Friday, March 27, 2015
Dad is enjoying being released from his house arrest. He went to one of his exercise classes yesterday, then ran a few errands. When I talked to him he was heating some of his leftover braised short ribs and feeling pretty good!
Wednesday, March 25, 2015
The report from Dr. Hasan, the infectious disease specialist, was negative. The blood cultures showed no sign of infection and he is released for surgery. The wounds on his legs are much, much better, though he still has some swelling. (His physical therapist has suggested compression socks and Musselman agrees.)
The report downloaded from his pacemaker along with the EKG showed additional deterioration of the strength of the left ventricle. This could be remedied by the addition of a third lead from the pacemaker to the left ventricle.
Also under consideration is switching the pacemaker to a unit with a defibrillator. The performance of the heart is near the borderline and then there is the question of Medicare qualification. The matter is under discussion between Musselman and Dr. D. (the pacemaker specialist.)
Dr. M thinks it's a good idea to do the pacemaker work before the heart surgery. He prefers "optimizing the performance of the heart" and advises "not to take this surgery lightly, after all, he is what 89 and three quarters." We agreed.
So, Dad expects a call this afternoon scheduling the pacemaker update. It will involve a small incision to install the lead and run it to the heart. An overnight stay will be required for observation and fine tuning.
The new lead will give a new syncopation to the heart rhythm. Dr. M said there is a slight chance this will improve the mitral regurgitation, but he also said he's not expecting the improvement. but he DID mention it.
A timetable for the valve surgery was not discussed. Dr. M. did say that while the leaking is serious and needs attention, it is not an emergency. Dad should be able to return to his normal life in the interim.
Tuesday, March 24, 2015
Dad has a 9:00 appointment Wednesday with the cardiologist and we fully expect to know which way the path will go from here.
I don't have all the details, but there were some issues with his pacemaker review session last week but I expect to have these issues clarified tomorrow as well as the details from the blood culture grown last week.
So, tune in tomorrow!
Saturday, March 21, 2015
Talked to Dad every day this week. He doesn't seem too anxious and says he got stuff done around the apartment which is a change. He's usually complaining how he never has time to get anything done. Nurses coming and going. Kind of a routine has been established.
He did call doctors looking for results yesterday and finally called the right one, Dr. Hasan who is the infectious disease specialist. The nurse he spoke with was evidently friendly and patient with him. They are running a 5 day culture and the blood got to the lab on Tuesday, so it sounds like we should expect news on Monday. She did say that it was a good sign that the test was going the full five days. If an infection had bloomed, the news would have spread quickly.
Dad is staying put at the apartment and out of general circulation, but seems in good spirits. Phone calls are welcome. (214.696.1271)
I'll post as soon we know anything.
Monday, March 16, 2015
We knew the confusion was there. It was discussed at dinner Friday night and persisted through the weekend.
So I showed up at Dad's halfway expecting to meet the home nurse who was to take blood samples. Then we were going to head to the cardiologist. Or maybe were going to the cardiologist at 9 and coming home to meet the home nurse. (The confusion!)
So there was Dad waiting to get in the car with a third option and we went to an 8 o'clock appointment, only to be greeted, "Honey, you're several hours early!"
His only appointment for today was this afternoon for a routine pacemaker check. So home we went and waited.
Finally both the nurse and physical therapist came at the same time. Dad got a good workout, his PT test (much better numbers) and blood was drawn for the cultures to test for the infection.
And it's the first warm sunny day in Big D in an unusually long time.
Sunday, March 15, 2015
Dad has spent the last couple of weeks since his discharge from the hospital at his apartment waiting to see if his infections flared. He went a week of IV antibiotics in the hospital, then a week of oral antibiotics at home, followed by a week with no antibiotics. The good news is that he has shown no sign of infection. And the infectious wound (scrape) on his left shin is healing as well.
The Man is getting restless, with two weeks under what amounts to house arrest. Helen has been spending nights. Nursing care and rehab has been provided by the hospital. Much support (meals and phone calls) has been received from the church community. Nancy Nichols and Amy Severson brought dinner fixed by Chef 'Sevy' of Sevy's Grill last week: Double Manhattans, linguini with lobster and strip steaks with pie and crème brulees for dessert. He's doin' alright.
Action resumes tomorrow.
He has two appointments with his cardiologist, one for his PT test (aka pro time, or prothrombin time test) and one to meet with Dr. Musselman.
He also has an appointment to get a blood draw which will be sent to the infectious wound specialist who will grow a culture to check for infections. Results won't be known for at least 24 hours.
Obviously the next hurdle is to make sure he's clear of infection, then we can begin to discuss rescheduling the heart surgery to repair/replace the valve.
Wednesday, March 4, 2015
Last night was wound crisis night. Helen called and we were at a loss for exact instructions on caring for the leg wound (red and swollen after a day on his feet messing around the apartment) as well as the IV puncture started bleeding again. It stopped after applying a second compression bandage.
Three nurses came this afternoon. The leg is looking better, he says (and evidently they say.) The bleeding from the IV spot is another matter. They called various doctors and nurses and decided to back off on the heparin injections until the spot clots and heals. His INR is still low, 1.4, but he just keeps bleeding when the compression is eased.
His spirits are good. Food deliveries continue on schedule and the fridge is filling up.
Apartment bound with a full larder will be a good way to spend the next couple of days!
Monday, March 2, 2015
We can close some issues. Others remain ongoing.
1. Some blood showed in a stool at one point last week. Coupled with slight anemia, there was some concern about bleeding (ulcers?) Which would require endoscopy. Tests were negative and convert here has been ruled out.
2. Evidently the TEE performed Friday was not as clean as we had been led to believe. The aortic repair, the replaced valve and the pacemaker leads were all clear with no sign of infection. However, there was a spot on the leaf of the mitral valve that is probably the tear causing the leakage, but the possibility that it was vegetative (infection) could not be ruled out. So the final decision tested with Dr. Hasan, the infectious disease specialist.
Dr. Hasan feels confident the infection is currently at bay and that the spot is a tear. However, if it is infection, it will flair up quickly once he transitions from IV to oral antibiotic. Dad will have to keep close tabs on his temperature to watch out for fever.
3. Dad's INR blood viscosity has not responded quickly, it is still at 1, it needs to be between 2 and 3. He will need two Lovenox infections a day for the next few days. Home health will visit in the mornings to do vital signs and P.T. and can administer one injection. Dad will have to learn to inject himself.
Which he just did!
AND we are discharged!
Today is Dad's second Monday in the hospital.
We just met with the committee of Internists, headed up by Dr. Gill. They are satisfied with Dad's condition and see no reason he could not be discharged today. Except for two things.
First, his blood is not thin enough. Currently it is one, the level should be between 2 and 3. He needs another two or three days of heparin injections before he can rely on oral medication alone. Home injections would have to be arranged.
Second, the ultimate decision rests with Dr. Hasan, whom we have yet to see. Dad is currently receiving another dose of IV antibiotic.
More news as it happens!