are there secured. I’ll show you pictures after Lisa comes home.
We had a wonderful visit with Jack and Napua Davis who stopped by for a few days on their way back to Norman, OK. They were visiting their daughter and her family in California, and make like grandparents. They were in Phoenix last Sunday with Lisa and Richard. Napua told me that Lisa turned her eyes to Jack when he began playing his flute for her. The music is his signature and private channel to Lisa’s heart.
Richard used the camera in his phone for these pictures of Michael. They were taken at the hospital healing garden.
Michael
mlwintory@msn.com
ed her weight. She has reached 132 lbs, and now is breathing on her own without oxygen assistance; also Lisa’s heart rate is normal. She has begun to vocalize somewhat, and as Ann Peterson would say, “That’s a good thing.” Patrice Mills, Lisa’s Certified Nurse Assistant is completely on board. She is managing the inventory of supplies and equipment that Lisa will need after she arrives in Tucson at Lisa and Richard’s home. I don’t have a picture of Patrice yet, but will include one after Lisa comes home. By-the-way, her discharge is coming up soon, but I do not have an exact date yet because everything must be in-place and at hand for Lisa when she arrives, and that big job is being worked on as we speak by Richard and Patrice here, and others in Phoenix at the insurance company and the hospital. I am happy to report that we have a physician on board with us now in Tucson. His name is Joel Moncizaiz, M.D. I’ll tell you more about Dr. Moncizaiz and how Sherry recruited him later. Understand this, no skilled nursing facility her was willing to take Lisa; therefore homecare was the only option, and further without a physician to supervise her care… well that’s a nightmare thought.I told you about the Ed Hill and the gang raising $6,000.00 for Lisa’s care and credited everyone who made it possible, well almost everyone except Dennis Frazier. You’d think he’d be first on everyone’s mind… because it was Dennis who provided the lunches for class participants and donated the funds to Lisa and Richard. Please accept our belated thanks to Dennis, and absolutely everyone else who contributed to make the project such a big succes
++%26+healing+garden.jpg)
s.On June 10th, Michael celebrated his 15-month birthday at the doctor’s office. No big deal: a quick height and weight check-a couple of shots and out the door, or so I thought. He contracted some kind of bloody bug that made him quite ill. I’ll spare you the details because most of the people who read this know about from their own experience and for those who may not, sooner or later you-they will. Thank goodness for Huggies.
The rail which will enable Lisa to be comfortably transported (outside of a wheelchair) is up in Richard and Lisa’s home. The track runs from the great room, of their home, up the stairs into the master bedroom and on to the bathroom. There is a spur off of the track leading into what will become Lisa’s therapy room. The workman did a very nice job. The track (rail) is secured with large, long bolts with go through the roof and are there secured. I’ll show you pictures after Lisa comes home.
We had a wonderful visit with Jack and Napua Davis who stopped by for a few days on their way back to Norman, OK. They were visiting their daughter and her family in California, and make like grandparents. They were in Phoenix last Sunday with Lisa and Richard. Napua told me that Lisa turned her eyes to Jack when he began playing his flute for her. The music is his signature and private channel to Lisa’s heart.
Richard used the camera in his phone for these pictures of Michael. They were taken at the hospital healing garden.
Michael
mlwintory@msn.com
Thursday, May 24, 2007
Lisa Today - May 16, 2007
I retired from the U.S. Air Force with 22-years service. During my service, I witnessed countless acts of kindness extended to others in times of crisis by the airmen with whom I served. These selfless acts were, to my knowledge, never given as a savings deposit for some future personal calamity; instead, people came forth from every level with helping hands and resources. When I returned to civilian life I observed the phenomena again; never anticipating a personal need for someone as close as my immediate family. And yet, reflecting upon how I came to America, people bestowing kindness should not have been a surprise to me. I won’t go into all that, but I do want you to know what a few of the good guys are doing in their “spare” time to make a difference in Richard and Lisa’s lives... It is extremely noteworthy to recognize the countless federal employees who altruistically donated their personal, annual leave time to Lisa, and the magnanimous contribution by Christina Cabanillas and Tom Bevel for Lisa’s care.
The first of last March a two-day, accredited seminar entitled “Tracking the Money” was conducted at the Oklahoma City Police Training Center as a fund raiser. It was attended by 52 students. For the most part, those responsible for putting it together was Major Ed Hill, Sergeant Wade Taylor from Oklahoma City Police who did a lot of the leg work. CJ Murphy with the Oklahoma Attorney General’s Office and Larry Andrews helped get the word out. We would be remise not to mention Butch Milan who arranged for Jim Holland to assist with the training. Butch paid Jim's air and lodging to get him here, and the rest was all up to the instructors who donated their time. All proceeds for the benefit of Richard and Lisa. Richard and Lisa received a check in the amount of $6,000.00. Major Hill said, “We knew there was a need and wanted to help. I am so glad it all finally came together.
The Oklahoma State Attorney General Drew Edmondson welcomed the attendees. (Mr. Edmondson had previously hired Richard and he also selected Lisa to lead his State Multi-County Grand Jury Unit.)
Tracking the Money, the five components
Financial Investigations by Dave Landrum
The first of last March a two-day, accredited seminar entitled “Tracking the Money” was conducted at the Oklahoma City Police Training Center as a fund raiser. It was attended by 52 students. For the most part, those responsible for putting it together was Major Ed Hill, Sergeant Wade Taylor from Oklahoma City Police who did a lot of the leg work. CJ Murphy with the Oklahoma Attorney General’s Office and Larry Andrews helped get the word out. We would be remise not to mention Butch Milan who arranged for Jim Holland to assist with the training. Butch paid Jim's air and lodging to get him here, and the rest was all up to the instructors who donated their time. All proceeds for the benefit of Richard and Lisa. Richard and Lisa received a check in the amount of $6,000.00. Major Hill said, “We knew there was a need and wanted to help. I am so glad it all finally came together.
The Oklahoma State Attorney General Drew Edmondson welcomed the attendees. (Mr. Edmondson had previously hired Richard and he also selected Lisa to lead his State Multi-County Grand Jury Unit.)
Tracking the Money, the five components
Financial Investigations by Dave Landrum
Interdiction & Tracking Drug Proceeds by Jim Holland
Preparing Financial Cases for Court by Dave Landrum
Preparing Financial Cases for Court by Dave Landrum
Tracking Money by Jeff Sandy
Tracking & Seizing the Terrorist’s Money by Jeff Sandy
The Instructors
Dave Landrum – Retired IRS Special Agent with 28 years as a CID Investigator including 10 years experience as a long-term undercover agent in money laundering investigations. Landrum has taught money laundering investigative methods in Europe, Africa and Asia. Currently serves as a consultant to law firms on criminal and civil financial crime issues and assists financial institutions in complying with the Bank Secrecy Act.
Jim Holland – Lieutenant with Texas DPS who oversees Criminal and Drug Interdiction and forfeiture investigative techniques.
Jeff Sandy – Certified fraud examiner and owner of Forensic Financial Investigative Services LLC, worked for over 25-years as a special agent for the U.S. Department of the Treasury, Internal Revenue Service CID, Mr. Sandy has supervised some of the nation’s largest investigations into corporate fraud, bank fraud, worker compensation fraud, and narcotics trafficking. In 2003, Mr. Sandy was assigned to a U.S. Military Joint Operation called the Iraqi Survey Group to trace the hidden assets of the Saddam Hussein regime. As a result of his work in Iraq, Mr. Sandy received the Honor Award from the Secretary of the Treasury and a Joint Service Achievement Medal from the U.S. Army.
Tracking & Seizing the Terrorist’s Money by Jeff Sandy
The Instructors
Dave Landrum – Retired IRS Special Agent with 28 years as a CID Investigator including 10 years experience as a long-term undercover agent in money laundering investigations. Landrum has taught money laundering investigative methods in Europe, Africa and Asia. Currently serves as a consultant to law firms on criminal and civil financial crime issues and assists financial institutions in complying with the Bank Secrecy Act.
Jim Holland – Lieutenant with Texas DPS who oversees Criminal and Drug Interdiction and forfeiture investigative techniques.
Jeff Sandy – Certified fraud examiner and owner of Forensic Financial Investigative Services LLC, worked for over 25-years as a special agent for the U.S. Department of the Treasury, Internal Revenue Service CID, Mr. Sandy has supervised some of the nation’s largest investigations into corporate fraud, bank fraud, worker compensation fraud, and narcotics trafficking. In 2003, Mr. Sandy was assigned to a U.S. Military Joint Operation called the Iraqi Survey Group to trace the hidden assets of the Saddam Hussein regime. As a result of his work in Iraq, Mr. Sandy received the Honor Award from the Secretary of the Treasury and a Joint Service Achievement Medal from the U.S. Army.
Michael
mlwintory@msn.com
Monday, May 07, 2007
Lisa Today - May 6, 2007
Select Specialty Hospital
Phoenix, Arizona
Not a lot to talk about this week so I have included three pictures of Michael to share with you. All of the pictures were taken while Lisa with Richard and Michael were all resting in the
healing garden at St. Joseph’s Medical Center. Richard’s cell phone, as you can see does a pretty nice job on a catch as catch can camera work. The weather was picturesque according to Richard, and Michael was really fun to be with as he remains mostly cheerful. The third photograph clearly illustrates that for a 15-month old; idleness is altogether uninteresting and
therefore intolerable. So, here he is trying out some of his moves. For Michael movement is constant. His every wakening moment is an opportunity for discovery, adventure and exploration. But then, running constantly at a very high RPM rate is not without its consequences, and resting one’s engine is not only necessary, but as the picture on the left proves; irresistible.
Richard meanwhile continues his recruiting efforts to find the right person who can and will provide Lisa’s home health care. I’ll let you know as soon as possible when he finds the right person, but for now there’s nothing new to tell you.
I’m sad to report; the Susie and Lyle Wuertz Family of Indiana suffered a dreadful loss last week with the passing of Susie’s dear Mother--who had just recently celebrated her 99th birthday. The Wuertz’s are close friends to Richard and Lisa. When one’s time of passing arrives it brings a deep sadness and isolation to our core. Though, with the touch of those to whom we draw close, we find comfort, and thank G_d, for that and the life lived.
Michael
mlwintory@msn.com
Phoenix, Arizona
Not a lot to talk about this week so I have included three pictures of Michael to share with you. All of the pictures were taken while Lisa with Richard and Michael were all resting in the
healing garden at St. Joseph’s Medical Center. Richard’s cell phone, as you can see does a pretty nice job on a catch as catch can camera work. The weather was picturesque according to Richard, and Michael was really fun to be with as he remains mostly cheerful. The third photograph clearly illustrates that for a 15-month old; idleness is altogether uninteresting and
therefore intolerable. So, here he is trying out some of his moves. For Michael movement is constant. His every wakening moment is an opportunity for discovery, adventure and exploration. But then, running constantly at a very high RPM rate is not without its consequences, and resting one’s engine is not only necessary, but as the picture on the left proves; irresistible.Richard meanwhile continues his recruiting efforts to find the right person who can and will provide Lisa’s home health care. I’ll let you know as soon as possible when he finds the right person, but for now there’s nothing new to tell you.
I’m sad to report; the Susie and Lyle Wuertz Family of Indiana suffered a dreadful loss last week with the passing of Susie’s dear Mother--who had just recently celebrated her 99th birthday. The Wuertz’s are close friends to Richard and Lisa. When one’s time of passing arrives it brings a deep sadness and isolation to our core. Though, with the touch of those to whom we draw close, we find comfort, and thank G_d, for that and the life lived.
