Carey's Story
Life is messy. It’s hectic. Managing a household full of scheduled activities, chores, responsibilities and family leisure time is an ongoing, day-to-day challenge. When we conquer our daily schedule, even briefly, with careful planning and routine, we want that to become the norm and we never expect something catastrophic to throw everything up in the air.
Carey Hothan, 55, had life down to a science. “I stay home and take care of my family. Chauffeur the kids to activities, walk the dog … I’m an active church goer and go to the gym regularly,” Carey explained. She is also involved in community activities, such as coaching volleyball for her local parks and recreation department. Carey was known for having everything under control … until she didn’t.
“I remember having trouble seeing things on my left for about a week,” Carey said. This made it difficult for Carey to drive. Suddenly, she was only using her right foot on the leg press at the gym and she wasn’t closing the shower curtain at home, allowing water to cover her bathroom floor.
“I knew it was strange, but I didn’t think it was serious,” Carey said. However, a trip to the emergency room at UH St. John Medical Center proved to Carey’s family that she was in real, imminent danger. Doctors diagnosed Carey with a brain abscess. To remove the infected material and relieve the pressure on her brain, Carey was transferred to UH Cleveland Medical Center where doctors safely operated. After placing a device to measure the pressure in her skull and a drain to remove the abscess, Carey would spend the next three weeks recovering in the ICU.
“Someone explained to me that what I had was a traumatic brain injury. I really wasn’t aware of what was wrong at first. All my limbs felt very heavy and I couldn’t move. I couldn’t talk. I was dependent for everything,” Carey recalled. She also had a tracheostomy tube inserted through her neck and into her airway. The tube was hooked to a ventilator to assist with breathing. A feeding tube was also placed for nutrition. So, while Carey was no longer in danger of dying, she would need help returning to the life she had become accustomed to.
Carey’s husband of 23 years, Freddie, began the search for a critical care facility. “My husband said that the hospital’s case manager highly recommended Regency Hospital – Cleveland West,” Carey said. “He told him that ‘if my wife were sick, I would want her to go there.’” When Carey arrived at Regency Hospital, her physician-led care team developed a personalized treatment plan to help her regain her strength and independence.
Therapy began with mobility protocols. Nurses made sure that Carey was upright at least twice a day. This position was more natural for breathing and helped strengthen her lungs and core muscles. Her respiratory therapist implemented spontaneous breathing trials, lowering the support provided by the ventilator and forcing Carey’s lungs to work harder. After two days, Carey was capable of breathing on her own. Her therapist then attached a speaking valve to her tracheostomy, which forced air out over her vocal cords and gave Carey her voice back.
A week after admission, as the strength of her voice returned, Carey was allowed to have ice chips, the first step in testing her ability to eat on her own again. One week later, a fiberoptic endoscopic evaluation of swallowing (FEES) was conducted by passing a camera on a flexible rod into Carey’s esophagus to determine if she was capable of safely swallowing. She was cleared to begin eating and skipped from thick liquids to thin liquids given the strength of her swallowing capabilities.
While they worked to get her off the ventilator and back to eating solid foods, Carey, who had arrived moderately conscious with delayed responses, was slowly coming back to herself. By carefully explaining procedures and activities and engaging in regular conversation, the nurses and therapists helped Carey focus as she became more aware of her surroundings.
The physical therapy team began by helping Carey sit on the edge of the bed and taking her through range of motion and reaching exercises. The day after she arrived, Carey began standing trials with the assistance of her therapists. After 10 days of practicing standing and strengthening her legs with seated marching and resistance training, Carey took her first steps. She did it with a two-person assist, but it was still a big milestone moment in her recovery. Six days later, Carey was using a walker to stand and pivot to a chair with the help of only one person. “After working with physical therapy, the first time I transferred with the nurses, I realized how much stronger I had become,” Carey said.
Another major part of our personal independence comes from being able to care for day-to-day needs. For that, Carey’s occupational therapist helped her practice brushing her hair and teeth, getting dressed and feeding herself.
