Thursday, September 15, 2005

Weak heart, Possible PICC infection, LTAC?

Top of today's news isn't great. Denise had an echochardiogram that showed no signs of infection in her heart, and no fluid around the heart. But it showed that her heart is weak. Her ejection fraction is only 30-35% (normal should be 60-70%). What this means is that her heart is not squeezing out enough volume per beat. This may be attributed to having such a high heart rate for so long. She's getting tired. So they're going to give her some meds (coreg & cardizen... I haven't had time to learn anything about them yet) to slow her heart rate down, thereby hopefully allowing enough time for the valves to fully open/close & get a favorable amount of blood volume flowing. Now since they're going to slow her heart down, that means that they need to get more hemoglobin into her system to accomplish the same amount of oxygen saturation with fewer heartbeats... they've gotta get more bang for the beat. So they're transfusing more blood tonight to get the hemoglobin count up. Other problems might be related to her current heart concern. Might be coronary disease, but not likely. There is an off-chance of a thyroid abnormality, so that'll be checked. There's also a possibility of postpartum cardiomyopathy (simplified, a weak heart muscle). But that's also not likely, since Denise probably wasn't far enough along into the third trimester for this to happen. Still, no stone unturned. I forgot to ask the doctor if this is something that's a new hurdle/crisis, or if it's been there for quite some time, and it's just the next thing to scratch off of the to-do list. Since the doctor has been so great about feeding me all the details regularly, I fear that it's the former.
The infectious disease doctor is planning to change up Denise's antifungal medication (though not showing up for a while, the Valley Fever fungus might still be lurking). The new med will be voricanozole. The reason for the switch is apparently to avoid having Denise build up resistance to the current antifungal med. The fever curve had been lowering over the last few days (at least when I was visiting) but tonight when I left she was at 102.6, which is higher than what I've seen with my own eyes. So the fevers seem to be creeping upward again. That reminds me, just before dinner tonight, there was what appeared to be pus where Denise's PICC line went into her arm. So they removed the PICC line and sent the pus and the tip of the line for culturing. Seems to me the other day, there was the thought that the PICC line might be a player in the blood infection.
The IV feedings and gastro tube feedings are still being adjusted. They're going to try to lower the lipid content of the IV feedings. There's some concern about dehydration, as evidenced by the increasing heart rate... at least that was the thinking this morning, before the echocardiogram. Also this morning, there was talk about getting the possibility of starting to look into a long term acute care (LTAC) facility if she stays stable and things continue to move in a favorable direction. That was also before the echocardiogram, which kind of blew that LTAC idea out the water for the moment. LTAC is something else we're not looking forward to, as none of us like the idea of Denise being gone for months beyond the two months she's already spent in the hospital.

And from the "When It Rains, It Pours" department, my dad started back on chemotherapy yesterday (maybe I should set up a blog for my mom & pop), and Gracie & Jacob are both running fevers tonight. The pediatrician on call (at 10 pm) said that from the sounds of things, Jake might have an ear infection, so we've got an appointment for tomorrow morning and we're praying that I don't have to go to urgent care later tonight.

4 Comments:

Anonymous marcia said...

Phil:

I get down just reading this post, so I can't imagine how you are feeling today. I'm so sorry your father is back to chemo, and the kids are sick on top of things. Vitamins and rest for you, okay?

I am encouraged that the docs and staff are so on top of things for Denise. Her situation continues to be so complicated, and you are fortunate to have so dedicated a staff. Something to be grateful for on this dreary fall morning...

marcia

September 16, 2005 8:20 AM  
Anonymous Anonymous said...

I pray for strength and endurance for you in this time. When you are down in the dumps, remember to look up and find comfort in the Father's arms.

Love, hugs and kisses,
Rachel T.

September 16, 2005 9:22 AM  
Anonymous Anonymous said...

We continue to lift you and yours before the Lord my friend.

Love - Rose

September 16, 2005 10:38 AM  
Anonymous Skye Morgan said...

Hi Phil,
It was so nice talking to you and your father-in-law today. After I did the Ultrasound today for Denise's Paracentesis, I drove home just thinking how lucky she is to have a great husband and great family. It made me feel so good today when she reached up and touched my arm to say thanks! She is such a fighter! Your kids are so beautiful too. I will be praying for all you. I hope she doesn't need any more taps to her belly, but if she does I hope I am there to do it. I'm glad that I could be a part of something that hopefully brought her some comfort and relief! Keep your head up!

Skye or Ski as you know me from Arroyo!

September 22, 2005 8:41 PM  

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