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ProfessorTomoe

Changing Medications (Level of Trust Required)

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23 hours ago, mlooney said:

How did you appointment with the pain doctor go?  Or was this the doctor you were seeing on the 5th?

Pain doctor? That was a while back. They switched me to Dilaudid. Next appointment is on the 26th, I think.

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Bob Gammage.

I'm headed back to the Emergency Room.

I woke up this morning to red, swollen, warm legs - not the kind of thing you want to see when you're already on two strong antibiotics. I wound up having to send pics over to my infectious diseases doctor, who told me to get myself into the ER for intravenous antibiotics.

Looks like my weekend is farked. Sorry, folks.

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It's starting to look like I *might* be on another long course of IV antibiotics again, long being anywhere from 2 to 4 weeks per the infectious diseases doctor. How and where I get them (hospital, LTAC, skilled nursing center, home) is up in the air at the moment, thanks to Medicare's limitations. I should know more by Tuesday at the latest.

If I do get long term IV antibiotics, I'll probably wind up with yet another PICC line (ouch). I'm getting 3 IV antibiotics right now, which they're having to administer one at a time. I'm sure they'd like to give me two at once if they could (there are 2 leads on a PICC line). And as much as they hurt for me going in, I'll admit that PICC lines are more comfortable for the first couple of weeks once they've been installed. They get a bit itchy after that, but if they're still administering two or more IV antibiotics, they're worth that small problem, IMHO.

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Nightmarish Hospital Update 7/12/2022:

I'm going to be discharged from the hospital to a rehab center (read: Skilled Nursing Facility) for an approximately 2-4 week stay to receive intravenous antibiotics. Prior to that, I need to get a PICC line inserted. Attempts were made to do this yesterday and today.

Yes, attempts. Both unsuccessful. Allow me to explain.

On Monday, they tried to put a PiCC line into a vein in my left arm. They used a different vein than they did last time in order to avoid causing me pain upon insertion that I'd experienced with the previous PICC line. As part of this, I had to withstand a temporary bout of pain in my right shoulder and arm caused by my rotator cuff injury. (I can't lie down more than a few moments without experiencing severe pain, starting at 7 on a 1-to-10 scale.) Around 10 minutes into the procedure, they hit a snag - the line got stuck due to what the thought was narrowing of the vein. They tried to remove it, but they couldn't - it was stuck coming out as well. During this time, my right arm pain skyrocketed as the procedure dragged on and on and on. I hit between a 9 and a 10 on that same 1-to-10 pain scale, even after they ended the procedure and finally let me sit up. An eventual Dilaudid dose helped, but the torture was done. The removal was going to have to be done under moderate sedation the next day.

On Tuesday. I was wheeled down to the Cath Lab (I think), where I was prepped for what I was told would be a short procedure to remove and re-place the line in a different vein. I was told I'd be given Versed as a sedative and Fentanyl as a pain medication during the procedure. They laid me out and set me up under a sterile field, during which time the arm pain set in and began to build above an 8. By the time the doctor finally got the line out of my arm, I'd hit a 9 again. So, as you can imagine, when asked if I would be willing to start over from scratch then and there and try to insert a new PICC line, I said no way.

They eventually brought me back up to my room, where I met with my doctor. Several options were discussed, but I insisted on being put under for the next attempt. He agreed, so the next try will be done tomorrow (Wednesday 7/13) with me under general anesthesia. I want them to get this over with.

I've spent the rest of the day trying to recover from the 2nd failed procedure in a row. I've been through the wringer, and it's only Tuesday. 

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4 hours ago, mlooney said:

Tell us how it comes out once you are un-groggy and able to use your computer.

I've recovered sufficiently.

I woke up and went straight into level 9 pain in my right arm. I learned very quickly that they'd put the PICC line into my right arm, against my wishes. I thought it was causing my pain, but it wasn't. Turns out they'd only given me Fentanyl for my shoulder, which does absolutely nothing for my pain. Fortunately, they were able to give me Dilaudid, which knocked out the pain in a somewhat slowish manner (at least it did something significant). After an agonizing period of time, I was back down under an 8, but just barely.

