Tuesday 12/23 8:17 PM (from chilly San Antonio)

An update from San Antonio....

I just talked to Sharon and got an update on the last few days.  Sally saw Dr. Brown at Dr. Jiminez's office today.  Dr. Jiminez is out with the flu.  Dr. Brown agreed that the stone surgery (endoscopic) is set for Jan. 5th.  Sally will get some blood work done next Monday after her appointment with Dr. Newton.  This will be her first post-op appointment with Dr. newton since her discharge and we hope he's pleased with her progress and is comfortable with her going ahead with the kidney stones' removal.

There have been a couple of scares with the nephrostomy bag leaking and with some of the fluid being pink or cloudy.  Dr. Brown said that this is normal with that stone on the kidney.  Whew!

Sally's had lots of company.  Lots of family these last few days including Abigail, her newest great-granddaughter.  What a joy I know that brought to Sally's Day!

Her "bed-sore"is getting better.  This is one that's tough to treat, since sitting or laying on it retards the healing, so we're extremely grateful to see the progress.

We'll pray for Sally's Christmas to be especially joyful.  She's already told us how glad she is to be with us.  We are especially grateful for the progress that she is making.  I know this is  a result of many answered prayers.

I'll remain in San Antonio until New Year's Day.  Then I get to head back to be with our sister!

Merry Christmas!

Friday 12/19 3:55 PM

Sally went home yesterday!  The morning was full of being briefed on meds, etc. and trying to coordinate follow-up appointments with the various doctors.  The upcoming holidays make the appointments a little more difficult to schedule but we have the critical ones.

Sally had a sandwich on the way home and remarked several times that she felt strange and in a different world.  Thirty-nine days in the hospital definitely made going home feel different, though quite welcome!

It appears that the endoscopic removal of the three kidney stones in her lower right ureter will be on January 5th.   We have an appointment with Dr. Jiminez for Dec. 23rd and the procedure should be set up then.  We also have a follow-up appointment with Dr. Newton, the cardio-thoracic surgeon on Dec. 29th.

Sharon arrived Thursday afternoon and, along with Karen, we filled prescriptions and sorted out her medication regimen and schedule, including the insulin injections for control of her blood sugar.  There is lots of technology related to blood sugar testing and insulin injections for us to master.  Sally tolerated all of our questions, instructions and organizing pretty well.

Karen helped Sally dress for bed and Sally asked for a touch of her special cologne so she could sleep well (she’d missed that in the hospital).  She is really glad to be home!!

Sally got a good night's sleep and was glad to be in her own bed.  She had Cheerio's for breakfast, just like in the hospital.

Kelly, the nurse from the home health care agency came about 11 and did a full work-up on Sally, including changing her wound dressings and showing us how to do this.

Sharon did the first three insulin injections this morning and did a great job!  Like she'd done this for years!

I'm sitting in the Birmingham airport now just waiting for my 6:00 flight home to San Antonio.  It'll be nice to be home.  Especially since Sally is doing so well!

Wednesday 12/17 4:06 PM

A busy day for Sally;  getting everything ready to check out of here tomorrow!  Her own wheel chair arrived this afternoon and is all set up and in use.  The physical therapist (Jenny) ordered a special gel-filled cushion for the chair to assist in the healing of the bed-sore.  It's nice.

It turns out that the appointment with Dr. Jiminez is for 9:00 AM tomorrow, so we will get here early and try to clear everything so we can be on-time for him.  If not, we'll swing back by later and finish any paperwork.  Sally's real excited about going home!

Her ribs are a little sore from the upper body exercises and will require a little healing.

As much as we like this place and the people, we are ready to head for Arab in the morning.  I took a load of clothes and things to Sally's house yesterday and her daughters have done a great job getting her house cleaned.

We'll also miss the Blount Hospitality House where the folks have really provided a home-away-from-home for the Pitts family since about November 11th.  Thanks to Marydae, Margie and the other staff as well as the other residents that have been so friendly!!

Tuesday 12/16 9:36 PM

Sally's getting stronger.  We learned that we have an appointment with Dr. Jiminez, the urologist at 9:30 AM on Thursday right after her discharge from the Rehab hospital.  So, this should help us understand the potential timing of the kidney stones' resolution.

Tomorrow will be a big day, getting final training for Sally's trip home.  Exercises, diet, food  preparation, etc. 

Monday 12/15 8:37 PM

Not much new news this evening.  Dr. McCrory, the pulmonologist came by this afternoon to see Sally.  She was asleep so he said he'll drop by again before she's discharged.

She did really great in physical and occupational therapy.  Even did more "reps" on one exercise than the therapist asked for.  Just showing off...  :-)

It's cold and rainy again tonight here in Huntsville.

Monday 12/15 1:22 PM

I came in early this morning and got to be here when Dr. Anderson came to see Sally.  He says they are going to try to set up an appointment for Sally to see Dr. Jiminez on Thursday morning, the day of her discharge from HealthSouth.  This should allow us to get all of our Urology questions answered.  This will also let us think about the time frame for her next surgery.

We will get a prescription for insulin and insulin syringes.  The wheel chair should be here ready on Thursday morning.  Also, Nan, the wound care nurse is also the person who teaches the diabetic classes, so they will make sure that we get Sally in that class.

More later....

Sunday 12/14 8:18 PM

Another good day today.  Sally enjoyed the break from therapy.  When I arrived this morning, she said she had news!  She said Dr. Anderson came by to tell her that they have decided that she will be going home on Thursday.  They're going to send her home to build up her strength and then bring her back to remove the kidney stones.  She's happy about being at home for Christmas but a little apprehensive about what might happen if one of those kidney stones begins to move while she's home.

She'll need some instruction in giving the insulin to herself, but there's time between now and Thursday morning for that.  Her bed sore is still problematic, too.  Connie, today's RN says the chair is what's causing most of the pressure on the sore.  She should be on her side in the bed in between therapy sessions rather than sitting in the wheel chair.  We'll work on that for the next few days.  We tried the rubber "doughnut-shaped" cushion but rather than providing relief, that was uncomfortable for her.

When the opportunity arises, I will seek a little more clarity on the issue of when they might plan for the kidney stone removal.

Thank you again for the prayers for Sally.  She's feeling positive about her next moves but there's enough uncertainty to concern her, as well.

