Funeral Arrangements...

Click here to see my mom's obituary.

Thursday, March 3rd
Viewing & Visitation, 5pm-7pm
Romero Funeral Home
4750 Tejon St
Denver, CO

Friday, March 4th
Funeral Service, 2:30pm
Reception, immediately following service in church hall.
The Sanctuary Downtown
2215 W 30th Ave
Denver, CO 80211

Saturday, March 5th
Viewing & Visitation, 9am-11am
Rosary, 11:00am
Romero Funeral Home
110 Cleveland St
Pueblo, CO 81004

Interment, following Rosary
Roselawn Cemetary
1706 Roselawn Rd
Pueblo, CO 81006

Memorial Dinner, 3:30pm (Please bring your favorite story of mom to share)
Home of Dorie & Isaac Gonzalez
7 Malibu Ct
Pueblo, CO 81005

For those of you who have asked to contribute food, we thank you very much. Please contact the following people to coordinate:
Friday, Denver: Rosita Coca 303-477-7940
Saturday, Pueblo: Gloria Gomez 719-564-0693 or 719-214-7211
*If anyone has folding chairs or chaffing dishes we can borrow in Pueblo, please call Dorie at 719-582-9006.

An obituary will be placed in the Pueblo Chieftan later this week.

Just a quick note to let you know that my family is in the process of making funeral arrangments for my mom. I will post details as soon as they are determined.

Peace be with you momma...

My momma fought long and hard. I think she stayed around to give us a chance to see her laugh, and hug us and kiss us goodbye.

She was 67 years old (11/18/1943).

She was two days shy of celebrating her 41st anniversary with my dad (2/28/1970).

Focusing on LOVING her...

I'd really like to thank everyone for respecting my dad's, my brother's, my sister's, and my desire to spend yesterday alone with my mom.

She continues to be a fighter, which as I have said before, is true to her spirit.

We would also like for you to know that we have not made, and will not be making, any decisions on mom's arrangements at this time. We are thankful to spend what time we have left with her, loving on her.

Thank you,
Tommy

Pray for us...

O Lord, grant that I may meet all that this coming day brings to me with spiritual tranquility. Grant that I may fully surrender myself to Your holy Will.

At every hour of this day, direct and support me in all things. Whatsoever news may reach me in the course of the day, teach me to accept it with a calm soul and the firm conviction that all is subject to Your holy Will.

Direct my thoughts and feelings in all my words and actions. In all unexpected occurrences, do not let me forget that all is sent down from You.

Grant that I may deal straightforwardly and wisely with every member of my family, neither embarrassing nor saddening anyone.

O Lord, grant me the strength to endure the fatigue of the coming day and all the events that take place during it. Direct my will and teach me to pray, to believe, to hope, to be patient, to forgive, and to love.

Amen.

Heart wrenching decision...

Mom stayed sedated through the night yesterday evening and mostly comfortable. There was a point that her blood pressure got low enough that Dr. Solomon was called and ordered a fluid bolus to counteract. It didn't take long until it worked and mom's blood pressure readings came back to normal.

This morning Dr. Soloman came in and told us that mom's sputum lab came back positive for a kind of "super bug" infection. From what I understand, the strain of pneumonia that mom got at Swedish hospital was very resistant to antibiotics. The exception was the one that they chose to treat her with (Zosyn). Eventually, the Zosyn stopped being effective and was discontinued. The lab tests done on this new bug, are showing resistance to all other types of antibiotics that might be available. They are going to try to treat it with Amikacin (a previously used antibiotic), but aren't very confident it will work.

He also thought mom was dehydrated and ordered a fluid drip. By this evening, her lungs were sounding very "junkie" and the respiratory treatment did not seem to be doing the trick. Joseph, her nurse, called Dr. Solomonn and explained the symptons and her input/output stats. He ordered Lasix to help with removal of the extra fluids. She seems to be breathing better in the 3-4 hours since it was administered.

On a very much harder to write note, my brothers and sisters and I talked to my dad about mom's state and about her future care. We all agree that we have done everything we can to give mom a chance to come back to us and we believe that it has come to the time to let her go as peacefully as she possibly can. My mom, true to her spirit, has fought hard and allowed us some precious moments since this journey started back on January 1st. We were blessed to have her back for a short time to "talk" with us (ya ya ya), laugh with us, see joy in her face as she looked upon us, and even care for us, as she fought. I know that I will always cherish those moments.

