He's still bleeding. Unit #9 of pRBCs running. I'm tired of watching all the numbers and microanalyzing everything thing. I'm driving myself nuts. Looking for some peace. May have to find it in a corporeal form.
They are reversing him completely now. Trying to get his INR back to a normal person's completely. Trying to wobble along that path between the lions and the f*cking pirahnas. Argh.
Libby's birthday is tomorrow.
Sunday, March 4, 2012
Watching Closely
Carlos is feeling better, perkier this morning. He no longer has to lie flat on his back (had to lie flat without moving for 6 hours after yesterday's procedure). His hemoglobin was up to 8.8 and his INR was 1.9. They plan to start him back on a low dose of coumadin to try and get him therapuetic once they confirm, he is no longer bleeding. He did have bleeding this morning but he also hadn't been to the bathroom since yesterday before all the procedures so they expect there will be some blood that needs to come out. They will be rechecking his hemoglobin in a bit. Hopefully it will hold steady. If it drops, then there is a possibility that he is still bleeding. S o we all get to wait and watch. He's staying in the ICU until tomorrow at least.
Saturday, March 3, 2012
Holy Batshit, Back to the Batcave
Carlos was only gone for a couple hours for the bleeding scan. They were able to locate the bleeding in the cecum. They then decided to try and avoid the colonoscopy, and took him for an abdominal angiogram. The hope was that they could find the specific artery that was bleeding and inject coils to block it off. GI surgery is very risky for Carlos and they consider that a last resort.
Three hours went by before we finally got to see him and find out what happened....grrr. They were successful in inserting 4 coils into the rapidly bleeding artery. It fortunately was not a major artery. They are keeping him in the batcave (ICU) until Monday to watch him closely. They need to be sure the coils will work, otherwise surgery to remove that part of the intestine...ack! The interventional radiologist seemed pretty confident according to Carlos. He will continue to get blood products. The count is currently 6 units of pRBCs and 3 units of plasma. His last hemoglobin was 7.1 and his INR was 2.7.
So back to chilling in the batcave until Monday, flat on his back. UGH!
Three hours went by before we finally got to see him and find out what happened....grrr. They were successful in inserting 4 coils into the rapidly bleeding artery. It fortunately was not a major artery. They are keeping him in the batcave (ICU) until Monday to watch him closely. They need to be sure the coils will work, otherwise surgery to remove that part of the intestine...ack! The interventional radiologist seemed pretty confident according to Carlos. He will continue to get blood products. The count is currently 6 units of pRBCs and 3 units of plasma. His last hemoglobin was 7.1 and his INR was 2.7.
So back to chilling in the batcave until Monday, flat on his back. UGH!
Piranhas and Lions
Carlos continues to have bleeding issues :( The GI team and Dr Pujaro had a discussion with us about the plan. One of my concerns is the fact that GI needs the INR ( most recently was at 3.6) to be less than 2 in order to do a colonoscopy. Which the head GI doc keeps telling Carlos he would need to have in two years time anyway. I'm pretty sure Carlos's preference would be two years from now, as opposed to tomorrow! The concern with the INR being that low is that is not a therapeutic range for LVAD patients. He will be at increased risk for blood clots around the pump. If that occurs, the pump would have to be replaced....but we are NOT going there. On the other hand, he said that patients have gone for days and weeks without anticoagulation and have done fine. Freaks me out a bit cause has already had a history of two clots. Sigh. So Dr Pujaro (surgeon) says it's like having piranhas on one side of you and lions on the other....we have to do something and try to balance everything as much as possible. I wasn't terribly thrilled with his analogy.
They started a fifth unit of blood to be followed by a sixth and some plasma. They took him for a bleeding scan (having link difficulties on my tablet - sorry!). We are waiting for him to return. They said he could be gone for about 4 hours.
They started a fifth unit of blood to be followed by a sixth and some plasma. They took him for a bleeding scan (having link difficulties on my tablet - sorry!). We are waiting for him to return. They said he could be gone for about 4 hours.
The Longest Night Ever
It was a long night. And not a terribly positive night. The night shift nurse left after saying that's the most blood I've ever given in one shift. Well, that can't be a good thing.
