Thursday, July 2, 2009

Mom's Home, Too

Angela has continued regaining her health, slowly and with a bump or two. Her doctor told her the hardest part is the part just before you're well, when you want to resume your regular activities but aren't quite ready. She's finding this to be true.

Last Thursday she developed a fever and was started on antibiotics again. An x-ray Friday confirmed pneumonia, but we didn't hear that result until Monday, and by then she was feeling good again. Apparently the antibiotic was the right one and she got it early enough to head off anything really bad.

I have returned to my home, leaving her in the capable hands of her caregivers. She is planning to go today back to the day program she was attending and discuss returning. I think the tentative plan is for her to go back in a couple of weeks, but they have to do some paperwork and that kind of stuff, and she still has to get a little stronger.

We have appreciated all the prayers and kind words from everyone. God has truly blessed us with a loving family of friends. We thank Him for His healing and look forward to what He must have in store for Angela.

As of now, I don't intend any further posting here since I believe this blog has accomplished its purpose. Thank you all for caring.

Monday, June 22, 2009

Home Again

Yesterday afternoon we came home from San Francisco. Angela's liver enzymes started trending down, though they haven't gone far and she's still very yellow. The doctors are pretty sure what she has was caused by some drug given to her in conjunction with her recent illness, most likely an antibiotic, but they say that since she had so many different medications, we may never know which it was.

For now, she needs blood tests twice a week for a while. After they really start to get better, the frequency can be reduced. They were hopeful that her jaundice could be mostly gone within a couple of weeks.

We are so thankful to everyone for their prayers and encouragement. It's great to be back home. Now we need to get the insulin tweaked so her blood sugars are better controlled and keep her exercising to get stronger. God continues to keep us in His care, and is there a better place to be?

Friday, June 19, 2009

Turning the corner?

Yesterday, Angela had a day full of tests and she wasn't able to eat until 6:00 p.m. I can tell you she really enjoyed supper! This morning she said she woke up with her usual appetite, for the first time in days. There weren't many tests today, just several blood drawings, which are a piece of cake with the PICC line. They have asked her to join a study of drug induced liver injuries and gave her a long questionnaire to fill out. All the doctors now seem to agree that it is a drug induced injury, though not all the results are back and they won't say for absolute certainty.

I didn't get numbers, but her liver enzymes looked "slightly better" today. They want her to stay at least two more days, to make sure the downward trend continues and look at the test results that aren't in yet. Then, hopefully, she will just let time make things better. Our bodies, especially our livers, were made with a remarkable ability to heal themselves. We may never know which drug caused this, though it would surely be nice to know which one we need to stay clear of.

It's now another Sabbath, to be spent in the hospital instead of church. We do have a private room and may be able to listen to something on the computer, though it will have to be something we already have as I've been having terrible luck with their WiFi -- it's so slow most sites time out waiting, but they say they haven't gotten gripes from any other users.

God is blessing us by making Angela feel well again and with doctors who are working to find out the cause and hopefully cure for her liver. He's also blessing Angela with a strong desire to spend more time reading her Bible. In all her down time today, I'm not sure if I even saw her pick up a puzzle book -- maybe for a couple of minutes -- but she's been reading from one of the gospels. We are both looking forward to going home -- to Red Bluff, Addy, and most of all Heaven.

Thursday, June 18, 2009

To San Francisco

I haven’t written anything for a while because there was really nothing new – just hanging in. Angela had an appointment with a hepatologist on Wednesday and I thought there might be something new after that. Well, when she saw him on Wednesday, he wanted her admitted to the hospital he works at, California Pacific in San Francisco. So, we threw some stuff together and came. It was around 9:00 when we got here. I circled the hospital about three times, trying to find a place to park, finally finding a parking garage several blocks away. I left Angela in the car and went to find where to take her, since she certainly couldn’t be walking around, up and down hills, not knowing where we were going. After I found out, I drove her where I could let her off, and they took her to her room. This time, instead of going back to the parking garage – the first time was $4 – I was able to find a place on the street. By the time the paperwork and all was finished, I left close to midnight.

The hospital has arrangements with a local hotel for patients’ families. The rate is about half and it includes parking and breakfast. They also have a complementary shuttle – but it stops around 6:00 p.m. It is strange not having my car to use as a locker during the day, but I’ll adapt. I really don’t want to be driving when I can’t find a place to park and if I do the cost is astronomical.

One of the first things they did was to insert a PICC line, so they don’t have to keep sticking her over and over. Then another ultrasound. This afternoon she is to have a liver biopsy. They will be going through her neck and will be able to test pressures in her heart and liver blood vessels as well as get a tissue sample. The doctors have several causes they are considering for her liver trouble, but she doesn’t exactly fit the picture for any of them. This morning I was told that her liver is doing its necessary functions of removing toxin and synthesizing proteins, but it is very inflamed. I guess it’s nice to know that it is working any way. In a couple of days, they should have the biopsy results and be able to formulate a plan of attack.

Angela is getting a bit tired of all this, and her mood hasn’t been as upbeat, but she wants to be here and get this figured out. She continues to ask God for strength as well as healing, and we are praying for wisdom for the doctors as they try to discover the cause, or at least a cure, for her liver ailment. God has been so good to us, and I know that isn’t going to stop.

Friday, June 12, 2009

Home but not well yet

Angela did get to come home Thursday!!

However, it's not all good. Her liver enzymes, bilirubin, and blood sugars continue to be greatly elevated, and her hemoglobin & hematocrit are well below what they should be.

Thursday evening, Angela's blood glucose was 475 and she was feeling bad and clammy. By phone, the nurses at Mercy advised me to take her to the ER, so we spent about four hours at the local ER, St. Elizabeth's, where she got insulin and some fluid for rehydration.