Friends and family, if you haven't had a chance to say your goodbyes and you would like the opportunity, please stop by Colorado Acute anytime tomorrow (Monday, February 21st).

We - my brothers, my sisters, my dad, and my nieces and my nephews - would like to take some time to share the day privately with my mom as we place her in "Comfort Care" on Tuesday. (Comfort Care is like Hospice Care, except it will continue here at Colorado Acute Hospital instead of transfering her to another location.) The doctors are unable to tell us how long mom will stay with us once this transition has begun.

It doesn't matter how much we know that this is the right thing to do, it's the hardest thing ever. My heart aches more than mere words could ever convey...

We do thank you, for all of your thoughts and prayers...

xox,
Tommy

Removing stressors...

I know I should have posted this much earlier. In a way I didn't want to say anything in fear of jinxing it...

About 11:30pm last night, mom's heart rate went down dramatically to the low 80's. I watched the monitor for a minute and seeing that it didn't bounce up and down as it had been, I asked JJ to keep time on it. Five minutes later, it was still steady at 81-82. Rachel, her night nurse came in and turned off the Diltiazem. Her heart rate maintained and she came in and turned off the Amiodarone. The term they use is that her heart rate "converted" and went back to a normal rythym. It's held through the night and the day.

Treatment has continued. The doctor came in and said that they discontinued the Vancomycin antibiotic since they found out what "bug" she has. He believes it should respond to the Doripenem. She has been put on full support of the ventilator to relieve any extra stressors being placed on her. Throughout the day mom has been given painkillers (Oxycodone, Fentanyl and Ativan) in hopes of letting her recover from the trauma of yesterday. She's been in a highly sedated but restful state through the day.

Thank you God for giving me one more day with my mom.

xox,
Tommy

Annointing of the Sick...

Mom's very early morning (3am-7am) was a little bit rough. She had a fever and her heart rate and respiratory rate were elevated. She was doing better by morning after medication (to treat and for pain) was administered. Her linens were changed and the CNA Naomi layed her on her side about 8:30am. She seemed to really like that and laid there comfortably until the physical therapist came in just before 11:00am.

Her physical therapy session was pretty intense and lasted about 20 minutes. She did better than yesterday in the way that she opened her eyes pretty wide and even held her head up a bit. She seemed to focus on dad and look in the direction of where he was standing. For some reason, her physical therapist had shut off the monitor which also shut off the feed to the main desk. When we put the monitor back on, her heart rate was elevated up to the 170's (normal range is about 60-100). An EKG was ordered and confirmed that she was having an episode of atrial fibrillation (afib).

She has been given a series of medications to treat her high heart rate.

• Metoprolol first, with no positive results.
• Diltiazem next, with no positive results and rate going up to the 180's.
• Then Amiodarone. This drug is administered in a different manner. First, they did what's called a "bolus" (which is a faster way to get the medication) over the first hour. For the next six hours it was administered via IV at a slower rate. And the next 18 hours at an even slower rate. By 6:30pm, it also had no positive results.

Dr. Waddell consulted with Dr. Solomon and added Diltiazem (again) to the administration order in addition to Ativan. This is where she currently is at. Her heart rate has come down to the 110 to 130's. Not where we want it to be, but closer. Her nurse has been asked to make sure her blood pressure does not get too low. If it does, they will treat with fluids. So far, it's been okay. She also has a fever of 100.9 which is being treated with Tylenol.

At the same time, she is being administered pain medication to make her as comfortable as possible.

We had another meeting with Dr. Waddell this evening and have made a decision to place mom on a "Limited DNR" order at this time, which means they will continue to treat her, but should her heart give out, we will not ask the medical team to try to resuscitate her electronically or with compressions.

Father Daniel Cardo came in this evening to administer the Annointing of the Sick (I'm sorry if that's not the correct terminology - I didn't even know that they no longer give last rights). We think it's what she would have wanted.

Dad especially wanted me to ask and thank you for your prayers.

xox,
Tommy

Family Meeting...

Before we had the family meeting, Dr. Solomon came in and told us that they had results of the CT scan from yesterday.  Mom has had at least two more strokes - this time on the right side of her brain.  He said specifically in the right middle area and the right posterior area.  This can be part of the reason that mom is not waking up and responding as we would hope for her to.  That being said, she did open her eyes a couple of times last night and today. 

