Tag Archives: Coumadin

by | February 2, 2012 · 9:43 pm

“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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by | February 1, 2012 · 2:45 pm

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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by | January 31, 2012 · 10:11 pm

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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by | January 30, 2012 · 8:21 pm

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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by | January 26, 2012 · 10:31 pm

Some steps forward, a couple of steps sideways

Sometimes a journey has a few sideways steps in order to go forward. Lucy’s blood clot is not responding as well as hoped. Dr. Thurmes, a hematologist, stopped by this afternoon. He wants to use a catheter inserted closer to the clot and use a stronger blood thinner. The catheter insertion happens tomorrow unless something changes. The process will take about two days and Lucy obviously will stay in the hospital until at least Saturday. He also ordered a head CT scan as a precaution.

One thing noted during her blood work is her white count and platelets are a little low. This is most likely from the Taxol used in the previous round of chemo. Because of the blood thinner they are using, she will receive a platelet transfusion tomorrow.

Cancer can cause blood-clotting problems. Lucy also has a blood-clotting factor discovered during more thorough blood work, which could put her at a slightly higher risk of recurrence. The factor also means a standard INR test is misleading. This means they will use a different clotting factor test.
Right now, the focus is on getting the clot dissolved. Lucy will likely be on Coumadin for a time after she gets released from the hospital. It’s still too early to determine exactly for how long. We did not get a chance to discuss her anemia, but that needs addressing in the near future.

The last sideways step is she is still having pain management issues despite getting Dilaudid in her IV. It does make her sleepy so she is getting rest.

Now on to the steps forward! Lucy’s appetite is good and her sense of taste is a lot better. The blood transfusion took several hours last night, but she did get all three units without too much drama. Her hemoglobin is 9.8 several hours after the transfusion, which is a big step in the right direction. She has good color in her cheeks again. Her blood work did not indicate infection and her kidneys are working well.

It was a long night for both of us. Lucy managed to get more sleep than me. She will be getting her pain medication in a few minutes and then I’m heading home. We’re thankful for the steps forward!

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