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Day 226 – Getting Better Every Day

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Please take the poll on the right to give me your opinion about the quizzes.    ——–>>> 

Cindy continues to improve.  

  • She no longer needs any blood pressure medication.  Her blood pressure is at a prefect level.  It had been very  low last week before going to the hospital.
  • She is still using a breathing tube, but there is only one machine helping her breath.  The nitric oxide machine was removed yesterday.
  • Instead of 3 poles of various medications and fluids, there is only one.
  • She is being weaned off of the sedation and pain medication, so she is slowly waking up.
  • Her platelets are low – not sure why.
  • The Pulmonary Artery Catheter has been removed.  There is no longer a reason to monitor her heart so closely.

The cardiologist and pulmonary doctor are discussing what “cocktail”  to give Cindy for the Pulmonary Hypertension.

And if you’re wondering who has been bringing you all the news that’s fit to post, meet Debbie in the  picture below:.

Debbie hard at work blogging

Day 225 – No Blood Clot

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One of the possible problems that concerned Cindy’s doctors was that there might be a blood clot in her lungs.  She has been taking a blood thinner just in case she had one.  Looking for a blood clot meant injecting a contrast (dye) into a vein in her arm.  The contrast cannot be used if her kidneys are compromised, so they had to wait until her kidney function improved.  Today was that day.  An expert from the line team put a new line into Cindy’s arm, she was scanned, and no blood Clot was found.  YAY!!!

http://www.vascularweb.org/vascularhealth/Pages/pulmonary-embolism.aspx

The good news about not having a blood clot is that the medications that Cindy needs does not work well with blood thinners.  Now the doctors can prescribe better medications to treat Cindy’s condition.

Day 224 – Win a $10 Starbucks Card

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Here’s a quick update.  Cindy is improving – slowly.  The goal this week is to wean her off some of the support medications and breathing device.  She is resting comfortably.
In honor of Cindy doing so well, I’m going to suggest we have a drink in honor of her.  Also, here’s a quiz about Cindy’s favorite drink:
Quiz:
What is Cindy’s favorite beverage?
http://s236.photobucket.com/user/caitchaos/media/starbucks-IV.jpg.html
Here are some hints:

  • The base ingredient is coffee or possibly strawberries and cream.
  • It’s blended with ice and other ingredients.
  • It usually has whipped cream on top.
  • It is sold in stores and vending machines
  • The name of the beverage comes from French and Italian
  • It was developed, name, trademarked, and sold by a coffee shop chain called Coffee Connection.
Please answer in the comments section.  The winner gets a $10 Starbucks card.  We might need to have a runoff if there are too many correct answers. 
Good luck!

Day 223 – Pulmonary Hypertension

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What is Pulmonary Hypertension?

Cindy was diagnosed with Pulmonary Hypertension.  Pulmonary Hypertension occurs when there is an increase in pressure in the pulmonary arteries – the arteries that carry blood from the heart to the lungs.  The diagnosis is based on the readings from the Pulmonary Artery Catheter (see post-Day 221 – Pulmonary Artery Catheterization).

Pulmonary Hypertension
Pulmonary Hypertension
Picture of Heart from Wikipedia

This is how the heart works

  1. The right atrium (upper right side of the heart) pumps de-oxygenated blood to the right ventricle.
  2. The right ventricle (lower right side of the heart) pumps blood to the pulmonary arteries.
  3. The blood flows to the lungs
  4. The blood picks up oxygen
  5. The blood flows to the left atrium (upper left side of the heart)
  6. The blood is pumped to the left ventricle (lower left side of the heart)
  7. The blood is pumped to the rest of the body  through the aorta

When Pulmonary Arteries Become Inflamed

Cindy’s pulmonary arteries have become inflamed.  The inflammation is due to one or more of the following:

  1. A blood clot
  2. Plaque in the arteries
  3. The arteries have been damaged for other reasons

What Does All This Mean?

  1. Her heart cannot push blood through her pulmonary arteries and into her lungs
  2. Pressure increases in the arteries
  3. Her heart has to work harder to pump the blood
  4. Her right ventricle has become weak
  5. Fluid backs up causing fluid retention
  6. Her lungs aren’t  getting enough blood
  7. Her left ventricle doesn’t have enough blood to push through the rest of her body (Heart failure)
  8. Her kidneys start to fail because they are not getting enough blood.  Her kidneys work sufficient to flush waste but not enough for her to produce urine.

What is the Plan?

