Sunday, February 16, 2020

To use the title of a hymn, and it could even be considered blasphemous "there's power in the blood"! The unit of blood worked its magic and all of his numbers have stabilized. He was awake and "growling" when I got here. The trach was leaking some so he could make some noise and it was just a growl.

Stephanie said the EKG showed sinus tachycardia but no afib which is what she was afraid of. The lab work showed some elevated levels but she's going to leave any treatment for that up to infectious disease since he's already on antibiotics. So , he's going back to the SIMV mode today!

His nurse just came in with morning meds and she said he slept well all night. So the timing of his sleep meds must have been right.

I was able to find what I was looking for on Supraventricular tachycardia and sinus tachycardia is a form of that. I also looked at the signs of anemia and he had several of those. Usually we only see Dr. Muir once a week so to see him 3 days in a row, he must have suspected this.

So a much better start to the day. Walt is not going to switch his vent quite yet. He sometimes starts breathing harder. We're going to hold the xanax since he's pretty calm right now.

Saturday, February 15, 2020

Final update for today. Dr. Muir the hematologist came in and said that Bill's hematocrit was barely under the limit for giving blood, so he ordered a unit. That explains his comment about his numbers are acceptable. He said the cut-off for giving blood is 24 (it was 25 in ICU) and his was 23.8. So, just barely under, but under nonetheless. He thought that treating the anemia would make a difference.

I never did get any results on the EKG or the lab tests. I'll ask Stephanie in the morning.

Bill did perk up some this afternoon and we talked a little. He wanted to know how long he had been in the hospital and couldn't believe it was 3 months. He wanted then to know how long he would be there and all I could tell him was we didn't know.

He was trying to nap again when I left but I could tell he wasn't really resting and although his numbers were staying in the acceptable range, I don't think it would take much to send them higher. I told Laura to use her judgment as to giving him more Xanax. We decided that unless he needed it sooner, she would give him some when she gave the last meds for her shift. He would then get his Seroquel at 9, so maybe he would sleep and rest through the night. At this point, I don't care if he sleeps most of the day again tomorrow.

I had a post show up on Facebook about a condition (and like an idiot I can't remember the name of it or find the post again) where your heart just starts beating too fast. And one of the treatments that is non-invasive, is Xanax! An episode usually lasts a few hours to a few days (Bill's episodes of this rapid heart beat and respiration usually last about 24 hours). So, I'm going to be doing some research on this and see if I can find the article again. Wish me luck! All I can remember is that it came from the Mayo Connect Group that I'm a member of, but I didn't find it there. So, I'll keep looking.

I'm still in no mood to talk to people. I have been texting some, but I just need to be quiet and still. I love all of you and know that you only want to help. Giving me space is the best way you can do that. I'll let you know when I'm ready. 

I hadn't planned on updating during the day, but it's not a good day.  After his numbers being good yesterday he was back on full vent when I got here this morning. They said he got agitated about 6:30 so they gave him his xanax Ann's that didn't help. His respiration went up again along with his heart rate while his oxygen dropped. Walter, one of my favorite respiratory techs, went ahead and put him back on full vent but that also didn't help.

Stephanie ordered an EKG and some labs to check his calcium levels and also gave him some dilaudid to further calm him. That worked for a while, but it also really disorients him and makes it difficult for him to do even simple things like pick up his urinal. It has worn off more now and he's asking questions about eating and what they are going to do next.

They haven't had to suction much and he's not coughing much. I don't know if this is a good or bad thing. They haven't given me any results from the tests yet. Amanda from cardiology wasn't aware of the EKG so she was going to look at that and said that Dr. Edwards was on call this weekend Ann's should probably be in later. But as you know he likes to round late so I will probably be gone if he comes.

They keep saying he has no fever because his temps have been in the 98.4 range. But normal for him is 97.5 and I have told them that numerous times. He's still getting his antibiotics and since one is very high powered he should have responded to it by now according to infectious disease.

I did tell Laura about the lethargy yesterday and that he eventually really responded. So she said we'll just watch and see if we think something else is happening like small strokes.

I was looking at pictures I had taken of him and the deterioration from the day he was transferred from ICU to today is very apparent and, to me, very sad. I did make myself ask the big question about giving up and he still does not want to stop anything. But I can also tell he's getting very tired of it all.

