Updates on Lee - Sabbath, April 30 - 1430

1305 - Dialysis starts

1400 - Just had a long talk with Dr. Cho. He is the Kaiser Internal Medicine Doc.

Here are the highlights:

* Lee still has some serious issues (Kidneys not working properly, heart is weak, infections still being treated, things we all know); however, the new issue needs to be dealt with soon.

* The septic infection from old caused some vegetation on the heart valve. The valve is working with a little less efficiency, but the problem now is the vegetation as it "flakes" off the valve. It is causing mini/micro strokes and this is putting Lee in a precarious position.

Here are the options he presented:

1) Stay here at AVH, keep doing what we are doing, and hope the vegetation dissolve and go away on their own. The problem with this is, each time one flakes off, additional damage is possible. Not a good option in the long run.

2) Transport him to Kaiser Sunset where the Heart Specialists are. They have the personnel and equipment to fix whatever his issues are. AVH is not equipped to handle these specialized treatments. Best option for the long run, even if they decide he does not need the invasive procedures, they can better handle what he needs. Only problem is, there is a greater risk to perform these procedures.

Atfer a few more questions and answers, we decided option 2 is the plan. It is too late in the day to attempt such things, so they will take a look in the morning. Once they determine there is a green light, they will transport him in the ICU Ice Cream truck.

We will keep you posted on this, so you can wave when he goes by....

Vent 35%, peeps 5%
HR 120ish
BP 108/46 MAP69
SpO2 100%




Professor

Eternal Vigilance
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Updates on Lee - Sabbath, April 30 - 1000

Wow! I slept until 0810 this morning. Must have been tired.

Lee's night was uneventful. There is still some heart rate issues, and they are attributing that to two things: He still has the underlying infection (still be treated with long-term heavy duty antibiotics) that got him here in the first place, and the little vegetation (growth) on one of the valves that came from the infection. This second item is now presenting itself now, as up until this time, the rest of his systems were the priority. as the systems become stable, the remaining issues become clear.

Form Dr. Ahmed this morning (once again apologies, as I am not as expert as Nanny is in the interpretations/translations (She spent a few years working with the State Bank of India, and she has been here four weeks):

* We had him on CPAP test for quite awhile, he did very well, about 34 hours. He is back on assist mode, and he is resting well. Numbers look good.
 

* He still has the infection that brought him here, and when the Infectious Doc comes in, ask for more details.

 

* During the TEE, we did discover some evidence of a "possible" stroke. Mild, yet noticeable.
 

* At the beginning, when he first arrived, we did not think he would would make it, but thanks to God, he is where he is now.
 

* His lungs are doing well, in most cases, it takes some time for the drugs to clear out before we see major changes. In his case, we are looking at some extra time before FULL RECOVERY.

* His Rehab won't be here, but there are rehab places where this will happen.

1020 -

Numbers Game:
Vent 35%, peeps 5%
HR 110-120
BP 96/44 MAP 64
SpO2 99%

Professor

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Updates on Lee - Friday, April 29 - 2130

Nanny left the building around 1900

Professor here now.

The last 24 hours have been very informative:

0800 - Still  on CPAP, all is well. Numbers look good.

0930 - ABG taken, looking good, but not good enough to remove from vent.

1100 - Dr Lemus came by to check on catheter ports. Looking good for dialysis in the afternoon.

1105 - Just spoke to Kaiser Dr. Rohas (IM). There is a small growth on one of the heart valves that came from the infection (called vegetation). Lee might need surgery to remove this, but AVH is not the place for this procedure. Kaiser Sunset is. There is no way anything will take place until the rest of the systems are stable enough for the move, and this will be another wait-and-see process.

1115 - Nanny reviews ABG info with Robert (RT): Lee's ABG respiratory numbers were fine, but the other numbers were not as good, e.g., Kidney.... Duh...he needs dialysis. Robert said it is best to let Lee rest more and get stronger before they take him off the vent.

noon - still

noon - Still  on CPAP, all is well. Numbers look good.

1400 - Still  on CPAP, all is well. Numbers look good.

1500 - Dialysis process begins

1915 - Dialysis done. At ths time, Lee does not like the Dialysis. Because of the valve issue, the heart is working hard, and the BP still dips....

As of this writing:
2145 - Switched back to vent assist.....Lee had a GREAT workout! He on CPAP mode for the last 30 hours! Time to rest a bit. 

