Say Good Bye to Heparin

Ever since Shirley's transplant she has received thrice-daily shots of Heparin, a blood thinner intended to reduce the chance of a stroke-inducing clot from forming. And like virtually every other drug she is taking, there is an unfortunate side effect.  In this case, it's not really a side-effect as much as just an "effect".

After all, since it is a blood thinner, what would you expect to happen when you inject it?  You get a gold star if you guessed bleeding and bruising.  And the recommended place to get a Heparin shot is in your belly.  For the first few weeks, Shirley's belly looked like polka dots of bruising--each about the diameter of a dime. But as time went on, the nurses ran out of un-bruised spots and her stomach became a single bruise.  

Do the math:  66 days in the hospital x 3 shots a day = lots of dime-sized bruises.

But yesterday, she asked the question "how long do I have to get these shots?" and the answer was, until she was walking at least 200 feet per day.  Well, as luck would have it, she had been doing that for a few days, so the doctors ordered an end to the heparin.

Rehabilitation Ward

I apologize for the drought of blog posts.  My work took me out of town for several days.  But now I'm back and there is all kinds of exciting news to share.

Yesterday, Shirley was released from the Medical Unit of the hospital and is now a resident of the Rehabilitation unit.  She's been moved to a new room on a different wing and is now surrounded by other patients recovering from a wide assortment of conditions.  The UW Medical Center Rehabilitation Program is nationally recognized as one of the finest in the country.  It current ranks #1 and has been in the top four every year for the past 13.  She is in good hands.

Life on the Rehab ward is very structured with lots of scheduled visits.  So structured, that everyone gets a menu each evening and has to pick all their meals for the next day, as there is not time to order and wait for delivery.

Morning routine consists of breakfast, an hour-long Physical Therapy session and another hour of Occupational Therapy. After lunch, there is another 30 minutes each of PT and OT, then a group exercise class and an endurance session where patients work on cardio machines in the gym.

In addition to being seen by the therapists, Shirley has been seen by two physicians, a psychologist, a nutritionist, a Physician's Assistant specializing in diabetes treatment (more on this in another blog), a case manager and two different visits by staff from the Spiritual Care Department.

Being away for five days, I can already see signs of her getting stronger.  I am very excited to see the progress after just two days on this ward.  They are projecting a two-week stay, but this is subject to review based on her progress.  We have a meeting next Wednesday with the entire rehab team and expect we'll get a more specific target discharge date after that meeting.

Last Operation?

After the two previous wound vac changes done bedside, today's procedure was scheduled for the OR again.  The expectation was that they might be doing more suturing and closing some of the remaining portion of the incision wound.  But when they got Shirley in, they determined that the healing was progressing sufficiently that sutures would not likely be needed. They were glad the procedure was done in the OR, as they found a couple of spots on bone that they needed to debridement.

In a post-procedure consult with Dr. Chung, we learned the following:

• One of the two wound vac tubes was removed.  So Shirley is down to 3 total tubes!
• The sutures around the original edges of the incision were removed and things are healing nicely.
• Friday, during the next scheduled wound vac change, they will do the procedure bedside and will possibly remove the sponge that is part of the wound vac and replace with "wet to dry" gauze (a layer of gauze saturated in saline and a dry gauze on top).  
• He also suggested that she is getting ever closer to being ready for transfer to the rehabilitation unit for intensive physical and occupational therapy.
• They expected that even if the next change required another sponge and wound vac, that the procedure would be bedside and no more operations should be needed.*

It was all very positive. And Shirley was even feeling better about how sore her chest felt once she understood that they had worked on her rib and sternum.

* well, there still is that issue of the gall bladder that will eventually have to come out, but that is likely several weeks or months down the road.

Think happy thoughts and smile with us on this encouraging news.

