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).

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

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. 

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.

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!!!

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. 

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

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.