Pradaxa (the pills)!
Dr. Thurmes told us that Lucy will be going on Pradaxa twice per day for her clotting problems. He wanted something with a shorter half-life in case she starts getting the serious nosebleeds again. Pradaxa has been approved for DVT therapy in cancer patients in Europe. FDA approval is pending, but it can be legally prescribed for Lucy's situation.
Lucy's hemoglobin was at 7.2 and she received a one unit transfusion. Her IVs are disconnected. She had two long walks today while still tethered to the IV tree. Her longest walk came after untethering.
As of right now, the only thing that would keep her in the hospital is a fever spike higher than 101.5° tonight. Her pain management is fine. She started her oral antibiotic. That will be twice per day for a week starting tomorrow. The pills are very large uncoated capsules, so we will split them so she has an easier time swallowing them.
Lucy heard from Steve, Julie and Suzy today so she got to tell them about her imminent release. The nice thing is the pace here has slowed down.
Showing posts with label heparin. Show all posts
Showing posts with label heparin. Show all posts
Sunday, March 4, 2012
Saturday, March 3, 2012
One small step for Lucy...
She still hasn't had the giant leap towards going home. Dr. Rousey (hematologist) stopped by this morning. He and Dr. Thurmes are still digging though research studies to see if Pradaxa will be the drug of choice, with Arixta as the runner up. Pradaxa apparently has a shorter half-life which is helpful in case of a complication. Lucy likes the fact that it is oral rather than an injection (OK, so do I!). Neither drug will require as frequent blood testing as Coumadin. I think it is because both drugs are tailored to manage specific coagulation factors while Coumadin takes more of a scorched earth approach?
The IV antibiotics are still going. Right now she gets Vancocin and ampicillin, and both are available orally. While the hematologists are researching Pradaxa, Lucy is still on IV heparin. She has not needed a blood test because she hit therapeutic range.
Julie stopped by this afternoon and really made Lucy's day! It was nice having nearly no interruptions while Julie was here.
Lucy took two walks today. The first was about 50 feet. Her second was close to 150 feet. She would go farther if the damned IVs were done. Her left ankle is loosening up a little. On her second walk, she was able to get her heel on the floor while walking, at least for a few steps. There was still discomfort walking, but she did not get wiped out afterwards. Like last time, her pain started decreasing when she sat down.
Dr. Thurmes will be on rounds tomorrow and said he will stop by. He's been so good to Lucy through this ordeal. He might have the home care anticoagulant and antibiotic choices tomorrow. If so, she will probably be released tomorrow.
The IV antibiotics are still going. Right now she gets Vancocin and ampicillin, and both are available orally. While the hematologists are researching Pradaxa, Lucy is still on IV heparin. She has not needed a blood test because she hit therapeutic range.
Julie stopped by this afternoon and really made Lucy's day! It was nice having nearly no interruptions while Julie was here.
Lucy took two walks today. The first was about 50 feet. Her second was close to 150 feet. She would go farther if the damned IVs were done. Her left ankle is loosening up a little. On her second walk, she was able to get her heel on the floor while walking, at least for a few steps. There was still discomfort walking, but she did not get wiped out afterwards. Like last time, her pain started decreasing when she sat down.
Dr. Thurmes will be on rounds tomorrow and said he will stop by. He's been so good to Lucy through this ordeal. He might have the home care anticoagulant and antibiotic choices tomorrow. If so, she will probably be released tomorrow.
Friday, March 2, 2012
Home on Sunday?
Diane visited Lucy this morning. She always manages to cheer Lucy up and today was no different.
Lucy received some good news today. The Infectious Disease group is very comfortable that the fever spikes and redness in her leg are clot related. She is still on antibiotics. Her Heparin Factor X is at 0.29. Therapeutic range starts at 0.30.
Dr. Thurmes came by and gave her some better news. Since she will be going on either Arixtra (injection) or Pradaxa (oral), her heparin level can be close to therapeutic. Her IV heparin will be stopping soon, and she will be getting switched over to oral antibiotics. He mentioned possibly Sunday as a release date. Lucy has to be off the IVs before going home.
