Friday at the Cath Lab

Roche Family News
Thursday was a pretty uneventful day. No better, no worse. They are still stumped with what is causing all of the breathing distress. Dr. Thompson is going to try using the ecocardiagram to see if they can tweak the pacemaker again. He saw something different in her labs today.

Friday
Bridget came to visit this afternoon and found the "Rapid Response Team" rushing around Mom. She was having chest pain. They put in a call to Dr. Thompson who decided to take her to the cath lab for another catheterization. Bridge called us all and Colleen and I met her in the waiting room along with Cathy Anderson who came to visit.

She went in about 2:30PM and came out about 4:00PM. Dr. Thompson said that the arteries were open and clear and the stent that he put in 1 1/2 years ago was working well. It does appear that she has had a heart attack at some point that is affecting the heart's ability to pump. On the whole, he is still stumped but hasn't given up.

He is trying new medications and put in a pick line so she doesn't have to have IVs threaded through her veins every few days. They are down to using infant sized needles because her veins are thin and they collapse easily.

She was alert at dinner time and looked and sounded as good as she has since she's been in the hospital.

The roller coaster ride continues!!!

Another Dip in the Road

Roche Family News
Monday
Not such a good day for Mom on Monday. She was in bed all day, struggling with her breathing. She is quite swollen and the doctors are playing with the water pills to try and make her more comfortable. The down side is that more diuretic affects her kidneys and other levels. She was pretty agitated so they gave her Adavan to calm her.

Bridget and I went to meet with the St. Anne's social worker, Dagnia and nurse Pat. It was a good meeting. We politely expressed our concerns : Why was the V-tach not communitcated to us or the doctor? Ans: It was observed by a non medical staff member and so only recorded. Why did it take 2 hours to get her from St. Anne's to Columbia? Ans: don't know. Will look into it. Where are we in the process of ordering shoes? Ans: don't know. Will look into it. How can you monitor her health if she comes back? Ans: Able to handle meds through the IV but not injected medications into the IV site. Oxygen is not an issue. Lab orders will monitor other levels. Why can't PT/OT work on strengthening and range of motion until she is strong enough for standing and walking? Ans: They can. At this point, it may not be an issue what they can do.

Tuesday
Bridget spent the day at the hospital and Colleen came in for the afternoon and evening. Mom was in a chair but breathing was still very labored. She was very clear sometimes and other times she was talking to people who weren't there. Her arms twitch and her whole body shakes as she tries to get enough air. She has breathing treatments every 4 hours and they seem to relax her for awhile. Mary Ellen, Kathleen and Rainey came to visit. Mary Ellen was able to wash her hair with some type of shampoo cap and that made her feel better. The nurses felt that she was much better from Monday. I don't think any of us felt that way.

Wednesday
Mom is talking a little better today. Mary Ellen and Kathleen came back and Mary Ellen curled her hair and did her nails. She was thrilled. Bridget's friend, Loye has also been visiting and she came up today to help with lunch. It really helps her frame of mind. I'll go up again after school

Another Dip in the Road

Roche Family News

Sunday

Roche Family News
Quiet day at the hospital. Mom is resting in her room. She is anxious to get up tomorrow and sit in the chair for awhile. Her blood sugar was good and her breathing is OK. I asked the nurse to see if there is another Mersa culture scheduled to see if the infection is gone. She left a message for the doctor. She looked good, more like herself. Bridge, Colleen and Kyle all visited Sunday evening.

Meeting tomorrow with the St. Anne's staff.

Saturday Addendum

Just saw Mom. She is looking better. She ate about half of her dinner but is sitting up in bed ready to watch TV. Her new room number is 277 and her phone is 961-4277.

Too Busy to Blog

Roche Family News
Wednesday
For all who don't know, Mother is back in Columbia Hospital. Wed. evening, Bridge & Al were visiting when they witnessed an episode that looked like a short seizure. Bridge called the nurse who also saw it and told Bridge that they had seen it before. From 8:00 until the ambulance arrived, there were at least 8 more episodes. They arrived at Columbia's ER around 10:00 pm, greeted by Mick, Colleen, Brendan and I, Colleen, John, and Chris.

