Stroke, multiple complications, long story could use any advice.

[MSChemist]

I am having trouble with my mother and could use advice. It is a long complicated story so thanks for reading.

She has had multiple medical problems for a while. She had breast cancer and has no lymph nodes in her right arm and atrial fibrillation and has been stable on Coumadin for years.

Anyways the Friday before memorial day she had a seizure. MRI revealed clots from atrial fibrilation caused multiple infarctions in the brain (strokes) one of which caused the seizure. She was hospitalized very quickly after it happened as fortunately I was there and called an ambulance.

Complication 1. She had swelling in the throat and had to be put on a ventilator. It looks like the Keppra caused a severe allergic reaction which included stridor and anaphalaxis. She was intubated and extubated several times as a result.

Complication 2. We finally had her extubated and on CPAP mask and she was doing decently when she developed  compartment syndrome in the aforementioned right arm with no lymph nodes. The hospital stupidly drew blood and even botched an attempt to start an arterial line to monitor her blood pressure there. They had to do an emergency fasciatomy and of course intubate her again because she was under general. The first few days were rough as she had some rabdomylosis and infection issues but those were brought under control.

They did a tracheostomy as she was going to need multiple procedures and they could not keep intubating her.  They also did a G tube to replace the NG tube. A lot of tissue died from the fasciatomy so we are not sure how much function that arm will end up having.

She was transfered to a LTAC hospital. They did not like the way the arm looked and did 2 more debriding procedures. At one point the surgeon put amputation on the table but the arm is looking cleaner now but he removed a lot of muscle and other tissue so I am not sure if she will have much function on the right arm.

We were hoping the LTAC would address the dysphagia (she failed swallow tests) and eventually get her off the trach. However, it doesn't look like they have made any progress on either. She had to be put on vent again via trach because she started bleeding due to rough suctioning. They had to stop blood thinners and are weaning her now. Last I heard about the arm is they plan to let it heal closed on its own over months.

My concern is after 3.5 weeks the LTAC hospital seems to be maintaining the status quo and not pushing very hard for recovery. I am wondering if she should be transferred to a more specialized stroke rehab facility or something. She is starting to lose her spirits and we are getting increasingly concerned.