Tag Archives: Coumadin

Home sweet home

Yesterday was spent getting settled in at home. Lucy wanted to how her ankle would react to the home setting. That went better than either of us expected. No problems navigating with the walker, she can stand for more than a couple minutes, and she has cut way back on the pain meds. She is still doing her physical therapy exercises and her energy level is still pretty good.

Today we took a trip to Lions Tap in Eden Prairie. It got her out of the house for a bit, they have great burgers, and she had a birthday coupon. We took her walker along, but it turned out she managed OK without it. I noticed she didn’t need much support when I held her arm. She still has discomfort in her ankle and her knee is still a touch stiff. There is no way she can drive yet. Her leg bothers her more if she sits for extended periods of time.

Tomorrow she has some blood tests to ensure her Coumadin dose is still correct. The test is later in the afternoon so the results may not be known until Friday.

We know this posting isn’t as action packed as the hospital posts, but we’re having a lot more fun!

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“Going Mobile”

Discharge day! We’re thrilled! The post title is an appropriate song by The Who. Today’s events went like this:

10:45 am: It sounds like the doctors are happier with her heparin blood level. The heparin IV could come out today. Because her Chromogenic Factor X test takes several hours, we will not know if she can go home. If she does stay, she will move to a different room on 8th floor. Fairview is stripping and cleaning the floors and performing maintenance checks on the rooms. “Hurry up and wait” is the theme for today.

2:00 pm: The expectation of a hospital stay is for the patient to focus on recovery. Fairview Southdale has been exceptional in that regard. Certain administrative obligations pop up detracting from recovery, like dealing with the short-term disability people. “Benefits coordination” is an oxymoron in that company. Lucy got passed to three people so far and each of them asked the same questions. They were just as clueless after her surgery nearly two years ago.

3:00 pm: Lucy’s Chromogenic Factor X result was at the midpoint of her therapeutic range. Her Coumadin dose is set and she has her instructions. The IV lines are removed and she is dressed. Everything is loaded and she has her walker. All that remains is waiting for the pharmacy to fill her prescriptions.

5:30 pm: The pharmacy finally asked for her prescription insurance card. She has a new drug plan this year and the old information was still on file, and there always is a delay when painkillers are involved. Lucy is moving with more confidence after the IV tree went away. Her friend Diane called while I was loading the vehicle. Lucy also called her siblings during the wait. The sunset was nice.

6:10 pm: Lucy headed home wondering what sort of mess waits after me having full run of the house for the past eleven days. She didn’t cringe after touring the house, so I think I did all right. I think the chicken strip dinner I picked up for her at Dairy Queen also helped.

Our house is a rambler with a basement. The basement has a rec room, a laundry room, an office, a ¾ bathroom, and a storage area. The bedrooms are on the main level. One of the guest rooms is now an office for her. She doesn’t need to go downstairs until her leg is better. Most of the main level has laminate flooring. She is navigating the walker quite well in the house.

I picked up some of the wet wipe style washcloths hospitals use for cleaning up a patient in bed. I also picked up a couple of the shower caps that have the shampoo in them. Lucy does not have to worry about slipping in the shower.

Lucy’s next blood test is Thursday. Next week she will get a PET scan since it has been about a year since her last one, see Dr. Thurmes about her leg, and see Dr. Boente about her next Alimta treatment. There is a possibility she may need a break from chemo until her leg fully recovers. Even though her medical leave got extended until February 13th, she may need another week added. Her next assessment may not happen until after that date.

We’re happy being home and are grateful and humbled by the outpouring of love and support you have given us through this ordeal. Thank you!
I picked up some of the wet wipe style washcloths hospitals use for cleaning up a patient in bed. I also picked up a couple of the shower caps that have the shampoo in them. Lucy does not have to worry about slipping in the shower.

Lucy’s next blood test is Thursday. Next week she will get a PET scan since it has been about a year since her last one, see Dr. Thurmes about her leg, and see Dr. Boente about her next Alimta treatment. There is a possibility she may need a break from chemo until her leg fully recovers. Even though her leave was extended until February 13th, she may need another week added. Her next assessment may not happen until after that date.

We’re happy to be home and are grateful and humbled by the outpouring of love and support you have given us through this ordeal. Thank you!

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“A Room with a View”

Stained glass panel at Fairview Southdale

This stained glass panel is next to the admissions desk at Fairview Southdale hospital.

During Lucy’s hospital stay, I have parked in the Skyway Ramp and I walk past this stained glass panel every day. The flash on my phone’s camera causes a lot of flare. The gnome is not lighting flatulence (though he looks guilty) and the owl is not looking for the culprit.

I believe Lucy saw the movie referenced in the post title. The book it was based on was an optional choice for my World Literature II class at Augustana College. I didn’t read it because it was optional.

Lucy took a short walk this morning. It helps clear the fog of the pain pills. Her leg color has gotten noticeably better in the past day. Her right calf circumference is within 3 cm. (about 1.2″) of her left calf. She says that her ankle is stiff but is getting a bit more range of motion. Lucy has worked on her physical therapy exercises. Her Braden risk bracelet got removed because she is more active and her skin can air out.