Michael
mlwintory@msn.com
Monday, April 30, 2007
Lisa Today - April 30, 2007
Select Specialty Hospital
Phoenix, Arizona
Phoenix, Arizona
Three-days
+(2).jpg)
ago, April the 27th was Lisa’s 41st birthday. It was the second she “celebrated” with Richard and Michael in a Phoenix hospital. Looking back a year ago, at this time, one would have found her hospital room wall-papered with birthday cards, well wishes, letters and tracks of encouragement, and religious praise for G_d. This year, not the same volume of cards, but many inspiring ones, and some quite humorous arrived to share their spirit and message with Lisa. Richard read (and carefully described) each and every of them to Lisa with Michael sleeping peacefully in her arms. For the occasion, the staff festively placed birthday decorations on the equipment stands within Lisa’s view beside her bed. Inflated surgical gloves make wonderful happy faces when decorated with a magic marker. The spiked-pointy-fingers remind me of Sanjaya’s Mohawk hairstyle from a recent American Idol FOX-TV Network program; that you may have seen.The picture of Lisa is from her wedding day at a magnificent resort hotel, The El Conquistador in Oro Valley, Arizona, November 9th, 2004.
It was a beautiful weekend in Phoenix; the Palo Verde trees are in full bloom. The trunks and limbs of this tree are green and the abundance of bright yellow flowers make it a joy to behold. The cherry blossoms in Washington DC compare, but the annual display here is much more shocking to me considering the contrast to what I’ve seen desert display most of the year. I’ve included a PhotoShow to let you see it.
Health wise Lisa’s weight is stable at 128 pounds, and she continues to receive nutritional supplements for a weight gain regimen. Dr. Bliss is treating Lisa for a staph infection. He is going after it very aggressively with powerful antibiotics.
Richard’s hunt continues for a full-time, in-house, caregiver for Lisa. There are some prospects that he is communicating with but no contract has been signed yet. Bummer.
Michael
mlwintory@msn.com
Monday, April 23, 2007
LISA TODAY - 22 April 2007
Select Specialty Hospital
Phoenix, Arizona
You may have noticed from the “Lisa Today” heading that Lis
a is still in Phoenix. You remember, I told you she was, pretty-much, expected to come home last week. The hospital’s discharge intentions and the coming home to Tucson plans have not changed. What happened? The nursing facility in Tucson informed the folks at Select Specialty Hospital in Phoenix that they did not have “bed space” for her on Friday as we thought. Hey, the on again-off again really doesn’t bother or stress us because SNAFU has been the norm for the past year, and we all have gotten used to living with it. You know, to be fair to all concerned, getting a reservation at a nursing facility for Lisa is quite a bit more complex than booking a motel room; I’m sure you would agree. I know it is self serving for me to say; but, we all have been extremely sensitive that we “not kill the messenger” when bad news comes our way. It’s fair to all concerned and worked pretty well in keeping everyone’s blood pressure down and lines of communication open.
For the trip back
home to Tucson, Lisa she will be transported by ambulance. Her specialized wheel-chair will accompany her in the ambulance. The wheelchair is so heavy because it is made to become motorized, with additional equipment modification; hence the heavy weight of the chair.
Then late Friday afternoon, we learned Lisa’s transfer on Monday was also ruled out; so we’re now on a “runway alert” situation, as we used to say in my old Air Force days. Anyway, with the transfer delayed it gives Richard an opportunity this weekend to say thanks, and say goodbye to everyone at the hospital again. And another thing, I know that strong attachments were formed during the past year so it’s really bitter sweet for everyone at the hospital and for Richard, Lisa and Michael. I wanted Richard to take a lot of pictures to share with you so you can get a sense of how it is in Phoenix.
Late afternoon las
t Monday, Ruben, the contractor, who will make the necessary modifications to the residence, met with Richard to review the plans for Lisa’s lift, and establish the work schedule. After meeting with Ruben, we’re thinking it’s about 45-days to completion. How realistic this is, well is anyone’s guess at this time.
On another front, finding the right caregiver for Lisa’s continues to be the number one priority. We have had high hopes in finding some, but with caution—and caution was justified as so far nothing has come to fruition. At the moment, Richard is discussing the caregiver position with a physical therapist. According to her resume, she has good experience working with patients who’ve had similar diagnosis as Lisa. She seems very qualified. Correspondence is flying between her and Richard now. She is our best prospect to fill the bill.
Ri
chard took the pictures shown here when the family was resting in the beautiful Healing Garden at St. Joseph’s Hospital. Michael, until just recently, has not tolerated any sort of head cover. The ball cap does a nice job of shading his eyes. In the third picture (from the top) Lisa joins Michael for a nap. In the last picture, you can see what nice garden it is.
That’s all the news for now. Hope you have a great week!
Phoenix, Arizona
You may have noticed from the “Lisa Today” heading that Lis
a is still in Phoenix. You remember, I told you she was, pretty-much, expected to come home last week. The hospital’s discharge intentions and the coming home to Tucson plans have not changed. What happened? The nursing facility in Tucson informed the folks at Select Specialty Hospital in Phoenix that they did not have “bed space” for her on Friday as we thought. Hey, the on again-off again really doesn’t bother or stress us because SNAFU has been the norm for the past year, and we all have gotten used to living with it. You know, to be fair to all concerned, getting a reservation at a nursing facility for Lisa is quite a bit more complex than booking a motel room; I’m sure you would agree. I know it is self serving for me to say; but, we all have been extremely sensitive that we “not kill the messenger” when bad news comes our way. It’s fair to all concerned and worked pretty well in keeping everyone’s blood pressure down and lines of communication open.For the trip back
home to Tucson, Lisa she will be transported by ambulance. Her specialized wheel-chair will accompany her in the ambulance. The wheelchair is so heavy because it is made to become motorized, with additional equipment modification; hence the heavy weight of the chair.Then late Friday afternoon, we learned Lisa’s transfer on Monday was also ruled out; so we’re now on a “runway alert” situation, as we used to say in my old Air Force days. Anyway, with the transfer delayed it gives Richard an opportunity this weekend to say thanks, and say goodbye to everyone at the hospital again. And another thing, I know that strong attachments were formed during the past year so it’s really bitter sweet for everyone at the hospital and for Richard, Lisa and Michael. I wanted Richard to take a lot of pictures to share with you so you can get a sense of how it is in Phoenix.
Late afternoon las
t Monday, Ruben, the contractor, who will make the necessary modifications to the residence, met with Richard to review the plans for Lisa’s lift, and establish the work schedule. After meeting with Ruben, we’re thinking it’s about 45-days to completion. How realistic this is, well is anyone’s guess at this time.On another front, finding the right caregiver for Lisa’s continues to be the number one priority. We have had high hopes in finding some, but with caution—and caution was justified as so far nothing has come to fruition. At the moment, Richard is discussing the caregiver position with a physical therapist. According to her resume, she has good experience working with patients who’ve had similar diagnosis as Lisa. She seems very qualified. Correspondence is flying between her and Richard now. She is our best prospect to fill the bill.
Ri
chard took the pictures shown here when the family was resting in the beautiful Healing Garden at St. Joseph’s Hospital. Michael, until just recently, has not tolerated any sort of head cover. The ball cap does a nice job of shading his eyes. In the third picture (from the top) Lisa joins Michael for a nap. In the last picture, you can see what nice garden it is.That’s all the news for now. Hope you have a great week!
Michael
mlwintory@msn.com
mlwintory@msn.com
Monday, April 16, 2007
Lisa Today - 16 April 2007
Lisa Today – April 16th, 2007
Select Specialty Hospital
Phoenix, Arizona
For over a year now in Phoenix, St. Joseph’s Medical Center has provided a.jpg)
roof over Lisa’s head; within the medical center, is Select Specialty a long term acute care hospital designed to care for patients like Lisa. Her admission was justified and approved because she met their criteria of needing healthcare services for a patient with a medically complex, and catastrophic injury. Select Specialty, is taking care of Lisa’s medical deficiencies while the Barrow Neurological Institute (also housed at St. Joseph’s) continues to monitor her neurological progress and treatment. Lisa no longer requires hospitalization for neurological reasons.
Another big player in the provision of Lisa’s care is her insurer, Blue Cross–Blue Shield. Until recently the insurer has been stellar in providing the financial resources so vital in giving Lisa the best opportunity for recovery. I mention this now only in passing to let you know that we have appealed their decision to cut off funding, but so far haven’t received a reply as she continues her $2000.00 a-day, acute care long-term hospitalization.
In answer to the question, “how’s Lisa doing?” We believe, with the staff, that Lisa is present and aware; we’ve known this by her past responsiveness to instructions and questions. Lisa, to her great credit, has been relentless in her fight to overcome the painful effects of Spasticity, and the other medical issues that confront her… relentless until very recently. But now, regrettably, she isn’t responding to stimulus except for loud, sudden noises.
Lisa is medically stable and soon will be ready for discharge, meaning she can be cared for at home; therefore Richard has redoubled his efforts to find the right person to care for Lisa at their home in Tucson. He has placed more advertisements in more places for a caregiver; also Deb Pope, Therapy Supervisor, Select Specialty Hospital has put him in touch with new Tucson resources to expedite the recruiting effort.
Richard’s attorney has successfully facilitated his getting a home equity loan to pay for the renovation of the residence. He has a meeting with the contractor and builder is later this week, and hopefully the remodeling will start soon.
Finally, we learned that a skilled nursing facility in Tucson has agreed to take Lisa. Sherry and I intend to visit the facility as soon as possible, and I’ll let you know how it goes. This information came to Richard at a time when Select Specialty Hospital declared Lisa ready for discharge. But on top of that her primary care physician is treating her for a bladder infection, and is not going to authorize the discharge until the medical issue resolves.
Michael
mlwintory@msn.com
Select Specialty Hospital
Phoenix, Arizona
For over a year now in Phoenix, St. Joseph’s Medical Center has provided a
.jpg)
roof over Lisa’s head; within the medical center, is Select Specialty a long term acute care hospital designed to care for patients like Lisa. Her admission was justified and approved because she met their criteria of needing healthcare services for a patient with a medically complex, and catastrophic injury. Select Specialty, is taking care of Lisa’s medical deficiencies while the Barrow Neurological Institute (also housed at St. Joseph’s) continues to monitor her neurological progress and treatment. Lisa no longer requires hospitalization for neurological reasons.Another big player in the provision of Lisa’s care is her insurer, Blue Cross–Blue Shield. Until recently the insurer has been stellar in providing the financial resources so vital in giving Lisa the best opportunity for recovery. I mention this now only in passing to let you know that we have appealed their decision to cut off funding, but so far haven’t received a reply as she continues her $2000.00 a-day, acute care long-term hospitalization.
In answer to the question, “how’s Lisa doing?” We believe, with the staff, that Lisa is present and aware; we’ve known this by her past responsiveness to instructions and questions. Lisa, to her great credit, has been relentless in her fight to overcome the painful effects of Spasticity, and the other medical issues that confront her… relentless until very recently. But now, regrettably, she isn’t responding to stimulus except for loud, sudden noises.
Lisa is medically stable and soon will be ready for discharge, meaning she can be cared for at home; therefore Richard has redoubled his efforts to find the right person to care for Lisa at their home in Tucson. He has placed more advertisements in more places for a caregiver; also Deb Pope, Therapy Supervisor, Select Specialty Hospital has put him in touch with new Tucson resources to expedite the recruiting effort.
Richard’s attorney has successfully facilitated his getting a home equity loan to pay for the renovation of the residence. He has a meeting with the contractor and builder is later this week, and hopefully the remodeling will start soon.
Finally, we learned that a skilled nursing facility in Tucson has agreed to take Lisa. Sherry and I intend to visit the facility as soon as possible, and I’ll let you know how it goes. This information came to Richard at a time when Select Specialty Hospital declared Lisa ready for discharge. But on top of that her primary care physician is treating her for a bladder infection, and is not going to authorize the discharge until the medical issue resolves.
Michael
mlwintory@msn.com
Monday, April 09, 2007
Lisa Today – Easter 2007
Select Specialty Hospital
Phoenix, AZ
There are times when ones child makes one proud, and Michael was indeed an Angel during Easter Services at St. Joseph’s Hospital Chapel last Sunday. He was almost attentive, well I shouldn’t go that far, but he didn’t squirm around, chirp or cry. Richard reported, “He was with us, Lisa and me, and I felt blessed and I believe Lisa did too.”
