Tuesday PM 09-30-08

After several hours off of the ventilator, everything seems to be fine. Mother is breathing on her own and is under observation with the ventilator in bypass mode; that is, mother is breathing without oxygen. Her blood oxygen level is still in the 90s. She is off of the Propofol anethesia and is mildly alert. Her eyes are open wide and she looks into your eyes at times, but other times her eyes glaze over. It will take a while for her to get back into this world mentally; she will be more cognizant in 2-3 days.

As a result of the Profonol cutoff, her blood pressure has returned to normal. I asked the nurse to keep an eye on it because she was on blood proessure medicine before all of this started. She said she has a watch for 170 on top and is to call the doctor if it gets that high. It was 145 when I left. The nurse said her current pressure is actually within the normal range.

Mother tested negative in her blood for CDIF, a condition of the colon or intestines. That was good news.

The plan for tonight is to be at or close to her side all night. She will gradually regain full awareness of her surroundings. Tomoorrow morning, the doctor plans to remove the ventilator. At that point, we expect her to have an extraction tube for fluids in her mouth and nothing more.

The pulmonary doctor was upbeat this afternoon. He was routing for her to recover and noting how miraculous all of this progress has been. In the photo to the left, on the right is mother and on the left her sister Avis.

Monday and Tuesday 09-30-08

We have some major changes today. Over the weekend, the feasibility of removing the ventilator was tested. Mother passed the tests. The doctor is now taking her off of the Propofol, which is used to sedate her. She is being prepared for removing the ventilator altogether today. This will require the family to make a decision on what to do should this fail. That is, do we put her back on the ventilator if her lungs suddenly fail to do the job or let her go? This gets rather complicated for our family. It has to do with the doctor’s vision of her future and dependence on dialysis. The attending physician discussed her general condition with me this morning and he is predicting her to be bed ridden for more than six months and in a nursing home for the next year.

Over the weekend, mother had bleeding and lost a couple of pints of blood in her bowel movements. This is believed to be an ulcer related to the event that led up to the current situation. They gave her a rest from tube feeding and went back to the IV feeding method. Today, after three units of blood being given her over the past 3 days, she has stopped bleeding visually and her blood tests indicate that she has stopped losing blood. Therefore, they will resume tube feeding but at a lower rate and keep with the IV feeding at the same time to keep her system active but working less to see if this problem just goes away.

Her white blood count is 14800, dropping quite a bit from yesterday. That shows her infections have not gotten worse and maybe a little better. Her skin continues to have a lesion on the back, buttocks and calf. Those are the worse lesions needing to heal. The good news is that all three continue to get smaller. On the other hand, she has developed another one on her right back heel and that has grown a bit over the past few days. This may be a bedsore although she has a special bed. They are propping it up to relieve the pressure on it. Her mouth and skin continues to improve. The area of most general concern is the buttocks area because it is difficult to keep her weight off of that part of the body.

Her dialysis took 2.5 liters of water yesterday, which was the goal. Her blood pressure was normal. It took a 4 mic dose of heart pressure elevator medicine to get it high enough for an effective dialysis. The nurse says she is weaning her back to zero today.

Sunday 09-28-08

There are few changes today. However, the lung doctor continues to wean mother from the breathing machine. He ordered her cut from 12 to 8 breath assists per minute (50%of her breath rate on Friday). Her blood oxygenation dropped from near 100% to about 93% with yesterdays cut by 4 breaths. Also the blood pressure medicine to raise her pressure has been completely turned off. Both of these steps are necessary for her to return to normal and we are trusting the doctors with the timing of these actions.

Saturday AM 09-27-08 incrementally improving

Today's goals besides to nurse her through this, are to continue to lower her dependence on heart medicine and to reduce her dependence on the ventilator. The Pulmonary doctor ordered her breathing rate to be reduced from 16 to 12, a 25% reduction target but leave the oxygen level at 40%. Her heart mediine for increased blood pressure has been cut in half from last night of 2 mics to 1.0 mics today, a very very small amount being administered. She is holding a fairly good blood pressure at 50-54 but a bit lower than last night. Not much other difference in any of her vital stats or other medicines. Her white blood cell count remains about the same at 14000. She was partially out from her blankets this morning with "I love Lucy" on TV, with the sound volume up. She moved about a bit when I addressed her, but not much. She did not open her eyes while I was there. However, she did respond to the nurse when she asked her to cough. Last night I read scripture to her and stayed there in a rather noisy environment. Her nurse was quite loud. Mom's mouth continues to improve. I was there when the nurse treated it tis morning, swabbing it out and then treating with the simplex salve. I did not get a report on her skin. She will have another bandage treatment about 230PM today. Monday will be her next dialysis.

Visitors over the weekend

Mother continues to be weak and non-responsive, under the influence of sedatives. However, we believe she listens and if she knows your voice, she will be comforted by visitors presence. Our family would appreciate readings from the bible from those whose voices would be recognized. I read to her from Psalms last night. I believe that is really good therapy - the bible and those she loves. I think I will be here. Chepa is planning to come Saturday evening.

Friday AM 09-26-08 - I am wearing jeans

I'm wearing jeans.

Today things are even looking better for mother. I made a mistake yesterday in saying Dr McKennon's assessment is 35-40% survival. I will change that statement. He meant me to understand that she has a 35-40% non-survival rate! That is, she has a 65-70% chance of making it through this ordeal! He said this morning that he is optimistic that she will make it! One has to manage one's expectations however. There is a huge probability that given her survival and recuperation, she will remain on a three times a week dialysis. There remains a slim chance of her kidneys returning to normal. Assuming she does survive and elects to remain on dialysis, the quality of her life becomes the issue as well as where she should live. Right now, it looks to me to continue to be her apartment but with added services, perhaps nursing at first and later some assisted living services. We will see. It is too early yet to draw up a plan.

The Pulmonary doctor says her lungs will fail sometime after he takes her off of the ventilator. We have to resolve this gap in view between these two doctors. The basis of his assessment is the survival rate of ARDS patients and her age. It should be noted however that she may not even have ARDS. His initiative to remove the ventilator stems from us hoping to get her off of it as early as practical. We would not like our influence to be the driving factor however. It must be the right thing to do medically for her to get well. Her general attending physician is aligned with its removal, but the decision will be made by the Pulmonary doctor. There was a lot of confusion in the lung doctor's position, but I concluded that he was taking a pessimistic view of her survival different from Dr McKennon and assuming some things Dr McKennon is not. So my view is guarded but biased towards Dr McKennon's view since mother has essentially been his patient, and he is being assisted by the specialists. The Pulmonary doctor has started assessing if mother can get off of the ventilator. I believe he does not want to give us false expectations and hope. The primary attending doctor McKennon told us that his position is based on a professor's statement in medical school, "There is no value in pessimism." This is the prevailing thought of the day and one we will embrace.

This morning mother had her Friday dialysis. That process pulled the largest amount of fluid from her system than any dialysis she had to date - 2.5 liters. That is almost the goal. The process fell short 1/2 liter in the 3.5 hour session. (liter approximately the same as a quart).

Her blood pressure was good this morning, much better than the past few days. That was the result of applying a little more heart pressure stimulant than before. It was 115/43 (61 average) while in the first hour of dialysis. Her white blood count lowered to 13300, the lowest it has been all week. That probably means that her skin is having to fight bacteria with fewer white blood cells and therefore is healing. That corresponds to what is apparent in her skin healing. Mother will be given two units of blood today to help bring up the hemoglobin level in her arteries and support her blood pressure.

Yep, I am wearing jeans. I am relaxing a bit from this stress. Mother will fight her fight for survival, with us helping her through our support. Our family will be unified by our approach to getting her well so she can live a respected and fulfilling life through her remaining years. This is our hope and prayer.

