Sunday, February 26, 2012

Home Again

I was released from the hospital on Friday, brought home by Sue Sacks (many thanks!).   We even managed to stop my the urgent care center and found my shoes which failed to make it upstairs to my room.  They had a huge bag of abandoned footwear.  I picture all sorts of patients leaving the hospital stocking footed, wondering where their shoes went.

This stay was so long (eight days) because they take pulmonary embolisms very seriously. Alas, the CT with contrast showed a bunch of blood clots in my body. It seems that this is a common consequence of cancer. This means that even with my IVC filter, I am at serious risk of a clot moving where it can do serious damage, either a pulmonary embolism, which can damage the heart, or to the brain, causing stroke. So it is imperative that I go back on blood thinners, forever. In the hospital, they prefer heparin drip since its effects are immediately reversible. They shut off the heparin before the IR procedure to insert the Mediport, and bleeding was not an issue.  At home, they strongly prefer twice-daily injections of low molecular weight heparin, Lovenox, over other thinners like Coumadin. When even my oncologist niece, Allison, said that the Lovenox is better, I agreed. I am finding injecting them into the upper thigh easier than into the belly, especially into my poor beleaguered belly.

The pneumonia was a secondary but still serious concern, since it keeps coming back. So they brought out the big guns, including IV Vancomycin.  This antibiotic of last resort, since it has not yet encountered resistance, amused me since it has been a major research focus of my brother-in-law, Chris. I was sent home with another high-tech oral antibiotic, Augmentin, which, according to Chris, who has literally written a book on antibiotics, is a combination of ampicillin with an enzyme that counters the usual factors that lead to its resistance.  This one was studied by Chris's Harvard colleague and good friend, Jeremy Knowles.  Thanks, chemistry colleagues.

Since I came in with chest pain, and since pulmonary embolisms can damage the heart, the cardiac team has been added to my case.  When Diana was visiting we laughed at the large number of docs who stopped by for a quick visit and check.  Pulmonary, cardiac, hematology, renal, pain management, counseling.  Oh, and physical therapy and who knows what else.  Of course each will show up on the bill.  So we began saying "ka-ching" as each one left, and imagined a world where the patient, concerned about costs, cold ask each doc as she or he arrived, what the visit would cost, and politely decline some.

I had an echocardiogram at one point, heart fine. This is a curiously intimate procedure as the technician places the probe just to the side of the breast and manipulates it around for a good ten minutes. This technician was good, distracting me from the contact by encouraging me to watch the images, including false-color Doppler imaging. He commented that many people don't want to look, but I found it quite fascinating.

The team that sees you daily consists of the senior Attending, a bunch of Fellows, and some residents. One resident would see me first, often before dawn, and report to the team before  rounds. I will call him Dr. Paul. He came by often. Very young, of course, and quite handsome, he had a wonderful bedside manner. When I was quite unhappy about going back on injections, picturing the misery that had followed this in the fall, he sat holding my hand carefully explaining the benefits. On the first day that I was scheduled to the insertion of the Mediport, when I fasted starting at midnight only to be told at 3:30 PM that there was no room for me on the schedule, I think he was more upset that I. When I told him that I would prefer coming home with prescriptions rather that the drugs, since waiting for the pharmacy had delayed my release twice before, he explained that he wanted his patients to go home with the actual meds, and he would see to it that there was no delay.  Then it turned out that the pharmacy there didn't have the Augmentum. Calls to my local pharmacy showed that they had it, but then the insurance company added an extra wrinkle, saying that this required special approval. Diana made many calls, until it was promised, but the pharmacy closed before she arrived to pick it up. But sweet Dr. Paul had said he wouldn't sleep if he thought I didn't have it, so we didn't tell him. (Sue picked it up on the way from the hospital. Its special status resulted in a $50 co-pay.)

My roommate, Risa, was most envious of the attention I received from Dr. Paul.  Her resident would breeze in and out so fast that Risa didn't have time to formulate the many questions she wanted to ask. I was quite lucky.  Thank-you, Dr. Paul. (I didn't call him that.)

The Mediport is a great addition, even as the insertion site is still very sore today. Inserted by an IR doc, it lies completely under the skin, a couple of inches below my right collar bone. It was ready for use right away. Both blood draws and IV infusions can go through the port. A needle goes through the skin and a septum below, attaching the various hoses for access. When the process is all done, the needle and hoses are removed, and all that remains is a small bump under the skin. The poor veins in my arms had been poked so much that even the better nurses were struggling to find a vein.  It will make my weekly infusions easier, and will be a great help in future hospitalizations.  But the blood thinner has to go in muscle.

I am again grotesquely bloated. The CT contrast fluid is harmful to kidneys, and my one kidney needs special care. So long as the creatinine levels were up, indicating kidney distress, they pushed and pushed and pushed saline. I gained 35 pounds, no exaggeration. Most is on the lower half of my body, legs swollen almost beyond recognition, and lots of extra girth about my middle. I don't fold well, even to sit up. This will pass over time, but is certainly a major discomfort at this point.

In an earlier blog I made a crack about a whiner, and from the above you can see that I do whine.  But I am grateful for the fantastic nurses at MSKCC, for the excellent care there, for sweet Dr. Paul, for Diana for coming down from Boston, for Helene who is always around, or so it seems, and for the many friends who stopped by for a visit.

Until the swelling in my legs subsides I do not picture forays outside, but I would welcome brief visits to break up the day. Give me a call.

5 comments:

Marsha said...

Sally, So glad you're back home with Cosmos. I hope you took your pick of the shoes in the shoe bag and came home with some nice Jimmy Choos instead of the flip-flops you probably arrived in. A word of warning: as the mother of every 3-year-old knows, Augmentin is powerful stuff and pediatric nurses always warn one to load a kid up with yogurt to counter-act its sorry effects on the digestive system. It was always a happy day at our house when we finished the bottle, and the good intestinal bacteria could begin to flourish again. Please don't think you are a whiner-- your posts are always insightful and meaningful, and you raise social questions that this country must face, sooner rather than later. It is so generous of you to allow us to come on this arduous journey with you.

Jjulia said...

Hi Sally, Amoxi/Clavulanate is actually a very common cat & dog antibiotic! We vets call it Clavamox, and it's one of the things I prescribe the most. Next time you need any C-mox, be sure to let me know. I can set you up, no problem ;-)

Jjulia said...

Hi Sally, Amoxi/Clavulanate is actually a very common cat & dog antibiotic! We vets call it Clavamox, and it's one of the things I prescribe the most. Next time you need any C-mox, be sure to let me know. I can set you up, no problem ;-)

Jjulia said...

Hi Sally, Amoxi/Clavulanate is actually a very common cat & dog antibiotic! We vets call it Clavamox, and it's one of the things I prescribe the most. Next time you need any C-mox, be sure to let me know. I can set you up, no problem ;-)

Jjulia said...

Hi Sally, Amoxi/Clavulanate is actually a very common cat & dog antibiotic! We vets call it Clavamox, and it's one of the things I prescribe the most. Next time you need any C-mox, be sure to let me know. I can set you up, no problem ;-)