Dear Family & Friends,
I'm happy to be sending an update with quite a bit of news to report. We see God's hand at work in many ways, and we are so grateful for your faithful prayers.
On Monday we took Gerry back to Riverside County Regional Medical Center, where he was first admitted after his accident, to finally remove the braces from his teeth. As Lori mentioned in her last update, we went a couple of weeks before, but Gerry had an incident of low blood pressure and collapse. So, we were very happy that this time it was "Mission Accomplished"! The braces were removed, and although it was a very painful procedure for Gerry, and a long day, he did remarkably well.
Because of the low blood pressure incident, the doctor removed Gerry from all medications that can cause low blood pressure. So far, he has not had any further problems. Gerry has been having periods of frustration or agitation, which is a result of his brain injury. The hospital was putting him on a strong prescription, Adavan, when they felt it was necessary. We noticed that this medication made Gerry very "loopy". It would bring him up, and then later he would drop way down, with his coherency being greatly affected, and even his physical balance and stamina.
We talked about it and both agreed that Gerry is not going to be able to learn to deal with those feelings and cope if he is just medicated through those episodes. This will be especially important once he returns home and is out and about. Lori talked to the medical team, and this week they agreed to take him off of the Adavan. They will now use other measures to help him cope, like getting Lori on the phone, or putting on the music that he loves, or watching a family or church video that we have at the hospital for him. Gerry was thrilled to hear that they will not be giving him the Adavan anymore!
Another praise report is that Lori felt Gerry was ready for an overnight pass, and she was able to arrange that for this Saturday night. She will pick him up in he afternoon, and bring him back by Sunday evening. Lord willing, Gerry will be able to worship with his family at their own church on Sunday! When Lori told Gerry he was coming home for one night, he was overjoyed! This may be a lot of stimulation for Gerry, so for those of you at their church, the only thing we want to mention is to keep conversations with Gerry short. We pray for a successful, enjoyable home and church visit for Gerry and pray that he will return to Ballard willingly. Lori has been talking to him about his remaining time in the hospital as "his job" to learn the skills he needs to come home soon.
These past couple of weeks we are seeing an increase in Gerry's understanding, and also his emotions, which is all good! He has been able to communicate his feelings. At times, he has confided to Lori about how difficult things have been. He has explained his frustration, and when she questioned him further about how he feels, he said, "I feel like a black in the South". Lori said, "How does that make you feel?" And Gerry replied, "It's hard because people think I'm stupid." It is so good that he is able to communicate these feelings! In our family visits, as we joke back and forth with Gerry, we often see great clarity and alertness. He loves to lead in prayer, and we see great clarity there as well. He is now communicating that he wants to come home. He calls Lori on the phone and says "When are you coming, at 2 or 3?" or "When are you coming to take me home?" Another time on the phone he said to her "Hi Doll, love ya', babe!" When we were at his appointment, he went up to the desk and asked why they hadn't called his name yet. Seeing these totally appropriate responses has been very encouraging to us. When we take him out for any reason, like out for the appointment this week, or for ice cream on other occasions, etc., he doesn't want to get out of the van when returning to Ballard. We do believe that his level of understanding is greater than he is able to articulate with words. We know that he is there, and we pray that in time, through therapy, or after returning to his normal surroundings at home, that he will be able to communicate better with words. At times, you can clearly understand his words (generally shorter statements). Other times, he can babble on and you will not be able to understand, partially because of the sound of his voice, and also because his of his inability to find the right words. He may not look quite normal or act quite like the old Gerry, but he is in there, and for those of you that will be able to see him, we know that you will treat him normally and embrace him with joy for the miracle that he is!
Gerry can also receive phone calls now, and he really enjoys hearing from family & friends.
He has improved at Ballard in many ways, and believe he is now ready for the next step. We are still on target for release in mid-October. There is still no official written denial from the insurance co. for further treatment at a transitional living center, and we are not sure why. The Escondido Learning Services where we would like him to go next is coming out on Tuesday to evaluate Gerry. Please pray for this and for acceptance into this program. If acceptance is denied, and our appeals are also denied, we pray that some creative financing can be arranged so that we can get Gerry the further treatment he needs. If all doors close for a transitional living center, then Gerry will likely be coming home, so we ask your prayers for the many upcoming decisions. Lori asks for prayer as she questions short term vs. long term decisions regarding Gerry's care, financial issues, job issues, and all the possibilities of Gerry's inpatient and/or outpatient care, their home life, and for God's continued miracle of healing for Gerry.
God's faithfulness is great! We have been amazed and encouraged by your faithful prayers!
'The Lord also will be a stronghold for the oppressed, a stronghold in times of trouble, And those who know Thy name will put thy trust in Thee; For Thou, O Lord, has not forsaken those who seek Thee.' Psalm 9:9-10
God bless you all!