Vent 35%, peeps 5%
HR 130 (and dropping slowly)
BP 112/54 MAP 74
SpO2 99-100%


Professor

Eternal Vigilance
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Updates on Lee - Thursday, April 28 - 2000

Joe Friday here..

Day started with pretty much the same numbers as last night.

Been a very bust and productive day:

A new catheter was installed yesterday. Now clogged. Tick Tock.

1345 - Switched to CPAP mode....plan to keep him on it until he can no longer do the work.

New catheter still clogged. Tick Tock, Tick Tock.

Two rounds of PT & OT, on CPAP mode the entire time. No issues.

New catheter still clogged. Tick Tock, Tick Tock, Tick Tock. There is little concern, as it has not been 24 hours since his last dialysis, so there is time to get 'er done.

2000 - passed 6 hour mark on CPAP mode
Numbers Game:
Vent 35%, peeps 5%
HR 85-100
BP 103/35 MAP 63
SpO2 97%

Only Meds/Drugs going in at this time: Antibiotic and blood thinner.

"..awake for most of the day, now sleeping for the last several hours."

New catheter still clogged. Tick Tock, Tick Tock, Tick Tock, Tick Tock.

2100 - Still on CPAP and SpO2 holding @ 100%

Professor

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Updates on Lee - Wednesday, April 27 - 1900

1500 - All going fine. Lee was breathing on his own (CPAP mode) for four hours! as time passed, he was getting tired, so at the four hour mark, he asked to be switched back to assist mode. He has been quite alert today.  We need more "lerts" like him in this world. 😀.  Anyhow, he is resting and we are waiting for the two procedures to take place (Exchanging the catheter in groin where dialysis is administered and the TEE.

A transesophageal echo (TEE) test is a type of echo test in which the ultrasound transducer, positioned on an endoscope, is guided down the patient's throat into the esophagus (the "food pipe" leading from the mouth into the stomach). An endoscope is a long, thin, flexible instrument that is about ½ inch in diameter.

This just in:

We now have some concrete answers: I spoke to Dr. Eddin (cardiologist). (I know we already knew this, so do not think he is telling me something new.) Anyhow,  Lee had the strep B bacteria infection that entered into his blood from the open sore on his leg. (Derek had this as a days old baby.)
This traveled to his aortic valve and caused a growth/vegetation (endocarditis) on the valve. This was confirmed by the TEE.  He has, and continues to be on antibiotics for this, but sometimes it takes awhile to kill the bacteria.  Doc said is is probably the root of all of Lee's recent evils in addition to the kidney and lung issues. If the antibiotics do not kill this vegetation, surgery may be necessary (TBD). He also said he may have had a little stroke based on what showed in the MRI.

More later, as news becomes available.
 
Nanny
 
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Updates on Lee - Wednesday, April 27 - 1300

Morning brings more progress.

Currently his HR is better but still all over the place.

BP  = 117/43 MAP 70
Ventilator O2 35%, PREPs 5%
SpO2 = 96.  ❤️❤️

Now that some of his systems are cleaning out, Nanette noticed Lee's eyes are blue. She has know him for 40+ years, .....

1037 - Switched th ventilator to CPAP mode

1135 - On CPAP for an hour and SpO2 holding at 96/97%

More later, as news becomes available.
Nanny
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Updates on Lee - Tuesday, April 26 - 2300

Many apologies for the timing.

Very long day, lots of SOSDD from all parties involved.

Today, Lee was pretty much working the slow, but sure plan.

Had the dialysis, a little stressful, and still a little groggy.

His White blood cell count is still a bit high, so as they investigate, they scratch their heads. More samples are taken to see if there is an underlying infection somewhere.

PT came by to do some work.

Lips are still getting the coconut oil....Nanette is doing her part to build the muscles she can reach, so holds the sponge tip and plays tug of war with Lee's embouchure.

MRI done at 2000. Results should arrive in the morning. Expecting to see a clear view of Scully and Mulder.

Lee is still very weak, and it will take time to gain his strength back. Technically, he started of from rock bottom on Monday, April 4, 2016. All that has taken place since then is all progress.

Here are his numbers at 2200:
Lee is resting comfortably.
HR still bouncing around but nor as high as yesterday.
BP 110/51  MAP 72
Ventilator Input O2 = 35% (moved down 5% today)
PEEP still at 5%
SpO2 = 98%

We are still learning a lot.

More later, as news becomes available.

Nanny

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