Saturday, February 28, 2015

A Quick Visit

Stopped by the hospital on my way to work today.

Dad was surprised to see me. He'd been watching the news and weather reports and thought everything was a frozen sheet of ice. By the time I was out, it was starting to drizzle and the temperature was starting to climb. The thaw was underway.

No news to report. He was in good spirits and is ready to go home, but not yet anxious about it. They are still using heparin to thin his blood, but gave him some warfarin this morning, so they are starting the transition.

It was kind of an embarrassing visit. I just sat there and dozed on and off. Dad was polite about it.

Friday, February 27, 2015

Some relief

Helen just texted me that the TEE showed no infection of the heart. So Dad can go home Monday on oral antibiotics for a week, then a week free and clear, then back to Dr. Platt the heart surgeon to schedule the valve replacement that started all this. Hoo. Ray. I mean that.

At Last, Some News

It's another cold day in Dallas as I arrived at the hospital around 7 this morning. Winter mix is on the way, so they say.
(Pause in the time line.)
Make that snow! Coming down at a reasonable clip. Dad was in as good as his spirits can be when you keep the man from his breakfast.

We heard the big news earlier, first from his nurse, then from the internist. The Gallium screens came back negative, showing no signs of further infection. That's the big news we've been waiting to hear!
Not only that but no culture has grown from the blood draw they took yesterday. Previous blood draws earlier in the week had grown cultures within the first 12 hours. More good news!
Now the TEE just has to show clean images of the  artificial parts of his heart. I left him in the preop and hope to hear results this morning.
The next step will be getting him off of heparin and stabilized on Coumadin. And then there's the future course of followup antibiotics. He'll stay in the hospital through the weekend.

Thursday, February 26, 2015

Leaving temporarily

Daddy finally got a good night's sleep last night after a busy day—lots of visitors, phone calls, consultations.
He spent a lot of the day sitting up and took some walks and exercises. He's intent on trying to maintain his strength especially after one nurse helpfully pointed out that "it takes 3 days of activity to catch up with one day spent in bed."
We learned a lot from a conversation with the occupational therapist—advice for allowing Dad to remain independent in his own apartment as long as possible.
His strength, acuity and general health, which were his strong points headed into this surgery, have been hugely sapped by the infection.
Today he goes for his last galium scan. Tomorrow the TEE and, one doctor has told us, possibly some actual information, i.e. test results.
Until then, we're in limbo.

Wednesday, February 25, 2015

Wednesday Late

After a long day today and another long tomorrow, a few words for those who might be following.

Really, nothing new to report today.

He had his first gallium screening today, more to follow. He had a sonogram of his kidneys today. He is doing some physical therapy, walking and such. He's in better spirits and seems to be responding to the antibiotics. That's good news and might be a sign that the infection is not widely spread. If it were, he would probably not be recovering as quickly.

So, just another day.

Michael and Laura summed things up in our conversation last night, "How lucky we are that the infection surfaced and he didn't carry it through into open heart surgery." I mentioned this to Dad and Mary today. The conversation went on.

A few minutes later, Dad smiled and shook his head. "They were  really right!" He said with a smile. It was a real positive realization.

So, we're in a holding pattern until we know the extent of the infection.

Mary is flying back to Utah Thursday morning.

Mary and Helen, Susan and myself met for a dinner of restorative curries at Royal Thai to review the week and discuss the future.

Tuesday, February 24, 2015

Last word on Tuesday

A parade of doctors, residents (they say Daddy's is a "very interesting" case), nurses and new procedures left us with better best-case and worse worst-case scenarios.

The strep infection in the leg is in the bloodstream.

The rapidity of Dad's response to the antibiotics might indicate that the infection has not colonized any other part of the body, particularly the previous heart surgeries which would be especially vulnerable. Theoretically, if the infection were in the artificial valve and Pacemaker sites, it should be more resistant. So maybe he will be infection-free fairly soon and the surgeons can proceed with the new valve replacement.

However, if the infection is in the sites of the previous surgeries, they will take longer to recover from the strep and may mean that the Pacemaker and the valve put in four years ago will have to replaced on top of doing the new valve replacement.

Making it a hell of an operation.

The docs are doing a gallium screening (radioactive dye traces the sources of inflammation) over the next few days, plus another TEE to find out the answers.

Daddy will probably be in the hospital until Saturday at least. I will return to SLC on Thursday and possibly come back to Dallas when the surgery is rescheduled.

Meanwhile, Daddy is more cheerful and clearer than yesterday. Will brought him BBQ for dinner tonight: a good sign.

The surest sign of health in a Waddington

is appetite.
Last night, Dad couldn't even eat a bite of the beef stew David brought him.
Today for lunch, he ate a whole container full. WITH a bread and butter sandwich, followed by a black and white cookie from Lilly's bakery in Brooklyn.
Yes, he is feeling better.

