During the previous hospital stay, the path to get out and get home was fairly straight forward: ICU; then to a general medical floor; then once Shirley could tolerate two hours of physical therapy a day, off to the Rehab unit. And on the Rehab floors, specific goals were agreed upon and once achieved, out the door you go.
This time around, the path is much less clear. The extended stay in ICU, coupled with the trach has provided some forks in the road ahead that we had not previously known about. Talk yesterday started to include the potential of a stay in an LTAC. That stands for Long Term Acute Care facility. It's the type of facility that can support a patient that has a trachea tube and may be on and off a ventilator. So if Shirley is cured of whatever is causing her white blood count to continue to run high, but she still has the potential need to go back on a ventilator, then an LTAC may be a stop on the way to home.
I've tried to be care and use words like "may" and "potential" because if she gains enough strength and the fears that she may need to revert to the ventilator pass, then the LTAC is removed from the equation.
Adding to this potential is the fact that this morning Shirley was struggling with her breathing and they put her back on the vent. She had been off it since Friday morning and had spent nearly 24 hours on room air. Fortunately, the trach makes going and and coming off the vent a simple process and my guess is that tomorrow morning they will at least test her ability to breath on her own again.
I spoke at length today with the Transplant docs about this and they are not concerned about the this. They say it is very common during this phase of recovery for a person to need a "day off" from having to breath on their own. In Shirley's case, they suspect that fluid build-up attributable to her kidneys not working at full capacity is at issue. It sounds like they are going to continue to use dialysis on a daily basis. Every other day, it will be for cleansing her blood of toxins and every day, it will be to remove fluid. They reminded me that lung transplant patients no longer have connections to the lymphatic system into their lungs. These connections help the rest of us remove fluid from our lungs. For lung transplant patients, the only way to remove fluid is through blood flow. And without kidneys, the fluid can build up making it more difficult to breath.
Shirley's hematocrit level fell for no apparent reason today. They gave her a unit of packed red cells to bring it up and will be watching it for the next day or so to see if it stays in the normal range.
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