Hyperbaric Oxygen Therapy made a huge difference in Tram's life!

Dealing with the consequences of a stroke. My only dream now is... to get my eyes back!

Have you ever wondered how you would feel if you were struck by an hemorrhagic stroke, to feel what is going on around you without being able to do anything, to communicate your pain, your distress, your fear, then have your mind disconnected from your physical body for a moment until...this big black hole?
This is what happened to Tram, my wife, on February 22nd, 2008 at about 9:00pm

"I started to see things around me more and more blurry. I felt something was going wrong and I said to my husband that we had to go to the hospital. I was terribly scared. By the time I stood up and reached for the wardrobe, I had this feeling that my mind was disconnecting from my body. It was feeling as if I was flying, floating in the air. Then this weird sensation was followed by a horrible pain in the head. My husband told me to lay down on the bed, then within seconds, that was it, the black hole. I don't remember anything. My husband, later will tell me the rest from firefighters and paramedics intervention to one hospital, then to another one before medical staff perform a life-saving procedure."

This testimonial is not only about Tram, but also about all of those who sustained a hemorrhagic or ischemic stroke and all of us who are still untouched and affected and who are still unaware that this could happen to us at anytime, at any age in our life.
Also, because we've been and we're still through it, we'll try to share our experiences, therapies, treatments we tried, well everything that we did to help Tram recover one day at a time and make her everyday's life a little bit easier every day, and that could help others in the same situation.

Please if you are a stroke or TBI survivor or a caregiver,send us your stories. We'd like to hear from you.


Destiny, Fate...Hemorrhagic Stroke is no picnic!

Often, there is no premonitory sign...and when it strikes, it's already TOO LATE! in many cases it causes death and in most of the cases causes permanent damages to the brain resulting in permanent disabilities.
Few of us are aware that even though people aged 60+ are more likely than young people to have a stroke, it can and does happen to people of all ages. Tram and I met young boys and girls aged 14 - 18 at GF Strong Rehab Center who sustained a hemorrhagic stroke. Tram received an email from a women in the state of Georgia whose son aged 9 sustained an hemorrhagic stroke caused by the rupture of an AVM, just like Tram, in January 2008.
Kids, teenagers and young adults up to 40 - 45 years old are more likely to have a hemorrhagic stroke as opposed to seniors who aremore likely to sustain a ischemic stroke because of medical conditions such as heart desease, high levels of cholesterol, hypertension...etc. Also, women are more likely than men to have a hemorrhagic stroke.
Tram, my wife sustained a massive hemorrhagic stroke caused by the rupture of an AVM ( ArterioVenous Malformation ) a tangle, abnormal collection of blood vessels. Red oxygenated blood is pumped by the heart through arteries to the brain where it enters a fine network of tiny vessels called capillaries. It is in these capillary beds where the blood nourishes the brain tissues, the grey matter which has a kind of fresh Tofu consistency. "Blue", deoxygenated blood then passes back to the heart back through branching thin walled tubes called veins. Arterial-Venous-Malformations build up where there are areas that lack those tiny capillaries to feed the tissues.
The location of the connection between the artery and the vein is called the shunt. An AVM can be thought of as a "Short Circuit" where the blood does not go to the tissues - and as a result does not bring oxygen to the tissues - but is pumped through the shunt and back direct to the heart without ever giving nutrients to the tissues. Tram's Neuro-surgeon told us that they actually really don't know the cause of the AVM. People are born with it and may be caused by a rupture or clotting of a blood vessel that happens during development before one is born.
Usually, people do not know they have an AVM. Tram never knew until it bursts. A number of people with AVMs have seizures or persistent headaches. But, like Tram's Neuro-surgeon said, headaches doesn't mean anything. He says that he got patients who came to him with very bad chronic headaches, migraines, and he never found anything on the CTs or MRIs. On the opposite, he got people who never complained and later, months or year laters turned out to have a stroke.
An AVM can put additional strain on the blood vessels and the surrounding tissues. This is usually well tolerated in the first 20 to 40 years of life. But the increased flow of blood caused by the shunt weakens the blood vessels. These weakened blood vessels can rupture any time. This is known as a hemorrhage or bleed. In Tram's case, the kind of hemorrhage was a Subdural Hematoma and at the time of the massive bleed, she experienced symptoms like severe headache, loss of vision, motor weakness and paralysis and finally loss of consciousness. A surgical craniotomy had to be performed as definitive treatment. If you suffer severe migraines, and have symptoms that I describe further down, DO NOT take aspirin or medication containing aspirin or any other blood thinner. In case of hemorrhagic stroke, this could lead to a worst bleed.
AVMs can be seen on CT's ( Computerized tomography scan) or MRI's ( Magnetic resonance imaging )images. Angiograms / Angiography ( CTA - MRA ) are procedures needed to visualize the arteries and veins before any treatment. An angiogram is a image of the blood flowing through the blood vessels. It is made by injecting a dye into the arteries going into the head and taking a series of images. The difference between a CT and a MRI is the use of powerful electro-magnetic field for the MRI instead of X-rays ( radiations) in a CT, which makes the MRI much more "friendly".
Because symptoms can vary significantly from excruciating headache, vomitting, loss of control of one side of the body and loss of consciousness, and because not all of these symptoms are always present, diagnosing a hemorrhagic stroke is not necessarily a straightforward process. The consequences of the hemorrhagic stroke can be catastrophic and depend on the location within the brain where the bleed occured, how much blood did flow outside the brain and how long the bleeding lasted. The blood acts like a toxic ingredient when in contact with the thin membrane surrounding the outer surface of the brain and the longer the bleed, the bigger the pressure against the brain which in turn can lead to a brain shift with its consequences. This is also what Tram suffered. The massive hemorrhage was on the left side pushing the brain to the right, which caused, according to the Neuro-surgeon, paralysis to the entire left side of her body, from head to toe possibly by pinching, squeezing, affecting the nerve pathways going from the right hemisphere of the brain to the left side of the body. Even though a person, having a hemorrhagic stroke, receives prompt and appropriate medical attention, chances are it won't prevent impairments that will significantly interfere with someone's ability to negotiate daily life in the way that they did before the stroke.
Now, stroke survivors face the major problem of not getting the appropriate treatments that they need and deserve. Of course, they spend time in Neuro Intensive Care Unit for a month, 2 months or even more, then get transferred to a Rehab center where they find support, assistance to help them regain as much strength as they can get as quick as possible and work on other techniques to give them more confidence in facing the usual tasks they use to do at home, and just like them, Tram spent one month in a rehab center working with a physiotherapist and a recreational therapist and other professionals. She did well, tremendously progressed and from moving around in a wheel chair, at the end she was able to walk on her own without any aid, even without a cane, even though she had huge balance issues.
At the end of the rehab program, patients are often send back home without any further assistance, help, they are left on their own, or they're put on a waiting list - 6 months or more - in order to participate in physiotherapy and speech therapy programs, also recreational and vocational programs. But it's not everyone that has access to these services. Many of stroke survivors are left with no support to work on other major impairments and disabilities. Victims of brain injury and stroke survivors and their families often are not given adequate information regarding the nature of their medical condition and the extent of the damages. Unfortunately, nowadays, health care providers do not have the time or resources to adequately address all of the medical and recovery issues involved.
In the case of my wife, she has totally lost her right visual field, and professionals and doctors told us that ONLY time will tell us if she will regain some of her visual field, ONLY TIME! We have appointments with the Neuro-Ophalmologist as well as the Visual Field Specialist for assessments, but that's JUST assessments. Nothing is done to work on the problem. They even don't talk about possible solutions, leaving us on our own to find something that could help. Because time is the essence of healing, especially when one is dealing with brain damage, we cannot afford to wait and wait for something that will ever come.
That's why I had to look myself for solutions, and do it fast. And after spending countless hours of research over months, comparing, reading comments, documentations, abstracts...I found solutions, solutions that actually help stroke survivors as well as brain injury survivors in general regain partially or totally or decrease dramatically their disabilities, allowing them to go back to a more normal life, go back to work, and even sometimes drive a car again.

Between Life and Death

Tram suffered long and endless minutes before the emergency teams ( fire and rescue team at first, then the paramedics ) finally arrived to find her completely paralyzed on her bed, unable to respond to any stimuli.
Her month was closed and her upper and lower jaws were totally jammed, making it almost impossible for the emergency team to open up her mouth and insert a Guedel Airway to assure proper ventilation.
Minutes earlier, before emergency teams show up, our daughter and myself were doing all we could to maintain her alive by preventing her airways to fill up with saliva and mucus while on the phone with a 911 staff telling us that the ambulance was on the way. We had to keep on talking to Tram clear and loud in order to keep her senses, at least what she got left in an active state of awareness.
Finally, when the paramedics managed to insert this Guedel Airway in her mouth and throat, they carried her into the wheel chair - the kind of folding wheel chair you can easily put in your car trunk.
Then, not without any problem the rushed her outside of the house, into the ambulance.
From the time it all started until the minute she was in the ambulance, about 30 long minutes had elapsed, already too much time when you think that every second counts when parts of the brain are deprived of adequate oxygen and start dying which in turn may cause permanent losses of movement, speech, clear thinking, memory, vision and other abilities.
She were brought in to Surrey Memorial Hospital where she immediately underwent a CTscan. This is when they found that Tram had a major sub-dural hemorrhage on the left side of her brain. The hemorrhage, on the back left side of the visual cortex was compressing and pushing dangerously the brain to the right of the head. Tram had to be transfered immediately to Vancouver General Hospital for a life-saving procedure.
It took about more than 1 hour for Tram to get from her bed where it all happened to the CTScan at SMH (Surrey Memorial Hospital) when they discovered her terrible medical condition and to decide to transfer her to VGH ( Vancouver General Hospital)which is approximately a 30mn trip -in an ambulance- from Surrey, for a life-saving surgery, simply because there was and there still no Neuro-surgeon there.
All together, it took about almost 3 hours before being brought in to the operating room, which is unacceptable nowadays with all the technology surrounding us.
Before something like that happens in your life or around you, ask the nearest hospital if they have the staff to perform neuro-surgery, if not, then look for the nearest hospital that can do it.
And if this happens to one of your family or friends one day, and we pray this never ever happens, don't hesitate and ask the paramedics to get to the hospital that can perform neuro-surgery RIGHT AWAY! It's a life-threatening condition where each second counts.