Thursday AM 09-25-08

I talked to all the doctors this morning to get new insights into her health. I will approach this from their responibilities and specialties, presenting the facts and their views as I undertood them in our conversations.

Overall (attending physician)

She has a 65%-70% (corrected 9/26/08)chance of survival. She is ventilator and dialysis dependent. The Zestin antibiotics worked well to relieve her lungs from pneumonia. We no longer have that issue. Also, she has normal digestive system functions now. All her food is coming from a tube-fed liquid diet. That diet may need to be increased in volume but the dietician believes it has the right contents for mother's illnesses and condition. She is tolerating the liquid diet very well. Her skin lesions on the back are healing. The lesions on her left leg and buttocks continue to be about the same, perhaps slightly improved. The family will need to consider whether they want her to get a trachiostomy. I have not read up on this yet, but I am planning to read this article on it - John Hopkins University. It is something to start thinking about. The doctor said it would need to be done in two weeks, but the Pulmonary specialist said that is incorrect. His information is outdated. Two weeks used to require a change of the entry method but now with current technology applied, we can wait a couple of months. We don't know why her blood pressure is so low. The doctor will talk to the Cardiologist to see if another EKG could be acquired. Another cat scan is considered not neccessary. The EKG should tell us everything we need to know about any changes in the heart. Her arteries and circulation system elsewhere seems to be stable. She is not losing any significant blood. The blood on her mouth is not as bad as it looks but it is a "horrific" case of simplex that is being treated and getting better. Her diet is OK but may need more volume given to her. The dietition has reviewed the content of her tube feedings and she is getting sufficient calories for her condition. The doctor believes her skin requires more calories, thus the volume question. Her heart medicine for pressure is being given to her in low doses. When they started treating blood pressure they were giving it to her at a rate of 102- Mics. Now it is at 3 to 3.5 mics. She is on 30 mics propofol for a general sedative and pain reliever. She gets morphine for bandage changes. (I think dialysis is also included but not sure). A conference between doctors and family might be a good idea at this point.

Kidneys

Using same IV to perform dialysis as put on her on 9/12. She is producing no urine, so the kidneys are not functiong. There is a method to assess if the kidneys should we at sometime decide to pull support, that is to stop dialysis while she is dependent on it. It is called Nuclear Median Scan. It has no usefulness otherwise. It can tell how much the kidneys are damaged. Most patients in the ICU recover from situations like mother's. That does not mean she will recover her kidney functions but she has decent chance of that. Her prognosis is very poor, but we do not give her a zero chance of recovering her kidneys! If we thought that, a conference between families and doctors would be appropriate.

Lungs

She may have a condition known as ARDS. A web link for reference: ARDS. If so, there would not be any change in treatment. It is just academic to discuss this. It would be like beating her lungs and bruising them. The symptoms are there and the history of the patient indicates this is a feasible diagnosis (possibility raised by Dr McKellon). There is substantial water in her lung tissues but she is getting oxygenated quite well with the ventilator machine. Her blood acidity is about normal indicating that she is removing the CO2. The healing process is slow.

Heart

Not much discussion today. Dr McKennon indicated he would be requesting an EKG. Other than that, previous discussions still hold true. Her heart is pumping well. Dr McKennon said that the fluids are dispersing in her system from her heart abnormally because of the liquid content of her tissues. It is like going into a large cavity, so the low pressure is lower than normal.

Her stats for the day:
White blood count 15.5 (about the same), Red blood count 3.01, Hemoglobin 9.1, Hearbeat 72, O2 95, breathing rate 16, blood pressure 107/41 (56). Her lungs are getting 40% O2 under an air pressure of 25.

To live or not to live, that is the question

I discussed mother's condition with all of her doctors this morning. Based on those conversations, I am prepared to offer this summary plus my personal view. As ususal, I am also publishing the details from those conversations, but this is essentially an editorial.

Mother looks a lot worse than she is, but she is not well by any means of the imagination. She needs the ICU care to get out of the woods. She continues to have multiple organ issues. One organ can be classified as failure since it is not functioning at this time. That is the kidney. Sometimes we need to step back and look at the whole picture and remember the history of how she got here to keep ourselves aligned with what is happening.

She got here by falling and being on a hard floor for probably about 36-40 hours, causing a shock to her entire system. It is like getting bruised inside and out. Her organs must be repaired before her health can improve. That includes her skin, kidneys, colon, lungs and heart. She had a mild heart attack recently but we do not know when. She is weak but recovering. The doctors do not know what her outcome will be but provide insights and opinions. Nurses do also but are not charged with her health decisions, but are there for her hour to hour care.

Mother continues to be treated with various interventions to make her healthy again. This includes heart pressure medicine, heartbeat medicine, ventilator machine, dialysis machine, salves and bandages, antbiotics and pain relievers. She has dependencies on all these right now. She has been given roughly 30-40% chance of survival by her primary attending physician, Dr McKennon.

My personal view, knowing my mom, is that we should be continuing with the treatments with a positive view. She is 87 but has a strong will and wants to live until she is 90. Her love of life will not be forgotten as well as her will to live in the oncoming days or weeks. She is not in a terminal situation nor being treated as such. That is, she is not a terminal patient who is on life support to keep her organs alive. She is a living being, trying to recover from injuries. She is being treated to overcome the issues at hand. We could be facing 3 months or ever 6 months for rehabilitation after this to get her to any kind of quality life.

The question that remains is what quality of life she will have after this intervention, if she does survive. No one knows. I have heard of several cases recently where such a patient has recovered and gained 10 or more years of quality life.

I write this article because three times (maybe even four) now we have been put under the stress of requests to end her life. I want to be very clear about this. My mother cannot communicate now but she did several times while she did not have the ventilator and could communicate. She is substantially weaker now, but she still has the mandate that she presented in the ICU to the attending physician. "Yes, I want intervention." She does not however want to be a vegetable nor live indefinately depending on life support systems. That is where the family could have to make a decision in the future. Those systems are in place now as intervention so that her organs can be repaired. She needs the prayers of family and friends. She needs presence of family, encouragement and support. Personally, I realize people relate to this in various ways. The bottom line however is not our will nor our emotions but hers. It is her life, and she is entitled to it. We will do everything we can to support her.

I will do what I can to get her to the point where she can receive roses she so carefully helped to create when she partnered with the Clairmont. Those roses are at the height of the blooms now, and she has not seen them since they have broken into their full beauty. When she can touch and smell them, that will be a bid day for her. I am looking forward to the day when she can see my brother's video of him receiving his award in Fort Worth. I am looking forward to the day when she can again attend church. There is much to look forward to and she is squarely directing her energies at this moment to reaching her goals of life. Hopefully, these days will come. We are all at the mercy of God's enduring love. If He wants her to see those days, he will help her through this trial with her body.

Randy's cell

My cell phone is lost, somewhere on Highway 290. I doubt if I can be contacted over the next few days except by email and face to face. I will be spending some time at the hospital today, but will try to get some rest after looking for the phone to about 3AM this morning. Russ or Kelly are better phone contacts until I get my cell back or get another one.

Heart medicines

She is taking two dangerous medicines to help her through this crisis.

1. Amiodaron - to control heart speed and especially to prevent another episode of fibrillation. Link is to Drugs.com. I was told by the Cardiologist that this drug could have long term effects but for the moment, it is helping her to recover. It is "peripheral vasoconstrictor (alpha-adrenergic action) and as an inotropic stimulator of the heart and dilator of coronary arteries".
2. Levofed - to maintain and raise her blood pressure. This is an arterial constrictive drug. Link is to Drugs.com.

