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Day 236 – Waiting for Thursday

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The pulmonologist wanted to remove Cindy’s breathing tube today and do a tracheotomy.  The trachea would be inserted and capped so that Cindy can breathe on her own but still be able to use a ventilator if necessary.  They did a blood test and determined that she needs to be off the blood thinner for at least 48 hours before any incisions should be made, just to make sure that she doesn’t bleed too much and her blood will clot.  
Shooting for Thursday for the Tracheotomy
 So the expectation is that the breathing tube will be removed sometime this week, no earlier than Thursday, and the tracheotomy will be done.  Cindy can’t wait.  She would love to be able to suck on ice chips (and eat and drink) and be able to speak instead of communicating by writing.

Day 235 – A Day of Rest

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Cindy is taking a day off from totally breathing on her own.  She has been on and off the ventilator today in the hope that she will be able to wean off the ventilator tomorrow or Tuesday.

She sat up in a chair for a few hours today, but has been sleeping most of the day.  In honor of the occasion, two of her dogs decided to join her.

Ruby cuddling Itty.  They needed no coaxing to take a nap.

Day 234 – Standby

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Big step for Cindy today.  She has been breathing without the ventilater today.  They took a blood gas this afternoon to see how she is doing and found that her levels were OK but not perfect.  She was put back on the ventilator this evening.  There is no breathing assistance from the machine.  Tomorrow morning she will have the ventilator off again and have another blood test done to see if the breathing tube removed.

Ventilator on Standby

In other news, her jaundice has been decreasing.  Dr. Lane, her gastrologist, does not believe that the jaundice is caused by her gall bladder.  It is possible it is from the medication that was being used to improve her platelet count (which is now normal).

Day 233 – Introducting the Biliary System

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Cindy  has lost 15 pounds since she was admitted to the hospital a couple of weeks ago.  The doctors have decided that they can wait until next Monday or Tuesday to determine if she will need a trachea.  If she doesn’t need it, that will shorten her recovery time and remove one rehab from the recovery plan.

Cindy has been jaundiced for the last few days.  The doctors decided to give her an ultrasound to see what’s going on.  Cindy has had Gall Bladder stones/sludge in the past.  The Ultrasound showed.sludge in her Gall Bladder and some stones that are not blocking any ducts.  There is no treatment plan at this time.

Biliary System
Courtesy of Wikipedia

1 – 6 are Bile Ducts
7 – Ampulla of Vater
8 – Major duodenal papilla
9 – Gall Bladder
10 – 11 are the right and left lobes of the liver
12 – Spleen
13 – Esophagus
14 – Stomach (Small Intesting)
15 – Duodenum
16 – Jejunum
17 – Pancreas
18 – Accessory pancreatic duct
19 – Pancreatic duct
20 – 21 are the Right and left Kidneys

Day 232 – A Tentative Plan

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Labs are great.  Her platelets count is at 125000.  Things are going well.  She is resting comfortably listening to calming music so she can have enjoy a Zen experience.

The Pulmonologist came up with a tentative plan today:  He hasn’t checked with any of the other doctors, so this might be pretty preliminary:

Here’s the tentative plan:

  • If she can maintain or improve her breathing, a trachea will be inserted in the next day or two.
  • Cindy will be transferred to Kindred to be weaned from trachea
  • After she is weaned, they will NOT remove the trachea, but close it up and leave it in.
  • Cindy will be transferred to a SubQ (rehab) for general recovery including physical therapy, nutrition, and not sure what else.
  • Depending on how Cindy is doing, she will either go home or be transferred back to John Muir Hospital for surgery to remove her hernia
  • If Cindy goes home, she would probably have the surgery done within the next 3 months

Not everyone has agreed to this, but it is the most supportive plan with lots of resources for Cindy to help her on her way to a full recovery. 

Day 231 – Communicating with Pen and Paper

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Cindy is awake, aware and bossing us around.  And after all we’ve done for her.  YAY!  Keep up the good work, Cindy!

All of Cindy’s labs are good.  She is slowly getting weaned off the breathing tube.  Her platelet count is at 86,000.  What more could she want?  Well, I’ll tell you.  All day long she’s been asking for water, seltzer, food and the answer to “When do I get out?”