I never knew...

...that cleaning a wound with hydrogen peroxide has not been recommended by wound specialists for ten years.
We learned this from Presby's wound specialist when he came to look at Daddy's leg. So Daddy, who had cleaned the scrape on his leg with hydrogen peroxide and bandaged it with neosporin, which is exactly what I would have done, shouldna done that. 
Soap and water is what you want. 
Daddy's leg was photographed—all wounds are photographed and attached to patient records—then a patch of Medihoney was applied and a loose elastic open weave bandage. 
Honey! It's manuka honey, pretty much exclusively from New Zealand bees who feed on flowers from the manuka plant which is related to myrtle. It has osmotic properties and draws out the fluid from the infection and it also has anti-bacterial properties. 
We also learned that silver has anti-bacterial properties: In modern times it was first used to help combat foot rot in Vietnam soldiers and now they use it in burn and wound bandaging. 
Good news for me, obviously. I wear 16 silver rings most of the time.

And good news for Susan—I see a whole line of silver jewelry designed to be worn over healing tattoos. An upsell for tattoo parlors...
I guess copper bracelets are so out now. 

Some questions answered

Daddy had a good night even with all the frequent wake-ups. His blood-pressure dipped again and they gave him fluids to bring it up, but he slept well. (So did I, especially after I ate some of Dave's fantastic stew—with a little Chimayo chile in the beef dredge—and a big glass of the  wonderful red.)

His white count is down but he still has a low fever. But the big news is that the blood cultures came back and they know what the bug is now: streptococcus G group. (They swabbed last night for MRSA which I have learned to be very afraid of, so streptococcus sounded better than staph to me.) It's one that is responsive to antibiotics (duh, that's why his white count is down.)

They believe now the infection came from the leg injury.

Dr. Platt came by and explained his main concern: The strep bacteria can travel in the bloodstream and "colonize" other parts of the body, and the replaced valve is especially susceptible to infection. So he wants to be absolutely sure that it is gone before he even thinks of the heart surgery.

They're sending an infectious disease specialist in today, and Dr. Musselman will come by too.

Although the prognosis is good, Daddy will be in the hospital for awhile. He needs IV antibiotics and he is still very unsteady—needs a walker to walk. The physical therapist came by today and is working on that.

Meanwhile, the antibiotics are wreaking havoc on his digestion. And the main challenge is to Dad's spirits—he hates the hospital, is uncomfortable in the bed and is bored, bored, bored.

Monday, February 23, 2015

See What Tomorrow Brings

Dad finally got into a room mid-afternoon in the Hamon wing which is for cardiac patients. His temperature immediately rose to 102. He was given some Tylenol, the fever broke and dropped to 100. He had some chicken noodle soup and stabilized.

After a long day with Dad at the hospital, Mary went back to the apartment to gather some things. (In the rush, Dad left without his glasses!) When she returned, Helen who had been there much of the day, left and went home. Mary planned to stay the night.

I spent the day making a beef stew (quite delicious if I say so myself!) I took servings to Mary and Dad at the hospital and smuggled in the remnants of a rockin' bottle of red wine. Much appreciated especially by Mary, who, like her Mother, starves herself in times of crisis and above all does NOT eat hospital food. Mom would always bring homemade meals to Dad which he always relished. The fact that he did not feel up to even a bite of the stew is a crisis of appetite that could only be described by the great P.G. Wodehouse himself.

Needless to say they continue to run tests. Confirmed symptoms include:
  • Fever
  • Low Blood Pressure
  • Elevated Liver Enzymes
  • High white blood cell count
Negative tests include:
  • Simple influenza test
  • CT scan of the liver
  • Chest x-rays
Tests in progress include:
  • A more in depth influenza test
  • Culture for staph infection
  • Culture for MRSA
And I might be forgetting something, but I think I got it right.

We had a good visit and he was resting comfortably when we left. Hopefully we'll learn more when the doctors make their morning rounds.

And Here's the Latest...

Latest news from the hospital:

Dad is feeling somewhat better. He is on antibiotics and is waiting in Emergency for a room to open where he will be admitted. Due to today's onslaught of Thundersleet, schools are closed and staffs are short-handed. Also patients are not leaving who would otherwise be leaving. So if you think hospital time moves slowly...

The urinary tract has been ruled out as a cause of infection, which is too bad because uti's are easily and quickly treated. He does have some congestion in the bottom of his lungs. When they asked him if he'd had a cold he said no, but I told Mary he'd had at least three, on one of which he went back to his primary caregiver for a second dose of Amoxicillin. Tests are underway. Currently the cause of the infection is undiagnosed.

Surgery has been postponed indefinitely.

Oops! Didnt' See THAT Coming!

The week following Dad's decision to undergo mitral valve surgery was relatively uneventful. His breathlessness seems to be worsening a rapid rate. His resolve to repair the issue is very strong. And that's huge.