Today she saw her primary care physician who said her liver is so bad, she wants to focus only on that until it's better. She stopped all meds and supplements, even multi-vitamins, and put her on only insulin, iron, folic acid, and Metamucil. She's also sending Angela to a liver specialist -- just where and when hasn't yet been decided.

This evening Angela's blood sugar was again very elevated, but we had the insulin and instructions, and could take care of it.

Angela wanted to go to her Bible study, but she was just too tired. She also wants to go to Sabbath School, church, and potluck tomorrow. I have convinced her that is too much, and so we'll try for church.

God has healed her lungs; now we're praying for that same healing for her liver. I know he'll answer us according to His love and what He knows is best.

Thursday, June 11, 2009

Going Home - Or Not

Yesterday, Wednesday, Angela had her studies, which didn't get finished until about 1:00. After lunch, breathing treatment, and a walk, she was resting and getting ready to take a shower when the social worker came in and said her doctor was sending her home if the results of the test were negative, as expected. I felt terribly unprepared as I expected a day or two's notice and still felt there were unresolved issues. Anyway, after talking them over with the doctor and with her reassurance, I was OK with it, except for not having the house the way I wanted it for her to come home, like clean sheets on the bed, etc., and the fact that it was too late to arrange for things like a walker, cane and bath seat, that we will need.

But while the paperwork was being done and transport coming to get her - which took a couple of hours = Angela dozed off and wasn't really able to wake up for me. The nurse was able to wake her up and she said she felt like her blood sugar was high. The tested it and it was again over 400, so they gave her insulin and decided to keep her overnight. I am so glad it happened there and not after she came home. That was one of the issues I felt needed better addressing, but I don't think the doctor was aware that this has been happening frequently. Her sugars had been much better the previous day or two in Mercy than they had recently at the rehab hospital.

The fatty liver diagnosis explains most of what is going on, but it doesn't deal with the anemia. She's staying pretty stable, not getting worse but not getting better, either. Maybe there is some connection to the fact that they draw blood from her every time they turn around. Anyway, they decided to give her two more units of red cells last night. She should feel stronger today. The cause of this needs to be figured out. The hosipital doctor wants her primary doctor to order a bone marrow biopsy.

So, I expect I will be bringing her home this evening, 72 days since she's been here!

Praise God!!

Tuesday, June 9, 2009

Maybe an answer

I saw Dr. Johnson, one of Angela's ICU doctors, in the hospital today and told him she was back and why. He said it's fatty liver, then looked at her chart and scans and said she needs to be eating less (though she is eating relatively well) and having her blood sugar more controlled. Then he called her current doctor (the one who admitted her last night was just filling in) and gave her his opinion. When I met this new doctor this afternoon (I wish I could remember her name - I do like her), she said she wanted another test and a discussion with a GI doctor, but basically agreed with Dr. Johnson.

I've spent some time looking up the condition, and it seems that there isn't really a "fix"; Angela just needs to lose weight, keep her diabetes under control, and exercise--things we already know, and maybe take some antioxidants. If it's early enough, it can be reversed. Otherwise, it's progression can at least be stopped. If not, it can lead to cirrhosis, so it's important to take care of it.

That's my short version - hopefully it's correct. At least this makes sense; it's frustrating asking questions and not getting answers.

We are extremely grateful to God for Dr. Johnson and for running into him today.

Monday, June 8, 2009

Back to Mercy Again

The jaundice is getting worse and the liver enzymes are really rising, but she still isn't in pain--enough to get sent back to Mercy Hospital instead of going home. Whoever created "the system" didn't care too much for efficiency. We again spent many hours in the emergency room after the Rehab Hospital doctor was told Angela couldn't be directly admitted. The triage nurse at the ER said she could have been, but we obviously were the victims of a failure to communicate somewhere along the line.

She now has another doctor, who is also baffled by her lack of symptoms to go with her labs and appearance. He's ordered a test or two for tomorrow, and I'm not sure what happens next. Hopefully, something will show up, something fixable.

I am praying that the doctor will be given the wisdom to order the right tests and interpret them correctly.

When this gets resolved, I expect her to go directly home. She has rehabilitated well enough that she doesn't need to return to the rehab hospital. She will still have to work hard at regaining her strength, but she can walk well with a walker or cane - certainly enough to get around her house.

Thursday, June 4, 2009

Tentatively Tuesday

Angela has a tentative date to go home, next Tuesday, June 9. Her rehab is coming along fine. With the therapist, she is walking with only a cane and doing fine. She hasn't been cleared yet to do that with me or one of the aides, though. She is getting stronger and working hard to get her muscles back to what they were.

Medically, she is still jaundiced. Her doctor is still sure it is her gallbladder and that it will have to come out at some point. I'm not sure, but he obviously knows more than I do. Her anemia was a little better the last time it was checked, but with a hemoglobin of 8.0 she still has a ways to go. Her cellulitis is better - her legs are still red, but that's not abnormal for her. They are no longer hot. Her ankles are still swollen, not so bad after a night of elevation, but then worsening during the day. She tried TED hose, but unbelievably they seemed to make it worse, with her foot and ankles swollen even more, but her calves were fine. Her blood sugar is still way too high, and she is resigned to coming home on insulin. I am hopeful that at home, where her diet can be more controlled, maybe we can get a better handle on it. They feed her actually quite well, but she does seem to get a lot of stuff made from white flour - garlic bread, pasta, pancakes, etc.

We continue to pray that she will be completely healed from all the issues that remain, but God knows best, and she is in His hands. He is so good to us.