The ER docs felt these were heart related. V-tac episodes where her ventrical chamber is beating erratically. They stabilized her and she went to ICU around 3:30 in the AM. Bridget & Colleen & I stayed through the night and she didn't have another episode.

Thursday
Dr. Thompson was in. He feels that a chemical imbalance between her potassium and magnesium which were very low and her thyroid which is still out of whack was causing the v-tac. He added potassium and changed meds and is watching her kidney output. She had one episode at dinner but no others. She has a urinary tract infection, some bacterial infection called c-difficile, and a staph infection in her wounds, so she is in isolation. That means anyone who enters the room has to gown up.

We found out that the synthroid error happened at Columbia so she was off her synthroid for about 10-11 days. Colleen and John stayed till about 9:00. It was John's birthday, so we celebrated with Chinese take out in the waiting room watching Grey's Anatomy. What a party!@!

Friday
Chris visited at noon and found Mom having trouble staying awake. She nodded off in the middle of talking and seemed confused. He reported it to the nurses. I saw her at dinner time and saw the same thing. She was in a chair, still has a catheter and occasional IV meds. Seems very tired. Still embarassed about her hair and wishing for a permanent. She hasn't given up yet!

Her blood sugar has been too low now so they are offering her juices. They have taken her off the methadone now as they feel that is the only med that could have contributed to this. They are trying a different pain med that starts with phen???

An associate of Dr. Thompson, I believe, was in to tell us of the med change. She said if the medication route doesn't work, another alternative is to implant a defibrillator that would shock her heart back into rhythm. Sounds extreme. Don't think that's an option at 87.

Saturday
Checked in with the nurse. Her weight is up but they are being cautious about the Lasik, 20 mg. The new pain med is fentanyl and it is a patch that she wears. She has had no loose stools for 2 days. Dr. Deshpandi, who put in her pacemaker, was in to check on her. Now she is moving to a regular room on the second floor. Room 277, still in isolation. I asked about the other doctors following her. It will not be Dr. Hawes, she passed her off to the hospitalist and will just check in. Soap Opera!?!? Stay Tuned.

Tuesday's News

Roche Family News:
This is the news from Stacy's end of things:

Csilla told me after her visit that she had a lot of difficulty getting
information from the RN on the floor regarding your mother's condition
and her wound dressings. She was referred back to Georgie. Csilla told
me that it sounded like Georgie was ok with the decision to continue
with Dr. Altman. Csilla left a message for Pat today as she really
seems to know more about what is going on. Csilla was also very
concerned about her low energy level. As far as the coban dressing goes
- if Dr. Altman orders it, the nursing home has to follow his orders and
provide it. I also received a message about the Medicare Part B running
out. I am waiting for a return call from the therapy director. It is
possible that they are counting the times she received therapy through
Healthreach Rehab back at home. She also mentioned an extension and I
hope to find out more from her on if that is possible. Part D covers
medication only. I will keep you updated on what I find out on my end.

Stacy

Monday Monday

Roche Family News
I received a call from Heather Baumgartner, the PT today. She suggested that they discharge Mom from PT and OT. She was in bed all day today and was too ill or tired to walk for them. They suggested that we wait until she is healthier. I agreed.

She did make a comment about being out of her Medicare B days anyway and that we would have to go through different funding. I asked Bridget to check with Stacy on that. Bridget had trouble reaching Mom by phone today and had to call the maintenance man for help.

I went to see Mom tonight because all reports sounded pretty grim. She looked better to me. She was not dressed and was up in the chair eating. The swelling in her legs is down and she is off the oxygen. Her breathing sounds better and it looks like her weight is down. I hope we weren't premature in stopping PT.

Bridge is coming to take her to the doctor tomorrow. She'll get Dr. Altmann's opinion and I hope some anwers on the dressings. They used ace bandages again and they were pooled at her ankle, uneven and the Kerlix was only over the wound and not wrapped from heel to knee. Not sure why they are so resistant. I'd like to do it myself.

