Day 222 - Is There a Doctor in the House?

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 221 - Pulmonary Artery Catheterization

Cindy continues to be stable.  However, the doctors are not sure that they are medically treating her correctly due to all her complications.  Today they decided to do a procedure called Pulmonary Artery Catheterization (also called Swan-Ganz).  The procedure consists of a catheter that is inserted into the groin and "pushed" up to the heart.  An x-ray is used to watch the catheter to make sure it is in place correctly.  The purpose of the test is to monitor her heart's pressure.  This will help them determine if Cindy is having heart failure, pulmonarry hypertension, or valvular disease.  It will also measure volume status.  Both a Cardiologist and a Pulmonologist with be doing the procedure and monitoring the results.

The benefit of this procedure is to be able to make good treatment decisions.  The doctors will be collecting information from the pulmonary artery catheter so they can determine the best form of therapy for Cindy.  

For more information on the procedure, check out https://www.bu.edu/av/courses/med/05sprgmedanesthesiology/002/Pulmonary%20Artery%20Catheter.ppt

One of the biggest challenges the staff will face is transporting her to where the procedure will take place.  Cindy is hooked up to so many tubes and monitors and has to be transferred to a guerney from her bed.  Below is a picture of what was following Cindy as she went down for the procedure.

The procedure went well, but the doctors never came to tell us anything.  Updates on her condition later.

Answer to yesterday's quiz.

Intubate means to insert a tube for the purpose of mechanical ventilation (helping someone breath).

Day 220 - A New Beginning

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

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

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!!!