Lisa’s weight los.jpg)
s is now under control, and we’re all pleased with that. Her caloric intake was increased and is being very carefully monitored. She is expected to show progress with her weight soon. Her therapy continues as are all of the other services we’ve come to expect. In the picture below, Mary Francis and Moira are shown with Michael; it is a wonderful picture because it typifies the relationship he has with them and the other hospital staff. It occurs to me just how much a part of his life that these wonderful people have become over the past 14-months. And, I am so grateful to them for the warmth and nurturing kindness he receives from all the wonderful folks who take care of Lisa at the Select Specialty Hospital in Phoenix.
Sherry took Michael to the pool several times this past week, I came along too, but it was really Sherry and Michael’s deal. Among her many skills, being a certified swimming instructor is one. To say he took to the swimming pool like a duck to water would.jpg)
be an understatement… he loved it. The water temperature was 84 degrees and the air temp was 90, perfect! There’s something special swimming in an outdoor pool in early April that is a real turn on, after living in Illinois and Iowa for most of my life. The thing is he has these big blue eyes and golden curly hair that strangely affects the ladies. It is something I certainly never experienced! I’ll illustrate some of his charm in the picture of him (on the right) eating his morning tooth brush.
I took too long between updates, and I apologize to you for not keeping you current. I now realize that a little bit news is much, much better than no news so I have rededicated myself to crank out one of these weekly.
Michael
mlwintory@msn.com
Phoenix, AZ
There are times when ones child makes one proud, and Michael was indeed an Angel during Easter Services at St. Joseph’s Hospital Chapel last Sunday. He was almost attentive, well I shouldn’t go that far, but he didn’t squirm around, chirp or cry. Richard reported, “He was with us, Lisa and me, and I felt blessed and I believe Lisa did too.”
Lisa’s weight los
.jpg)
s is now under control, and we’re all pleased with that. Her caloric intake was increased and is being very carefully monitored. She is expected to show progress with her weight soon. Her therapy continues as are all of the other services we’ve come to expect. In the picture below, Mary Francis and Moira are shown with Michael; it is a wonderful picture because it typifies the relationship he has with them and the other hospital staff. It occurs to me just how much a part of his life that these wonderful people have become over the past 14-months. And, I am so grateful to them for the warmth and nurturing kindness he receives from all the wonderful folks who take care of Lisa at the Select Specialty Hospital in Phoenix.Sherry took Michael to the pool several times this past week, I came along too, but it was really Sherry and Michael’s deal. Among her many skills, being a certified swimming instructor is one. To say he took to the swimming pool like a duck to water would
.jpg)
be an understatement… he loved it. The water temperature was 84 degrees and the air temp was 90, perfect! There’s something special swimming in an outdoor pool in early April that is a real turn on, after living in Illinois and Iowa for most of my life. The thing is he has these big blue eyes and golden curly hair that strangely affects the ladies. It is something I certainly never experienced! I’ll illustrate some of his charm in the picture of him (on the right) eating his morning tooth brush.I took too long between updates, and I apologize to you for not keeping you current. I now realize that a little bit news is much, much better than no news so I have rededicated myself to crank out one of these weekly.
Michael
mlwintory@msn.com
Saturday, March 31, 2007
LISA TODAY - 31 March 2007
Select Specialty Hospital
Phoenix, Arizona
Mid-February through End-March 2007
Richard’s hopes were running high—in fact, we all had high hopes that Lisa’s spasticity would lessen after receiving 20- medically approved hyperbaric therapy treatments. If Lisa’s muscle tone returned closer to normal, she would be much more comfortable. And, those who care for her could do so with less difficulty when they move her in bed and to and from her wheelchair, or when she receives physical therapy, and range of motion exercises.
We knew there were no guarantees we got the message at a special meeting Richard attended with all of the principals who care for, manage, fund, administer, and oversee the healthcare services Lisa receives at Select Specialty Hospital. The meeting was called to assure everyone understood and agreed to their part in Lisa’s upcoming hyperbaric therapy and her eventual discharge from the hospital. It was all discussed: who, how, where, what, when and why. Richard drove to Phoenix to attend that Thursday meeting. The bottom line, Lisa would have to show 'measurable improvement' for the hyperbaric treatment to be deemed successful. The 'measuring' would be done by her therapists and caregivers. They would be in the best position to evaluate her progress and provide the most objective, timely and informed assessment of Lisa's functional improvement. Their findings would be documented and reported to Dr. Kwasnica.
It was stated that if 'measurable improvement' was shown, Lisa would qualify for additional hyperbaric treatments until her improvement would 'plateau'. Blue Cross representatives who were present, later that day agreed in writing to pay for 20-sessions under these guidelines. They further agreed Lisa would stay at Select throughout this process.
Part of the 'process' was to be Lisa's discharge plan. The discharge plan is a detailed strategy to assure all concerned that Lisa would have a safe, secure, well equipped, supplied and properly staffed once she was ready to leave Select.
All agreed the options for Lisa to make significant improvement were about played out and that afterward, whatever gain came from the hyperbaric and other tone management treatments, Lisa's discharge plan would include:
• Getting Lisa as medically stable as possible, that is her nutrition via tube feeding, her airway protection through her trach, her susceptibility to motion sickness and other medical conditions should be capable of being maintained in a home setting.
• Identifying the braces, splints and other equipment she would need to manage her spasticity, along with the optimum mix of medications for her pump.
• Identifying, ordering, and have delivered the equipment and supplies necessary for Lisa to survive and be comfortable at home. It was understood that Blue Cross would have to review the lists of medical and rehabilitation equipment to determine what would be covered by insurance. Richard would be expected to come up with the money for the necessary, but uncovered items. For example, for Lisa’s bath a lift is needed to transport her from bed to bath, and a special chair to position her safely in the tub, but neither the expensive lift nor the chair are covered.
• Staffing needed to be recruited and hired, and then they along with family required training in order to provide Lisa with the 247 care she requires.
• Doctors in Tucson would need to be identified and willing to manage Lisa's care. The Tucson medical staff will be briefed by Lisa's current team in Phoenix.
'Homework' assignments were made and accepted. The Phoenix doctors would oversee Lisa's care for their areas of practice and find or at least brief in Tucson physicians. That is Dr. Fracica hyperbaric; Dr. Kwasnica neuro rehab and Dr. Bliss all other medical issues as Lisa's attending physician.
The Select staff would prepare and submit for review (to the Phoenix doctors) a list of equipment and supply items, once approved would then go through vendors to Blue Cross for review and approval. The approved items could then be ordered and delivered.
Richard's assignment included ordering non-covered items, finding the staff to care for Lisa, getting the necessary modifications made to their home (the ceiling lift being the biggie) and then figuring out how to pay for it all. This was no small task.
After hiring two different law firms which specialize in the field of healthcare disability benefits, Richard learned Lisa was ineligible to receive Medicare home health benefits for 2- years from when she began receiving Social Security Disability benefits. The waiting period was because Lisa did not meet the 65-years of age requirement. She was also found ineligible to receive Medicaid or Arizona state benefits as well.
Blue Cross offered to help Richard with the logistics to find caregivers. This was certainly welcomed; unfortunately that offer was a dry well. ((while all this was going on in Phoenix and, as an aside to all of this, As a prosecutor in Tucson Richard’s work gave him the heaviest trial case load since coming to Tucson.
While all this was going on in Phoenix, as if it weren’t enough, Richard’s work as a prosecutor in Tucson found him with the heaviest trial case load he has had since coming to Tucson. I mention this, because I marvel that he “continues to pull the plow with his head up. Frankly I don’t know how he does it… must come from his father. Just kidding, it is all about Lisa and Michael because that’s clearly what motivates him. However, it does stagger one, considering all that he is doing, and besides, has in fact, lead his office since Thanksgiving in the number of cases tried.)
Whew! So the meeting ended with much said and promised. But two things never stated were to fundamentally change Lisa's treatment.
First, Dr. Kwasnica changed the “rules in the middle of game which adversely impacted upon the financial support she received from Blue Cross/Blue Shield.” Even though she was present for the meeting and interacted with the rehab staff during the time they developed and documented their measurements of Lisa’s response to hyperbaric, Dr. Kwasnica decided, without telling anyone, to use a much more rigid and inflexible standard for measuring Lisa’s improvement. The “Ashworth scale” doesn’t, for example, count Lisa’s sitting more easily in her wheel chair if other factors aren’t also found. Simply put, the Ashworth scale would ignore the improvement Lisa’s therapists and caregiver were objectively measuring.
What happened next was a punch in the stomach because although Blue Cross representatives were present at the meeting, and everyone understood that discharge planning would be going on simultaneously during the hyperbaric therapy, they never said Lisa's insurance coverage would end once hyperbaric treatments were finished; or that all discharge planning must be completed by then. We approached hyperbaric with cautious optimism, because to us, these two critical points were undisclosed at the meeting, even after everyone supposedly was on the “same page”.
Trying to keep this all in chronological order and yet coherent is a… somewhat difficult, I hope you are still with me.
From the onset, every precaution was taken for Lisa during the hyperbaric treatments so she would not be unduly stressed or become uncomfortable during the therapy treatments. For instance, small tubes were placed in Lisa’s ears to help balance the atmospheric pressure of the hyperbaric chamber on her ear drums. No one predicted how she would respond, so we waited. But the wait was bearable thanks to the encouragement we received from emails and phone calls. People were telling us of the many prayers, and many extra prayers which were taking place… prayers of praise and prayers for Lisa from all over the United States.
Then Lisa’s first reports did measurably to show improvement over her spasticity during her early hyperbaric treatments. Her physical therapist noted her muscle tone was more relaxed during therapy sessions. We also heard from Lisa’s Rangers that they were able to move her arms and legs with less resistance than they had for the previous months. And further, Lisa's hospital caregivers, many of whom didn't even know Lisa had started hyperbaric, observed and charted Lisa's improvement from when they bathed and turned her.
It was about this time that three complications adversely affected Lisa’s medical condition, and retracted her response to the hyperbaric treatments. Her progress took a dive.
• First, the scopolamine patch Lisa wears behind her ear controls vertigo, nausea, gagging which comes from her brain injury and occurs when she is moved. In fact, at an earlier time, vertigo forced her therapy to be stopped until prescribing the patch helped her regain control of the vertigo. The patch is the similar to the one people use on a pleasure cruise to control their motion sickness. A patch was removed during her hyperbaric treatments, and once removed, came off again because Lisa perspires when she exerted or exerts herself. Lisa had been vomiting for several days in therapy and her muscle tone had increased before the problem was discovered and resolved.
• Second, her tube feedings were discontinued for an extra 8-hour to accommodate the time for Lisa's transport to and from and treatment in the hyperbaric chamber, as well as her regular therapy time. This was deemed necessary to prevent Lisa from vomiting and then inhaling tube feedings should the movement cause nausea. The result was Lisa received significantly fewer calories per day leading to a dramatic weight loss. Lisa lost over 10% of her body weight in less than a month. This degree of weight loss requires medical treatment and close nutritional observation and correction. Therefore, one might reason it is an acute medical condition.
• Third, Lisa was diagnosed with a bowel condition which contributed to her weight loss, and required antibiotic therapy for over a week to correct.
No one could reasonably expect hyperbaric therapy to overcome the impact of these three complications. To Richard, Lisa's therapists and her hyperbaric doctors the next steps seemed clear: resolve the complications (keep the patch on, increase her tube feedings, and clear the bowel infection) then see if the documented 'measurable improvement' returned and increased during another 20 sessions.
By the time Lisa's last one hour session in the hyperbaric chamber was completed, Richard was confident everyone would support another 20 sessions. Lisa's patch was secured with tape, her infection was clearing and her nutritionist was working on a plan for Lisa to regain her weight. Rehab supervisor Deb Pope had documented Lisa's improvement as well as the complications in a memo to Dr. Kwasnica.