Monday, June 1, 2009

Very Little Change

I haven't written anything lately because there hasn't been much change in Angela's condition. She is still getting stronger, still jaundiced, still having difficulty with blood sugar control, and still having ankle edema. Actually, her leg edema has worsened. Yesterday, her legs were red and hot, in addition to being swollen, and she was started on antibiotics for cellulitis.

Today, she again showed her independent spirit, deciding that she wasn't going to use a wheelchair or walker but was going to walk by herself. Fortunately her CNA came by and so I didn't have to be the "bad guy". Later, she did take a walk with me and the walker, in spite of her feet being swollen and somewhat painful.

Her doctor has been off for the weekend, and the weekend charge nurse has been trying to figure out the jaundice--she left him a couple of long notes. It doesn't seem certain that it is her gallbladder--too much doesn't fit. I've spent quite some time on the Internet, and I've found lots of information, but getting it to exactly fit her symptoms and labs is much more difficult than I had thought it would be.

Angela's Bible study group came to visit her on Friday evening. They brought flowers, sang songs, had a study from Hebrews, and prayed. She was so blessed by the visit and told them that, Lord willing, she'll be back meeting with them in two weeks.

We continue to thank God for His healing power and grace.

Thursday, May 28, 2009

Keeping on keeping on

Angela's strengthening program is coming along. She's also getting occupational therapy, to help with some adaptive tools and ideas for dressing (putting on socks has always been a challenge), etc. Her lungs are clearing up. She still has a few issues, none of them at all major, compared to where she's been.

She is still jaundiced. According to her doctor, she will need to have her gallbladder removed. He says it can be put off until she develops significant pain, which the doctor is surprised she isn't having. He said her jaundice and high billirubin readings won't damage anything if they are left for the time being. She needs to stay well hydrated to keep her gallbladder functioning as well as it can.

She is somewhat anemic. According to the doctor, this is not related to the gallbladder. Hopefully, it will correct itself. The doctor thinks this is likely.

Her blood sugars have been way out of control. Angela thinks she has this figured out and has cut back on how much she is eating. She says she feels better, and today she actually had at least one normal reading (on insulin). Again, I am told this is not related to her gallbladder issue.

Her feet and ankles have been quite swollen. This is at least partially due to the fact that she spends a large part of each day in her wheelchair, with her feet down. In the morning, after a night of elevating them slightly, they are better. She has been encouraged to stay up, but she thinks starting tomorrow she'll try to take half-hour stretches of being in bed and elevating her feet in an effort to lessen the swelling.

She continues to work hard at getting stronger. No one has said anything further about a discharge date, but I'm going to ask again tomorrow. I understand that they have a weekly conference regarding all patients' probable discharge on Thursdays, so I may get an approximate answer.

Angela's Bible study group is planning to come see her tomorrow evening, and she is very excited about that. She really has appreciated the visits of those who have come, and the cards, thoughts, and prayers of everyone who cares.

God continues to bless her and keep her attitude positive, and we're so grateful.

Monday, May 25, 2009

Getting Stronger

Angela's big accomplishment today was being able to stand up from the toilet in her room by herself. It is rather low, making it more difficult, and she is very proud of this new ability.

Yesterday and today she walked, pushing her wheelchair instead of her walker (which is a bit more difficult but necessary to carry oxygen) from her room to the lobby of the hospital. I'm not good with distances, but I'll bet it is over 300 feet.

She has continued with her physical therapy exercises in spite of the holiday and is looking forward to getting some new ones tomorrow.

Her jaundice is not improving, in spite of the IV fluids and discontinuing the Prilosec. There are two other candidate medications, and the doctor said he is considering stopping or decreasing them, but he was not certain yet that she did not still need them.

She is in good spirits and has been enjoying supper outside at a picnic table.

We continue to thank God for her recovery and to pray that the cause of her jaundice can be determined and corrected.

Friday, May 22, 2009

Jaundiced again

Angela is working hard at getting her legs stronger. She walked several times with the physical therapist and did sitting and standing exercises. She is doing well enough that they signed off on it being OK for her to walk with a nurse or aide or me. I am very glad for that because she won't be getting PT over the long weekend, except what I can do. So, I wrote notes about what she did today and will try to repeat that.

We have a first, tentative idea of when she may be able to go home - possibly the end of next week.

One of the hardest things she'll need to do is go up steps. When we were asked about her steps, I remembered that there were two, but I'd never really paid attention to the configuration, and I told the therapist that I thought they were right together, so that a walker couldn't be placed on one step at a time. When I got back to her house and looked, she has one step up to a 3-foot or so porch, then one step into the house. It will be much easier this way than what I had thought. Another example of God's answering our need before we even knew we needed it!!

Her jaundice appears to have returned, and no one seems to know really why. She'll be having more lab tests tomorrow, and I don't know what treatment may be suggested. She feels fine, with no pain, but her skin itches all over. That may or may not be related. It could be related to her not getting a shower for a while. She asked yesterday and was told she could have one today, but the floor got very busy and no one got showers. She was promised one tomorrow morning. I know it will make her feel better; whether or not it helps the itchiness remains to be seen.

This evening I took her out in her wheelchair to a picnic area just outside the hospital and we ate our supper there. She really likes being outside, and the temperature was just right. We enjoyed it a lot, even though we had to cut it short a bit becasue of mosquitos.

We continue to praise God for her increasing strength.

Wednesday, May 20, 2009

Out with the Foley

One more tube is out, one less thing to get in the way while walking, one more step back to a normal life. Without the catheter, she feels less like a patient and more in control.

