Monday, January 30, 2006

Walked with quad cane

Sorry for not posting for a few days. This transfer kept us on our toes and very busy with changes to paperwork, talking to doctors, caregivers, double-checking and triple-checking everything... Overall, Denise is making progress. The following is the very short version of what went on. And it's still a long read...

Wednesday night was not good for Denise- no air mattress and the bed didn't work correctly, lots of new noises all night.Vomiting and pain. She was one tired cookie on Thursday. Thursday morning Denise was seen by her new SNF doctor. New place- New doctor. HMO's don't want us to get used to anyone. Because he didn't know Denise from Adam or Eve before Thursday morning the orders needed to be reviewed by us and tweaked a bit to fit Denise's special needs. She's a very special gal. Friday we spent putting the new orders in place with the
staff who seem to be getting to know Denise and appreciating how special she is.
Denise is now getting PT(physical therapy) twice a day 6 days a week, OT( occupational therapy) once a day 5 days a week. Friday she started putting on real clothes, not the stylish gown provided. Street clothes make us all feel a little more normal. Friday she walked quite a ways (150-200 feet) to the PT room where she then used a quad cane and walked very well with it. Saturday she walked to and from the PT room and later out to the patio. The PT on Saturday happened to be a therapist who worked with Denise when she was in the ICU at Methodist on respirators and many machines and tubes. She was amazed at how good Denise looked and how far she has come. She got out of bed and to the commode by herself with the OT Friday. This is a very independent step when your spending your days in a SNF. She is able to help pull herself up in bed and turn herself more now also.
Unfortunately she is still having problems with vomiting. They are trying to aspirate from the G tube very shift to try to get the gastric acid out before it comes up. Aspirations were ordered every four hours, but that is a bit much to expect from the SNF situation. We just started doing it and not sure if its helping that much yet. Friday she was evaluated by the Speech Therapist for swallowing. The G tube was aspirated and she had Droperidol for nausea 30 minutes before her eating test. She sat at the side of the bed and ate a few bites of rice, more bites of ice cream, some applesauce, and drank some mystery juice (none of us was sure what it was). She sat up for another 15 minutes after eating. Even though she had some vomiting later during the night that food stayed down. The speech therapist will discuss recommendations with the doctor Monday and she will hopefully start getting one meal a day.

Saturaday morning she vomited 4 times from 7 am to 12:30pm, but did better the next 3 1/2 hours. Her J tube feeding was set for only 16 hours a day instead of the 24 hours a day at Huntington on Thursday but was increased to 75 cc per hour for 22 hours a day on Friday night at 9:30pm. That will now deliver just shy of 2000 calories a day... what she needs to gain weight. Denise said she had a loose stool on Thursday. She had two hard stools Sat afternoon. For those familiar with tube feedings it usually can cause diarrhea so this is unusual. For those not familiar with tube, it's just more gross stuff to read about.

She got a shower on Saturday. Wednesday and Saturdays are shower days for bed Cs they tell us. She just told us it felt good.
Labs done Thursday am - Creatinine 0.4 alittle low. Sodium 133-low, Potassium 4.6 normal, Chloride 95 low, Calcium 9.7 normal, Albumin 2.2 low,SGPT 37 above normal but nowhere as high as back at Methodist, Alk Phos 312 high, Magnesium 1.8 normal. Her Hb was 9.8. On Sat early am her Hb was 9.2. Plts 553. She had the Red Blood cell growth factor Tuesday at Huntington when it was 8.7. She was not getting iron when on TPN she is now getting some in her feeding but probably is behind in iron stores. We are checking if the Iron panel was done at Huntington. Friday night we got a scary call at 11pm that her HB was 7.5 and she might be transfered to a acute care facility. It turned out on recheck to be 9.2. My aunt said it was something about waste in the PICC line... I'm so tired I didn't have time to learn about that. But the medically-inclined that are reading this can post or email explainations later on.

Denise has had a private caregiver every 12 hours since Thursday 7pm and will continue until 7pm Monday if things are going well. The nurse aunt recommended this, though expensive, it will help Denise through a tough transition of an acute care setting to the much sparer staff setting of a SNF and assure me that her needs are being met when I can't be there night or day. Though the staff is caring and concerned about Denise, the reality is that the staffing ratios at a SNF makes it difficult for them to always meet Denise's needs in as timely a fashion as they would like.


Anonymous Anonymous said...

Thanks for the update, Phil, even though you're exhausted. It's amazing how hard it is to wait when you don't post every day! I'm glad, for the most part, that things are getting better every day. Bless you and your family!

January 30, 2006 11:54 AM  

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