Category: Post Visit

A visiting doctor thought Nancy might be experience gastroparesis.  This translates to stomach paralysis.  Test will be on Thursday.

Here is a link and the first paragraph there from:

http://www.gi.org/patients/gihealth/gastroparesis.asp

>>Gastroparesis literally translated means “stomach paralysis”. Gastroparesis is a digestive disorder in which the motility of the stomach is either abnormal or absent. In health, when the stomach is functioning normally, contractions of the stomach help to crush ingested food and then propel the pulverized food into the small intestine where further digestion and absorption of nutrients occurs. When the condition of gastroparesis is present the stomach is unable to contract normally, and therefore cannot crush food nor propel food into the small intestine properly. Normal digestion may not occur.<<

Today’s events:  All was progressing well today until after lunch.  I had been talking to the nurse about having Nancy do more than just be in the bed.  Could she walk around some?  Was there a 4-wheeled walker around or could I bring one in?  That sort of thing.

There was a CWU EMT student there for the day so the nurse agreed to more exercise after she and the young man checked Nancy’s vital signs as she moved about – sitting, standing, in and out of a chair.  That all went well.  So after a little exercise she got back into bed and I started to leave.  At that point she expressed some stomach discomfort – like she had to burp.  I urged her to sit up straight and do so.  It was more than a burp.  It was all the liquid she had consumed at lunch.  She has learned to keep a pan handy and so all the mess was contained.

Shortly thereafter the visiting “hospitalist” came in and talked to Nancy and the others that had witnessed the event.  She was less than surprised and based on Nancy’s long stay in bed before and after surgery expressed her opinion that this would not be uncommon.

She wanted Nancy to eat (mostly liquid and soft food tonight) and then nothing until they start the examination tomorrow.  They will give her food with ingredients that will show on an X-ray and then over several hours and several pictures determine if the food stays in the stomach overly long.

We will learn more tomorrow.

Pneumonia was not confirmed.  No fever and no sign of the right germs or whatever it takes in one’s coughed-up material, which there was almost none of anyway.

A couple of weeks ago with Nancy seemingly stable the diuretic was eliminated from the drug arsenal.  But as she was not eating the right stuff, combined with the less than robust heart function, she began to retain fluid again.  To Nancy, currently, the ideal food is Lipton or Campbell noodle soup with a fake chicken aroma and lots of salt.  Sometimes she even eats the noodles.

I can’t hardly buy anything she will eat that isn’t loaded with salt.  I guess the next thing is to buy a grinder and get pieces of things small enough that she will swallow them.  The local hospital calls this a soft mechanical diet.  Think of a chicken salad sandwich without the bread.  Such pureed foods are sold, I think, in the grocery store under the heading of baby food.  That probably won’t do.

Before they kick her out of the hospital tomorrow I will have to have a plan in place.

The past week and weekend were busy and the night’s not very restful.  By Sunday evening late Nancy’s heart rate and pressure were going up and her breathing a bit ragged.  This morning Nancy called the doctor’s clinic and talked to a nurse that knows her.  The nurse, based on the sound of Nancy’s voice and the above mentioned symptoms, suggested bypassing the clinic and going to the ER.  Off we went.

Sure enough, after listening to chest sounds and looking at the chest X-ray we were well on the way to being admitted to the ICU – again.  That occurred right after a massive IV of the combo-antibiotic Zosyn®.  The ER nurse was new to Nancy but the ICU nurse called her by name – not having seen her since last June.  She was the nurse on duty the night Nancy had a big fluid build-up and was sensing an on-coming heart attack.  She initiated the move from the normal hospital bed to the ICU.  Today was just her fourth day of being an ICU nurse.

I spent the initial ER time with Nancy and then ran out to get food.  I was beginning to think they would have to admit me too.  I got back just as the initial Zosyn-IV finished dripping into her arm.  Then I helped with (or got in the way of) the move between ER and ICU.

The expectation is that Nancy will be there two days.  Assuming an improvement the norm will be for discharge (Wednesday?) with oral antibiotics and related follow-up.

I came home about 4 P.M. and missed a lengthily visit by an ICU doctor. I’ll add more information here as soon as I can.  It is now 5:30.  I’ve got dogs and horses to feed and then I’ll head back into town.  I likely won’t get home before 8 or 9.

Pneumonia is covered here:

http://www.medicinenet.com/pneumonia/article.htm

… in my recliner using my laptop — having checked out of the Kittitas Valley Rehabilitation Center yesterday right before noon, after my physical therapy.   John drove me to CWU campus where we participated in a scholarship luncheon with my normal Friday group.   Then home – first time since I left at 3:00 A.M. with chest pains, the day after Thanksgiving.

I was hopeful John would continue the blog because my writing nowhere touches his, but he insisted I needed to pick up now that I’m home with access to my computer (wow.. have not touched it so almost forgot how to start a Word document).  John says he will do a couple more general things before he quits but the day-to-day ones I can do.  We have an appointment with the heart surgeon on March 9^th.  We will report on that and likely stop then.