Gina
Thursday, September 30, 2004
Thursday, September 16, 2004
Subject: Marinucci No. 56 (from Lori)
Subject: Marinucci No. 56
Just a minute for a quick update. The Team/Family Conference went well.
The Ballard Team made presentation that Gerry is progressing well. They are
optimistic that he can improve with continued existing therapy and requested
a 1 month extension until Oct 14th which most likely will be approved.
There is still much negotiation, research and clarification needed for the
"next step" by all parties to determine if the insurance company is
responsible. Ballard will recommend the facility in Escondido, whereby I expect Hemet to do a formal denial and then I will start the appeals process. We will see
who pays for the next step-- insurance, Victims of Crime or private pay.
Today (Wed, 9/15/04) we took Gerard to his facial maxial surgeon appointment at
9:00 a.m. in anticipation of removing his braces. The surgeon was located in the
basement of the hospital where Gerry was in intensive care for 6+ weeks and
we're were excited about the prospect of him walking in to thank his devoted
doctors and nurses. We had some glitches regarding the referral
process, lack of payment by insurance so they were reluctant to do
further work, etc. Finally they were able to get us in and just prior
to any treatment, Gerry either had a seizure or an episode of very
low blood pressure and a spasm. At either rate, he ended up in the
Emergency Room. He resolved and following blood work, CT Scans
and IV's he was released. We were then able to go upstairs to say "Hi" to
the IC staff and then transported him back to Ballard about 5:00 p.m. I need
to make another appointment for the teeth/face for another day.
God is answering prayer in an interesting fashion according to my
perspective, but who am I the "pot" to question the "Potter"?
Continue to pray God's Will! So let it be.
Love, Lori
Just a minute for a quick update. The Team/Family Conference went well.
The Ballard Team made presentation that Gerry is progressing well. They are
optimistic that he can improve with continued existing therapy and requested
a 1 month extension until Oct 14th which most likely will be approved.
There is still much negotiation, research and clarification needed for the
"next step" by all parties to determine if the insurance company is
responsible. Ballard will recommend the facility in Escondido, whereby I expect Hemet to do a formal denial and then I will start the appeals process. We will see
who pays for the next step-- insurance, Victims of Crime or private pay.
Today (Wed, 9/15/04) we took Gerard to his facial maxial surgeon appointment at
9:00 a.m. in anticipation of removing his braces. The surgeon was located in the
basement of the hospital where Gerry was in intensive care for 6+ weeks and
we're were excited about the prospect of him walking in to thank his devoted
doctors and nurses. We had some glitches regarding the referral
process, lack of payment by insurance so they were reluctant to do
further work, etc. Finally they were able to get us in and just prior
to any treatment, Gerry either had a seizure or an episode of very
low blood pressure and a spasm. At either rate, he ended up in the
Emergency Room. He resolved and following blood work, CT Scans
and IV's he was released. We were then able to go upstairs to say "Hi" to
the IC staff and then transported him back to Ballard about 5:00 p.m. I need
to make another appointment for the teeth/face for another day.
God is answering prayer in an interesting fashion according to my
perspective, but who am I the "pot" to question the "Potter"?
Continue to pray God's Will! So let it be.
Love, Lori
Monday, September 13, 2004
Update: Marinucci No. 55 from Lori
This is an important week for prayer. I am grateful for my elders and family who have given good counsel and support. Specifically pray for:
1) The insurance company has given me a verbal denial for the next step of rehabilitation. It is Hemet Community Medical Group's intent to release Gerry home with limited outpatient therapy here in Temecula. However, when I telephoned the outpatient facility Hemet recommends, they don't handle speech/cognition and more importantly, don't even accept my insurance!!!! I will need to
file an appeal once I receive the written denial.
2) Interestingly, his treating doctors don't agree with the Hemet. Ballard believes Gerry should continue at an inpatient rehabilitation facility and one with an emphasis on cognition. They have recommended, and we have toured a facility in Escondido (30 miles south) that seems favorable.
3) Tuesday at 3:30 p.m. the Case Manager for Hemet is coming to Ballard for the team/family meeting with the purpose of encouraging them to educate/train me to have Gerry home right away. Ballard on the other hand intends to educate Hemet regarding brain injury and that further rehabilitation treatment is needed. Clarity and direction as a result of this meeting.
4) Gerry finally has an appointment with the facial surgeon on Wed morning. I am hoping they remove the braces but more importantly, for wisdom regarding the "lock jaw" episodes and a final determination, if further treatment is necessary.