He thinks that bloodclots caused by the cancer thickening her blood are the cause of the strokes.  The thing is, they can't really treat her anymore for this because she is already receiving the maximum dosage of blood thinnner that is safe for her to take.  He mentioned that they could send her to Saint Anthony's for an MRI to better determine the exact source, but even with that he doesn't believe there is any alternative treatment.

They have taken her off the last antibiotic she was on called Zosyn and have ordered a couple of new ones, Doripenem and Vancomycin, intended to treat a new infection as well as her pneumonia.

They also have weaned her completely off of the ventilator and she is using what is called a "trache-collar" to offer oxygen support.  So far, she's doing well on it.

The family meeting was held with Dr. Solomon, Dr. Waddell, our Patient Advocate, a nurse and a respiratory therapist.  Basically, Dr. Solomon said that they really have done everything that they can do for mom, he doesn't think she will ever get to the point of being able to leave the hospital, and the chances of her getting any better than she is right now are very low.  There's no guarantee either way, but he offered up the decision for us to choose if and when we might want to put mom in a "Comfort Care" facility or a Hospice center.  The choice is either to treat her "aggressively" or just try to make her comfortable.

We have decided, for right now, to continue to treat mom.  Aggressive is a bit of a reach as they are unable to do any surgeries and won't transfer her even for the MRI, knowing that it won't change the current course of treatment.  They will, however, continue to administer antibiotics and pain medication.

We are very hopeful that we'll have some more time with mom, but we just don't know how long that will be.  We understand that some of you might want to visit and want to let you know that she is in the ICU ward at Colorado Acute. If you come, please go to the 2nd floor and come into the Family Waiting room first before you head to her room. 

Thanks for all of your thoughts, love and prayers.

xox,
Tommy

Pardon my language... Again.

Nothing much new yesterday except that mom had her last dose of Amikacin (which we expected) and she was taken off one of the anti-seizure medications called Dilantin. She had some Physical Therapy where Jeff and Garth came in and moved her legs and arms. And she still had a low grade fever through the day. Dr. Solomon mentioned that he might take her for a brain xray if she didn't respond by opening her eyes in the next couple of days.

Today...

Dr. Solomon (Pulmologist) came in again and said that he would be ordering a lot of labs (blood, urine, fecal and sputum) and also a CT scan to see if they can figure out the source of her fevers. The most common source would be an infection (and her white blood counts are up which kind of goes with that). However, they've been treating her with so many antibiotics for so long, it's hard to tell. He mentioned that he would hope that it's a stomach type issue rather than something more serious like bleeding in her brain or meningitis, and I just kind of had to catch my breath. It's hard to know all the things it could be and it's even harder to think about them once they mention it. (He did say that it was an extremely low chance of meningitis and that she was not showing other common symptoms of it). Another source would be blood clots (and he mentioned she had one in her arm). The third source, cancer. Have you ever heard of a cancer fever? I've heard the term quite a bit lately and I don't like it.

When he mentioned the blood clot, I asked him if he was talking about the superficial clot they had found back when she was still at Swedish (because that was the third time I had heard it referred to in the couple of days). He double checked and said that this was not a superficial clot, it was a new one that was found on the 12th. The cause is likely the PICC line (one of them told me it was common) and it's being treated. He didn't seem overly concerned about that, although that hasn't given me much comfort.

Lastly, he said he would like to have a family meeting within the next couple of days to get on the same page with all the docs and to discuss the next steps. I've had a hard time catching my breath over that one too...

Dr. Waddell (Hospitalist) talked to us, basically echoing what Dr. Solomon had said - except while he said he might put her on a broader antibiotic, she said she would like to take mom off of the rest of the antibiotics she's currently taking and try to see how that goes. Reasons given are that antibiotics can lose their effectiveness when given for such a long period of time and that they can cause false results on lab tests. I asked how this would affect her pneumonia (the last antibiotic she is on was ordered for that) and she said it might be that her pneumonia is not as bad as they think. What??

Dr. Yarnell (Neurologist) - is an ass. I'm glad he's supposed to be so great and amazing and a genius and all that, but he has the worst bedside manner. No people skills. And, he's never done anything more than come and look at my mom, ask us and the nurses questions, to which he never seems to listen to the answer of, and then say "She had a seizure" or today "I think you've done all you can". Serioulsy? WTF!!!!