Wednesday AM 09-24-08

Mother is resting after having her bandages changed. She received a little mor morphone this morning to take away the pain. She looked much more at ease with the bandaging process. There is no change in her condition. Her mouth was cleaned up a bit today of dried blood, so she looks better. Her face has better color and her skin looks like it has just about totally recovered from the oxygen mask. She has no feeeever but her white blood cell count is a little elevated from the last time I checked. It is 15400, up from 14000. Her red blood count is low, as well as her albumin. I am concerned about the albumin and the protein level in her bood stream. She continues to be undernourished. I did not ask but will put this on the question list. It looks like she is off of IV feeding. Her digestive system might not be absorbing proteins and albumin. She continues to be fed a liguid diet through the tube. The nurse is considering a plan to take her off of IV for the remaining drugs and using her food mixture for administration of meds. The doctor has not ordered this yet, but she is suggesting to the doctors that this would be better practice. Today, Kate is her nurse. Mother's vital signs this morning when I went to see her were: heartbeat 70, O2 in blood 96%, breathing rate 14 (still assisted by ventilator), blood pressure 120/33 (54). Her pressure dropped to 49 when put on morphine.

Tuesday AM 09-23-08

Mom continues to have issues with blood pressure. The dialysis only pulled 400ml yesterday due to that problem. This was the lowest water take from a dialysis since she started the treatments. She continues to not have a temperature problem. I do not have her white blood count today. Other key elements were extracted OK yesterday in the dialysis. Her BUN is 39 (OK), Albumin 2.5 (remains low), Creatinine 2.8 (OK). Her mouth seems better. There is better clotting and no new blood detected when they swabbed the mouth this morning.

The wound therapist told us early afternoon that she was in more pain today than normal and the three places that appeared yesterday have remained the same. Tomorrow I will engage with the doctors to get an updated prognosis.

Monday PM 09-22-08

This evening, mother was on a dialysis targeted for 4 hours and 2 or 3 liters of water removal. That is a very stressful dialysis. She had not completed the process as of the last check but was doing fine. Earler, her blood pressure was low, giving us concern about the dialysis but mother is doing OK now.

There is a new tissue issue. There are three new places about the size of a dime where the skin has started to die (turn black). This may be caused by the heart medicine. It is of course being watched for change. There is one on each heel and one on her back.

Her mouth continues to bleed and she has blood clots in her mouth.

Monday AM 09-22-08

I am characterizing yesterday as a good day. Not any changes today to report yet, so it may also be a good day. Her blood pressure is OK - in the 50s. She is scheduled for a dialysis. The nurse (a new one she has not had before) discussed the sedatives this morning and said they are not affecting her blood pressure. I have asked for the white blood count and temperature this morning.Her tests from the fecal material has come back and she is reported to have no bad bacteria. There is apparently no water issue either. All of this is information from the nurse.

Basically, mother is not in a good state for visitors. She has several tubes and lots of wires on her. She generally keeps her eyes closed and is not responsive due to the sedatives. Her mouth is not very comfortable. That is her primary gripe right now. The nurse is changing how they treat her simplex herpes and the related minor bleeding and chapping. Today, Linda is back treating her skin. The bandage changes have been completed for the day.

Sunday PM 09-21-08

Mother was resting well. Her blood pressure had lowered during her skin treatment in the early afternoon but had gone back up some. I am a bit concerned that the nurse felt he had to increase the Levophed last night. That is what is being used to elevate her blood pressure. Otherwise, she remains in a fairly stable condition, being fed both IV and by tube. She is weak and not very responsive with all the sedation she is getting. I will raise these issues to the doctors tomorrow.

At 345PM, her stats were heartbeat 68, oxygen saturation 96, breathing rate 22, pressure 93/32 (46). She will get a dialysis tomorrow.

Sunday AM 09-21-08

Mother is in a holding pattern today. That is good news. There is nothing particularly bad. She remains weak with some issues on her face. Her mouth was bleeding and that was not good. It seems that her lip herpes has gotten worse rather than better over the last 24 hours. Her blood tests looked good. Her tube feeding seems to be doing fine as the doctor said yesterday, that she is tolerating it well after consuming 300 ml. She remains on IV feeding as well. Her blood pressure is up from last night and that is good. She will have dialysis tomorrow, so no dialysis on either Saturday or Sunday. The doctor is planning to have dialysis three times a week for now. Her kidney doctor remains somewhat optimistic. He was the only doctor I saw this morning.

We took a "sedation vacation" tis morning where she was taken off all sedation drungs for about 1/2 hour to see if she is responsive and give her a view of the outside world. She listened to Wayne as he talked to her about her condition. She was not in any perceptible pain or discomfort during this timeout. She was fairly alert, responding to Wayne when he asked her to open her eyes. Her eyes were more glazed today than a few days ago, but the same as yesterday.

She is passing no urine. When and if she does, that will indicate her kidneys are coming back. The only number chemistry that is really high is her Creatinine. The kidney doctor said that was normal in this situation and not anything to be concerned about. Her white blood cell count remains at 14000 today. She is no longer running any fever. She is excreting fecal material in significant volumes and her bowels are making plenty of noise.

We anticipate church visitors today. She is not very well and should not have visitors in my opinion. She is not able to engage visitors now.

Saturday PM 09-20-08

This afternoon, mother remained about the same. The ICU staff continued to work on all fronts but concentrating on her skin and her comfort. Her bandages were changed and showed improvement in almost all areas. Her blood pressure had dropped a little but was in acceptable limits. She was sedated and appeared to be heavily sedated but the nurse said she is not. Her eyelids are scaly, so this evening I asked the nurse to clean them. She said that she had been doing that but would ask the doctor if a salve could be put on them to help her.

Wayne flew in today and mother instantly recognized his voice (who wouldn't?). She lies there not wanting to open her eyes. I noticed that they are red, not clear like a few days ago. I think the oxygen leakage from the mask of yesterday and the day before has damaged her skin and eyes but it will be a question for the doctor tomorrow. It is apparent that we should have gone with the doctor's recommendation of the ventilator earlier.

I discussed mother's lung condition with the pulmonary doctor. He said he wanted to keep her on the ventilator for two more days before weaning her. The rationale is to not expend breathing energy and allow that energy to be used elsewhere to repair her other organs, including the skin. A normal person expends 25% of their energy breathing. He calls the current role of the ventilator as full assistance.

The wound nurse, Linda, told me that normally a person heals in 3-5 days using the techniques she is using. Mother's skin was severely damaged and is now almost totally in a state of repair. To get to this stage, all of the dead scabs must fall off and show only red color. She showed me several places that had almost totally healed. The worse places were now almost totally red, with some yellow. The yellow places will disappear soon. She is treating each color differently. Now all areas are treated once per day instead of two. This is definite progress. It will take some time, but her skin should completely heal itself. The pain remains in treatment and will so for a few more days while the skin heals, but she is given morphine each time they treat it, to remove the edge of the process. Linda will not treat her tomorrow. The ICU nurse will. He got specific instructions from Linda today when he helped her.

Some caution on our optimism was advised by the pulmonary doctor. "She is not out of the woods but she can certainly see though the limbs now." Her left lung still has an infiltrate in one lobe. Her lungs are clear but this condition still exists in the x-ray. He will keep his eye on it. He said that could be pneumonia or the start of it but he cannot tell right now. It could simply be part of the mucous and fallout from the fall.

Wayne, Sharon, Randy, Russ, Kell and Shilla visited her today.

Saturday AM 09-20-08

Today is a very good day, at least so far. The alternating good day / bad day cycle continues. I could hardly believe the prognosis this morning after yesterday's difficulties! Mother's colon appears well and she will be fed by tube today to see if she can tolerate feeding. Her ventilation machine may not be needed now since her lungs are clear this morning. It is expected that she will be weaned from the machine over the next couple of days. She continues to need dialysis but her blood content is well within the norm after yesterday's dialysis. She should be off the dialysis today and tomorrow with the next dialysis on Monday- that is the current plan. Her skin is improved and she has gone to once a day bandaging treatment except for the one place on her left calf. Her heart is doing fine on the medicine to raise her blood pressure. She is having a few small rapid heartbeat events, but the heart doctor is satisfied with that situation for now.