Lucy's left ankle is still extremely stiff. She has not tried walking with her walker yet. Maneuvering is interesting enough without having to coordinate with someone pushing the IV stand. If she gets rid of her IVs tomorrow, she will start walking around and get used to being on her feet again.
Lucy received some good news today. The Infectious Disease group is very comfortable that the fever spikes and redness in her leg are clot related. She is still on antibiotics. Her Heparin Factor X is at 0.29. Therapeutic range starts at 0.30.
Dr. Thurmes came by and gave her some better news. Since she will be going on either Arixtra (injection) or Pradaxa (oral), her heparin level can be close to therapeutic. Her IV heparin will be stopping soon, and she will be getting switched over to oral antibiotics. He mentioned possibly Sunday as a release date. Lucy has to be off the IVs before going home.
Lucy's left ankle is still extremely stiff. She has not tried walking with her walker yet. Maneuvering is interesting enough without having to coordinate with someone pushing the IV stand. If she gets rid of her IVs tomorrow, she will start walking around and get used to being on her feet again.
Thursday, March 1, 2012
March came in like a lion (in a good way)
Lucy had a very busy day with all the people in and out to check on her.
Dr. Dettis (infectious disease) was by and told her he was better than 90% certain her fevers and leg redness were solely from the clots, but he wants her to be on antibiotics for another day or two. That was reassuring for her to hear.
One of the hospital chaplins stopped by, and then Dr. Thurmes (hematologist) was by to see how she was doing. Unfortunately her hemoglobin was at 7.1 so she received one unit of blood just before going to IR. He feels the Coumadin and Lovenox are not working and had two other anticoagulants in mind. One is Pradaxa, which is a pill. The other is a once per day injection which she couldn't remember. We are hoping Pradaxa is a workable solution. Dr. Thurmes had a couple of areas he needed to research first.
Her TPA procedure was delayed because of a couple higher priority cases. She was originally scheduled for 8:30 and finally went down at 12:45. The procedure was done by 1:15. She no longer is on TPA and they can stop doing the neurological tests in another four hours. She should be able to get more sleep tonight and have fewer interruptions.
She did have to have her arm IV access changed. Getting a different one in was very problematic. Her arms have really been poked. Certain drugs cannot be administered into a port, and her antibiotics are all incompatible with heparin.
Julie called tonight and like last night didn't get much time to talk to Lucy. The arm access IV adventure was just beginning.
Lucy got to sit on the edge of the bed for over a half hour. She even managed to stand up before getting back into bed. Tomorrow she will get out of bed and go for some short walks.
Getting the TPA catheter removed is a step towards going home. The next two steps are getting her off IV heparin and letting her leg heal a bit more. Getting the heparin level in line will probably be the most difficult given her past experience. We still don't have a firm release date.
Keep your fingers crossed, and thank you for all the thoughts, prayers, positive energy and good wishes!
Dr. Dettis (infectious disease) was by and told her he was better than 90% certain her fevers and leg redness were solely from the clots, but he wants her to be on antibiotics for another day or two. That was reassuring for her to hear.
One of the hospital chaplins stopped by, and then Dr. Thurmes (hematologist) was by to see how she was doing. Unfortunately her hemoglobin was at 7.1 so she received one unit of blood just before going to IR. He feels the Coumadin and Lovenox are not working and had two other anticoagulants in mind. One is Pradaxa, which is a pill. The other is a once per day injection which she couldn't remember. We are hoping Pradaxa is a workable solution. Dr. Thurmes had a couple of areas he needed to research first.
Her TPA procedure was delayed because of a couple higher priority cases. She was originally scheduled for 8:30 and finally went down at 12:45. The procedure was done by 1:15. She no longer is on TPA and they can stop doing the neurological tests in another four hours. She should be able to get more sleep tonight and have fewer interruptions.
She did have to have her arm IV access changed. Getting a different one in was very problematic. Her arms have really been poked. Certain drugs cannot be administered into a port, and her antibiotics are all incompatible with heparin.