Susan and I left Friday for a quick weekend together in New York City. And had a fabulous time, thank you very much. Well documented on Facebook. So we were out of the pre-surgery weekend picture.

Mary flew down from Salt Lake Saturday to be here for the week. They were scheduled to go for some pre-surgery tests this morning (Monday.) The weather threw the first punch by bringing in an inch of sleet in the early morning hours. Much better than freezing rain which is debilitating.

Dad threw the second punch by waking up with shaking spasms and a high fever. He woke Mary up who called an ambulance and took him to the emergency room. I spoke to her about 7 this morning and it looks like he has an urinary tract infection. A little rare in men, but he showed blood in his urine a couple of days ago. His doctors were somewhat laissez-faire since he was going into the hospital in just a couple of days. I'm not sure I totally understand that rationale since he was going in for heart surgery, but our inclination is always to trust the doctors.

Usually UTIs clear up quick with IV antibiotics. No decision had been made regarding postponing surgery when I talked with Mary this morning,

I'll post more as information becomes available.

Friday, February 13, 2015

Episode 2.3: A Meeting with the Surgeon. GAME ON!!!

In a zealous display of enthusiasm reminiscent of the late, great Ernie Banks, Dad has decided "Let's do TWO!" Two replacement valves that is. The 3-4 hour surgery is slated to be scheduled for Tuesday, 24 Feb at 7:30 am.  The final go-ahead will come after Dr. Platt reviews the images from a CT scan that Dad should be finishing right about now. He wants to make sure that things are just as him left them when he sewed Dad up back in July, 2011. It will also let him check on scar tissue.

Needless to say, our appointment went well yesterday. Dr. Platt is no nonsense, but listens well and has a dry, understated sense of humor. He is the surgeon who deemed Mom's cancer inoperable and who did Dad's heart surgery. We liked him then and we like him now.

The tone of the visit was set when he asked Dad, who was sitting on the examination table, to lift up his legs and lie down. Dad pivoted and swung his legs up and onto the table in perfect form, straight legs, feet together, toes down, just like a gymnast mounting a pommel horse.

"Well, you're certainly fit and in good shape!" noted the Doctor.

He only works out five times a week, we explained.

Several pertinent facts came out during the examination:
  • Dad's heart is left-dominant, meaning that the heart itself is supplied by the arteries from the left side of the heart. Fairly rare.
  • He has no blockages, the vessels are extremely clean.
  • The replacement valve is working perfectly.
  • The left ventricle has not diminished in strength since the last surgery. It was weakened then to the same degree that it is weakened now.
  • He had moderate mitral regurgitation at the time of the last surgery, graded 2+.
  • The leakage is worse now, graded 4+.
  • He did not address the mitral valve then because the aortic valve and the aneurysm were more demanding problems. He thought that three procedures would have been to much to address in one surgery.
The plan is to use the same incision and route of entry as the last surgery. While he always looks to repair, he anticipates that the best course will probably be to replace the 90 year old valve. A replacement should work for at least  10 years. Dr. Platt sees no reason not to procede. Dad is in great shape, much better shape than most of his patients who are younger.

The most important factor is that Dad wants to procede. He was out of breath after bending over and tying one shoe.

"All I know is that I just can't go on like this!"

Thursday, February 12, 2015

Warning: Contains Graphic Descriptons

If, like me, you have been browsing "mitral regurgitation repair" you have been seeing the term minimally invasive thrown about as a quicker low impact form of heart surgery. The term suggests something like an overnight or even a day surgery arthroscope of a knee or an elbow. In heart surgery land it just means that they don't 'crack' open the chest. To repair a valve, the surgeon has to get inside the heart and the only way to get there is to cut. Maybe less invasive is a better term than minimal.

If you want an illustrated step by step on "Minimally invasive valve sparring valve repair" just click.

We meet with the surgeon in a couple of hours and will certainly know more then.

Wednesday, February 11, 2015

Episode 2.2: A Visit With the Cardiologist

This morning we had our big meeting with Dr. Musselman to discuss the new diagnosis of 'mitral regurgitation' and what to do about it.

He said that when Dad first complained about shortness of breath, which was last fall, by his notes, he could hear a heart murmur, which was the first sign of leakiness. Last week the murmur had changed considerably which was why he ordered the TEE test on Monday.

The test revealed several things.
  • The aortic valve which was replaced several years ago is working fine.
  • The quality of the left ventricle muscle has declined.
  • The leaking of the left mitral valve is severe.
What that means is that the left ventricle muscle is pumping but the valve is letting the blood pour back into the chamber. It requires multiple contractions to move the amount of blood that should be moved with one contraction.

There are several ways that medication can help mitigate the situation. He has added those medications and Dad said they seem to be helping.

