Angie & Jim

More Questionsby Jim

Well, things were going great: Angie was feeling well, we were weaning her off of the oxygen, etc.  Angie wanted to go for a walk, but I convinced her that she ought to try something a little less intense, like sitting in a chair for a bit instead.  (Previous attempts at walks have been really hard on her.)  She wants to go home and has been anxious to try and push herself to accomplish her daily goals.  So, we called the nurse and got her sitting in the chair.  Very quickly, her oxygen saturation levels got quite low.  Low enough that they called the doctors and ordered a stat chest x-ray and blood work.  There were 2 or 3 nurses in here very quickly as we got her back into bed and lying down.  They hurriedly put a face mask on her instead of the nasal cannula and turned up the oxygen to the max.

The doctors came and all looked a little concerned as they talked to us and each other.  The biggest concern they have is why this is happening.  During the whole thing, Angie remained calm and didn’t feel any pain or discomfort besides some strong fatigue while in the chair.  One of the younger doctors came in after their meeting out in the hallway and chatted with us for a minute.  His name is Dr. Perizo and he was very nice.  He wanted to try a little experiment with the oxygen saturation levels and sitting up.  They wanted to see if the low sats came from exertion or from body position.  So, they put the bed all the way down and let Angie lie for 5 minutes to see how she would do.  She got to 96% saturation, which is actually the best she’s been since she’s been here.  Of course, she was on a ton of extra oxygen.  She runs between 90-92% without any extra oxygen just normally with room air.  Then Dr. Perizo and I helped her to sit up in the bed and watched for 5 minutes.  It took a bit, but her oxygen slowly dropped to below 85% and her heart rate went up a little.  She didn’t feel any worse, but it was clear something was different.  We even tried swinging her legs over the edge of the bed and letting her sit like that, but it wasn’t much different.

Here’s the thing: I’m not sure this is anything new.  The few times she has gotten up over the last few days we unplug her oxygen sensor so she can walk away from the bed, and by the time we plug her back into the sensor, she’s lying on the bed.  We had never had her plugged in and vertical since she has arrived.  A couple of times getting up, she’s started to look really pale.  I think that this has happened a few times, but we’ve just not seen it.  I’m really glad we caught it so we can watch for it, but it certainly gave us a little scare.  The chest x-ray showed her pneumothorax has healed, which is great (but doesn’t explain the recent episode).  I think nothing new happened this evening, I think we just saw something that has been happening unobserved previously.  It is still concerning, but not as bad as originally feared, I think.

Angie’s doing just fine now.  Since everyone was so worried, the nurses wanted her on a mask, but she had just ordered dinner.  Eating was interesting.  She seems to do better lying down, so we reclined the bed, but that made it difficult to eat, so I fed her instead.  They let her put the nasal cannula back on and just hold the mask near her face and put it on between bites.  They wanted her to stay above 88% while she ate.  We were able to forgo the back-and-forth and just let the mask sit on her chest while I fed her.  She’s sitting now on the bed with her phone looking at facebook & such with sats between 90-92%, and she’s not wearing her mask (shh, don’t tell the nurse).

Now for the best part; this ought to give you a smile.  You’ve earned it by reading through this post.  So, Angie is on a “very low sodium diet” as per doctor’s orders.  The menu has a few items marked as low sodium, but she is very low sodium, so even some of those are off-limits.  Angie has had the turkey before, but of course she can’t have gravy.  Instead of just eating it dry, she decided to get creative.  She ordered some vegetable broth and mashed potatoes and just mixed them together to make her own gravy!  That’ll show those dieticians that are trying to foil our good flavor.  That’s why I love Angie.  Well, just one of the many reasons why…

Another visit from PAWSby Jim

A little while ago we got another visit from PAWS.  It was a pleasant surprise, since they just came by yesterday.  Today we were visited by two dogs, Cici and Guinness.  When they first came in, the patient sharing a room with us got really excited and asked if they could visit her too.  They okayed it with her nurses and were able to spend some time with her as well.  That made Angie feel really good that she was able to brighten someone else’s day too.

Cici is a Schnoodle and is a snuggler.  She made herself comfortable next to Angie right away and seemed very happy.  Guinness was the entertainment.  I’ve uploaded a video so you can see his performance.  After the show, Guinness sat with the other patient and then they swapped places and Angie got to sit with him.  Once again, it really brightened Angie’s day to have some very sweet dogs to sit with and love.  They ladies that came with the dogs were very kind and asked about our cat and we showed pictures and told them about how sweet our cat is.  The healing influence of animals is amazing.

