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!
The weather was supposed to be very challenging today. The Twin Cities was under a Winter Storm Warning due to anticipated heavy snow, sleet, freezing rain and high winds. As the morning went on, the storm shifted farther to the north. The Warning was then downgraded to an Advisory. As of this writing, it is raining hard. There is still a chance of freezing rain tonight and a chance of a couple of inches of snow tomorrow. The day had an unexpected turn of events, but it was in our favor.
Lucy’s day had an unexpected turn of events, but in her favor. Marynne from Minnesota Oncology visited with her this morning because Dr. Thurmes was unavailable. Lucy’s leg is improving very slowly. Dr. Nashawaty feels that since Lucy had not had a nosebleed in several days, perhaps the TPA catheter option is available.
Her next visitor was Dr. Dittes, an Infectious Disease specialist. He felt that Lucy may have cellulitis but acknowledged to her that her blood cultures and blood tests show no obvious indication of a bacterial infection. He also told her that her blood clots could be the majority of the fever spikes and redness. He changed the antibiotic she was on to two different IV antibiotics. There is no cause for concern.
Marynne came back a bit later. She was going to see if Interventional Radiology wanted to do the TPA procedure. The best guess was that Lucy would have it done tomorrow morning. They had time today and got to her about 1:30 this afternoon.
The procedure went very quickly. They completed it by 2:45. There was a very large clot in her thigh. The clot in her calf was small enough that they were going to let nature take its course. Her left leg was less clogged than her right leg was a couple of weeks ago. We hope that means she will not need subsequent procedures and her recovery time will be shorter. It will be a couple of days before she will be able to do the Hokey Pokey.
Of course having the procedure means she also moved from 8th floor to 3rd floor. The first move was into a two bed room. She moved again about 20 minutes later to a private room.
Her evening is winding down now that there isn’t as much activity. She knows sleeping will be tough tonight because they have to wake her every two hours to do a neurology check. Lucy talked to Diane and Julie on the phone tonight and that helped brighten her day. I found the beaded owl pictured below in the gift shop. It is beaded and stands about 6″ tall.
Here’s hoping Leap Day goes well for her. We wish all of you a good evening and have a Happy Leap Day tomorrow!
Lucy’s newest owl friend
Lucy’s third TPA procedure took about two hours. She will need a fourth procedure tomorrow. There was clot material just under the sheath they put in near her knee. They removed that sheath. Lucy will be here through tomorrow.
Lucy’s hemoglobin is starting to drop again. After her transfusion on Thursday, it was at 9.8. Yesterday it was at 8.0. Today it is at 7.3. She will be getting a one unit transfusion tonight just to bring it over 7.5. The anticoagulants and clot dissolving drug plus all the IV fluids she has had can “dilute” her hemoglobin levels.
There is good news to report, too. Her calf circumference is already 1 cm (0.4″) smaller after today’s procedure, though we could expect some fluctuation. The color is not so dark red and her foot and ankle pulses are louder through the Doppler flow detector.
Molly stopped by, and Dr. Thurmes visited about a half-hour later. Dr. Thurmes feels Lucy’s mild fever spikes, occasional chills, and slightly low blood pressure (hypotension) is due to the clots, not an infection. Her blood cultures are still “unremarkable” which is great.
Please indulge me for a moment while I go off the subject of Lucy for a moment:
- In blog related news, comments work and we encourage you to use them. Blogger has had some issues with spammers injecting crap in the comments, so we will moderate comments.
- For those of you who have a Facebook account, I have set up a “Journey of the Teal Owl” group. I am looking at using RSS Graffiti to automatically publish the blog posts on the Facebook group page. Bear with me on that.
- In addition, those of you with a Twitter account can follow @tealowljourney. I will try to send a tweet when there is a new or updated post. This is all a work in progress and will be quite fluid for a while.
Thank you for your patience! We are so grateful for all your love and support!
Lucy’s procedure finished around 1:00. She moved down to the Surgical Specialties unit on third floor, so there goes the view.
They gave her a pain pump and she is already noticing a decrease in pain. This is the first time this week where her pain self-assessment went down.
The clot treatment consists of a “clot busting” drug (alteplase) as well as a blood thinner (heparin). Alteplase is the activator and the procedure is formally named “Tissue Plasminogen Activator” or TPA for short. The hardware looks impressive: seven infusers and a pain pump. Two of the infusers got shut off after a couple of hours, one managing the clot buster and the other administering the blood thinner. We’re hoping this is a good sign. Lucy will have the catheters moved tomorrow and her hematologist will be by on rounds, too.
Lucy changed rooms twice today. She is in a bigger room. The care providers have some elbow room now. She actually had some time to herself tonight. The fast-paced choreography of this morning has slowed to a graceful ballet. Now she’ll get more of a chance to relax.
This does it for tonight. Thank you so much for your good wishes for Lucy!