But then everything started going very wrong. Dr. Kwasnica reported to Blue Cross 'no measurable improvement' based upon her, use of the Ashworth scale, which does not consider all the functional, observed, documented improvements measured by the therapists reporting to Dr. Kwasnica.
With that verdict, Dr. Fracica's (Lisa's hyperbaric doc) hands were tied. Blue Cross was off the hook- why should they pay given Dr. Kwasnica's report- even though their own representatives had told of the 'measurable improvements' over the preceding weeks. So, no more hyperbaric treatments for Lisa, at least while at Select Specialty Hospital.
Next, Blue Cross asks Dr. Kwasnica if Lisa is still 'acute.' A pretty important question, if Lisa's condition is acute her placement in a 'long term acute care' (or LTAC) facility like Select is medically necessary and covered. But there's a serious breakdown here. This question is properly asked of Dr. Bliss; Lisa's attending who can describe her medical acuity. Instead, Dr. Kwasnica answered from a neuro point of view: no, Lisa's not acute.
Unfortunately, the distinction was lost on Blue Cross. They heard what they needed. In fact, when Dr. Bliss returns from the vacation he was in the middle of, he will tell Blue Cross the combination of complications and particularly the weight loss makes Lisa 'acute' and her stay at Select medically necessary, but by that time the decision had been made: Lisa will lose additional hyperbaric treatments and continued coverage for her stay at Select.
Rather than the commitment to helping implementation of the discharge plan, Blue Cross gives us 4 days to get Lisa out of Select or start footing the $2,000 a day bill.
Blue Cross says this knowing that the equipment, supplies, staffing necessary for Lisa's survival are not yet in place; that her attending physician isn't in town and the doc covering for him refused to discharge Lisa because it would be 'unsafe.' Blue Cross maintains their position even after Dr. Kwasnica corrects the misunderstanding and tells them she gave no information about Lisa's medical acuity.
Forced to choose between an unsafe, premature discharge and potential bankruptcy, the choice for Richard is clear. Lisa will stay at Select while an appeal of Blue Cross's decision is pursued and the discharge plan is implemented.
We never expected, at this important time that “Lisa’s response” to the hyperbaric therapy, despite her complications, would become an evaluation using never disclosed scales rather than the ones agreed upon. Then, taking that information from the neurologist, that Lisa’s insurance company, Blue Cross/Blue Shield, would decline to pay for additional hyperbaric treatments or the continuation of her hospitalization at Select Specialty Hospital.
The conflict, in my opinion, led to an administrative blindness to the three (vital) complications that happened during Lisa’s hyperbaric therapy. Three factors that inhibited Lisa from getting evenhanded benefits from the therapy she received, and in my opinion skewed the interpretation of her response to hyperbaric treatments. This translates to Richard and Lisa receiving a request from the hospital to immediately make a $60,000.00 payment to the hospital, and pay the hospital $2,000.00 a day and for 30 days advance.
The 'good news' is that because no facility offering a lower level of care will accept Lisa in her current condition and with no coverage, she will remain at Select.
And that's a very good thing. Efforts to simultaneously increase Lisa's tube feedings while trading down to a smaller trach were a disaster. Lisa began vomiting and with the smaller trach not providing the protection to her airway, she inhales the material resulting in yet another infection.
Fortunately, Lisa's doctors have gotten her through this before and will again.
A new trach, still small enough for Lisa to vocalize and breathe with it capped but with a lung -protecting cuff is replacing the current one and Lisa is slowly regaining weight. (The smaller trach was put in place this past week, and Lisa is breathing easier.)
So, do you suppose these developments, which would have required Lisa's hospitalization even had she been discharged before, have gotten renewed coverage? Blue Cross representatives say no, they are 'through' with Lisa!
Well, we'll see about that.
Michael Wintory
mlwintory@msn.com
(I want to acknowledge and thank Sherry for her input and clarification which helped me immensely me in writing of this journal and Richard too for his patient accounting of the events. Without their assistance, I couldn’t master the material.)
Lisa’s web site is: http://lisalatest.blogspot.com
Phoenix, Arizona
Mid-February through End-March 2007
Richard’s hopes were running high—in fact, we all had high hopes that Lisa’s spasticity would lessen after receiving 20- medically approved hyperbaric therapy treatments. If Lisa’s muscle tone returned closer to normal, she would be much more comfortable. And, those who care for her could do so with less difficulty when they move her in bed and to and from her wheelchair, or when she receives physical therapy, and range of motion exercises.
We knew there were no guarantees we got the message at a special meeting Richard attended with all of the principals who care for, manage, fund, administer, and oversee the healthcare services Lisa receives at Select Specialty Hospital. The meeting was called to assure everyone understood and agreed to their part in Lisa’s upcoming hyperbaric therapy and her eventual discharge from the hospital. It was all discussed: who, how, where, what, when and why. Richard drove to Phoenix to attend that Thursday meeting. The bottom line, Lisa would have to show 'measurable improvement' for the hyperbaric treatment to be deemed successful. The 'measuring' would be done by her therapists and caregivers. They would be in the best position to evaluate her progress and provide the most objective, timely and informed assessment of Lisa's functional improvement. Their findings would be documented and reported to Dr. Kwasnica.
It was stated that if 'measurable improvement' was shown, Lisa would qualify for additional hyperbaric treatments until her improvement would 'plateau'. Blue Cross representatives who were present, later that day agreed in writing to pay for 20-sessions under these guidelines. They further agreed Lisa would stay at Select throughout this process.
Part of the 'process' was to be Lisa's discharge plan. The discharge plan is a detailed strategy to assure all concerned that Lisa would have a safe, secure, well equipped, supplied and properly staffed once she was ready to leave Select.
All agreed the options for Lisa to make significant improvement were about played out and that afterward, whatever gain came from the hyperbaric and other tone management treatments, Lisa's discharge plan would include:
• Getting Lisa as medically stable as possible, that is her nutrition via tube feeding, her airway protection through her trach, her susceptibility to motion sickness and other medical conditions should be capable of being maintained in a home setting.
• Identifying the braces, splints and other equipment she would need to manage her spasticity, along with the optimum mix of medications for her pump.
• Identifying, ordering, and have delivered the equipment and supplies necessary for Lisa to survive and be comfortable at home. It was understood that Blue Cross would have to review the lists of medical and rehabilitation equipment to determine what would be covered by insurance. Richard would be expected to come up with the money for the necessary, but uncovered items. For example, for Lisa’s bath a lift is needed to transport her from bed to bath, and a special chair to position her safely in the tub, but neither the expensive lift nor the chair are covered.
• Staffing needed to be recruited and hired, and then they along with family required training in order to provide Lisa with the 247 care she requires.
• Doctors in Tucson would need to be identified and willing to manage Lisa's care. The Tucson medical staff will be briefed by Lisa's current team in Phoenix.
'Homework' assignments were made and accepted. The Phoenix doctors would oversee Lisa's care for their areas of practice and find or at least brief in Tucson physicians. That is Dr. Fracica hyperbaric; Dr. Kwasnica neuro rehab and Dr. Bliss all other medical issues as Lisa's attending physician.
The Select staff would prepare and submit for review (to the Phoenix doctors) a list of equipment and supply items, once approved would then go through vendors to Blue Cross for review and approval. The approved items could then be ordered and delivered.
Richard's assignment included ordering non-covered items, finding the staff to care for Lisa, getting the necessary modifications made to their home (the ceiling lift being the biggie) and then figuring out how to pay for it all. This was no small task.
After hiring two different law firms which specialize in the field of healthcare disability benefits, Richard learned Lisa was ineligible to receive Medicare home health benefits for 2- years from when she began receiving Social Security Disability benefits. The waiting period was because Lisa did not meet the 65-years of age requirement. She was also found ineligible to receive Medicaid or Arizona state benefits as well.
Blue Cross offered to help Richard with the logistics to find caregivers. This was certainly welcomed; unfortunately that offer was a dry well. ((while all this was going on in Phoenix and, as an aside to all of this, As a prosecutor in Tucson Richard’s work gave him the heaviest trial case load since coming to Tucson.
While all this was going on in Phoenix, as if it weren’t enough, Richard’s work as a prosecutor in Tucson found him with the heaviest trial case load he has had since coming to Tucson. I mention this, because I marvel that he “continues to pull the plow with his head up. Frankly I don’t know how he does it… must come from his father. Just kidding, it is all about Lisa and Michael because that’s clearly what motivates him. However, it does stagger one, considering all that he is doing, and besides, has in fact, lead his office since Thanksgiving in the number of cases tried.)
Whew! So the meeting ended with much said and promised. But two things never stated were to fundamentally change Lisa's treatment.
First, Dr. Kwasnica changed the “rules in the middle of game which adversely impacted upon the financial support she received from Blue Cross/Blue Shield.” Even though she was present for the meeting and interacted with the rehab staff during the time they developed and documented their measurements of Lisa’s response to hyperbaric, Dr. Kwasnica decided, without telling anyone, to use a much more rigid and inflexible standard for measuring Lisa’s improvement. The “Ashworth scale” doesn’t, for example, count Lisa’s sitting more easily in her wheel chair if other factors aren’t also found. Simply put, the Ashworth scale would ignore the improvement Lisa’s therapists and caregiver were objectively measuring.
What happened next was a punch in the stomach because although Blue Cross representatives were present at the meeting, and everyone understood that discharge planning would be going on simultaneously during the hyperbaric therapy, they never said Lisa's insurance coverage would end once hyperbaric treatments were finished; or that all discharge planning must be completed by then. We approached hyperbaric with cautious optimism, because to us, these two critical points were undisclosed at the meeting, even after everyone supposedly was on the “same page”.
Trying to keep this all in chronological order and yet coherent is a… somewhat difficult, I hope you are still with me.
From the onset, every precaution was taken for Lisa during the hyperbaric treatments so she would not be unduly stressed or become uncomfortable during the therapy treatments. For instance, small tubes were placed in Lisa’s ears to help balance the atmospheric pressure of the hyperbaric chamber on her ear drums. No one predicted how she would respond, so we waited. But the wait was bearable thanks to the encouragement we received from emails and phone calls. People were telling us of the many prayers, and many extra prayers which were taking place… prayers of praise and prayers for Lisa from all over the United States.
Then Lisa’s first reports did measurably to show improvement over her spasticity during her early hyperbaric treatments. Her physical therapist noted her muscle tone was more relaxed during therapy sessions. We also heard from Lisa’s Rangers that they were able to move her arms and legs with less resistance than they had for the previous months. And further, Lisa's hospital caregivers, many of whom didn't even know Lisa had started hyperbaric, observed and charted Lisa's improvement from when they bathed and turned her.
It was about this time that three complications adversely affected Lisa’s medical condition, and retracted her response to the hyperbaric treatments. Her progress took a dive.
• First, the scopolamine patch Lisa wears behind her ear controls vertigo, nausea, gagging which comes from her brain injury and occurs when she is moved. In fact, at an earlier time, vertigo forced her therapy to be stopped until prescribing the patch helped her regain control of the vertigo. The patch is the similar to the one people use on a pleasure cruise to control their motion sickness. A patch was removed during her hyperbaric treatments, and once removed, came off again because Lisa perspires when she exerted or exerts herself. Lisa had been vomiting for several days in therapy and her muscle tone had increased before the problem was discovered and resolved.
• Second, her tube feedings were discontinued for an extra 8-hour to accommodate the time for Lisa's transport to and from and treatment in the hyperbaric chamber, as well as her regular therapy time. This was deemed necessary to prevent Lisa from vomiting and then inhaling tube feedings should the movement cause nausea. The result was Lisa received significantly fewer calories per day leading to a dramatic weight loss. Lisa lost over 10% of her body weight in less than a month. This degree of weight loss requires medical treatment and close nutritional observation and correction. Therefore, one might reason it is an acute medical condition.
• Third, Lisa was diagnosed with a bowel condition which contributed to her weight loss, and required antibiotic therapy for over a week to correct.