Cici

Guinness

Each of the dogs has a little trading card picture that they leave with each patient.  It has a picture of the dog on the front and information about the dog on the back.  They are really adorable.

Another updateby Jim

We haven’t heard the results from the CT scan, but Angie’s been back for several hours.  In the meantime, we’ve been visited by a dietician here at Stanford to help us understand how to help Angie gain some weight over the next few months.  Her name was Johanna and she was very nice and very helpful.  The bottom line is that Angie needs more calories.  The doctor actually told her things like butter, ice cream, and cheese sauce are great for dense calories.  Not often does a doctor tell you to more eat cheese sauce.  The catch is that she also has to be on low sodium to help keep the fluid from building up.

I’m really glad we asked to talk to the dietician because it helped to clarify some things and get a better understanding of what we’ve got in store for us in the coming months.  She also mentioned that there is a dietician that works in the heart clinic that Angie goes to, so we will probably arrange to have a few visits while Angie comes in the future.  That should really help keep an eye on things and get her back to normal.

Bring on the cheese sauce!

The Home Stretchby Jim

The doctors just came and chatted with us for a bit.  Dr. Rogers, who has been heading up Angie’s care while she’s here, talked to us about the plan for the day and mentioned the plan for getting home.  That is good news, but we’re not out of the woods yet.  Here’s the scoop:

They’re doing a CT Scan this morning (just took her away, actually) to check her liver and other organs.  Her fluid is much lower and she’s only drained about 100 ccs since last night.  Dr. Rogers said they are going to lower her dosage of the drugs that make her lose fluids (which should help with the blood pressure).  Her oxygen saturation levels have been looking good, but she’s on a lot of extra oxygen.  He said he wants her levels to get back to normal without any oxygen before she goes home.  He also wants her able to get up and walk around without it completely wearing her out.  So, those are our goals for going home: weaning her off of the oxygen over the course of the day (as her levels permit), and getting up and taking walks.  We can do that.

Over the first 24-36 hours of being here, Angie lost about 4.5 L of fluid, which is about 10 lbs of weight.  This was after she’d lost several pounds in just the last couple months.  She’s down to under 100 lbs, which is definitely in the “underweight” classification.  We were concerned about it, so we’ve asked about getting a nutritionist to stop by and consult with us to find a way to healthily (is that a word?) get her back up to normal weight.  We believe that with all the fluid that was building up inside her, it was putting extra pressure on her digestive system and making her have very little appetite.  When she did eat, she would eat very little before feeling full.  I’m hoping that now that the fluid is gone, she’ll bounce back to her usual self and her appetite will return to normal.

After the doctors left, and I think to try and gauge her levels, Angie wanted to get up to brush her teeth.  It may have been a bit premature, because it really took a toll on her.  Just as she sat back down and was catching her breath, the CT scan people came to cart her away.  She got on the bed and they wheeled her out.  I will post again after I’ve heard the results from the CT scan.  Thanks for reading.

A Long-Expected Visitby Jim

Last year when we were in the hospital, I noticed an interesting sign posted in the hallway as I was leaving Angie’s room.  I snapped a photo on my phone and we talked about it later.  Apparently, Stanford has a group of volunteers that bring their dogs to help patients heal.  Well, she asked about it and requested a visit.  We were told they would stop by sometime today.  Angie was really excited and was rather anxious all day while we waited.

Max, the Labradoodle, came to visit us this afternoon at about 4.  A team of about 4 very kind women came in and chatted with us for a bit.  Max is fairly new at his job and is still in training with his owner.  He was very kind and did very well.  He is 7 years old and has been doing visits for about 6 months.  They are a service called PAWS, which is an acronym for Patient Assisted Wellness @ Stanford.  They even gave us a little card with Max’s picture and information on the back.

I knew it would cheer up Angie, but I was actually surprised by how much it lifted her spirits.  There is really something very special about animals and their healing influence.

Today was a lot better than yesterday.  I’m sorry I didn’t post until now, I’m running very low on sick leave, so I had to spend more time working than I have previously.  Between attending Angie and trying to keep up with things in Livermore, my day was pretty full.  That and no procedures to give me some time to post.  Anyway, enough about me…

Pain was in control all day and her vitals have looked great all day.  Her O2 saturation levels have been in the 90s most of the day (94 as of right now), which is fabulous.  Of course, she’s on 6 L of oxygen, so we’re not back to normal yet.  But, the bottom line is that her breathing is good and she’s feeling well.  She even muscled through a wall all the way down the hallway.  (That was right after a dose of morphine, so she was extra brave.)