That's the latest. I'm managing to hold it together...barely. And if you read this and think about calling, please don't. I'm not ready to talk.
As good as Thursday was, yesterday was a bust. His numbers were all good, stayed in the 20s most of the time and his oxygen stayed in the high 90s with his heart rate 80s to 90s. He was awake when I got there and not agitated, so I was surprised that Stephanie said she didn't want to make any changes to the vent and that they would get another chest xray Monday. I don't know if something went on in the night that was reported by the respiratory tech or what. Cam, the cardiology nurse was puzzled also.

When he got his Xanax about 8, he went back to sleep and slept all day and was very lethargic when he was awake. Occupational therapy came in (she did come in after I left early one afternoon) and he wouldn't even try to move his arms on his own. So, she was just doing more passive range of motion exercises. He also had trouble trying to do the clothes pins.

I also noticed that when he needed to roll in bed, he wasn't reaching for the bed rails as before. And, he would just tap on his bed tray to get my attention and then point to his urinal, which was sitting right next to where he was tapping! He could put the urinal back on the tray when he was finished, but wouldn't reach for it. He was also very passive during his bath, which is a good thing, but he also slept through a lot of it.

Emily, McKenna and her boyfriend Logan stopped by late in the afternoon. Emily had a drs. appointment in Memphis so came by after. Bill was awake, mostly by then, and by the time they left about 4:30 he was fully awake. He also started interacting with McKenna a little. When it came time for me to leave, we went through the usual routine of leaving and he was almost back to normal. So, I don't know what was going on. I talked to his nurse and we decided to hold the afternoon dose of Xanax, and she told me that he hadn't had any Thursday after the dose at 4. But he did get his Seroquel, so maybe it was all just too much. We'll see this morning.

The hematologist, who is Dr. Muir, is pleased with his blood numbers, doesn't see anything really wrong. He's also a nice chatty man. Dr. Oktied was happy with his blood sugar numbers. We ran into each other at the elevators so I got a quick update.

That's about it, a very quiet Valentine's Day. I got him a little balloon and a stuffed kitty from the gift shop, but he wasn't too impressed. Oh well, I tried. I crocheted all day while he slept, and I can tell it in my hands this morning.

It's cold this morning again so I may wait a little longer to leave, not that it will be any warmer, but since it's Saturday, parking shouldn't be much of an issue. Stay warm, stay cool, stay safe wherever you may be.

Thursday, February 13, 2020

Bill's numbers were a little wacky again this morning, but he hadn't had his xanax and I could tell he was a little agitated. So I talked to his nurse and he got it about 8:30. Stephanie was skeptical about switching him from full vent to the SIMV assist mode, but she finally decided that if he could keep his respirations in the 30s she would take it, even though she didn't like it...and he did well!

He slept for a while after the xanax was given, but he got into his chair about 11:30. He really didn't want to do it, but Chris and I told him that he had to get out of bed. And he stayed up until 4:30. He did take a little nap, but he watched TV all afternoon. I showed him some pictures of the grandkids holding puppies and McKenna at her Valentine Court presentation.

The antibiotics are working. Ashley didn't say how long they would give them. Since this strain only responds to 4 antibiotics, they don't want it to become resistant to any of them. So, we'll see. I imagine it will be a minimum of 7 days.

That's about it, no speech therapy or OT. But, at least he got out of bed today. Tomorrow marks 3 months in the hospital and he wants to come home so much. He does know I can't take care of him right now, but he still tells me he wants to come home with me. One of these days, one of these days!

So, even though this is short, it was all in all a good day. And now, it's just about time for me to go to bed. Goodnight!

Wednesday, February 12, 2020

Today was a much, much better day! Bill was awake when I got there and his nurse said he had a good night.The only thing I know that happened was that he refused to let them give him a bath. His numbers were all good, back to where they should be. His respirations were still a little high in the low 30s, but heart rate was 107 and oxygen was 96.

He got a good bath from Albert and a shave which made him feel much better. He also did argue about the bath and Albert gave Caleb a run for his money in bathing and shaving. He's been the PCA all week and he's been wonderful with him. He said that today is his Friday so we won't have him for a couple of days, and then they may move him to the other hall.

When he was suctioned this morning, she said he still had a bunch of secretions and they are gray. I watch the collection container when they flush the suction tube to see what it looks like. But, she only had to go down once. When Stephanie came in she lowered the pressure on the vent, but kept the rate the same. She said that tomorrow, since he will have had 2 days of antibiotics and xanax, she may put the vent back to SIMV mode to see how he does. She had also run some blood gases yesterday after I left and they were perfect.

Janet from infectious disease said he still sounded junky to her, but overall thought he looked better. 

