Another Public Holiday - Another Fall!

Last Friday Margaret was given her shower by another Blue Care RN who commented how independent Margaret was.  Margaret loved her because she thinks that Helen and I worry too much about her. The RN also saw a couple of incidents which highlighted Margaret's confused state.  When the RN arrived Helen was having a shower and Margaret told her to hurry up as she was going to have her shower.  I thought she was worried about our water pressure dropping when both showers are in use which can cause the shower to suddenly run cold or hot.  Helen said that she had finished but Margaret told her to get out as she needed the shower.  I pointed out that she had her own shower and she told me that she didn't know that.

The weekend has been pretty good with Margaret sitting up and chatting with Helen on out back patio and looking a Helen's photos on her computer,   Margaret has been very tired and going to bed quite early but in general she has been quite happy.  Sunday was Anzac Day and Monday was a public holiday.  At about 4.45am Margaret got up to go to the toilet and fell.  She didn't hit anything hard but landed on the carpet on her knees and left arm.  Helen was with her in a few seconds with me close behind.  When we rolled her over we saw that she had two big skin tears on her arm and and her knee was developing a large bruise.  The tears were too much for me to dress so we called an ambulance.  The paramedics applied a temporary dressing and took her to Noosa Emergency Dept for the second time in four weeks.

Margaret's injuries were dressed immediately and after a brief period for her to get herself back to normal she was given a check over by the Doctor.  Fortunately she had no other side effects and was sent home at 8.00am.  her arm is very sore as she has lost some skin so the nurse could not drag it back over the wound.  She rested for the rest of the day but got up and had dinner with us in the evening. She has had a good nights rest but i think that Helen has stayed awake to look out for Margaret going to the toilet.

The following photo was taken as Margaret was being comforted by Helen while we waited twenty minutes for the ambulance.

  The nurse manged to roll back the skin over 90% of the larger area but about half of the smaller area's skin had been torn off.  The modern dressings used will stay on until the weekend.

The Blue Care RN is coming to check on Margaret today and also shower her so we will have an expert to check that things are OK.

A Quiet Few Days

On Tuesday Margaret had her second visit by a Blue Care carer to help shower her.  As usual she was worried that the carer would be nasty and even more worrying that she would not like Louis.  When the carer, also an RN, arrived she was greeted by Louis and she said, "Hello gorgeous!" so she was OK.  In fact, as usual with Blue Care, they treated her very gently and Margaret was soon tucked up in bed again.  She rests most of the day and still gets exhausted by the slightest  exertion and takes a few minutes to regain her breath.

Wednesday was my normal Computer Club day and as my sister, Sue, could not fly out fron England until next week due to the Volcanic Ash problems in Europe, I took the opportunity to attend.  Helen looked after Margaret while I was away for just over four hours.  At the meeting the normal leader was away due to medical tests and her backup was also a bit under the weather so I gave and impromptue talk on Wiki On a Stick and used it to give a short tutorial on Using The Color Tools in The Gimp.  It actually went down quite well as I covered the basics of what is often seen as a complex subject.  It made a great change to be dealing with technical problems and interacting with an interested audience.  If I can make it,  I shall cover the Selection Tools next month.

The major worry with Margaret is that she appears to get very upset when I am not around.  Helen says that she begins looking for me about ten minutes after I go out and does not settle until I come home.  This could be a problem when Helen goes back to South Australia in a just over a weeks time as I normally leave Margaret on her own while I walk Louis or go shopping.  She can contact me on my mobile phone but when she fell at Easter she was not near a phone nor did she have her mobile phone with her.  I have set up her mobile with one touch dialing to my mobile and it is on a lanyard to hang it around her neck but she forgets.  I suppose I shall just have to phone her every quarter of an hour or so to let her know I am still around.

On Thursday we intended to take Margaret out to lunch but she had one of her accidents and decided that she could not make it after all.  We had an alfresco lunch on our back patio, take away roast chicken, salads, mashed potatoes and gravy plus chips for me and Helen.  This was washed down by a bottle of champagne (the EU wont be upset if I put it all in lower case!).

Margaret has been going to bed  at 8.30 pm and we get her settled by 9.00 pm.  She takes a sleeping pill, ducene and some painkillers, parecetamol, and normally sleeps reasonably well.