Saturday 12/13 9:09 PM

Sally had a good day today.  She had therapy today but with a little less intensity than during the week.  One of the OT sessions included practicing walking, both on level ground and climbing stairs.  Sally said they told her that shuffling is a no-no.  She had lots of company this afternoon; Christian and Tanya, Karen and Pookie., and Lisa.

Lisa cleaned Sally's house today and I installed four grab bars in Sally's house for her assistance when she gets home.  Jack and Barbara got these great grab bars for Sally.  Thanks Jack and Barbara!

Sally wanted everyone to see what her Princess bed looks like, so I'm including a picture for you.  Frankly, she's getting a little tired of being zipped up in it every night, but this prevents her falling and the nursing staff has to come if she needs to get up for anything.

No therapy tomorrow.  Sally says yea!

Friday 12/12 9:01 PM

Sally’s doing great!  The bedsore looks better.  Loretta, the RN showed me again how to dress it and bandage it.  Her therapy sessions get more and more intense so she knows she’s getting stronger.  She’s proud of that and loves to tell others.  She says her strength is gradually getting better, not quickly but consistently.

She’s appreciative of all the prayers on her behalf.  She says “Keep ‘em coming!”  We know we still aren’t through but we’re grateful for how far she’s come.

I spoke with the case manager and requested that she ask Dr.  Anderson to coordinate with Dr. Jiminez as to when and under what circumstances the kidney stones will be removed.  She said she would talk with Dr.  Anderson, but we heard nothing more today about this.  

Sally is feeling more positive about being able to manage when she goes home.  She recognizes that one of us will be with her 24/7.

Thursday 12/11 3:05 PM

Sally slept pretty well last night.  She said they woke her about 4 AM to dress her bottom sore.  Then she had a little difficulty getting back to sleep.  She didn't get a Flexeril this morning (unlike yesterday) so she was much more alert during her occupational and physical therapy sessions.  All of the therapists noticed this.  To a person, they all said she is doing so much better!

I came in at 8 AM so I could be here when the wound-care nurse dressed her sore.  She gave good instructions including giving Sally breaks during the day when she should be out of the chair. Apparently sitting in the chair causes more pressure on the sore.  In the bed, she can be propped up to give the affected area some relief.

It was good to be able to observe the various therapies today. Between the therapists and the nurses, they are doing all that they can to prepare us to care for Sally when she gets to go home.

No word from Dr. Jiminez about the kidney stones' removal.  I'll give it another day before I re-contact him or his staff.

Wednesday 12/10 4:46 PM

Today Sally celebrates one month since entering Huntsville Hospital!  We decided that we are tickled with her progress so far!

Sally, Karen and I had our education sessions with the Occupational Therapist, Physical Therapist, Nurse and Case Manager.  These are to begin to prepare for her discharge which is tentatively scheduled by Medicare and the hospital for December 18th.  They are recommending someone to care for her 24/7 supplemented by home health care and periodic nursing drop-bys.  They're telling us what equipment to acquire and how to assist her in recovering from her surgery and the complications surrounding it.  Then, on the day of discharge they will give us prescriptions, contact information, etc and send us off....

We aren't sure how the timing of her kidney stone surgery or surgeries ties in with this date of the 18th.  I dropped by Dr. Jiminez's office this afternoon and left him a note apprising him of the planned discharge date and asking him how the decision will be made that she's ready for the kidney stone surgery and who will make the decision.  I also asked for guidance as to what the family needs to do to best assist in Sally's health care and treatment.

Sally's dozing now, having had a full day.

Tuesday 12/9 6:36 PM

Sally's had a good day today.  Her therapies started this morning at 8 and continued until about 2, interrupted only by a brief break at lunch.  So, she was tired when therapy was finished and had a short nap.

I promised you the mailing address for the rehab hospital and here it is:

Sara Smith

HealthSouth Rehabilitation Hospital

Room 302

107 Governors Drive SW

Huntsville, AL  35801

You may want to be sure to use Sara not Sally to ensure delivery.  That was a problem when she was over in the regular hospital.

She is stronger every day, so we are anxious to find out what and when the next step will be.  

Monday 12/8 Evening

Sally had a great visit tonight with her granddaughter Tanya and Tanya's daughters.  It really brightened her day.

She said she can tell that she's getting stronger because she can sit up longer and doesn't feel so lethargic!  That's a praise God!

Slow, but steady progress.....

Monday 12/8 Mid-day

The rehab hospital doesn't have the ready wireless access to the internet, so my posts might be less frequent.

Sally had a good Sunday.  Both daughters spent a lot of time with her and even sneaked in an adventure by wheel chair back over to the Hospital to see the beautiful lobby Christmas tree.  Her appetite isn't great so we're still seeking menu choices that appeal to her.  Lots of learning here for all of us.

Her blood sugar is still ranging from the 100s to the 200s, so insulin injections are still needed.  She has had 3 physical therapy sessions today and would just as soon have no more, thank you!

Sally has enjoyed her cards, visitors and phone calls.  I have to say that she's in better spirits than I might be if I had been in here almost a month! 

We're expecting to get an idea on Wednesday about how long she'll be here in rehab.  We'll sure let y'all know.

Sunday Morning, 12/7

It's nice to be back in Huntsville.  I saw Sally last night after Conrad and Rita picked me up from the Birmingham airport.  Sally's color looks good.  A week makes a lot of difference.  She has been having some neck pain so they had just given her a muscle relaxer when we arrived and she was drifting off to sleep.

The HealthSouth Rehabilitation Hospital seems ideal for Sally's needs.  We still don't know how long she might be there, though.

More later.

Knox 

Friday, Dec. 5

Sally had a new nephrostomy tube put in today (the fourth one!) and it is working beautifully. She had several therapy sessions today and was resting well when we left her this evening. Her room telephone number is: 256-428-2658. She is looking forward to seeing Knox when he arrives on Saturday.
Thank you for all the cards, calls and especially, the prayers.

Wednesday, Dec.3 & Thursday, Dec.4

Wednesday morning Sally was transferred to Health South Rehabilitation Center. We made quite a parade walking across the Governor's Drive walkway from the hospital---with balloons, roses, and gifts from her birthday on Monday! We were greeted by several staff members, who guided us through orientation. Mark Anderson, Physician's Assistant, spent a good bit of time "interviewing" Sally on her health history and home environment. Conrad and Rita took careful notes during the interview.

Sally's room number is 302. I will post the telephone number later today.

