Thursday, December 29, 2005

PT visitor, SMA syndrome? Granulomas? Med change-up

We're still waiting to see if Denise comes home this weekend, or stays through the weekend. The USC doctor paid another visit today and said he thought that everything revolves around nutrition, and he's concerned about her staying in the hospital and losing ground. True. The hospitalist then came in and said she put in a request for rehab. A PT came by to do a rehab evaluation. The good news is that Denise is strong enough to not need to go to rehab. The bad news is that if she doesn't go to rehab, she either stays in the regular room and only gets PT/OT once a day, or she goes home for this weekend (and I already stated my concerns in a previous post). She used her walker to do a circuit around the nurse's station. It's not nearly the distance she did in rehab, but it's much farther than the couple of yards that she walked yesterday.
Now here's a very cool twist that makes not going to rehab not so bad... One of Denise's college buddies is a PT. She's not currently employed. She lives in Pasadena. She made herself available to work with Denise. Talk about a godsend! She came by today and had Denise do some bed exercises, which Denise loved. Thank you, thank you, thank you!

A G.I. doctor talked to me about yesterday's test with the barium. The barium went down fine, but was delayed at the duodenum (the beginning of the small intestine). They rolled Denise to one side, and the barium continued nicely through the slow part. He said that there's a possibility that Denise's vomiting might be caused by something called SMA (Superior Mesenteric Artery) syndrome. There's an artery that crosses over the duodenum. In really skinny people (like Denise is now), the artery can press on the duodenum so much that the duodenum compresses and makes for a blockage, and sometimes some pukeage (did I just make up a word?). I learn something new every day! I think I remember hearing about this also happening during pregnancy. Another possible cause for the vomiting is that the cocci (valley fever fungus) did go to the brain and damage the basal ganglia, which the G.I. doctor described as the vomit control center. Since Denise's case is rather rare, there's not much data that the doctors can gather from other cases and apply to helping her. Instead, it seems that she'll be the source of data. Perhaps her case will make it into medical journals and be of help to other people that have Valley Fever. By the way, a cardiologist today said that Denise seems to be the only person on record to survive having disseminated Valley Fever while in the third trimester of pregnancy. And the cocci went to the brain on top of it all. She's our miracle girl!

I'd like to say that I learned another new thing today, but I really don't understand what I'm about to write. I haven't researched it, so I'll just try to spew out what I heard. Denise's test for ionized calcium (not regular calcium) came back high. There are a couple of things that can cause this. The spores associated with Valley Fever can cause granulomas (where? I don't know... I forgot to ask). These granulomas put out something like vitamin D... which is associated with calcium. OR immobility and lack of weight-bearing by the bones can cause the bones to leach out calcium, also making for high calcium test results. I think there was supposed to be another possible cause, but doggone it, I can't remember.

Other developments:
  • Off of Coreg & Digoxin meds that were helping the heart... pulse up to 100, and they'll keep an eye on it to make sure it doesn't go too high
  • Seizure meds: Depokote stopped. I think the new med is called Topamax. Great! I can see it now... another prescription that I won't be able to fill if she's discharged over another holiday weekend.
  • Denise was in better spirits today, didn't vomit, and doesn't have to stick to the liquid diet anymore. In spite of that, a doctor recommended that a psychologist visit to evaluate her for depression.
  • Potassium went lower again today... 2.6 (normal is 3.5 - 5.3)
  • There will be some electrolyte, metabolic & endocrine tests on deck
  • My favorite: Hair's growing back... the bald top & back of her head is starting to get peach-fuzzy!


Anonymous Anonymous said...

I am just amazed by the amount of medical knowledge you have aquired! By the time Denise has been home for a while, you could open your own practice!! (scary thought, isn't it??!!)

It is so wonderful that God has brought Denise through this awful valley fever, and to the place she is now. It's probably best to never be the medical study, but what a testament to faith in God that she has survived and is doing so much better. It has truly been a long haul, but God has worked miracles in her life.

I hope that whether Denise goes home today, tomorrow, or Tuesday, you are able to get the medications that she needs and the help from the medical community that you need to make the transition smoother this time around. And I hope that whenever she does get home this time, that it is permanent!!!

God bless you all,
Lisa J.

December 30, 2005 8:54 AM  
Anonymous Anonymous said...

"a cardiologist today said that Denise seems to be the only person on record to survive having disseminated Valley Fever while in the third trimester of pregnancy." Well, we know the reason for this, don't we? Praise You, Lord, and thank You for keeping Denise in the palm of Your hand. Keep on keeping on, Phil. I'm here in Coalinga joining with the rest who are praying for you all.

December 30, 2005 9:11 AM  

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