5) Hemet Medical Group (making the denial) believes they can't convert the nursing home benefit in my contract to services for rehab because Aetna won't allow it. While Aetna (who only exists in a supervising capacity because of the contract they have with Hemet) claims Hemet has full authority to make such a compromise provision should they desire to do so. That Hemet will
reconsider, once the appeal is filed.
6) Guidance for whenever Gerry does come home. Should I continue to attempt to work, do rehab myself, bring in help, seek adult day care, take a leave from work, file for medical and/or other government programs etc.? For someone who has an expertise in the legal/financial aspects of spend down for medical benefits.
7) I am advised that both Hemet and Aetna may still have legal requirements they are not fulfilling, such as an ongoing obligation to provide rehabilitation as long as Gerry continues to progress (which Gerry has). Again, Ger's primary injury is his brain. Cognitive training is difficult to get on an outpatient basis. I have several potential contacts with attorneys regarding their
assistance in this regard.
8) If in fact Gerry comes home in the near future, that Gerry's primary care physician will effectively manage Gerry's care. There has been difficulty, tension and significant delays with the referral process between the doctor's office and Hemet. Communication has been a problem. That an acceptable rehab
treatment plan is immediately put in place and no lapse in treatment will occur because of these problems. That I can get an appointment to meet with Gerry's primary doctor prior to the first date available on November 9th.
9) Prayer for the girls and their adjustment to the next phase and for endurance, peace and good judgment for me. May God's will be done!
Thank you for your willingness to be faithful in prayer! Both Gerry and I can testify that our Living and True God hears and answers prayer. He does not turn a deaf ear to the cries of his children. We'll soon see what His great and good plan is for us!
Lovingly, Lori
1) The insurance company has given me a verbal denial for the next step of rehabilitation. It is Hemet Community Medical Group's intent to release Gerry home with limited outpatient therapy here in Temecula. However, when I telephoned the outpatient facility Hemet recommends, they don't handle speech/cognition and more importantly, don't even accept my insurance!!!! I will need to
file an appeal once I receive the written denial.
2) Interestingly, his treating doctors don't agree with the Hemet. Ballard believes Gerry should continue at an inpatient rehabilitation facility and one with an emphasis on cognition. They have recommended, and we have toured a facility in Escondido (30 miles south) that seems favorable.
3) Tuesday at 3:30 p.m. the Case Manager for Hemet is coming to Ballard for the team/family meeting with the purpose of encouraging them to educate/train me to have Gerry home right away. Ballard on the other hand intends to educate Hemet regarding brain injury and that further rehabilitation treatment is needed. Clarity and direction as a result of this meeting.
4) Gerry finally has an appointment with the facial surgeon on Wed morning. I am hoping they remove the braces but more importantly, for wisdom regarding the "lock jaw" episodes and a final determination, if further treatment is necessary.
5) Hemet Medical Group (making the denial) believes they can't convert the nursing home benefit in my contract to services for rehab because Aetna won't allow it. While Aetna (who only exists in a supervising capacity because of the contract they have with Hemet) claims Hemet has full authority to make such a compromise provision should they desire to do so. That Hemet will
reconsider, once the appeal is filed.
6) Guidance for whenever Gerry does come home. Should I continue to attempt to work, do rehab myself, bring in help, seek adult day care, take a leave from work, file for medical and/or other government programs etc.? For someone who has an expertise in the legal/financial aspects of spend down for medical benefits.
7) I am advised that both Hemet and Aetna may still have legal requirements they are not fulfilling, such as an ongoing obligation to provide rehabilitation as long as Gerry continues to progress (which Gerry has). Again, Ger's primary injury is his brain. Cognitive training is difficult to get on an outpatient basis. I have several potential contacts with attorneys regarding their
assistance in this regard.
8) If in fact Gerry comes home in the near future, that Gerry's primary care physician will effectively manage Gerry's care. There has been difficulty, tension and significant delays with the referral process between the doctor's office and Hemet. Communication has been a problem. That an acceptable rehab
treatment plan is immediately put in place and no lapse in treatment will occur because of these problems. That I can get an appointment to meet with Gerry's primary doctor prior to the first date available on November 9th.
9) Prayer for the girls and their adjustment to the next phase and for endurance, peace and good judgment for me. May God's will be done!
Thank you for your willingness to be faithful in prayer! Both Gerry and I can testify that our Living and True God hears and answers prayer. He does not turn a deaf ear to the cries of his children. We'll soon see what His great and good plan is for us!
Lovingly, Lori
Monday, September 06, 2004
Mon 9/6/04 from Gina
Yesterday we took Gerry out to lunch for his birthday, which we all enjoyed very much. He has now been at Ballard Rehabilitation in San Bernardino for about 1 & 1/2 weeks. Lori and Mom met with his new doctor last week, who said that Gerry is doing very well. A few main points they discussed were as follows: What they need to focus on medically for Gerry is his memory and regaining physical strength and balance. The doctor felt that Gerry would benefit from a transitional living center upon leaving Ballard. The insurance company could try to release Gerry from Ballard at any time, but will hopefully keep him there for another 2-3 weeks as he continues to get stronger.