Sally slept well Wednesday night and ate a good breakfast on Thursday morning. She had three separate physical therapy sessions on Thursday---walking, climbing stairs and other activities. She has a nice room with a view of Monsanto Mtn. Thursday morning she brushed her teeth, combed her hair and put on lipstick. She is a girly-girl princess. We have named the safety enclosure bed her princess bed. She had told the staff when she arrived that her name was Princess Sara!

Thank you for your prayers and please continue to pray for our Sally.

Tuesday - Dec.02

Picking up where last entry ended....
Monday night..
9:00p - Blood Sugar = 179, Walked one lap of 6th floor.
9:30p - Gina/nurse practitioner checked Sally's left leg/calf. Sally had been having pain in that leg. Gina says it looks o.k.

Tuesday - Dec. 02
02:10a - Blood Sugar = 161
06:30a - BP 165/76
07:30a - Dr. Cowart - said they will increase the insulin now that she is eating. She will continue on insulin in rehab and when she goes home. They will decide at a later date whether she will continue on the insulin indefinitely.
08:40a - Dr. Mengesha came by - said he would see Sally again in his office...after her surgeries, when she is stable.
09:30a - "wet" the chair (remember, the foley is gone). Nurse brought fresh underwear & pads. Earlier this a.m., Sally did walk to the bathroom, with assistance, and urinated in toilet.
10:00a - BP = 157/70
10:30a - Blood Sugar = 250
10:35a - Nicole- exercised Sally and walked 1/2 lap.
11:30a - Lunch : Ate 90% of roast pork, 50% of potatoes, 1/3 of green beans, and 1/2 roll, all of fruit bowl, and all of tea.
12:15p - Insulin and checked tube. When they empty the ba, they will strain it to see if there's any stones in it.
Used the Spirometer (500 highest reading).
Nurse applied cream for yeast infection.
12:20p - Breathing Treatment
12:40p - Walked one lap.
1:10p - Bath time.
1:30p - Walked one lap.
2:00p - Dr. McCrory came by and said Sally will probably go to rehab tomorrow.
3:05p - Vitals > by Kathy - BP 146/70 (elec.) Oxy 93
3:10p - Spirometer
3:20p - Becky (Rebecca), charge nurse came by to see if Sally needed anything....Sally says no.
3:35p - Blood Sugar = 124
3:45p - A lady came by to repeat what Dr. McCrory had said earlier, that Sally will be going to rehab tomorrow. Dr. McCrory & Dr. Newton have both approved. She said Sally needs comfortble clothes to wear. She will be going around 10:00a.m. She said that most people stay a maximum of 10 days.
4:15p - Breathing Treatment
5:00p - Supper > Ate 50% of Chicken & Rice soup, 75% of Jello, and 1/2 of tea.
5:15p - Urinated & nurse put cream on bed sore.
5:20p Spirometer (5 times) but quit early... says it hurts too much when it makes her cough.
6:20p - Meds > Insulin, Prevacol for cholesterol, pain pills (2 Prevacet).
Dr. Brown (Dr. Jimenez' partner) says to irrigate the nephrostomy bag. They said it didn't seem to be draining as much as it should.
7:30p - Vitals > BP = 149/72 (elec.), Temp 98.3.

til next time...

Monday...Happy Birthday, Sally !!

Sunday night 10:40 p.m. Sally helped into bed.
11:15 p.m. Breathing treatment.
Monday 12:15 a.m. Blood Sugar 144 BP 168/80
2:30 a.m. BM
2:45 a.m. Walked a lap.
3:15 a.m. Breathing Treatment.
6:25 a.m. Dr. Newton came by - wished Sally a Happy Birthday. Said we'd celebrate by walking. People will be coming later to evaluate Sally for Rehab. Oxygen 94, off of canula.
7:10 a.m. Dr. Harris listened to her heart and wished her a good day.
7:15 a.m. Dr. Cowart (Endocrinologist, works with Dr. Johnson) came and listened to her heart. Says he's having them schedule a faster acting insulin (Novalog).
7:45 a.m. Sherri/tech checked vitals. BP 175/83 Temperature 98.8 Oxygen 93.
8:10 a.m. Scott/nurse gave her morning meds: Aspirin, Centroid (?), Levaquin (antibiotic), and an expectorant. He said that Dr. Cowart had ordered an increased dosage of Lantis (a longer acting insulin).
8:30 a.m. Sally chose her meals for Tuesday: Breakfast: Bagel with cream cheese, margarine, cheerios with banana, and peach yogurt. Lunch: Roast pork, green beans, mashed potatoes, iced tea Supper: Bowl of chicken and rice soup, jello.
8:40 - 9:15 a.m. Sally took another walk around the hall (1 lap).
10:00 a.m. Mary/RN came by to check Sally's ulcer (bed sore). Says it's looking better. Mary says she also has a yeast infection. She'll order some cream for that. Mary mentioned again that Sally needs to be moved at least every 2 hours to reduce pressure on the ulcer/bed sore.
11:05 a.m. BP 188/74 (elec).
11:10 a.m. Lunch: Beef burgundy with nodles and carrots, iced tea with splenda (She ate it all).
11:15 a.m. Scott gave Sally her scheduled novalog/insulin shot. Scott and Sherri treated Sally's sore and moved her from bed to chair.
12 noon Spirometer.
12:10 p.m. Nurse checked BP (man) 160/70.
12:12 p.m. Breathing Treatment.
1:00 p.m. Bath Time.
1:25 - 1:35 p.m. A lap around the floor.
1:35 p.m. Physical Therapist/Nicole helped Sally exercise her feet and ankles.
1:45 p.m. Dr. McCrory came by and wished Sally a happy birthday. He says she may go to Rehab as early as tomorrow (Tuesday). I told him our concerns about Sally being sent to rehab too quick, before her numbers were under control, such as blood sugar, BP, etc. He said her health treatment will continue at rehab unabated. Rehab is located just across the street and is connected by a walkway over the street. Says the only holdup right now is bed availability.
2:20 p.m. Spirometer.
3:00 p.m. Small BM.
3:20 p.m. Dr. Jimenez said he would like to remove the kidney stones within the month, preferably before Christmas. He said her respiratory isn't strong enough for surgery yet. He said as far as he's concerned, her foley can come out if Dr. Newton says it's O.K. He asked how long Sally will be in Rehab. (We know there's a 21 day maximum that insusrance will pay for). Karen had heard 5 to 7 days. Dr. Newton said on Sunday that Rehab might be 7 to 10 days.
3:25 p.m. Temperature 96.9 BP 200/87 (elec). BP 178/70 (man).
3:50 p.m. Blood Sugar 163.
4:30 p.m. Breathing Treatment.
5:20 p.m. Dinner: Roast beef 45%, mashed potatoes 50%, broccoli 25%, tea with splenda, bite of roll and jello 50%.
5:35 p.m. Removed foley!
5:45 p.m. Insulin and Prevacol.
6:30 p.m. Cleaned incision.
6:50 p.m. Spirometer.
7:15 p.m. Temperature 98.4, BP 188/88 (elec), BP 168/78 (man).
7:20 p.m. Meds. BP medicine/Lisinopril, Coreg, Mucinex, Percocet (for leg pain).