More exercising, more walking, more wheeling the wheelchair with her arms. Hemoglobin started to go back up - 8.6 this morning, but so did liver enzymes. Angela has a new doctor today - I think he and the one she had yesterday and last week at Rehab trade off. This one rounds early and I missed him this morning. Tomorrow I'll try to be there at 7:00. This morning he said he wanted her to drink a lot of water today to help with gallbladder function, but nobody told me until around 7:00 this evening, so I didn't particularly encourage it. The staff here are friendly and competent but appear to be overworked. They are always running to someone who needs them, so I'm afraid "little" things like encouraging extra water may get overlooked. Anyway, I really need to see and hear for myself what the doctor wants and be able to ask any questions, so I'll get up early.

God continues to bless us and we continue to be grateful.

Tuesday, May 19, 2009

Back to Rehab

Angela keeps getting stronger in her legs, though slowly. Her lungs are also clearing, but again, slowly.

The liver and gallbladder studies were apparently normal, though I was not able to discuss them specifically with the doctor. Her enzymes are much better, though not normal yet, and she is no longer jaundiced.

Anyway, she returned to the rehab hospital this evening, so we're back to where we were about five days ago.

I am a little concerned that for the past 4-5 days, her hemoglobin has been dropping a little more with each test. Today's was 8.0. If it doesn't turn around in the morning, hopefully I'll be able to corner the doctor and at least ask why that might be and what they intend to do about it.

Other than that, she is progressing, and we are so grateful to God.

Monday, May 18, 2009

No Cholecystectomy

Angela's HIDA scan showed her gallbladder to be working fine, so she won't be having it removed. It is still unclear what has made her liver enzymes shoot up and her eyes turn yellow, but the eyes, at least, are better today.

I have found a gripe about Mercy Hospital - it is next to impossible to get Physical Therapy on Sunday. So Angela spent the day without walking. We did a little exercising of her legs and she stood, with help, a few times. Actually, she was able to have a regular chest x-ray, standing. Her first non-portable chest x-ray, I believe.

She had been kept NPO since yesterday afternoon because of the possibility of surgery, so the clear liquids that they allowed her this evening tasted quite good.

Maybe tomorrow we'll get some answers. In the meantime, her spirits are good, and she feels fine.

We continue to be grateful to God for the healing He is providing.

Saturday, May 16, 2009

Setback

This morning Angela was feeling fine. She got a real shower, her first in ages. I took her outside in a wheelchair, and we walked around the rehab hospital. She really enjoyed it. After lunch, she got tired, so she went back to bed and rested.

But her liver enzymes have been consistently climbing since before she left Mercy, and this morning her eyes looked a bit yellow. So the doctor sent her back to Mercy to have an ultrasound of her gallbladder. They ended up readmitting her. Her new medical doctor said she has cholecystitis and needs to have a cholecystectomy - the sooner the better. But the surgeon said he wasn't sure if the gallbladder was the source of her troubles and has ordered a HIDA scan - a nuclear medicine study of the gallbladder. He says that should show if it is the gallbladder that is the source of the trouble. That should happen tomorrow morning.

God has taken such marvelous care of her so far, and I know He is still watching over her. That thought inspires me.

Standing Under Her Own Power

Yesterday, Angela was able to stand entirely under her own power. She used a walker and had people there in case she needed them, but her legs were strong enough to do the job themselves. She actually walked a shorter distance, but it was with a regular walker that requires her legs to do all the work and doesn't let her lean her upper body on it. This was in the morning; by evening she was again needing some help to stand.

She's also continuing to cough well, with lots of gunk still needing to get out.

At the rehab hospital they have a room with tables and patients can go there for their meals. Angela likes that and has been getting up into a wheelchair for that.

Her prednisone has been cut back to a quarter of what it once was, but she's still taking enough to make her a bit shaky, so eating is not always as neat as she'd like. Her blood sugar still increases, especially in the afternoon, but yesterday it was 200+ instead of the 400+ the day before.

Her spirits are good and she is determined to regain her strength.

We are so thankful to God for all the big and little blessings He has given and continues to give us.

Thursday, May 14, 2009

Another big step

Today Angela was moved from Mercy Hospital to Northern California Rehab Hospital - the name may not be exact, it's from my memory. This is another step towards going home. She has been walking quite well with the physical therapist and the rehab walker. She was practicing putting all of her weight on her legs and now she will need to use a regular walker which will require that. When she feels energetic, typically in the morning, she does much better. By evening, her leg muscles are tired and she finds it harder to stand. She is to have physical therapy twice or even three times a day now. She will also continue her respiratory therapy. Hopefully, it won't be too long until she can go home!!

God truly is good to us.

Wednesday, May 13, 2009

Slow, steady progress

Today, Angela walked a little further - still with the walker and the physical therapist - and she went out the door onto the balcony. This was the first time she could breathe fresh air in many weeks, and she said it energized her.

Her lungs are clearing up. She still sounds very noisy breathing, but the respiratory therapists all say the sounds they heard in the bases are clearing up and what we can hear is stuff much higher up and much more easily coughed up. Angela is coughing quite well - getting rid of the gunk.

It may not be long before she is ready to leave the hospital for a rehab place, to keep gaining strength in her legs. This has not yet been determined but is likely.

We continue to praise God for his wonderful healing.

Sunday, May 10, 2009

Continuing to Improve

Angela continues her respiratory and physical therapy - improving with both. She walked for - I'm guessing - about 40 feet with the walker and physical therapist today. She was up in the chair without a great deal of help on a couple of occasions, and has been coughing quite a bit. The doctor says her chest x-ray looks another 10% better from yesterday, and she is seeming quite like herself. He also started reducing her prednisone and theophylline. She may even be going home by the end of this week. Tomorrow, she should have her swallow evaluated again and will probably be allowed to drink thin liquids like water. That should make taking pills a little easier - she's been using V8.