Dr. Singh from Minnesota Oncology came by. Lucy moved back to 8th floor this afternoon. Her hemoglobin dropped after yesterday’s increase so she will get a two-unit transfusion. This means the four transfusions she has had since admission have required eight units of blood. She will be here until Monday at the earliest. The rest of the blood work sounded OK. Her Coumadin dosage got dropped to 2.5 mg and they did not have to administer a quick “blast” of heparin (called a bolus). We hope this means she is getting close to removal of the IV heparin and her Coumadin dose is getting set.

I did get to take Lucy to the Meditation Sanctuary before she moved to 8th floor. We used a wheelchair because it was a quick trip. She liked the fireplace and water feature. Changing her scenery also helped.

The view from her room is great. For those of you in the Twin Cities area, she overlooks Crosstown Highway and France Ave. The fog lifted and the sun came out and we can see all the way to Highway 100.

Lucy’s birthday is tomorrow and she will be spending it in the hospital. I’m grateful for getting to celebrate another birthday with her! I do wish she were released today. Comments are working, so please feel free to send her birthday greetings tomorrow. Thank you so much for your support!

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“Eight Days on the Road”

There was a little extra news from last night that didn’t make the post (and I was too tired to do the update). Lucy sat on the edge of the bed last night for almost a half hour. I gave her a long back rub, which helped her relax. Her calf diameter went down another ½ cm. Her pain level has stayed the same, but it is significantly better than a week ago. Her blood work is showing normal values except for her hemoglobin being low. Adult women should range between 12.1 and 15.1 grams/deciliter (g/dL). They want Lucy’s hemoglobin to stay above 7.5. If it goes below that, she will get a transfusion.

It’s ironic the title of today’s post is a song by Foghat. This morning was incredibly foggy. It has been a very mild winter here unlike last year’s near-record seasonal snowfall and unusually cold temperatures. We earned a break after last year. I normally can drive from home to Fairview Southdale in about twenty minutes for the six mile trip. France Ave. has a bunch of unsynchronized stoplights once I cross into Edina from Bloomington. Today I needed fifty minutes. There is a large lake and marshy area near Normandale College at 98th St. and France Ave. The fog in that area reduced visibility to about fifty feet. Even the inside of the hospital’s parking ramp was a bit foggy.

Dr. Thurmes stopped by to see how Lucy was progressing. Her Coumadin dosage still needs a tweak. She had noticeable improvement in her hemoglobin after yesterday’s transfusion, rising from 6.1 to 8.4. Lucy will probably be here until Saturday at least. Dr. Thurmes wants to see two consecutive acceptable results before disconnecting the IV heparin.

Lucy had the PT and OT people here today. She ran through her exercises and has a walker to use. She can get out of bed without needing a handrail. Her right ankle is still very stiff. She walked close to one hundred feet in total today, half with the walker, in four walking sessions. Now she has a recliner to sit in so she spent most of the day in the chair. It still takes her a moment after she stands up before her ankle loosens up enough to work slightly.

Thank you for taking the time to read this and for your concern for Lucy!

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And on the seventh day…

Lucy’s Coumadin dosage needs adjusting upward, so she will be here at least one more day. Unfortunately, her hemoglobin dropped from 7.8 to 6.1 so she needed a two-unit transfusion. Lucy’s birthday is Sunday the 5th and I would love to see her home by then! It is a day-by-day holding pattern.

Molly, Dr. Nashawaty, and Jackie from Minnesota Oncology were by to see her progress. Acute anemia can show up in patients receiving chemo. Lucy was originally scheduled for her next Alimta treatment on Thursday, February 2nd. The treatment moved to February 16th. Her body will get a little more chance to recover. Her white count is stable and in the normal range, and her platelet count is normal and stable.

So maybe today didn’t start great, but there is still good news. Molly noted that Lucy’s calf skin is less taut. It no longer looks like it is going to split open. She still has quite a bit of swelling in her right ankle and a slight amount in her left ankle. The left ankle swelling will reduce as she becomes more active. Her right leg still cannot be massaged and they can’t put a “puffer” on it because there are still a couple small clots. They do not want the clots to dislodge and start traveling. A “stay-cation” is good enough for the clots.

Lucy only needed one Dilaudid shot last night for pain. She is taking oxycodone tablets to manage pain. Her pain pump got removed last night.

A Physical Therapy specialist came by this morning and checked Lucy’s strength and range of motion. She also had Lucy do a series of simple exercises that could be done in bed and left a booklet detailing how to do the exercises. Lucy will do them twice a day.

An Occupational Therapy specialist came by about an hour later. She assisted Lucy out of bed. Lucy managed to walk around the bed. Lucy’s pain doesn’t increase very much when she puts weight on her leg. Her ankle still has a limited range of motion so getting her foot flat on the floor is a challenge. After a couple of minutes she can stand flat-footed. Walking is very slow. She is not unsteady on her feet. Lucy has surprising physical strength for someone so petite. The goal is to keep her from losing strength while her leg gets better. She will try using a walker tomorrow.