This morning she woke up very confused and told Helen that she was late and had to have shower before going to work.  She is gradually having more of these episodes of confusion and last night asked when Easter was so she could eat her Easter Egg.

Later today she has another shower courtesy of Blue Care, actually we do pay a nominal fee for their services.

Matgaret's First Week Back Home

It has been a week since Margaret came home from hospital following her heart attack.  It has not been an easy week for her as she is in a great deal of pain and her feet and legs have become very swollen.

Last Thursday she was visited by "that woman" akna the Bluecare RN.  She was quite upset by the thought of the visit but when the RN called she was very good.  I updated the RN on Margaret's condition and medications and she had been briefed by the social worker at the Sunshine Coast Private hospital.  She had a brief talk with Margaret and was very gentle and kind with her.  She also persuaded her to let her shower her.  This was a surprise as Margaret normally wont let anybody shower her.  A carer is calling today, Tuesday, to shower her and I hope Margaret is as cooperative.  The RN commented on Margaret's swollen feet and agreed that I should increase her diuretics, Lasics, to two tablets a day (80mg).

On Friday Helen and I took Margaret for a blood test and had intended to take out to lunch afterwards but Margaret wasn't up to it.  Instead we bought a take away roast chicken, chips and a couple of salads.  We ate these alfresco on our back patio with Margaret sitting in her wheelchair.  It was a great success especially as we had a bottle of sparkling white wine (which we can't call champagne) with the meal. 

Saturday and Sunday were normal days by which I mean Margaret was in a great deal of discomfort, very tired and confused.  Helen and I spent the days catching up with the housework and washing while attending to Margaret's needs.  She gets very worried if left alone for any period of time.  We have finally got her to push the intercom button on her phone when she needs help and we keep an wireless extension nearby through out the day.  Occasionally we answer it with "Room Service!".

Even with the increased diuretics Margaret's legs continued to swell up and she was getting more and more breathless.

On Monday I took her to see he GP for the bloodtest results and advice on her continuing care.  The first thing he did was to increase her diuretics to three tablets a day (120mg) which was where she was before her heart attack. He said that she was showing signs of pulmonary edema which has caused congestive heart failure in the past.  He described her blood test results as terrible, but normal for Margaret.  While they held at this level Margaret was relatively safe.  The eGFR was 25 and creatinine level of 140.  She will have another blood test in a couple of weeks.

Margaret is Home

On Sunday morning I drove down to Brisbane Airport to pick up Helen at 9.00 am. The drive takes about ninety minutes on a good day and it was a good day.   We got back to the hospital just after 10.30 pm.  The hospital is on the way home from Brisbane.

Margaret was still in the ICU so we hung around most of the day to see if we could talk to the specialist but he didn't come before we left at 4.00 pm.  Margaret was pleased to see Helen and we took turns in going to lunch.  Margaret just wanted to go home and was getting upset because her specialist hadn't come.

We got home about 5.00 pm and Margaret phoned me at 6.00 pm to say that she had been transferred to a private room and was coming home tomorrow (Monday).  I phoned the ICU who confirmed that she had been moved but knew nothing about her being discharged next day as she was still on a portable heart monitor because her heart heart rate was still erratic.   I then phoned the ward who said that there might be decision at 9.00 am next day.

On Monday I phoned again and was told that the specialist would not be in to later in the day so we visited at the normal time of 10.30 am.

Throughout the day Margaret became more and more agitated and finally at 3.30 pm I phoned the specialist's rooms only to find that he was not expected to make his rounds until 6.30 pm because he was consulting at another clinic that day.  I phoned the clinic and left a message for him to phone me as soon as he had seen Margaret.  Margaret was very upset when we left to go home but Helen and I were exhausted.

The specialist rang at 6.30 pm.  Basically there was no medical reason for Margaret to stay but he would get the Social Worker to talk to us on Tuesday to see if  if we could cope at home or if we needed extra support.  He said that the tests had shown that Margaret had suffered some heart damage and the problem of blocked arteries still existed.   She would not survive stenting or bypass surgery so she was coming home on medications to minimize the possibility of future attacks.  She would need to be treated with kid gloves.  She could get up and walk around the house using her wheely walker but must use her wheel chair for outside walking even in the garden.  He said that her renal condition was still causing concern.  He had started her on a low dose of diuretics but this had to be monitored as we were in a classic "Catch 22" situation.  The diuretics increase the likelihood of the blood supply to the heart dropping and causing a heart attack but the build up of fluid due to renal failure could cause pulmonary oedema followed congestive heart failure so diuretics are a necessity! 

