Procedure to remove stone

Hello!  Phillip and I were able to visit with Oma today in her rehab facility.  She looked great.   She was excited to see us and told us all about how she is doing missionary work to the workers at the facility.  She has found some "golden people" to share the gospel with.  She is working hard with the physical therapists who say that she is their oldest and most obedient patient there.  Oma said that she walked a block and a half with the therapists. 
Tomorrow Oma will be going to LDS hospital early in the morning for a same day procedure called Lithotripsy.  The procedure will take about 4-5 hrs and Oma will be back in her rehab facility by late afternoon.  Extracorporeal shock wave lithotripsy (ESWL) is a non invasive treatment to remove kidney stones.  Oma will not have any incisions made,  pulsing shock waves will be aimed at the stone and will break it down into smaller pieces which can then pass through the ureters into the bladder and out the urethra (see earlier post for picture of anatomy).

Phillip and Klint gave Oma a blessing tonight and she seems in very good spirits and has a positive attitude.  Keep her in your thoughts and prayers.  Let me know if you have any questions.

Thursday

On Wednesday Oma was able to leave the Hospital!!!  She was given a blood transfusion prior to leaving since her platelets were still low and the doctors are hoping to be able to do surgery in a couple of weeks to remove the kidney stone.  She still has the nephrostomy tube in and will continue to have it until her surgery.  She was moved to Legacy House Assited Living and rehab, it is located on 3200 West and about 5400 South.  Her room is 114 and it is in the farthest North building of the complex, right behind the tire store.

We tried to visit Oma today and she was sound asleep when we got there, she didn't even wake up when we knocked on the door and said her name so we just let her continue to rest.  The nurse said she'd worked with physical therapy this morning and they helped her shower and she has been sleeping a lot.  If you need to call her the room number is 801-613-4648.  I'll keep updating this blog as things happen but probably not on an everyday basis for at least the next little while.  If anyone has any stories or pictures they want me to post just let me know and I'll be happy to do it!

Tuesday

Oma was in great spirits today.  When I arrived at the hospital she was up walking with physical therapy and looked great.  She is still weak but was able to go down to the window and back to her room using her walker and she only stopped once to rest.  Her nephrostomy tube is draining a light clear yellow fluid now  and the plan is for Oma to keep it in when she discharges from the hospital and follow up with a Urologist in a couple of weeks to determine what to do from there.  She was able to have all of her antibiotics switch from IV medications to oral pills. 

Oma's platelet count is very low, about 1/10 of what it should be.  Platelets are responsible for helping the blood clot so Oma is bleeding very easily right now.  The oxygen in her nose caused a nose bleed.  The doctors stopped her aspirin at this time because it can further thin her blood.  Her platelets did improve some today so they are moving in the right direction.  Oma's oxygen levels are improving, when she is awake she doesn't need to wear any but when she sleeps she still needs to wear it.

 Jonathan and Heidi were visiting while I was there.  Oma was talking about how much missionary work she has been able to do in the hospital and Jonathan teased her that this was all part of her master plan to get out of the house and meet more people to bring into the gospel.  Oma said she was having the time of her life.  Really, she said that, what a great attitude!

The plan is as long as Oma is medically stable tomorrow she will be able to discharge to Legacy house.  They are only a 40 patient facility and Oma got the last room there, yay! 

I was pretty happy Oma would let me take pictures today, she wouldn't let me any other visits but she says with a smile that  she doesn't have any pride anymore after living without her wig for so long and was happy to let me take as many pictures as I wanted.  Here are her "battle wound arms"  The left one is a bit swollen, one of her IV's infiltrated and the fluid that should have stayed in her blood stream leaked into her subcutaneous tissue, or fat tissue.  It should heal soon though, warm blankets and time do wonders for infiltated IV's. 

The nurses just love Oma.  She had her wig with it's head shaped stand at the hospital, her nurses figured out a way to make it look like someone was sitting in the chair using the wig and stand.  Here is her nurse comforting the "patient".   Remember, there isn't anyone actually there, pretty good huh?  The staff thought this was the funnies thing ever and tried to see how many other staff members they could trick.  They have big plans for the doctors tomorrow...

Monday

I wasn't able to visit with Oma myself today but my sweetheart did and he took great notes for me to write today's blog update!  Oma was able to have her foley catheter taken out today- this is the one that leads to the bladder and makes it so that she doesn't have to get up to go to the bathroom. ( I won't post a picture of that one, haha). It's great that they were able to take it out today since this is also the day that she started working with therapy so she is able to get up and out of bed.  Oma said she started exercising today and went for a small walk in the hospital with a therapist.  She is still wearing a little bit of oxygen which is causing her poor nose to dry out and bleed but hopefully she won't need it too much longer.

Oma still has her nephrostomy tube in and it is draining well.  At this point the doctors haven't said when they think it will come out but Oma said today that she won't be needing another surgery at this time.  Her heart rate and blood pressure are both very stable and she hadn't had any fever today. 