Give your loved ones a hug from us, and thank you for your support!

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Slowly becoming untethered

Lucy is continuing to make progress. Her calf diameter is another ½ cm. (0.2″) smaller. She no longer needs her pain pump and is taking oral pain medication. Her hemoglobin dropped very slightly from 8.1 to 7.8. However, her white count is now in the normal range. She still needs assistance getting out of bed and cannot walk more than a couple of steps on her right leg. Physical Therapy will be by tomorrow to see what else they can do. Lucy would like more mobility. She has always enjoyed walking for recreation and exercise.

Lucy’s friend Diane visited us this afternoon and brought a little stuffed “Hug Me” elephant. That really brightened Lucy’s day. Yesterday’s delay in Lucy’s procedure precluded her sister Julie from coming to visit. Julie and Lucy have been on the phone a few times. Those calls also brighten her day. We know her sister Suzy is under the weather and we hope she feels better soon.

We don’t have a firm idea of when Lucy can go home. The two main milestones are getting her off IV heparin and they would like to see her calf less swollen and red. Her Coumadin restarted yesterday. Since the INR test will not be accurate, they are using a Chromogenic Factor X test instead.

Molly and Dr. Nashawaty from Minnesota Oncology checked in on Lucy this afternoon.

Lucy has a “Braden risk” bracelet. That means she is at risk for pressure ulcers (“bed sores” is the archaic term). She tries to change her position in bed regularly and so far has no signs of pressure ulcers. The risk will vanish when she is more mobile. It is not a cause for alarm.

Cellulitis is a concern. She is still getting Levaquin once per day as a preventative. And yes, the medical term for “preventative” is “prophylactic”. Lucy is not showing any symptoms of cellulitis.

That’s all for tonight. We’re very touched by the number of people reading the blog. It means the world to us!

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Take 4

Lucy was initially scheduled for her procedure at around 8:30 this morning. An emergency case came up and she got bumped for the time being. She has her Nook Color to help pass the time.

Her blood transfusion occurred without incident last night.

As part of her blood clot treatment, she has a simple neurological check performed every two hours, even at night. She says she falls back to sleep quickly afterwards.

A very large part of the hospital is cell phone friendly and the patient rooms have Wi-Fi Internet access. The IV Therapy area and Day Surgery suites still require cell phones be shut off, but Wi-Fi access is in those areas.

This might be a multiple update day. Bear with us.

UPDATE #1: Lucy finally went down to Interventional Radiation at 12:15 pm. Her procedures have averaged a bit over two hours, so I was pleasantly surprised when she returned at 1:05! All the “plumbing” on her left leg is gone. She went from nine infusers plus a pain pump to two infusers plus a pain pump. There are some small clots remaining in her calf region but they are going to let those dissolve on their own. After four hours, Lucy potentially could get out of bed and walk a bit.

UPDATE #2: Lucy is restarting Coumadin tonight. She is also still getting heparin. They had to run an IV into her arm so they could administer some Levaquin, an antibiotic, as a preventative. The skin on her right leg looks sunburned. A skin infection called cellulitis may form if the antibiotic is not administered.

She still has a couple very small clots in her right calf, but Dr. Siddiqui wants to let the clots dissolve on their own. We know she will be in the hospital until at least tomorrow and until she no longer needs the heparin IV. Molly and Dr. Weinshel from Minnesota Oncology were by to see how Lucy was doing today.

Lucy did manage to stand up with some help and took a few small steps. She was confined to bed Thursday and her leg immobilized for a couple of days. Her ankle was very stiff which hindered walking. However, she has noticed a little more range of motion in her ankle as time goes on. She had a large catheter inserted on the inside of her ankle. That also contributes to the swelling in the area. Her pain has dropped down a bit. She was grading herself on the 10-point pain scale at an 8. After her procedures, it dropped to 5. At 7:00 pm, she gave it a 4.

Her calf circumference is another ½ cm smaller (about 0.2″). It doesn’t sound like much, but it is getting smaller. Her thigh is still open and the color has nearly returned to normal. The bottom of her right foot has normal coloration instead of being very dark pink. The Doppler flow detector does not need the volume set to maximum just to pick up a faint pulse. Her right foot and ankle pulses sound as loud as the pulses in her left foot and ankle.

Lucy also got a fun little ride today. Even though she is a petite woman, she got put in a patient lift and thought it was fun. The lift also ensured her weight was more evenly distributed. For us, the big plus is it helps prevent injuries to the care staff. Even a person of average weight is difficult to lift and balance. Too many care providers suffer injuries or disabilities from an awkward patient lift.

We’re hopeful of Lucy coming home yet this week. Thank you for your thoughts, prayers, love, and support. You really help us get through this!

UPDATE #3: While we don’t have a definite date when Lucy can go home, we did get some really good news about her Complete Blood Count (CBC) from tonight. Her hemoglobin went up higher than expected after the transfusion. Her white count is back in the normal range and there is still no indication of infection. It’s nice to have a couple more victories!

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