I've since spoken with Mrs. Prof and my doctor. Mrs. Prof had some issues to work out with the target rehab facility, namely that of IV pain meds. I've talked to the doctor about this, and he's going to present me with a plan sometime tomorrow that covers a switch back to oral pain meds, but at a dose equivalent to what I'm taking now. Until then, it's status quo for the Dilaudid IV route and strength. Forget crossing fingers, I've got my small intestines crossed on this one.

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Update Monday July 18th, 2022:

Things have changed significantly since I last updated on Wednesday the 13th. I'm now at a new LTAC hospital instead of a rehab facility. The target rehab turned us down for some nebulous reason, then several others said no for other unknown reasons. My case manager changed the target facility type from rehab to LTAC, and the possibilities opened up instantly. So, I now will spend the next couple of weeks at Mesquite Specialty Hospital in Mesquite, TX (web site https://msh.ernesthealth.com - it's not that great of an internet site, but they let you poke around everywhere, pretty much). The most recent length end date I heard was Thursday, the 28th of this month.

(And yes, I give out the location of the LTAC for a reason. I've been in these places for too long by myself (my wife excluded).  I need a card or a flower or something, Bob Gammage.)

Unfortunately, this stay has already been with its share of pain. Level 9 pain, at that. Yesterday, a nurse came in to change the dressing on my PICC line.  He held my right arm - the one that hurts so bad - in a painful position for much too long so that he could access the dressing. I can't 100% fault him, since he had to get to the dressing somehow, but that doesn't negate the fact that he pushed and pulled me into sustained level 9 pain. This time, I couldn't ask for intravenous Dilaudid for immediate relief - I had only the pills I'd already taken earlier to fall back on. It took me several hours to completely recover from the experience.

So anyway. My jobs for now are as follows:

  • To sit back and soak up all three antibiotics (Clindamycin, Cefepime, and Vancomycin).
  • To not make myself sicker.
  • To do what the Physical and Occupational Therapists tell me to do.
  • To not piss off the nurses. Or Mrs. Prof. Definitely not Mrs. Prof.

So, fun times in the LTAC for the next couple of weeks. Please wish me luck.

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I'm experiencing a separate problem that I could use some help with. Do any of you have anything like this...?

My middle finger on my right hand, also known as the right-click finger on my mouse, is out of control. It right-clicks on its own, with no input from me, and I am unable to keep it from doing it. The only way I can stop it from right-clicking is to pull my middle finger off  the mouse entirely, which is impractical since my mouse is a bit too wide for me to do this (it's a Kensington Pro Fit "Full Size" Mouse). It's a full-blown, uncontrollable nervous tic. Do any of you have any experience with this, or know anyone with experience with it?

Barring a miracle cure, I've ordered an ergonomic mouse which I hope will solve the problem. Here's an Amazon Smile link to the thing:

https://smile.amazon.com/gp/product/B09J1TB35S

It's a Logitech Lift Vertical Ergonomic Mouse. The way it's set up, my right hand will be in a handshake position when it grips the mouse. I'm thinking that it'll take gravity out of the situation by pulling my middle finger sideways away from the key instead of down toward the key like it is now. I could have saved a few bucks by buying it with a discount code directly from Logitech, but I got it from Amazon for the ease in returning the thing if it doesn't solve the problem.

Anyway, any and all advice on any aspect of the situation would be appreciated.

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1 hour ago, ProfessorTomoe said:

I'm experiencing a separate problem that I could use some help with. Do any of you have anything like this...?

My middle finger on my right hand, also known as the right-click finger on my mouse, is out of control. It right-clicks on its own, with no input from me, and I am unable to keep it from doing it. The only way I can stop it from right-clicking is to pull my middle finger off  the mouse entirely, which is impractical since my mouse is a bit too wide for me to do this (it's a Kensington Pro Fit "Full Size" Mouse). It's a full-blown, uncontrollable nervous tic. Do any of you have any experience with this, or know anyone with experience with it?

