Back in the Hospital - Round 11

I just realized that I have 46 unique text threads going related to Shirley’s current medical situation.  Not only is this not sustainable, but it’s hard to keep track of who I have told what to.  So, I’m reverting back to her old transplant blog to provide everyone with a common set of updates.  I plan to use this entry to let you know her current status and going forward, I’ll provide both recent updates and some background for those trying to catch up.

The situation as of today, Sunday, October 6:  Shirley is at St. Vincent’s Medical Center.  This is the 11th time she has been admitted to the hospital since late April.  She came in on Thursday at the urgent request of her primary care doctor because of highly elevated numbers indicating kidney failure. 

As of Sunday evening, she has now had two dialysis sessions. The second just finished, so we haven’t yet seen the impact in terms of improved kidney function, but the first dialysis session yielded improvements to both her BUN (from 128 to 74) and Creatine levels  (from 4.16 to 2.87).  For those interested in the meaning behind these numbers, here’s a link.

Before Shirley could have a dialysis treatment, they needed to install a port that could both draw and return blood.  On weekends, the only place to do this is in the ICU.  At about 1 pm on Saturday, Shirley was taken to the ICU for a port installation and I was told she would be taken directly to the dialysis clinic from there.  Here appointment in the clinic was for 2:40 pm.  Visitors were not allowed in either the ICU procedure room or the clinic, so I first waited in her upstairs room and then in a public waiting room nearby. Thanks to Tom Hauge for coming by and hanging out with me.  We were told they would call us when her treatment started, so we would know that she’d be returning to her room two hours later.  We arranged to have them call us when Shirley started her treatment – which didn’t come until 5:45 pm – which meant with transport that she didn’t get back to her room until after 8 pm.

Besides her kidney function, nutrition has become a major concern.  Shirley just doesn’t have much of an appetite and is eating far less than necessary to build needed muscles. She always eats her meals later than most people and we had arranged for her meals to be delivered to her room at 10 am, 2 pm and 7 pm.  On Friday, she nibbled on her breakfast eventually eating about a cup of scrambled eggs and one half piece of French toast.  For lunch, she had about 5 bits of grilled chicken and a few bites of mashed potatoes.  She never got around to eating dinner.  Saturday, she hadn’t started eating a meal before they came to take her to the ICU at 1 pm and when she came back, she was too exhausted to eat.  Shortly after midnight, she choked while trying to drink some water and that caused them to cease all feeding until a swallow assessment could be conducted.  When they came to do this Sunday morning, she refused to do the test.  As a result, as of 11 pm Sunday night, she has not had anything to eat in nearly 60 hours.

To remedy this, the plan is to install a feeding tube that can be used to provide her with high nutrient fluids.  The tube is called an NG tube (nasal-gastro) and is run through one nostril, down the back of the throat and into the stomach.  More on this in a moment.

A third issue is Shirley’s oxygen levels.  Since arriving at the hospital, Shirley has been receiving small doses of supplemental oxygen. But a few hours after returning from the dialysis treatment, her needs when way up.  She’s now getting 15 liters – which is the maximum that can be administered from the oxygen in the room.

Now, back to the NG-tube:  in order to install this tube, her nasal canula that delivers the oxygen would need to be removed for several minutes.  This makes an uncomfortable procedure become much more challenging and dangerous, as her O2 levels would reach critical levels.  For this reason, it was determined that the installation should be done in a surgery room under anesthesia.  This removes the discomfort element and makes it much safer, BUT means they can’t do it until Monday morning, so she’ll go another 12 hours without food.

She is receiving a dextrose fluid via IV.  This provides some basic fuel to her blood to feed her cells, but no protein or other nutrients.