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
Tuesday, December 9, 2008
Friday, December 5, 2008
Parvovirus B19 infection
BIDMC test came back positive. This is Fifths disease and has been going thru the Stow school system.
Wednesday, December 3, 2008
Wednesday 12/3/08 Medical update
- 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.
- 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.
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.
Saturday, November 29, 2008
Saturday 11/29/08 Medical update
-Spinal tap #3 preliminary results are in. Only showing 2 white blood cells. This is down from 81 (spinal tap #1) and 70 (spinal tap #2)
- Sue has slightly more mobility in her arms.
- Sue continues to have focal seizures. Occasionally these focal seizures seem to rattle her. Some of them seem stronger. They do not hurt her but they seem to cause her some distress.
- I thought doctors orders were to take her off of Versad, but she is still on it. This is probably good since seizures are still occurring.
- Not sure how long she can stay intubated without needing a tracheotomy.
- Sue has slightly more mobility in her arms.
- Sue continues to have focal seizures. Occasionally these focal seizures seem to rattle her. Some of them seem stronger. They do not hurt her but they seem to cause her some distress.
- I thought doctors orders were to take her off of Versad, but she is still on it. This is probably good since seizures are still occurring.
- Not sure how long she can stay intubated without needing a tracheotomy.
Powassan virus?
I hope thing are going well today. I was just brushing up on my viral encephalitides and paraneoplastic syndromes. I came across this helpful summary article on viral encephalitis-- which it still sounds most likely to be. I found a virus that sounds like a possible cause: Powassan, an arbovirus caused by a tickbite. I'm wondering if this was tested for, or if it could be tested for??
Most of the others on this table sound relatively unlikely-- not in the right part of the world, wrong time of year, wrong symptom complex, etc. http://www.emedicine.com/neuro/topic393.htm
The more I read about the neuro paraneoplastic syndromes, the less likely it sounds. Limbic encephalitis is one of those-- 60% of people who have it have an underlying cancer. Its features do not sound consistent with what Susan has, from what I've read.
Friday, November 28, 2008
11/28/08 Medical Update
There is a lot of information below. Please comment and let us know what u think. thanks jb.
Report from Infectious Disease Doctor (Dr. Pillai)
- The seizures are diminishing. She's now on Phenobarbital, which is sedating. Her fever is down, and is now low-grade. A repeat MRI was done which showed focal lesions in the inferior medial temporal rectus gyrus, frontal gyrus and right orbital gyrus on FLAIR images and was interpreted most consistent with viral encephalitis of the Herpes virus family. These lesions were not present on the first MRI. Since Susan is clinically improving-- more awake, more responsive, and lower fever-- it's unclear if her underlying process is worse, or if the MRI images are lagging behind her clinical improvement.
- Because of the MRI findings, neurologist is wondering if Susan's clinical improvement is due to better control of her seizures, of if the underlying process, whatever it may, is actually improving. Therefore, they are considering a brain biopsy to see what these lesions are, and a repeat lumbar puncture to send for antibodies that would suggest a paraneoplastic process as the cause (eg, an underlying cancer as the primary cause, which is secreting a substance that would cause her neurologic picture). We still do not have results of some of more unusual viruses that were sent off. Susan had a total body CT scan tonight, looking for tumors or other clues as to what is going on in her brain.
- Regarding Paraneoplastic – this does not usually have a fever. So maybe we don’t have to worry about this one so much.
- Today Jack and Melissa talked to the ID consultant, Dr Pillai. He thought it was reasonable to ask the neurosurgeons if any of the lesions were easily accessible. Chances are, it wouldn't be done until next week. By that time we may have more information: Susan may be alot better, and/or some of the other tests might be back. It also may be reasonable to repeat the Herpes tests, which were initially negative, to see if they are now positive. He mentioned that tb is considered unlikely, as is rabies. Of note, an ophthmalogic exam was done last week and did not show retinitis.
- Susan is now on Acyclovir, Doyxcycline and Ampicilin, to cover Herpes, Rickettsial or other tick-born disease, and Listeria, respectively. She is not on steroids. She is on Phenobarbital and Versed (midazolam) to control her seizures.
Report from Dr. Herman/Dr Eckstein (Neurology) and Dr. Patel (MICU):
- There is still no diagnosis for the ‘Primary Process’. Since we are now getting conflicting data points (Sue responding well but negative MRI), the doctors are looking more closely at other non-viral root causes.
- Though ‘Infection Process’ is still the number one most likely root cause.
- The 2nd MRI ‘looked’ like HSV but HSV was ruled out last week when the test came back negative. Dr. Pillai has seen cases where the first test is negative and a second later test is positive.
- There are multiple foci on MRI #2. These foci may be referred to as lesions or areas of inflammation. They are not saying.
- Something about …. Increased signal could be inflammation, infection, or swelling
- Abnormalities in the cortex
- Several areas of increased signal inflammation, infection, and/or swelling which are close to seizure areas
- Put dye into her to ‘look at contrast’ and the dye did not leak into the brain
- No indication of stroke
- No bleeding in the brain
- Inflammation is patchy and this makes it look like something other than encephalitis.