Julie called tonight and like last night didn't get much time to talk to Lucy. The arm access IV adventure was just beginning.
Lucy got to sit on the edge of the bed for over a half hour. She even managed to stand up before getting back into bed. Tomorrow she will get out of bed and go for some short walks.
Getting the TPA catheter removed is a step towards going home. The next two steps are getting her off IV heparin and letting her leg heal a bit more. Getting the heparin level in line will probably be the most difficult given her past experience. We still don't have a firm release date.
Keep your fingers crossed, and thank you for all the thoughts, prayers, positive energy and good wishes!
Wednesday, February 29, 2012
Progress by small steps, not leaps and bounds
Lucy had her TPA procedure this morning. It took less than 90 minutes. She was told they will need to repeat it tomorrow, but they made progress. She still can't get out of bed and she is to keep her leg as still as possible. Lucy seems to be in a little less discomfort today. Lucy doesn't have a firm time for tomorrow's procedure, but it could be as early as 7:30. She is really tired today because of being awakened every two hours for the last couple days, and now has at least one more night of tests.
The hospital plays "Twinkle Twinkle Little Star" when a baby is born. I swear it was playing on a continuous loop today. There is an anecdote stating more babies are born when during bad weather because of the drop in air pressure. The barometer here dropped to 29.23 early this morning and is slowly rising.
Julie called tonight, but Lucy had to get a blood draw a few minutes into the call. Lucy's arms have been poked so much she is bruised. The heparin isn't helping with that either.
We'll see how it goes tomorrow. Thank you for spending some time reading this and have a Happy Leap Day!
The hospital plays "Twinkle Twinkle Little Star" when a baby is born. I swear it was playing on a continuous loop today. There is an anecdote stating more babies are born when during bad weather because of the drop in air pressure. The barometer here dropped to 29.23 early this morning and is slowly rising.
Julie called tonight, but Lucy had to get a blood draw a few minutes into the call. Lucy's arms have been poked so much she is bruised. The heparin isn't helping with that either.
We'll see how it goes tomorrow. Thank you for spending some time reading this and have a Happy Leap Day!
Tuesday, February 28, 2012
"You put your left leg in, you put your left leg out..."
The weather was supposed to be very challenging today. The Twin Cities was under a Winter Storm Warning due to anticipated heavy snow, sleet, freezing rain and high winds. As the morning went on, the storm shifted farther to the north. The Warning was downgraded to an Advisory. As of this writing, it is raining hard. There is still a chance of freezing rain tonight and a chance of a couple inches of snow tomorrow. The day had an unexpected turn of events, but it was in our favor.
Lucy's day had an unexpected turn of events, but in her favor. Marynne from Minnesota Oncology visited with her this morning. Dr. Thurmes was unavailable this morning. Lucy's leg was improving very slowly. Dr. Nashawaty felt that since Lucy had not had a nosebleed in several days, perhaps the TPA catheter option was available.
Her next visitor was Dr. Dittes, an Infections Disease specialist. He felt that Lucy may have celluitis but acknowledged to her that her blood cultures and blood tests show no obvious indication of a bacterial infection. He also told her that her blood clots could be the majority of the fever spikes and redness. He changed the antibiotic she was on to two different IV antibiotics. There is nothing to be concerned about.
Marynne came back a bit later. She was going to see if Interventional Radiology wanted to do the TPA procedure. The best guess was that Lucy would have it done tomorrow morning. They had time today and got to her about 1:30 this afternoon.
The procedure went very quickly. She was done by 2:45. There was a very large clot in her thigh. The clot in her calf was small enough that they were going to let nature take its course. Her left leg was much less clogged than her right leg was a couple weeks ago. We hope that means she will not need subsequent procedures and her recovery time will be shorter. It will be a couple days before she will be able to do the Hokey Pokey.
Of course having the procedure means she also got moved from 8th floor to 3rd floor. The first move was into a two bed room. She got moved again about 20 minutes later to a private room.