February, Saturday 23, 2008 - AM
After hours, Tram is finally brought in to the operating room for a Life-Saving procedure to drain the blood compressing the brain causing it to shift to the right side of the head. I spent the whole night in ICU ( Intensive Care Unit) waiting room. In middle of the night, the surgeon comes to me to let me know that the procedure went good. He has to keep her asleep and maintain blood pressure low in the brain.
I spend the rest of the night and the whole Saturday at the hospital. Finally, I can go to visit Tram in recovery unit. She is in a comatose-like state. At this time, it's hard to describe the feeling to see a loved one who was, hours earlier, joking around and laughing lying now between life and death, hooked up to tens of tubes and wires, because at this point, even if the medical staff saved her life from her certain death, I still don't know what will be the consequences of the stroke and as such what will be her future.

February, Sunday 24, 2008
Tram is stable. Blood pressure and heart rate are monitored closely. She can move her right side ( arm / hand / leg / foot ). They are relatively strong compared to the left side that she cannot move at all. Staff has to tie her right arm so she cannot reach for the tubes and pull them.

February, Monday 25, 2008
Tram is still stable I speak with another surgeon who will perform ( tomorrow ) an embolization to close off the vein that feeds the AVM (ArteroVeinous Malformation ). He shows me the angiograms that show all the vessels and capillaries. He says that she's been having this AVM since she was born, and it grew over the years to get that big. He explains that an artery is directly connected to the vein that feeds this AVM. The vein is not supposed to receive such a blood pressure and cannot stand that pressure. What happened is that this vein simply burst, ruptured after reaching a point where the vein wall was unable to stand any more pressure.
The angiogram clearly shows the artery, the vein and the blood vessel cluster (AVM).
The embolization consists in running a catheter through an artery in the groin, all the way up to the brain, through the artery to the vein. From there, the surgeon injects a sort of glue, pretty much like "crazy-glue" to close off, seal this vein and prevent it from bleeding again. This procedure ( non-invasive ) should take about 2 hours.

February, Tuesday 26, 2008
Tram is taken to operating room for embolization at 1:00pm. It will take about 2 hours. The procedure did not go well but they managed to stabilized the AVM. The surgeon says that they will need to re-open in about a week or so period of time frame to remove the AVM and the huge blood clot that has formed at the back of her head, that looks like a gelatinous mass and applies pressure against the brain.
After the procedure, the remaining blood clot residues if some left will be re-absorbed naturally by the body, by the brain itself.
Tram still has a drain on top of the head that helps drain off the excess fluid that might compress the brain. Tram is still under strong sedation.

February, Wednesday 27, 2008
Staff reduced sedation. Tram responds to commands ( right side ) very slowly. Left side still unresponsive ( left eye, arm/hand , leg, foot).

February, Thursday 28, 2008
Tram starts communicating from her right side. She can gently rub my hand, move her hand, open up just a little her right eye ( 1/3 ) Her entire left side still cannot move.

February, Friday 29, 2008
Tram is doing relatively better. She now breathing on her own. She is no longer hooked up to the assisted ventilation ( respirator) and she is going to be moved to anothe unit. She will be transfered from ICU ( Intensive Care Unit ) to NICU ( Neuro Intensive Care Unit ) at Jim Pattison Pavillion (VGH).
She breathes on her own through a breathing tube - A humidifier is still in place to help keep her throat / airways moist. Tram is aware of what's going on around her and can moves pretty much her right side.
She communicates with me from her right side - I manage to make her squeeze my hand with her right hand. She even makes me understand that she wants to write something. I give her a piece of paper that I hold, a pen that I put in her hand between her thumb and index and guide her onto the sheet of paper.
Though she is extremely weak, and left-handed, she still can write clear enough for me to understand. The amazing thing is that although her first language is Vietnamese, she starts communicating in English and even in French, language she learnt at school back in Vietnam, way long ago.
Now she is starting moving a little bit on the left. She responds ( slowly ) to commands or has some reflexes. She still can open her right eye 1/3. Her left eye is completely closed. Pupils check is okay. She caughs good - which is very good because that means that she's aware that she feels something going down her airway and she has to get rid of this something that is trying to go down her chest, to her lungs.
The staff turns her every 2-3 hours to prevent her from having back skin wounds.
They have to give her morphine to make her relax ( against post-surgery pain and discomfort caused by tubes in her throat).

March, Saturday 01, 2008 11:00am
she knows I'm here by her side. She communicates with me. I start giving her a gently massage on her legs and belly. I ask her if she likes it. She answers by "yes" by moving her head. No change on her left side. Still can respond but very very weak. Still relatively strong on right side She can open right eye 1/3 - 1/2
Overall condition: she is doing good. She can cough: good cough!
I'm told that they are planning to take out the tube for oxygen tomorrow (Sunday)

March, Sunday 02, 2008
She opens her eye right away when she sees me (my shadow). I start talking to her and she understands everything and answers by moving her head.
8:50am they take out the breathing tube for oxygen
9:10am, I'm back with Tram, finally she is without the tubes running through her throat.
9:30 - 9:45 Tram seems to be in big trouble and starts being abnormally agitated. A quick look at the blood pressure / heart monitor tells me that something is going completely wrong.
It seems that because of the irritation caused by tubes she had for about 2 weeks in her throat, the airway is pretty much irritated causing it to swell and shrink. She has difficulty to breathe. Blood pressure rises to 200+. I Call the nurse. Code Blue teams and called in to re-insert breathing tube in airway ASAP. I have to leave the room at 9:50am.
10:10am, I speak with surgeon/resident. They have to take her to CTscan because her blood pressure went too high, much too high and they want to make sure there is no bleed, nothing happened in the brain.
He says she will be transfered back to ICU right after CTscan within an hour or so.
11:10am I go back to ICU. See resident who was in charge of sending Tram to CTscan and ICU.
He says that was just a "pipe" issue. She was not getting enough oxygen. in response to that, she started to stress and her blood pression went up fast. CTscan is fine - there is no bleed in the brain.
Team in ICU is settling her up. Takes about 20-30mn. And they will assess her if she is okay. I'm waiting in ICU waiting room before I can get in to visit her.
Back to her bed side at 12:05pm. She is on sedation - and they will reduce it later on. Hours later, she finally can communicate again a little bit.

March, Monday 03, 2008 3:00pm
Tram communicates with me. She wants to write. And in a 30mn period of time frame, she writes me 6 whole sentences which I can read and understand at 90%.
Frustration, anger, fear . she needs to communicate her thoughts, her feelings
She is very aware. She is in pain and knows how to let me know.
I talk to her a lot to reassure her, to comfort her. She knows that I love her so much and I won't let her down. She got a collapsed left lung. They had to put a drain. That hurts and she knows how to make me understand.

March, Tuesday 04, 2008
visit from 5:00 to 9:00pm. Tram is in pain but awake. She is doing better. Now she can open a little bit her left eye and move her left arm a little more / squeeze my hand with her left hand a little more.
She even tries to move her head towards my face like if she wanted to give me a kiss
No writing today. Some communication, but tired, in pain. I leave her 9:00pm, she is sleeping / resting - on morphine.

March Wednesday 05, 2008
I call the hospital at 11:00am for an update. She is on morphine. She had a restful night, still in pain ( head and chest tube).
She is transfered back to NICU around 11:10am.
I call back around 2:00pm, she is transfered back to NICU. She is doing ok. She is awake. I come visit her from 8:00pm to 10:00. She is awake on and off - on morphine. Everything is very slow. I talk to her to reassure, comfort her.
I talk to surgeon/resident, they plan next surgery for next Monday.

March, Thursday 06, 2008
I call for an update at 10:35. Nurse is on her break. Have to call back. call back at 11:00. No change. surgery still scheduled on Monday. I go visit her at 8:00pm until 10:00pm. I talk to her a little bit. I ask her if she wants me to massage her lower back. She says ( with head) yes. In case I hurt her, I tell her to give me a sign, to show me her thumb. At one point she does it, to let me know that it hurts. I stop massaging. I must say that to that point we're having a good communication.
It's 8:30pm, she rests / sleeps. I notice that she moves quite much her right leg to release pressure. She complains of lower back pain. I talk to the nurse who gives her morphine

March, Friday 07, 2008
Visit at 3:00pm. No change, stable according to nurse. Still waiting for a decision to remove the chest tube.
As for the breathing tube, Tram has to keep it at least until surgery on Monday is completed.
Tram can communicate on/off. I've notice though major changes:
-can open a little more left eye (1/2)
-can move her lips
-can wiggle a little bit more her left toes
-can move left arm much better but still very weak

5:10pm speak with Dr Redekop ( Surgeon in charge)
- he is confident that there is no reason why she should not recover
- eventually they will remove chest tube this week end
- he scheduled surgery on Monday morning - 1st thing to remove AVM
- after a couple of days, if she is doing well, they should be able to unhook her from the majority of the tubes and lines.
- about the breating tube, they will have to assess her to know if there is no swelling after they pull out the tube. If there is a swelling, they will have to do a tracheotomy, open a little hole right under the vocal cords and insert a tube. That should make Tram feel more comfortable. Besides, this breathing tube in the throat cannot be kept more than 2 weeks, leaving it in place more than 2 weeks would cause the airway to swell all the time and to have the airway badly irritated.
5:30pm, I speak with Anaestesist who will be in charge of the breathing/respiratory procedures during surgery.