Sunday

3:30 a.m. Breathing Treatment.
3:50 a.m. BP 189/73 on wall unit. 199/93 on machine. Wt 155.9.
Small BM on seat - moved from bed to chair.
Medicine applied to bed sore.
4:00 a.m. Complained of burning. Repositioned foley catheter.
5:10 a.m. BP 175/78 (wall unit). Oxygen 93.
5:20 a.m. Irrigated foley.
5:30 a.m. Bladder scan - 765 in bladder.
5:40 a.m. Blood Sugar 158.
5:55 a.m. BP 159/70
6:40 a.m. Put in new foley.
7:10 a.m. Temp 97.8 BP 154/72.
7:30 a.m. Chest Xray.
8:15 a.m. Ate all breakfast. Breathing Treatment.
8:25 a.m. Spirometer.
8:45 a.m. Got bath - Teeth brushed.
10:00 a.m. Walked a complete lap around the floor. - Yoo Hoo!
10:30 a.m. Blood Sugar - 341. Karen said they will take away grapes and bread.
10:45 a.m. Dr. Newton came and said Sally should stay in Rehab 7 - 10 days - Rehab will come today and talk to us about Rehab and do an evaluation. Dr. Newton was proud of her walking her lap.
11:05 a.m. Temp 97.3. BP 152/80. Oxygen 92.
1:00 p.m. Spirometer.
Karen said that yesterday afternoon after she had been lying on her left side in bed for a while, they moved her to her right side. She started having difficulty breathing and was sounding raspy. So they switched her back to her left side and breathing got better again. Then they did a chest xray. Dr. Newton and another doctor are both going to read the xray to look for differences in the two sides.
1:15 p.m. Taken for a walk by physical therapist. (I'm still concerned about Sally's progress in mobility and alertness).
1:50 p.m. Completed lap 2 of walk. (Lap 1 was at 10:00 a.m.) She's very tired.
Areas of concern that may affect Sally's discharge day - Rehab: 1. Bed sore. 2. Occasional high BP. 3. High Blood Sugar. 4. Mobility difficulty.
3:24 p.m. BP 154/72. Temp 99.4.
3:30 p.m. Breathing Treatment.
3:45 p.m. Blood Sugar 281.
3:50 p.m. Spirometer.
4:00 p.m. Walked around the block in 30 minutes.
4:50 p.m. Out-take 530.
5:00 p.m. Nephrostomy bag emptied - 150.
5:05 p.m. Supper - Ate most of soup, 1/2 peaches, 1/4 broccoli, 10% pasta, drank all tea.
5:25 p.m. Insulin- upped it to 3 units plus sliding scale.
Rehab (HealthSouth) Visiting Hours: Mon. - Sat. 4:00 p.m. - 8:00 p.m. Sundays and Holidays -
12 noon - 8:00 p.m.
7:10 p.m. Vitals (by John) Temp 99.4, Oxygen 95, BP 180/81 by machine.
7:12 p.m. Breathing Treatment (by Tommy).
7:20 p.m. Nurse/Amy came by and rechecked BP manually - 162/78. She also checked for swelling, checked her incision and checked leg where vein was removed, flushed PICC, will come back and put cream on bed sore when she gets her ready for bed.
8:00 p.m. Sharon to spend the night tonight.
Still have not heard from Rehab at this time.

Saturday

Up at 5:00 a.m. to go to x-ray. Weighed 155. Blood sugar - 96.
Nurse gave suppository at 5:30 a.m. Mobility is still not very good. Needs to try and change positions occasionally because of bed sore.
Had good BM at 6:30 a.m.
Breakfast at 7:30 a.m. Ate all cherrios, grapes and yogart. Didn't eat toast. Temperature - 98. Blood Pressure - 138/80.
Had BM at 8:00 a.m.
11:30 a.m. Blood Sugar - 249.
For lunch Sally ate all Tomato Soup, 1/2 roll, all peaches, 1/2 broccoli and 1/2 potatoes.
12 noon Dr. Newton came by and talked to Lisa and Sally and asked if Rehab Therapist had talked to them. Lisa said Sally has been snoozing this morning.
12:30 p.m. Used incentive spirometer. Sally isn't using cannula right now.
12:35 p.m. Manual BP is 190/89! Nurse says that's high. She asked if Sally is taking anything for it, then left. Sally told us she normally takes verapomil (Sp.?) for BP.
12:45 p.m. Nurse asked us to leave while she applied some cream to Sally's bed sore.
Sally still seems somewhat lethargic. Don't know if that's normal or not at this stage. Maybe it's a result of her BP reading of 190/89.
1:10 p.m. Tech asked us to leave so she could bathe Sally.
2:10 p.m. Sally did the incentive spirometer for about 10 times.
3:20 p.m. Sally was put back in bed on left side. Needs to be moved to other side at 5:20. Sore is in middle of back.
4:00 p.m. Breathing Treatment
4:10 p.m. Blood Sugar - 149.
4:45 p.m. Sally swallowed pill, nurse flushed pic line and offered to turn Sally, but Sally didn't want to.
4:50 BP - 173/79. Temperature - 97.8.
5:15 p.m. Used Incentive spirometer. Got up to 500.
5:20 p.m. Supper - Sally ate 1/2 of potatoes, 75% of soup, 3 bites of collard greens, 1/2 of fruit bowl and drank 1/2 of tea.
5:45 p.m. 650 total out-take. 150 total in-take. Don't push drinking water until doctor tells us different.
6:10 p.m. Sally used incentive spirometer. Got up to 500 again.
7:00 p.m. Vitals BP - 163/78. Temperature - 99.9.
7:20 p.m. Breathing Treatment from Respiratory Therapist.

