Day 228 - Red Blood Cells to the Rescue

Cindy continues to improve - lots of baby-steps, but she's going in the right direction.  The doctors came up with a decision on what to do about Cindy's low platelet count (see yesterday's post).  They've decided to give Cindy a medication that "attacks" her red blood cells instead of the platelets.  The downside of this procedure would be that Cindy becomes anemic which is less of a problem than her blood not clotting.

http://en.wikipedia.org/wiki/Red_blood_cell#mediaviewer/File:Redbloodcells.jpg

 

 

Day 227 - Where Have all the Platelets Gone?

Cindy's condition keeps on improving.  She is becoming more awake and beginning to be more responsive.  The doctors are continuing to wean her off some of the medications and administer just medications for the pulmonary hypertension.  The cardiologist is happy with her progress.  She is even beginning to lose some of the fluids that have become a major problem (7 pounds).

The pulmunologist told us that her blood platelet count was low and they had no idea why.  Her count yesterday was 19,000 and today it is 17,000.  Platelet count should be between 150,000 and 450,000.  Platelets are made by the bone marrow and plays an important role in blood clotting and preventing blood loss.  Yesterday, when Cindy's Pulmonary Artery Catheter was removed, there was a lot of blood loss.  It took ten minutes to stop the bleeding.

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. 

Day 226 - Getting Better Every Day

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

Day 225 - No Blood Clot

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.

Day 224 - Win a $10 Starbucks Card

Here’s a quick update.  Cindy is improving – slowly.  The goal this week is to wean her off some of the support medications and breathing device.  She is resting comfortably.

In honor of Cindy doing so well, I’m going to suggest we have a drink in honor of her.  Also, here’s a quiz about Cindy’s favorite drink:

Quiz:

What is Cindy’s favorite beverage?

http://s236.photobucket.com/user/caitchaos/media/starbucks-IV.jpg.html

Here are some hints:

• The base ingredient is coffee or possibly strawberries and cream.
• It’s blended with ice and other ingredients.
• It usually has whipped cream on top.
• It is sold in stores and vending machines
• The name of the beverage comes from French and Italian
• It was developed, name, trademarked, and sold by a coffee shop chain called Coffee Connection.

Please answer in the comments section.  The winner gets a $10 Starbucks card.  We might need to have a runoff if there are too many correct answers. 

Good luck!

Day 223 - Pulmonary Hypertension

Cindy was diagnosed with Pulmonary Hypertension.  Pulmonary Hypertension occurs when there is an increase in pressure in the pulmonary arteries - the arteries that carry blood form the heart to the lungs.  The diagnosis is based on the readings from the Pulmonary Artery Catheter (see post Day 221 - Pulmonary Artery Catheterization).

Picture of Heart from Wikipedia

This is how the heart works:

1. The right atrium (upper right side of the heart) pumps de-oxygenated blood to the right ventricle.
2. The right ventricle (lower right side of the heart) pumps blood to the the pulmonary arteries.  
3. The blood flows to the lungs
4. The blood picks up oxygen
5. The blood flows to the left atrium (upper left side of the heart) 
6. The blood is pumped to the left ventricle (lower left side of the heart) 
7. The blood is pumped to the rest of the body.through the aorta

Cindy's pulmonary arteries have become inflamed.  The inflamation is due to one or more of the following:

1. A blood clot
2. Plaque in the arteries
3. The arteries are damaged for other reasons

What does this mean?

1. Her heart cannot push blood through her pulmonary arteries and into her lungs
2. Pressure increases in the arteries
3. Her heart has to work harder to pump the blood
4. Her right ventricle has become weak
5. Fluid backs up causing fluid retention
6. Her lungs aren't  getting enough blood
7. Her left ventricle doesn't have enough blood to push through the rest of her body (Heart failure)
8. Her kidneys start to fail because they are not getting enough blood.  Her kidneys work enough to flush waste but not enough for her to produce urine.

What is the plan?

1. Administer medication to the heart to get her out of heart failure.  This includes medication to strengthen the right side and calm down the left side.
2. Increase fluid intake, reduce saline, administer diuretics to get her out of kidney failure and remove excess fluids.
3. When kidneys start to work better, check for a clot in her lung.  Due to her kidney problem, the procedure could not be done.  She is currently getting a blood thinner in the assumption she has a blood clot.  The blood thinner cannot be used with some of the medications that would help her heart. 

This is a lot of information to understand and can be confusing.   If you have any questions, you can leave it for me in the comments section.

QUIZ:

Fill in the blank:

Viagra was initially developed as a medication for _______________________.

Answer in tomorrow's post.