I just looked at him and I bet I looked angry, because at least this time he asked me if I had any questions. And I said "Yes. My question is why do her other doctors say that it can take a couple of days for the Propofol to wear off. And, they've also said it's good that she is moving and showing in expression when she feels pain, and at least twitches her eyes when we talk to her?" And then he says "Well, she is moving both of her legs and her left arm. And she is doing good on CPAP. The first thing we need to do is get her off the vent." Then I asked him about Dr. Solomon mentioning ordering a brain scan to check for bleeding and he says "I don't know anything about that." Well, can you find it the fuck out please?!?! I mean, I may be wrong, but he's neurology. Shouldn't he be checking on her brain!!!

<<<Sigh>>> Sorry about that. I've been dreading writing this because I just don't know how to say what I've heard, what's going on, and to separate it from how I feel - because I'm pretty pissed off. And I'm scared too...

The thing is, I don't need false hope. If the doctor told me that there was no way she was coming back to us... No chance of recognition... Then I would process that. It would be the hardest thing in the world, but I would. BUT THEY HAVEN'T SAID THAT! They've been giving us hope and saying it could go either way, but one of those potential ways is her getting better. And if there is any chance for her to get better, we all (dad and brothers & sisters) agree that that is what she would want. What she would fight for.

Anyway, just a little bit after that, Jeff, one of her Physical Therapists came in and he asked me how I was doing. But he didn't ask it in a way where I could just say "I'm okay" and I don't know if I would have anyway. I said "I'm kind of frustrated" and I mentioned my meeting with Dr. Yarnell.

Wow. Jeff was amazing. (And I should say, he is not the first to understand my frustration at the lack of Dr. Yarnell's manner.) He talked about working with stroke patients and having seen them come back from places as bad or worse than where my mom is right now. He talked to me while I helped him with her therapy and he sat her on the side of her bed. As he held her up from the back, he asked me to sit on a chair right in front of her and talk to her. She opened her eyes. Now mom's eyes are not in the best shape and they've been closed for a long time, so they're swollen. It was more of a squint, but they were open and he said - "Now, if Dr. Yarnell would have done something like this, he could have seen. She needs stimulation." He was so caring and talked to me about real-scenarios and gave me hope.

Well, I didn't hear when the meeting will be but I suspect probably tomorrow. I'm guessing some labs will come back too.

Please pray for my mom.

Thank you!
xox,
Tommy

Let the weaning begin...

4:30am - Temp 99.0.

8:00am - Temp 101.6.

About 8:15 this morning, Karen (her respiratory therapist) put her on CPAP (continuous positive airway pressure) of 15. This is a weaning as she had been on "full" support for a while.

At 8:45, Ashley (her nurse) turned of mom's IV drip of Propofol. We don't know how long it will take for this heavy sedation to wear off, but have noticed that she is moving a bit more. Her arms and legs hardly stay still as a matter of fact.

A few times it looked like she might be trying to open her eyes, but that might just be wishful thinking. Being sedated and on the ventilator for this period of time has had affected her eyes - to me - quite a bit. Her left eye has badly broken blood vessels (we'll told that they will heal over time) and her right eye looks swollen and perhaps infected. A new antibiotic called Gentamicin was adminstered a few hours ago to treat that.

9:05am - Ashley stopped Amikacin, an antibiotic which they started administering on Tuesday, February 8th. It's a pretty serious drug and they take blood labs every so often to check levels. Mom's levels were high this morning, so the pharmacists will work with the Infectious Disease doctors to come up with a new dosage. From what I've found, this is a short-term drug and would not be administered for more than 7-10 days, and she's at the 7 day mark today.

9:45am - Karen reduced CPAP to 12. Mom is doing well respiratory wise.

At about 10:15am, a Physical Therapist came in to work with mom. He sat her up in her bed and tried to get her to open her eyes. He did some excercises with her arms, stretching them out and then reaching up to her nose, ears and head. That lasted about 10-15 minutes and he said he would come back tomorrow. I can't wait to see her be more responsive, or at least, a little bit alert. Her vitals all stayed good through the session.

10:35am Temp - 100.7.

So, it's noon now and she seems to be doing okay. She's wiggley, but her face doesn't seem to be showing an "in pain" grimmace. We're keeping a close eye though.

Lab results for the fluid taken from the side of her lung yesterday will be back in waves, some possibly today or tomorrow and some, not until closer to the end of the week. I'll let you know when we hear anything.

Take care & xox,
Tommy

Fluid in the lining...

Did I mention that mom had a CT scan yesterday? The results from the X-ray were apparently inconclusive so Dr. Vocal ordered the scan. He came in a couple of hours ago and gave us some information about what the results can mean for mom.

