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ProfessorTomoe

Changing Medications (Level of Trust Required)

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While I do read facebook, I don't mind seeing the posts here as well.  After all, I crosspost my Explorer the Cat posts to here, Facebook and the EGS Discord server.

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2 minutes ago, mlooney said:

After all, I crosspost my Explorer the Cat posts to here, Facebook and the EGS Discord server.

This is true. Okay, I'll post here as well, as long as I'm not pissing anyone off. Let me know when that starts to happen.

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It's pretty much a lock that I'm not going to be discharged to go home any time soon. Instead, I'm getting sent to a Long-Term Acute Care hospital. There, the doctors will be able to monitor my antibiotic serum levels more closely than they ever would at home. (I've been flirting with toxic levels of vancomycin.) They'll also be able to continue managing my pain with Dilaudid, something they can't do at home. I'm probably going to be there for a minimum of two weeks.

Come to find out from talking to the infectious disease doctor that the vancomycin they've been giving me has been aimed at treating me for a possible MRSA infection. You see, when I was hospitalized back in December 2020, I had a MRSA infection that was confirmed in a toe that got amputated. They can't confirm MRSA in this toe, since there are no open wounds - they'd have to cut the toe open and swab the inside, which they're not about to do. Therefore, they're going with my medical history and treating me for MRSA as a precaution.

I'll post another update if I get more info on the LTAC hospital later today.

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17 minutes ago, ProfessorTomoe said:

they can't confirm MRSA in this toe, since there are no open wounds - they'd have to cut the toe open and swab the inside,

That does sound less than optimal.

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I've learned that I'm being transferred to a Long-Term Acute Care hospital tomorrow (Saturday). The hospital is called Kindred Hospital, and it's in the middle of Dallas, TX. I got lucky, since it's one of the hardest ones to get into in the D/FW Metroplex and it has a top-notch reputation.

I'm expecting to spend at least a couple of weeks in there. The Clinical Liason, who came by to see me earlier, said I'll be in a private room, and I'll be getting the same level of treatment that I'm getting now in the regular hospital. This covers antibiotics, pain management, and regular medications.

In other news, the increased dosage and frequency of Dilaudid is making a difference. I'm not floating along at a steady level 7 pain any more. Instead, I run closer to a 6/6.5, with the latter number coming in at the end of the four-hour cycle. (The cycles never run exactly four hours - Thursday had one that ran almost five-and-a-half, due to the nursing snafus (which are gone today, thankfully).)

I'll report again later if I get any further info.

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Hospital Update 2021/07/24:

Today is moving day. I've met with the case worker and have been told that I'm being transferred to Kindred Hospital at 6pm today. I wouldn't bet on the accuracy of that statement, given the fluid nature of Hospital Standard Time, so let's just put it in the ballpark of somewhere around 6 this evening.

Today has also seen a change in my nurses, and with it a change in the quality and timing of my care. Both have most definitely improved. My calls to the nurses' station have been answered faster, and a nurse has shown up in my room more quickly after the calls than before. A very welcome change, and a better way to remember the hospital than before.

I'll see you from Kindred. Later.

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I am now in the new place, Kindred. Have been for a few hours over 12. My new room is older than my old room and a good deal smaller, making me feel somewhat cooped up. So far, only two people that I've met appear to have English as a first language - my doctor (thank goodness) and a physical therapist (whom I won't be seeing anymore). With me wearing hearing aids, it's making comprehension rather difficult.

I have yet to receive my antibiotics yet. The explanation I've been given is that the pharmacy hasn't been open. Well, it opened up 40 minutes ago, so hurry up and get the stuff here. I've already missed a dose, and this infection has proven to be quite stubborn. (EDIT: I've just been told that the pharmacy is mixing up my antibiotics now. Still taking too long.)

The pharmacy is also missing one of my other medications. This got input as a generic on my medication transfer sheet, when it's not available as a generic yet to my knowledge. Who knows what's going on with that one.

What's been the most fun has been my attempts at getting sleep. I've only managed to get any in one hour increments. Either I've woken myself up, or the cold air in the room has, or else the nurse has by drawing my blood. I'll probably fall into micro-sleep mode during the day, where I doze off uncontrollably for minutes at a time. Zzzzz...