March, Saturday 08, 2008
Tram is pretty much drowsy, sleeping from 2:00pm until 6:00pm. However she wants to communicate once in a while. She wants to joke sometimes, makes me understand that she wants to write. She writes " It's boring here ". That shows that she has some kind of humour though she is in pain.
Sometimes, she wants to communicate her pain and that she needs something from us or from the staff.
I talk to the surgeon / resident about the surgery on Monday to remove AVM and the clot at the back of the head. Everything should be okay though there is always a risk of bleed or infection, but it's calculated risk and the infection risk is 1 in a million he says.
She is pain - blood pressure around 120 ( should be around 100) because of stress caused by pain and discomfort. Staff has to turn her. Blood pressure goes down to 99-101
When I leave her, she seems to be sleeping... peacefully.

March, Sunday 09, 2008
1:30pm. She doesn't open her eyes today ( tired, also because of the AVM and the blood clot at the back of her head compressing the brain. Hopefully, she will be better Monday afternoon after the surgery that will consist in removing this AVM ( ArteroVeinous Malformation )and the blood clot. The brain will gain more space and as a result the pressure will decrease.
Though she is unable to open her eyes, she can move pretty much on the right side. Her left leg is not moving.
The last 2 hours before I leave, at 6:00pm, that is to say from 4:00 to 6:00pm, she is active, alternating between moving her arm / hand, leg, trying to take out her breathing tube, other tubes and wires of all kinds, trying to take out her - what she calls -"socks" to massage her calf muscles to avoid blood clot build-ups.
She even writes many sentences, without opening her eye, just by feeling the sheet of paper and the tip of the pen, some of them are just funny; "tell the doctors when I can go home?", "I need to pee", "it's too hot!" without omitting the question marks and exclamation marks.
At the end, when she knows that I'm about to leave, she grabs my hand, hold it tight so I cannot go. I comfort her saying that everything would be alright and tomorrow, after the surgery, I would come visit her.

March, Monday 10, 2008
Today, this morning, Tram will go to surgery to get this AVM and this blood clot at the back of her head removed.
I cannot wait until everything's done. I know everything will be alright. This morning I will be waiting for the surgeon to give me a call, a call to let me know that everything went well!

March, Monday 10, 2008
When I was on my way to the hospital this afternoon, I never stopped thinking about Tram and the surgery, praying so hard that everything was okay, that the doctors made it without any problem. I was anxious, but I the same time, I was saying to myself that there was no doubt she was doing good. The doctors do this everyday, of course, every patient is a different case with different issues and complications. And with today's technology and knowledge, they make it easier and safer.
At 3:30pm, I get in NICU, walk to my wife's room. I can see a nurse taking care of Tram. She is talking to her and is joking, at times. I ask her if everything is okay, and she says that everything is just fine, she's pretty sleepy now because of the medication for the brain swelling, but she is fine and can respond to voice commands. Besides, she is very strong... still on her right side.
By chance, one of the surgeons who did the surgery is around. He comes to me and starts giving me details. When they removed the big blood clot at the back of the head, they also, at the same time took out the AVM. They had to cut off the AVM of the artery / vein that was previously feeding it and that had been partially embolized, and both the clot and the AVM came out all together. No bleeding, absolutely no complication whatsoever.
It was such a relief for me to know that now my wife had the best chances to come back to how she was before this terrible thing strikes.
Around 4:00pm, she starts opening her both eyes - 1/2 way - for a little while, but it doesn't last long. However, she doesn't stop moving - her right side - trying to pull down her air-cuffs. She even makes me understand that she has a headache, I call the nurse, Tram makes the sign again, pointing her hand to her head, the nurse askes if she has a headache, Tram shakes her head to say yes.
Later, she lets me know that she is hot. I grab a cardboard tray and start using it as a fan. I tell her to let me know when she's starting getting cold, I say, make me the sign you know so I'll understand and will stop fanning. I didn't want to remind her the sign she had to make, simply because I wanted to know if her memory was still good. And this sign, she knew it from the day before.
I start cooling her down, then finally, she gives me a "thumbs up" to let me know she has enough. This makes my day, with all the rest.
I leave her at 6:15pm, after the nurse has turned her ( they turned the patients every 2 hours or so ). In her new position, Tram falls asleep. She looks like a baby, sleeping peacefully.

March, Tuesday 11, 2008
9:20am. Just got a call from the hospital to let me know that they're going to put Tram to sleep for another surgery by tonight or tomorrow depending on OR ( Operating Room) availability.
They will need to do a tracheotomy as they cannot leave her intubated any longer. Having a breathing tube for more than 2 weeks all the way down the airway causes discomfort and can create dangerous swelling, inflamation, complications of all kinds.
This procedure will make Tram feel more comfortable and will help her recover faster, in better conditions.

March, Tuesday 11, 2008
This afternoon, although Tram is very tired, she still can find the strength to write, and this time, not in english but in vietnamese, and ask questions such as " what happened to me?", "how is everybody at home? "... I can easily understand that she feels totally confused, lost, disoriented.
Tomorrow, she will go for another surgery, a tracheotomy as a precaution before they take out the breathing tube.

March Wednesday 12, 2008
I've called the hospital this morning, around 11:20am...from my work. I always call everyday, every morning, every afternoon. I miss my wife so much. The nurse in charge for the day shift says that she's doing fine.
-No more fever. They are still investigating on the cause of yesterday's fever, awaiting blood sample results.
-Tram's surgery ( tracheo ) was actually done last night. And they finally took out the breathing tube.
They should be doing Xrays of her lung this afternoon or tomorrow to see if they can also take out the chest tube.
Tram is moving a little more on her left side. Her overall condition is a little bit better... I will go visit her this afternoon!

March, wednesday 12, 2008
What an afternoon! I arrive at 3:30pm. Tram is moving on her bed trying to find the best position, using her right leg to push herself and turn. She still has her head wrapped up with bandages. But there is no more drain on top of the head. Also no more tubes in her mouth, finally! Instead, she has a shorter tube through a hole at the base of the neck for her to breathe comfortably. To feed her, she has a small tube running through her nose down to the stomach.
She starts communicating with me, she doesn't want to stop and rest, she has so many things to ask me. She will write 4-5 pages of a small note book. At times, she even try talking, but the words won't come out. More than 2 weeks with tubes in her throat don't help much! Also because of the tracheo, the air is not going through the vocal cords, so no sound can be produced.
One of the surgeons arrives with 2 assistants, he lets me know that they're going to take out the chest tube and unwrap her head. So I pop out of the room for about 30mn. When I come back, Tram looks so different, more awake. I now can see her shaved head and her 2 large scars on 2 sides (back and left) of the head. The stitches are still there. She has no more tube on her left side, she now can move freely. Later, the nurse asks her simple questions, and Tram has to try speaking, it's a kind of test to check first, her memory and also to make her use her vocal cords.
Questions: Nurse: What's you name?
Tram: Tram
Nurse: what's you last name?
Tram: Doan
Nurse: How old are your children?
Tram: 26 and 13
Nurse: do you know what month we are?
Tram: February
Nurse: close, we are in March, the 12th

Tram actually only remembers when she got struck by this stroke, and it was in February.
She keeps on asking me if everything is ok at home, if the kids are fine, if her employer knows... I make her understand that everything is under control, that she doesn't have to worry about anything but to take care of herself, be strong, because we want her back home as soon as possible, because we miss her.
She still wants to write, but she's getting tired, she's falling asleep, but her hand won't stop pushing that pen on the page of the note book. I tell her that she has to rest now, that anyway, she's so exhausted that I cannot even understand what she's writing.
She falls asleep, peacefully. I have a little chat with the nurse who tells me that this morning, the physiotherapist came over and made her sit on the edge of the bed and put her feet to the floor, and try to stand up a little bit to check her ability to manage her balance. She was doing pretty good..for a first time.
Tomorrow, they will give her a "wheelchair ride". I leave her at 6:30pm. I'll come visit her tomorrow night.

March, Thursday 13, 2008
I call the hospital at 10:30am this morning. She's doing pretty good, writing a lot, and trying to talk much more, to mouth words.
The physiotherapist is there with her to settle her up in the wheelchair. The purpose of this is to make her use and strengthen her neck muscles that support the head and force her to use her chest muscle for breathing.
She is so happy and willing to get out of her bed, even though it is for a short period of time.

March, Friday 14, 2008
Although Tram was very tired today because she didn't sleep much last time, she's still moving on her bed, tossing and turning, squirming like an eel trying to find the right position for her head, for her bum, for her legs, but all this in very very slow motion. She wrote me a couple of sentences today to let me know how she was feeling, and what she needed from the nurses.
I'd say, for the last couple of days, she keeps me busy...and the nurse as well for sure. She has a little more strength in her left arm and hand, but still very weak. She can wiggle a little her left toes and move a little bit more her left leg. That's encouraging. One step at a time.
Regarding her vision, she sees, but it seems that it's like out of focus, extremely blurry, from her right eye, she sees double and shadows. That will take quite some time since the part of the brain responsible for the vision is at the back of the head which has been under pressure during the hemorrhage.
As of today, the only tubes she still has is the one running through her nose for the feeding and the "hose" for the oxygen to her neck ( tracheo). The breathing tube that was in her throat, the chest tube and even the bladder tube to urinate have been taken out. And that's why now she can move more freely.
She tries to talk, but we'll have to wait weeks before we can start understanding the sounds that will come out of her mouth.
Tomorrow is another day, and I will go visit her in the afternoon.