They have removed the "peg tube" from Gerry's stomach. My Mom asked if Gerry's voice will return to normal. The doctor explained that his vocal chords have come apart, which has allowed air to escape between them. This why his voice sounds very nasally and gravelly. In time, this problem could correct itself. If it does not, there is a simple procedure that can be done to correct it. The doctor, of course, cannot give us a prediction of how much better Gerry will get cognitively, stating that it was not good that Gerry remained in a coma for so long. However, he was very encouraged to see how far Gerry has come. In another 6 months or so, we will have a better idea about Gerry's prognosis.
Gerry continues to get agitated at times, which is a result of the brain injury. We seem to notice that he can get agitated when he is overstimulated or understimulated. Lori has noticed a recent increase in his agitation, and we ask for your prayers. She is struggling to decide whether it is time to take him home permanently or continue to push the insurance company to allow Gerry to go to a transitional living center for a couple of months. She is concerned that Gerry has gotten more depressed since his one day visit at home a month or so ago. He did so well that day, and she feels that if she takes a couple months of leave from work to help him re-adjust, this may help him more than his extended stay at rehab would. However, we are concerned about his agitation becoming a problem at times. Specifically, when out and about, he has refused to get back in the van more than once. This could make running necessary errands a problem, and add a great deal of stress to Lori and the family.
Lori went to look at another transitional living center in Escondido last week, and really liked it. Mom and I are going to go check it out tomorrow. We will be asking them what would be the benefits of inpatient care vs. outpatient care, etc. because once Gerry comes home to live, we know we will only have access to outpatient therapy from that point on. We thank you for keeping this in prayer, as Lori will need to be making this important decision right away. In addition, we sincerely hope and pray that after a few months at home, Gerry will be able to not only stay by himself, but also watch the girls. We know there is a possibility that may not be so. If that is the reality, Lori would need to hire a caregiver to help watch Gerry and the girls while she is at work. We are very mindful of all of these important concerns as we pray for God's direction at this critical time. We thank you for praying along with us, as you have so graciously done all along!
Blessings,
Gina
They have removed the "peg tube" from Gerry's stomach. My Mom asked if Gerry's voice will return to normal. The doctor explained that his vocal chords have come apart, which has allowed air to escape between them. This why his voice sounds very nasally and gravelly. In time, this problem could correct itself. If it does not, there is a simple procedure that can be done to correct it. The doctor, of course, cannot give us a prediction of how much better Gerry will get cognitively, stating that it was not good that Gerry remained in a coma for so long. However, he was very encouraged to see how far Gerry has come. In another 6 months or so, we will have a better idea about Gerry's prognosis.
Gerry continues to get agitated at times, which is a result of the brain injury. We seem to notice that he can get agitated when he is overstimulated or understimulated. Lori has noticed a recent increase in his agitation, and we ask for your prayers. She is struggling to decide whether it is time to take him home permanently or continue to push the insurance company to allow Gerry to go to a transitional living center for a couple of months. She is concerned that Gerry has gotten more depressed since his one day visit at home a month or so ago. He did so well that day, and she feels that if she takes a couple months of leave from work to help him re-adjust, this may help him more than his extended stay at rehab would. However, we are concerned about his agitation becoming a problem at times. Specifically, when out and about, he has refused to get back in the van more than once. This could make running necessary errands a problem, and add a great deal of stress to Lori and the family.
Lori went to look at another transitional living center in Escondido last week, and really liked it. Mom and I are going to go check it out tomorrow. We will be asking them what would be the benefits of inpatient care vs. outpatient care, etc. because once Gerry comes home to live, we know we will only have access to outpatient therapy from that point on. We thank you for keeping this in prayer, as Lori will need to be making this important decision right away. In addition, we sincerely hope and pray that after a few months at home, Gerry will be able to not only stay by himself, but also watch the girls. We know there is a possibility that may not be so. If that is the reality, Lori would need to hire a caregiver to help watch Gerry and the girls while she is at work. We are very mindful of all of these important concerns as we pray for God's direction at this critical time. We thank you for praying along with us, as you have so graciously done all along!
Blessings,
Gina
Saturday, September 04, 2004
Happy birthday, Gerry! (from Steve)
Nothing really to report, but we just want to say happy birthday to Gerry. His birthday is Sept. 5. Gina told us plans are to take him out to a restaurant for dinner. Hope it's a great day for you, bro!
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