Her evening is winding down now that there isn't as much activity. She knows sleeping will be tough tonight because they have to wake her every two hours to do a neurology check. Lucy got to talk to Diane and Julie on the phone tonight which helped brighten her day. I found the beaded owl pictured below in the gift shop. It is beaded and stands about 6" tall.
Here's hoping Leap Day goes well for her. We wish all of you a good evening and have a Happy Leap Day tomorrow!
Lucy's day had an unexpected turn of events, but in her favor. Marynne from Minnesota Oncology visited with her this morning. Dr. Thurmes was unavailable this morning. Lucy's leg was improving very slowly. Dr. Nashawaty felt that since Lucy had not had a nosebleed in several days, perhaps the TPA catheter option was available.
Her next visitor was Dr. Dittes, an Infections Disease specialist. He felt that Lucy may have celluitis but acknowledged to her that her blood cultures and blood tests show no obvious indication of a bacterial infection. He also told her that her blood clots could be the majority of the fever spikes and redness. He changed the antibiotic she was on to two different IV antibiotics. There is nothing to be concerned about.
Marynne came back a bit later. She was going to see if Interventional Radiology wanted to do the TPA procedure. The best guess was that Lucy would have it done tomorrow morning. They had time today and got to her about 1:30 this afternoon.
The procedure went very quickly. She was done by 2:45. There was a very large clot in her thigh. The clot in her calf was small enough that they were going to let nature take its course. Her left leg was much less clogged than her right leg was a couple weeks ago. We hope that means she will not need subsequent procedures and her recovery time will be shorter. It will be a couple days before she will be able to do the Hokey Pokey.
Of course having the procedure means she also got moved from 8th floor to 3rd floor. The first move was into a two bed room. She got moved again about 20 minutes later to a private room.
Her evening is winding down now that there isn't as much activity. She knows sleeping will be tough tonight because they have to wake her every two hours to do a neurology check. Lucy got to talk to Diane and Julie on the phone tonight which helped brighten her day. I found the beaded owl pictured below in the gift shop. It is beaded and stands about 6" tall.
Here's hoping Leap Day goes well for her. We wish all of you a good evening and have a Happy Leap Day tomorrow!
 |
| Lucy's new friend |
Monday, February 27, 2012
Holding pattern
So much for Lucy's heparin staying in the therapeutic range. She has had two adjustments and boluses today and will have a re-test at 9:30 pm tonight. It sounds like she is close to where they want her. The tricky part is having her stay in the therapeutic range for a couple days.
Her nosebleeds have stopped, but Dr. Thurmes is very reluctant to run a TPA catheter in her leg. The TPA would speed up getting rid of the thigh clot. Right now she has to stay the course. Perhaps that could change the longer she goes without a nosebleed. Right now she is dabbing saline gel in her nostrils every four hours and that seems to be working.
The two unit transfusion helped a little, but Lucy's hemoglobin was only at 7.9 today. More than likely she will need a transfusion tomorrow or Wednesday. We have not heard how her white count or platelet count were faring.
She has still been having fever spikes today. Her worst one was 102.8° which was taken down with Tylenol and cool washcloths on the forehead. There is still no indication of an infection. The fevers break within 30 minutes.
One nice thing was she got to use a shower today. The disposable washcloths are nice, but having some independence is nicer. She also got a birthday rose from one of the floral shops today. That was a nice present.
It's still wait and see. A lot depends on how fast her body starts wearing down that clot in the thigh. We have no idea how soon she will be going home. It's frustrating, but it is what it is.
Thank you so much for caring! Your comments are like her getting a Get Well card without having to wait for mail delivery.
Her nosebleeds have stopped, but Dr. Thurmes is very reluctant to run a TPA catheter in her leg. The TPA would speed up getting rid of the thigh clot. Right now she has to stay the course. Perhaps that could change the longer she goes without a nosebleed. Right now she is dabbing saline gel in her nostrils every four hours and that seems to be working.
The two unit transfusion helped a little, but Lucy's hemoglobin was only at 7.9 today. More than likely she will need a transfusion tomorrow or Wednesday. We have not heard how her white count or platelet count were faring.