It was a good Friday with Sally today

Sally's central line was taken out today :)
Also, the drain tube from her lungs was removed by Dr. Newton.
Oxygen through the cannula was stopped this morning, but was put back at 7:10 tonight when her vitals were taken. Her oxygen reading was low (89). With the oxygen started again, the level went up to 91, and we were told it would probably go up higher in a little while.
At 7:10 p.m. BP was 166/76 and Temp. was 100.4.
Her daughter, Lisa, will spend the night with her tonight.
Her night nurse tonight is Joe. He says he'll be looking in on her throughout the night.

Sally may be going to the HealthSouth rehab facility this coming Monday to help with her walking. Earlier today she walked from her chair to the door and back with a walker. Right after that, the physical therapist came in to help her walk some more. That time she was only able to walk a few more steps. She also walked from her chair to the bathroom with the help of 3 people.

Diane, the Diabetic Educator, came by and told Lisa & Karen that all caregivers must learn to give insulin injections. Sally will need them once a day, in the morning, at the same time every day. The injections will be given in the stomach. One day for one side and the next day, on the other side of the stomach.

Sally's case worker, Regina, came by and said that someone from rehab would be coming by....then later, Sheila, from HealthSouth came and talked a little about rehab. She mentioned that the visiting hours will be restricted while in rehab.

Thanksgiving Day

Sally's had a good Thanksgiving Day today. We (Conrad & Rita) are filling in for Knox to try to post significant events as they occur regarding Sally's progress.
7:00 a.m. today - Dr. Newton's assistant said everything looks good. Sally does not have an IV because of a fear of swelling. The family was told to only give Sally something to drink if she asks for it.
The kidney doctor came by. He also noted that everything looks good. He says they will continue with antibiotics because the kidney stone is infected, so they will continue with a low dose of antibiotics probably until the stone is removed.
8:10 a.m. - Breathing treatment. She did it on her own and took the entire treatment.
12:25p.m. - For lunch she had a couple of bites of mashed potatoes, a bite of turkey, 1 green bean, and one bite of pumpkin pie.
Dr. Swearingen - pulmonary came by. Says lungs sound good and chest xray looks good.
3:00 p.m. - BP 169/76
3:45 p.m. - Breathing Treatment: This time she had to use the mask for the treatment because of low energy level.
Sally has been very thirsty. She drank a whole pitcher of water and a couple of glasses of tea. The nurse said to start giving Sally ice because she was drinking too much water.
7:30 p.m. - BP 161/78
8:30 p.m. - Sally told the nurse she was getting sore from sitting so much. The charge nurse decided it was time to move from chair to the bed for the night. Sally was then able to walk a few steps to the bed. She's had a busy day, with lots of visitors. Will post more soon.

Wednesday 8:46 PM

Sally's sleeping now.  She's still quite groggy and she prefers sleeping in the chair.  The nurse, John says many heart surgery patients prefer sleeping sitting up in the chair rather than in the bed.

It's home to San Antonio for me tomorrow for a few days.

Happy Thanksgiving!

Knox

Wednesday 11/26 4:18 PM

Sally is out of the ICU! She's still a little groggy, but very responsive! She's in Room 654.

She'll start her aggressive walking regimen tomorrow.

What a trip!

Tuesday 11/25 9:30 PM

Wow, what a day! We saw Sally and she was able to move her eyes and hands a little bit. The nurse said she's breathing on her own and that they will probably remove the intubation tube this evening as soon as she can raise her head. She's making terrific progress!

An gentleman from an organization called Mended Hearts came this afternoon and brought a large red heart-shaped stuffed pillow for Sally to use to press against her chest when she has to cough or sneeze. The organization consists of people who have had open-heart surgery who band together to encourage one another and patients who are experiencing this for the first time. They have regular monthly meetings and they invited Sally to join them. Great idea!

Nurses and Techs from other floors who have ministered to her in the last few days keep coming by to check on her. Everybody should have a chance to see how many people love them and care for them the way Sally has seen demonstrated these past few days.

Sally was in a little pain when we left her so they gave her something and we trust she'll have a good night.

Tuesday 11/25 6:01 PM

We saw Sally a little while ago an she's beginning to open her eyes.  Our nephew Gerald Pitts calls Sally his "Gypsy Aunt" so we're going to play this song for her when she gets to her room:

more Cher lyrics

Gypsies, Tramps & Thieves Lyrics

I was born in the wagon of a travelin' show

Tuesday 11/25 11:40 AM

Dr. Newton came to tell us that everything went well.  No additional blood was required and the bypasses went like they were supposed to!

Sally will be out or very drowsy until late in the afternoon, but we'll be able to see her in a little while.

More gratitude for all of you who love Sally and prayed for her!

Tuesday 11/25 10:59 AM

GOOD NEWS!  Dawn, one of her nurses just came up to say that they are taking her off of bypass and closing her up.  Everything went well!!

It'll take about an hour to wrap up in the OR, then she'll come up to ICU.  Then, we should get to see her in about another hour.

What else can I say?  We're all grateful for our prayers to be answered!

We'll let you know after we get to see her (probably in a couple of hours).

Tuesday 11/25 10:33 AM

Sally's in surgery now.  The cardiac staff continues to remind us that "no news is good news".  Their practice is to let the family know as soon as she's off the heart/lung machine.

We'll let you know.

Tuesday 11/25 7:26 AM

They took Sally about 6:00 for the surgery prep.  According to the anesthesiologist last night, all of the prep, including harvesting the vein for the bypasses takes a couple of hours.  So, they want to get that done and have her stabilized before actually beginning the surgery.  That might be about 8 AM.  She was already zonked out as they wheeled her down.

Everything is going as planned.  We saw  Dr. Newton, the heart surgeon as we left her floor at 6:10 and he assured us that he got a good night's sleep.  He's great.

Monday 11/24 7:40 PM

Sally has received one of the three baths that she must have before tomorrow's surgery.  She's waiting for the second then she'll try to catch 40 winks before they bother her again.

Dr. Constantine, the anesthesiologist came to explain to Sally exactly what will be happening in the morning and in what sequence.