March, Saturday 15, 2008
Tram was very tired today as last night she was pretty much agitated and didn't sleep quite much. No major changes today, to me. But from the nurses' point of view, she's doing better.
Of course, her favorite medium of communication is writing as she cannot speak. At least, she tries to do her best to mouth the words.
Today I've noticed that her face looks healthier, much less swollen as opposed to the previous days. Her cheeks and lips got their colour back.
She is pain, complaining that her head hurts as well as her belly ( bladder). They have to give her Tylenol every 2 hours and in between, some morphine.
Today, I read her the many messages that she has received from tens of people, family members, friends, co-workers, and even total strangers. But because she was so tired and she was certainly unable to focus on what I was reading though she was listening and understanding because she made comments, later, when she will feel better, I will re-read these messages again, and again, so she can see that people out there worry and care for her.

March, Sunday 16, 2008
Today Sunday, Tram is doing better. The nurse said that in a little while, they will check if she can breathe on her own through her mouth by shutting off for a minute or less the tracheo tube. If she can, then they will shut it off using a valve as a precaution that they still can re-open in case she cannot breathe through her mouth.
She will normally be able to regain her voice and her vocal cords usage, and speak normally. That'll be easier for Tram to communicate.
She's doing great, she moves a lot in her bed, changing position to feel more comfortable.
This morning, the nurse and the physiotherapist put her in the wheel chair. That was amazing what she could do. Although her full vision is far from back to normal, at least back to what it was before her stroke ( it's kind of blurry, and she doesn't see on the sides ), she can hold her head up, move her head, move her right side much more, and it's getting stronger. The left side also gets suprisingly "stronger", faster than I would have imagined.
And because of all the support she receives, she's incredibly motivated to recover as fast as possible.
I was right by her side today, her in the wheelchair, and she was practicing on her own or with my help lifting her arms, grabbing objects, even with her left hand. She was able to move her both legs, and even wave both hands to me. I couldn't believe my eyes. I was so happy.

March, Monday 17, 2008
Today, she is doing very well. The nurse said that she stayed in her wheelchair for more than 2 hours. The day before, Tram stayed only about 40 mn.
Again today, a lot of writing. She really wants to speak, she tries hard but the words won't come out....and they won't come out until they shut down the tracheo tube, forcing the air through the vocal cords.
She has bad headaches, but the nurses take a good care of her, and she gets her medication for pain regularly.
The back of her head is still very swollen, causing the pain and possibly the very poor vision. But she's improving day after day.
I know that she needs support, a lot of support. Of course, we, family (daughter, son )are there, I am here of course everyday, it's as much important for her as it is for me. Her family in California, Vietnam and France are also there in thoughts and prayers. But she also needs to know that people out there care, and think about her all the time, and send her messages, messages in english, in vietnamese and in french. She never had so many fans.
Thanks again for the support people have been giving her. It's priceless!

March,Thursday 20, 2008
Yesterday, Wednesday, not much changes though she is beginning doing some physio in the morning after staff put her in her wheelchair. The physiotherapist make her pratice some exercises with her arms and legs, head and eyes. She stays in her wheelchair a couple of hours.
Oh yes, there is one change I would say! They put a smaller tube in her tracheo, in a sense, she is improving, more and more she will use her normal airway to breathe. Until they finally close the tracheo for her to breathe completely through her mouth. Then, hopefully, she will get her voice back.
In regards to the vision, no change, she can distinguish shapes, like people by her side, but she still in a kind of thick fog, and one eye sees double.
My stepdaughter will visit her this morning, for my part, i will go this afternoon. Tram needs support from us, I will make sure she gets it. I've got to be there by her side every single day.
And later, when her condition will allow it, she will have visits from friends and co-workers. But for now, though she needs us to visit her, she still has to rest. The more she rests, the faster and the better her brain will recover.

March, Thursday 20, 2008 2:35pm
I've just got some news from the nurse who is taking care of her today, and this morning, they put a cap on the tracheo tube forcing Tram to breathe normally through her natural airway. So far, she seems to be alright. They will have to monitor her for 48 hours to see if she's able to tolerate it. As far as I'm concerned, that would be a major improvement!

March, Friday 21, 2008
Tram is doing good. She is transfered over to another section of the neurosciences dept. , to another room. The nurses are wonderful, taking a great care of Tram.
Now she can speak. No more writing. Of course, it'll take time for Tram to have her normal voice back. It's like having a big cold and one's throat badly irritated. Her head still hurts and she needs to ask for pain killers very often.
Tomorrow, as always, I will put lavender lotion on her hands and legs, perhaps on her back. It'll help her to feel a little more relaxed and forget for a moment about her pain. I will also do a manicure. I told her that I will bring her her portable DVD player tomorrow. Even though she doesn't see yet, having some music and movie sounds in background other than the beeps from the medical appliances will make a significant difference down the road.

March, Saturday 22, 2008
Now Tram is in the ward, her final destination here at the hospital before totally recovering and going back home. How long it'll take for her to come back home, we still don't know. It's going to be a long process of physio and rehab. But what I can say for now is Tram is doing much better.
Yesterday, I spent almost 6 hours with her, from 1:30pm until 7:15pm, taking care of her, being by her side anytime she needed me to. She speaks better, she is getting stronger. She tolerates pretty well having her tracheo plugged though it's tough at times. But she's allright. Everytime she needs to cough now, she sits up, which is more comfortable and makes it easier for her to cough. Besides, it's also good for her lungs. She can start swallowing.
She is still in pain, asking pain killers pretty much every hour. Very soon, Monday or Tuesday, they will assess her breathing and perform swallow test to see how she is doing. Hopefully, if she passes, Tram will get her tracheo tube and her feeding tube in her nose taken out. That will be another huge step forward and much more comfort for her.
Yesterday, I gave her a manicure, finishing by a hand lotion application to keep her hand's skin soft and smooth. She was so happy. I also gave her a back massage together with leg / feet massage with a lavender body lotion to help her relax and forget her pain for a little while. Staff said that she looks so young and beautiful.
Today, Saturday, I'm going to see her in the morning this time, I will leave to be over there around 9:00am. I just hope she had a good and restful night. Her brain recovery depends on that.

March, Monday 24, 2008
This long Easter week end was very busy, starting Friday from 3:30pm until 9:00pm, Saturday from 9:00am to 3:00pm and finally Sunday from 9:00am to 9:00pm.
Even though it's not time yet for people to come visit her, Tram needs to be with us. She always says that "it's boring here!". She has a portable DVD player she can play anytime, even though she cannot see very much even at 1 foot away from the screen. That's more for the background sound.
Tram doesn't sleep much...at night, and tends to sleep more day time. The nurses insist on having her sleep less during the day.
That's why we, my step daughter and myself take turn to come visit her and try to keep her awake as much as we can. But she is so tired that we cannot force her to stay awake. She has to rest anyway.
When she is awake, she has some energy to joke around. Now I even manage to make her smile and even laugh. It's so beautiful to see her with a nice smile upon her face.
I apply body and hand lotion every day, that makes her relax and it keeps her skin soft. In regards to her overall condition, she's is improving, getting stronger. She doesn't want to sit in the wheel chair. She rather sits up in her bed, and she does it many times a day, which is good for her lungs, and at the same time, she strengthens her back and abs.
Now when she stands up, on her both legs, she can stand on her own, but like a baby making the first steps, we still have to hold her so she won't fall over.
Her left arm/hand are getting relatively stronger. She is doing great. Her head still hurts badly. She has a lot of swelling that gives her bad headaches, and she has to be on pain killers pretty much all the time.
Sunday, they took out the tracheo tube and put gauzes and taped all that. The hole should heal up within a couple of weeks.
Tomorrow, they will assess her and have her take a swallow test which she should pass. If she passes this test, then, they will take out the feeding tube in her nose that really bothers. Tram said that without this tube, she will be like in heaven! Another huge step forward in her recovery.
My main concern now is her eye sight, and we don't know yet how this will evolve. I keep faith and say to myself, and tell her that it is just a matter of time.
I'm going to see her this afternoon, probably until 9:00pm.
At the hospital, the nurses asked me if I wanted to get a nursing job and work full time, because they see how I'm taking care of Tram, I'm doing half of their jobs - they were joking around of course! ...

