Days 242 and 243 - Just Passing Time

Sorry I skipped a day in relating Cindy's progress.  The truth is, there was absolutely nothing going on.  Cindy slept and watched TV most of the day yesterday and just hung ot in her chair, watching the clock for a good part of the day today.  

Watching the Clock

The swallow test did not go well today.  It's probably too early anyway.  .She will have another swallow test tomorrow.

Day 241 - Ice Please

Cindy is happier and calmer now that the breathing tube is finally out.  The swallow test did not happen today.  It will probably happen some time this week.  Until then, she continues to dream of sucking on an ice cube.

Day 240 - Trached!!!

Cindy had the tracheostomy today.  The surgery went well and now she's one step closer to recovery.  This also meant that she left the ICU and moved right across the hall to the PCU (see picture below).  This is another good step towards Cindy's recovery.  Instead of an immediate transfer to the rehab she was in last year, she will stay in the hospital.

Right across from the ICU is the PCU
(Pulmonary/Cardio Unit)

We believe that Cindy will get better medical care in the hospital than in a rehab.  Even though she is "stable", she is still seriously ill.  Last year it seemed she was "forced out" too soon and the staff at the rehab did not have0020twa grasp on what her medical situation was.  Of course, the hospital staff and, of course, the insurance company might decide differently.

On Saturday, she will have a swallow test.  Hopefuly, she will do well.  Cindy would love to be able to eat real food and drink through her mouth instead of an IV.  She will also become more mobile and Physical Therapy should start soon.

Day 239 - Not Today

Cindy was upset, discouraged, and  frustrated  today.   The tracheostomy did not happen today.  It is scheduled to take place at 2:00 tomorrow. 

The doctors are continuing to have a difficult time deciding what the treatment plan is for Cindy.  We're not even sure who the doctor is that makes the final decision.  Today we were informed that they are consulting doctors from UCSF and Stanford. 

 

Is this good?  Are Cindy's doctors stuck?  Looking for more brain power? 

Day 238 - Flip a Coin

Today's doctors report was not so encouraging.  The pulmonologist who has been seeing Cindy in the hospital has been on vacation this week.  His partner, who is Cindy pulmonologist when she is not in the hospital, has a totally different point of view of Cindy's treatment plan.  You would think that two doctors from the same group, would agree on their patient's prognosis.  Instead, it seems like Cindy's recovery is based on the flip of a coin.

This week, Cindy was often on total assist from the ventilator.  The doctor thinks it would be kinder for her to be comfortable more than trying to make more progress in weaning off the ventilator.  The tracheotomy will probably be done this Friday afternoon.  At some point (not sure when), she will have a swallow test to see if she can eat and drink.  Her most immediate goal is to suck on some ice.  Anything more than that would be a bonus.  It isn't clear when she will be leaving the hospital. 

Cindy was also told that she is not a candidate for the surgery to repair the hernia any time in the near future because her heart can't take it.   It might be possible to have the surgery in a year or two.

Today, a nurse observed how much Cindy is able to tolerate having the breathing tube down her throat.  She said that most people  don't do as well as Cindy does.  I know that I couldn't.  She is braver than me.

Day 237 - MONEY!!!

Rita, Mary and Debbie (that's me) often have lunch in the hospital cafeteria.  No, this story isn't about bad cafeteria food.  It's about where you are in line to pay for lunch and how your choices affects life experiences.

Rita and I were minding own business, grabbing a tray, salad, soup, sandwich, drink, etc.  There were two cashiers.  I stood in the shorter one and watched Rita leave the line I was in and walk over to a table.  My eye wandered back to the front of my line to a woman who was dressed in a black fancy dress and heels.  She was very thin and looked frantic as she searched her purse for what I assumed to be money to pay for lunch.  She was also engaged in an angry conversation with the cashier, but I couldn't hear what they were saying, since there were three people between us.  The line wasn't moving so I moved to the other line behind two other people.  I paid for lunch and walked to the table Rita was at, passing the woman who was still in discussion with the cashier.  I noticed there was a lot of food on her tray for one person and wondered if she was not able to cover her bill. 

Right after I sat down, the woman passed our table.  Rita looked frazzled.  The woman sat at the table furthest from us.  I was about to say something when I noticed the woman was heading towards us like as if her pants were on fire. 

 

"HERE!!!"  she bellowed at Rita, throwing a $10 bill at her.  "The cashier said that was how much your meal was.  That should cover it."  She turned around and walked back to her table.

"I didn't realize I was cutting in front of her."  Rita said. "I didn't think she was in line."

Then the woman appeared out of nowhere.

"That's Karma for you."  and she walked away again.

"Wait!" I quietly called after her so she couldn't hear me.  "I think I cut in front of you, too - twice."  I was hoping for a $20 bill to fly in front of my face
 
Mary came into the cafeteria a little while later and sat down between us.  Rita told her what happened. 

"Well, there's your lunch money for tomorrow,"  Mary said laughing.

As if she had heard Mary laughing at her, the woman got up, picked up her tray and started walking over towards us again.  I was hoping for more cash, but instead ....

"Take that.  You can bus my tray.  HAH!"  and she was gone - thank goodness.

The woman at the next table, who was in front of me in the cashier line, said "I would never want to mess with her."

Mary picked up the woman's tray - which was still had most of her food on it -shook her head and said "Let's just hope we don't see her again."

Truthfully, I'd like to have someone throw some money at me, wouldn't you?
 
Oh, how's Cindy?  The same.  Sitting in a chair, breathing on her own, watching daytime TV, and waiting for the breathing tube to be removed.

Day 236 - Waiting for Thursday

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

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

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

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

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.