Oma is doing so well, in fact, that they are already starting to make plans for her when she discharges.  She will be going to a rehab facility when she first leaves the hospital but plans for further in the future are still up in the air.  Right now it looks like she might go to Legacy House which is located in Taylorsville on about 5400 S 3200 W.  It's possible she could discharge as early as tomorrow.  Oma is starting to loose her voice and is still very tired but she loves seeing all of her family. 

The nurse gave Oma a big hug at the end of the shift today before leaving, I'm pretty sure Oma has tried adopting half of the staff as her honorary grandchildren.  I keep thinking about how if all my patients were like her I'd never feel the need to leave the hospital.  She even had her hair brought in today and now she's all dolled up.  I think her favorite part of today was when Rosanne brought her some dental floss, it made her far more happy than floss has ever made me :)  Keep up the good thoughts, prayers, and love going her way, they have obviously made a difference in helping with Oma's recovery.

Sunday

We visited with Oma today and she had just been transferred from the ICU to the 8th floor. She is now in room T832, or room 32. We were able to speak with the ICU nurse at that time and he said Oma had done well and that she was producing urine better. Her kidney labs are still high but stable. She still has the nephrostomy tube in but it is draining a lighter brown color fluid now instead of the blood it was draining previously which is good.

The nurses are working on weaning Oma off of the oxygen and she is so far doing well. Her heart rate is in a normal rhythm and her blood pressure is stable, actually a bit high today at 160/80 but the Dr's would rather have it high than low right now. Oma had a ultra sound of her heart on Friday and the nurse said everything looked good on it. Her ejection fraction was 55% which means her heart is strong enough to pump the right percentage of blood in the ventricle every time it beats. Normal is 55-65%.

Oma's mental status is doing better and she visited well with us. She was very tired though and fell asleep quickly when we were talking to the staff. The nurse thought she would probably start working with physical therapy tomorrow. Oma is eating a regular diet now and is happy about that since she says they didn't let her eat the first two days.

Everyone in the hospital just loves her and they are taking good care of her. I shouldn't be so surprised any more at how tough Oma is but every time we see her I am amazed. People who are half her age usually don't do as well as she has with what she went through. Her battle isn't over yet but she is one tough warrior! Oma said she is grateful for all the love, prayers, and support she has received.

Saturday

We visited Oma Saturday afternoon and she seemed to be doing much better.  They were able to take her off of the Levophed early in the morning.  Her blood pressure was still on the low side, about 90/50 but both Oma and the Dr's think that's probably her normal blood pressure and she's ok to stay there.  The nurse said that they also think Oma has some some inflammation of her Gallbladder and probably gall stones but that it probably isn't related to the infection and not necessary to treat at this time.  They will continue to monitor it and do something if neccesary.

Oma was breathing easier and was only on 2L of oxygen instead of the 5L she was on the day before.  She was also producing urine better and her BUN and Creatinine (the kidney blood labs) were both stable.  Her heart rythm remained normal and she was taking the Amiodarone (the medication to help make her heart rythm normal) as an oral pill instead of through her IV. 

For now the nephrostomy tube will stay in while they keep monitoring her kidney functions and labs.  The kidney stone is too large for her to pass on her own.  They only ways to get rid of it is to either break it up with ultrasonic waves and let her pass them on her own (still traumatic as the small pieces are painful to pass down the Ureters and through the Urethra) or to have a sugery where they will make a small incision and remove the stone.  Oma is not quite medically stable enough to tolerate either of those right now so they will just leave the tube in at this time. 

I'm pretty sure Oma has been doing missionary work with the whole ICU and she seemed mildly infatuated with her cute young nurse today, Jeff.  She told him she always has room for one more grandson in the Day family.  Her mental status seemed to be improved  and the RN said that if she continues to do well she may be able to transfer out of the ICU and onto a regular Medical floor in the hospital tomorrow or the next day.  Phillip and I took in some cupcakes to the ICU staff and a thank you card to let the know how much we appreciate their care of Oma. 

Oma has not been resting very much, at least partially because of all the wonderful visitors she has had.  Pease let her rest as much as possible and keep visits short.  She loves her family so much she will never ask anyone to leave or let her sleep but she desperately needs it right now.  More updates to come!

Friday

Through the Thursday night Oma recieved the medications to help bring her blood pressure up and it was pretty darn successful.  By midday on Friday she was taken if off completely and her BP was holding steady at about 110/60. Her heart rate had also flipped into an irregular rythym called Atrial Fibrillation or A-fib.  Her heart rate had been a bit high since she arrive to the hospital (around 120) but once she went into A-fib her heart rate increased to 150.  They gave her a medication called Amiodarone to bring it back into a regular rythm and by Friday she was looking normal again with a heart rate of about 80. 

Normal Rythm:

Atrial Fibrillation

 She had a CT scan done of her kidneys and abdomen.  They found that Oma had developed a kidney stone in her right kidney.  The stone was so large they think that it was actually blocking the kidneys ability to drain down to the bladder and was the major source of infection.  Here's a picture of how the kidneys normally work.  They kidneys filter the blood and create urine, they then drain the urine down tubes called Ureters into the bladder and once the bladder is full it drains down the urethra and out of the body.