- Area involved is deep in the surface of the brain
- Hers is patchy and sketchy all over the place
- It is a little atypical for infection
- Looking for other inflammatory ailments. Lupus has been ruled out but looking at other things like Rheumatoid and other auto immune conditions.
- Lymbic Encephalitis is another thing they are considering. This would make sense as fevers can be intermittent if this is what she has.
- Neurologists think that seizure control is the most likely reason for recent improvement. This could mean that there are other reasons still unknown for Sue’s condition, so the doctors are now widening their consideration of other root causes.
- Visual seizures (facial twitching and hand moving) are so small that they are not being captured on the EEG but are visual.
- Between 1pm-5pm today, 1 seizure was captured on the EEG that lasted for only a few seconds.
- Jack saw about 4 focal seizures during that same period of time. 2 of these may have been stimulated by coughing. Sometimes stimulus (coughing, emotions, etc) can cause those seizures
- Sent of more blood test to check for auto-immune diseases, such as rheumatoid arthritis, lupus (although already tested negative for lupus), etc.
-
Next Steps:
- Get results of full body Cat-scan (done this evening) to check for any tumors elsewhere in the body
- Repeat spinal tap (CSV) so that fluid and blood can be sent out to research labs to check for paraneoplastic syndrome. Will also compare to see if white blood cell count is improving (1st test count was at 80; 2nd test count was at 71)
- Jack signed form authorizing paraneopalastic tests to be sent out. Results could take 1-4 weeks.
- Check for auto-immune vasculitis
- Most likely is still Viral encephalitis (meningeoencephalitis?).
- May consider having neuro-muscular perform test on arm strength however, will ask them if it is worth it at this point. May be that Sue is just very weak from being in the ICU. This tests nerves and muscles. Sue’s limbs are very weak. They are not sure if this is normal due to hospitalization in ICU or if it could be Vasculitis.
- A brain biopsy is now being considered by Neurology. Dr. Pillai does not think it hurts to consult with the brain surgeons but wants to see results of PCR and other tests first. Some of the tests (EEE, WNV, …) can take 10-15 days, which means they could be back next week.
- This surgery would be for next week and they would extract tissue so that cells can be analyzed and compared for infection, inflammation, and cancer.
- Dr Kiriakoplis (Neurolgy) will be rounding on Saturday
- Dr. Pang (Neurolgy) on Sunday
- Dr Krishnamurphy (Neurolgy) takes over for Dr. Herman on Monday for about 2 weeks.
- A Petscan can be considered but Sue needs to be off of Respirator for this. A Petscan could uncover cancer if it is hiding and Catscan does not show.
-
Other Observations:
- Sue is doing real well with the Ventilator. The RATE is set for 12 but Sue is breathing 16 times per minutes. The Respiratory Tech was real impressed with her coughing. There is some gurgling but she is able to cough on her own to help clear it.
- Sue is a candidate to come off ventilator once her she is weaned off her sedation meds.
- There is no talk about a tracheotomy. Some on this list have mentioned that this may be a necessary next step if she is on the ventilator for more than 1 week.
- The plan is to take Sue off of Versad on Saturday, leaving her only on Phenobarbital. This could allow them to take Sue off the ventilator in the next few days.
- Temperature high was 101.1 today. Sue’s hand are no longer cold but body temperature
- Sue was VERY responsive when the shift changed Friday @7pm. She raised both arms as new Nursing team entered the room. This was done without being asked. She was showing off for the nurses to show how much she is improving. This was the best I have seen her.
Report from Infectious Disease Doctor (Dr. Pillai)
- The seizures are diminishing. She's now on Phenobarbital, which is sedating. Her fever is down, and is now low-grade. A repeat MRI was done which showed focal lesions in the inferior medial temporal rectus gyrus, frontal gyrus and right orbital gyrus on FLAIR images and was interpreted most consistent with viral encephalitis of the Herpes virus family. These lesions were not present on the first MRI. Since Susan is clinically improving-- more awake, more responsive, and lower fever-- it's unclear if her underlying process is worse, or if the MRI images are lagging behind her clinical improvement.
- Because of the MRI findings, neurologist is wondering if Susan's clinical improvement is due to better control of her seizures, of if the underlying process, whatever it may, is actually improving. Therefore, they are considering a brain biopsy to see what these lesions are, and a repeat lumbar puncture to send for antibodies that would suggest a paraneoplastic process as the cause (eg, an underlying cancer as the primary cause, which is secreting a substance that would cause her neurologic picture). We still do not have results of some of more unusual viruses that were sent off. Susan had a total body CT scan tonight, looking for tumors or other clues as to what is going on in her brain.
- Regarding Paraneoplastic – this does not usually have a fever. So maybe we don’t have to worry about this one so much.
