Wednesday, January 11, 2006

In the hospital, PICC line, No J-tube, No SMAS? IV nutrition on deck

I just got back from Huntington Hospital, where Denise was admitted again to try to correct her malnutrition resulting from not being able to hold food down (and get meds into her that she hasn't been able to keep down). The gastro surgeon told us that it's reasonable to expect at least a week in the hospital. A PICC line is being inserted. IV nutrition will start tomorrow. It's called TPN, and it's custom-mixed to meet a patient's needs (looks like a pina colada, which we could probably all use right about now). Unfortunately, an order wasn't put in for Denise in time for the 3pm deadline to mix the stuff. So her order will be picked up tomorrow after 3pm, processed, and she'll get her TPN started hopefully soon thereafter. In the mean time, she's getting an IV with electrolytes & as many of her meds as can be given through the IV. She is on a clear liquid diet, but only drank a little bit of apple juice and ate a few spoonfuls of chicken broth for dinner tonight. She likes to sleep and is weak, but did sit up at the edge of the bed for a few minutes and used a walker to get into the bathroom. That's about as much activity as she could handle.
The gastro surgeon had doubts about Denise's vomiting being caused by Superior Mesenteric Artery Syndrome (SMAS?). I also got quite an education about what a J-tube is and is not. Denise already had a G-tube and a J/G-tube (combo, the J-tube being inserted within the G-tube). I thought it was the same as a G-tube, except placed to the jejunum instead of the stomach. But it's not that simple. Placing a J-tube is much trickier than placing a G-tube and can cause more long-term problems. The gastro surgeon thought it'd be better to give Denise IV nutrition instead, as she's so frail that she might not do well during a surgery. Earlier today the gastro surgeon discussed the case with the USC doctor, who thought that Denise would do well to stay on the TPN for at least a month (start at the hospital, then have nurses continue it at home).
Today we signed up to start a caregiver with Denise. She sounds super. But Denise isn't here to care for right now. Ironic, isn't it? We need lots of wisdom & guidance in what to do next. We're kicking around some ideas about how many hours a day to have a caregiver for Denise, and now whether to pay to retain this one that can work the hours we think we need, or pass & start looking again whenever Denise is well enough to come home again. We're also considering finding somene to stay with us once my aunt's gone to take up the slack with meals, housework, kids, errands, etc. A live-in caregiver from the agency isn't much more per day than paying hourly, and can help with the tasks. We've also got a couple other possibilities to pursue. I never thought I'd be worrying about these things at this stage in my life, that's for sure.


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