Firstly, there is a fluid build-up. However, the scan doesn't show exactly what the cause is.

Possibilities follow;

1) Extra Fluids: Fluids may be draining slower than it would normally take because of excess fluid intake. If this is the case (and we want this to be the case), she will possibly be given Lasix to help remove the fluids and the remainder should drain or absorb eventually.

2) Infection: There's a chance that infection has spread to the lining. If so, he has told us that the response would be to insert a chest tube. He could insert a large chest tube here at Colorado Acute or she would be transferred to Saint Anthonys for a small chest tubes. There are pros and cons to either option. And although he acknowledges that the large tube would be painful, he seems to be leaning towards that one for a recommendation. They would use this tube to drain the fluid causing the infection.

3) Metastasis: It's possible that the cancer has spread to the lining. He is especially concerned about this because after reviewing the scans from Swedish and comparing them to the scan from yesterday, he noted dramatic growth. If this fluid is caused by cancer, it will limit the options available to apply to this root cause. It could be that we would only be able to try to make her as comfortable as possible and continue to use ibuprofen to treat the "cancer" fever (has to do with swelling). We would continue to try to wean her off of the vent and pull her out of her coma-like sedation in order to do as much to help her recover from the stroke and be able to continue on with her therapy as much as she is able to handle.

Right now they are preparing to do a procedure called thoracentesis on her to collect some of the fluid to determine which situation is her's.

Thoracentesis

Thoracentesis

To remove fluid for laboratory analysis, your doctor may suggest a procedure called thoracentesis. In this procedure, your doctor first injects a local anesthetic, then inserts a needle through your chest wall between your ribs to remove fluid. In addition, a sample of tissue (pleural biopsy) for microscopic analysis may be obtained if your doctor is concerned that the fluid collection may be caused by tuberculosis or cancer. If only a small amount of fluid is present, your doctor may insert the needle with the help of ultrasound guidance over the site of the fluid.

Tracheostomy and fevers...

Mom had a temp through the day yesterday, which they said may be attributed to the seizure (neuro) but not sure. They started her on a new medication called Metropolo, to treat high blood pressure as well.

Early this morning - 5:45am - the transport team came in to prep her for the move to Saint Anthony's. It's only a couple of blocks away, so leaving Colorado Acute at about 6:15am got us there about 6:30am. She was prepped for the procedure and given some more medication to calm her and for blood pressure and heart rate. Surgery was scheduled and performed at 8:30am.

At about 9:30am Dr. Beck (her surgeon) came out and told us that everything went well. She was moved back to Colorado Acute at 11:15am. She is resting now, but has a fever of 103.2. Dr. Vocal says that it could be a couple of things, but is concerned that it might be a fluid buildup in a lining on the side of her lungs. An xray has been ordered to see if this is the case. If it is an infection, the fluid would need to be removed via a needle that would be stuck through her side. Another possibility is that her tumor has metastasized and is causing a blockage that is not allowing the fluid to drain. If this is the case, then that would mean that her cancer is Stage IV (right now it's IIIb). Nothing about that would be good. As far as we have been told, not only is mom not a surgical candidate - it's my understanding that they wouldn't even treat her. She's just not strong enough to take any kind of chemo or radiation type therapy.

Please pray that the fevers stop and that if they find the source of them, it's something or somewhere that they can treat.

Right now I can't help but be thankful that she finally got the tracheostomy. Thank God.

xox,
Tommy

Tracheostomy scheduled...

Mom is still in stable condition.  Her respiratory therapists are a bit concerned about the possibility of her having too much fluid in her system again.  They will talk to her Pulmologist today.

 

The tracheostomy has been scheduled for tomorrow at Saint Anthony's.  She'll be transported over there at 5:45 in the morning and it's expected that she will be able to come back to Colorado Acute Hospital by the evening.

F this "bug"!

Yesterday morning...  Because of mom's level of discomfort and pain, Dr. Lyn-Kew has taken her off of the Versed and Fentanyl and put her on a new drug called Propoflo.  It put her in a semi-concious sedation while they tried to figure out what was causing her agitation.  He believes it was too much fluid in her body causing what I am pretty sure he called a pulmonary edema (non-cardiac?).  They have treated her with lasix (as they did before) to remove the extra fluid and it seemes to be helping as her breathing has become much less labored.

Yesterday evening...  Dr. Lyn-Kew asked the nurse to start a gradual decrease on the dosage drip of the Propoflo.  He would like to be able to pull her out of the sedation enough to respond, but not so much that she is in pain.  By the time I left last night, she was moving her arms and legs, but not responding much more than that.