March, Wednesday 26, 2008
Tram is doing much better. They assessed her swallowing this morning and she passed the swallow test. They took the feeding tube out...finally. It was like being in hell for Tram. She got her first real meal at lunch time then her second one for dinner. She did great. She jokes with the nurses. Globally, she feels better.
She is not there yet, but she's improving amazingly fast. Now, she "can walk" very slowly, with a lot of hesitation - with my help or a nurse's help - from her bed to the washroom. Of course, all her movements are very slow, but she is getting stronger, a littel bit every day. She stays longer in the wheelchair, which is helping her lungs to get stronger. Staying in bed for weeks doesn't help!
Last night, I met one of the doctors who will be in charge of her rehab very soon. She told me that she read through Tram's chart, and she was positively surprised to see how fast she was recovering after such a brain accident. If everything is doing fine, she said that Tram would be transfered to GF Strong Rehab Center in Vancouver, not far from VGH. There, she would spend a couple of months, maybe more depending on how she is recovering. There will start a long and tough process of rehabilitation, physical of course, but she will also work on things that we normally do on a daily basis, the kind of things that we take for granted when we are not ill.
She will work on her sight as well. The doctor told me that she has some brain damage, at the back of the head that has been caused by the pressure from the hemorrhage onto the brain, and the bleeding itself causing parts of the brain to lack oxygen. But the accident is still fresh, it's been just 5 weeks, things can be different within the next weeks, the next month, the next couple of months. Then, they will be able to know a little more about that. But in the meantime, Tram will have to work on her vision. For now, she has a blurry-doubled vision and a peripheral vision disorder.
I spend between 3 and 6 hours every day with her, and on week ends between 6 to 9 hours, and I think that's part of her recovery, to know that I am here for her, to support her, to help her...well to love her.
And Thi, my step daughter is here too. Tram knows that she is not alone. And many other people, family members in California and in Vietnam who worry and pray for her, friends, co-workers who are out there waiting for this moment they will finally be able to come visit her.
Hold on Tram, it's gonna be a long journey, but we are by your side to hold your hand.

March, Friday 28, 2008
Yesterday was another day with its surprises and hopes. Tram is doing better even though she's down at times, especially when we are not here by her side, when she feels lonely and she thinks about her future, will she be able to see like before, to walk like before, do the things she used to do everyday.
Yesterday, I made her read some sort of "vision test" sheet I made that consists in about ten easy-to-read sentences, in large letters at the top, letters decreasing in size to become much smaller at the bottom of the sheet.
One week ago, she was unable to even see the very first line, holding the sheet at about 8 inches from her eyes.
Now, holding the same sheet at a distance of 10 inches, she can not only see but read the 9 first sentences, for the bottom one ( the smaller font one )there is only one word she cannot read. I told her that it'll take a little more time for her brain to be able to put together the information that comes from her eyes.
There is a clock in the room which is not even in front of her, but on the side and in a 90 degree angle. And she can read the time. I wouldn't be able to do better than her.
Now Tram wants to put me to work. She wants me to help her strengthen her legs, so alternating between the right and left leg, but working pretty much more on the weaker leg ( left ), I hold her foot, and I ask her to push me as I apply some resistance. Then it's my turn to push and her to resist.
She is really motivated to get stronger, fast. She knows that we are here for her, to support her each and every day, and that she is improving day after day, that it is not a dead end and there is plenty of room for improvement.
She knows that it will take time, but I will, we will always be there to help her get through this.
She is eating very well. After asking the nurses if I could bring Tram some yummy foods she likes and she misses - some foods soft enough and with a certain consistancy that they won't give her any trouble when swallowing - now, I'm bringing her a little every day. Yogurts, egg tarts, Congee, Mango and Papaya chunks, Tofu dessert...etc.
I know she will enjoy, because eating the regular hospital diet they serve you every day is not fun. She was supposed to get transfered to the Rehab Center within the next 2 weeks, but given that she is improving faster and she is a very good candidate for rehab, they want to transfer her sooner, within the next week, which is very good and motivating.

March, Sunday 30, 2008
Friday was a pretty tough day for Tram...and myself. When I came in Tram's room, the neuro-ophthalmologist was there. He had finished to examine her. He told us that Tram had a permanent brain damage due to the huge hemorrhage and the AVM that were located in the left hand-side part of her head. According to him, she has a permanent damage that causes the total loss of the right peripheral vision of each eye. The eyes are working perfectly, but half of the information coming from the eyes is not interpreted by the part of the brain that processes the right side vision of each eye. The left side is perfectly normal, though her vision is blurry and doubled. This should improve over time. Only time will tell us.
Maybe 15 mn after this specialist told us about the bad news, Tram's surgeon came in to give us a some hope, in the sense that Tram should be able to become functional, pretty much like before, with some restrictions though. She would have to learn how to live with this. The only thing that Tram wouldn't be able to do would be to drive a vehicle.
Of course, nurses and myself, and later on, friends and co-workers who were coming visiting her were there to support and comfort her.
We tried to convince her that the worst is behind and she can only get better, over time, She needs only time. Time will tell us, tell her. The brain is such a wonderful and complex piece of the human body, and doctors only know maybe 10 percent of it. They tell us what they know now, at the moment, what they can understand, but they cannot know how the brain will be in 2 months from now, 6 months, a year.
Miracles happen, healthy parts of the brain take over the damaged parts.
We told Tram that, now it's a matter of time....and of work, hard work in rehab, and it's going to take every single day, every single minute of Tram's life for at least 2 months in rehab to work on herself and to make sure that she can fully recover physically, meaning she can walk, use her hands, speak like before, can deal with every day situation or activities that healthy people take for granted, such as cooking, doing the grocery shopping, banking...etc, but also to work on her vision, what to do in order to move without hitting obstacles such as walls, doors, and also force her good brain to try to work harder in order to compensate for the loss of the part of the brain that has been damaged. It's going to be a long process.
Even though Tram should be staying for about 2 months in rehab, it could possibly be more if necessary, her rehab will continue well after these 2 months. But she won't be alone. She will need and she will have a lot of support from her family, and also from her friends and co-workers who are also friends.
I'm waiting for a decision from the rehab doctors to transfer her to GF Strong Rehab Center. I've been told that Tram should be transfered within a week.
Yesterday, Saturday, Tram was feeling a bit better even though she kept crying over and over. But now with our support she knows that everything is still possible, she can make it if she wants. And she wants, she wants to go back home and do the things she used to do before and take care of her family.
I went to visit her at 11:00am to leave her at 10:00pm after she fell asleep after another busy day full of emotion and sadness. Today, Sunday, I will go visit her around 9:00am, and I will certainly stay with her until late, probably until 9:00pm. I want to be there for her, no matter what.

April 24 is her birthday. I promised her that I will take my day off to be with her. Her daughter also will be there.

Everyday, Tram wakes up and hopes her eyes will get better, just a little better. She knows that her eyes themselves are just fine - we went to the ophtalmologist for a thorough check up of both eyes to get confirmation that her eyes are perfectly healthy - that the problem is her brain. She knows that she has to do her best to keep her busy, first to prevent her from thinking too much about her condition and depress, but also to stimulate her brain.
But it's really not easy when you barely see around you, you have severe headaches and you have to rely on the walls or a cane, or even someone to prevent you from falling over because of the constant dizziness you are living with.

Tram moves to GF Strong Rehabilitation Centre

April, Wednesday 02, 2008
It's been a very very busy day today, first, to get all Tram's belongings packed up. I had to get some documents from the hospital. Then it was the transfer over to GF Strong around 11:00am. The centre is just less than 10mn away from VGH. Then, it was lunch time. Tram doesn't really like the hospital food. It has no taste and besides, she misses her cooking. I will try to fix that later as we can bring our own foods.
In the afternoon, one after the other, therapists introduced themselves to Tram and to me. They asked her many questions, and assessed her ( eyes, walking, balance, hand/arms/legs coordination...). Then finally, she could rest a bit before dinner. After dinner, back to bed to relax. Because it's been a pretty busy day for her and a lot of walking - she is doing very good now - she was very tired. She took a couple of naps, call her family in vietnam, in California, and a couple of friends in Vancouver. But she had to wait until she gets her sleeping pill ( to help her sleep straight until the morning ) to really start relaxing and finally fall asleep. I left her at 9:00pm,
Though she still has her vision problem ( half vision field loss + double / blurry vision) which is her and my main concern, she is doing great, physically, she is gaining more strength. She now can walk by herself, slowly, still under somebody's supervision, walk to the washroom, without bumping into walls, furnitures, doors, sit in her wheel chair, get out of it to go back to her bed. Her voice is doing better, she can swallow just fine, still under supervision. It's not all the foods she can swallow. But that shouldn't be long until she can swallow pretty much everything.
Tomorrow Thursday April 3rd will be another busy day as she will start her classes. She will be so busy that she should be able to sleep without taking her sleeping pill, I give her less than a week to stop taking it.

April, Monday 07, 2008
Tram is doing a little bit better. This week end was very busy for her as many came to visit her, family, friends, co-workers. She had a couple of little problems, but nothing to worry about. Here, the nurses take a good care of her and are nice. She still takes her sleeping pill around 8:30pm, but now takes only half pill as she doesn't want to feel drowsy in the morning when it's time for her to go to her physiotherapy class.
In her room, she wants to walk as much as possible, uses 2 lb dumbells to exercise her both arms and wrists, especially the weak ones (left). Because she was unable to move her left side for about 4 weeks, now she's getting a stiff and painful shoulder joint and wrist joint. That's one of the after-stroke issues encountered by most people. And that's why now she has to constantly move her left arm to avoid complications.
Her very poor vision is still stable but she tries to be positive...with our help. It's just 6 weeks since the stroke after all!
She eats very well now though she is tired of eating the food they serve here. She misses her cooking so much. So, now we bring her some congee, fruits, her favorites are mangos and strawberries.
Tram is eager to go home for the first time very soon. Maybe next week end, she will be able to go home, no sleep over, just for the day, from 9:00am until 9:00pm back to the center.
We still have to meet with the therapists and the psychologist. The staff told her that she might cry, feels depressive when she is back home. It's a normal psychologial reaction and they want us and her to get prepared. In the meantime, she really wants to get back to shape and work on her physio.

