Thu - April 28 10:40

Thursday morning – 9:45
Visited with Ed this morning. Good news first then I get into the rest. His creatinine is holding, so no dialysis today. Last night there was some confusion what the creatinine was (had 8.6 written down). Checked with the Dr today and his values are:
Monday 25th: 8.04 –then went to dialysis
Tuesday 26th: 5.67
Wed 27th : 6.18 – no dialysis
Thu 28th: 5.97 – no dialysis.
Dr. Lee came in and was very positive about this holding/decreasing trend. He may release Ed to go home tomorrow or Monday. We asked if Saturday would be an option to make sure the trend is holding before they pull the catheter out. Dr. Lee will be back tomorrow morning to make those final decisions. Jeanne and Ed need to think and talk if there is any help they would like from a transition place or home aid. Ed needs to focus on strength and fitness.
The result from the tryptane test is not back yet. Eosinophiles were not measured today, but Dr. Lee ordered it for tomorrow. Ed’s hematocrit is still low (25-26%) ( I think >35 is desirable). That is also expected with kidney problems. The kidney makes EPO that stimulates blood cell production. Dr. Lee may give him some Procrit, but that needs to be rediscussed tomorrow. Some people do 2 Units of blood transfusion – but that is not called for in Ed’s case he said.
The skin on Ed’s toe cracked and started bleeding. His skin is still very dry. The nurse cleaned and bandaged it. There is a little bit of fluid in his lower left lung and walking and deep breathing should help to clear that up, but it should be watched.
Follow up for back and infection problem/history: Dr. Lee will help Ed to get an appointment with Dr. Engeman at Big Wake Med in Raleigh, who has trained at Duke and has access to all Duke records. It would be a good second opinion and follow up in a non-teaching setting. The goal is to establish history and status – is the infection still there, how can it be monitored, what needs to be done about it. In parallel Ed will try to get an appointment with Dr Isaacs to follow up on the spine issue.
Follow up for kidney can be done at Cary clinic also manned by Schmidt, Godwin, Lee, and Eckel (Eckel is fourth in the group we have not met him yet). Ed would go there Monday and often to get labs drawn, but they say they have no place there to do cleaning, flushing, maintaining of the catheter. If Ed goes home with the catheter, then he could make an outpatient appointment at the hospital to have it removed later next week.
We are thrilled that the going home plan is materializing.
--Friederike