No one could reasonably expect hyperbaric therapy to overcome the impact of these three complications. To Richard, Lisa's therapists and her hyperbaric doctors the next steps seemed clear: resolve the complications (keep the patch on, increase her tube feedings, and clear the bowel infection) then see if the documented 'measurable improvement' returned and increased during another 20 sessions.
By the time Lisa's last one hour session in the hyperbaric chamber was completed, Richard was confident everyone would support another 20 sessions. Lisa's patch was secured with tape, her infection was clearing and her nutritionist was working on a plan for Lisa to regain her weight. Rehab supervisor Deb Pope had documented Lisa's improvement as well as the complications in a memo to Dr. Kwasnica.
But then everything started going very wrong. Dr. Kwasnica reported to Blue Cross 'no measurable improvement' based upon her, use of the Ashworth scale, which does not consider all the functional, observed, documented improvements measured by the therapists reporting to Dr. Kwasnica.
With that verdict, Dr. Fracica's (Lisa's hyperbaric doc) hands were tied. Blue Cross was off the hook- why should they pay given Dr. Kwasnica's report- even though their own representatives had told of the 'measurable improvements' over the preceding weeks. So, no more hyperbaric treatments for Lisa, at least while at Select Specialty Hospital.
Next, Blue Cross asks Dr. Kwasnica if Lisa is still 'acute.' A pretty important question, if Lisa's condition is acute her placement in a 'long term acute care' (or LTAC) facility like Select is medically necessary and covered. But there's a serious breakdown here. This question is properly asked of Dr. Bliss; Lisa's attending who can describe her medical acuity. Instead, Dr. Kwasnica answered from a neuro point of view: no, Lisa's not acute.
Unfortunately, the distinction was lost on Blue Cross. They heard what they needed. In fact, when Dr. Bliss returns from the vacation he was in the middle of, he will tell Blue Cross the combination of complications and particularly the weight loss makes Lisa 'acute' and her stay at Select medically necessary, but by that time the decision had been made: Lisa will lose additional hyperbaric treatments and continued coverage for her stay at Select.
Rather than the commitment to helping implementation of the discharge plan, Blue Cross gives us 4 days to get Lisa out of Select or start footing the $2,000 a day bill.
Blue Cross says this knowing that the equipment, supplies, staffing necessary for Lisa's survival are not yet in place; that her attending physician isn't in town and the doc covering for him refused to discharge Lisa because it would be 'unsafe.' Blue Cross maintains their position even after Dr. Kwasnica corrects the misunderstanding and tells them she gave no information about Lisa's medical acuity.
Forced to choose between an unsafe, premature discharge and potential bankruptcy, the choice for Richard is clear. Lisa will stay at Select while an appeal of Blue Cross's decision is pursued and the discharge plan is implemented.
We never expected, at this important time that “Lisa’s response” to the hyperbaric therapy, despite her complications, would become an evaluation using never disclosed scales rather than the ones agreed upon. Then, taking that information from the neurologist, that Lisa’s insurance company, Blue Cross/Blue Shield, would decline to pay for additional hyperbaric treatments or the continuation of her hospitalization at Select Specialty Hospital.
The conflict, in my opinion, led to an administrative blindness to the three (vital) complications that happened during Lisa’s hyperbaric therapy. Three factors that inhibited Lisa from getting evenhanded benefits from the therapy she received, and in my opinion skewed the interpretation of her response to hyperbaric treatments. This translates to Richard and Lisa receiving a request from the hospital to immediately make a $60,000.00 payment to the hospital, and pay the hospital $2,000.00 a day and for 30 days advance.
The 'good news' is that because no facility offering a lower level of care will accept Lisa in her current condition and with no coverage, she will remain at Select.
And that's a very good thing. Efforts to simultaneously increase Lisa's tube feedings while trading down to a smaller trach were a disaster. Lisa began vomiting and with the smaller trach not providing the protection to her airway, she inhales the material resulting in yet another infection.
Fortunately, Lisa's doctors have gotten her through this before and will again.
A new trach, still small enough for Lisa to vocalize and breathe with it capped but with a lung -protecting cuff is replacing the current one and Lisa is slowly regaining weight. (The smaller trach was put in place this past week, and Lisa is breathing easier.)
So, do you suppose these developments, which would have required Lisa's hospitalization even had she been discharged before, have gotten renewed coverage? Blue Cross representatives say no, they are 'through' with Lisa!
Well, we'll see about that.
Michael Wintory
mlwintory@msn.com
(I want to acknowledge and thank Sherry for her input and clarification which helped me immensely me in writing of this journal and Richard too for his patient accounting of the events. Without their assistance, I couldn’t master the material.)
Lisa’s web site is: http://lisalatest.blogspot.com
Thursday, February 15, 2007
Sunday, January 28, 2007
LISA TODAY - January 28, 2007
St. Joseph Medical Center
Select Specialty Hospital
Phoenix, Arizona
Hey gang, Richard here from Lisa’s room, it’s a beautiful Sunday here in Phoenix. Aft.jpg)
er a chilly (by the standards here) couple of weeks we’re back into the upper 60’s and low 70’s and are able to all go outside again. Making the best of it during the “cool snap” we found a large carpeted lobby fronted with windows that is mostly empty on the weekends. It was here that Michael stood on his own for his mom and dad, memorialized with my phone/camera, and just yesterday took a number of enthusiastic, if not graceful, steps.
Lisa started hyperbaric this past Tuesday; I drove up early to sign the paperwork and be with her as she had the first of 20 treatments. The chamber is about 10 feet long and 3 feet in diameter, the top half is clear Lexan ( the stuff jet cockpits are made of) music is piped in along with updates from nurses and interested observers. Lisa, under the watchful eye of Dr. Fracica, handled the treatment with flying colors and has been green lighted for daily sessions.
So for the rest of the week, Lisa spent an hour in the chamber and her early afternoons in therapy, speech, physical and occupational. Later in the afternoons, Lisa is visited by Yolanda, who ranges her and adjusts her splints, early evening with visits from her rangers, Sandy, Bruce and Laura, Bill or Suzanne (depending on which one isn’t in trial or sick from the bug they keep passing to each other but won’t risk passing to Lisa) and Ken, Vince and Lynn (who’s taken up the calling and leaving her civil practice for prosecution). At night Lisa is visited by her favorite rehab tech from neuro rehab, Heather, who after her day shift, studies with Lisa.
How’s the hyperbaric doing for Lisa? Well, it’s too soon to tell, but so far she had an impressive week in therapy with good nods and a thumb wiggle in response to requests from Maureen, her speech therapist. Lisa’s stiffness due to her spasticity is usually most pronounced in the mornings, I’ve come to expect to have to use all my strength and weight to be able to bend her legs slowly up to relieve cramps and to help her fit into her wheelchair. When Lisa is in pain, or fighting an infection her stiff muscle tone (these folks just refer to it as “tone”) really kicks up.
Yesterday morning (Saturday), when I came to range Lisa’s legs, I found that they were stiff, but noticeably, less than they have been in… well, months. This was true through out the day and into the evening. I tell you that my heart was racing a bit, Lisa was even less stiff this morning. Is this just a good week? Maybe. Could I just be seeing or feeling what I desperately want to? Certainly. So, I took it as a good sign. Last night, Lisa’s nurse’s aide, Jay, who has cared for her regularly since last March told me that Lisa’s tone was much better the last two nights than it was last week. Jay asked me if the medicine in her pump had been adjusted. He said he didn’t know that Lisa had started hyperbaric! Here’s the bottom line, this is the first of four weeks in Lisa’s evaluation period. If these good signs are from the hyperbaric sessions, than we should maintain the improvements and see more. While Lisa was approved for 20 sessions, is she shows measurable (by her therapy team) improvements, Dr. Fracica will continue them. We’ll keep you posted.
On the hom
e front, I want to echo Dad’s thanks to everyone who literally kept a roof over our heads and available for Lisa’s by donating leave time to get us past the time the federal Office of Personnel Management (OPM) need to approve Lisa’s disability retirement. I’d been told in December when I called OPM that we were looking at 3-4 months, and I just about, well, broke out in a cold sweat! But all of our family’s guardian angels weren’t going to let us down.
One of the many calls I got was from an old friend (fearing that a good deed may go punished, I’ll leave him unnamed) who had worked at the Department of Justice and later at the National District Attorney’s Association. We hadn’t spoken in a while and he told me that in the intervening years he’d come to know folks at OPM and offered to see if anything could be done to expedite a review of Lisa’s case. No promises other than the effort. Guess the effort paid off for Lisa, she was approved in half the time I’d been told!
While these angels were at work, so were others. Our friend at NDAA, Jim Polley put the word out of our need for more leave time and many responded. One of those is an Assistant United States Attorney from Missouri, Michael Reilly, who put the word out on the DOJ network. Lisa ranger Suzanne Cohen reached out to a local judge who’d worked in the federal system in phoenix, he spread the word. I received many calls and e-mails from federal prosecutors all over the country many refusing to give their names, just wanting to let us know they were going to help. And of course DEA Special Agent Rich Kivi and my other “homies” in federal law enforcement in southern Arizona at our drug task force and in the DEA Tucson District Office proved again, DEA takes care of its own.
Folks helped even when they didn’t have leave time to give. A former Pima county prosecutor, now working as an AUSA in Tucson, Chris Cabanillas and others sent enough unbelievably generous help that we’re now able to pay for the large portion of the costs of the genetic testing Lisa and Michael needed that insurance didn’t cover.
The combination of donated hours and a 2 month process instead 4 months means we made it over the hump. Fortunately, donated time we don’t need will go back to the folks who offered their leave. Now, Lisa will receive “interim pay” (about half her current salary) until OPM finishes processing her “approved” application, (another couple of months we’re told) before her retirement officially begins.
I’ve pretty much been in trial constantly since before thanksgiving, and was scheduled to start another 3 week racketeering case next week. As it turns out, the defense lawyers got the case continued so I’ve got a week or so to concentrate on the logistics of bringing Lisa home, oh, and I’ve got a birthday party to plan for my favorite saint, Michael.
Hey gang, Richard here from Lisa’s room, it’s a beautiful Sunday here in Phoenix. Aft
.jpg)
er a chilly (by the standards here) couple of weeks we’re back into the upper 60’s and low 70’s and are able to all go outside again. Making the best of it during the “cool snap” we found a large carpeted lobby fronted with windows that is mostly empty on the weekends. It was here that Michael stood on his own for his mom and dad, memorialized with my phone/camera, and just yesterday took a number of enthusiastic, if not graceful, steps.Lisa started hyperbaric this past Tuesday; I drove up early to sign the paperwork and be with her as she had the first of 20 treatments. The chamber is about 10 feet long and 3 feet in diameter, the top half is clear Lexan ( the stuff jet cockpits are made of) music is piped in along with updates from nurses and interested observers. Lisa, under the watchful eye of Dr. Fracica, handled the treatment with flying colors and has been green lighted for daily sessions.
So for the rest of the week, Lisa spent an hour in the chamber and her early afternoons in therapy, speech, physical and occupational. Later in the afternoons, Lisa is visited by Yolanda, who ranges her and adjusts her splints, early evening with visits from her rangers, Sandy, Bruce and Laura, Bill or Suzanne (depending on which one isn’t in trial or sick from the bug they keep passing to each other but won’t risk passing to Lisa) and Ken, Vince and Lynn (who’s taken up the calling and leaving her civil practice for prosecution). At night Lisa is visited by her favorite rehab tech from neuro rehab, Heather, who after her day shift, studies with Lisa.
How’s the hyperbaric doing for Lisa? Well, it’s too soon to tell, but so far she had an impressive week in therapy with good nods and a thumb wiggle in response to requests from Maureen, her speech therapist. Lisa’s stiffness due to her spasticity is usually most pronounced in the mornings, I’ve come to expect to have to use all my strength and weight to be able to bend her legs slowly up to relieve cramps and to help her fit into her wheelchair. When Lisa is in pain, or fighting an infection her stiff muscle tone (these folks just refer to it as “tone”) really kicks up.