She has still been having fever spikes today. Her worst one was 102.8° which was taken down with Tylenol and cool washcloths on the forehead. There is still no indication of an infection. The fevers break within 30 minutes.
One nice thing was she got to use a shower today. The disposable washcloths are nice, but having some independence is nicer. She also got a birthday rose from one of the floral shops today. That was a nice present.
It's still wait and see. A lot depends on how fast her body starts wearing down that clot in the thigh. We have no idea how soon she will be going home. It's frustrating, but it is what it is.
Thank you so much for caring! Your comments are like her getting a Get Well card without having to wait for mail delivery.
Sunday, February 26, 2012
Land of transfusion
Lucy's hemoglobin was at 6.0 and her platelets were at 50,000. Dr. Nashawaty had rounds this weekend and he mentioned the irony of keeping Lucy on heparin but also having to transfuse platelets. Her Alimta treatment probably caused the platelet count drop and may be contributing to the hemoglobin level being low.
On the plus side, her heparin is in therapeutic range. She will be in the hospital until at least tomorrow. One of the criteria for release is getting her off IV heparin. Our guess is they would also like to see any risk of infection in her leg eliminated and a noticeable improvement in her leg. It appears her leg is getting a little better. Like her last hospital stay, this will be a day-by-day event.
Today saw a steady stream of nurses and nurses assistants in and out. Lucy said one of her arm blood draws was at 3:00 am this morning. Her port has heparin in it so certain blood tests must be done via her arm.
Lucy's appetite is still good. I went the to cafeteria and picked up a grilled chicken sandwich for lunch. She asked to sample it and wound up eating the whole thing.
Steve and Liz came by this morning and brought cookies. Suzy was by this afternoon and left a stuffed snowy owl and a couple magazines. Julie called to see how Lucy is doing. We also appreciated all the great notes from everyone. Lucy and I do read the comments left in the group or in the blog, and we thank everyone for their words of encouragement.
We're hoping her heparin stays in therapeutic range tomorrow. That will put her one step closer to going home.
On the plus side, her heparin is in therapeutic range. She will be in the hospital until at least tomorrow. One of the criteria for release is getting her off IV heparin. Our guess is they would also like to see any risk of infection in her leg eliminated and a noticeable improvement in her leg. It appears her leg is getting a little better. Like her last hospital stay, this will be a day-by-day event.
Today saw a steady stream of nurses and nurses assistants in and out. Lucy said one of her arm blood draws was at 3:00 am this morning. Her port has heparin in it so certain blood tests must be done via her arm.
Lucy's appetite is still good. I went the to cafeteria and picked up a grilled chicken sandwich for lunch. She asked to sample it and wound up eating the whole thing.
Steve and Liz came by this morning and brought cookies. Suzy was by this afternoon and left a stuffed snowy owl and a couple magazines. Julie called to see how Lucy is doing. We also appreciated all the great notes from everyone. Lucy and I do read the comments left in the group or in the blog, and we thank everyone for their words of encouragement.
We're hoping her heparin stays in therapeutic range tomorrow. That will put her one step closer to going home.
 |
| I found this scrub top in the gift shop. Lucy wants to see it when she is more mobile. I'm sure she will get one. |
 |
| Suzy brought along a new friend for Lucy |
Saturday, February 25, 2012
There will be blood
This morning started with a 75 minute nosebleed. Lucy was supposed to start using Afrin nasal spray but her bleeding started moments after the first spray. She got switched over to a saline gel.
Diane visited Lucy this afternoon. It really helped Lucy's mood. Diane can get Lucy laughing which is really needed right now. Thank you, Diane! She also suggested the title for tonight's post (it was originally Let it bleed). Between the nosebleed and the blood draws, Lucy could have supplied the blood for this season of "Dexter".