The other treatment is surgical. Sometimes the valve can be repaired and sometimes it has to be replaced.

Without treatment, the condition gradually (or rapidly) deteriorates into congestive heart failure, heart attack or stroke.

Dr. Musselman indicated that he feels that surgery is possible and that a return to Dad's present level of health is possible. He recommended Dr. Platt, who did Dad's previous surgery, and said that he would provide information and details to him. We are to meet with Musselman again after meeting with Platt. And that was that.

Dr. Platt's office contacted Dad the same day and the appointment was set for Thurs, Feb 12 at 2:30.

We all remember Dr. Platt to be a formidable presence who doesn't mince words. It will be interesting to hear what he has to say. I was struck by the difference in opinion between the Doctor with whom I spoke Monday and Dr Musselman today. She was so pessimistic and Musselman seemed optimistic. I wonder if he is just letting Platt play the role of the bad cop and deliver the harsh news. We'll see.

I approach surgery with great trepidation. Surgery is discussed with a cavalier and commonplace attitude, like it is no big deal. But major surgery is a huge trauma. Dad doesn't remember how hard his recovery was three and a half years ago, but I think we do. It was extremely hard for him and it took a long time for him to fully recover to the point where he could really live by himself. I have my doubts.

Well, He's Got That Goin' For Him!

Dad saw his neurologist a couple of weeks ago.

"What's the deal with this Parkinson's?" he asked. "It never has gotten any worse."

"Well, there are your tremors," she said. "Hold out your hand."

He held out his left hand. Stiff as a board.

She put him through a number of the standard physical tests. And then told him about a new test which measures the dopamine output in the parts of the brain suspected of causing Parkinson's. Evidently the test has been used for some time in Europe, but was only approved two years ago by the FDA. It is most useful for distinguishing between 'essential tremor' and Parkinson's. And so she scheduled a Dat Scan.

And now he doesn't have Parkinson's. She is slowing weaning him off his medications.

AND, he's got THAT goin' for him!!!

Episode 2.1: Several Months Later, the Plot Thickens

Well, the pacemaker was a great success. Dad felt great and went on his Honor Flight to Washington D.C. In retrospect, I think that trip means more to him now than he thought it would. They are an aggressive group, they've stayed in touch with him, had him back to a reunion group.

Dad was never one to talk about his war experiences. All I ever heard about was that he lived on a beach in the Philippines, he had a monkey and his group had a house boy and they drank too much Tuber, the indigenous fermented coconut milk. Shades of MASH. Since then, more stories have come out, like he navigated the voyage home from the Philippines on an LST because he had gone to Georgia Tech. And instead of taking leave of the services in San Francisco, he helped pilot the craft down through the Panama Canal all the way to the Atlantic Coast. I think he left the service in Charleston. He said the cost of transportation home was cheaper and he got paid.

He went with us to Santa Fe after the New Year. It was there that he really started complaining of shortness of breath and exhaustion. I didn't pay much attention, chalking his complaints off to the altitude and cold, dry weather. It was rough on all of us.

We all had continual colds through January. None of us could breath, all anyone could do was cough.

But Dad's shortness of breath persisted.

He complained at one of his exercise classes, they did a EKG (they keep one on hand!) and he contacted Dr. Musselman, his cardiologist. They did a read out of his pacemaker and did more in depth EKG scans.

The way Dad tells the story, it was almost as an afterthought that Musselman asked him if he had ever had a TEE (Transesophageal Echocardiogram.)

Of course Dad said, "No."

"Well maybe we ought to consider one in the next few months. Think about and give me a call." Dad remembers Musselman saying.

And the next thing Dad knows, he's signed up for the test the very next Monday! He asked Helen to take him to the hospital for the test and he asked me to pick him up. He was vague about what was going on, except that Musselman had made it seem casual and routine.

Monday morning I received a message from Helen saying that the Doctor performing the test would be ready to see me at 9:30. This was earlier than Dad had suggested, so I hurried over to the hospital and got there about 9:45. I spoke to the Doctor on the telephone. She described the procedure and said that the test showed "moderate to severe" leaking on his heart valve. She described the heart muscle as severely weakened and probably too weak especially when combined with Dad's age for surgery to be an option, but that we needed to make an appointment with Dr. Musselman as soon as possible."

Needless to say I was floored.

I went back into Dad's room. I asked him if the Doctor had spoken to him. He said, "No."

I decided I was not the one to deliver such a grim diagnosis and just told him it looked like there might be some valve leakage,  that we needed to make an appointment and talk with Dr. Musselman.

He agreed. Eventually he was discharged and we went across town to the Circle Grill, where people don't look like they're from Dallas (they're not, they are from Garland, Mesquite and East Dallas.) After eggs, sausages, grits and hashbrowns, we felt much, much better.

And he made an appointment with Musselman for Wednesday morning. (Feb 11)