Between tests, baths, blood draws, etc., she's beginning to realize that she might not get much sleep tonight.  We'll be here.

Her granddaughters, Dahlia, Rachel, their mom Laura, and Rachel's sons Isaac and Noah arrived this evening from Hawaii, Guam and Las Vegas.  Sally hasn't seen them in a long while so she was thrilled to see them.  

Sally is truly blessed to have such a loving and supportive family.

Thanks to all for your prayers!!

Knox

Monday 11/24 2:18 PM

Wendy from Dr. Newton's office came by.  They've been talking a lot about Sally this morning.  Her surgery is scheduled for 7:30 tomorrow morning!

She does get supper tonight then nothing to eat or drink after midnight.  They'll be by to prep her later.

Dr. McCrory came just after Wendy. He said from a pulmonary perspective that she's ready to go.  He feels that this surgery should be a textbook case.  Of course there are risks but he's feeling good about where she is.

Just then, the techs came in to do the nerve conduction test (EMG).  This will be uncomfortable with a little stinging and shocks.  But, it will help the neurologist figure out what the difficulty is with her walking.

Monday 11/24 12:52

Sally has had her nephrostomy tube replaced and it's flowing well, now.

She got up and actually stood and took a step on her own!  She went to the regular bathroom for the first time and said she felt like a normal person.

She also ate all of her lunch, a plate of assorted fruit.

Her latest blood sugar is 114, so that's more good news.  Of course, until lunch, she hadn't had any food since early last evening.

We're awaiting the EMG.

Monday 11/24 10:32 AM

Sally had a good night.  The nephrostomy tube is draining well so we are relieved that the risk of further infection in that right kidney is reduced.  She's had a small (less than one degree) fever last night but that's gone now.  Her color looks good.

She's had a half lap of walking this morning but no breakfast so far.  They are awaiting the nerve conduction study (Electromyography (en.wikipedia.org/wiki/Electromyography)) before she gets more food or beverage so she's hungry.  That's also a good sign.

Her blood sugar spiked last night to 280 so she got more insulin.  Her last two blood sugar readings are better:  90 and 123.

The neurologist came by this morning and said they would do this EMG in her room and that he would come by this afternoon and give us the results.

They also said that they have ruled out Parkinson's.  Yea! 

Sunday 6:15 PM

Sally continues to walk her laps here on the 6th floor.

The nephrostomy tube still doesn't seem to be draining adequately, so Dr. Chapman has instructed that an x-ray be done first thing in the morning to determine why.

Sally has had several visitors today and she is encouraged by their love and concern for her.

Sunday 12:50 PM

Sally had a good night.  She walked another lap both yesterday afternoon and this morning, so this is working.

Dr. Chapman (Dr. Jiminez's partner), urologist came by to explain that he'll have them clear the nephrostomy tube (which has stopped flowing).  He also explained that she'll likely go home after her  bypass surgery with this tube and that this isn't a big deal.  She'll just have to fuss with it.  Then, when the heart doctors feel that she's sufficiently recovered from her heart surgery to undergo another general anesthesia, they'll take care of the stones.

Dr. Abbas, infectious disease doctor  came and reiterated that we have to get the nephrostomy tube cleared to get that infection cleared.  He'll switch her antibiotics to pill form.

We'll post when that tube is cleared.

Saturday 9:20 AM

Sally had a pretty good night.  The night nurse originally told her that he would be in about 4 AM to get her to walk, but he came at 4 and said that would wait until morning.  She continues to get a chest x-ray each might in the middle of the night.

This morning, Physical Therapy just came and she walked a full lap of the floor with a walker!  Yea!  Almost as soon as she sat back down, they came and took her down for a brain MRI.  We're not sure why but I'm sure we'll be told.

The focus this weekend will be her strengthening, I am sure.

Friday 5:00

Dr. Mengesha, the neurologist came to check her for diabetic neuropathy.  He said this might be the case.  He'll do nerve conduction studies on Monday.

Dr. Newton, the heart surgeon then came and said he's tentatively planning the surgery for Tuesday, based on the blood work and other tests this weekend.  His associate, Dr. Cohen will be seeing her this weekend.

She's sitting up, smiling and watching some old movies on Turner Classic Movies channel.

Friday 12:15 PM

Sally has been transferred to 665.  Over here, the room is a little smaller and they don't allow eating in the bed.  They have a sign that says:  "Please sit in a chair for all meals. This will help speed up your recovery time".  This is also the floor/area that she will be brought back to after her surgery.  The nurse said they do not allow children to visit this unit.  She said that they just bring too many germs and potential infections for their fragile patients. 

They all say this is the walking, walking, walking unit so this gives us a foretaste of what's to come.

Right now she is sitting up having her chicken salad for lunch.

She will likely have a Nerve Conduction Test this afternoon.  They want to understand the source of her walking difficulties.

Friday 11:15 AM

Sally had a pretty good night.  Her blood sugar got down to 159 during the night and then spiked back up 319.  So, they're managing this with insulin.  She's had a bath and has gotten up and used a walker to get over to the chair.  Yea!

We're waiting to transfer rooms.  She will be in 665 as soon as we transfer.  So, if you have her old phone number,  just substitute 665 for the last 3 digits.  She should be in there soon.

Thursday 5:35 PM

Dr. Newton, the heart surgeon came to tell us that  he's checked the tests that he ordered.  The vein-mapping and carotid echo are fine.  The pulmonary tests show the need for a little work, though.  He's concerned that she hasn't been up very much...   he wants to change that.  So, he's going to transfer her, maybe as early as tomorrow, to his floor on 6 West.  There they focus on getting patients to ambulate (walk).  So, we'll publish her room number as soon as she moves.

He said that the pulmonary doctors have a little work to do on her breathing, etc. before her surgery.  He said that he's tentatively hoping to fix her early to mid next week.  So maybe before Thanksgiving she'll get her bypass surgery.

Thursday 10:50 AM

Sally had a good night.  Initially she had a slight temp but just now it's 98.1.

Her blood sugar has been rising but I think they've allowed her to make a few poor dietary choices like a yeast roll as well as mashed potatoes for supper last night.  We won't let that happen again.  Dr. Yedla was just by and changed her diet to be more restrictive.  Dr. Yedla indicated that the bypass surgery is almost always indicated for diabetics rather than stents.  So, that confirms that this is likely the path that we're on.  Dr. Yedla also wrote orders for Sally to get a consultation and education from a diabetes expert, particularly about nutrition.