The kidney doctor came in first this morning and listened to her colon, lungs and read her blood test results. All elements in her blood were within normalcy ranges. She has been a little low on hemoglobin. That is the reason for a one unit blood transfusion yesterday. Her white blood cell count dramatically lowered overnight to 14000 from the 20000 yesterday. That coupled with a low grade fever means she still has some kind of infection but the internist should comment on that. She had 1.5 liters of fluids removed yesterday and 2.4 liters input. That is an expected increase in fluids, so she is a little swollen this morning but he believes she is within acceptable levels of hydration. He will look at her again tomorrow to make sure she is OK with the hydration level. Asked if she will require dialysis i f she recovers from everything else, he responded that he cannot predict the future. He has patients regularly go either way, so it will be a wait and see situation. He commented on the photo of the 4 wheeler with mother driving it. We put that in her room to give her something familiar from her apartment to see. We also put her Xmas gift from her children (the blanket) in the room. He was impressed that she would be doing something like getting on a 4-wheeler at her age. I am too! He has been aboard my description of her from the beginning - a strong woman for her age and capable of recovery.

Dr McKennon was more positive than I have ever seen him. A total reverse from yesterday. He said she is having clear and normal bowel sounds today. This was the primary obstacle to her recovery and negative prognosis. He now gives her a good chance of recovery except for the kidneys. He said he believes almost certainly she will require dialysis WHEN she leaves the hospital. He ordered the feeding by tube today and said if she tolerates it, he will take her totally off of IV feeding(TPN) as early as tomorrow. The fecal culture came back with preliminary results of being only yeast. He normally does not treat yeast unless it shows up elsewhere in the body. He will not be treating the yeast in this case either. It is a normal situation when on antibiotics. Chepa reminded me today that she told me the very same thing yesterday. Yep, she did! He was questioning her thyroid medicine and regiment of treatment before this even occurred, so he can make sure she is getting all the medicines she needs normally. I told him I thought she was off of thyroid medicines but he found where it was being administered to her via IV and that her TSH was normal, so he would leave it at that for now. He will watch the TSH to make sure she is not over dosing it nor under dosing it. Not a problem, he said.

The nurse said she rested well overnight. We went in about 10PM and returned home to sleep, allowing us, her and the rest of the ICU patients to rest.

Amazing the difference one day makes!

Kimberly, Cassie, her daughter Peighton, Shauna and Rachael all visited her yesterday. Linda, Chepa, Maria and Miguel came also. Wayne will be here today. Russ left on a 2 day business trip.

Friday PM 09-19-08

Today is finally ending. It's been a tough road for us and her. Mother had her dialysis this evening without much ado. That is good news considering t hat we almost lost her this afternoon. We will get the results tomorrow of her fecal culture test and a culture test of phlegm in her lungs.

Friday 09-19-08 AM - bad day

To say that she is having a bad day would be an understatement. It seems that she has alternating good and bad days. We thought we might be losing her early in the afternoon today. Her oxygen level in her blood went down quickly and her heartbeat went down. Drugs were administered, her lungs pumped for fluid removal and she was put on a ventilator. Her condition switched from unstable and declining to a stable state. As I write this, she is on dialysis and now on a ventilator. The doctor's prognosis is that "she is slowly slippng away." Her white blood count continues to stay high at 20000. Her face is dry from the oxygen mask, so is her eyelids.

Her lungs were the main issue today. Her left lung remained about the same as yesterday and her right lung has improved as evidenced by xrays. The mask and O2 machine put on her yesterday has been chapping her face and eyelids by leaks in the mask. The Pulmonary doctor said that we should go to the ventilator today if we want to leverage its capability. We did not have time to wait. I called Wayne and informed him and called Gail (previously discussed this with her) and discussed it with the doctor and family. We all decided to deploy the ventilator immediately. I called Gail again but she did not answer. Mother did not respond to questions so we made the decision through Russ.

Mother had two bowel movemensts overnight. That was great news to us but Dr McKennon took a negative view. He explained that it was diarhea and he would wait to comment on the output when lab tests came in. He did say that she does not have CDIF (bacterial infection that creates a false lining of the colos) but would get a second test to confirm that. Her colon condition according to the doctor is severe ischemic colitis.

Her skin continues to improve. The nursne has decided to treat her only once a day now except for her right leg which continues to ooze and bleed.

Her kidney prognosis is not good but not impossible. After given a strong dose (160cc) of Lasix, she produced no urine. This is still a recoverable situation for her kidneys, so we are in a wait state for her kidneys' recovery. SHe may or may not get her kidneys to function. She is having a dialysis this aftiernoon which will put 1 to 1.5 liters of fluid. Her hands are swollen and that is in my estimation to be caused by excess body fluids. The nurse said otherwise, so take that for face value. I may not be correct but the doctors seemed to be with me on this.

Her heart has been underfunctioning all day except after they put the ventilator on her when her pressure increased to a more acceptable level. At 430PM, her vital signs were OK.

Thursday AM update - about the same

We are now in day 10. The kidney doctor, Dr Welsh, told me this morning that we have general lack of progress. He does not hear bowel sounds. However, the nurses tell me they continue to hear bowel sounds. That falls outside of the domain of the kidney doctor, but he was just offering his opinion on the status of mother. He said that lack of progress in ICU means deterioration of her health to the hospital because she is getting the best of care. Today he is looking at xrays to determine if he should try lasix. He does not want to further dehydrate her unless he needs to. The lungs may need less fluid so he is trying to balance his decision with the appropriate facts. Furthermore, her blood chemical stats are within normalcy now. That includes CO2 acidity and the O2 saturation level.

The lungs doctor, Dr Charbeneau, said that there is less fluid on her lungs today. The hospital reduced her oxygen intake significantly from 100% under the mask to 35%. They tried 30% but her O2 saturation went below 90, so they increased to 35% from that trial level. He wants to put her under ventilation but I asked he try the external ventilation technique first, which is a mask attached to an external machine which pushes and pulls air inside the mask instead from within the lungs. So far that procedure has been working. He says it is inevitable from what he has seen to go to the ventilator. He also stated that she is treatable.

Dr McKennon says he does not hear bowel sounds and believes she has a long hard road ahead of her to recovery if she recovers. He repeated his previous prognosis that she is in a holding pattern and we just do not know where this will take us. If one thing improves, the others are likely to improve as well. The reverse is also the case.

Her skin is improving. The two worse lesions continue to bleed and/or produce excretions but are diminishing in size. The skin nurse notes that they may be able to reduce the number of treatments to one per day in one or two days at this rate. They will treat her again at 1PM today.

Her diet continues to be analyzed. The kidney doctor said she is still malnourished and needs more calories. Dr McKennon said he is awaiting the dietitian who has not completed the analysis of her needs. When they recommend a change (should be today), he will order the TPN modified for her. We expect to see a higher intake of calories and albumin. Her albumin remains at 2.3 and that is low but not in the critical range (it is above 2.0). Her other blood test results show a great improvement in all her numbers. The Bun is at 47. Dialysis has helped her blood chemistry a great deal.

There will be no dialysis today.

Kimberly, Rachael, Shauna (has cold), and Jeff are there visiting from out of town.

Wednesday Am Update - new issues

My assessment is that she is about the same as yesterday except her mouth sores are worse and she has a bit of pneumonia in her left lung. Fluid buildup in her tissues has been growing over the past couple of days causing the pneumonia. Although healing, her skin has some issues and the treatment is a slow process.