April, Thursday 10, 2008
Although Tram's eye sight is pretty much the same, no major changes, her physical condition ( walking, speech, balance, movement coordination, memory...) is improving very fast...to my point of view, and more importantly, according to the therapists ( physiotherapist and occupational therapist ) and the doctor in charge of her here at GF Strong.
She is doing so well and they are so confident that Tram will go home for the week end. She is so excited. And so we are!
I will come pick her up Saturday morning 9:00am, and I will have to take her back to the rehab center on Sunday night by 9:00pm. Hopefully, the next week end, she might be able to go home, but this time, on Friday night. But as always, it will depend on the therapists' decision.
Yesterday evening, the nurse removed about 25 staples at the back of her head. And about 16 others will have to be removed later, on April 23, when Tram will go see her surgeon for an assessment...just one day before her birthday.
Besides, her younger sister from California will come visit her the very same week, for the first time since the stroke struck. Tram is so happy.

April, Monday 14, 2008
It was Tram's first days at home this week end since her stroke. She was happy. She spent most of the time resting, something she cannot do much at the rehab center as she has to go for breakfast early morning and for lunch and dinner at specific hours. Besides, it's always more or less noisy. At home it was like in heaven. Tram is doing good, gaining more strength. He sight, of course always makes her worry. She still has a double and blurry vision, as a result, she cannot keep her balance when she walks. Even when she seats up too fast, her vision field spins around for a while.

April, Wednesday 16, 2008
This past couple of days, Tram felt a bit depressed always because of her poor eye sight. But now she is back to a more normal mood. We try to do our best to comfort her and make her understand that it will take a little longer for her to see noticeable changes, but already we can see an improvement. For the rest, Tram is doing better, getting more strength. Her PT and OT ( physiotherapist and occupational therapist) are more than satisfied about her progress. They keep her very busy, mornings and afternoons, swinging between physio, occupational therapy, eye scanning, speech therapy. She is doing so well and show them that she is truly motivated to get her autonomy back, her progress exceeds their expectations. Even the doctor in charge has only positive comments.
Tomorrow, Tram, myself and the "team" will have a meeting at the rehab center to discuss about Tram's improvement and our future goals, our main concerns, it's going to be a time for questions and answers.
The doctor gave her an eye patch, so she can practice with one eye at a time, on rotation, over time, this should help reduce the double vision.
Today, Tram and her occupational therapist went to Safeway grocery store, it's just a 3 minute walk (wheelchair) from the center. Because tomorrow, Thursday, Tram will have to cook something, that's part of her occupational therapy, her therapist needed to see how she would do in a grocery store, to find her way within the aisles, choose the ingredients and foods needed, to deal with people around, and finally to get to the cashier. And she did very good. It was a positive experience.
This Friday, I will come pick her up around 5:00pm for another week end at home....home sweet home!

April, Thursday 17, 2008
Today's meeting with the therapists was about Tram's current health and physical condition, improvement and her / the team's goal. From the therapists' point of view, Tram is doing great, she is motivated to regain confidence, strength and independence. She even manages to communicate her positive spirit to other patients in ABI ( Acquired Brain Injury )which as a result works nicely on them. She said that she will probably volunteer at GF Strong Rehab Center even before thinking of going back to work one day. She feels that here is like a big family.
The team's goal for Tram is to have her discharged by May 15th. This could be before if Tram improves faster and proves that she can walk on her own without walker, but with a cane certainly, and she can do things she used to do before in a safely manner just like cooking and managing activities in the house.
Of course, when Tram is discharged, it's far from over, she will receive support from therapists on a regular basis in Surrey who will come home. A large percentage of her walking / balance issue comes from her vision, and it's not before 6 to 9 months that specialists will start working on it.
In the meantime Tram will have to keep on exercising her vision and her balance constantly. It's going to be a long process and a lot of personal work, also support from us as well.
Her next appointment with her neuro-surgeon is on April 28, and another appointment, this time with the neuro-ophtalmologist is scheduled on Wednesday May 7th. Today, after the meeting, Tram went to her occupational class and this time was all about cooking and how to work in the kitchen, where to find ingredients, ustensils, use the range, the microwave oven,the rice cooker, prepare a meal and use of a knife, set the table, clean..etc, well everything that one normally does while cooking, setting the table, cleaning the counter top, the cutting board...
And Tram did absolutely very well. Her therapists were pretty surprised to see how well she could manage things so well without any problem. And to crown it all, many people in the occupational area came over to the kitchen to know who was cooking and told Tram how much her cooking was smelling so good!
Tomorrow afternoon, I will return to GF Strong, this time to pick Tram up for another week end at home. This time, she wants to practice on the treadmill, at very slow speed of course. She really wants to progress fast.
She always says that she doesn't want to be a load for her family. When Tram wants something, usually she gets what she wants...most of the time. This time, we'll make it work.

April, Monday 21, 2008
Tram came back to GF Strong last night around 8:30pm after having a good restful week end at home. She spent most of the time sleeping or resting on the bed, the blinds rolled down so there is not much brightness getting in the bedroom. Tram is still very sensitive to daylight and has to wear sunglasses. It seems that her double vision decreases, however, she still has a blurry vision...to what point? only Tram knows. So far she proved that she could read some road signs while in the car, see some details.
At home, she practiced on the treadmill for about 7 minutes, myself was standing right behind her, holding the emergency stop device in case. She did well even though she had some difficulties to lift her left leg, the weak one. And she did walk without holding on to the side bars.
She is walking around the house with more confidence and tries to do things without waiting for my help. She is really motivated to get her independence back. I admire her for that.
I'm going to set up a room downstairs for her to exercise during the week ends and every day of the week later, after she gets discharged; treadmill, balance, dumbbells, steps...
Also, I want to set up eye sight exercise program at home ( scanning + visual restoration therapy )- in cooperation with therapists -. I know that some of the brain nervous cells ( neurons )in some parts of the brain when damaged cannot be restored. But other nervous cells in good parts of the brain can take over and compensate for the loss of theses damaged cells, something that was believed impossible 10 years ago. By using stimuli, one can trigger new connections from the good nervous cells which will develop, grow and work for the part that has been damaged.
Time, work, perseverance...and love are the magic ingredients that cannot be overlooked.
Tram wants to thank friends for visiting her yesterday and before yesterday, for spending a little time with her and help her to forget, for a couple of hours, her condition.

April, Tuesday 29, 2008
It was a very busy week last week for Tram. Many co-workers and friends, her sister from California was here as well, came over after 4pm for her birthday that was actually on April 24. Flowers, gifts, cakes, balloons. Tram was truly surprised to see so many caring for her. She got a huge birthday card filled with tens of messages and signatures. She was so happy. And later we went downstairs to continue our little Tram's birthday party to the cafeteria. Although Tram was very tired, she had a lot of fun and really appreciated that moment.
She said that it was the best birthday he's ever had in her life. She is extremely motivated to get well, to get her strength back as fast as possible and her therapists can see that. They are very surprised to see how fast she progresses and how determined she is. Now she can walk 3 blocks without any aid ( no walker, no cane), slowly, with some dificulties though, but she can do it. Of course, she still has to work on her balance which is compromised by her blurry and double vision. However, she's doing much better.
Last week end, she needed to rest, and she slept many hours during the day on Saturday and Sunday. It is known that stroke survivors get extremely tired and excessively need to rest in order to recover. Each effort, each move that we take for granted when we are not sick or struck by life-threatening illness is taking them huge amounts of energy.
Despite this fact, Tram still wants to prove to herself that she can do things. Friday night, back home, she wanted to cook a little bit. Last Saturday, we went to the restaurant for a take-out and right after this, she wanted to go to The Home Depot to buy flowers and potting soil for our hanging baskets. Back home, she started to have a little fun with her flowers...in the garage.
When that was done, she had to go rest in our bedroom...for the rest of the day. The next day, Sunday, a friend of her invited us to the restaurant for lunch. Then later, back home, she slept until it was time for her to return to GF Strong.
She really had a good week end and a memorable birthday Day thanks to her friends. She wants to thank so much everybody who participated to her birthday.

Yesterday, Monday 28, we went to her appointment with her doctor/surgeon, the one who is in charge of her since the beginning and who worked on the removal of the blood clot and the AVM. He was surprised to see her walking with no aid. He was amazed by the fact that she was recovering so fast, actually, it would take people in her case many more months to be able to do what she is capable of doing now. And for the first time since her admission to VGH, she finally met the very first surgeon, the one who was responsible for her life-saving procedure on April 23, in the early morning.
She knows that without his intervention, this first surgery to drain the blood off her head, she wouldn't be here today. Tram has another appointment with her surgeon in June. But before that, on May 7, she will see the neuro-ophtalmologist for a assessement. Lately, Tram was supposed to get discharged on May 15, but this decision has been revised, and the staff decided that because Tram is doing so well, she could get back home on May 8.
Tram is excited to be able to get back home for good even though she will miss the people at GF Strong, the staff and other patients. But she promised that she will volunteer at GF Strong later, when she's doing better.
She really wants to help and give back to the community and to people who are living the same situation. Again, Tram wants to thank all the co-workers and of course her family for supporting her.

