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.