In situations like Carey’s, the strangeness of having to relearn basic tasks and the constant work of strengthening your body takes a toll, causing some patients to lose hope and motivation. Carey had a strong support network that kept her moving forward. “My husband was with me every day, twice a day. He encouraged me during therapy and motivated me,” Carey shared. “My sisters helped out at home as surrogate moms, doing everything that I would have done for my kids. And my church reached out and helped take care of my family by providing meals.”
After 17 days at Regency Hospital, Carey was now capable of breathing on her own, eating soft foods and taking care of her basic needs. Her tracheostomy was removed and she was able to stand and transfer with minimal assistance.
“My time at Regency Hospital was phenomenal. The thing that really impressed me was how positive everyone was. They were so encouraging and motivating. It’s like they were all cheerleaders,” Carey said as she prepared to depart for the next step in her journey at Cleveland Clinic Rehabilitation Hospital, Avon.
Carey’s primary goals for inpatient rehabilitation were to fully regain her function and independence: “I want to be back to how I was before,” she said. Upon admission, Carey required significant assistance to dress herself, use the bathroom and get in and out of a car. She also needed assistance to bathe and transfer from laying to sitting to standing. Carey could only walk 10 feet using a walker and the assistance of two staff members. Her left arm and leg were also weakened, causing instability and a lack of coordination.
Carey’s physician-led team of nurses, physical therapists and occupational therapists devised a rehabilitation plan that would help her reach her goals. She was excited to continue her recovery and motivated to improve every day. “It wasn’t overwhelming,” she said of her move to inpatient rehab. “I was looking forward to it.”
Physical therapists focused on getting Carey to improve her mobility, strength and endurance. They used functional electrical stimulation (FES) to provide stimulation to Carey’s weakened muscles and nerves via electrodes that are attached to the skin of the affected area. The FES works by causing muscles and nerves to contract and work more effectively. Carey used FES in both physical and occupational therapy sessions, which she said helped her significantly. Physical therapists also used a compact, wireless foot and thigh rehabilitation system that uses FES to stimulate specific muscles in order to help individuals walk more naturally with improved speed and balance. Carey was struggling with foot drop, or the inability to lift the front part of the foot, causing it to drag or flop down when walking. Using FES allowed Carey to make progress in lifting her feet to navigate stairs and uneven surfaces. As she became stronger, therapists had Carey use a body weight-support system that uses a harness and sensor system to support a patient while they re-learn to walk without an assistive device such as a cane or walker.
In addition to utilizing FES, occupational therapists used a specialized mat table to help Carey improve her core strength as well her ability to move her left arm. While on the table, therapists had Carey hold different postures, including a plank position and kneeling on all fours, as well as practice rolling and stretching. Therapists adjusted the height and seat and by raising the backrest slowly which helps patients use core muscles to sit up and work on transferring positions. Real-time data allowed Carey’s therapists to provide instant feedback and track progress. In the activities of daily living suite, occupational therapists had Carey practice real-world activities such as carrying a full laundry hamper and using a vacuum.
Carey spent 24 days at Cleveland Clinic Rehabilitation Hospital, Avon making significant progress. She said that being able to stand up without assistance, walk without foot drop and being able to raise her left arm were big milestones during her stay. In addition, Carey was able to walk 200+ feet with a walker independently. She could also walk without a device with close supervision. Carey could also go up and down 16 steps independently while holding the handrail and achieved full independence with her personal care tasks.
“Everything exceeded my expectations,” Carey said, adding, “I am so thrilled with how far I have come. Every day was a challenge because progress came in baby steps, but looking back now, I can see I have improved in leaps and bounds.” Carey plans to continue her recovery with outpatient therapy and is looking forward to “going back to life as I know it.”
Carey feels profoundly changed by her illness and subsequent recovery. “I am more positive, more optimistic and more expressive with the people I love,” she stated. “I am more patient and grateful toward people.”