He also talked about the "bug" mom has which I gather from our conversations is her pneumonia.  We're told it's a strain that is very resistant to antibiotics, with the exception of the one that they happen to be giving to mom at this time.  There has been some improvement in the pneumonia looking at the last couple of xrays, but Dr. Lyn-Kew stressed that it could reverse or change at any time.  He talked to us about this in case there is a time when we would need to look at an alternative.  It turns out that what might be available are a couple of very old treatments that also happen to be quite toxic.  As a precaution, he is going to start a conversation about mom's case and condition with the Infectious Disease (ID) doctors so that if we get to that point, we have a plan in place.

(By the way, if you visit - she is under somewhat of a quarantine room.  It is important for the safety of the other patients in ICU who have weakened defenses that you wash and santize your hands when you come in and leave her room.  And also just a warning that the nurses will put on gowns each time they come in, so it doesn't freak anyone out.)

We asked Dr. Lyn-Kew if we could solicit other hospitals in the area for the tracheostomy.  He said her levels are at a point where he could recommend her for the surgery and we don't want her to fall out of that.  Since we've asked for the tracheostomy, they have only been working with Saint Anthony's to schedule it and it just doesn't seem to be moving along. He promised that he would call on someone at Swedish and if that didn't work out, move on to Rose Medical Center.  Both are capable of performing the procedure.  Hoping and praying to hear things move along quickly regarding this.

They also took blood labs from mom (they are always taking blood labs) and the results came back with low blood counts.  Ashley, her nurse (love her), said that it could be that her blood was diluted due to the extra fluids she recieved on Sunday.  However, it might also mean that she will need a blood transfusion.  She had said that the results from that lab would come back quickly, but as of this morning, dad had still not heard anything or been asked to sign a consent.

This morning...  Dad said that she had a pretty good night.  They stopped lowering the dosage on the Propoflo at shift change (7pm) and she stayed about the same as she had been when I left - that is moving, but not in pain and not alert.  Dad said he even got some rest and was happy that although mom wasn't in "need" of the kind of attention she's needed the past week through the night - her nurse still came in and did everything to make her comfortable.  Changing her sheets, cleaning her up and rubbing lotion on her back - just because.

Again, if you could please send out good thoughts and prayers about getting her tracheostomy as soon as possible, that would be great.

xox,
Tommy

Propofol

Propofol

 

General anesthetics normally are used to produce loss of consciousness before and during surgery. However, for obstetrics (labor and delivery) or certain minor procedures, an anesthetic may be given in small amounts to relieve anxiety or pain without causing unconsciousness. Some of the anesthetics may be used for certain procedures in a medical doctor's or dentist's office.

Propofol is used sometimes in patients in intensive care units in hospitals to cause unconsciousness. This may allow the patients to withstand the stress of being in the intensive care unit and help the patients cooperate when a machine must be used to assist with breathing. However, propofol should not be used in children in intensive care units.

X-Ray Results...

Mario and I stayed with mom last night, although I slept the whole night. He said she rested and was given pain medication when needed. The results of the xray showed that the intubation tube was placed correctly and there were no changes from the last one - meaning she did not aspirate that they could see. Thank God.

Re-Intubation...

I could use a Valium about now...

Another rough night starting about 3am. Mom was in an obvious discomfort and looked as if she was in a lot of pain. At 4:15am she had a fever of 100.6. At 5:35am, it was 101.9 with an elevated heart rate and blood pressure. She was administered extra Fentanyl, Cardizen and Tylenol and eventually settled down, albeit hours later.

Mom's day nurse from yesterday was back and I was, and am still, so thankful. He paid such close attention to her, checked on her constantly, pro-actively monitored and treated her for pain and just in general was amazing.

I left for a short time just before his shift ended at 7pm. When I got back from dinner at about 8pm, her night nurse was just coming in to change her. When he rolled her to her side, her intubation tube came out. All hell broke loose about then and I am not going to lie, I was scared. The respiratory therapist came in and "bagged" mom while she ordered an emergency intubation kit and called for the doctor. He had already left for the evening and she simply said "Get him back here. Now." A scene right out of ER errupted right in front of me as the room was filled with people. Joseph (her day nurse) came in too - already changed and with his jacket on ready to walk out the door, he quickly got right into the mix and started helping.

