Tuesday, July 30, 2013

Layers of Infiltration

In the previous post, Mom spent two weeks tethered to a portable wound vacuum (affectionately known as Kirby) to help a surgical incision on her abdomen heal. This post will cover the following week, the week of July 22. So what is on Mom's schedule for this week? Other than dialysis on Monday, Wednesday and Friday, she has Ed's funeral on Tuesday near Austin, an appointment with Dr. K on Wednesday to examine the surgery site, and Mohs surgery for a spot of skin cancer on her right leg on Thursday. It's a busy week, so let's hope everything goes well.

Nope, that didn't happen. The week began poorly at dialysis on Monday, July 22. They infiltrated Mom's fistula today, which is when a needle enters a blood vessel like it is supposed to, but it continues in too far and creates another hole. When a fistula is infiltrated it causes blood to flow out of the blood vessel and pool under the skin. Mom ended up having just a little more than one hour of dialysis that day (instead of her usual four hours), and they told her she still needs to come in for three more sessions. She can't come in Tuesday because she will be out of town for the funeral, and she can't come in Thursday because she has Mohs surgery scheduled, so that leaves Saturday.

As if that wasn't bad enough, she also weighed more after this short dialysis session than she did before, which means they did not remove any fluid and she probably ended up retaining some of the saline solution they periodically flush the lines with. They told her not to drink anything and to keep her ankles propped up to reduce swelling due to edema. They also told her to get to an emergency room as soon as possible if she experienced any shortness of breath. She also needs to keep ice on her arm to reduce the swelling and bruising. This is just what she needs to deal with the day before going to Ed's funeral.

On Tuesday ten of us, including Mom, went to Ed's funeral in Taylor, TX. It was a long day and we were gone from Mom's house a little more than 12 hours. Mom did fine, although she was standing up on her feet more than usual. When we arrived back to her house she realized her ankles were very swollen, so she took it easy and kept her feet propped up as much as possible the rest of the night. She obviously still had a fluid issue due to the shortened dialysis session on Monday, but after dialysis the next day she said she could see her ankles again, so the fluid appeared to be under control.

On Wednesday after dialysis she saw Dr. K for a follow-up visit on her surgery site. There is still a small amount of discharge, but he said it is coming along fine. Regarding the small knot Mom noticed below the wound, he said that was normal and should go away over time.

On Thursday, July 25, she had Mohs surgery for the skin cancer on her right leg. The surgeon only had to remove one more layer since most of it had already been removed when the biopsy was done in June, so that is some good news that the skin cancer had not gone very deep at all.

Friday, July 26 was a good news/bad news day at dialysis. The good news is that Dr. N said she did not need another dialysis session on Saturday, since things seemed to be under control. He also lowered her dry weight again. The bad news is that Mom's blood clotting issue seems to be getting worse, meaning the machine gets clogged up. She is now taking aspirin and fish oil to address that situation. Hopefully that gets under control so we don't have to seriously consider putting her on Coumadin.

That gets us caught up with the Mom updates for now, so maybe I can get back to some article reviews while things are relatively calm.

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