Here's hoping tomorrow brings some good news. Any more days off her feet and I'm afraid she'll never be up and walking.

Packer Sunday

Roche Family News
I went to mass this morning with Mom. She said she had a bad night. Her stomach was upset and she needed to use the bathroom often. You could still hear her stomach gurgling from across the room. (She complained that one of the night aides was sort of rough with her. We'll talk with the nurses about that.) She is back on the oxygen and sounds wheezy. She had a breathing treatment after mass. She still looks kind of beat.

Colleen P and Bridget came to visit too. We were there when Mom's leg dressings were changed. The wounds look better but there is much swelling at and above the knee. Colleen and I were able to talk with Mike the nurse about the way her legs should be dressed. They are using ace bandages rather than coban and that causes some problems. The bandages aren't long enough to reach the knee and they bind at the ankle causing her discomfort. Not sure why we can't get that settled.

There is a care plan meeting on Wed. am and Stacy will be there. I'm hoping she can get an answer as to why they won't order the coban. Bridge will try to set up a family meeting after 4:00 some night.

Kathleen Andries, Mary Ellen and Rainey came to visit in the pm. Mom was thrilled to see them. Kathleen brought pictures from their party for John's boat opening.

Grandma and Sam Christmas 2005

Roche Family News

Roche Family News

Saturday September 16, 2006

I visited in the early evening today. When I talked to Mom earlier, she said she was dressed and sitting in the chair. She looked better tonight but her breathing was very wheezy. They have her on oxygen again. We took a walk (wheelchair) outside and sat for awhile in the nice weather. She really enjoyed that. She has been ordering meals in her room. Can't convince her otherwise.

I had a chance to read over the records sent from Trinity (41pages). I was looking for inconsistencies in the med lists. They sent the two doctor reports from 8/11 and 8/24 at Trinity which included a med list each. They also had Dr. Christopher's notes from the first stay at Columbia. They sent therapy notes from OT,PT, and Speech but no day to day nursing notes and no med list that the nurses worked off of (the one they would copy for Dr. Altmann).

Both of the med lists include the synthroid. The 8/11 list had "Simvastatin 40 mg" but no Zocor. The 8/24 list had no Cozaar and a drug called "Losartan 50 mg" and no stool softener on either list. (Maria's answer to that was that St. Anne's protocol is to offer milk of magnesia for discomfort and a suppository if someone is constipated.)

If anyone wants to do a web search to find out what those other drugs were or if Bill or Diane knows, Maria could not find it in their PDR. But the bottom line is that Trinity's doctor notes state that she was on synthroid (levothyroxine). Bridge if you see something different on the med list that Dr. Altmann kept, maybe that is the answer. For now I don't know how it was missed in the hospital but it appears that it was being given at Trinity. Good catch, Bridge. We could have been looking at another hospital stay if you hadn't caught that.

I will be going to church with her on Sundays if anyone wants to join us, 9:45am. We are hoping to sit outside again.

By the way, for those who are interested, I checked her leg bandages today and they are wrapped only over the wound, so her leg is bulging above and below and there are ace bandages. Her legs are still extremely swollen. Not sure why no one can or will follow Dr. Altmann's orders.

Betty Updates

Sunday September 3, 2006
Got an early morning call from Trinity saying Mother was still throwing up and now has abdominal pain. Dr. Hankwitz wants her to go to the ER at Columbia.

9:30
Met the ambulance at Columbia. Dr. Mays (surgeon) ordered a catscan and redressed her legs himself. He found the dressings to be poorly done and leaking. Catscan inconclusive but best guess is colitis since she believes her appendix was taken out with her gall bladder. Admitted to the 5th floor. Followed by Dr. Lee and then Dr. Kastopolous(sic?). Discovered a previous culture for an infection called Mersa which was done by Dr. Altman. Recultured and still waiting for results. Takes 72 hours. Isolation procedures in place (gowns and gloves for staff). Antibiotics begun.