Yesterday morning (Saturday), when I came to range Lisa’s legs, I found that they were stiff, but noticeably, less than they have been in… well, months. This was true through out the day and into the evening. I tell you that my heart was racing a bit, Lisa was even less stiff this morning. Is this just a good week? Maybe. Could I just be seeing or feeling what I desperately want to? Certainly. So, I took it as a good sign. Last night, Lisa’s nurse’s aide, Jay, who has cared for her regularly since last March told me that Lisa’s tone was much better the last two nights than it was last week. Jay asked me if the medicine in her pump had been adjusted. He said he didn’t know that Lisa had started hyperbaric! Here’s the bottom line, this is the first of four weeks in Lisa’s evaluation period. If these good signs are from the hyperbaric sessions, than we should maintain the improvements and see more. While Lisa was approved for 20 sessions, is she shows measurable (by her therapy team) improvements, Dr. Fracica will continue them. We’ll keep you posted.
On the hom
e front, I want to echo Dad’s thanks to everyone who literally kept a roof over our heads and available for Lisa’s by donating leave time to get us past the time the federal Office of Personnel Management (OPM) need to approve Lisa’s disability retirement. I’d been told in December when I called OPM that we were looking at 3-4 months, and I just about, well, broke out in a cold sweat! But all of our family’s guardian angels weren’t going to let us down.One of the many calls I got was from an old friend (fearing that a good deed may go punished, I’ll leave him unnamed) who had worked at the Department of Justice and later at the National District Attorney’s Association. We hadn’t spoken in a while and he told me that in the intervening years he’d come to know folks at OPM and offered to see if anything could be done to expedite a review of Lisa’s case. No promises other than the effort. Guess the effort paid off for Lisa, she was approved in half the time I’d been told!
While these angels were at work, so were others. Our friend at NDAA, Jim Polley put the word out of our need for more leave time and many responded. One of those is an Assistant United States Attorney from Missouri, Michael Reilly, who put the word out on the DOJ network. Lisa ranger Suzanne Cohen reached out to a local judge who’d worked in the federal system in phoenix, he spread the word. I received many calls and e-mails from federal prosecutors all over the country many refusing to give their names, just wanting to let us know they were going to help. And of course DEA Special Agent Rich Kivi and my other “homies” in federal law enforcement in southern Arizona at our drug task force and in the DEA Tucson District Office proved again, DEA takes care of its own.
Folks helped even when they didn’t have leave time to give. A former Pima county prosecutor, now working as an AUSA in Tucson, Chris Cabanillas and others sent enough unbelievably generous help that we’re now able to pay for the large portion of the costs of the genetic testing Lisa and Michael needed that insurance didn’t cover.
The combination of donated hours and a 2 month process instead 4 months means we made it over the hump. Fortunately, donated time we don’t need will go back to the folks who offered their leave. Now, Lisa will receive “interim pay” (about half her current salary) until OPM finishes processing her “approved” application, (another couple of months we’re told) before her retirement officially begins.
I’ve pretty much been in trial constantly since before thanksgiving, and was scheduled to start another 3 week racketeering case next week. As it turns out, the defense lawyers got the case continued so I’ve got a week or so to concentrate on the logistics of bringing Lisa home, oh, and I’ve got a birthday party to plan for my favorite saint, Michael.
michael
mlwintory@msn.com
Friday, January 26, 2007
Lisa Today - January 26, 2007
St. Joseph Medical Center
Select Specialty Hospital
Phoenix, Arizona
Michael giv
es us all kinds of looks throughout the day. I’m not sure what they all mean, but I have a pretty good idea what the one on the left means. “Do Not Disturb! I am busy with the duck!” I was trying to capture a pose from him for a Valentine Card, but what do I know?Lisa will as be coming home as soon as she completes the hyperbaric therapy that she began 3-days ago. Everything else, all of the other treatments, I mean, (physical, occupational, and speech therapy) will continue throughout her hospitalization at St. Joseph’s Medical Center in Phoenix. “So when, you ask?” We are anticipating, by late February-early March. Blue Cross/Blue Shield approved her receiving the hyperbaric treatments and the necessary hospitalization time to have them admin-istered. The prescription called for 20, Monday-Friday sessions or 4-weeks time.
I want so very much to have you feel uplifted, about the magnanimous response we received for leave-time for Lisa. Hours flooded in! Enough hours to get Lisa and her family where they needed to be, in order to save the farm-so-to-speak! It was a “Guide Post,” moment for us. May G_d Bless You!
Richard heard from, Betty Willis, Lisa’s Human Resources Specialist. She said that Lisa’s application for retirement was approved by the Office of Personnel Management, and Richard also received a copy of the notification. Clarified this means that Lisa will be separated from the Office of Homeland Security 03 February 2007, and her leave-donations will cease on that date as well. Ms. Willis then noted, “That any excess leave-time must be returned to the donor.” Richard then asked Ms. Willis, “… about the leave-time that came to Lisa by folks facing a, ‘use-it-or-lose-it’ situation? Will they get the opportunity to give it to someone
else in need, or would the time just be lost?” To which Ms. Willis replied, “[Unfortunately] we have no control of what will happen with the leave once it is restored to the employee. If it results in leave that they may possibly lose, they will individually have to take that matter up with their agency.” At this time I’m thinking, “No good deed goes unpunished.”This picture of Bathtub Boy gives you an idea of how Lisa and Richard’s son (11 month old) Michael can melt ones heart! Are all grandchildren capable of this, or is it just me?
Michael (mlwintory@msn.com)
Lisa Today - January 23, 2006
St. Joseph Medical Center
Select Specialty Hospital
Phoenix, Arizona
It will be a year, February 23, 2006, that Lisa was relaxing in her living room in Oro Valley-just 13-days after giving birth to Michael--shown on the right in a picture I took yesterday, that her tragic saga began. We could look back in Lisa’s BLOG Site Journal (http://www.lisalatest.com/) to get the date when first the idea of hyperbaric therapy was mentioned, but frankly, it doesn’t matter because it is water under the bridge, what does matter is the answer to a question, “… what have you done for me lately.”
This morning at 8:00 A.M., Lisa was transferred from her hospital bed to a narrow, but comfortable gurney. This particular gurney more narrow than most, is to permit it to easily slide into the hyperbaric chamber (tube) that was waiting for her a couple of floors beneath her hospital room. It wasn’t a long trip in the sense of distance… just a few floors and corridors away, and it was easily reached by the sure, steady hands that guided her chariot through the hospital labyrinth. I asked Richard, who left for Phoenix before 6:00 AM this morning to be there with her, “How did she take the ride?” “Lisa appeared comfortable,” he said, “… dozing in fact” – as she waited for all the medical players to arrive. Today, of all days, the Joint Commission on Hospital Accreditation was at St. Joseph’s on a surprise inspection. The inspectors never give a hospital an exact date—it’s mo
re like a range. I compare the Joint Commission to the military’s inspector general (no stress there J). Anyway after a tolerable delay, Lisa was rolled into the chamber, which turned out to be a perfectly-clear Plexiglas tube. She was dozing at the time, but awoke to the sound of Richard’s voice. He, Richard, explained to Lisa what was about to happen, and for Lisa’s listening pleasure country & western music was being sent to her during the oxygen therapy she was about to receive. One of her doctors arrived then to turn off the Baclofen pump during the time she receives the oxygen therapy. The doctor said she will arrange to teach the technicians who operate the hyperbaric chamber how to “turn the pump off and on,” as it will facilitate Lisa’s care. Every precaution was taken during the 1-hour therapy session as the necessary life support equipment was on hand for Lisa should there become a need. The chamber’s therapeutic level was calculated to 1.75 atmospheres that would be like descending 41.25 feet in the ocean. Let me ask you to recall what happens when one’s inner ear when a person submerges in a swimming pool and reaches the bottom at the deep end. Well, to protect Lisa’s ear drums, tiny tubes were inserted painlessly into her ears. I mention this to express the thoughtful care she continues to receive from the staff at Select Specialty Hospital and St. Joseph’s Medical. Here is a factoid that might interest you, Lisa’s trach is held into place with a Velcro strap, Velcro can generate a spark, and a spark inside of a pure oxygen tube is not a good thing, so it had to be taken into account as was Lisa’s cigarette lighter and flint. (Just kidding!)
Blue Cross/Blue Shield is very supportive of the new therapy for Lisa. In fact, they have been beside her every step of the way.
The rest of Lisa’s day was quite busy. She was with Marty (speech therapist) and Connie (physical therapist) at 1:00 p.m. In fact for the next few weeks, her regular PT, OT and SP therapy will continue as well as the hyperbaric. Lisa’s hands, wrists, and ankles are significantly under the control of her Spasticity. And, recently finding a splint to countermeasure its progress has been difficult.
Michael (mlwintory@msn.com)
Select Specialty Hospital
Phoenix, Arizona
It will be a year, February 23, 2006, that Lisa was relaxing in her living room in Oro Valley-just 13-days after giving birth to Michael--shown on the right in a picture I took yesterday, that her tragic saga began. We could look back in Lisa’s BLOG Site Journal (http://www.lisalatest.com/) to get the date when first the idea of hyperbaric therapy was mentioned, but frankly, it doesn’t matter because it is water under the bridge, what does matter is the answer to a question, “… what have you done for me lately.”
This morning at 8:00 A.M., Lisa was transferred from her hospital bed to a narrow, but comfortable gurney. This particular gurney more narrow than most, is to permit it to easily slide into the hyperbaric chamber (tube) that was waiting for her a couple of floors beneath her hospital room. It wasn’t a long trip in the sense of distance… just a few floors and corridors away, and it was easily reached by the sure, steady hands that guided her chariot through the hospital labyrinth. I asked Richard, who left for Phoenix before 6:00 AM this morning to be there with her, “How did she take the ride?” “Lisa appeared comfortable,” he said, “… dozing in fact” – as she waited for all the medical players to arrive. Today, of all days, the Joint Commission on Hospital Accreditation was at St. Joseph’s on a surprise inspection. The inspectors never give a hospital an exact date—it’s mo
re like a range. I compare the Joint Commission to the military’s inspector general (no stress there J). Anyway after a tolerable delay, Lisa was rolled into the chamber, which turned out to be a perfectly-clear Plexiglas tube. She was dozing at the time, but awoke to the sound of Richard’s voice. He, Richard, explained to Lisa what was about to happen, and for Lisa’s listening pleasure country & western music was being sent to her during the oxygen therapy she was about to receive. One of her doctors arrived then to turn off the Baclofen pump during the time she receives the oxygen therapy. The doctor said she will arrange to teach the technicians who operate the hyperbaric chamber how to “turn the pump off and on,” as it will facilitate Lisa’s care. Every precaution was taken during the 1-hour therapy session as the necessary life support equipment was on hand for Lisa should there become a need. The chamber’s therapeutic level was calculated to 1.75 atmospheres that would be like descending 41.25 feet in the ocean. Let me ask you to recall what happens when one’s inner ear when a person submerges in a swimming pool and reaches the bottom at the deep end. Well, to protect Lisa’s ear drums, tiny tubes were inserted painlessly into her ears. I mention this to express the thoughtful care she continues to receive from the staff at Select Specialty Hospital and St. Joseph’s Medical. Here is a factoid that might interest you, Lisa’s trach is held into place with a Velcro strap, Velcro can generate a spark, and a spark inside of a pure oxygen tube is not a good thing, so it had to be taken into account as was Lisa’s cigarette lighter and flint. (Just kidding!)Blue Cross/Blue Shield is very supportive of the new therapy for Lisa. In fact, they have been beside her every step of the way.
The rest of Lisa’s day was quite busy. She was with Marty (speech therapist) and Connie (physical therapist) at 1:00 p.m. In fact for the next few weeks, her regular PT, OT and SP therapy will continue as well as the hyperbaric. Lisa’s hands, wrists, and ankles are significantly under the control of her Spasticity. And, recently finding a splint to countermeasure its progress has been difficult.