- Today Jack and Melissa talked to the ID consultant, Dr Pillai. He thought it was reasonable to ask the neurosurgeons if any of the lesions were easily accessible. Chances are, it wouldn't be done until next week. By that time we may have more information: Susan may be alot better, and/or some of the other tests might be back. It also may be reasonable to repeat the Herpes tests, which were initially negative, to see if they are now positive. He mentioned that tb is considered unlikely, as is rabies. Of note, an ophthmalogic exam was done last week and did not show retinitis.
- Susan is now on Acyclovir, Doyxcycline and Ampicilin, to cover Herpes, Rickettsial or other tick-born disease, and Listeria, respectively. She is not on steroids. She is on Phenobarbital and Versed (midazolam) to control her seizures.
Report from Dr. Herman/Dr Eckstein (Neurology) and Dr. Patel (MICU):
- There is still no diagnosis for the ‘Primary Process’. Since we are now getting conflicting data points (Sue responding well but negative MRI), the doctors are looking more closely at other non-viral root causes.
- Though ‘Infection Process’ is still the number one most likely root cause.
- The 2nd MRI ‘looked’ like HSV but HSV was ruled out last week when the test came back negative. Dr. Pillai has seen cases where the first test is negative and a second later test is positive.
- There are multiple foci on MRI #2. These foci may be referred to as lesions or areas of inflammation. They are not saying.
- Something about …. Increased signal could be inflammation, infection, or swelling
- Abnormalities in the cortex
- Several areas of increased signal inflammation, infection, and/or swelling which are close to seizure areas
- Put dye into her to ‘look at contrast’ and the dye did not leak into the brain
- No indication of stroke
- No bleeding in the brain
- Inflammation is patchy and this makes it look like something other than encephalitis.
- Area involved is deep in the surface of the brain
- Hers is patchy and sketchy all over the place
- It is a little atypical for infection
- Looking for other inflammatory ailments. Lupus has been ruled out but looking at other things like Rheumatoid and other auto immune conditions.
- Lymbic Encephalitis is another thing they are considering. This would make sense as fevers can be intermittent if this is what she has.
- Neurologists think that seizure control is the most likely reason for recent improvement. This could mean that there are other reasons still unknown for Sue’s condition, so the doctors are now widening their consideration of other root causes.
- Visual seizures (facial twitching and hand moving) are so small that they are not being captured on the EEG but are visual.
- Between 1pm-5pm today, 1 seizure was captured on the EEG that lasted for only a few seconds.
- Jack saw about 4 focal seizures during that same period of time. 2 of these may have been stimulated by coughing. Sometimes stimulus (coughing, emotions, etc) can cause those seizures
- Sent of more blood test to check for auto-immune diseases, such as rheumatoid arthritis, lupus (although already tested negative for lupus), etc.
-
Next Steps:
- Get results of full body Cat-scan (done this evening) to check for any tumors elsewhere in the body
- Repeat spinal tap (CSV) so that fluid and blood can be sent out to research labs to check for paraneoplastic syndrome. Will also compare to see if white blood cell count is improving (1st test count was at 80; 2nd test count was at 71)
- Jack signed form authorizing paraneopalastic tests to be sent out. Results could take 1-4 weeks.
- Check for auto-immune vasculitis
- Most likely is still Viral encephalitis (meningeoencephalitis?).
- May consider having neuro-muscular perform test on arm strength however, will ask them if it is worth it at this point. May be that Sue is just very weak from being in the ICU. This tests nerves and muscles. Sue’s limbs are very weak. They are not sure if this is normal due to hospitalization in ICU or if it could be Vasculitis.
- A brain biopsy is now being considered by Neurology. Dr. Pillai does not think it hurts to consult with the brain surgeons but wants to see results of PCR and other tests first. Some of the tests (EEE, WNV, …) can take 10-15 days, which means they could be back next week.
- This surgery would be for next week and they would extract tissue so that cells can be analyzed and compared for infection, inflammation, and cancer.
- Dr Kiriakoplis (Neurolgy) will be rounding on Saturday
- Dr. Pang (Neurolgy) on Sunday
- Dr Krishnamurphy (Neurolgy) takes over for Dr. Herman on Monday for about 2 weeks.
- A Petscan can be considered but Sue needs to be off of Respirator for this. A Petscan could uncover cancer if it is hiding and Catscan does not show.
-
Other Observations:
- Sue is doing real well with the Ventilator. The RATE is set for 12 but Sue is breathing 16 times per minutes. The Respiratory Tech was real impressed with her coughing. There is some gurgling but she is able to cough on her own to help clear it.
- Sue is a candidate to come off ventilator once her she is weaned off her sedation meds.
- There is no talk about a tracheotomy. Some on this list have mentioned that this may be a necessary next step if she is on the ventilator for more than 1 week.
- The plan is to take Sue off of Versad on Saturday, leaving her only on Phenobarbital. This could allow them to take Sue off the ventilator in the next few days.
- Temperature high was 101.1 today. Sue’s hand are no longer cold but body temperature
- Sue was VERY responsive when the shift changed Friday @7pm. She raised both arms as new Nursing team entered the room. This was done without being asked. She was showing off for the nurses to show how much she is improving. This was the best I have seen her.
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