August 7th - Progress By Carol Buzalsky — 30 minutes ago Mom had a great day! She was smiling when I was there before work, at lunch and after work. She was breathing without the ventilator for a large part of today. It was still through the trach site as when they cap the trach she has a hard time breathing due to the size of the trach. Hopefully tomorrow they will remove the current trach and replace it with a smaller one so that when they cap it she can breath easier and also talk. An increase was made to the amount of her feedings through her stomach and a decrease to the nasal feeding source. The plan is to remove the nasal feeding tube within a few days. Mom sat on the edge of the bed today for about 6 minutes and with no pain. She was supposed to have dialysis today but did not. She continues to produce urine and her kidney lab values werent great but it must have been ok enough that they decided not to do dialysis and will reevaluate tomorrow. I never thought I would see the day when I would be excited to walk into moms hospital room and be excited to see pee in a bag, but I have reached that point!! Discussions have been held yesterday and today regarding where mom will continue her care. The social work informed us today that Bethesda in St Paul reviewed moms case again in depth and declined her again (Bethesda was check into for mom in early July also). Their rational is that she is on a vent, on dialysis, wound vac and concern for her heart issues. I have met with the business director at Vibra regarding my concerns and I am feeling better about steps they are taking to improve their consistency in policies and procedures. The social worker is continuing to look at options for us but even though mom is smiling and improving in her health, she remains in a very fragile condition with a lot of factors to consider such as the ventilator, dialysis, and etc. Now that so many Sanford specialty doctors are familiar with moms case the best place for her to continue to heal is in Fargo. Mom, Marlene and I had an interesting discussion with Roxanne Newman, Sanfords Cardiovascular Surgeon. She is a very well known physician. An echo of moms heart was done yesterday. This showed no worsening of the vegetation and valve damage. She still has regurgitation of the valves (tricuspid and mitral). The tricuspid is very bad. The concern with the valve replacement surgery is the amount of time it takes to heal from having to access her heart through her sternum and the length recovery time from that surgery. The good news from Dr Newman is that her heart muscle is good and the issue is entirely with her valves. The continued leakage/regurgitation of her heart, if not repaired, will cause issues with her lungs from the fluid as well as her abdomen and liver. Dr. Newman thinks outside of the box in her procedures so she does have an idea for a less invasive fix to moms heart. I got very lost in the details of the procedure, but to fix one of the valves she would go through moms left side to access one valve and repair it with something (sorry got lost here) and to help with the leakage on the other valve she would go through the groin and place something here and here (she pointed where on her body). Everyone got that? The key part I took away was the sternum method opens mom up for much more infection, is risky and longer recovery. If that is the route to take for moms heart she would be looking at 6 weeks from now. If she uses what I am calling the outside of the box method, its less invasive, less recovery time and would be done in 4 weeks from now. If I understood correctly the materials used in either procedure would not require her to be on Coumadin which is a concern given her prior bleeds she has had. The sternum method requires mom to be on bypass during the procedure and the out of the box method does not require bypass. Mom will have another TEE (the one where they look at moms heart through a scope down her esophagus) so that measurements can be taken to determine the size of the of what will be needed to fix moms heart. Im guessing that will be scheduled for tomorrow sometime. So, overall, I hope Dr. Newman will walk through these procedures again so I can get a better grasp of the options AND it was encouraging to hear that there is hope for repairing moms heart. It could be as early as tomorrow or not until next week sometime that mom will be moved out of the ICU. Progress....
Posted on: Fri, 08 Aug 2014 02:40:00 +0000
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