The dialyses are working. Yesterday 1/2 liter of liquid was taken, but that was not enough. Today a third dialysis will be conducted and 1 1/2 liters removal is planned. I discussed this with the kidney doctor and asked if he could use lasix instead. He agreed to try to use lasix for water management, so I do not know if her reduced the plan for water removal today by dialysis or not but I think so. His plan has been to do 3 initially, rest one day and then do another if she needs it. I am trying to get him to use different parameters for need so that she is not stressed so much. She definitely needs to have water removed but the technique should be coupling dialysis for urea and other blood toxins, to lasix for water management. He had lost track of the prior effectiveness of the lasix for removing water.

Mother has water in her left lung. This is a type of pneumonia. It is a result of being in the hospital and laying down. It is being treated by antibiotics. Water needs to be removed form her system since tissue is holding water in her system. She appears a little bloated due to the water retention. The kidney doctor's responsibility is to get that fluid retention out of her body, so he initially ordered 1 1/2 liters removed by dialysis today but I think he is changing that plan to a better method as described above, that will be easier on her.

Her mouth area has gotten worse. Her lips and tongue lesions were swabbed and Staph bacteria was found in the culture. This is a dangerous situation and to be treated with more antibiotics.The nurse and general doctor believe the basic problem in her mouth area is simplex Herpes rather than the Staph bacteria. They will treat this with a topical ointment. There is no imminent danger but she has been having blood in her phlegm and it is getting worse. She coughs but cannot rid herself of the liquids. There is a lot of dried blood in her mouth so they have been trying to loosen it all up with steam.

Her skin treatments will apparently be altered to improve the lesions on her back and one leg. They will switch to using Silvadene. That requires 4 dressing changes a day instead of 2. That will cause more stress to her but the additional rollovers might be good for her body in general. Her skin no dojbt hurts her during this process but this technique is a preferred one for burn victims, especially for soothing the skin and providing a better healing environment. The wound care nurse came in just as I left.

She is needing a little more oxygen to maintain a good blood oxygen level now. She is at a 50% mixture or 6 liters. Her vital signs are fine. I talked to the cardiologist and he is continuing with the heart medicine to reduce her heart speed issue. She has not had a run of her heart since the dialysis yesterday.

Her general care doctor was negative again today but not giving any predictions. He said she will be in rehabilitation for months if she gets past all these problems. She is in a "holding pattern" right now, to quote the doctor. He is considering changing the TPN (nutrition mixture) to increase her daily calorie intake. He will discuss this with the dietitian. Normally, burn victims require much higher calorie intake, something in the order of 9000 calories daily. She is on a 3000 calorie diet. He told me that her colon on a scale of 1-10 is at a 0.6 activity level. The nurse explained that there has been some movement in her bowels over the past 24 hours which is good news.He did say that she remains "salvageable" despite her many problems. That was a somewhat optimistic statement for him. He believes the key to her entire system is the colon. If it gets better, the rest of her health shoud as well.

Her white blood cell count is at 20000 this morning where it was 21000 yesterday morning. Not much decrease but also not increasing despite the issues, which is good news. Her BUN (urea) count is now 76, down from 150 high and 100 yesterday. A result of the dialysis. That is still a high number but not so dangerous anymore. It will go down again with today's treatment.

Bulletin: Russ just called me after I wrote this an told me she has taken a turn for the worse with her pneumonia and now the oxygen being administered is at maximum. The doctor is being called back in.

Wednesday PM - getting to be too much

This afternoon mother has gone through a lot. She is now on 150% oxygen. That is, she is using a mask of 100% oxygen in addition to the 50% nose feed. The reason is that xrays reveal both lungs have water. So she has pneumonia. She has an additional doctor, a pulmonary specialist, Dr Charbeneau. As of late night, mother had stabilized. This new situation will probably be the straw to break the camel's back.

Other news is that the skin doctor is trying to get her to a point where she has only one skin treatment per day. She will not have a dialysis tomorrow. She will likely be given lasix to pull some water. The question is whether the kidneys are capable of producing that water as urine. The nurse last night told me she believes the kidneys have now failed and will not respond to the lasix. Today's dialysis pulled 1.2 liters of water from her system.

Jeff came in from Houston and Kelly returned from a business trip, so we all hunkered down in the evening to be with her until about 11PM. She was resting and interacting with us but not much. You can tell she feels bad. Hope for a recovery is fading.

Tuesday PM UPdate

George Brown came by this evening. Mother is resting. Her mouth continues to give her difficulty. Everything remains basically the same. Visitors combined with dialysis has tired her. It looks to me that we need be more cautious on the number of visitors for a couple of days. Kimberly came in from out of town and is here today and tomorrow , so her visits need to take priority. Mother will have another dialysis tomorrow.

Thursday will be a better day to visit her.

Tuesday AM Update

What a seesaw! Today, the general practitioner was surprised finding some sounds in mother's intestinal system. He thought he was hearing machine noise with his stethoscope at first and just could not believe that her system might be changing for the better. It is improving! Signs are that her digestive system may be recovering. He is guarded and not saying that she is out of the woods. This issue is the single-most threat to her life, so the possibility of her colon living through this is a very positive step forward for her.

Dialysis was successful yesterday and today. After yesterday's treatment, her BUN number decreased from 125 to 100. It remained way too high over night but certainly was better. After today's 3-hour dialysis, it should be much lower tomorrow. She completed todays dialysis about 1130AM today. During the dialysis, her heart took a run at about 140 beats/minute. Medicine injected by IV rapidly controlled it so that she did not experience a blood pressure drop that would threaten her digestive system more.

I walked through her skin abrasions again with the skin specialist nurse and actually helped the nurses with bandaging and dressing. This was the second time I have seen her treating mother. Mother's skin is like one of a burn victim. The treatments are similar if not the same as a burn victim. Two spots remain big issues, but most of her skin is healing quite well. Her mouth continues to hurt and she is reluctant to open her mouth very wide. I understood her more today than any other day yet.

Her white blood cell count is high - 21. That is probably due to the skin, not colon. The doctor indicated to me that he is thinking that the colon is returning back to health and a possible recovery in such cases is rare, but mother seems to be heading to be a rare case. A little bit of hope!

The kidneys did not produce much urine overnight - 35ml. That is disturbing because it was one of the lowest nights for urine volume so far.

She saw many guests this morning including Cliff, Kimberly, two of her girls, Linda, Wesley Booker, George Booker and his wife, Chris.

Monday PM

Mother had her first 3-hour dialysis today. It required a second catheter so Dr Ciplieeu put it in on the left side of the neck. So she has one on both sides now. This will last at least one week, probably two for additional dialysis treatments. Tomorrow she will have a second treatment. They are taking a slow process right now, so about 1/2 of her blood stream is being processed each time. This is a careful approach. She did pretty good through it. We are going to visit her again this evening to make sure everything is OK.

Today, Karen and Ted visited her in addition to several family members.

Monday AM not good news

This morning, mother is alert with her mouth hurting due to the cold sores on her lips and on her tongue. She was asking for ice very strongly. The nurse is now giving her ice and I gave her some also. The general doctor gave her a 5% chance of survival today. We are not telling her this because it is subjective.

The doctors are now asking if we want a dialysis for her. I will be discussing with Gail and Wayne. Today the renal doctor is Dr Cipleeu; he talked this morning to Dr Welch about the situation, so her regular kidney doctor is plugged into this request for a dialysis as well. The dialysis will require another catheter on the other side of her neck, which will last for about 7 days or so. The first dialysis will be for 3 hours. Then we would see what the situation was like afterwards. Russ also has to be involved in this decision. Although her sodium and potassium is normal, overnight her Creatinine and BUN numbers got into levels requiring dialysis. Creatinine is 5.6 compared to 5.6 yesterday. Ureatins (BUN) jumped from 125 yesterday (normal is 20) to 150 today.