May 10, 2008
Tram has finally been discharged from GF Strong Rehab Center. On Thursday May 08, around 12:00pm, she walked out the entrance door after saying goodbuy to nurses, doctors, therapists and other patients. The day before, on Wednesday May 07 in the morning, she had an appointment with the Neuro-Ophtalmologist for a checkup. I was with her in the doctor's office to answer questions and to know a little bit more about the examination procedure. Thanks to different tools and equipments, he checked eye muscles reaction, overall vision, colour vision, visual field... To his point of view, the blurriness, the double vision and eye coordination issues will go away within the next few months naturally. Which is very encouraging. Tram was very happy to hear that. Tram will have another appointment in November ( a 6 month period of time) of this year for another complete check up with the same doctor and another one for assessing her right visual field loss at VGH/UBC Eye Care Center in Vancouver.
That was very pretty good news to hear prior to being discharged. On Thursday May 08 before stepping out of GF Strong, as Tram was having a chat with her occupational therapist, she promised that she'll be back to volunteer at GF Strong, to give back time, to help and support patients who got the same thing as she got, stroke and acquired brain injury(ABI), volunteering that she has already started weeks ago, here, being herself a "stroke survivor". And many patients and therapists already told her that they will miss her as a patient and as a human being helping others and they will be very happy to see her again as a visitor and hopefully as a volunteer.
Tram is gaining more and more strength, she is doing more and more usual things, like sorting clothes, doing dish washing, cooking, moving around in the house, going down to the basement, going back upstairs with no major problem, remembering that she has to be very careful at every step she makes. Despite the fact that she's doing much better, however she still has a right visual field loss, and she has to scan or turn her head to the right in order to be able to see. But that's something she's now doing normally. On Tuesday May 13, we are going to CNIB in Vancouver ( Canadian National Institute for Blind) for meeting with a counsellor and having a look at different tools available for Tram to use and help her in everydays' life, remembering that Tram is FAR from BLIND, she is what we call VISUALLY IMPAIRED, and though still needs somebody to supervise her ( like myself for instance) and help her outside home to cross the streets and go to unfamiliar places and deal with crowds.
On Monday May 26, someone from CNIB will come over to have a look in the house and give us advice on what can be modified to make it easier and safer for Tram. On June 9, there is another appointment with her neuro-surgeon for an assessment. Her file is also in our family doctor's hands. So far so good. Tram is happy to be back home, once for all, remembering that she has to be cautious everytime she makes a move and that we have to monitor her blood pressure every single day to detect and prevent any other similar debilitating illness.
Tram wants to say thanks so much again to friends and other people supporting her during her illness. The worst is behind, but it's still an on-going process that will last months, even years.

Tram is using little things at home to help her in her everydays life, such as a telephone with large buttons and large display a list of phone numbers and names in large text size, a big calendar with large text and also to accomplish certain tasks such as a Hand Magnifier( w/ light)to read books and documents when needed and the zoom-in function that is part of Windows to make text in web pages ( among others) larger so she can read much easier.

It takes Tram a huge amount of energy to read a simple paragraph, either in a book or on the web and she has to scan in order to be able to read through the whole line before going down to the next line, something she was unable to do months ago, in April/ May 2008, when she used to skip the end of each line because of her right visual field loss. Now she can deal with this problem just by rotating her head to the right or better by turning her eyes to the right ( scanning) which is something she had to learn.
Many things to help visually impaired stroke survivors and TBI survivors exist that are free, such as the above-mentioned feature from Microsoft on its Windows OS. Here is some details on how to use this simple and free function on your computer:
How you can adjust text size:

In browsers such as Microsoft's Internet Explorer, Mozilla's Firefox and Apple's Safari, you can enlarge text on your screen by holding down the Control ("Ctrl") key on your keyboard and tapping the "+" key until you reach the proper size for your sight.

To return the text to its normal size, tap the "-" key while holding down the Control key. You also can hold down the Control or Command key, then use the wheel on top of your mouse to increase or decrease the text size on your screen.
Still another way to enlarge text on your screen is to use the "Text Size" or "Make Text Larger" command within "View" in the drop-down menu bar that appears at the top of your screen, but only when you use popular software programs such as Microsoft Word and Outlook.

But for those who are looking at more specific visual aids such as special software to either display computer data in large print or read the material aloud in a synthetic voice, there is a full range of solutions ( non-free ) on the net.

Tram also uses a blood pressure monitor to regularly check her blood pressure which is important to maintain - in her case - around 120/80

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Tram starts a new life at home...and a long process towards her recovery

May, Thursday 08, 2008, Tram is now back home. She can finally rest. But things won't be that easy for her. She used to be surrounded by other patients and medical staff 24 hours a day. Now, at home, she is pretty much on her own for a great part of the day, and alone, she starts depressing and her overall psychological condition worsens. I strive to contact her several times in the morning and in the afternoon to make sure that she is okay and also to spend time talking with her over the phone.
My step-daughter and myself will take our vacations in July, then we'll be able to spend more time with Tram, to keep her busy and to have an eye on her. During summer, our son will stay home, giving Tram a little more confidence knowing that she won't be alone. And she has the MIGO, this cool kid's phone that I decided to provide her when she was at GF Strong. The Migo allows her to contact 4 different pre-programmed phone numbers plus an emergency one ( 911 for example, which she doesn't need at GF Strong while already taken care of by medical staff ), using a keypad with large buttons. What made me decide to buy this phone was simply because, due to her visual impairment, she was totally unable to use a regular cellular phone, small display, small keypad. With the MIGO, she has absolutely no problem and can now keep in touch with me, her daughter, and 2 other good friends of hers. Besides, all her friends and co-workers can call her.

May 16, 2008 Tram is doing good. Despite the fact that her eye sight is a real problem, she is doing just fine, getting more active, getting more strength, making jokes, really motivated to improve no matter what! Yesterday, we went to Crescent Beach to get some fresh air. She got quickly very tired but she enjoyed each minute by the beach...and a big double Butter Pecan ice cream in a waffle cone! Different appointments are scheduled for the next couple of months with a counsellor at the CNIB ( Canadian National Institute for the Blind ), the CNIB is supposed to provide her psychological support any time, to help her choose some equipments that she might need such as a magnifier w/light to read, an ID cane and another long white/red cane with a rolling ball as a mobility device to help her for her balance that is still a big problem. She also will see her family doctor for other blood tests, the neuro-surgeon and the neuro-ophtalmologist for other assessments, a specialist for a visual field assessment and a CATScan at SMH ( Surrey Memorial Hospital ) on August 13th. Tram has appointments either in Surrey or in Vancouver, pretty much every week, requesting me to take half-days off or entire days off to drive her there. But like I told her, this is my duty to be with her, to help her and support her during her long journey to recovery, even if it means sacrifices, long day work, driving back and forth during rush hours.
Even though Tram's condition is stable, she is still in pain ( headaches) and has at times nausea and dizziness most of the time, though she gained a litte more of her strength back, everything seems to be smooth and easy. I even decided to take her regularly to the Institute of Massage, a college that trains future massage therapists, for her shoulder pain. After her stroke, Tram stayed immobilized for more than a month, her left side was unable to move. Besides, nurses had to move and turn her from one side to another every 2 hours, pulling and pushing on her left shoulder and arm, which in turn, over time has created stiffness and decalcification in the shoulder joint as well as the wrist. She also developped chronic pain in the forearm. We tried massage therapy for a while. It was much cheaper going there than going to a registered massage therapist, 30$ instead of 70$/hour, while being treated by senior students who were a few months away from graduation, but it seemed that it wasn't of any help in Tram's case, actually, it was the opposite, it gave her more pain. We also tried Chiropratic for a while, without success. It seemed that manipulations was not the solution. I had to find something else. This is when I remembered that I had this copy of a newsletter I got from the local newspaper that was promoting a new Therapy for people living with pain, the Laser therapy for pain and soft tissue rehabilitation Our first appointment for an assessment was scheduled for September Monday 08, 2008 at 4:45pm.


Tram is in trouble and we must rush to Vancouver General Hospital EMERGENCY

On Thursday September 04, 2008 we go for our family doctor's appointment which is scheduled around 9:00am. As we're having a chat with our doctor, Tram starts not feeling well, she starts having a mild nausea, dizziness then vertigo with strong nausea. She can barely stand on her feet. Our doctor decides to call VGH Emergency immediately, which is right across the street, a block away to let them know that we're on our way as we decide to reach for our car and drive to VGH, that should be alright and there is no need to call in paramedics. Five minutes later, we are at the Emergency and Tram is immediately brought in, just the time to do some paper work, answer some questions, and Tram is taken inside on a bed, as I follow, worried, wondering what could cause this to her now. We will stay pretty much the all day while medical staff will perform blood work, X-ray and CT scan. Absolutely nothing has been found that could be the cause of this severe attack of vertigo.
The doctor in charge tell us though that there might be a problem in her inner ear within the vestibular system which contains sensors that control her balance, and this problem could have been caused by the stroke, but as far as he is concerned, they cannot do anything now. Tram is given Gravol in the form of tablets for relief of nausea and dizziness, the doctor gives us a prescription for taking Meclizine which is an antihistamine with anticholinergic properties used to treat nausea, vomiting, and dizziness associated with motion sickness. Tram is discharged later in the afternoon, and we can go back home. A couple of days later, we'll have to abort this treatment as the medication will turn out to be much too strong and will create much more dizziness.

