Monday, July 15, 2013

Post-cruise news

The last blog post ended with our return home from the cruise on Sunday, June 30. After the emergency on the ship Friday night, when Mom was essentially drowning due to the fluid buildup in her lungs, she was watching her fluid intake and diet very carefully in order to avoid another episode like that. We were hoping the dialysis sessions on the ship Friday night and Saturday morning took care of the fluid issue, such that her local nephrologist could now evaluate things and get her back to normal. Ha! 

My sister Laura spent the night at Mom's house Sunday night and she called me early on Monday morning, July 1. She said Mom was starting to have symptoms similar to what she experienced on the cruise ship Friday night, but they were not yet as bad. Mom was calling the dialysis clinic to see if they could take her immediately instead of waiting for her 11:00 AM appointment, since she knew she needed fluid pulled off. Fortunately they could get her in, so Laura took her to dialysis. Mom also took all of her dialysis flow sheets from the cruise and her records from the emergency room visit for the people at the dialysis clinic to review. The nephrologist, Dr. N, is typically at the clinic on Tuesday to see the Tuesday-Thursday-Saturday dialysis patients, and on Friday to see the Monday-Wednesday-Friday dialysis patients. So he was not there today, but I suggested that Mom have them make copies of everything so he could review it on Tuesday when he came in. I called his office and asked if they would have him call me about what happened on the cruise. I did not get a return call back, but I found out later that he talked to someone at the dialysis clinic about Mom's situation, so at least he is now aware of what happened.

Now that the dialysis is under control Monday morning, Mom needs to contact three different doctors about three different things. Using the phone during dialysis is one of Mom's favorite things to do, for two reasons. First, she cannot move her right arm much at all because that is where the needles are inserted into her fistula. And second, the nurses and techs in the clinic don't exactly speak as if they are in a library, so there is often a lot of loud talking or yelling across the room in the background. But in spite of all that, Mom was able to take care of the following items:

  • She contacted the office of her cardiologist and set up an appointment for tomorrow afternoon (Tuesday). You may recall the nephrologist on the cruise ship recommended she see a cardiologist due to how much distress she was in Friday night.
  • She contacted the office of her dermatologist regarding the biopsy results from the spot on her leg. As expected it is indeed a slowly progressing form of skin cancer, so she has scheduled Mohs surgery to take care of that on July 25.
  • The site of the June 11 surgery on her abdomen is getting red and appears to be infected. Mom called the office of the surgeon, Dr. K, and he called in a prescription for an antibiotic.

Laura took Mom home after dialysis, and then went to pick up the new prescription for the antibiotic (Bactrim). The pharmacist told her to be sure Mom drinks plenty of water when taking these pills, which is just what a person who is limiting her fluid intake wants to hear. Laura talked to the pharmacist and they decided that one full glass of water with each pill would be ok. (Since then I looked up Bactrim on the internet and the first two sites I looked at said to drink plenty of fluids to reduce the risk of kidney stones. Since Mom is still producing urine, I suppose kidney stones are still possible. Wouldn't that be wonderful?)

I took Mom to her cardiologist appointment the afternoon of Tuesday, July 2. If you have a really good memory, you may remember Mom last saw her cardiologist (Dr. R) when she had a chemical stress test in November of 2012. Everything was fine then, so I was not too concerned about this visit. We told him the story about what happened on the ship and what happened Monday morning. We gave him a copy of the EKG readings that were taken on the ship, and he said they looked fine. He examined her heart and lungs with a stethoscope and did not indicate that he found anything unusual there. He said the only way to really know for sure was to take a look at the heart, and he recommended she have a heart catheterization which is where a catheter is inserted up through the femoral artery and a dye is injected so the arteries can be clearly seen on an x-ray. We scheduled that procedure for Friday, July 5. If all goes well and they do not have to put in a stent, she will go home that same day. If they do have to put in a stent, she will stay overnight.

Mom also told Dr. R about the spot on her abdomen that she thought might be infected. She said it was now warm to the touch. He examined it and said it looks like there may be an abscess there that needs to be drained. He said the antibiotics she is taking would take care of the symptoms, but as soon as the antibiotics are discontinued the symptoms will come right back. That was not what we wanted to hear, so now Mom gets to call Dr. K's office tomorrow.

Given how Mom felt when she woke up on Monday before dialysis, we were all wondering how she was going to feel when she woke up Wednesday morning. My sister Laura called me in the morning and said Mom woke up feeling fine, she slept great, and she had no chest pain or shortness of breath. The dialysis clinic called and asked if she could come in early, so Laura took her to dialysis and they got started around 8:00 AM. So things were looking good Wednesday morning, but then Laura went to pick up Mom from dialysis around noon. Before Mom came out, the nurse Laura had spoken to that morning when she dropped Mom off came out and told Laura . . . I should probably end this blog post here. It seems long enough.

[2013 August 1: Minor edit. Inserted "care" in second bullet item.]

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