Pradaxa (the pills)!
Dr. Thurmes told us that Lucy is going on Pradaxa twice per day for her clotting problems. He wanted something with a shorter half-life in case she starts getting the serious nosebleeds again. Pradaxa has approval for DVT therapy in cancer patients in Europe. FDA approval is pending, but Pradaxa can be legally prescribed for Lucy’s situation.
Lucy’s hemoglobin was at 7.2 and she received a one unit transfusion. Her IVs are disconnected. She had two long walks today while still tethered to the IV tree. Her longest walk came after untethering.
As of now, the only thing that would keep her in the hospital is a fever spike higher than 101.5°F tonight. Her pain management is fine. She started her oral antibiotic. That will be twice per day for a week starting tomorrow. The pills are very large uncoated capsules, so we will split them so she has an easier time swallowing them.
Lucy heard from Steve, Julie, and Suzy today so she told them about her imminent release. The nice thing is the pace here has slowed down.
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!