Back to my first day home.  The 4 Brittanys were so happy to see me.   Meghan was the most responsive and sensitive first as I sat on the potty, my first stop in the house.  Then I walked to my recliner and got to pet Annie (youngest) and her dad, Dan.  Oh, Shay also came to say hi before I got back to the recliner.

It was a busy afternoon and I finally got to nap from about 4:00 to 5:20, and shortly after John and I went to a  home where our music group was having a potluck and play time.  We had to practice Irish music for an appearance the Saturday before St. Patrick’s day.  After bringing in the Mexican enchilada dish to share, John went on to the pharmacy to pick up the many meds I will have to take – no more nurses to hand them out.

My first night was longer than any recently because it was quiet and comfortable.  My only challenge is now I need John’s assistance to stand from the low & soft recliner.  All the chairs I have learned to get out of at Physical Therapy are higher and have a  sturdier push-up from seat.  It’s okay – I’ll get there soon.  I’m continuing out-patient therapy at the facility in town 3 days a week.

I’m so happy to be able to report I survived and am home again and regaining strength each day.   I could not have done it without the obvious help of doctors, surgeons, nurses, assistants, care providers, all the thoughts and prayers and contact from all of you, my friends and relatives.   Thank you all so much.  My most intensive support, love and concern, came from John, my sweetie.  It was rough on him to take care of the animals (3 horses & 4 dogs), and still make one or two trips to be with me in Yakima for all those many weeks.  I wasn’t transferred to the Rehab center here until Jan 20^th, and I could not get out of bed on my own for many weeks.   Then once there he visited for two meals each day.  At least the drive was closer.  He also has honchoed all the paperwork with CWU for retirement and cleaned out my office of the many boxes with materials back over all my teaching years (starting 1966 at Georgia State University in Atlanta).

So, I have written more than you will likely be willing to read, and there are many thank you messages to be done (I’ll get to some of those later) but, for now, I want to express a general Thank You! to those who got the word out to others, sent cards, presents, visited and so on.

I had contacts from all over the world.  It was very special.

Nancy

On Thursday we wheelchaired across the parking lot between the facility where Nancy is and another with assisted-living characteristics.  Nancy and other “fiddlers and friends” played music for a few folks in the dinning room.

Friday A.M. they have also taken the wheelchair away.  She is able to get out of bed and use the walker.  When it is not within reach she still is supposed to have someone move it into position and lock the wheels.  She can take herself to the potty, now fitted with a raised platform with arm rests.  This is making everyone’s day more pleasant.

If she is in a chair with a low seat she may still need a little tug to get vertical but less so each day.

Today I took my car to the back of the building.  Nancy trundled outside using the 4-wheeled walker and the physical therapist explained a safe way for her to approach, back up to, and seat herself in the passenger seat.  She did this more easily than we expected – even after a rather strenuous workout during the morning (inside) exercises.

The immediate need for the correct manner of getting in and out of the car is so we can go to another music session on Saturday.  The place is not far away but enough so that she is not ready to go that far with just the walker and I don’t want to push a wheelchair that far.  I think this little trip is on the level of Ivory Soap®-sure* but check back.

_______________________________________

* 99.44 % :  See 3^rd paragraph in History, here: http://en.wikipedia.org/wiki/Ivory_(soap)

The assembled members of the nursing and therapy council pronounced a stellar performance by Nancy at this point in her rehabilitation.

I think the thing that confounds just about all of us is that no one is quite sure of what Nancy is being rehabilitated from.  People tend to view situations a little differently based on their own previous experiences.  The views of the people we talked with today are influenced by the many patients they have cared for with injuries or strokes.  Nancy has a combination of factors that have incapacitated her but injury (a shattered hip from a fall, say) and stroke are not among her problems.

I wish I knew more about the damage done to organs and cells in the few days in late November and early December but it seems to me that the body’s natural repair of these things was a slow process.  During much of December this process was underway but complicated by the faulty heart.  This resulted in many days of “down time” for Nancy during which her muscles went unused.

In the midst of all this was open heart surgery.

Nancy can extract herself from bed, stand and move into either a walker or a wheel chair, and move about.  The seat of the wheel chair is lower to the floor than the bed so (today) it still required a helpful tug for her to achieve vertical status from the chair.  Still all this seems to be progressing well and a little faster than some thought it would.

One issue all would like complete recover for is the inability to maintain bladder control.  This function was compromised by the extended lack of use of the muscles and the use of a catheter.  In recent weeks Nancy has not been able to get out of bed on her own nor to get on to or off of the potty.  Help has not been timely, creating frequent unpleasantries for Nancy and the staff.

Following from Nancy’s increased mobility and ability to sit and stand from taller items, today a raised platform with arms was fitted over the low commode.  This and an introduction to “Kegel exercises” should soon resolve the problem and everyone, especially Nancy, will soon give a shout of joy.