The situation for her general health seems to be going downward. Her colon has not changed. This is of grave concern. Typically, as I was told, the colon will gradually deteriorate and end up in septicemia from the bacteria in the colon reaching the blood stream. That happens when the colon lining deteriorates due to lack of blood flow. There is no way to predict what the colon is going to do, but there is a very big threat to it. Her blood pressure is normal now and should provide blood to her colon. But her arteriosclerosis is probably preventing the blood flow according to the doctor.

The family has to do some what ifs now and determine what to do. The dialysis can cause additional blood circulation problems and c an cause the colon to go into shock and then the whole body. There does not seem to be any alternative except to hope and pray.

If you want to see her before she gets really bad, today might be the day to see her.

Sunday PM Update

Today was a day of setback and progress. The disappointment was with the heart. She had some fairly long increases in heartbeat. This time the rate increased to about 135 again. It was treated and lowered back to normal with heart medicine. The encouragement came from the startup of something to her digestive system. She took ice for the first time, asking for it and receiving it. Just small chips of ice, one at a time was put into her mouth. Her kidneys did not do as well as I had hoped. I am expecting the doctor to be disappointed with her kidney progress. Her nurse taught me to feed her and I did.

Just a reminder that we have a little cuddly bear to sign as a guest book. I know that is unusual, but it fits my mom. Marica the nurse was attentive but was often busy with another patient as well, showing the need to have family present. We asked for several changes today and she accomodated our wishes. Mother watched some TV. She even winked at Shilla when the nurse administered a piece of ice. Seba Faye, Gene, Jo and Norma Banta, Russ, Randy, and Shilla visited today. Sharon called and said she was there in spirit but had a spell of allergies which could be a cold so she did not want to expose mother to any germs.

This raises the issue of infection. Her skin is has sufficient issues that we must sanitize our hands before touching her. Please sanitize your hands with the hand-wash outside of her room before visiting her, even if you do not intend to touch her.

Her lower colon test was conducted but we won't have the results until tomorrow morning. Her condition continues to be "fair".

Sunday AM Update

Mother continues to make progress, little by little. Her urine output is in the acceptable level as far as I can see. She is averaging over 60cc's per hour. The nurse thought it was fine now. She will have one more treatment of the Lasiks today. I did not talk to the GP today but did talk to the GI doctor and surgeon. The emphasis seems to be on her intestinal system today. She will be given a partial test on her colon to look at her tissue and see exactly what the issue is. That will determine whether a change in antibiotics is needed. The GI doctor will look one foot into her colon, no more, to gain this information.

She remains on a small dose of morphine for her skin. She was in a little discomfort this morning, a little cold and hurting because of her skin. I had the nurse give her a blanket. Mother was watching TV when I came in this morning. She was awake and listened to what I had to say. She will take ice today. That will start some intake into her digestive system.

Her vital signs remain good. She remains on heart medicine. She had a small run of fast heartbeat last night of 130 beats per minute, much less severe than past episodes. Administration of the heart medicine fixed the problem.

Saturday AM - some change

Her general practioner said today his assessment is "only fair" due to the number of problems she has. However, her chemistry and vital signs are acceptable except for her kidney output fluid level. She is sufficiently hydrated for the general doctor to request that the kidney doctor administer a lexica drug for stimulating fluid output of the kidneys. Her fluid output is up to 450 cc's but not acceptable yet. Mother was awake and alert but not as much as yesterday. Her heart is OK and the heart doctor has decreased the level of heart calming medicine. Mother is hurting all over again today, mostly attributed to her skin issue. She has bled in the cracking of her skin and the nurse believes that is hurting her. A different bed was ordered for her so that the tenderness of the skin would not be such an issue with her. She has also been put on a low dose of morphine.

Mother cannot process all the sugar in the TPN (solution of nutrients). The doctor reduced the amount of glucose and added insulin to the TPN. Mother's chemistry has not been significantly and negatiively altered by the use of the TPN that started at 8PM last night. However, the doctor takes a guarded view of her health assessment. Mother's lungs appear to have some fluid today but her breathing rate and oxygen are OK at the moment. The doctor did not think the rise in breathing rate and oxygen required is anything to be overly concerned about. Mother is hungry. The doctor and nurse said that is normal.

has a substitute kidney doctor today for the weekend. Her Gastroenterologist is Vijay Poreddy. He said she seems to be getting over the hump. That is a good.

Friday PM Update - even better

Mother is now getting a lot more output from her kidneys. She has been producing 30 cc per hour, or 3 times more than yesterday. It is getting close to acceptable. She keeps saying she want to pee. We keep saying "then pee". :)

She started eating tonight at 8PM. That is an IV feeding. The nurse had the mixture available at 4PM but will feed her with everyone else at 8PM.

So she is doing much better. She had a short span of high heart rate at about 1PM. They gave her some heart medicine and it went away. Her heart rate went to 140.

Condition is better Friday AM

This morning, mother has shown her resilience. She is alert, interactive and emotional. She has cried and laughed, she has talked but she is difficult to understand with her dry mouth and no teeth. Her eyes are more open today than they have been since she arrived at the hospital. She asked for ice cream to eat this morning. In fact, she asked several times for it. Visitors may come today but only two people can be in her room at one time. Meretta and Chris came by for the first time today. There were quite a few of us there this morning, close to noon. Visitors should wait and talk in the ICU Waiting room, not in the ICU. MOther had a centrail ine IV installed this morning by the kidney doctor. I do not know if it being used yet but the nurse will take off the others and channel all IV's through the central line later today after verification that the line if functional and nothing was injured when it was installed. An Xray was taken to verify the procedure was successful.

Her heart condition has stablilized and the doctor has lowered the amount of heart medicine. It remains arithymic but at a normal pace. Her blood pressure is normal, slightly low on the low side because of the heart medicine.

Her chemistry markers for the kidneys are slightly better. She took 10 pounds of IV salt water yesterday. That has improved her hydration quite a bit. She remains on a relative high volume of hyrdration IV. Her color has also improved, probably from the hydration. The Kidney doctor is more positive now and has consented to an IV feeding trial. He said is is more positive now about her ability to get through this without a dyalisis and is resisting any suggestions to the contrary. She has not taken any nourishment other than vitamins for 5 days.

Speaking of nutrition, the surgeon (Dr Sankar) came by today and explained that her albumin is very low and she needs it raised. This is accomplished by food! The level is so low (1.3) that she is in a risk profile of 30% mortality rate, just because of nutrition. Anyone with an albumin reading less than 2 is at a 30% mortality risk. You add the other issues to this and mother is at high risk. The Kidney doctor said that he is willing now to see how her kidneys react to an IV feeding. He and Dr McKennon has agreed to take this step. Mother needs nutrition. I believe now that a nutritionist is being consulted for an IV formula.

Another specialist has been added to the consulting staff of Dr McKennon to follow the condition of her intestines. About half of the intestinal tract is inflamed as determined by the cat scan yesterday. This is potentially a threat to her health. It is one of the primary reasons the doctors are not going to feed her by tube anytime soon. Thre is no bowel sounds in her system so the doctors want to remove any risks of mother getting sores or infection in her intestines. Right now, they are swollen but there are no perforations. What they do not want is for her to have something like a perforated appendix.

Her skin is in pretty bad shape but improving. Laying on the floor for that length of time has caused various skin problems. I walked through them all with the attending in-hospital skin therapist. She came in and treated all mother's wounds with a salve and bandages, explaining her strategy and also demonstrating the procedutres to two UT students. On her back she has a severe wound where the subcutaneous skin has died. It is about 4x2 inches in size. There are several large places where the outside of the skin has died but healthy tissue lies underneath. The therapist explained that she probably laid mostly on her left side and for some time she also laid on her right side. Where the skin of her legs touched, there her legs also had circulation problems and has damage. The therapist said mother was lucky. It could have been much worse. She thinks mother will heal fine with this treatment. On Monday a decision will be made on whether to continue this treatment or do something else.