Michael (mlwintory@msn.com)
Saturday, January 20, 2007
LISA TODAY - January 20, 2007
Now for something different, here is a personal letter meant for you from Lisa's brother (David) and his Family...
From my wife Suzanne, my son Collin and my daughter Rylee we would would like to take this moment and say thank you.
Thank you to those of you who have made a donation to my sister's leave.
Thank you to those of you who stop by and visit with my sister daily.
Thank you to the doctors, caregivers, nurses and friends who help her in her rehab and constantly remind her that she is a fighter and she will win this battle.
Thank you to those of you who keep Richard going so he can help fight with my sister. It is truly amazing what everyone has done in this time of need. You have given Lisa so many days to continue her fight and also have helped ease some of the pressures from Richard so he can focus on working on that which needs to be done to help Lisa. It is a battle that they can't fight alone. It takes all 3 of them to help her. It takes all of us to stop and remember that it is our responsibility to do what we need to do so that Lisa can someday be an active part of their lives again. Michael gets crazy when he sees his mother and remember that you are a part of Richard, Lisa's and Michael's life. You are doing amazing things. Even a simple positive thought can move mountains.
Many of you we will never meet. But please understand this...you will never be out of our thoughts and prayers. Good things happen to good people and I believe in my mind and heart that you have done something simply awesome and truly incredible. I pray and hope that your lives will be touched and blessed in the way that you have touched and blessed Lisa, Richard and Micheal "the wild one" Wintory.
I am truly grateful for what you have done and I hope that I can carry on the spirit of doing what is right for other people when they or their family is in a time of need such as ours. I think everyone that has been affected by this tragedy has learned a lesson. I have learned many. I have learned lessons that I will pass on to my children and hopefully carry on what has been done here. I have learned that I can't be selfish and try to get Lisa better for my own needs...it's for her and her family. It's for Richard. It's for Michael. I had the best 35 years of my life with my sister. Now I start the journey of the next 35 + years of my life with my sister, not in a way I would have thought it would ever be...but I still have my sister. That was the deal I made. I told her to stick around and I will do the best that I can for her, Richard and Michael.
Your generosity, donations, thoughts and prayers have made it possible for Lisa and Richard to make it partially through yet another hurdle in their time of need. There may never be a chance for us to sit down and individually thank each and everyone of you who have done so many things for Lisa, Richard and Michael but please understand this once again...We appreciate all of the support and love for this family. I can't begin to thank you enough from the bottom of our hearts.
And once again....thank you for your unconditional support. It will never be forgotten.
David, Suzanne, Collin and Rylee Goodspeed
Michael (mlwintory@msn.com)
From my wife Suzanne, my son Collin and my daughter Rylee we would would like to take this moment and say thank you.
Thank you to those of you who have made a donation to my sister's leave.
Thank you to those of you who stop by and visit with my sister daily.
Thank you to the doctors, caregivers, nurses and friends who help her in her rehab and constantly remind her that she is a fighter and she will win this battle.
Thank you to those of you who keep Richard going so he can help fight with my sister. It is truly amazing what everyone has done in this time of need. You have given Lisa so many days to continue her fight and also have helped ease some of the pressures from Richard so he can focus on working on that which needs to be done to help Lisa. It is a battle that they can't fight alone. It takes all 3 of them to help her. It takes all of us to stop and remember that it is our responsibility to do what we need to do so that Lisa can someday be an active part of their lives again. Michael gets crazy when he sees his mother and remember that you are a part of Richard, Lisa's and Michael's life. You are doing amazing things. Even a simple positive thought can move mountains.
Many of you we will never meet. But please understand this...you will never be out of our thoughts and prayers. Good things happen to good people and I believe in my mind and heart that you have done something simply awesome and truly incredible. I pray and hope that your lives will be touched and blessed in the way that you have touched and blessed Lisa, Richard and Micheal "the wild one" Wintory.
I am truly grateful for what you have done and I hope that I can carry on the spirit of doing what is right for other people when they or their family is in a time of need such as ours. I think everyone that has been affected by this tragedy has learned a lesson. I have learned many. I have learned lessons that I will pass on to my children and hopefully carry on what has been done here. I have learned that I can't be selfish and try to get Lisa better for my own needs...it's for her and her family. It's for Richard. It's for Michael. I had the best 35 years of my life with my sister. Now I start the journey of the next 35 + years of my life with my sister, not in a way I would have thought it would ever be...but I still have my sister. That was the deal I made. I told her to stick around and I will do the best that I can for her, Richard and Michael.
Your generosity, donations, thoughts and prayers have made it possible for Lisa and Richard to make it partially through yet another hurdle in their time of need. There may never be a chance for us to sit down and individually thank each and everyone of you who have done so many things for Lisa, Richard and Michael but please understand this once again...We appreciate all of the support and love for this family. I can't begin to thank you enough from the bottom of our hearts.
And once again....thank you for your unconditional support. It will never be forgotten.
David, Suzanne, Collin and Rylee Goodspeed
Michael (mlwintory@msn.com)
Wednesday, December 27, 2006
Lisa Today - 27 December 2006
This is a request I hoped, in so many ways, I wouldn't have to make, but maybe you can help Lisa Today.
Despite many months of struggling through setbacks and complications, Lisa has continued to show us she's with us, aware of her condition and wants to reclaim her life. Unfortunately, the degree of her brain injury has limited her ability to communicate to only blinks and slight nods. We have had to come to accept that Lisa will not be able to return to her career as a prosecutor for Homeland Security's Operation Predator. Therefore, Richard submitted the necessary paperwork for Lisa to take disability retirement from federal service.
The delay of this heartbreaking decision for Richard and Lisa, was with the desperate hope for her to be able to make a significant recovery, consequently it has put them in a bind. We learned from the Office of Personnel Management in Washington recently that there probably will be 120-days to process, review and approve Lisa’s retirement application. You see, they won't even assign Lisa's case for 30 days; then it will take up to an additional 90 more days before it's approved. Lisa's leave time will run out sometime in January. When that happens well, to be blunt, Richard and Lisa are a two paycheck family and can't make it-in their home-on just Richard’s salary. This situation they are in is more than an ordinary threat as Lisa is quickly approaching the day she will come home to her residence in Oro Valley.
Therefore, I am asking you, if you or your colleagues in federal service who may have some surplus annual leave time, or are in a "use it or lose it" situation before the end-of-the-year help us by donating some or all of your surplus to Lisa. Those of you who can, and will help, please contact your personnel office to complete a "voluntary leave transfer program" (VLTP) form for Lisa Wintory, DHS/ICE and have the personnel office certify the transfer and fax the form to:
Nina Candol: (949) 425-4919
If you are willing and able to help and want more information about Lisa, please take a look at her BLOG site: http://lisalatest.blogspot.com or contact me at: mlwintory@msn.com or call me at 520-744-4408.
Please accept our best wishes for the New Year!
Michael L. Wintory
mlwintory@msn.com
An additional note, Lisa’s Sheltie, Maggie lost her valiant fight with lymphoma today, among other things Cancer is nasty business, and none of us are taking it real well right now
Despite many months of struggling through setbacks and complications, Lisa has continued to show us she's with us, aware of her condition and wants to reclaim her life. Unfortunately, the degree of her brain injury has limited her ability to communicate to only blinks and slight nods. We have had to come to accept that Lisa will not be able to return to her career as a prosecutor for Homeland Security's Operation Predator. Therefore, Richard submitted the necessary paperwork for Lisa to take disability retirement from federal service.
The delay of this heartbreaking decision for Richard and Lisa, was with the desperate hope for her to be able to make a significant recovery, consequently it has put them in a bind. We learned from the Office of Personnel Management in Washington recently that there probably will be 120-days to process, review and approve Lisa’s retirement application. You see, they won't even assign Lisa's case for 30 days; then it will take up to an additional 90 more days before it's approved. Lisa's leave time will run out sometime in January. When that happens well, to be blunt, Richard and Lisa are a two paycheck family and can't make it-in their home-on just Richard’s salary. This situation they are in is more than an ordinary threat as Lisa is quickly approaching the day she will come home to her residence in Oro Valley.
Therefore, I am asking you, if you or your colleagues in federal service who may have some surplus annual leave time, or are in a "use it or lose it" situation before the end-of-the-year help us by donating some or all of your surplus to Lisa. Those of you who can, and will help, please contact your personnel office to complete a "voluntary leave transfer program" (VLTP) form for Lisa Wintory, DHS/ICE and have the personnel office certify the transfer and fax the form to:
Nina Candol: (949) 425-4919
If you are willing and able to help and want more information about Lisa, please take a look at her BLOG site: http://lisalatest.blogspot.com or contact me at: mlwintory@msn.com or call me at 520-744-4408.
Please accept our best wishes for the New Year!
Michael L. Wintory
mlwintory@msn.com
An additional note, Lisa’s Sheltie, Maggie lost her valiant fight with lymphoma today, among other things Cancer is nasty business, and none of us are taking it real well right now
Monday, December 25, 2006
Lisa Anne Wintory's Christmas
Lisa update,
Christmas Eve
If Christmas Eve is supposed to be one of excitement and anticipation, than I hope we can be forgiven for making Christmas Eve’s day one of rest, contemplation of our many blessings and prayers for those who’ve been such a blessing to us.
The venue couldn’t be better;. We’re in the wonderful new healing garden at St. Joseph’s Medical Center; a beautiful acre of block granite fountains, sculptures that move with the breeze (we have breeze in Arizona, these would spin into the ground in Oklahoma), beautiful desert plants grouped carefully around the meandering paths and patios.
It’s warm in the sun, the air is cool enough for this to be perfect napping
weather, and Maggie, Michael and Mom Lisa are taking full advantage. Michael is asleep in his mom’s lap, displacing Maggie, at least temporarily. He lies across Lisa; head on the armrest of her wheelchair with his legs below the knee dangling down the other armrest. Outdoor speakers softly play gentle Christmas music to compete with the water splashing down the face of the fountains. Only the regular helicopters landings bringing tragedy from “out there” to hope and help “in here” which serves to reminds us where we are.
Lisa’s dozing follows a good night’s sleep, I know because we were 
given a special Christmas gift from Dr. Bliss, (with the intercession from our angels in rehab) and for the first time in months, our family spent the night together. The dispensation will last through the Christmas weekend so Lisa, Maggie, Michael and I will be together to share Michael’s first Christmas Eve and morning together.
It’s hard to know the best gift, but having Lisa’s brother coming again to see Lisa and then drag me to the Fiesta Bowl to watch OU play here in Phoenix will be a great way for our entire family to start the New Year.
I hope each of you have a bit of the joy you have brought our family this Christmas. God bless you all. Richard
Wednesday, December 20, 2006
Lisa Today - 16 DEC 2006
On Sunday last, Lisa's brother spent the day in Phoenix with her, Michael and Richard. From the countless trips to the hospital that Richard and Michael have made, they have come to know everyone at Starbucks by name, and vise versa. On Sunday the boys made their regular visit with Uncle Dave entow, and to the delight of everyone, Michael was introduced to whipped cream. Here's what a 10-month old does with a small cup of whipped cream:
Monday, December 04, 2006
LISA TODAY - 26 NOV 2006
Michael was baptized by Father Milt; hospital Chaplin at the St. Joseph Medical Center Chapel in Phoenix on Saturday, Nov. 25, 2006. Jack and Napua Davis, Michael’s Godparents traveled from Oklahoma expressly for the occasion. The baptism ceremony was also witnessed by Chris & Michelle Ward, Steve & Jodie Bunting, Bruce & Laura Rhodes, Michael’s baptism is celebrated! Sandy Janzen, Sherry & Michael Wintory, several Select Specialty Hospital staff and Maggie-groomed who was specially groomed for for the event. (In the photograph on the left, the sun is streaming over Father Milt's shoulder and on to the face of Michael and Napua Davis. Richard looks on with Lisa (out of camera range))
On the home front for Lisa’s brother David and his family… David was recognized for his performance and accomplishments as the Manager of the Year. David manages the “PARADIES SHOPS” at the Oklahoma City and Tulsa airports. The company operates airport gift shops throughout the United States. This is well earned recognition for David and his family. (In the photograph on the left, Michael and his Uncle David share a moment in Oklahoma City earlier this summer.Lisa receives therapy Lisa’s therapy continues with ankle casts in place. The new physical therapy equipment, MotoMed Viva 2, which we talked earlier (see Lisa Today edition 03-06 Nov 2006) adapts well to the casts, and records her efforts.