We waited in the hall while they worked on mom. Joseph came out with an update telling us that the tube had come out and they would have to re-intubate her. He assured us that she would be okay. An hour later, Dr. Patel (the day hospitalist) and the night doctor, came out and let us know that the re-intubation had been completed and that it appeared to have gone ok. Mom's vital stats stayed steady throughout the procedure. They've taken an xray to check that placement is correct and should be able to tell if she aspirated as well. Not sure when those results will come back but we were told it would be sometime tonight.

She was heavily sedated for the procedure with Versed, Fentanyl and Succinylcholine and appears to be resting okay. We're definitely keeping an eye on her.

As always, your thoughts and prayers are appreciated.

xox,
Tommy

Temp 104.7

Mom was uncomfortable yesterday evening when her night shift nurse came in (about 7pm). Mario was staying with her as my dad went home for the evening and he had been trying to get her some pain medication for a while. He was told by the day nurse that they would alternately be administering Versed and Fentanyl every half hour. At 8:10, she got her first doses. About 8:30 two nurses came in to set up a Fentanyl drip so that they wouldn't risk missing a manual administration of the prescribed dosage.

At 9:00pm the drip was just finishing being set up, when Mario asked the nurse if she knew what mom's temperature was because she felt hot. She didn't know so she started to take a reading and before the thermometer was done, she confirmed that she did have a temperature and then left the room to get a doctor. Her temperature was 104.5.

Five minutes later Dr. Patel, the hospitalist, came in and checked her stomach. He said it was not acute. He was concerned of a distended abdomen. He told Mario that if there was a perforation it might cause her stomach to harden and swell. If this happens, Dr. Patel says that they probably will not be able to treat it as she is not likely to be a surgical candidate.

At 9:15pm her temp was 104.7. They iced mom up pretty good - ice bags under her neck, arms and legs and treated her with Tylenol, Ibuprofen and Vancomycin. At 11:20pm her temperature was 99.6. The nurse said she had never seen a temp go down so quickly.

Blood labs were drawn and showed that her white count was up. Dr. Patel said that it was good that they had already ordered and administered antibiotic to treat.

At about 4:40am, mom's blood pressure started getting low and her temp was at 96 so they turned off the Fentanyl drip. There's a fear that in such a sedated state, mom's brain might not be allowing her to "take care of herself". After that it seemed to be okay as she rested well through the rest of the night and most of the morning before needing another dose. (At 5pm this evening, the drip was put back on and they will be monitoring it closely. )

At 7:30am, her heart rate went crazy. It got up to 155 and they acted fast to get that under control by administering Lopressor and Cardizen. At 10:50am it stabilized and has been okay since then. Likewise with her blood pressure.

It's been a whirlwind of medications today and I will have to look them up to get it straight in my head. They kept a really good eye on her and I think she rested well. It's hard to know since she is unable to communicate with us at all. It's very hard to see her like this, but I am faithful and hopeful that the tracheostomy will happen next week and put her on a road to recovery. Please pray for this.

xox,
Tommy

Intubation... (is that how you spell it?)

The EEG trip took just over an hour and there were no issues going and coming back from Saint Anthonys. We still haven't got the results, and are hoping that what we have learned is true - No news, is good news.

Yesterday she was started on another anti-seizure medication called Dilantin in addition to the one that they started her on on Wednesday (Keppra). I'm not sure what has done what, but she doesn't appear to be tensing up with her brows furrowed nearly as much. Dad said she rested through the day and got by okay with Percocet. She does wince and get fidgety, but it's not as constant as it was before. Her face was more relaxed (her lips were not pursed together like they had been) and she seemed to get some rest through the night.

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Just talked to Dr. Vocal (Pulmologist). He is recomending that we intubate my mom to reduce the risk of her getting another case of pneumonia. In her current state, she non-responsive and the fear is that she will aspirate on the mucus that she does manage to cough up. This will put her on a ventilator and in a medicated coma. We are hoping that this will help to speed up the scheduling of her tracheostomy, which we have been waiting for.

This is not considered an emergency procedure - as in placing her on life support with no other options. She has been breathing on her own (although with a nasal cannula to offer supplemental oxygen) - and we were asked by the doctor if we wanted to go through with this recommendation. We feel like pneumonia is a huge risk and has been one of the main things to bring her down, again and again and because of that, we wanted to do the elective tracheostomy in the first place.

Once more, I don't know if this even makes sense... I'm trying to wrap my head around it and am praying that we are making the best decisions for my mom.

Please pray that we are...

xox,
Tommy

Restless night...

