Wednesday, September 30, 2015

Spontaneous Confusion

Today's post will be an update on Mom. As you may recall, as of the previous update (July 30) Mom was fighting an infection that had essentially eaten away some vertebrae and surrounding tissue in her upper back. She also had an upcoming appointment with her cardiologist to discuss the findings of her pulmonologist regarding her heart. The cardiologist appointment was on August 6, and it was no real surprise that he said we just need to wait until the back infection is gone, then schedule a heart catheterization. I suppose it is a good thing that he did not think there was anything serious enough to justify more immediate action.

After her pain levels were significantly reduced while on the initial round of antibiotics, Mom's back pain started coming back around August 9 but not as intense as before the antibiotics started. Her bloodwork from the August 10 blood draw did show the infection marker coming back up, from a low of 3.2 to 10.1 now. (It started at 25.) Dr. L, the infectious disease doctor, was notified, and she said to stay on the oral antibiotics for now. (She had switched Mom from the IV antibiotics to oral less than two weeks prior to the back pain coming back.) The infection marker (and pain level) did start going down the following week, so it looks to me like the oral antibiotics just needed a little time to start having an effect. It probably takes a little longer in a dialysis patient anyway. On September 1 Mom had an appointment with Dr. L, and she wants Mom to stay on the oral antibiotics another two months.

On September 3 I went to Mom's appointment with Dr. S, the neurosurgeon. We were expecting to have a discussion of what her surgical options would be to repair the damage done by the infection. But Dr. S said right now it looks like her T5 and T6 vertebrae are beginning to repair on their own, and they should actually fuse together over time. He showed us the most recent MRI (August 10) and compared that to her initial one from May 26. In both MRIs the normal vertebrae appear white, very similar to the way bones look on an X-ray. The infected vertebrae appear much darker due to the lack of bone material. In the original MRI this dark area was very large such that there was very little left of T5 and T6. But in the latest MRI it is apparent that this dark area is starting to fill in with white, indicating the bone is repairing itself. Dr. S said the patient's pain will typically improve faster than the actual bone repair as indicated on the MRI images, and if all goes well she will not need any surgery. Needless to say we were very happy to hear this news from Dr. S. And of course the first thing I googled when I got home was "spontaneous spinal fusion." Neat stuff.

So we are feeling good about the antibiotics taking care of the back infection, and the fact that the vertebrae seem to be healing on their own. But there always has to be some sort of issue lingering in the background, and in this case it happens to be Mom's blood pressure. She's been on medication for high blood pressure for many years, but in late August she started having problems with low blood pressure at dialysis, as in 90-something over 40-something. Usually they can get it to come back up after dialysis by having her lie down flat and/or feeding her some soup with a moderate sodium content. One time they had to administer some saline solution via IV. She checks her blood pressure at home a few times per day, and it had been fine at home until August 25 when the systolic pressure (top number) was under 100. The nephrologist at the dialysis clinic, Dr. P, said it looks like they are removing too much fluid at dialysis so he intends to adjust her dry weight since she has gained some weight over the past few months. He also asked her to cut the dosage of one of her high blood pressure medicines in half, and if her blood pressure is low in the evening (systolic under 100), do not take the evening dose of that medicine.

As of late September she is still having issues with low blood pressure, and she usually has to stay awhile after dialysis to get it to come back up. The blood pressure medication that was previously cut in half has now been stopped altogether, so the nephrologist is still trying to get this issue under control. Another issue (unrelated to blood pressure) is that she cannot take Humira for her arthritis due to the infection, so the arthritis pain is becoming more prevalent.

The only other news is that Mom had to have another balloon angioplasty on her fistula on September 29. The doctor said he opened up two locations that were slightly restricted. The dialysis clinic has also stopped using the buttonhole technique for the dialysis needles on all their patients due to the risk of infection, so now Mom gets to experience two large needle pokes at the beginning of every dialysis session. Thank goodness for the lidocaine cream to make that a little more bearable.

One month until the familial meeting in Chicago!

=====Monthly Blog Status Update===== 

As of August 31, 2015:

Total posts: 155 (1 in August)

Total pageviews: 28,900 (~700 in August)

Email subscribers: 12 (unchanged)

Total number of countries that have viewed the blog: 105

No new countries visited the blog in August.

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