His nurse Kayla said they had to increase his insulin again. When they checked his blood sugar at one point yesterday evening, and since Kayla was there it was probably at 4, it was over 400! So, they called Dr. Oktied and he increased it again. Between the Prednisone and the tube feeds, they are really causing havoc with his blood sugar.

He stayed nice and calm all day, watching TV and napping. He hadn't had any therapy before I left and I told him if they came after I was gone, not to argue with them, to get in the chair if they wanted him to, or do his leg exercises, or move the rings and clothes pins. His numbers when I left were perfect. They have his respirations set at 25 and he was at 27, oxygen was 99 and heart rate was 85. 

I left somewhat early again and needed a motor boat just to get to my car in the parking lot! It rained hard, with the fog, all the way home. Mary Rose called while I was on the road and after I said hello, she just said Oh my, she could hear the rain. But since my car is hands free, we could talk for a bit. After I got home, since I was partially wet, I took the trash to the curb and the water was ankle deep in the backyard! Of course I didn't know that until I stepped in it. So, jeans hanging over the bathtub dripping and tennis shoes in the dryer. Hopefully they will be dry by morning!

I went to bed at 7 last night and slept until 4. I'm going to try to stay up a little later tonight as Blytheville is going to be on the ID channel tonight for an unusual murder. 

So, that's it. I've done a couple of tax returns and cooked myself some dinner and now I'm ready to curl up on the couch for a bit with the cats. Hopefully tomorrow will be just as good as today!

Tuesday, February 11, 2020

It was a broken night to say the least. Bill slept most of the night and gave his nurse a hard time at one point when she came in and had to wake him. I finally got up about 4. The couch was not comfortable to sleep on and the room was freezing cold. All of that aggravated my hip and toe and I was in pain. So, took a pain pill first thing in the morning. Bill was also awake and winked at me! He also tracked me across the room as I was going to the bathroom. I think now that it confused him for me to be there in the night last night.

He was laying so crooked in his bed this morning that he could almost touch the floor with his feet. So when the day shift came on Albert, the PCA we've had for the last 3-4 days came in and got him resettled in bed, and then brought me ice for my Artic cup.

Bill was still breathing very fast and his oxygen was in the low 90s. But, it was his heart rate that was most concerning. It was in the 120s to 130s. He was also warm to the touch. He looked at me and mouthed "help me" and it breaks my heart that I can't help him! I asked him if he wanted to just stop everything and see what happened and he didn't indicate one way or the other what he wanted to do. I think he was just too busy trying to breathe.

His morning xanax, suctioning and cannula change didn't make much of a difference in his breathing or heart rate. Tori, the respiratory tech and I both thought he needed to be put on full vent again so that he wouldn't have to work so hard. The day time tech, Wendy, did put him on full vent after talking to Stephanie.

Janet from infectious disease said she finally convinced Dr. Threlkeld to re-start Zerbaxa, a really powerful antibiotic. She also said that his white count was 22,500. He should start to feel better in a couple of days, we hope.

When Stephanie came in she tweaked the vent some, since he was still having problems. She also said that when the antibiotics kicked in and he was feeling better, she would get him fast-tracked with weaning, doing it a little faster, but not so fast that he's back and forth a lot. It wouldn't really surprise me for them to put him on CPAP at night each time. I think we'll be adding a CPAP machine to our inventory of medical equipment.

He fell asleep about noon and I could tell that he was really sleeping. His numbers were also starting to stabilize. He got the first dose of Zerbaxa and I don't think it works quite that fast, but his numbers were looking pretty good. 

Chris from PT popped in and said that he had talked to the nurse and respiratory and he thought it would be best to just let him rest today and maybe tomorrow he'd be able to get to his chair. He hasn't been out of bed now since last Wednesday.

I came home about 1:30. Bill was OK with that and asked if I would be back in the morning. I told him I would. Usually he asks if I'm coming back that night and I always tell him no, so that's why I think it really confused him for me to come back last night. But, he was good with me leaving and was going to sleep some more. His respirations were still in the upper 30s, but his oxygen level was 99 and his heart rate was down to 107.

I didn't see anyone from cardiology before I left, but I know that Kayla, his nurse had let Dr. Edwards know the situation. I told Kayla I was heading home to sleep and she said she would call if I was needed.

That's it for today. It's not quite 6 and I've eaten, fed the animals and have my pjs on. I'm going to try to stay up a bit longer, but if I can't who cares, there's no one here but me and the cats!