We continue to marvel at the wonderful providence of God in bring her through this experience and ask for his continued healing and guiding in her life.

Saturday, May 9, 2009

Out of ICU

Yesterday, Angela's doctor said she was to be moved out of ICU, but it didn't happen until this afternoon. She has a private room with a window but the view isn't as good. Before she could look out and see the helicopter land, and she enjoyed that. She's still getting the respiratory therapy like she was, and that is good because she still needs it. Tonight, she needed to have her IV replaced, and she had a tummy ache that we couldn't figure out what it was from unless it was constipation. Again, we are blessed to have nothing worse than this type of complaint.

God is so good.

Friday, May 8, 2009

A Few Steps

Angela walked a total of about 10 feet today, with a walker. She is getting stronger. Her cough is also stronger, and she is coughing up lots of gunk. One of her doctors believes strongly in positional percussion and drainage, meaning she is put on her side with her head down slightly and for 10 minutes the respiratory therapist moves this vibrator/percussor machine over her back, and the secretions drain out. It has worked very well. In fact this evening she is breathing oxygen at a flow rate of only 1 liter per minute and her saturation levels are in the high 90's. Before she got sick she was using 2 liters per minute and her sat rates were in the low 90's. I'm hoping we can learn some similar techniques that she can use at home.

Her diet was advanced to include solid food. She still can't have thin liquids like water until Monday. They get into the lungs easier than thicker foods. She is learning to eat slowly, finish one bite before starting the next, and stop frequently to cough. It isn't easy for her but she's trying hard.

The doctor said she doesn't have to stay in ICU any more, but when I left there were no immediate plans to move her. Her nurse this evening said that for some reason, people in the hospital seem to move around midnight. So, I'm not sure where I'll find her in the morning.

God is so good to us. The hospital staff are saying they love to see miracles like this. Of course, we won't argue. Many of them also believe that God answers prayers.

Thursday, May 7, 2009

Coughing Better

Angela's cough is getting better. She is coughing up some nasty stuff, and the respiratory therapist was able to suction quite a bit of it out. She responds well to the percussion over her lung - so well that tonight they are even going to wake her up a couple of times for that, instead of letting her sleep. Today, she sat up in the chair for about three hours. She stood up for much longer - maybe a minute or so - with Physical Therapy and took some very small shuffle steps in getting from the bed to the chair.

The tentative plan is for her to move from ICU to a rehab hospital a couple of miles away some time next week.

God is continuing to bless her with healing and we are continuing to thank Him.

Wednesday, May 6, 2009

Eating Actual Food

Angela passed the swallow test today, at least well enough to have thick liquids. So, for lunch she had thickened apple juice, mushroom soup, tapioca pudding, and a strawberry shake. All serving sizes were small and she didn't even finish everything, so I didn't really think she had overdone it. But a little later she started complaining of nausea and just not feeling good. We decided she had put too much in her stomach after such a long time without real food. This evening, she ate less and I don't believe had similar troubles.

Her physical therapist was trying to get her to stand with his help, and she was refusing, and I couldn't figure out why. Finally, she got it out that she didn't want his help, she wanted to do it herself, which she isn't capable of quite yet. Anyway, he was very patient and helped her just enough so she stood for him three times, each only a few seconds. But tonight, with two nurses helping her to get from her bed to the chair to eat, she took about three baby steps. That made her feel great.

The respiratory therapy treatments are really helping and she is coughing quite a bit. Her lungs still don't sound great, but they are a lot better. The doctor said that yesterday her chest x-ray looked pretty good but today it was another 40% improved. I looked it and it actually did look like a chest x-ray, not all white like it was the last time I looked.

She is talking in short sentences now. Her voice sounds a little like she inhaled some helium - it is a bit high and soft.

She was using a regular nasal cannula with oxygen at about 5 liters per minute this morning, but the doctor wants her to use the high-pressure cannula because the extra pressure helps her lungs to open up better. She doesn't like the way it feels and complains that it is hard to breathe, so she uses it a little. When she sleeps, she is using the BiPAP, with settings only little higher than she was using before getting sick.

God is continuing to bless us, and we continue to thank Him.

Tuesday, May 5, 2009

Looking Better

Angela had a great day today. Her chest x-ray is looking much better and so is she. She still can't swallow, but she is starting to cough a little. And her respiratory therapist today had a couple of neat tricks. He has a machine called a cough assist that blows air into someone's mouth via a mouthpiece and then sucks it out, encouraging a cough. The hospital has only had the machine a year or so and not everyone is familiar with it or uses it. When he told us about it I was reminded of the Bible verse that says "Before they call I will answer". I was praying for some help for Angela's cough and there it was. Another machine he has does a percussion on her chest to loosen things. She thought it felt a bit like a massage.

She sat up a couple of times and tried to stand with Physical Therapy but wasn't entirely successful. Tomorrow they plan to try a special kind of walker that they said would support her in a way she would feel more secure.

Her voice is coming back. It is weak and a bit squeaky, but I am starting to be able to hear her, and she actually talked to Mike on the phone, a couple of words.

Most of the day today, when she wasn't sleeping, she was using just a plain nasal cannula - at around 5 liters per minute, rather than the high-pressure one she had yesterday or the BiPAP. She was on about 35% oxygen. This is getting into the neighborhood of where she was before the pneumonia and is making everyone very happy.

God has been so good to us and I feel very blessed.

Monday, May 4, 2009

Can't swallow yet - or cough

Angela failed the swallow test - she couldn't swallow the thickened water they gave her, or the applesauce. She will try again tomorrow or soon. I was told not to worry - she would regain her swallowing ability in due course. They put in another tube to feed her, so she is getting some nutrition again.