Tram is in trouble and we must rush to Surrey Memorial Hospital EMERGENCY
September, Monday 08, 2008 After Tram's assessment appointment for laser therapy at 4:45pm, we went back home. Later in the evening, around 7:20pm, she really started not to feel good. She started to feel more weakness in her body and especially in her legs, her eye sight got more blurry, she started to tremble. I decide to immediately rush her to the hospital. Byt the time we arrived, 10 minutes later, her condition changed dramatically. Fortunately, I found a parking spot not far from the emergency entrance. Tram didn't give me time to reach for the passenger side, she was already out of the car, and she simply fell on her knees. I just had time to hold her and prevent her from hitting her head on the ground. I literally dragged her to a nearby wheelchair that had been left on the parking lot and pushed her to the emergency admission. By the time we got there, the situation got worse.
She was now unresponsive with her eyes wind opened. I had to fight with the staff who insisted to do the paperwork first. This is when I started to get really mad and say that she was a stroke survivor and she might be having another one right here in front of everybody. A minute later, four - five staff where helping me to take her to the ER where they started monitoring her vitals and doing what they have to do in such a situation.
At this moment, Tram was totally unresponsive, her eyes still wide-opened, she started to have essential tremors in her arms. After about 10 minutes, Tram came back up to the surface, still in shock. She tried to speak, but she could hardly pronouce the words as her voice was terribly shaking. She was complaining of headache, stiff neck, dizziness. They transfered her to the emergency ward to be taken care off - vitals monitoring, CTscan, blood work...etc. In the end, doctors didn't really find anything that could have been the cause of this "attack". And she was still having her tremors on and off, shaking voice and bad headache. They decided to keep her for an indetermined period of time to know more about her case and see if they could find something.
Tram was really scared to death which was not helping at all, many times her heart started to pound so hard that she started to have a panic attack and nurses thought she was having a heart attack. Tram got transfered to another floor and stayed there for 2 weeks. She got discharged on September 22, after the staff said they didn't find anything so far, and that the neurologist in charge would have to follow up. Upon her discharge, Tram had no essential tremors and shaking voice anymore. But her headaches and pain everywhere in her chest and upper back were still there.
An appointment with the neurology clinic for an EEG was scheduled on October 2nd, 2008. A couple of days later, we got the news from the hospital that Tram had had in fact another stroke, possibly an ischemic stroke that resolved on its own or a mini stroke, though the doctors are not totally sure given that the CTScan images were not 100% positive. But what else could have possibly caused this attack if not another stroke?

Tram is back to the hospital...again!
One week after her discharge from Surrey Memorial Hospital, Tram starts a new therapy that promises to bring significant improvements in her recovery.
On Monday September 29, 2008, she starts her Hyperbaric Oxygen therapy. On Thursday October 2nd, as scheduled, she has her appointment at the neurology clinic for an EEG. And in the afternoon, another appointment with our family doctor. Between the day she got discharged and Oct 02, 2008, she will complain of very acute pain in her chest, neck, jaws, upper back, arms, right shoulder and numbness right under the chest. After a 30 second examination, the family doctor will tell her that it's simply caused by gastric acid reflux, which I don't believe. Of course, he will prescribe, as always, another medication for heart burn.
Tram keeps on doing her HBO therapy every night at 6:00pm. On our way back home after the fifth HBOT session on Friday Oct.03, we have to stop by the emergency...again. The pain in her chest gets more intense. And again, medical staff will perfom blood work and ECG, blood pressure and Oxygen check. Everything is perfectly normal

On Thursday Oct.09, 2008, again, the same thing, and again, the ECG is fine, and blood chemistry results are fine, levels are within ranges, especially levels of Troponin which is the enzyme released by the heart muscle in case of heart attack or Angina, and levels for Pancreas, Liver, Gall Bladder and Kidneys. The only level that is too high is the bicarbonate's. Well, according to the emergency doctor, everything is normal, and he doesn't really know what can cause this pretty disturbing problem. The next day, we'll talk to our HBOT doctor ( Dr. Zayd Ratansi ) that explains to us that it is not uncommon for stroke survivors to suffer what is called " Neuropathic Pain ", and in Tram's case " Central Neuropathic Pain " which is actually caused by a damaged nerve or damaged nerves that send false signals back to the brain.
For more info, you can go to http://www.nepknowmore.ca/en/pain/what_is_neuropathic_pain/ Our HBOT doctor says that, in Tram's case for instance, after her stroke, a nerve or many nerves have been damaged that send signals to brain that in turn interprets that as pain, but cannot pinpoint the exact location.
The pain seems to be coming from everywhere in her upper body. And as Tram is having this constant pain coming from everywhere and most importantly from her chest, she starts worrying, stressing out, and as she starts worrying, adrenaline level increases making her heart pound. As she feels her heart beat faster and pound, she starts to become more agitated and tends to panic much more which in turn leads to those "attacks" that she often mistakes for a heart attack or another stroke.
The thing is that it could become a vicious circle, a never ending story...as long as nothing is done to stop this "Neuropathic Pain".
According to Dr. Ratansi, Tram's HBOT doctor, Oxygen therapy should fix this over time.

TRAM'S WISH
Tram is, was a very active woman, working her 12 hour shifts 4 days per week, and was working at home, just like millions of other women, after work, preparing dinner, and lunch boxes for the next day, and working at many other tasks, the usually things any spouse and mother would do for her family. She had projects, dreams, the kind of things you think about when your life is just doing fine, when you have no worries, when you take everything you have for granted.
Today, all this is not her priority any longer. Today, her wish, her DREAM is to get her life back, to get her eyes back, to be like before, active, be able to do stuff on her own, be able to wake up every single day of the week to go to work and have a social life.
And I told her that, whatever it takes, we'll fight for her.
Tram uses to say " I don't mind if I don't recover my right visual field, if I remain half blind but I truly hope, and I pray every single day for that, I will at least get my normal eye sight on my left side and I don't suffer these vertigo, dizziness and strong headaches anymore, so I can take care of my family".

But first she has to recover, to get better, much better. We have to do anything we can possibly do for her to recover her eyes, to recover her self esteem, her confidence and make her feel that she can be back as a citizen who contributes to the society, who works for her family and pays taxes to the government and does not depend on it by receiving a long-term disability cheque that just tells her that she is not useful to the society any longer which grants her to survive with 60% of what she used to make when she was working.
Tram doesn't want to spend the rest of her life at home, walking unsafely from her bed to the kitchen, to the bathroom, back to the bed, simply because she cannot be active more than an hour, sometimes more than 10mn because of the loss of her visual field and the vertigo and dizziness that she has, waiting for her husband, her kids, her friends to come over help her go out for grocery shopping, for going to the bank or for anything else.

The story behind starting HBOT
I was unsatisfied with what was available to Tram in terms of rehabilitation programs. On one hand, doctors tell you that they don't know much about Tram's condition. They did what they had to do, which somewhere is just great because they saved her from a certain death - and we are grateful for what they did - but they cannot do anything else to help her improve, physically and for her eyes. Some doctors will say " only time will tell", others will say, as for her eyes "this will be permanent and she will have to learn to live with this impairment every single day of her life".

On the other hand, being able to access a rehabilitation program is a nightmare. They put you on a waiting list and you just wait for them to call you. In Tram's case, it took more than 6 months before they call her to let us know she was enrolled and that she would start months later.

I was of course not satisfied with this situtation and I had to do my homeworks and find out what else we could possibly do to work on Tram's rehab, faster and efficiently without depending on the good will and decision of others.

I started to do a lot of research on the internet, especially on HBOT that I knew for helping patients with different sort of medical conditions. And I started to find and read about HBOT used on brain injury patients. I found a HBOT clinic, 5 minutes from my work, and I decided to go for a visit. I met Dr Ratansi at the Advanced Hyperbaric and recovery Centre in Coquitlam, I told him about tram's story and her medical condition and he said that she would be a very good candidate for that kind of therapy. He convinced me that HBOT would definitely help her to recover her strength and some of her lost eye sight. From this moment on, it was just a matter of time before Tram starts on September 29, 2008, the day that would start her journey to almost a full recovery.

After having completed the first 20 treatments, we started noticing improvements in her balance and in her left visual field. After 40 treatments, things were doing even better, even though at times, her left peripheral vision seemed to get back to square one.

Today, as of October 10, 2009, 12 months later and after almost 120 HBOT treatments, things are doing just great for Tram. Her gait is almost back to normal but still somehow affected by her current visual impairment, her balance has come back to - I would say - 98%. The supposedly "neuropathic" pain she used to live with that was radiating from everywhere in her body has simply gone. She has no more headaches, no more dizziness, no more nausea. Her overall strength has tremendously improved, especially in her left arm and leg. She is now able to stay active, walk around in the house, go out - supervised - the whole day whereas 12 months ago, she was just able to have some sort of activity for less than a hour and had to spend the rest of the day in bed to rest.

As for her eye sight, I am, we are very impressed and happy to see such an outstanding improvement while doctors, a year ago told us that it was permanent and chances to see improvements were slight to nonexistent.
Her left visual field in both eyes - according to Tram - is much better, yet often blurry. Most of the time it's like looking through a clear white cloud, but more and more often it becomes clearer. She then can read small wording on licence plates 20 feet away, road signs as we are in the car, she can read newspapers, textual content on the internet. Of course, it takes her a little longer that it would normal take to someone with no visual impairment simply because of the bluriness, it takes some time to focus, her right visual field is affected and so her visual depth perception. According to her neuro-ophtalmologist and her ophtalmologist, her colour perception is outstanding.

As of her right visual field that she had totally lost, still according to Tram, she now can perceive objects that are within a 30-35 deg.angle to the right. Of course, what she can perceive is still extremely blurry, but this is a huge improvement that gives us hope for much more as we remember that months ago she was perceiving nothing but darkness.
Everyday, she works on her visual scanning that she put to the test when we go to public places with crowds such as shopping malls. And she is doing very good, walking at a normal speed and scanning ( eyes/ head) at the same time to make sure there is no object or people on her path she would bump into. But sometimes, Tram gets distracted and forgets to scan which in turn leads to funny consequences where some people and herself are on a assured crash trajectory. But she knows that in these situations, and to avoid such problems, she has to use her cane that will identify her as an visually impaired person.



Tram and myself would like to thank Dr Ratansi, and the whole staff of the Advanced Hyperbaric and Recovery Centre, Lorraine and Kelly for simply believing in Tram's recovery in giving her the last chance that we could possibly find towards recovery and a brighter future.