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7 hours ago, ProfessorTomoe said:

What's been the most fun has been my attempts at getting sleep. I've only managed to get any in one hour increments.

That really sucks.   Not getting sleep in at least several hour blocks is Not Good.  

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Hospital Update 2021/07/26 9:45 p.m.:

My first full weekday (Monday-Friday) at Kindred has passed without too much fanfare. I have seen, in no particular order:

 

  • A case manager (not my case manager, but one of her colleagues).
  • A nutritionist/Registered Dietitian.
  • A wound care specialist.
  • The doctor leading my case (who comes in at 5:30 a.m. every morning).

Fortunately, none of them overlapped their meetings with each other, as has been the case during some of my other hospital visits. It's detrimental to my care when that happens.

The case manager was friendly enough. She explained living wills, medical Powers of Attorney, and all of that jive. I didn't have much in the way of questions for her, so the meeting was brief and concise.

The nutritionist was very friendly. She didn't try any tricks on me like putting me on a damned "Heart Healthy" diet like the doctor did back at the last hospital. She was concerned about my blood pressure, but when she found that my blood pressure was in fact a bit low, her concern went away.

The wound care specialist was also very friendly. She put a silver alginate patch over the tip of my left big toe, where the podiatrist/surgeon inserted the screw that's holding my newly fused bones together. She also re-wrapped my left leg with the ACE bandages to get the compression working again: the bandages had become a bit loose since they were last wrapped Saturday morning.

My case doctor - the early bird of the bunch - didn't have much to contribute this morning. He simply came in to check up on me, then left. Seriously, there wasn't much else to do, since my situation hasn't changed since Sunday. I'm still on vancomycin and Cefepime for IV antibiotics, and I'm still on Dilaudid every 4 hours or so for pain.

One bright spot of my day was a visit from my wife. She brought lunch from Hat Creek Burger Company, contraband in the form of assorted goodies, and some raspberry-cranberry-flavored sparkling water (good stuff). She also brought a couple of board games, but we only had time to play one of them, the Parker Brothers classic, "Sorry!" She trounced me, I swear on the sheer luck of the draw. We have Scrabble to play the next time she comes up. I fear for my fragile male ego.

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2 hours ago, Don Edwards said:

I think I would find it easier to stay up that late than to get up that early.

I've been getting up that early about 1 day in 3.  Sorta a pain in the butt.

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1 hour ago, ProfessorTomoe said:

The doctor came in at 4:45 a.m. this morning. I think the guy is working with a sleep disorder.

Either that or it's a plan to give you one.  Could go either way.

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Hospital Update #1 2021/07/30 10:45 a.m.:

 I've had a venous ultrasound of my arm lump run (see previous update on my blog). My nurse has just come in and told me that the lump is a DVT in my arm. He also says that they're probably going to have to remove my PICC line and switch it to my right arm. I don't see how that's possible, but he's a nurse and I'm a patient. I'd really rather hear all of this from a doctor, of course, but the nurse says the doctor may not come today. (???) We'll see what happens, and I'll keep you apprised of the situation.

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53 minutes ago, ProfessorTomoe said:

the nurse says the doctor may not come today.

Doesn't your doctor come in ungodly early in the morning?

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4 hours ago, mlooney said:

Doesn't your doctor come in ungodly early in the morning?

Yes, and he came in at 5:20 a.m. this morning.

The nurse called my doctor at home (I guess - could have been an office somewhere) and verified that the lump is a Deep Vein Thrombosis of the Upper Extremities (DVT-UE). So, here's what's going to happen to me in the immediate future:

  • My PICC line will NOT be removed. I guess it's either too much of a hassle, not enough of a danger, too much of a danger, or some combination of the three.
  • On those same lines, I will NOT have to endure getting a new PICC line put into my right arm.
  • I've been getting blood thinner shots (Lovenox) in my stomach in an attempt to ward off blood clots. Fat lot of good they've done me. Effective immediately, instead of one shot in the morning, I'm getting a shot in the morning and a shot at night with a dosage balanced out for my weight.

I don't know how this is going to affect my stay at Kindred, if at all. It's most likely going to affect my post-hospital life, that's for sure.

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