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If you care: http://en.wikipedia.org/wiki/Kegel_exercise

Nancy was carted over to the hospital this afternoon and seated between the open ends of a horseshoe-shaped thingy that lit up a monitor with an image (in shades of white, gray, and black) of her mouth and jaw, and points south.  Lowest on the screen were the top two metal sutures used to tightly re-close her split sternum.  If you lower your chin to your chest you will come close to where the top one of these appears.

Nancy was given food items containing a small amount of Barium sulfate that acts as a contrast agent with respect to the body tissue and bones.  That is, whereever this stuff goes can be seen on the screen as near black globs.  Because Barium is of relatively high atomic number (Z = 56), its compounds absorb X-rays more strongly than compounds derived from lighter nuclei.  Although barium is a heavy metal, and its water-soluble compounds are often highly toxic, the extremely low solubility of barium sulfate protects the patient from absorbing harmful amounts of the metal. Barium sulfate is also readily removed from the body.

The compound is administered as a suspension of fine particles mixed with foods of different texture.  Nancy had grape juice, applesauce, a fruit mixture, mashed banana, and mashed chicken.  Following her time in the ICU with tubes down her gullet Nancy existed primarily on non-solid foods, especially fortified drinks.  As more-solid textures were introduced she became accustomed to small bites and tentative swallowing.  Frequently she would chew something for awhile and then spit out the solid parts.

The passageway from lips to stomach experienced little real action for many weeks.  The muscles along the way degraded, lost their tone, or underwent “disuse atrophy.”  I think this is what we suspected and confirmed today.

As Nancy ingested the barium sulfate laced food all parts worked as they should except at the very lower limit of the image there was a just noticeable slowing of the material (the dark glob on the screen) and then it dropped out of range for the set-up being used.  Thus, while her real food intake is improving she instinctively remains cautious and rightly takes small amounts and swallows carefully.

In the room today for the exam we had Nancy, the imaging specialist, two swallowing specialists, and me.  Not that my opinion was needed, but we all agreed on what we saw, and what we thought it meant.

During Nancy’s time in the hospital (except when sedated) she continued to use her hands and arms – right more than left.  Since January 20^th she has had therapy on a regular basis.  Yesterday she was able to play her violin for the hour jam session with her friends, and it is now six weeks since open heart surgery.

However, Nancy is not yet able to get herself out of bed nor into a standing position from a sitting position.  Noticeable progress is apparent as regards these very visible muscular activities.  The tone of these less used muscles is returning more slowly than those in her hands and arms.  It seems reasonable that the equally atrophied muscles used for eating that we cannot see at work will likewise take longer to regain their capabilities.

So, having found nothing really out-of-whack, we expect continued improvement.

[whack?  See:   http://www.worldwidewords.org/qa/qa-out2.htm ]

Well, the work week began.  Everyone did their job as usual.  Nothing was particularly exciting or new.  All those with some knowledge of the rehabilitation process that talked to us said it would be slow.  It is slow.  What more can I say.

I’ve got some paperwork to catch up on.  You probably do to.

Nancy did well in the physical therapy room today.  She was helped from the wheel chair into a standing position and into a simple ‘walker’ and as she walked I followed with the chair.  While upright she is supported by another person holding onto her “gait belt.”  You may know this by another term, such as transfer belt or transfer aid, and it may (or may not have handles or loops for the assistant to grab.  The ones used for Nancy are simple heavy canvas straps with a single buckle.  Not fancy but they give a sturdy no-slack support.  She did two rounds of the circuit (about 100 feet) during the first excursion.

A person from a medical supply firm showed up with a half-dozen walkers of various styles.  The PT crew inspected them and used another lady and Nancy to test them for sturdiness and height.  Unlike the one Nancy has been using in the PT room, these were more fancy, with wheels (with hand brakes), and a seat.  Most are gray or black but the model that seemed most suitable for Nancy had a dark red anodized aluminum frame.  [Years ago when I was pretending to be an archer I assembled arrows both from wood and anodized aluminum.]  The process is described here:

http://en.wikipedia.org/wiki/Anodizing

Most folks are more likely to see this surface treatment on promotional items such as you will find by using Google Search, click on “Images” and cut-and-paste the following as a search phrase

[  carabiners “anodized aluminum”  ].

The ‘walker man’ had a bluetooth headset for his cell phone and talked with a person in their warehouse during his demonstration.  Very convenient.  It made me wonder why out in the facility the patients must still summon help by pressing a button on the end of a ten foot cord that then turns on a small light over the doorway in the hall – a light that might not be seen for several or several tens of minutes.  Then an aid comes into the room, turns out the light, assesses the patient’s need, and either helps or goes and finds someone, like a nurse, who can.  This signaling method became practical about 1910.  You do the math.

On another front the morning nurse did not have on her chart that it was allowed for Nancy to have the small carton of chocolate flavored drink with which she has been taking pills.  Two of these a day has been standard procedure now for at least a week.  Not this morning!  A little later someone brought her a cup of vanilla ice cream.  Then at supper an aid promised to bring her a scoop of strawberry ice cream.  The person was interrupted and that scoop never showed up.  The indignity of bureaucracy, procedure, and slow motion chaos is impressive.