My mother had what we believe to have been a massive hemmoraghic stroke to the left side of her brain on November 12, 2011. We think that she had the stroke during the early morning hours right before waking, and when she was finally taken to the hospital, the staff was reluctant to administer a type of medication that would only be helpful to stroke patients who received this within a few hours of the stroke. They were able to stabilize her, but were unable to perform any type of surgical treatment due to an erratic heart condition. After stabilizing her, she was sent to a convalescent hospital to undergo physical therapy. As of this date, she has had a total of three CAT scans, but we have not been able to determine and have not received any recommendations for any procedures that could be done to the affected areas of her brain as treatment for her stroke condition, or as preventative measures (i.e. stents to carotid arteries) for future strokes.
She is now at a convalescent hospital, and we are being told that she has "plateaued" in physical/occupational and speech therapy treatments and will therefore be discontinued under the medicare coverage because she is no longer in need of "skilled nursing care". We of course do not feel that she has plateaued in her rehabilitative progress, and that given the right therapy protocols, she will be able to continue making substantial improvements for a better quality of life.
She is suffering from hemiparesis and hemiplegia on her right side (both her right arm and right leg). We were told that the therapists were unable to utilize "E-stim" therapy because she has a pace maker, but are unsure if “E-stim” can be utilized on her right leg because of the substantial distance that this is away from her pacemaker (above her heart, up towards the left clavicle). Since this is the preferred and most effective protocol for PT treatment in stroke patients, we are hoping that this can be done for her right leg in order for her to progress in recovering use of the affected limb. During her last physical therapy session, she was placed on what I believe was called a "unicycle" (wheel chair is wheeled up to a foot and hand pedaled machine that measures % output on each side), and measured an 80% effort on her left and 20% effort on her right. This has increased from a 90% left and 10% right measurement from four weeks ago.
In regards to her speech therapy treatments, throughout her treatment, she has only had the benefit of a combined total of three and a half (3 ½ ) weeks of speech therapy , and has been diagnosed with Broca's Aphasia. It appears that she understands and can follow instructions, but becomes easily frustrated and unwilling to participate at times. We are still unable to establish concrete communication utilizing simple questions or even through the use of a communication board. We feel that other forms of therapy may be effective for her and are unsure that enough types of modalities have been utilized for her to benefit.
She is on several types of medication for high blood pressure, high cholesterol, pain management and anxiety but none that "require a LVN/RN to administer. She also has a PEG tube (reversible), but is able to take in enough food (pureed) in order to meet her nourishment requirements. However, she still requires additional water through the PEG tube to prevent dehydration. A month ago, we requested that her automated feeding schedule be reduced (It was originally scheduled from 7pm to 7am). We had decided this because we noticed that after a period of 3-4 hours on the feeding machine, she would exhibit signs of pain and discomfort in her abdominal area, and would end up having stomach pains every one to two hours after that...throughout the night.
In addition to this challenge, she has extreme pain while having bowel movements. This condition was present "Pre-Stroke" as a result of radiation treatment and a surgical procedure that was done in 2005 when she was treated for colorectal cancer. She has been in remission since then and it has been extremely hard for us to see her having to deal with this new health challenge. In a recent visit to her cardiologist, he expressed some concerns with swelling in her affected right hand, and recommended that she be seen by a neurologist to determine if there was some more serious condition presenting besides “pitting edema” as a result of her stroke. The referral to see the neurologists has not been scheduled as of this date.
She also has a history of arthritis and has had difficulty walking "Pre-Stroke" but has not been receiving any medication to help with this post stroke. Additionally, she has had X-Rays that revealed the development of osteoarthritis in both her right shoulder and right wrists in areas which she has exhibited signs of severe and constant pain in both areas...most especially when these areas are moved. We feel that these issues may be contributing factors in the difficulties she has had in fully participating and progressing while in her physical therapy sessions.
We would like to know if others have been able to appeal the diagnosis that a patient has "plateaued", and what arguments or points would be best to present when making this appeal. We will probably have to make the appeal in the next couple of days (February 20-21, 2012). We would appreciate any recommendations or suggestions that could help us!