INR Drama

Remember when Carlos had INR drama?  It was too high and he had a GI bleed.  Now he decided to do the opposite...his INR is too low.  It's been dropping the last few weeks despite increases in his coumadin.  So tomorrow we had to Mayo.  If it's increasing then they will continue to monitor.  If it's not, hello hospital admit for heparin.

Keep your fingers crossed it looks better tomorrow.  Liberty's birthday is on Tuesday and we are celebrating tomorrow night.  Last year, Carlos was in the hospital for her birthday.  Here's hoping no admit!

Back to the Mayo

So Carlos has been doing well at home aside from minor issues.  They managed to get his INR therapeutic two lab draws in a row!  That was just in time to stop the coumadin in preparation for this admission.  He's had some fluid status issues, as well, so they have been playing around with his lasix dose also.

So this is the hospital admission to re- begins this evening.  check his colonoscopy.  They need to follow up on the area that was ischemic (poorly oxygenated area) and check out a possible polyp that was mentioned in the previous pathology report.  If everything is good, then he will be reactivated on the waiting list for transplant.

It sucks that they can't do this outpatient.  Such is the life of an LVAD patient - nothing is ever simple any more.  He has to have a heparin bridge, which is where he stops the coumadin a couple days prior, gets an IV (which they have attempted to start three times thus far without success - waiting now for the PICC nurse to come have a stab...haha), and gets heparin to keep him anticoagulated until the procedure is done.  Heparin is very short acting so this enables him to keep his blood thinned until the last possible moment.  If you recall, the risk of developing blood clots in his pump is high if not adequately anticoagulated.  Then those clots can break off and pinball around his body, potentially leaving him a drooling idiot.  While part of that equation is in effect already, I cannot handle drooling....haha, jk.

Carlos enjoyed a lovely gourmet liquid lunch.  His enthusiam was very overwhelming.  Not.  The Golytely prep begins this evening. You can imagine how excited he is for that. My chat with him about maintaining a positive attitude during this hospitalization quickly was forgotten by the second IV attempt. The PICC nurse just showed up to give it a try. Will update tomorrow.

His INR is what???

Carlos had an appointment at Mayo today for a check-up.  His INR was 4.77!  Holy bleeding batman!  So he will hold the coumadin tonight and restart at half the dose tomorrow night with a recheck on the lab on Monday. His INR never did this before so I asked about it.  He had picked up about 5 pounds over the weekend that is slowly coming off and this may have caused liver congestion which is now improving....take a breath...which improves his liver's processing of medication.  But no bleeding from any orifices so it's all good.

They tweaked a couple other meds but nothing major.  His mean arterial pressure (MAP), which is all that is left of his blood pressure, is still trending to the higher side.  So they increased his carvedilol just a bit to try and get that down (it was 90).  That will help with his mildly tachy heart rate too.

We are opting not to go to Vegas this weekend due to financial constraints.  instead we are gonna do something local...not sure what yet, will figure it out later tonight.

Next appointment is Friday the 30th :)  Carlos starts cardiac rehab on Monday.  The only two things keeping him from being relisted are needs a follow-up colonoscopy, which will probably get scheduled in the first week or so of April, and being able to walk 1100 feet in 6 minutes in rehab.  I'm betting he can do that in the first session :D

Just Couldn't Get Enough

Yesterday, Carlos had a minor episode of bleeding from a place you wouldn't expect to see blood from. We did mention it when at the clinic and it was no surprise that his INR was a bit high at 3.3 or thereabouts.  But his hemoglobin was good at 9.6.  So they decided to watch it.

Unbeknownst to me it happened again this morning, slightly worse.  Then he started experiencing dizziness about lunch time.  This happened a couple times, where I was worried he might hit the floor.  We called the VAD clinic and spoke to one of the coordinators, who suggested we come on in.

When we arrived, he had some blood drawn.  Then he needed to use the restroom.  He was gone quite awhile.  But he eventually made it back to me and the wheelchair.  He said 'Tiff, it's getting worse'.  Sounded like horror movie scary....I knew then, he was destined for a ticket straight to the fourth floor. We got back to the room and met with the ladies from yesterday, Eva RN, and Jennifer PA. He was barely able to stay awake at this point. They looked at his labs...his hemoglobin had dropped to 7.3. This indicated a blood loss of 2 liters in the past 24 hours. I almost fell on the floor. His INR was way high at 4.5. A therapeutic level is between 2 and 3! Shortly after the arrival of Dr Scott, he promptly committed a couple times without warning. No blood in that thank god. Dr Scott left very quickly after that, after confirming that the PA was getting him a bed.

Lots of excitement as we arrived back on the 4th floor in Pod A. It's kinda sad when you know a lot of the staff by name. The GI team came and visited as did the cardio surgeons. The plan was formulated to transfuse packed RBCs and plasma. The plasma would hopefully 'thicken' his blood up a bit so the bleeding would slow or stop enough to possibly do a colonoscopy to determine the source of bleeding. At this point a couple of possible sources were tossed out on the table such as diverticulosis and hemorrhoids but find the source seems to be on the back burner. It seems they want to replenish and slow things first. Will post more tomorrow as things develop. Carlos is very down right now.....partially from the low hemoglobin but also being back in the hospital.