Good thing we bought her a lot of paper.

Day 230 – Viagra

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This is a quote from a nurse today:
     Cindy is a “sick lady doing absolutely awesome”  It’s true!!!
In the Day 223 – Pulmonary Hypertension post, I asked the question:
     Viagra was initially developed as a medication for _______________________.
And promised to answer the question the next day – but I didn’t.
And now for the answer.
Viagra was initially developed as a medication for Pulmonary Arterial Hypertension – exactly what Cindy has.
Sildenafil is sold as Viagra 
(picture from Wikipedia)
Cindy is now taking Sildenafil, which is Viagra.  It relieves the pressure on the right ventricle, improving her symptoms of right-sided heart failure.  Without Viagra, Cindy would not be recovering as well as she is.

Day 229 – A Balancing Act

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Cindy is improving and getting stronger every day.  She has been more awake and aware since last night.  This morning she was trying to pull out her breathing and feeding tubes.  She almost removed them a couple of times, so she had to be slightly sedated.

I said DON’T MOVE!!

 Both the cardio and pulmonary doctors were pleased with her progress:

  • Her  Blood Pressure and Oxidation level are good
  • She has lost 2 liters of fluid
  • An  x-ray showed that the right side of her heart is working better
  • Her platelet count went up to 35,000
  • She is “eating” through her nasal tube instead of her IV (better nutrition including protein)
  • Her kidneys are working perfectly
  • She is breathing better – weaning of the breathing  tube is going  well but slowly.  The  doctors will determine if she needs a trachea in   4 – 5 days.

GO CINDY!!!

Day 228 – Red Blood Cells to the Rescue

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Cindy continues to improve – lots of baby-steps, but she’s going in the right direction.  The doctors came up with a decision on what to do about Cindy’s low platelet count (see yesterday’s post).  They’ve decided to give Cindy a medication that “attacks” her red blood cells instead of the platelets.  The downside of this procedure would be that Cindy becomes anemic which is less of a problem than her blood not clotting.

http://en.wikipedia.org/wiki/Red_blood_cell#mediaviewer/File:Redbloodcells.jpg  

Day 227 – Where Have all the Platelets Gone?

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Cindy’s condition keeps on improving.  She is becoming more awake and beginning to be more responsive.  The doctors are continuing to wean her off some of the medications and administer just medications for the pulmonary hypertension.  The cardiologist is happy with her progress.  She is even beginning to lose some of the fluids that have become a major problem (7 pounds).

The pulmunologist told us that her blood platelet count was low and they had no idea why.  Her count yesterday was 19,000 and today it is 17,000.  Platelet count should be between 150,000 and 450,000.  Platelets are made by the bone marrow and plays an important role in blood clotting and preventing blood loss.  Yesterday, when Cindy’s Pulmonary Artery Catheter was removed, there was a lot of blood loss.  It took ten minutes to stop the bleeding.

http://blog.inceptsaves.com/blog/tag/platelets

Low platelet count, also know n as Thrombocytopenia, can be caused by many reasons:

  • Bone Marrow can’t make enough platelets
  • Cancer, such as leukemia and lymphoma, can damage the bone marrow
  • Aplastic Anemia, a rare blood disorder that interferes with platelet production in the bone marrow 
  • Exposure to toxic chemicals can slow the production of platelets
  • Certain medicines can slow the production of platelets.  One of them is diuretics.
  • Alcohol can also slow the production of platelets
  • Viruses, such as chickenpox, mumps, etc., can decrease platelet count temporarily.
  • Genetic conditions can lower platelet count
  • Infections can lower platelet count

All of the above reasons were ruled out.  One more possible reason for a low platelet count is an autoimmune disease called ITP.  ITP mistakenly attacks platelets assuming they are antibodies that fight infection and disease. 

A Hematologist came in to exam Cindy.  He thinks that the low platelet reading might not be correct.  He is going to do more testing to see if the materials used in the platelet lab work compromised the results.  If there is no problem with the platelet count, it is probably ITP and Cindy will probably get a platelet transfusion and/or steroids.