Saturday 6PM 4/23/11

A CT scan was ordered and executed earlier today to rule out mini-stroke or other brain issues. At 4:30PM, neurologist Dr. Gabr visited and reported that his CT was unremarkable, no evidence of stroke, tumor or seizure, his issues are metabolic. She diagnoses that Ed has delirium, which typically exhibits a sinusoidal pattern, as we are seeing. Ed's Risperdal had been reduced to 1x/day today and they will return to 2x/day tomorrow. Dr Gabr orderd an MRI for a more subtle structural brain scan. Which could be tonight or tomorrow. He would need to be administered Valium or Ativan (Loraepam) for sedation. I had reservations, considering the sedation required, which could set him back further. Dr Gabr also ordered Thiamin (B1).

At 5:40PM, Dr Godwin returned. We discussed the MRI and he said he would cancel the order. He thinks the MRI results would not change the treatment plan. Ed is making plenty of urine. Dr Godwin recommends Ed get out for a walk this evening.

-Stuart

Saturday 11:45 4/23/11

Ed has rallied after a rest. Friederike asked that I mention that he has been receiving a lidocain patch each day at 10AM (12 hrs on, 12 hrs off). They removed the patch today to limit the meds in his system with his confusion. The dietitian visited to go over the next few meal and he was understanding well and able to express his preferences. He reports that the turkey bacon from yesterday's breakfast "tasted like a telephone pole."

-Stuart

Saturday April 23 11:20 AM

8:40 AM Ed was waking up when I opened the door but it took him about 30 minutes to really wake up. He was frustrated because he did not feel as good as yesterday. More confused and out of it. He did eventually sit up and told me that Stuart had planned some card games for today. Ed ate all of his breakfast. Dr. Godwin (nephrologist) came by during breakfast. Creatinine at 7.9, but since Ed is making good amounts of urine he did not order dialysis today. The white blood cell count is very good and normal. He encouraged Ed to drink lots and eat well. At the end of breakfast Ed was not doing so well anymore. He could not get the words he wanted to say out of his mouth. He was trying hard, but only every 5th word was a real word, and he had trouble holding and putting down his coffee cup. He laid back down to sleep. Stuart came in and Jeanne is on her way. The nurse called Dr Godwin and Afridi (Hospitalist) and both will be back by to see him to re-evaluate. In the meantime they started a drip with saline, took his glucose levels (189 - a bit high). In addition a neurologist will come by and see him tonight. All to make sure the confusion does not have another reason than the low kidney function. Right now Ed is sleeping.--Friederike and Stuart

Friday 4-22 8 pm

Stuart just arrived.
Ed is a little tired but grateful. We just talked to Dr. Godwin, the leg catheter is coming out tonight. Tomorrow's blood values will determine if dialysis is needed. May not be necessary. Ed still has good urine output.
Good night
Friederike

Friday 4-22 2:50 PM

Just testing if I can post now.
Just talked to Ed. He was walking out in the Hall when they heard the phone ring and hurried back. He has been resting and sleeping (he called it "being a slug"). He reports some difficulty with spacial relationships , like finding food on his plate or adjusting the chair in the right way , but he acknowledges that his visitors seem to have some of those chair adjusting problems as well. He sounded just as good as this morning.
I will go back this afternoon and show him the blog entries and comments - so if you post/comment - he will definitely get to see and read it.
Friederike

Fri April 22

The following was mailed to me by Friederike.
She's been to visit Ed on a daily basis and I've invited her to post at the top level but until we get that setup, she's forwarded the following post via email.
Her commentary and level of detail have been excellent; Thank you Friederike!

This morning Ed was happy and energetic and realized he was just feeling so much better and with it. He knew it is Good Friday and did not feel like his tongue was all tight up. We had breakfast together and he devoured the turkey bacon. He had slept well and his “head in the bucket feeling” had gone away overnight. His voice was clear and strong this morning. He even wanted me to open the window shades to get more light. He washed his face standing up in front of the sink and combed himself and then we went for a walk in the hallway. By 10:30 he was getting understandably tired, his mind seems better, but his body still needs to recover. His creatinine was 5.something and I was thrilled. I think in the past week it had been between 7 and 8 even with dialysis. If this is due to kidney recovery or the pizza last night or the frozen plasma he got yesterday– I don’t know – but it is great to see some progress in the right direction.

