She still hasn’t had the giant leap towards going home. Dr. Rousey (hematologist) stopped by this morning. He and Dr. Thurmes are still digging though research studies to see if Pradaxa will be the drug of choice, with Arixtra as the runner-up. Pradaxa apparently has a shorter half-life, which is helpful in case of a complication. Lucy likes the fact that it is oral and not an injection (OK, so do I!). Neither drug will need as frequent blood testing as Coumadin requires. I think it is because both drugs manage specific coagulation factors while Coumadin takes more of a “scorched earth” approach.
The IV antibiotics are still going. Right now, she gets Vancocin (vancomycin) and ampicillin, and both are available orally. While the hematologists are researching Pradaxa, Lucy is still on IV heparin. She has not needed a blood test because she hit the therapeutic range.
Julie stopped by this afternoon and really made Lucy’s day! It was nice having nearly no interruptions while Julie was here.
Lucy took two walks today. The first was about 50 feet. Her second was close to 150 feet. She would go farther when they finally disconnect the damned IVs. Her left ankle is loosening up a little. On her second walk, she was able to get her heel on the floor while walking, at least for a few steps. There was still discomfort walking, but she was not wiped out afterwards. Like last time, her pain started decreasing when she sat down.
Dr. Thurmes will be on rounds tomorrow and said he will stop by. He’s been so good to Lucy through this ordeal. He might have the home care anticoagulant and antibiotic choices tomorrow. If so, she could be released tomorrow.
Diane visited Lucy this morning. She always manages to cheer Lucy up and today was no different.
Lucy received some good news today. The Infectious Disease group is very comfortable that the fever spikes and redness in her leg are both clot related. She is still on antibiotics. Her Heparin Factor X is at 0.29. Therapeutic range starts at 0.30.
Dr. Thurmes came by and gave her some better news. She will be going on either Arixtra (injection) or Pradaxa (oral), so her heparin level can be close to therapeutic range. Her IV heparin will be stopping soon, and she will switch to oral antibiotics. He mentioned Sunday as a possible release date. Lucy must be off the IVs before going home.
Lucy’s left ankle is still extremely stiff. She has not tried walking with her walker yet. Maneuvering is interesting enough without having to coordinate with someone pushing the IV stand. If she gets rid of her IVs tomorrow, she will start walking around and get used to being on her feet again.
Lucy had a very busy day with all the people in and out to check on her.
Dr. Dettis (infectious disease) was by and told her he was better than 90% certain her fevers and leg redness were solely from the clots, but he wants her to be on antibiotics for another day or two. That was reassuring for her to hear.
One of the hospital chaplains stopped by, and then Dr. Thurmes (hematologist) was by to see how she was doing. Unfortunately, her hemoglobin was at 7.1 so she received one unit of blood just before going to IR. He feels the Coumadin and Lovenox are not working and had two other anticoagulants in mind. One is Pradaxa, which is a pill. The other is a once per day injection which she couldn’t remember. We are hoping Pradaxa is a workable solution. Dr. Thurmes had a couple of areas he needed to research first.
Her TPA procedure got delayed because of a couple higher priority cases. She was originally scheduled for 8:30 and finally went down at 12:45. The procedure completed by 1:15. She no longer is on TPA and they can stop doing the neurological tests in another four hours. She should get more sleep tonight and have fewer interruptions.
She did have to have her arm IV access changed. Getting a different one in was very problematic. Her arms have really been poked. Certain drugs cannot be administered into a port, and her antibiotics are all incompatible with heparin.
Julie called tonight and like last night didn’t get much time to talk to Lucy. The arm access IV adventure was just beginning then.
Lucy got to sit on the edge of the bed for over a half hour. She even managed to stand up before getting back into bed. Tomorrow she will get out of bed and go for some short walks.
Getting the TPA catheter removed is a step towards going home. The next two steps are getting her off IV heparin and letting her leg heal a bit more. Getting the heparin level in line will probably be the most difficult given her experiences. We still don’t have a firm release date.
Keep your fingers crossed, and thank you for all the thoughts, prayers, positive energy, and good wishes!
Lucy had another TPA procedure this morning. It took less than 90 minutes. They will need to repeat it tomorrow, but they made progress. She still can’t get out of bed and she is to keep her leg as still as possible. Lucy seems to be in a little less discomfort today. Lucy doesn’t have a firm time for tomorrow’s procedure, but it could be as early as 7:30. She is really tired today because of being awakened every two hours for the last couple days, and now has at least one more night of tests.
