Tuesday 12/9/08 Medical Update

Summary:

- Sue getting moved to Neurology floor this week (Tuesday?). They are aware that she is having intermittent seizures as she is weaned from Versed.

- Sue's memory is much improved from last week. Memory is still waxing and waning. Sue is now cognizant of short term memories. Sue's remembers Doctor Pillai Friday visit plus visitors from Friday. Long term memory seems to be @50-90% restored. She now understands that she is hospitalized at BIDMC - no longer needs to be reminded of this. This change is probably attributed to the reduction/elimination of Versed.

- Jack saw a series of right-neck muscle focal seizures on Monday @6pm. These happened while Sue was eating - not sure if this is related. Neurologist phoned in and advised Nurse to give Atavan. Seizures are being recorded on monitor on the 'F' lines (F3, F5, F7. F2, + ?). There are 5 lines on the EEG monitor that seem to correlate to the seizures. Sue also experienced 'thumb' twitching during this episode.

- Sue motor skills much better than last week. Could not hold photograph last week but is now able to manipulate straw to mouth when cup is held in front of her. Able to hold toast and feed herself. Not able to return toast to side tray. Able to up-arrow bed but having trouble locating and depressing down-arrow on bed.

- Slight fever @100 degrees @6pm.

- Sue started experiencing 'shivers' today. She claims these are because she is cold. ICU doctor aware of shivers and does not think they are related to seizure activity. Shivers do not display in same pattern as focal seizures noted above.

- Sue is now extubated. There was some initial concern that vocal cords were irritated or that she had a cough. I guess we should be watching this closely to make sure no infection is brewing. Sue is now talking. Slightly hoarse but communicating well. Pronouniciation is good but Phenobarbital or other risidual meds have her a little drunk.

- Physical Therapy @1x per day. Legs are weak to stand on but moves them well in bed. Possible right side affects of focal seizures. Right leg was hard to move last week. Moving ok now but possibly affected during focal seizures. Sue able to sit herself up and roll over in bed.

- Sue ate 1/2 bowl of chunky chicken, noodles, and carrot soup. A few bites of Macaroni & cheese. Some pudding, jello, and apple sauce. Drank chocolate mik, apple juice, and water.


Meds:

- Final dose of antibiotics today. Sue is now off of ALL antibiotics
- Received final dose of Versed yesterday.
- Keppra (Orally)
- Phenobarbital 200mg x3 per day?
- Ativan (as needed to control focal seizures. This just re-added to the mix post-Versed).
- Heparin belly shot @2x day
- Motron (as requested for menstrual cramps)


Doctors:

- Dr. ? (ICU - Not sure who is lead doc this week. Dr. Patel last week. Dr. Gilmartin two weeks ago.)
- Dr. Chrisnamurphy (Neurology - specializes in seizures in Women. Dr. Herman is back on in 1-week)
- Dr. Wright (Infectious Disease. Replaced Dr. Pillai/Dr. Eliopolous)
- Dr. ? (Ophthalmology - Double vision)


Tests:

- Positive test for Parvovirus B19.
- CSF #2 being checked for Parvovirus antibody for comparison to CSF #3.
- Still waiting on EEE, WNV, and others.
- Two HSV tests were negative
- No new MRI's scheduled.
- Chest x-ray @6pm