Friederike

Fri April 22 9PM

I didn't have time to mention this in the last post; I wanted to look up reference on wikipedia. Ed was complaining about Patulous Eustachian Tube when I spoke with him last night, he couldn't finish the conversation.


Just spoke with Ed this AM and he sounded like the old Ed we all know and, well you know, kind of put up with. He was 100% clear and lucid, speaking fluidly. I cannot believe the difference! Considering this has just changed since I saw him the day before yesterday, I have to guess that it's the risperdal that he's been given. He's aware of the difference and acknowledged the sudden clarity.

I just hope the additional dialysis can help the kidneys heal as well.

Thurs April 21 6PM

I've just returned from Raleigh, called and got some info.
The anti-psychotic they're giving Ed is called Risperdal. I know he (the shrink) was talking about a large enough dose to be therapeutic but small enough that he doesn't fall asleep.

He was taken for dialysis first thing this am, then transported to a different hospital (my understanding) to have the new catheter installed. The old catheter was left in place because there's a long weekend ahead and they didn't want to have any trouble in the event the new catheter fails, they can always use the old one.
I guess they'll remove the old one on Monday.

more updates as soon as I can.

Wed April 20 7PM

Ed had a big crowd in his room this evening, several friends and relatives.

The Dr. is going to relocate the catheter from his groin to his chest because he's not recovering fast enough and they anticipate his needing more dialysis. They've been skipping every other day for the past few days. After 3 hours of dialysis today, he's scheduled for more dialysis again tomorrow.

A shrink stopped by and prescribed an anti-psychotic to attempt to help with his confusion, which will be a day at a time, as needed, if the script works.

Wed April 20 noon

Ed was scheduled for dialysis this am, so we didn't bother coming to the hospital until 11am, but he's not yet been taken for dialysis. The nurse is busy so I can't get blood work stats from her, but I will later.

This is my last day in NC, driving home tomorrow. Stuart will be coming in for a few days, arriving Fri eve. He can update the blog too.

I'll post again later when I have some data.

Tues April 19 Noon

Stopped in to visit this am, Ed was tired so I let him sleep.
The nurse gave me stats from this am blood work; Creatinine: 36, BUN: 7.24

Improvement is slow going, I see no change on a day to day basis. Ed is clearly experiencing his mortality and the best metric is contrition. On/off the wall comments.

Dialysis is scheduled again for tomorrow, which he finds very painful.
He is generally in quite a lot of pain because of his collapsed vertebrae, but he cannot be given any pain meds other than motrin because of his kidneys.

We're moving him around, on one side, then the other, occasionally on his back trying to watch tv, but there's 99 channels of shit on the wall, nothing intelligent, nothing worth watching; he can't even find any sports worth watching.

Please leave a comment, I read the blog to Ed while I'm here visiting,
At least while I'm in Raleigh I can let him know who's checking in,

Blogger stats shows 650+ page views in the past couple weeks.
Thank you all

Bloodwork

According to wikipedia the reference ranges for kidney function are different for males and females.

The Creatinine ranges from 0.7 to 1.3, his was 8.46 as of this AM, however that is prior to dialysis.
Bun ranges from 5 to 35, his was 47.

He's just returned from dialysis so tomorrow's blood work will reflect any improvement.

Presently he's very lucid and following along as I type this.

Ed says "thanks for all the well wishes"

Sun April 17th 4PM

I'm finally here in Ed's room after 6 hours in the car.

He's immobile, can't roll over, sit up, without experiencing extreme pain. He's still suffering from the vertebrae pain that started this entire affair.
No dialysis today, giving the body a chance to perform its own bodily functions and test the status of his kidneys. The Dr. is planning a few hours of dialysis for tomorrow so this process slowly plods along.

The nurse just came in the room and  gave me some stats.
His Creatinine is 7.53, BUN is 36, was 33 yesterday.
I don't know the normal ranges, I'll look it up later when we're at E&J's house
Their power was just restored, home is still in place.

I took a photo, but we'll wait for him to recover and put photos on his own personal blog(down at present).