- The new Neurological attending doctor changed Sue's phenobarbital from one large dose per day to three boluses per day. This change seems to make a positive difference. Sue went about 24 hours without a seizure. Though she started to have focal seizures again this evening.
- There is now a chance that Sue may be weaned off the Versed medicine on Thursday and extubated on Friday. So we may not have to go the tracheotomy route.
- Sue reported some vision problems today. She has either double vision or decreased vision in her right eye. I think an ophthalmologist will be consulted.
- I spoke to the Neurological Fellow today about the results of MRI #3. It seems that MRI #2 showed 5-10 lesions. These may have been in five sections of the brain. MRI #3 showed fewer and smaller lesions. Something about 'flairs' - this might be the type of MRI images. Also something about edema, some of the abnormal areas contained water? I will speak to Neuroglogical attending (Dr. Chrisnamurphy) Thursday AM.
- We quizzed the Neurlogist on whether the focal seizures are really seizures or just twitches. They are pretty confident they are seizures. Many do not show up on the EEG because they are coming from very small sections? They do see some of the focal seizures on the EEG.
- Today is Dr. Pillai's (ID doc) last day.
Wednesday, December 3, 2008
Tuesday 12/2/08 Medical Update
Spoke to Dr. Patel (MICU Attending) on Tuesday.
- Preliminary results from MRI #3 were favorable. Dr. Patel mentioned that they still see inflammation but I sense that there is less inflammation. He started to refer to neurological terms like 'Flair' and I started to question him on what that meant. He recommended that I speak to the Neurologist to get the info first hand. I will make a point of meeting with Neurologist today. Let me know who is available to conference call on this update so that we ask all the right follow up questions.
- Sue continues to exhibit increased arm and leg movement. Her hand and arm movements are becoming steadier. She is still not well enough to write with a pen or hold photos but is attempting lots of hand signals. Sue can do thumbs up, thumbs down, A-OK, and the single finger salute (ask Laura Mc about that one).
- Neurology is monitoring EEG and says that seizure activity is much better under control. Current seizure meds include Keppra, Phenobarbital, and Versed. I suspect that these improvements may also be related to the decreasing inflammation (my guess).
- Sue continues to have 'focal seizures' on the right side of her face. These are not painful but she is aware of them. She frowns when she gets them so I suspect that they may have some hidden effect on her thought process. She gets quiet during these periods although she can still yes/no nod if prompted to answer a question during these events. I have also seem some involuntary right arm movements, the arm starts raising on its own. She did this the other day while sleeping and this was witnessed by Dr. Pallai who documented this into the medical record.
- Some on this list are contemplating whether the focal seizures are seizures at all or whether they are just twitches. Not sure, but they seem to be slightly better or shorter when Sue turns her head to the right.
- Dr. Patel has indicated that Sue will probably need a Tracheotomy on Thursday. It seems that Sue will not be weaned off the Versed for another week or so. We are coming up on the 2-week mark for the intubation tube. Dr. Patel said they could hold off it were 3-4 more days but he suspects that it will take another week to get her off the Versed.
- The Tracheotomy will be more comfortable for Sue. She is starting to protest the tube in her throat. They move it each day left and right but I suspect her throat is getting irritated so the Tracheotomy is probably warranted. The Tracheotomy will also facilitate Sue's physical therapy as it will allow her and her Physical Therapist more mobility and freedom of movement.
- Sue is not as sleepy as she was a few days ago. I think this is related to her getting used to the Phenobarbital. They have increased her from one bolus per day to three. I think the plan is to keep hitting her with Phenobarbital until the blood level is suffient to support the reduction of Versed.
- Sue was on ventilator setting 'MMV' most of Tuesday. I understand this to be a manual setting where Sue does much of the work. She seemed to handle this well. Her heart rate is slightly elevated (@100) as Vent tech guy said 90 would be ideal.
- No new lab results in. We estimate that they should be back late this week or first of next week. That will be the 15 days from Spinal Tap #2.
- We are waiting on the Nashoba lab for the Parva B19 virus (Fifths Disease). Fifths Disease is going around the town of Stow as reported by the elementary schools. Sue did have flushed cheeks the Sunday before entering the hospital.
- Sue was visited by her daughter Ally on Tuesday. Ally is 10 and saw intubation picutures before going in and was not frightened. This visit was good for Sue and Ally.
- Sue continues to have spongey memory. I understand that the Versed can do this to your memory. We pretty much have to re-explain what happened each day and assure her that she is in good hands.
- Preliminary results from MRI #3 were favorable. Dr. Patel mentioned that they still see inflammation but I sense that there is less inflammation. He started to refer to neurological terms like 'Flair' and I started to question him on what that meant. He recommended that I speak to the Neurologist to get the info first hand. I will make a point of meeting with Neurologist today. Let me know who is available to conference call on this update so that we ask all the right follow up questions.
- Sue continues to exhibit increased arm and leg movement. Her hand and arm movements are becoming steadier. She is still not well enough to write with a pen or hold photos but is attempting lots of hand signals. Sue can do thumbs up, thumbs down, A-OK, and the single finger salute (ask Laura Mc about that one).
- Neurology is monitoring EEG and says that seizure activity is much better under control. Current seizure meds include Keppra, Phenobarbital, and Versed. I suspect that these improvements may also be related to the decreasing inflammation (my guess).
- Sue continues to have 'focal seizures' on the right side of her face. These are not painful but she is aware of them. She frowns when she gets them so I suspect that they may have some hidden effect on her thought process. She gets quiet during these periods although she can still yes/no nod if prompted to answer a question during these events. I have also seem some involuntary right arm movements, the arm starts raising on its own. She did this the other day while sleeping and this was witnessed by Dr. Pallai who documented this into the medical record.
- Some on this list are contemplating whether the focal seizures are seizures at all or whether they are just twitches. Not sure, but they seem to be slightly better or shorter when Sue turns her head to the right.
- Dr. Patel has indicated that Sue will probably need a Tracheotomy on Thursday. It seems that Sue will not be weaned off the Versed for another week or so. We are coming up on the 2-week mark for the intubation tube. Dr. Patel said they could hold off it were 3-4 more days but he suspects that it will take another week to get her off the Versed.
- The Tracheotomy will be more comfortable for Sue. She is starting to protest the tube in her throat. They move it each day left and right but I suspect her throat is getting irritated so the Tracheotomy is probably warranted. The Tracheotomy will also facilitate Sue's physical therapy as it will allow her and her Physical Therapist more mobility and freedom of movement.
- Sue is not as sleepy as she was a few days ago. I think this is related to her getting used to the Phenobarbital. They have increased her from one bolus per day to three. I think the plan is to keep hitting her with Phenobarbital until the blood level is suffient to support the reduction of Versed.
- Sue was on ventilator setting 'MMV' most of Tuesday. I understand this to be a manual setting where Sue does much of the work. She seemed to handle this well. Her heart rate is slightly elevated (@100) as Vent tech guy said 90 would be ideal.
- No new lab results in. We estimate that they should be back late this week or first of next week. That will be the 15 days from Spinal Tap #2.
- We are waiting on the Nashoba lab for the Parva B19 virus (Fifths Disease). Fifths Disease is going around the town of Stow as reported by the elementary schools. Sue did have flushed cheeks the Sunday before entering the hospital.
- Sue was visited by her daughter Ally on Tuesday. Ally is 10 and saw intubation picutures before going in and was not frightened. This visit was good for Sue and Ally.
- Sue continues to have spongey memory. I understand that the Versed can do this to your memory. We pretty much have to re-explain what happened each day and assure her that she is in good hands.
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