Saturday September 9, 2006
Discharged to St. Anne's Home for the Elderly. Passed on a 2 inch thick file of paperwork from Columbia Hospital. New doctor is Dr. Hawes. Colleen will meet with her on Monday 9-11. Watch for her update. OT and PT services to start Monday as well. Mom is in Room 215 and her phone number is 527-6787.

Wednesday September 13, 2006
Bridget took Mom to her appointment with the Wound Healing Clinic at Columbia Hospital. They still are unsure of the Mersa culture but proceeding with antibiotics directly applied to the wound , Bactriban. Her legs were significantly swollen (tree trunk sized), especially above the knees. Her slacks had to be taken off because the swelling was too much to slide them up. Bridge happened upon the discovery that Mom has not had any Synthroid for her thyroid condition for at least 11 days, since she entered Columbia Hospital. We'll have to check on the Trinity records to determine whether or not it has been longer. The nurses are contacting Dr. Hawes and she has started her on a "ramp up dosage" - 50mg. for 5 days, 100 mg. for 5 days and then 150 mg. daily. The synthroid began Thursday. Mom saw the wound nurse, Sue, who wrote detailed notes on the dressings to be used and the antibiotics necessary. The dressings from St. Anne's included the use of an Ace bandage and Sue prefers that not be used because of the compression and the tendency for it to slide off. That was communicated in her notes.

Thursday September 14, 2006
Received a report that Mom was vomiting and her stomach was upset. Brendan and I visited after dinner. She looked as bad as I have seen her. Very lethargic, hardly able to lift a glass to her lips, shallow, quick breathing and continued extreme swelling of her legs. She was running a low grade fever (100 degrees) and had some wheezing from her lungs. The nurses tried putting her on oxygen and offered her albuterol inhaler. She ate little for dinner and had been in her room most of the day. She needed much help to get to the wheelchair and when she was taken to the bathroom to get dressed for the night, she had a bout of diarrhea. She was very weak. She was given Tylenol for the fever and Tums for the stomach upset and put to bed. She says she slept soundly. The nurses reported that her fever was still 99 degrees during the night.

Michelle the nurse manager, came in to check her over and listen to her lungs before we left. I questioned the effects of missing Synthroid for longer than 10 days and she had me and mother sign a release of records form for Trinity. When they arrive, we should know how long it really has been.

Friday September 15, 2006
Called early to check on Mom and was told she was in bed. I was put through to Georgie Rosio who is the wound care specialist at St. Anne's. She has called me 2X previously, wanting us to transfer Mom's wound care to St. Anne's rather than taking her to Columbia. I explained that we were very happy with the progess she is making with Dr. Altman and do not believe that another change of doctors is in her best interests. She is very assertive and really pushed for us to do it her way. She insisted that the Bactriban that was prescribed was very expensive ($180) and would not be covered by her Medicare, T-19 or insurance. I told her I would check with Dr. Altman and get back to her.

I spoke to Sue at the Columbia Wound Clinic and she assured me that Bactriban should be covered. She even checked with the Newport Pharmacy in the hospital and they agreed and told her that there was a generic available. She feels that even if it was called into question, it could be challenged since the Mersa has been very resistant to other antibiotics. They are prescribing the use of both the Acuzime (to help to dissolve the dead tissue) and Bactriban (antibiotic) daily with a full leg dressing of Kerlix and Coban . She had OK'd the ace bandage over the phone if it was checked and repositioned at least 2X a day.

I went to visit over the lunch hour and Mother sounded a little better. Confused about where she is. Scott had been to visit and she wasn't sure when that was. She was in bed with her legs up. Her legs are still huge but her breathing is better and she was much more alert than last night.

Stacy met me there and we spoke to Pat Rosensteter the nurse about the medication and dressings. Pat even spoke on the phone herself with Sue from Columbia ( a personal friend of hers) and with Csilla. Csilla spoke to her about the antibacterial dressing that she has been suggesting and since Family Care will pay for it, they will order that as well. Stacy stayed and met with the PT people about her treatment plan and the diabetic shoes. I will update after she emails me.