All the more important that we build up her strength and her breathing capacity prior to surgery.

So, today, with the nursing help, we will try to get her up more and beginning to walk around.  This should improve her chances of having the surgery sooner rather than later.

Wednesday 7:30 PM

It's been a busy afternoon for Sally.  Just when her lunch arrived, two die-hard Alabama fans showed up to transport her down to Echo to get an echo of her carotid arteries and to map out the veins in her legs.  As some of you may know, bypass surgery usually means some vein is removed from a leg and used to bypass the blocked artery.

Dr. Jimenez, the urologist came by to confirm what we had already heard, that he could not address the stones until the heart is optimally repaired.  He also said that his big goal is to save the right kidney (the one that has the stones and kicked up a lot of this fuss).  He said when he was in training 14 years ago, they routinely just removed kidneys that are in the shape this one is.  He says it is damaged, but it's producing urine and he wants to save it if at all possible.  He'll be keeping in touch and will be ready to intervene with the stones as soon as practical.

Dr. McCrory, the lung doctor came and said he's seen the latest x-rays and that her lungs are really improving.  he said now that we see how blocked the heart was, we can see in retrospect that the heart's failure to adequately pump likely caused the lungs to deteriorate and fill with fluid.  I think I remember that he said it like that, but this is at least close.

The technician then came and administered the pulmonary lung/breathing tests that Dr. Newton had ordered.  This wrapped these tests up for the day.

Dr. Newton, the heart surgeon was our last doctor of the day (so far).  He explained that when he sees the results of these tests (carotid, pulmonary and vein-mapping) tomorrow, he can begin to assess the risks and begin to develop a timeline for her bypass surgery.

So, it appears to me that our job as family members is to help Sally get as strong as she can and get her stabilized in every way possible to improve her chances of a successful outcome!  I know this sounds serious, and it is.  But, when I think of where she was ten days ago on that Sunday evening, she's come a long way and we can be proud of her!  She has a great team of doctors and nurses working hard together to get the best possible outcome for her!

That's a lot to be grateful for!

Wednesday 12:30 PM

Dr. Drenning, the cardiologist dropped by to check.  He said that they are considering the options of stents and bypass.  I told him that Dr. Newton had sounded like it needed to be bypass.  He said they would be evaluating that and arrive at a conclusion in a few days, maybe as soon as next week.

I asked if there was a chance that the urologist would remove the kidney stones first.  He said no, that he understands that the stones require surgery and that the surgery wouldn't be safe until the arteries are cleared.

Mary Ann from Dr. Newton's office came by and said that they would be ordering some pre-surgery tests:  Carotid artery (neck), pulmonary function, and vein-mapping in the legs to see what veins might be good.

So, that's probably what will be happening this afternoon.

Wednesday Morning 11:00 AM

Sally just got back from having a PICC line installed.  This is a system that last much longer than traditional IV "Sticks" and allows both IV meds to be inserted as well as blood to be drawn out.  So it has the potential to prevent a lot of needle-sticks during the rest of her hospital stay.  We like the sound of that.

Nicole from physical therapy just came and worked some exercises with Sally.  They will work to strengthen her as much as possible before surgery.  We will also work to get her up as much as possible to strengthen her.

Her blood sugar so far has been 278 at 10 PM last might and 223 at 6 AM today.

Wednesday Morning 7:40 AM

Sally slept fairly well during the night.  I wanted to let you know her new room number 631 in the Cardiac Care Unit.  The hospital's address is:

Huntsville Hospital
101 Sivley Road
Huntsville, AL 35801

Dr. Alman was by early this morning.  She'll be back with Dr. Yedla in a little while.

Tuesday 7:30

A little change of plans...  Dr. Newton, the heart surgeon came and talked to Sally while she was in the Cardiac Short Stay area.  He shared that she has the 3 blockages and that they will need to be resolved by bypass surgery.  He said these major blockages could make her a candidate for a major heart attack, so they need to be addressed.  The problem is that her body is not in optimal shape yet for this surgery.  So, he said we need to work on optimizing her health in  beginning to pursue a course of preparing her for this surgery.  There will need to be some additional non-invasive tests also to prepare her.

She has been relocated to the sixth floor which is a cardiac care area.

We are hoping to know more tomorrow about what the next steps will be.

She ate a healthy supper of lasagna and garlic bread, so she's feeling better.

More later.....

Tuesday 2:30

Dr. Drenning came out after Sally's heart cath and showed me some pictures.  He said we have a very complicated situation.  She has a major blockage in the LAD artery and two blockages in another major artery.   This is likely what caused her heart attack.  He said the treatment plan is very complicated when you consider the kidney's functioning, too.  He said that he will have another heart surgeon take a look so he has another opinion.

He's not sure how long we can postpone the removal of the kidney stones (he mentioned a big one).  But, ideally he would like to consider opening the blockages by inserting stents and postpone the removal of the kidney stones for six weeks or so.  He said he just needs to consult the other doctors.

She will be in Cardiac Short Stay for  a little while and then will be returned to a different room, not the old one.  We'll let y'all know what room she's in as soon as we know.

I may remember other things the doctor said... If so, I'll post again right away.

Keep praying......

Tuesday 2:05

They came at 1:30 and took Sally for her heart catheterization.  I am now over in another part of the hospital, the cardiology waiting area.  Eric, the young man transporting her said the procedure could be from 45 minutes to 90 minutes.  Then, she will stay in the Cardiac Short Stay area until she's stabilized to go back to her room.

Tuesday 12;50

Dr. Jiminez, the urologist came by to check her.  He was glad she's sitting up.  He confirmed that the one stone had moved up back into the kidney.  He said that he's going to have to surgically remove the 3 lower stones.  He said he wants the other medical doctors to do their thing (I take that to mean the heart and lung issues) before addressing the stones.

I asked if the stone in the kidney might be a candidate for being pulverized.  He said that may be but he won't do that one at the same time.  He said he'll put a small stent in there (in the tube between the kidney and bladder?).

He said we might be addressing the stones next week.

Tuesday 11:15

Sally's back from x-ray and just waiting.  She's awake and talking to Jean who came up from Birmingham to visit.  Her blood sugar was just 179 at 11!