OK, now you see everything I see. Mother has several issues - heart, kiidney, skin, intestines. Fortunately, she is alert and her mind is healthy. I am cautiously optimistic. Seeing her smile this morning was simply emotionally uplifting. Seeing her crying was the same. I know she is going through a rough time. Getting that out emotionally is a good sign of strength. She is fighting to live and I am really happy to see that as I am sure you are also!

Thursday PM Update

MOther remains in the ICU. She had her scan test at 1200 noon. This is about the same process used for imaging a baby in a mother's womb except it also sees the lining of the digestive system. She also had an Xray. The kidney doctor did not return this afternoon. He will probably be in later since he will be performing a procedure to give her an IV tube in a major vein so they have a reliable and available entry into her blood system. The existing IV is is working but could be interrupted at any time and they would not have a means to administer drugs or medicine. Her veins are not very well defined in areas normally used for an IV.

When she had her cat scan, a tube was placed into her esophagus to administer the dye. That tube remains in her for feeding. She has not eaten anything for days! I am concerned about that and told the nurse so this evening. The nurse said they probably would not be feeding her until tomorrow. They must have the results from the cat scan to start feeding her. I do not think the doctor is aware of this need, so I am planning to talk to the evening nurse about it. We need an answer on the outcome of the cat scan. On the reverse side of this, the lack of information from the doctor is regarded as good news by the nurse. No news is good news. But we have the nutrition issue and I will be pushing for her to be fed.

The bottom line to me is that mother is looking better today and has interacted with us, not to the extent of two days ago but certainly is doing better than yesterday! Although not out of the woods yet, she made some progress today. I do not have stats on her urine flow but it looked like she was passing higher quantity and the color was better. I interpret that as there is less matter to clean from her body and the kidneys are having an easier time, returning to normal. However, I am not the doctor, and I take my assessment with a grain of salt. You should also.

Mother's heart rate did rise significantly after the test. The doctor again administered the cardiac medicine which lowered it back to normal - about 75 beats/minute.

Thursday 10AM Update

I am in Austin, arriving here about 1AM this morning. I went straight to the hospital and Kell was there waiting for the nurse to finish bathing mom. When we went in, I was surprised to see some good news. The heart medicne was wrking and she no longer had the fibrillation issue ut the heart was working arythmetically. After staying there a while and talking to the nurse, we left to get some sleep. There was nothing more we could do to help.

This morning, Russ, myself and Shilla went to the hospital. Kell, Linda and Sharon Cooper joined us a little later. We had interaction with three doctors and the nurse.

• Heart (Dr Joseph Imasis)- continued to work properly but with irregularities. The doctor said that the heart was doing its job and they would continue with the medicine that has stabilized it. There have been no further issues since early last night when they started the IV treatment. Her heart beat is in the 80's and due to the medicine, the blood pressure is abnormally low but not a concern. This is all good news.
• Kidneys (Dr Byron Welch)- this doctor is new for my mom. He is one of several from the same clinic. He said that her kidneys are functioning and removing a lot of garbage from her blood. However, there is not enough fluid in her system to flush it all out. They are measuring the output and it is very low. The kidneys are trying as evidenced from the dark color of the urine. He has presscribed more salt water IV to hydrate her. He said that she continues to be dehydrated. That normally causes aches and pains, which she was complaining about yesterday. He will wait a couple more days before asking for a temporary dialysis. He does not want to to do a dialysis because it would expose her to infection and bleeding issues. An upbeat report.
• General practitioner (Dr Stuart McKennon) - This doctor is in charge of her general health. His examination this morning gave him a gut feeling that she has atrophy in her digestive system, especially the upper colon area. This he suspects causes her pain when he pushes his hand into her stomach area. It often occurs when someone is down for a long time. This is speculative at this time but he ordered a cat scan to see if there is such a problem. Right now, after talking to the kidneyt doctor, this isi unlikely. However the GP want to validate that it is not a problem. If it is a problem, the only way to fix it is surgery. If he gets a positive interpretation, he will consult a surgeon. He prepared me for the worse. If the surgeon says she has too many other issues and cannot do surgery, he will recommend that we put her into a different care category. The test is scheduled for noon. The interpretation will be done immediately thereafter. Category 1 care means that the hospital staff will take every practical measure to inprove her health. Category 2 care means that the hopsital staff will take measures to improve her health but without certain procedures, example dialysis. Category 3 means they will not take measures to fix the problem but only care for her like a hospice, giving her only drugs to relieve pain and to let her die as comfortably as possible. He said we may be faced with some difficult decisions later in the day.
• Personal ICU nurse (Dana) - I call this young lady super nurse (20 years practicing). She advised the GP to change his order and she told him why. The doctor agreed and changed to image her digestive system with a chemical that will show the lining of her digestive track. I liked that in her. She was reeally looking out for her patient!

My take on this is that we are praying that she does not need surgery. That would give us lots of hope for her recovery. The general practitioner gave her a 20% chance of recovery if she has the digestive system issue and that we choose to go with category 2 care. I am taking a positive view but am giving everyone a heads up that her time might be short. Dana told me that they would not be giving her any nutrition until after the test. Mother has not had anything to eat and they have not given her any liguid food intraveniously yet. Dana was concerned about nutrition and rightfully so. So the doctor has agreed to start IV feeding to help strengthen her. She needs nutrients!

Say a prayer for her.

Grannie seems to be deteriorating

The doctors just ordered her back to ICU. This is not a good sign. More as soon as I know something. Shilla is at the hospital and called Russ saying that this was the situation. I have been worried about this all day.

Update 5:58PM - new problem. She now has an atrial fibrillation. This means her heart is stuttering in its upper part. She has been hurting all over all day which is a big change. She has been having difficulty taking her medicines so that is the reason she is in the ICU. Their goal is to level out the rhythms of her heart. If they are unsuccessful, they will need to jump start her heart on the morning. That is dangerous. We found out that her white blood count is higher than normal but her kidneys are not infected. New room number in ICU is 122.

More afternoon information

Sharon Cooper visited Grannie this afternoon. Grannie did not respond to her nor to the nurse, and was sleeping. Linda also came by for a visit and she was sleeping.

The doctors came by while she was there. The kidney doctor said that Grannie's kidney condition is worse today than yesterday. She has a lot of muscle deterioration material to pass and her kidneys are not doing it well. He is considering using a dialysis machine to help her rid her body of the tissue. Both doctors indicate that she is otherwise in reasonably good health, although quite weak.

Afternoon news

Not a lot is going on. I am in a holding pattern as far as going to Austin. I will watch both the storm and mother's condition from here until we know more about the storm. I have started preparing the house for a direct hit.

Russ got me all the information I need to get updates from the nurses. Gail and he went to the hospital this morning to see that she was being looked after properly.

George came and left a message. Grannie was sleeping at the time.

Grannie will appear to sleep but only have her eyes closed to rest them. if you come to visit her, it is a good idea (after asking the nurse) to say that you are there. She is getting a lot of rest. It is also a good idea not to converse with her very long. Just being there is a great thing for her.

Gail is chasing the doctor issue and other issues

I asked Gail to check for the heart doctor. I want to talk to him right away. She will also report back on the room and nurse situation. I have also asked for information on what she is eating. I did get some information from her nurse who is very difficult to understand on the phone. Mother's renal output continues to be about 10 ml 2/hours. Yesterday she registered one sample at 15 ml, a little better. but most samples were 10ml. 10 is low.