Stormy Day in Seattle

It's Saturday and Shirley and I are hanging around in her room.  Ashley from Physical Therapy came by and Shirley took an nice walk around the ward. When she came back to the room, she worked on sit to stand to sit on the seating platform on the walker. She found this fairly challenging and was a little disappointed until Ashley measured the height and discovered it was two inches lower than the seating height she was working from yesterday. Lower elevation means more effort and once we knew the reason, it was a victory instead of a frustration.

Shirley's brother Pete came by for a visit around 4:15.  While he was here, there were a flew flashes in the sky and claps of thunder.  About an hour later, we had an extended hail storm that left a blanket of white on the grassy rooftop of the hospital entrance we can see out of the window.

Then, around 5:45 the hospital lost power.  The first time, it was just a surge and came right back on. Then a few minutes later, it went off again and the building went to emergency power only.  That means, one fluorescent light in the room and two wall outlets.  Let me tell you, there is a lot of electronic equipment in this room and choosing what is most essential is a challenge.

In our case, we opted for the IV pump and Shirley's bed (she has an inflatable mattress and within a minute of the outage, it was deflated).  We came up with a plan of attack so that if the outage was extensive, we would rotate the IV pump and two wound vaccuums between the one outlet, as all have a battery that could last for a few hours.

Fortunately, we didn't need to put our contingency planning into play as the power was restored 95 minutes later.

Strange Night

Today was Shirley's normal day for having her wound vac changed. But today, for the first time, the procedure was done bedside.  This made it be a 15-minute procedure instead of a 2+ hour trip to the OR and general anesthesia.  Afterwards, the surgeons said they were happy with how the healing was progressing and that they intend to do another bed-side change on Friday. If all goes according to plan, next Tuesday will be a return trip to the OR as they suture more of the wound closed.

Shirley did a full hour with the Occupational Therapist. The session went well and the OT said she thought from her standpoint she was nearly ready to move to the in-patient rehab center.  I think Shirley is further behind with her physical therapy so we have to work more on that to catch up.  

One nice surprise was that the surgeons removed her feeding tube today.  She is now done to just four tubes remaining (2 wound vacs, gall bladder drain and her PICC IV line). 

Tonight, one of other patients just a couple doors down went into cardiac arrest.  We heard him call out and then heard them announce the Code Blue over the intercom.  Shirley's nurse for the night, Jamie, was also his nurse and had to revive him with the crash cart.  The man survived and has been moved to ICU.  It is amazing to watch the staff respond to an emergency like that. 

April 3 Update

I've had several folks reach out to me and comment that they haven't seen a blog update for awhile.  Perhaps the main reason for no updates is that by the time things settle down, we are interested in watching a movie and we've been using the laptop to catch up on our favorite shows on Xfinity, watch movies on Netflix or rent DVDs from Redbox.  This evening, after catching up on last Sunday's episode of Game of Thrones, I commandeered the laptop to pass along an update.

Yesterday, Shirley paid her bi-weekly visit to the OR to have her wound vac dressing replaced.  The surgeons decided that the healing was sufficient that they sutured up the outer 3 to 4 inches on each side leaving just the center. They indicated that there is still at least one more OR visit on Friday to do the next change, but that if they can suture up another couple inches on each side, future dressing changes can be done in her room.

The sutures have left her very sore, and after going a week or more on just Tylenol for pain control, she is using a little morphine again today to stay comfortable.

Shirley continues her OT and PT.  Today, the occupational therapist took it easy on her since she was in pain.  She used a couple of aerosol cans as weights and had her lifting in various positions to build up arm strength. For her PT session, she went up to the rehap gym again and walked the length of the parallel bars and back twice.  She held on to the bars for balance, but as able to support her weight while standing for several minutes.

People have been asking when Shirley is going to get out of the hospital.  There isn't a good answer at this point.  I've heard phrases such as "in a few weeks," which is vague, but it's the best we have right now.  Bottom line, Shirley isn't sick any more and it all comes down to how fast she can regain her strength and energy.  They say that for every day you don't use your muscles, it takes two to rebuild. She went over two weeks without being able to get out of bed--so that suggests four weeks to get back (with one down).