.jpg)
On the Left: Michael & Godfather Jack Davis On the Right The Baptismal Party.jpg)
Bruce Bowers and Sandy Jazen
share a lighter moment before
the service.
Maggie is in a dog fight with cancer. It was a rough time for her leading up to last weekend. She needed radiation therapy and hospitalization (but not necessarily in that order).
Maggie’s doctor is taking wonderful care of her. The swollen lymphoid responded well to the radiation and she snapped back well enough to make the trip to be with Lisa and everyone
for Michael’s baptism. Steve and Jodie Bunting were gracious enough to bring her with them
on their trip to Phoenix. While I’m talking about Maggie, Jim Peterson has attended to her
also, and for this help many thanks. -30-
A lot is going on behind the scenes with regard to upcoming therapy for Lisa. We’ve talked about this in the past, so I won’t go all through it again; suffice it to say, after the internal review board at St. Joseph’s completes their review and publishes their review we will let you
know about their finding, and what it will mean for Lisa.
In future Lisa Today updates, I would like to share some of your comments, but I'll ask for your permission before posting.
Richard and Michael are spending this past weekend with Lisa at Select Specialty Hospital in St. Joseph’s. The days are spent with Lisa in her room and outside to the hospital gardens and fresh air. Their evenings and nights are with the grace of Sandy Janzen. Maggie loves to be in Lisa’s lap, she is clearly contented and happy to be there.
I hope you all have had a wonderful, fulfilling Thanksgiving Holiday, and that you were able to
share it with those nearest and dearest to you. Thank you as well for caring about Lisa, and the
rest of us here in Tucson. It provides incalculable comfort and feeling of support.
Michael (mlwintory@msn.com)
Friday, November 24, 2006
Lisa Today --- Thanksgiving 2006
Hey gang, we've had a lot going on so let's get right to it.
Lisa has moved out of Barrow Neuro Rehab Unit and is back with the group of therapists who worked with her from March thru June when Lisa made the greatest gains since her injury in February. You'll remember after Lisa's dramatic helicopter flight from Tucson for treatment of the deadly Stevens Johnson reaction at the Arizona Burn Center here in Phoenix, Lisa was transferred to Select Specialty Hospital, a long term acute care facility (ltac) located in St. Joseph's medical center and under the care of Dr. Kwasnica, program director of the world famous Barrow neuro rehab unit.
It was with Maureen (speech therapy), Connie (occupational therapy), Deb and Marty (sharing physical therapy duties) that Lisa went from virtually no ability to interact with us to consistent head nods to very complicated questions. Then, as we all know, Lisa's muscle tone driven by errant signals from the severely damaged portions of her brain, took away her gains and left her vulnerable to a series of complications and infections.
The effort to protect Lisa's opportunity to make a significant recovery led her doctors to transfer her from Select Specialty Hospital to the Barrow neuro rehab unit also located here at St. Joe's. The valiant efforts made by her doctors and therapists there protected Lisa's health and range of motion, but failed to break through her spasticity. Unable to make progress, Lisa could not remain in the neuro rehab unit. The folks there felt that evaluating and possibly adjusting the med mix in her pump, reviewing her amenability to other spasticity treatments including hyperbaric should be done while Lisa is in another acute care facility. Then, if Lisa does show significant enough improvement to meet Barrow's criteria she will be welcomed back.
When we did our last update, where Lisa was going was still unresolved. I told you Select had initially declined to accept Lisa back as a patient for reasons I hoped to have resolved by November 8th. My hopes were realized and Lisa was given the opportunity to return to a group of nurses, CAN's and therapists (while retaining her team of doctors) who've cared about and for Lisa through thick and thin since March.
Lisa's return was pretty emotional. It seemed like a big step back, and yet coming here was so much better than any alternative. I was also concerned about how we'd be received for reasons that I'll explain another time. As it turns out, I shouldn't have been worried at all. Waiting for us were old and good friends with tears and open arms. Her therapists know what Lisa can do and have been able to help Lisa do things she hasn't done in months- head nods, jaw movements – not in a big way yet, but still really encouraging.
The Select folks also got a moto-med dad talked about in the last update, and I am able to use that on the weekends with Lisa. This past weekend was a hoot, I set the moto-med up in a day room with windows facing the city, Michael- who will not be contained- crawled, lunged and cruised on the freshly mopped floor, while Lisa worked out for about 50 minutes, pedaling over 7 and half on her own according to the machine's software. While we're still having our ups and downs, overall, Lisa's tone is less and her responsiveness is more than it has been in quite some time.
We're still waiting for the final approval from St. Joe's Internal Review Board for Lisa to receive hyperbaric treatments but expect to hear in the next few days. Now that Lisa's therapy team has had a good chance to put her through her paces, they'll meet with Dr. Kwasnica to plan next steps. Serial casts are back on her ankles to get them back to a more neutral position, new splints developed by Lisa's Barrow OT, Trent, and Connie here are helping her wrists, hands and arms so all we need is a break!
Lisa's wonder dog Maggie has been proving that dog's and their masters share similar attributes because she's certainly got Lisa's fighting spirit. Maggie had been struggling with a congestive heart condition when she was diagnosed with lymphoma. Her vet, (actually, a board certified oncologist) has been treating her with chemo and other drugs. After an initial downturn, Maggie's responded beautifully, demanding her morning walks and darn near knocking me down when I walked in the door- pretty good for an eleven year old sheltie.
This past week though, it seemed her luck was running out. A big lymph node in the center of her chest combined with her enlarged heart had us all worried we'd lose her this week. Instead, she took a dose of radiation, a stay in an oxygen cage, and now we expect to have her here with Lisa this weekend! Maggie's visits are a treat for Lisa and her staff and I'm grateful to our friend and neighbor Jim and my Dad for making this possible by giving Maggie her meds, getting her to the vet and bringing her up to Phoenix.
Speaking of my Dado, he and Sherry moved into their new home right down the road from us. Helped by their Posse, they got set up enough to have a place of their own in record time. Our good friends and Louisiana natives Butch and Rebecca Milan drove from their home outside of Austin to cook authentic crawfish etoufee, jambalaya, white beans, and crab gratin for the moving crew and their supporters. How authentic? Rebecca had the crawfish and crab Fed Ex'ed in from the Gulf of Mexico to meet her here in Tucson.
Despite the trauma of moving in, dad and sherry haven't missed a beat in caring for their grandson. Dad comes and picks his namesake up in the morning; they make sure he gets his medicine and the ever increasing doses of affection and attention Michael requires. Sherry conducts the forays for food, diapers and other essentials all the while unpacking, organizing, storing, cooking and otherwise caring and feeding the Wintory men. Amazing.
So you can see, it's not hard for me to find things to be thankful for on Thanksgiving night. One of Lisa's rangers, Sandy, took time to bring to Lisa's room a plate of t-day dinner cooked by she and her family- good stuff(ing). Our friends Tracy and Carl Miller picked Maggie up from the vet and have brought her home tonight where Jim will look after her, this is after he and Ann cooked Thanksgiving dinner for Dad and Sherry still setting up their home while caring for Michael.
All these folks and others make it possible for me to keep my promise to Lisa to care for her as she would care for me.
Something happened to me today while driving up to Phoenix that increased my determination even more. A traffic accident a short distance ahead of me forced the line of cars all traveling close near 80 mph to slam on their brakes, the large SUV driving a Texas family that had been traveling more or less in tandem with me was, at that moment to my rear. I looked up in the rear view mirror and with relief saw he was going to be able to stop. I looked back ahead to see what had started this mess when suddenly the Texas SUV shot past me on the left in the median. Confused, I looked back into the rear view mirror to see an 18 wheeler hurtling towards us smoke billowing from his tires. I braced for impact and worse.
The semi's driver followed just to the left of the SUV into the median, which was steeply banked, his trailer slowly starting to jackknife towards us. He somehow kept his rig straight enough to avoid hitting us, going into oncoming traffic or jackknifing and doing both. I later judged his lane of life to be less than 20 feet in the middle of a sharply sloped median.
His cab and trailer gradually came to a stop and tipped ever so slowly left against the slope of the median, about a 45 degree list. I was looking at space between the two sets of tires. I'd once prosecuted a case where an 18 wheeler had climbed over the top of a car like mine; the picture of the crushed victim came to mind. I ran to cab tilting crazily for its bulk. Others came running, including the father of the Texas family in the SUV. I shouted for the driver to see if he was ok, to tell him he had to get out of there. The Texas SUV guy shouted I needed to get out of there, the cab was tipping over. Having used up my share of luck, I instantly got back over to the passenger side now towering over us from the list.
As the driver was jumping into our waiting arms, we shouted that he was a hero, I asked how he avoided us, and he answered without pause: "I prayed to God and He heard me!" I left my card with him and the responding officers, who wanted us out of there ASAP. The driver called later this afternoon. He said he really didn't remember what happened it was all so quick, he'd never been in an accident of any kind. He just knew there were families in front of him, he had a family and he didn't want anyone hurt on Thanksgiving.
So I'm thankful I'm alive, but for that life to be worth having been spared it must be dedicated to caring for those in need, and, as the wicked witch of the west said "and your little dog, too!" -rmw
Monday, November 06, 2006
Lisa Today - 11 NOV 2006
Update, 03-06 Nov 06
Lisa’s weekend with Richard and Michael was, to say the least, engaged! She took on a new physical
therapy challenge under the guidance of her Physical Therapist Rosemary. Rosemary introduced Lisa to a MotoMed Viva 2. The Viva 2 is an easy to use movement therapy system designed to provide her with a comprehensive movement therapy program. The speed and motor power of the Viva-2 can be adjusted independent of each other providing safe operation.MotoMed provides continuous user feedback to keep the training session moving in the right direction. Feedback includes a unique symmetry training feature that shows and motivates the user to strengthen and exert greater effort.
This is what the MOTOmed Smooth Drive System does: loosens long term muscular tension (spasticity = high muscle tone) Stiff muscles of arms or legs can be loosened by gently moving the limbs in a flowing motion, slowly releasing muscle tension. Using this knowledge, a particularly gentle drive system has been developed for the MOTOmed viva: the MOTOmed Smooth Drive System (employing a belt drive system rather than a gear drive).
If you would like more information about this here is my source: http://www.southwestmedical.com/Exercise_Fitness/MotoMed_Models/MotoMed_Viva_2_Movement_Therapy_System/12860p0.
Simply copy and paste this Internet address into your Browser’s address field.
Simply copy and paste this Internet address into your Browser’s address field.
Rosemary reported to Richard that Lisa increased pressure when asked to perform the exercise, and found this encouraging.
Michael’s doctor appointment last week turned out great. He weighs 21 pounds and is now 29” long. His EKG was perfect, and Dr. Sampson prescribed a new medicine to protect him against Long QT syndrome 3. A local pharmacy had to formulate the prescription and make into liquid form, so that the dose, he receives, 3-times a day is perfect. So, we got the medication, learned how to administer it by syringe, and tasted it to see just how bad it was going to be. The pharmacist suggested we quickly follow the dose with white grape juice. Sherry told me it was not a pleasant taste at all. Michael took the stuff like a Man! Heck, he didn’t even flinch, but we learned he loved the grape juice kicker. It’s back to basics with Michael: food, rest, exercise, bath, something to bite on, and he’s a happy camper.
Sherry and I move into our new residence November 16th. It is an exciting-busy time for us.
Best wishes from Tucson & Phoenix!
Michael
mlwintory@msn.com
Subscribe to:
Comments (Atom)