Barring a miracle cure, I've ordered an ergonomic mouse which I hope will solve the problem. Here's an Amazon Smile link to the thing:

https://smile.amazon.com/gp/product/B09J1TB35S

It's a Logitech Lift Vertical Ergonomic Mouse. The way it's set up, my right hand will be in a handshake position when it grips the mouse. I'm thinking that it'll take gravity out of the situation by pulling my middle finger sideways away from the key instead of down toward the key like it is now. I could have saved a few bucks by buying it with a discount code directly from Logitech, but I got it from Amazon for the ease in returning the thing if it doesn't solve the problem.

Anyway, any and all advice on any aspect of the situation would be appreciated.

My hand gets weird if I'm at the keyboard too long, like all day on a weekend. All I can do to remedy it is take a break.

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3 hours ago, Darth Fluffy said:

My hand gets weird if I'm at the keyboard too long, like all day on a weekend. All I can do to remedy it is take a break.

Not the situation here. My right middle finger is twitchy from the word go on my mouse.

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I was having a similar problem with my left hand index finger.   It would randomly twitch like I was pulling trigger.  It started and stopped for no good reason.

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34 minutes ago, mlooney said:

I was having a similar problem with my left hand index finger.   It would randomly twitch like I was pulling trigger.  It started and stopped for no good reason.

How long was the duration of your problem?

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2 hours ago, ProfessorTomoe said:

How long was the duration of your problem?

About 2 months.  Of course it being my left hand it wasn't nearly the problem it would have been on my right.  I right handed.

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Update 7/20/22:

My edema is getting worse again. The swelling has reached up above my left knee, to about a third of the way up my thigh. I've spent a good deal of the day walking and elevating to try and fight it.

My doctor has put me back on oral Bumex diuretic pills 2x a day to try and reduce the swelling. If that doesn't work, he's going to put me back on my old friend, a 24/7 Bumex IV drip for a few days. No fun, but at least it comes with an upside - I won't have to take oral potassium horse tablets! :) He said he can do IV potassium, which would be a blessing.

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20 hours ago, ProfessorTomoe said:

My doctor has put me back on oral Bumex diuretic pills 2x a day to try and reduce the swelling. If that doesn't work, he's going to put me back on my old friend, a 24/7 Bumex IV drip for a few days. No fun, but at least it comes with an upside - I won't have to take oral potassium horse tablets! :) He said he can do IV potassium, which would be a blessing.

You do NOT want to take a hefty diuretic dose without potassium!

My dad had not been informed of this, so he went a few days without the potassium (until he was planning to go into town anyway). As he was walking across the street to the pharmacist, suddenly the curb in front of him appeared to grow about three feet higher. So he sat down on it - by feel - and a few minutes later the pharmacist came out to ask him what was going on... helped him get inside and on a chair, had him take ALL the potassium pills he'd missed, and then wouldn't let him leave for a couple hours.

It's just an amazingly good thing that Dad's eyes didn't go wonky any earlier... like as he was driving...

But... IV potassium is surely at least as effective as pills. (It definitely all gets into your bloodstream, which is the first step to getting it everywhere else.)

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2 hours ago, Don Edwards said:

You do NOT want to take a hefty diuretic dose without potassium!

My dad had not been informed of this, so he went a few days without the potassium (until he was planning to go into town anyway). As he was walking across the street to the pharmacist, suddenly the curb in front of him appeared to grow about three feet higher. So he sat down on it - by feel - and a few minutes later the pharmacist came out to ask him what was going on... helped him get inside and on a chair, had him take ALL the potassium pills he'd missed, and then wouldn't let him leave for a couple hours.

It's just an amazingly good thing that Dad's eyes didn't go wonky any earlier... like as he was driving...

But... IV potassium is surely at least as effective as pills. (It definitely all gets into your bloodstream, which is the first step to getting it everywhere else.)

Worry not. My potassium levels are being monitored. The nurses are drawing blood through my PICC line and running tests on it regularly. I spoke with the doctor, and he assured me that I will receive an appropriate dose of potassium via IV as the tests warrant. I thank you for your concerns, though.

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