Her lungs are still not clear; they have a lot of fluid and thick secretions in them. She needs to cough, deep and often, and that is a real problem. Even when she's healthy she can't cough very well. Now she seems almost totally unable to cough at all. If she doesn't get the gunk out of her lungs, she is likely to develop another pneumonia, so they are mentioning the possibility of reintubating her so she can be oxygenated/ventilated while they do a bronchosopy to suction out fluids down deep. It doesn't sound good at all to me, but then neither does another pneumonia. Maybe tomorrow will tell.

She did get up again today. When I got there this morning she was sitting in the chair I usually sit in - I was surely surprised. She sat up again this evening, and stood a few seconds for physical therapy. It is amazing how much strength she has lost and will have to regain.

We continue to praise God for His healing so far and to pray that she will continue to gain strength and be able to get rid of the lung secretions.

Standing up

Oops - I forgot to write last night. Sorry.

Yesterday was a pretty much quiet day. The one forward step Angela made was to stand up. Physical Therapy got her to her feet for a few seconds. However, the effort tired her out and she slept for hours afterwards.

This morning a swallow study is planned to see if her swallow function is still working after all the time with the ET tube. If it is, she will get to start eating. You can imagine the smile on her face when I told her that!!

God has been so good to us and we are so grateful to Him.

Saturday, May 2, 2009

Extubation day

Angela's breathing tube was removed today, and she is no longer on the ventilator. We were expecting this soon, but not necessarily today, so it was a nice surprise when the doctor and respiratory therapist both said she was ready. She is now on BiPAP, which is the same thing she sleeps with at home for sleep apnea. Tomorrow, she'll get to try some food and maybe be able to talk.

God has truly blessed us.

Friday, May 1, 2009

Treading Water

Today, Angela's respiratory therapists made some tests to see if she could come off the ventilator. Three of the four she passed fine - the one where she has to inhale as big as she can and then blow it all out was not easy for her. It's hard to tell, but she may have forgotten how to tell those muscles what to do. After the test she started practicing deep breaths and seems to have gotten the idea. We'll see what tomorrow brings.

She did more exercising with the physical therapist, much the same as yesterday, but they didn't come until after 4:00, and she was tiring easily.

Tonight she wrote me something on a piece of paper to bring in tomorrow. It was difficult for her, and hard to read, but nice to have that available. Tomorrow, I think I'll take her a large size tablet and a crayon.

We continue to thank God for His healing hand on her and everyone for their support and prayers.

Thursday, April 30, 2009

Smiling

When I arrived this morning, Angela greeted me with a smile around her ET tube. It was a strange-looking but beautiful sight. She was alert most of the day. Physical Therapy came in and started her exercising her arms, back, and legs. She's not ready to stand yet, but that may come soon. Her rash and itching are much better. Her fever is somewhat better. Her bowels still aren't moving like they should. They tried a few things today, with limited success. One problem is that if things get backed up it can push on her lungs, and they don't need any squishing!

She was able to enjoy some get-well cards and a small bunch of flowers, which she isn't really supposed to have in ICU, but her nurse said that was just a "guideline". She also watched a little TV. I expect she is a little bit tired of the CDs I've been playing almost constantly for her, but I hope they did the job of helping her stay calm when she was unaware of what was happening.

We continue to marvel at God's blessing and our hearts are filled with gratitude.

Wednesday, April 29, 2009

She's awake

Today Angela is awake. Not entirely, but definitely enough to communicate. She nods or shakes her head, points, and otherwise lets me know what she wants. It is great to have her back.

She was getting a little panicky this morning, but by evening seemed more calm. She is moving her head, exercising her neck, and also moving her legs and arms trying to give them some exercise. She had PT yesterday, but today she's still fighting this infection, so they held it. Hopefully, tomorrow she will resume.

She got a chance to breathe on her own this afternoon for about 20 minutes. She still has the ventilator tube in her throat, but there is a setting on it that lets her do all the work, and they had her on that. The rash that she has had was itching her today, so she got some Benadryl.

It seems so nice to have the major issues be things like fever, rash, and itchiness.

We continue to thank God for healing her and all of you who have kept her in your prayers. There are likely still issues to be faced, but I expect they will not be as significant as what she's been through.

Tuesday, April 28, 2009

A Bump in the Road

Today, Angela developed a fever, and her blood culture showed bacteria. We were told this was not unexpected and is very treatable. She was started on Vancomycin and given Tylenol. Because of the infection, the PICC lines she had in her arms (they make it easier to give her IV fluids or medicines and draw blood for testing) were removed. According to the nurse, bacteria can hide on those lines so they needed to get outta there. That makes it much more difficult for her IV and for when she needs blood drawn - her veins are very difficult to stick. This evening the IV that was started this afternoon had to be removed because it wasn't working right and another one placed. They would like to wait 48 hours before reinserting another PICC line.

She isn't really conscious, though she sometimes appears to be able to answer simple questions or follow simple directions. She is very aware, though, when the nurse performs her "oral hygiene" and makes a very unhappy face. Being stuck for IVs and blood tests also provokes a reaction. She did seem to calm down some when I rubbed her feet. Her sedation medications continue to be decreased. Today, the Versed was stopped. The only thing left of that type is her pain medication.

Her extremities have an occasional sort of tremor or slight spastic movements - perhaps the result of the Ketamine she was on. Hopefully, this will decrease as it gets out of her body.

She has been quite stable on the ventilator and is trying to breathe on her own some, especially when she is agitated.

She appeared to be resting peacefully when I left, though she still had a fever.