After the Ativan wore off last night, mom started getting fidgety again.  The Percocet helped for a short time, but did not last the whole four hours between does.  She was given Dilaudid as well, but I don't see that having a great effect on her either.  Her night was quite restless, spent tossing and turning and moaning in what looked like pain to me. 

I left at 6:15 this morning as she was just about to get another dose of Percocet.  I talked to my dad at just after 8am and he said that it had seemed to calm her down and allow her to rest.  They were getting her prepped to transport to Saint Anthony's so that they could perform an EEG on her.

EEG (electroencephalogram)

An electroencephalogram (EEG) is a painless procedure that uses small, flat metal discs (electrodes) attached to your scalp to detect electrical activity in your brain. Your brain cells communicate via electrical impulses and are active all the time, even when you're asleep. This activity shows up as wavy lines on an EEG recording.

An EEG is one of the main diagnostic tests for epilepsy. An EEG may also play a role in diagnosing other brain disorders.

 

To read more about EEG's, click here.

Seizure...

Here I am again, not knowing where to even begin. My face hurts from crying... yet I know that things could be far worse and I have faith and hope that they will get better.

Mom had such a great day yesterday and I was so happy that it was a "snow day" at school which allowed me to spend time with her - seeing her do so well. It's hard to believe how quickly things can turn around.

Early this morning I talked to dad and he said she walked all the way around the ICU ward (more than twice as far as yesterday) without stopping for a break.

Today was a good friend of our families funeral. Manuel, who my dad worked with at RTD, passed away last week from Stage IV liver cancer. Mario made arrangements to come and stay with my mom so my dad would be able to attend the services.

I called Mario at 11:45 this morning to see how she was doing and he said good. She was sitting in her chair, dozing in and out while listening to the radio.

About 11:30, the nurse had come in and said that they might move her back up to the 3rd floor (non-ICU unit).

They had just taken her vitals at 11:40 and everything was good;
Temp 97.6, BP 132/60, Oxygen 97 & Heart Rate 79.

After our phone call, Mario said he noticed her dozing and told her "Mom. Wake up! You're missing the story!" and she looked at him and laughed, then dozed off again.

At 11:50 she suddenly woke up groaning and lifted both arms at the same time in a locked position in front of her. When he called to her and tried to get her attention, she lulled her head to the left but didn't focus or respond to him. He called for help.

The doctor came in with more staff and took her down for a CT scan. They had told Mario it could be another stroke, the same stroke, a hemorrhage, an infection or a seizure.

When I got to the hospital, she was lying in a non-responsive state with her lips pursed shut (very strange because we usually can't get her to close her mouth when we want her to breathe through her nose). The respiratory team was suctioning mucus through her nose.

The results of her CT showed no acute bleeding - although we were told this might not be seen for 6-7 hours. The neurologist came in and when he examined her, she finally responded. She raised her arms and moved her feet when he asked and she even seemed to open her eyes. He believes that she had a seizure which is apparently a common result of bleeding in the brain from a stroke. They have started her on a seizure medication called Kepra.

The best she came out if it was when she saw Mateo and Sophia and reached over to hug them. It was a brief glimpse of mom. Soon after, she seemed to be in pain and received her pain meds. It looked like they offered her some comfort in a less tense sleep.

About 6pm she started getting fidgety and making more groaning sounds. Her breathing sounded horrible. Her nurse said it was similar to her fit this morning. Respiratory did another nasal drain and she got more pain killers along with some Ativan. She is resting in a comfortable - or at least less tense although completely "out of it" kind of way. I can only hope and pray that this is what she needs. It's hard to imagine how much this day has taken out of her.

My apologies if this doesn't make a lot of sense. I'm writing this out on my phone with bloodshot eyes and a pounding headache.

Please pray for her.

xox,
Tommy

Spa Day...

It was a good day for mom. She walked almost twice as far this morning as she has this whole month - about 225 feet down the ICU hallway. She was doing well enough to be able to take a shower too. Although it wore her out, she was very relaxed when she got back into bed.

Her oxygen levels are doing better as well, and she is back on 4 liters. She is continuing to take Lasix to remove the extra fluids from her body and the reduction in swelling is really apparent. They have also ordered a new medication for the purpose of keeping her heart rate and blood pressure in check. All of this should reduce the risk of complications with the tracheostomy.

It was great to see her alert and even laughing today.

Hopeful for a good night's sleep and continued improvement of her condition.

xox,
Tommy