Tuesday 8:45

Pretty quiet here overnight.  Sharon sent the night with Sally and said both of them got a fair amount of sleep.  The Flexeril is keeping Sally pretty drowsy.  Dr. Alman came by about 8:30 and said they would x-ray the right index finger.  She said Dr. Yedla and team would be by in a little while. She's getting no more food or liquids in preparation for the heart cath this afternoon.  

The nurses, doctors and techs (CNAs) are great at this hospital.  We are really are grateful for the care she is receiving.

Thanks to all of you for praying!

Knox

Monday 4:15

Conrad and Rita left this afternoon for a quick trip back to South Carolina.  Conrad has an MRI tomorrow morning and an eye exam tomorrow afternoon.  Then they're coming back on Wednesday.

Dr. David Drenning, the cardiologist came by to say that he's planning on doing the heart cath tomorrow afternoon to go in and take pictures and see what's going on in there.  He asked if there was any reason that Sally couldn't lay flat on her back.  We said no.  He said we won't be installing any stents or anything tomorrow; just taking pictures.

Her blood sugar has been high.  Here's the most recent readings:

Sunday, 11/16, 3:00  PM      236

Sunday, 11/16, 9:00  PM      205

Monday, 11/17, 4:00 AM      195

Monday, 11/17, 11:00 AM     348

Monday, 11/17, 4:00 PM      298

We don't currently know why it spiked this morning.  She only had tea, cheerios with skim milk.

4:25 this afternoon they came in and got an EKG from Sally, probably in prep for tomorrow's heart cath. 

Monday 3:45

Sally is sitting up in the chair now.  Barbara, the physical therapist tried to get her to walk using the walker but Sally said her legs were rubberey.  So they compromised by having Sally sit in the chair.  She said that she'd try to get someone over here twice a day to work physical therapy with her.  She asked if sally was always lethargic...I told her no, I think that's the Flexeril. 

Dr. McCrory, the lung doctor came by a little while ago.  He said her oxygenation is great.  he was thrilled to see her sitting up!  He said as much as we can keep her out of that bed, the better it will be for her.  I told him that we were going to try to get her to use the Incentive Spirometer Volumetric Exerciser 6 times a day.  he said that you cannot use this too much.  It'll expand her breathing capacity and help prevent her from getting pneumonia.

Monday 12:45

Sally got back from her echo at 11:20.  After settling into bed, she felt that she was going to have a BM, so the tech and I got her up and on the toilet.  And she had success!

She's back in bed now (1:00) and resting.  She's pretty tired from all the getting up, etc. and doesn't feel much like eating her lunch, so we'll just hold on to it.

Her nurse, Sean just gave her potassium pills instead of the potassium IV that she's been getting and that hurt so much.  Big pills but better than the IV.

Dr. Harris, the infectious disease doctor just dropped by and checked her.  he said the urine is still clear and that's great!

Monday 10:30

Dr. Yedla and 3 other doctors came by and examined her.  She explained that the stone that was at the top of the tube nearest the kidney has moved back into the kidney.  She will wait to see what Dr. Jimenez wants to do about this.  She wants to send a Physical Therapist to begin to get her moving.  

Sally's oxygenation has improved.  Dr. Yedla wants her to do the "sucking machine" exercise at least 6 times a day.  Maybe every 4 hours.  This opens up her breathing and helps prevent her getting pneumonia.  She examined her back to explore the pain and it doesn't seem to be related to the tube.  It's probably because of being in the bed for so long so she wants her gotten up and begin to move around.  Sally will be given mild Flexeril to relax the back muscles and perhaps relieve the pain some.  Also, she will get a stool softener to encourage bowel movement.  She asked if the echocardiogram had been done yet and I told her that it hadn't.  Dr. Yedla just saw the CT scan and said there's no air in the right kidney so this kidney is a little shrunken (probably from the infection) and is smaller than the left.   This right kidney is where the stones are.

At 10:45 they came in and took her down for the echocardiogram.

Monday 10:15

Nothing much happening now.  Sally's watching old movies and hanging out.  We're working on her to take in more fluids.

Monday 8:45

Melissa from Radiology came by.  She's with the group that put the tube in her kidney.  She just listened to her and checked.  Then they took her down for the cat scan.  We'll make her menu choices for her next two meals when she gets back up here.

Monday 8 AM

Dr. Alman from the UAB group dropped by about 7:30 to listen to Sally's chest. She said that the cardiology notes indicate that they are to do an additional echocardiogram today to look at the heart before moving to a heart cath/angiogram.

Dr. Jimenez, the urologist, came at 8 AM and drew a little picture of her kidney stones.  There are actually 3 and they are in the tube that runs down from the kidney down to the bladder.  He says they are too low to be broken up by ultrasound.  They will probably need to be removed surgically.  He says that her health is not good enough right now to be going down to the operating room.  He says we can encourage her.  He said that he'll probably do another CT scan today or tomorrow to see what's going on in there.

Early Monday

Sally slept pretty well during the night.  She was awakened a few times for vitals checks, blood sugar checks, x-rays, etc.  Her blood sugar is down to 195.  We're waiting for her breakfast and to talk with the doctors.

More later when we've heard from them.

Hunstville Hospital Update

Sally was admitted last Sunday, November 9, 2008.  This blog is to provide updates for her family and friends while she's in the hospital getting her medical needs cared for.

The lung doctor came by this morning and said that they had gotten aggressive with the diuretics to get the fluids out of her lungs and that this aggressive treatment seems to be going well.  He opined that the fluid build up might have been because the heart wasn't "squeezing the lungs" hard enough. He said she's on 97 % oxygen.

This afternoon, Dr. McQuaid, (internal medicine) came by and checked her over.  He said the team needs to meet with the urologist and radiologist and figure out what to do about that tube in her back and the kidney stone.  He said that they either need to put the drain all the way in or take it out and in either case take care of that stone.  It's our expectation that this decision will be made tomorrow on Monday.

On Friday, Dr. Yedla (internal medicine), Sally's primary doctor said that her heart is of concern and that they plan to do a heart catheterization and angiogram next week to determine why her heart is only pumping at about half of its efficiency.  She also pointed out that the kidney infection and the lung oxygenation have to be improved before the heart cath can be done.

Sally was moved yesterday from the ICU unit to a regular room and we were all thrilled!  This allows us to stay in the room with her and assist here we can.

I'll post more as things develop.

Thanks for your prayers for our beloved sister, Sally.

Knox