I know we have to be prepared for some setbacks along the road, but they sure aren't as fun as yesterday was. Anyway, a new problem is another subject for prayer, and we sure continue to thank God that He has brought her this far.

Monday, April 27, 2009

Three giant steps forward

Today the whole ICU had smiles on their faces. Angela tolerated changing to the "regular" ventilator very well, then she got off the rotating bed and onto a "regular" bed, and she was a little bit responsive, being able to nod her head in answer to a question and squeeze fingers in her hand. The ketamine that she has had for sedation is being tapered off at a fast pace, so tomorrow she will probaby be even more awake.

I am so full of thanks to God first, but also to the entire staff at the hospital. They have been nothing short of wonderful. I was reminded that she still will have bumps in her road to recovery, but for right now I will simply rejoice at what is today.

Sunday, April 26, 2009

Still Not Ready

Angela tolerated the reduced airway pressure down to 16 well, but when they tried to switch her to the conventional ventilator, they found that her compliance (this is the opposite of stiffness) was not even close to what they wanted. This can be measured directly when one is hooked up to a conventional ventilator but not on the Oscillator, so they didn't know that in advance. The respiratory therapist who tried, used a bag on her to manually ventilate her and said that she didn't seem stiff to him, but she's just not ready. Her doctor said we were probably just getting a little impatient and she'll be ready in a day or two.

Other than that, the Lasix is working - the other day you could barely tell she had eyelashes, her eyes were so swollen. Today, she was trying to open them. Her hands are also about half the size they were.

So, it has been a positive day, just not quite what we had hoped for. When I left she was breathing 35% oxygen and maintaining sats of around 94% at an airway pressure of around 16. They will try to lower that to 15 overnight, but I don't think anything else is planned except to wait until her lungs heal a bit more.

God is continuing to heal her, but in His time, not ours. We are continuing to praise Him.

Saturday, April 25, 2009

Another Good Day

Today, Angela's doctor said she is doing "good". Her chest x-ray is better. Her blood gasses are better. She is on 30-35% oxygen, and they are trying to bring the ventilator airway pressure down. It was, earlier on, as high as 35, I believe. Today it started at 20 and was at 19 when I left. The doctor says when it gets to 17, she will go on the regular ventilator. He didn't say "try" - he said she would be ready. The amount of pressure she needs is an indication of how stiff her lungs are. As they become less stiff, less pressure is needed.

I spent the day rubbing her feet and hands and even sat down and read a little. Her bed is tipped with the head up about 10 degrees. She has always scooted downwards, necessitating the nurses to pull her up a couple of times a shift, but today, she was doing it much faster, needing to be pulled up every hour or more. Her nurse today allowed me to help, and the two of us could accomplish the job. Previously, she had to call two other nurses and the three of them would move her. I am becoming "trained". I also replaced her sat probe many times. That is the thing that clips onto her ear and tells the percent oxygen saturation of her blood. Her head is positioned between two cushions and as she rocks back and forth, it falls off frequently. Sometimes they put it on a finger where it stays better, but today her fingers were a little cold, and cold fingers don't give as accurate a reading.

We continue to praise God for the healing he is giving her. Every day when I leave I tell her that Jesus will stay with her and keep his arms around her and keep healing her lungs. Maybe she hears and can understand. Anyway it comforts me.

Friday, April 24, 2009

More baby steps forward

This morning, Angela's CO2 was down to an acceptable level. Respiratory Therapy lowered her % oxygen to 40. Her chest x-ray looks better. So, things are looking up. She has gained something like 25 pounds of fluid since being admitted. Apparently, that is not unusual, but she is now to the point that they are giving her a slow Lasix drip so she can get rid of it. I think that will be another big help.

There was discussion about again trying her on a regular ventilator. They really want to change her over, but not before she is ready. It may be tomorrow, but most likely will be soon. When that is successful, they will try to get her off the rocking bed she's on and if she tolerates that, start decreasing the sedatives and let her begin waking up.

I was reminded again today that were it not for the Oscillator ventilator she is on, or a spectacular miracle, we would have lost her. She is still considered fragile, but to me she seems much more stable than even a few days ago.

We are so thankful to God for His continued healing of Angela. Even though she can't apparently hear me, I'm always telling her that Jesus is right there with His arms around her, healing her lungs. I wonder if she'll remember that when she wakes up.

We are also thankful to each of our friends, family, and even those we don't know for your prayers. So many people are praying for her, and we are so very grateful.

Thursday, April 23, 2009

Holding Her Own

Today started with an elevated CO2, again. More fiddling with ventilator settings brought it down a bit.

The respiratory therapists use this ventilator a lot for newborns, but not so much for adults. That makes this somewhat of a learning process for them, too. They have several values they can set, and the combinations of this one up a little and that one down a little are nearly endless.

They went ahead and tried her on the conventional ventilator again, and again she wasn't ready. After that trial, they changed another setting on the Oscillator, which really brought her CO2 down - it's only about twice normal now.

Her other numbers continue to look good - she is able to maintain saturations in the 90's with only about 50% oxygen. As I understand it, her main problem now is that her lungs are still very stiff, needing lots of pressure to force oxygen in and carbon dioxide out. The increased steroids yesterday were to help that, but mostly she just needs to start healing.

The doctor did say that she is improving, albeit very slowly. Each of her nurses continues to remind me, generally subtly, that she is very, very sick still, and not at all out of the woods yet.

She remains in God's hands, and we do so appreciate all the prayers on her behalf. He will continue to heal her if it is His will.

Wednesday, April 22, 2009

A Good Day

Today didn't start so good. Angela's CO2 was elevated again, then she got another plug in her ventilator. Her hemoglobin was down in the 7 range. The doctor said her lungs felt stiff again. But she responded to the treatments.