After the first 2 units of packed red blood cells and 1 unit of plasma, his INR had dropped down to 3.3 ( goal is between 2 and 3). That was positive news. The bad news was that after continued bleeding, his hemoglobin had actually dropped a bit to 7 :(
So he then got 2 more units of red blood cells and another unit of plasma. We just got news that his hemoglobin was up to 7.6. While still pretty low, at least it didn't decrease. The INR is pending. All the docs are aware and deciding what to do with him.
Meanwhile he continues to be very tired and says he feels no different than he did when we got here.
After the first 2 units of packed red blood cells and 1 unit of plasma, his INR had dropped down to 3.3 ( goal is between 2 and 3). That was positive news. The bad news was that after continued bleeding, his hemoglobin had actually dropped a bit to 7 :(
So he then got 2 more units of red blood cells and another unit of plasma. We just got news that his hemoglobin was up to 7.6. While still pretty low, at least it didn't decrease. The INR is pending. All the docs are aware and deciding what to do with him.
Meanwhile he continues to be very tired and says he feels no different than he did when we got here.
Friday, March 2, 2012
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.
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.
Thursday, March 1, 2012
Life on the Outside
So we came home on the 28th, which was Tuesday. I'm not sure what I am going to do not having the nurse writing the date up on the whiteboard for me everyday!
Prior to discharge, we did our two outings and both went well. For our independent one, we went and saw Ghost Rider 2 which was OK. The first one was better :p. We came back to the hospital and were discharged.
After arriving home, I discovered I was running a temp and was really struggling with my asthma and breathing. Figures, after hanging out in a hospital for 30 days, I picked up the flu! Ugh, miserable. I did have a flu shot this year but oh well. It happens. It wasn't nearly as bad as the episode 3 or so years ago when I was late getting my shot. So yesterday, was like a black hole. I never left the bed other than to do Carlos's dressing change. And of course, now we have to worry and watch if carlos gets it :( Anyway, I'm feeling better today although headachy and mildly feverish now. But I can't complain, at least I don't have a tube coming out of my abdomen.
I told Carlos today, that he purrs like the cats now :-)
We went back back to the mayo for a follow-up appointment. They say Carlos is continuing to do really well. His nutritional markers are within normal limits. This is one of the criteria they look at for reactivating him on the list. When we go in on Monday, for the next appointment, they will have one of the surgeons take a peek at him and see if they can go ahead and reactivate him and at what status.
Emotionally, things have been pretty good. He struggled a bit this morning but perked up as we got moving :-)
Tomorrow's adventure is grocery shopping. I told him he could ride one of those electronic carts and maybe I wouldn't take a picture and post it on Facebook. Maybe. Lol
Prior to discharge, we did our two outings and both went well. For our independent one, we went and saw Ghost Rider 2 which was OK. The first one was better :p. We came back to the hospital and were discharged.
After arriving home, I discovered I was running a temp and was really struggling with my asthma and breathing. Figures, after hanging out in a hospital for 30 days, I picked up the flu! Ugh, miserable. I did have a flu shot this year but oh well. It happens. It wasn't nearly as bad as the episode 3 or so years ago when I was late getting my shot. So yesterday, was like a black hole. I never left the bed other than to do Carlos's dressing change. And of course, now we have to worry and watch if carlos gets it :( Anyway, I'm feeling better today although headachy and mildly feverish now. But I can't complain, at least I don't have a tube coming out of my abdomen.
I told Carlos today, that he purrs like the cats now :-)
We went back back to the mayo for a follow-up appointment. They say Carlos is continuing to do really well. His nutritional markers are within normal limits. This is one of the criteria they look at for reactivating him on the list. When we go in on Monday, for the next appointment, they will have one of the surgeons take a peek at him and see if they can go ahead and reactivate him and at what status.
Emotionally, things have been pretty good. He struggled a bit this morning but perked up as we got moving :-)
Tomorrow's adventure is grocery shopping. I told him he could ride one of those electronic carts and maybe I wouldn't take a picture and post it on Facebook. Maybe. Lol
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