Mom medical

questions

3/3/20

• What was learned from the CT scan?
• Is the PC doc still to come?
• Is there a team of discharge planners?
• Jean’s blood sugar is running >200 because of the steroid, should she be on a low dose of basal insulin?

Jean needs a nail clipper and emory board.

notes

3/3/20 tues

• physical therapist took her for a walk around the floor. She is out of breath. Then she lifted her leg bending at the knee 20x and lifting her knee up 15x. You cannot go home if you cannot walk.
• Dr Lopez stopped in.
• the NG nose tube is also used as a way to get mom meds. After giving meds the close off the tube for a while so the meds stay down.
• mom is getting lovrinox injections as a Coumadin replacement
• Mary the respiratory therapist stopped by with a session of nebulizer. Mom got a new mask with cool moist air to lower her problems with mucus.
• Mom is tired probably partly from the steroid she is taking and the (somehow connected) rise in her blood sugar level. Dr Chung spoke of bringing in an endocrinologist to consult.
• Dr tavak still a no show. Nurse is calling again
• Dr Kaushik was here with Dr Chung (who is still quarterbacking) The consensus on the throat is to leave it to heal on its own for 2 weeks. Feeding will be from PICC and they might experiment having the nose tube be used for some of her meds like Cumadin and blood pressure meds. It does not seem to be worth it in their view to put in a stomach feeding tube for the two weeks. She will likely have to remain in the hospital for two more weeks.
• Celifarco is consulting w another GI doc kaushik whose np Palmieri says they think endoscopic clip install is the way to go.

3/2/20 mon

• At 7:30pm ENT Dr Wodlin came to say that the injection to treat the “paralysis” is not needed now but may be before she starts ingesting food.An Esophogeal surgeon came in and weighed in saying “less is more” he would not opt for the drain or the incision to clip the tear The clip could close in fluid that could then lead to infection. An image of the area may look very different in a week.

• TPN nourishment through the PICC line new bag started at 9:30pm Jean was restless and pulled off the mittens.
• At 6:30pm Jean had a CT scan of her throat and chest to get more information (ie how deep is the tear)
• In the afternoon Dr Celifarco on the other hand, sees a collection junk in the esophagus wound and is recommending a drain. He's got a guy coming to look that and also evaluate whether they could non-surgically reach in and sew up the tear. He thinks drain first, feeding tube second. He agreed that a feeding tube entering the belly,done by a radiologist, so that it wouldn’t have to go through her esophagus would better allow the throat to heal.
• After the barium X-ray Dr dimeo came and said the tear was pretty high up near the vocal chords. Out of his territory. Recommending and consulting w general surgeon. Thinks surgery to put in neck drain is unnecessary now, use antibiotics instead.
• Dr Lopez the Infectious Disease specialist started antibiotics for esophagus wound, to prevent infection as there is no sign of infection (elevated white cells)
• So the trauma sustained that is keeping her from eating is both a partial paralysis and a tear of her esophagus. She has a PICC line (not in her chest but in her upper arm) and an NG tube. The NG tube is being used for medications. She is having a barium type swallow esophogiagram now with some water based substance to determine where the tear is located. result: long tear left external, high up but not sure how deep. The radiologist suggested that it might need to be repaired surgically, hope not.

• working on getting a primary care physician on board to coordinate and have the big picture

3/1/20 sun

• The ENT doc was just here, he says that her vocal cord is still paralyzed but that he has to wait to hear from her doc about where the tear is located. If it is along the shared wall with the wind pipe it is harder to take care of the shot (which usually is an instant cure for vocal paralysis, but if it is on the exterior wall of esophagus, much less complicated. He will consult with the doc looking at her esophagus after he knows the deal and work with him.
• The nurse Min said that all of the nutrients are being provided through an I.V. The 'feeding tube' is exclusively for medication.
• GI guy was here this morning and left note saying that an ENT person will come tomorrow to take a look at the current state of mom's esophagus tear.

2/29/20 Sat

• Feeding tube can't be used for 24 -36 hrs. Today a PIC line will be put in so she can get iv nourishment with protein carbs and fat. However her INR number is high so there is a hold on that.
• mom still not getting food
• The injection for the vocal cord was not done, the feeding tube was placed last night. The tube is a nasogastric (NG) tube and as of 10am there was no order to start feedings

2/28/20 Fri

• ENT doctor/- Dr Saul Wodlin examined mom's throat with a small scope and told me that the left side of her vocal cord is paralyzed. Stated this is the reason she cannot swallow or talk. The solution is to give mom an injection and this will very quickly repair the problem. The main issue is timing. This was just diagnosed , the OR is booked up. He is pushing very hard with everyone at the hospital to do this ASAP. If this can be done and if successful ( the doc is very confident) the feeding tube will be unnecessary.

2/26/20 Wed

• the main issue remains the throat trauma. Not able to ingest any liquids or food. The steroid that started 2/25@ 11:00am has been given regularly and the hope is that this can greatly aid in the throat healing. By later this afternoon doctor will evaluate the potential insertion of a feeding tube. They hope to avoid this for the potential strain on the throat could outweigh the nutritional advantage.

2/25/20 Tues

• Much less pain and discomfort today. Last night her doctor said one lung was not functioning - he used an endoscope to diagnose the problem. Detected a large amount of mucus around the lung and was able to suction it out. Started a new medication to help with breathing.
• Dr. Chung checked in, and is concerned about mom's throat, and the fact that she has not been able to drink or eat anything. Says she will remain in the ICU until her problem is resolved.

people

• Danielle - ENT nurse -
• Alis - nurse -
• Min - nurse -
• Dr. Chung - heart surgeon - installed the mitral valve clip
• Dr Saul Wodlin - ENT doctor - 2/28 the reason she cannot swallow or talk:the left side of her vocal cord is paralyzed
• Dr Celifarco - GI doctor
• Dr tavak - primary care
• Dr Lopez - infectious disease doc
• Dr serca installs drain
• Dr dimeo - cardiac thorasic sugeon
• Dr Kaushik director of Gastroenterology, 515-590-3700 https://ligastroendo.com
• Roberta Palmieri is np of kaushik