Friday, July 03, 2009

Early milestones

Hi everyone:

Patty accomplished two things later in the day that are significant in terms of her recovery. First, she went for a walk. The total return distance was approximately 30 feet, and each and every step was punctuated by searing pain. I think Patty was frustrated and disappointed, while everyone else was practically cheering. Even through the tears, you can tell she's a tough customer. Patty has a wonderful nurse, Tamara, who is part advisor, part cheerleader and entirely a good person.

The second accomplishment was getting out of bed and using a commode next to the bed. On the surface, this sounds like nothing much, but it involves quite a bit of bundling wires, shifting position, lowering the legs, supporting the arms, lifting, turning, sitting, standing (okay, you caught me...I skipped peeing and wiping) and basically the reverse of everything that preceded it. Again, all of this is painful for Patty, particularly since they've continued to give her Lasix, which makes this whole exercise one that is necessary every 15-20 minutes. The diuretic is necessary because Patty's feet and ankles are quite swollen, which was not a common occurrence for Patty even in heart failure days of the past.

We've been hearing murmurs that Patty isn't likely to escape the hospital until at least Tuesday, and some think even that is optimistic. The key issues at this point are:

(1) pain management--I've seen little to suggest we've made much ground here; they've changed the delivery method, but she's still needing a lot and it doesn't seem to be sparing her much pain

(2) oxygenation -- Patty's pulse-ox is okay until she removes the oxygen, at which point her oxygen level drops; the theory is that this will take care of itself. Her nurse reduced the oxygen level for tonight, to see how she does...I'll let you know the outcome.

(3) edema/urine output -- Patty is holding on to a lot of fluids; she's urinating frequently now, because of the Lasix, but she's still swollen. She's probably not going anywhere until this is fully resolved.

(4) inotrope removal --right now, she's being given dobutamine to strengthen her heart pumping (remember milrinone from Patty's days past?), especially while she's experiencing heart failure symptoms (swelling, arrhythmias, dyspnea, etc.). I really hope this is resolved quickly, because this makes me most nervous of all...especially since Patty has been largely asymptomatic for a couple of years.

If I was going to assess Patty's situation right now, I would say -- if moving, not so good; if still, pretty good. I'll write again if there's more to share...otherwise, have a great night.


P.S. I'm staying at the hospital again tonight.

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