About 5 in the evening Oma went down to have a procedure done where they put a tube in through her lower abdomen to her right kidney to drain the extra fluid that had built up from the kidney stone.  The doctors hoped to drain some of the infection this way.  The tube is called a Nephrostomy Tube and looks something like this:



The Doctors also did an ultrasound on Oma's lower legs just to make sure she didn't have any blood clots.  They found an old one that has probably been there for years, Oma already knew about it and there wasn't any new or acute problems there. 

As far as blood work goes Oma's kidney labs (called BUN and Creatinine) remained elevated but stable which was expected due to the beating her kidneys took from the infection.  A lab called Troponin was also elevated which showed that there was a little heart damage from the whole ordeal as well.  That was also expected and the Dr's are continuing to monitor it.  They also ordered an Ultrasound of her heart to see how well her heart was functioning.

Oma's breathing had been fast since she came in through the ER but Friday she was having more trouble breathing.  She was wearing much more oxygen- 5 Liters- and her oxygen levels were still on the low side.  This might have been partly due to all the fluids they gave her through her IV the night before as well as the infection so the Dr's had her start doing deep breathing exercises to help prevent pneumonia.

That evening Oma's blood pressure started drop and they put her back on Levophed (the pressor medication) to help bring it back up.  Oma's mental status was better on Friday but she still had a little trouble having conversations and answering all questions appropriately.

How it all started

Dear Oma has been in the hospital since Thursday, May 31st and during that time there has been a lot of confusion about her health status and what is going on in the hospital.  This blog is to help clarify what has happened so far and to also provide accurate, up to date information for her family and other loved ones.  I asked Oma's permission first and she gave me the go ahead to put this information out there so if you know anyone who would like to follow this blog please share the link with them.  If you have any questions just put them in the comment section and I will try to answer them as best I can.  I'll tell the story up until this point in chronological order.  I'll make a new blog post for each day so they are a little shorter in length.

Starting on Tuesday Oma started feeling sick, she was vomitting and having back pain.  This continued into Wednesday when she developed a fever.  Mentally she was having a little bit of a hard time but still seemed her usual self, just not feeling well.  She took some Tyelnol and went to bed Wednesday night.  Thursday morning she was able to get up and walk around a little bit in the morning, but in the afternoon her daily helper called uncle Val to let him know Oma wasn't doing well at all and might need to go to the hospital.  Val wasn't able to leave his store at that time and asked Phillip if he could check on Oma.  As soon as he got to her Phillip called me, Rachael, and said we needed to get Oma to the hospital as quick as possible.  By the time I got to the house Phillip had carried Oma out to his car as she was too weak to walk.  She was also having a harder time communicating and understanding questions.  She could recognize us though at this point. 

When we got to the IHC ER her blood pressure (BP) was a little low but stable, about 105/50 (normal is about 110/70 give or take about 10 points on both top and bottom numbers).  She was running a fever with a temperature of 102.9 and felt burning hot to the touch.  By the time we got back in an ER room and the nurse could check her BP again it had dropped to about 79/45 and Oma's mental status had dropped a bit, she was having more trouble talking and it sounded like she had marbles in her mouth.  Klint and Val both arrived shortly after Oma got settled into her room.  The nurses quickly started giving Oma fluids into her IV to help hydrate her and increase her BP.  This worked at first and she looked a bit better. 

They checked some blood work and got a urine sample and did a scan of her brain to check for stroke as well as a chest x-ray to check for pneumonia.  Her brain scan showed that she hadn't had a stroke, she didn't have pneumonia, and her labs were mostly normal although her kidneys looked like they were having a hard time (probably severe dehydration) and her urine sample showed she had a Urinary Tract Infection (UTI).  Oma had a dose of antibiotics in the ER.  Her blood pressure started dropping again and it looked like the UTI had spread to her blood stream (called Bacteremia)  and she was actually going into what's called Septic Shock, meaning that the infection was so bad her entired body system was going into shock.

They tried giving more fluids to bring her BP back up and this time it remained low.  Oma's mental status started dropping again as she was transported up to the ICU.  When she arrived there she wasn't answering questions and couldn't follow commands.  The ICU staff put what's called an Arterial Line into the artery on the inside of her wrist to more accurately monitor her blood pressure and found that it had dropped to 65/35- VERY LOW!  Her pulses were very weak.  This is mailnly because the Sepsis was causing all of her arteries to dilate and lower the BP and so she wasn't perfusing well.   Think of like the difference in pressure it would take to push the same amount of fluid from a small straw versus a hose.  This means that her organs and tissues weren't getting the blood flow and oxygen needed to work properly.   When we left the hospital late that night her blood pressures was 55/30 and  the ICU doctors were putting  a large catheter into Oma's internal jugal on the side of her neck to be able to push more fluids into her veins faster as well as give medications called "Pressors" to increase her blood pressure.  The medication was called Levophed.  Oma was very, very sick.