The doctor increased her steroids, gave her 2 units of red blood cells, and was satisfied with her response. When I left at 6:30 or so, she was on 49% oxygen with a pressure of around 20 and maintaining sat rates in the high 90's. I'm not sure of her CO2 level, because they hadn't drawn a blood gases in awhile. Her kidneys were working overtime - I think they said she produced 3 liters of urine today. That is one way the body has of getting rid of excess CO2, so it is a good thing.

These are small steps, and she is still very sick, but it looks like she's heading in the right direction, and we continue to thank God for that.

Tuesday, April 21, 2009

Two steps forward, one step backward

This morning, Angela had problems getting rid of carbon dioxide, not a new problem for her. In the late morning the doctor and respiratory therapists tweaked the ventilator settings, and she started improving. The goal is to get her mean airway pressure to around 15 (I don't remember the units). They were able to lower it to around 22, but tried for around 21 and she wasn't able to tolerate that. Her % oxygen was down below 50, but had to be raised a bit after the failed attempt to lower her airway pressure. By 6:00 when I left, her airway pressure was around 24 and % oxygen at 54.

The doctor wants to try her on the regular ventilator again, maybe tomorrow or the next day, depending on how well she continues to do. He told me today that the alveoli that were so stiff are becoming more pliable. I take that to mean that the lungs are starting to heal.

I am still being reminded that she is one very sick girl, but I think a little bit less sick than yesterday. Praise God.

Monday, April 20, 2009

Baby steps forward

Today has been a better day. When we arrived at the hospital she was on 80% oxygen, maintaining her saturation level. When we left this evening, she was only needing 65%. Also, she was able to maintain her saturation while the bed was stopped rotating for the breaking it down and bathing her that is done daily, and it was much more steady while rotating from side to side.

We're praising God for her improvement but are aware that she is still not out of the woods, and we're not off the roller coaster yet.

Sunday, April 19, 2009

No Headway

Today, Angela appeared to be doing well. She tolerated a lowered oxygen pressure and percentage - down to 59%. Then, midafternoon, she got a piece of secretions hung up in her ventilator tube, so it had to be changed. She didn't recover as quickly from that as she should, so the doctor bronchoscoped part of her lungs, looking for other pieces of gunk, but didn't really find any. As of 6:30, there was no further change from 5:00, when we left - her oxygen percent has been raised to 75%, and she desaturates when the bed turns her to her left, recovering when the bed puts her on her right.



She continues to be in the Lord's hands, and we know He will do what is best.

Saturday, April 18, 2009

Not Ready Yet

This morning, Angela was given a trial of switching to the regular ventilator. After a couple of hours of "fiddling", it was apparent that she wasn't doing well enough, so she was switched back to the rescue, Oscillator ventilator. After recovering from this attempt, she remained fairly stable at about the same settings as yesterday.

Her pastor came in the afternoon and annointed her.

She continues to be in God's hands, and we are truly as helpless as we feel.

Ups and Downs

The hospital staff keeps reminding us how very sick Angela is, and she continues to improve, followed by crisis after crisis.

Thursday night, she had to be retubed and was set back quite a bit. By Friday night she was looking better.

This morning, the plan is to change her to a "regular" ventilator.

This afternoon, her Pastor plans to come and annoint her.

Thanks for your prayers.

Thursday, April 16, 2009

History

I'm writing this blog to let those who are interested know how God is working in Angela's health.

Angela is in Mercy Hospital in Redding, CA with Adult Respiratory Distress Syndrome, apparently caused by viral pneumonia. She is getting better, but by baby steps, some forward and some backward.

Her life support consists of an oscillator ventilator, a rotating bed, a feeding tube, and nearly a dozen IVs.

The oscillator ventilator breathes for her, but not anything like normal breathing - it's probably around four times a second, and very shallow, making her belly look a little like she is laughing heartily. It is being used because the regular ventilator was not keeping her stable. This type of ventilator is used often for premature babies, but the ICU staff tells us they only use them on adults about every six months - they are reserved for people that fail the regular ventilator. Oxygen is forced into her lungs and then out. As of this evening, she was on 70% oxygen. Considering that she started at 100%, this is an improvement, but considering that room air is about 21% oxygen and that the 2 liters per minute she previously used at home translates to about 29% oxygen, she still has a ways to go. Her saturation rates are staying between 87 and 92, more or less. The goal is to lower the percent oxygen that she is given while maintaining those saturation levels. It is done in small increments, and sometimes has to be set back because her saturation rate lowers.

Yesterday, she had a very good day, with saturation levels remaining in the desired range while percent of oxygen was gradually decreased, to as far as 60%.

Today was a more challenging day. She is sedated for several reasons, one of which is to keep her from fighting to breathe on her own. She wants to be awake, and the staff is having a difficult time keeping her sedated. She has tried to talk, but we can't understand what she says, and that is very frustrating for her.

Mike's sister Kathryn came up from Turlock to stay with me for a few days, and I really appreciate that.

Tonight, when we left the hospital, Angela was sedated and seemed peaceful. We left her CD player with some music on for her. Her oxygen percent was at 70, and she seemed to be maintaining her saturation. I guess because of the difficult day, the plan was to just maintain her over night, without necessarily trying any further to lower her oxygen percent. I have learned, however, that plans are very fluid.

She had some visitors from her church today. I don't think she was aware they were there, but they had prayer with her and me. It was nice to know that others also care.

The physicians, nurses, respiratory therapists, and everyone else we have met at Mercy are superbly competent and caring, and we know she is in the best place she could be. Of course, she is in the Lord's hands, and we know He will keep her and heal her if that is His will.

I'll try to post here at least daily, to keep you informed of her progress.