Update Wednesday 10AM

Mother was transferred to room 218 last night at 10PM. Last night her heart rate went up to 170 and she was put on a heart medicine. It has gone back down to 100. This is a serious issue. I am waiting for the doctor's call now. She is stable right now.

Video from last night

Tuesday 9PM Update

Chepa and I went with Russ and Shilla to see Grannie and review her status this evening. Grannie was responding to our questions and statements and knew very well who we all were. She does not talk clearly and more often than not we do not understand her. However, she can talk plainly with effort. She is just tired. When asked "what is your name", she clearly said "Edith". She seems to have all her faculties. No one can say exactly what happened yet. She does not remember. The nurse told her she fell. That is the story she understands but it is not coming from her memory, just what people have told her.

Tuesday night nurse, Lindsey talking to mother in second photo.

The heart doctor told Russ today that there was nothing more to do about her heart. Kelly also reported that the heart doctor came into mother's room while he was there and said her heart was fine. However, we have some conflicting information from the nurse. We believe that the doctor stated her current condition and is of the opinion that her heart is fine from all we know. He had tests run at 9:30AM and talked to Russ and Kell this afternoon at separate times. The kidney doctor is still treating the dehydration and shortage of urine flow. The volume of urine remains low. That is the primary concern.

The nurse said that the doctors had released her from the ICU care and the hospital had ordered her moved to a less intensive care floor, but one that monitored her vital signs. That means less nurse care because she does not need the intensive nurse care she is currently getting. They will call me when she is moved. The nurse said this evening that she could be moved tonight but it could be a full day or so depending on the availability of rooms. When this occurs, she will need more of our help and attention.

She was smiling and almost laughing tonight when all of us came to see her. Her voice was weak and she is weak. She continues with the IV and oxygen. Her vital signs continue to be stable. Her heartbeat rate has gone down to about 94 average.

She needs to see familiar faces and ones with bright smiles. We told her of her condition, who had been asking for her and who has been visiting her. Russ and I decided it would be good to have a sign-in doll or book for her to review later. I hope we get that in place tomorrow morning. She likes to be touched and loved. When I saw her spirits so high after talking to us, I realized she is at the point where she needs loved ones around her. I will get back to her as soon as I can, maybe tomorrow night. I am back in The Woodlands right now. Chepa and I came back arriving a few minutes ago.

Visitors

Please let me know who visits my mom. Russ was there this morning. She was sleeping. He talked to the staff also. Chepa and I still plan to go this afternoon. Beth told me she would be able to go up there this weekend and care for her if we need her. She has done this for several people before and she is such a sweet caring person. I may ask her to go. Also Reed and Suan will be in the neighborhood this weekend and hopes to visit her.

Tuesday 11 AM Update

She is responding to nurses' questions,mostly with yes and no. I am planning to go up there this afternoon with Chepa and come back this evening. She recognized her doctor so her mental sharpness state seems to be OK. If she had a stroke, it is not apparent. The EKO heart test was just conducted and results will not be known until later today.

Right now they are working on balancing electrolytes in her system and continuing to pump liquids into her. The kidney doctor said continue on the same plan and ordered a series of lab tests at noon for her. Otherwise, there are no orders from the doctors for anything else today. Her heartbeat is 102, high but not very high. The nurse said that it is not abnormally high. Her urine is dark and the volume remains low.

First night in ICU

Her condition has not changed much. She rested well during the night. The kidney doctor was consulted twice during the night. Urine flow has not increased. Her blood test indicated a high sodium content but has normalized overnight. Her heart rate increased a couple of times during the night and then settled back to the higher than normal rate. I have not asked for numbers but will the next time I call later in the morning.

Update 9PM

Wayne and I are primary contacts. I called the ICU and talked to the night shift nurse, Tom. He promised to call me if her condition changed during the night.

I picked up some details from him. An EKG was run on her in the ambulance. It was repeated in the emergency room. Both indicated abnormalities. They are assuming for now that her EKG signature is from a past heart attack. They have ordered a Ekocardiogram which is an ultrasound imaging of her heart, to see how her heart if functioning. That will give insight into any danger she may have with her heart.

Her vital signs are fine except her heartbeat is a little fast. She has experienced some muscle breakdown. They continue with an intravenous IV for fluids. In the solution they are giving her a medicine for kidneys. They will measure her volume of urine output to see if her kidneys are improving or not. It is too early to tell. They should know more by the morning. I may call in for an update in the night but doubt that I will. Wayne might do so as well. Let's hope and pray she gets better during the night.

ICU Visitation

Mother is at North Austin hospital also known as St David's clinic. Visiting hours are unavailable from 630AM to 8:00AM and 6:30PM-8:00PM. Number is (512) 901-1000. I do not yet know her exact location in ICU.
12221 Mopac
Austin, TX 78758

Serious Health condition

Today, Grannie had to be transported by ambulance to the hospital. She was dehydrated and suffering from hypothermia and near renal failure. This was the result of a fall or accident in her apartment where she was unable to get up. The exact circumstances are unknown. She has not been able to communicate yet.

Here is the story as it was given to us by the Clairmont.

Suzanne and her husband who are assistant managers of the complex were called a week ago on the emergency pull line from the bathroom. Mother had fallen in the living room and crawled to the bathroom to call for help. She pulled the chord and the staff responded to help her beck to her feet. She said then that maybe she need to get a lifeline to help her in such situations. Suzanne's husband told her he would find the information. Mother apparently did not tell anyone else about this incident. Saturday night, Suzanne's husband said "we" need to take care of the lifeline for Edith. He went looking for the brochure and found it. They decided to wait until Sunday to give it to her.

On Sunday, George Brown came as usual to pick her up for church. She did not respond (per George). She sometimes does not and simply sleeps in or goes somewhere else not telling George or the Clairmont. Suzanne saw George leave the apartment complex without my mom. Suzanne says this happens and thought nothing of it. Normally however George will tell the Clairmont that she did not respond to the door.

Monday (today) morning Suzanne's husband went to mother's room and opened it when she did not respond. The door was locked. He saw her on the floor and called the front office for help. They called 911 and requested an ambulance which came out. They also called Russ who is the primary contact there in Austin. The medic called Russ and asked him for information. Russ called me because he did not have it. I called the medic and gave him the information he requested. He wanted to know about the medicines. I could not help him with that. He could not find them. I gave hin enough information for him to admit her to the emergency room. He wanted to know where to go, I said the closest place. He told Russ where he was going to take her and Russ called me to let me know. Russ went right to the hospital and waited outside the emergency room for info on her condition. She probably arrived a little after he did.

Mother was immediately put on an IV. She was not conscious. Her body looked flush and ears purple. A couple of hours later, her color returned to normal. Tests revealed that her kidneys were not functioning normally and her heart was not normal. Her heart issue could be a problem from a past heart attack so that issue was put on the back burner.

The living room was alright but the bedroom, kitchen and bathroom of her apartment had issues. Furniture was probably moved in the living room to allow the medics to transport her out of the apartment. Things were on the floor. A doll was on the floor as well as a salt shaker. Various items were knocked down from their normal places. There was blood on her knees and on the bathroom floor. Suzanne said both the front and back doors to her apartment were locked when her husband arrived on the scene.

As of this moment, mother has been put into a bed in the ICU for observation and continued treatment of the kidney issue. The kidneys are working at 30%, probably as a result of dehydration. We need for the kidneys to improve for her general health to improve.

Russ managed to find both pieces to her hearing aid. He got her medicines from her room and took them to the doctor at the hospital. SO now they know her daily pill treatment regiment. We have not found her teeth yet.

I will update this blog as we find out more so that we do not need to make so many telephone calls. If you want to talk, call me. It is good to discuss these things.