  1. Administer medication to the heart to get her out of heart failure.  This includes medication to strengthen the right side and calm down the left side.
  2. Increase fluid intake, reduce saline, administer diuretics to get her out of kidney failure and remove excess fluids.
  3. When kidneys start to work better, check for a clot in her lung.  Due to her kidney problem, the procedure could not be done.  She is currently getting a blood thinner assuming she has a blood clot.  The blood thinner should not be used with some of the medications that would help her heart.
This is a lot of information to understand and can be confusing.   If you have any questions, you can leave it for me in the comments section.

Quiz:

Fill in the blank:
Viagra was initially developed as a medication for _______________________.

Answer in tomorrow’s post.

Picture from Wikipedia

Day 222 – Is There a Doctor in the House?

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Cindy was visited by many doctors today; one from cardiology, one from pulmonary, one from renal, one from gastro, and a hospitalist.  Each had seen the results of the tests from yesterday.  Each had an opinion of the best treatment for Cindy.  Give her this medicine, run this test, that vital sign is too high, it’s too low, feed her, don’t feed her, use that  tube, increase that, lower this, and on and on and on.   


Even the nurses were frustrated.


Eventually, all the doctors got together and agreed on a plan. 

And what did they decide?  To be honest with you, it was explained to us many times.  Basically, Cindy has Pulmonary Hypertension.  That is probably the root cause of all her problems because it affects her lungs, her heart, her kidneys and probably more.  I have to admit, I took lots of notes, but I’m confused.  So, dear readers, you’re going to have to be satisfied with knowing that tomorrow’s post will give a more “educated” description of Cindy’s situation.

 

Day 220 – A New Beginning

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Hi folks,

Cindy had a fall last week and cut her shin.  After a couple of days, the cut started to look infected.  Debbie took her to the doctor.  He prescribed an antibiotic.  The antibiotic seemed to have cleared up the infection, but this past Thursday, the infection started to look pretty bad.  Debbie took her back to the doctor.  There were other issues going on for her, too.  She was having a difficult time with her breathing, walking, and she had been retaining a lot of fluids since February.  She was taking a high dosage of diuretics (Lasix) and another medication to “boost” the diuretics.  Nothing was working.  The doctor suggested she go to the emergency room.  

During triage (where they first do a medical intake to see how “bad off” you are) they found that her oxygen saturation level (how much oxygen you’re getting when you breath) was low.  Her blood pressure was also low.  They put her in a room in the ER and started giving her fluids, oxygen, and a tetnus shot (because of the fall.  You should have one every 10 years and her last one was more than 10 years ago).  They also took x-Rays, an EEG and checked her for clots.  

Debbie and Cindy were talking about old times when Cindy went into respiratory or heart failure.  Thankfully, there was a doctor in the room (and REALLY thankfully – we were at the ER) and he and a team of doctors, nurses, and technicians were able to revive her.    They had to intubate her (QUIZ– what does intubate mean?  Answer to quiz tomorrow or you can check out previous posts from last year).  So here we are again!!!

                            Deja Vu

Yesterday (Friday), Cindy was seen by a cardiologist, renal specialist, pulmonary specialist and hospitalist (doctor from the hospital).    The hospitalist told us the following:

1.  The Cardiologist found that the right side of her heart was struggling and the left side was working harder.  Her blood pressure is too low.  She is now on a medication that helps raise her blood pressure.

2.  The Renal Doctor found that one of the medications she was taking for her diabetes was interfering with the Lasix which was why she was retaining fluids.  That medication was also damaging her kidneys.  

3.  The pulmonary specialist was concerned about a possible clot in her lungs.  The test for a lung clot is a Cat Scan that requires a dye.  Because her kidneys are compromised, the dye couldn’t be administered and the test could not be given.  They started her on blood thinners to treat the clot just in case it is there.  

4.  The main goal is to get her vital signs stabilized; blood pressure and oxygen saturation levels need to go up.

Today, a machine that blows Nitric Oxide into Cindy’s left ventricle was attached to the breathing tube.  It acts as a muscle relaxer that works on her heart and will open her arteries so the doctors can see what’s going on.
Cindy will be in the hospital for a while – we don’t know how long.  She is in the ICU, next door to where she was last November.  The nurses and technicians all remember her (and Debbie, Rita and Mary).  She is getting great care.  
There will be daily posts as long as Cindy is in the hospital – or she tells me to stop.

Robotic Laparoscapy

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The underlying cause of Cindy’s “health scare” during the last two months of 2013 is due to a hiatal hernia and her stomach being twisted.  She is in danger of having the blood supply to her stomach being cut off.  She went to a surgeon (Dr. Kwan – see below) today who was confident that she would be able to successfully untwist and move Cindy’s stomach out of her thoracic cavity and repair the hiatal hernia using Robotic Laparoscopy.  Below is a picture showing the hernia (on the left) and Cindy’s stomach (on the right). 