The hospital plays “Twinkle Twinkle Little Star” when a baby is born. I swear it was playing on a continuous loop today. There is an anecdote stating more babies are born when during bad weather because of the drop in air pressure. The barometer here dropped to 29.23 in/Hg early this morning and is slowly rising.
Julie called tonight, but Lucy had to get a blood draw a few minutes into the call. Lucy has bruised arms because of all her arm draws. The heparin isn’t helping with that either.
We’ll see how it goes tomorrow. Thank you for spending some time reading this and have a Happy Leap Day!
So much for Lucy’s heparin staying in the therapeutic range. She has had two adjustments and boluses today and will have a re-test at 9:30 pm tonight. It sounds like she is close to where they want her. The tricky part is having her stay in the therapeutic range for a couple of days.
Her nosebleeds have stopped, but Dr. Thurmes is very reluctant to run a TPA catheter in her leg. The TPA would speed up getting rid of the thigh clot. Right now, she has to stay the course. Perhaps that could change the longer she goes without a nosebleed. She is dabbing saline gel in her nostrils every four hours and so far, that is working.
The two-unit transfusion helped a little, but Lucy’s hemoglobin was only at 7.9 today. She will probably need a transfusion tomorrow or Wednesday. We have not heard how her white count or platelet count was faring.
She has still been having fever spikes today. Her worst one was 102.8°F, which went down with Tylenol and cool washcloths on the forehead. There is still no indication of an infection. The fevers break within 30 minutes.
One nice thing was she used the shower today. The disposable washcloths are nice, but having some independence is nicer. She also received a birthday rose from one of the floral shops today. That was a nice present.
It’s still a “wait and see” situation. A lot depends on how fast her body starts wearing down that clot in the thigh. We have no idea how soon she will be going home. It’s frustrating, but it is what it is.
Thank you so much for caring! Your comments are like her getting a Get Well card without having to wait for mail delivery.
Lucy’s hemoglobin was at 6.0 and her platelets were at 50,000. Dr. Nashawaty had rounds this weekend and he mentioned the irony of keeping Lucy on heparin but also having to transfuse platelets. Her Alimta treatment probably caused the platelet count drop and to her low hemoglobin level.
On the plus side, her heparin is in therapeutic range. She will be in the hospital until at least tomorrow. One of the criteria for release is getting her off IV heparin. Our guess is they would also like to see any risk of infection in her leg eliminated and a noticeable improvement in her leg. It appears her leg is getting a little better. Like her last hospital stay, this will be a day-by-day event.
Today saw a steady stream of nurses and nurse’s assistants in and out of her room. Lucy said one of her arm blood draws was at 3:00 am this morning. Her port has heparin in it so certain blood tests must be done via her arm.
Lucy’s appetite is still good. I went to the cafeteria and picked up a grilled chicken sandwich for lunch. She asked to sample it and wound up eating the whole thing.
Steve and Liz came by this morning and brought cookies. Suzy was by this afternoon and left a stuffed snowy owl and a couple of magazines. Julie called to see how Lucy is doing. We also appreciated all the great notes from everyone. Lucy and I do read the comments left in the group or in the blog, and we thank everyone for their words of encouragement.
We’re hoping her heparin stays in therapeutic range tomorrow. That will put her one step closer to going home.
I found this scrub top in the gift shop. Lucy wants to see it when she is more mobile. I’m sure she will get one.
Suzy brought along a new friend for Lucy
This morning started with a 75-minute nosebleed. Lucy was to start using Afrin nasal spray but her bleeding started moments after the first spray. She then switched over to a saline gel. Diane visited Lucy this afternoon. It really helped Lucy’s mood. Diane can get Lucy laughing which is really needed now. Thank you, Diane! She also suggested the title for tonight’s post (it was originally “Let It Bleed”). Between the nosebleed and the blood draws, Lucy could have supplied the blood for this season of “Dexter”.Lucy is still running a temperature of around 101°F. They are running an IV antibiotic and she is getting Tylenol for her temp. They also drew blood to see if her blood thinner dose needs adjusting. Blood thinners are very touchy. Then they drew blood again looking at her Heparin Factor A, and then drew a third time for blood cultures (again). She also received two large heparin bolus doses.
It sounds like Suzy is going to visit Lucy tomorrow. Unfortunately, when Suzy called tonight, Lucy had a lab tech wrapping a tourniquet preparing for a blood draw and two nurses reviewing the heparin bolus double-check and co-signing procedure. Things do get a little hectic in the hospital.
Keep Lucy in your thoughts and prayers tonight. Thank you for all your support!