Lucy is still running a temperature of around 101°. They are running an IV antibiotic and she is getting Tylenol for her temp.They also drew blood to see if her blood thinner dose needs adjusting. Blood thinners are very touchy. Then they drew blood again looking at her Heparin Factor A. And then drew a third time for blood cultures (again). She also received two large heparin bolus doses.
It sounds like Suzy is going to visit Lucy tomorrow. Unfortunately when Suzy called tonight, Lucy had a lab tech wrapping a tourniquet getting ready for a blood draw and two nurses going over the heparin bolus double check and co-signing procedure. Things do get a little hectic.
Keep Lucy in your thoughts and prayers tonight. Thank you for all your support!
Diane visited Lucy this afternoon. It really helped Lucy's mood. Diane can get Lucy laughing which is really needed right now. Thank you, Diane! She also suggested the title for tonight's post (it was originally Let it bleed). Between the nosebleed and the blood draws, Lucy could have supplied the blood for this season of "Dexter".
Lucy is still running a temperature of around 101°. They are running an IV antibiotic and she is getting Tylenol for her temp.They also drew blood to see if her blood thinner dose needs adjusting. Blood thinners are very touchy. Then they drew blood again looking at her Heparin Factor A. And then drew a third time for blood cultures (again). She also received two large heparin bolus doses.
It sounds like Suzy is going to visit Lucy tomorrow. Unfortunately when Suzy called tonight, Lucy had a lab tech wrapping a tourniquet getting ready for a blood draw and two nurses going over the heparin bolus double check and co-signing procedure. Things do get a little hectic.
Keep Lucy in your thoughts and prayers tonight. Thank you for all your support!
Friday, February 24, 2012
Mondays are supposed to suck, not Fridays
Lucy's leg started getting worse this morning. She called Minnesota Oncology and they set up an appointment for 2:00 this afternoon.
Her nosebleed started at 1:30 and finally let up around 3:00. The nurse practitioner at Minnesota Oncology helped Lucy with her nosebleed. Anticoagulants are so fun. She also was contacted by Dr. Thurmes who was at Fairview Southdale on rounds.
She was admitted to Fairview Southdale as a precaution. Lucy also had some extra blood work drawn along with blood cultures. They need to wait 18 hours after her Lovenox injection before they can start IV heparin. That means she will get woken at 4:30 am. She just had completed an IV antibiotic because they suspect cellulitis. An ultrasound of the left leg found that the clot in her groin was solidifying. We are hoping she will not need a TPA catheter started tomorrow. In the past few hours, she started running a fever which is at about 102° right now. The Tylenol will help reduce the fever.
It is frustrating that this clotting problem flared up again. More than likely she is here until Sunday. We were looking forward to a nice quiet weekend at home and having her leg continue to heal. Now it's back to a wait and see mode. Keep Lucy in your thoughts and prayers this weekend. It helps us get through these setbacks.
At least I don't have to play Nurse Ratched with the Lovenox while she's in the hospital. See, I did manage to find something positive.
Her nosebleed started at 1:30 and finally let up around 3:00. The nurse practitioner at Minnesota Oncology helped Lucy with her nosebleed. Anticoagulants are so fun. She also was contacted by Dr. Thurmes who was at Fairview Southdale on rounds.
She was admitted to Fairview Southdale as a precaution. Lucy also had some extra blood work drawn along with blood cultures. They need to wait 18 hours after her Lovenox injection before they can start IV heparin. That means she will get woken at 4:30 am. She just had completed an IV antibiotic because they suspect cellulitis. An ultrasound of the left leg found that the clot in her groin was solidifying. We are hoping she will not need a TPA catheter started tomorrow. In the past few hours, she started running a fever which is at about 102° right now. The Tylenol will help reduce the fever.
It is frustrating that this clotting problem flared up again. More than likely she is here until Sunday. We were looking forward to a nice quiet weekend at home and having her leg continue to heal. Now it's back to a wait and see mode. Keep Lucy in your thoughts and prayers this weekend. It helps us get through these setbacks.
At least I don't have to play Nurse Ratched with the Lovenox while she's in the hospital. See, I did manage to find something positive.
Subscribe to:
Posts (Atom)