This afternoon, they wanted to turn on the suction for her chest tube again, as per doctor’s orders.  Last time she got up to -10 mmH2O, but it was causing extreme discomfort and severe pain, so they turned it off.  They wanted to give her some pain meds and ease it up to -20 mmH2O, which is where she is now.  We’ve got a plan to keep her medicated through the night with the scheduling of the different things she can have, so I think we’re set.

This afternoon a medical student training to be a doctor came and asked Angie a bunch of questions.  It is part of a program where they have students come and talk to patients to see if they ask the right questions to try and diagnose the problem they came into the hospital for.  They asked us to pretend it was Monday and answer questions as if he were the doctor we saw a few days ago.  After that, he asked for a complete medical history.  I’m not sure he knew what he was asking for!  We proceeded to recount, with as few back-tracks as possible, a chronological list of all of the surgeries and procedures over her lifetime and especially in the last 6-8 years.  He seemed genuinely interested (he even admitted he’d like to become a heart surgeon, I think) and had very good bedside manor.  I’m sure he’ll be a great doctor.  One funny thing did happen: while he was doing his examination, he wanted to check Angie’s eyes.  He didn’t have a flashlight on him, so he pulled out his phone to use the camera flash as a flashlight and then sheepishly looked up at the man who was observing his interview and asked, “This probably isn’t appropriate, is it?”  “No, it isn’t appropriate at all.”  Whoops.  He went on to say, “Some older patients think you are taking their picture because they don’t realize you can use it as just a flashlight.”  Yeah, I can see why that’d be bad.  Poor guy; besides that, he did a fantastic job.

Jon came by a few hours ago to drop off a couple things and to chat for a minute.  As we were explaining the current state of things he asked, “So, what does it feel like to have the fluid sucked out of you?”  Angie retorted, “Draining, literally.”  We all cracked a wry smile at her humor.  It was good to see Jon and visit for a bit.

Tomorrow we’ve got a CT scan planned to look at Angie’s liver to make sure it is still functioning properly.  I’ll let you know how that goes.

Well, I think that just about covers events for the day.  Sorry for the wait.  I hope you find it was worth it 🙂

Pneumothoraxby Jim

The doctors just came by for their morning rounds to give us an update.  The plans for today are the same: just rest.  Dr. Rogers told us the chest x-ray from last night looks great as far as fluid build-up is concerned.  He said it was, “dramatically different” from the x-ray taken when she first arrived.  So, that’s good.  He also told us about the pneumothorax that has developed in her right lung (this is the collapse I mentioned last night).  He said it is very small and isn’t dangerous as long as it doesn’t get any bigger.  They’ve got another x-ray scheduled for this morning to keep an eye on it.

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

A Well-earned Day of Restby Jim

After the events of yesterday, the doctors have decided to cancel everything scheduled for today so Angie can just recover.  Her body went through a lot yesterday and just needs some time to rest.  Ironically, weeks ago, Angie had a CT scan scheduled for today.  Last night we got a voicemail from Lucile Packard Medical Center to remind us of her appointment tomorrow and gave instructions about when to arrive, etc.  Apparently, the didn’t get the memo that she was already here.  We thought it would be convenient because as it turned out, they wanted to do the CT scan today anyway, so we could just keep the original appointment.  But, after last night, everything has been canceled.

When I came in this morning, Angie was feeling much better and was just about to eat breakfast.  I was really worried when I first came in, because she was sitting in front of her meal with her eyes closed just sitting there.  I thought maybe she had fallen asleep or that she was in a lot of pain.  She was praying.  😉  I guess we don’t generally smile while we pray… maybe we should.  After she finished, I saw that she was is very good spirits and feeling much better than last night.  Breathing is still good and pain is under control.  When Angie got up earlier today to use the restroom, she commented that her body felt really exhausted.  The pain wasn’t bad (considering), but the hardest thing was just feeling weak.  She could tell that her body is just tired.  I think after today, we’ll be in much better shape.  CT scans aren’t fun, so I think a day of rest will better prepare her for the strain.

Thank you all for all of your prayers and love.