The hernia is basically a hole into the thoracic cavity through which her stomach traveled to.  Her stomach is pushing against her right lung (giving her only 40% breathing capacity) and making her heart work harder.  Last Friday (3/28/14) Cindy’s heart had an irregular heart beat (rate of 178) which sent her to the emergency room.  They gave her a shot of digoxin – and some pills for home – which helped her heart but interfered with her oxygen absorption.  She was feeling confused during the weekend and was back in the emergency room the following Monday where they took her off the digoxin.  She is feeling much better now.  Cindy is also anemic and will have a colonoscopy this Monday (4/7/14) to see if there is any internal bleeding.

As long as Cindy’s labs and the results of the colonoscopy are all good and the Pulmonary doctor agrees that Cindy is healthy enough, the surgery will be in six weeks.  She expects to be in the hospital for about 2 days.  Recovery at home should last about 2 weeks. 
 
Meet Dr. Kwan:

Cindy says that Dr. Kwan reminds her of Dr. Christina Wang of Grey’s Anatomy.  Let’s hope she’s right.

Dr. Diane Kwan of John Muir Health
Diane Kwan, MD is a board certified general surgeon, who brings highly specialized, advanced minimally invasive skills to Walnut Creek Surgical Associates.  She is a graduate of Chicago Medical School and completed her General Surgery Residency at LSU New Orleans.  Dr. Kwan also completed a Minimally Invasive and Bariatric Surgery Fellowship at Alta Bates Summit Medical Center in Oakland where she trained in advanced laparoscopy, bariatrics (obesity surgery), and robotic surgery.  Her other interests include single incision laparoscopic surgery and hernia repair.   Additionally, Dr. Kwan is fluent in conversational Cantonese.

Final Word – for now

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This is the last post on this blog – for now.  Yesterday, Cindy left the hospital and went home for the first time in two months.  Her job now is to rest and recuperate from the ordeal she experienced for the last two months.  She will be getting physical and occupational therapy at home so she can function on her own without the help of a walker.  She sometimes needs oxygen to breath.  The original cause of her condition is a hiatal hernia and an inverted stomach that has cozied itself in her thoracic cavity under her right breast near her lungs and heart.  She will need surgery to correct this problem. 

On a spiritual note, yesterday was also our father’s Yahrzeit – the Hebrew anniversary of his death.  She went into the hospital on the anniversary of our mother’s death (on the Gregorian calendar).  It seems to me that this health scare was a spiritual message from our parents to Cindy. Cindy says she remembers my parents speaking to her during the last couple of months but can’t remember what they said.  I expect they are still staying close to her, making sure she gets healthy and strong enough for the surgery.
I will start posting on this blog again when Cindy has her surgery.
Cindy and Rita posted the following on Facebook.  I am posting it here in case you haven’t seen it:
From Cindy and Rita January 1, 2014
It is the New Year and I am truly blessed. Two months ago I was taken to the Hospital and suffered cardiac arrest, kidney failure, and my lungs were giving out. My family and friends who were with me day after day, were given no hope for me by my doctors. Rita told everyone “Don’t count her out!” You could count on Rita, Mary, Debbie(my sister), Lucy and Tony (Rita’s Parents), and Ann (a good friend) who made sure someone was always at my side. Either praying for my recovery …or screaming at me to wake up. Debbie and Rita reached out to my family and friends with updates on my health. There was an out pouring of prayers, well wishes, and love. Debbie put out a blog that would be updated each day. With all the support and prayers, my recovery has been amazing. After the first month I was transfer to a second hospital to ween off my trake. Rita would work from the hospital and make sure I was getting what I needed and not ignored (especially since I could not speak). Debbie would come by everyday. Mary would come by often but (even with her BAD back) when she was at home, painting (with some help from Rita) my room and cleaning my carpet, and putting up a bannister for my 3 steps to my room, her gift for my recovery. My Hospital room was usually filled with visitors giving me support and prays. After 2 months, on New Years Eve, they released me to go home finally, I still need to learn how to walk again, but I am getting in home therapy for that. And again Rita and Mary are helping me all the way. My recovery was nothing but amazing, so much so that one of my doctors in the 2nd hospital told me to go and surprise my lung doctor from the first hospital, who did not think I would recover.
I tell this because I am truly amazed how everyone rallied around me and I feel very blessed!
I want to Wish Everyone a Happy and Healthy New Year and to be sure you treasure those around you!!!