We visited at 10.30 am on Tuesday.  Margaret was very excited - she was going home but had forgotten the caveat "after the social worker has assessed her post discharge care plan".  The social worker came in at 12.30 pm and made some recommendations and agreed that that Margaret could come home providing the Blue Care RN visited to assess her condition.  This has been set up for today, Thursday.  We were nearly set to go except that the specialist hadn't officially discharged her.

A couple of hours later and phone calls by the ward sister to his rooms he finally came and signed her out.

We were home an hour later.

Margaret is very weak.  She gets very short of breath following the slightest exertion.  On Wednesday I took her to my GP to get new prescriptions for her new medication regime.  We used the wheelchair but she was exhausted when we came home.  Since then even getting out of bed to go to her bathroom results in he gasping for breath.  Unfortunately this can be due to either renal failure or her damaged heart.  She will have her normal renal function blood tests tomorrow and we will get the results next Monday when she visits her GP.

In general Margaret is quite calm and joins us for dinner and sits up a little while afterwards watching TV with us.  She is still difficult to settle down to sleep and can remember having her medications.  Luckily she doesn't seem to want more than a glass or two of wine, which is still permitted under the"What the heck?" condition by her specialist.

Today, Thursday, she is annoyed that the Blue Care RN is calling and "doesn't want that woman bossing me around!"

Helen is going to stay until the end of next week to help out and also meet my young sister who comes to stay next Wednesday form the UK.  They are closer in age to each other that I am to them and Helen loves to refer to her "Auntie Sue".

To close off a few loose ends the CJD concern has been discounted and the infection scare (VRE)  proved unfounded but she had shared a room with an infected person before Christmas.

Encouraging News

I missed Margaret's specialist again yesterday as he came in before lunch.  He did, however, leave a message for me.  Margaret's tests have shown that the heart attack was very mild and that there is only minor damage to the heart.  The main problem, as he identified last Saturday, is to come up with a medication regime which will thin her blood, prevent fluid build up and not make her kidneys worse.

She will probably be transferred to a normal ward today and he will be modifying her medications over the next few days to enable her to come home sometime next week.  Being in a normal ward will enable me to visit more easily as I wont be chucked our for two hours at midday.

Tomorrow I will pick up Helen at Brisbane Airport at 9.00 am and we should be at the hospital by 11 am.

A Further Update on Margaret

Margaret is still in the Cardiac ICU.  I haven't been able to speak to her specialist as he visits Margaret after dinner when I am back at home having spent up to six hours in the hospital.  This update is based on her hospital notes which the nurses give me access to.

On Monday Margaret had an Echocardiogram


I haven't been given the full results but there were some anomalies which required further investigation. To complicate matters her right ankle swelled up and turned purple.  She had it X-rayed on Tuesday but there were no breaks.  The specialist was concerned with internal bleeding and discontinued the blood thinners. He scheduled an ultrasound of the ankle which is the one where she had a strained Achilles tendon just before Christmas.  This showed that the swelling was a hematoma and it will be watched.

Te specialist was still concerned that Margaret's heart rate was abnormally high and arranged for a Nuclear Medicine test where isotopes are injected into her veins and the blood flow to the heart monitored while Margaret was at rest,  Normally the patient them exercises strenously and the flow monitored again.  This was not possible for Margaret so they injected a stimulant to simulate the effect of strenuous exercise.  This was done yesterday morning and took over four hours.  They had major problems finding a vein to insert the canular  and it was finally inserted by a Doctor from the Sudan who won Margaret over with his gentle and proficient behavior.  I will try and get the results today.

One pointer to Margaret's condition is her heart rate monitor.  While I was there yesterday she had to get out of bed to use her commode i.e just a couple of steps.  Her heart rate rose from a high 90 to a dangerous 133 and set off the alarm.  The specialist has discontinued her diuretics which can elevate the heart rate and the nurses are on watch for excessive fluid retention as it too can be dangerous.

This is Margaret's eighth day in the ICU an we have no idea when she will come home.

I have arranged for our daughter, Helen, to come up from South Australia on Sunday and stay for few days.  While Helen and Margaret love each other dearly Helen tends to smother Margaret with attention so this should provide an incentive for her to get well.

More later. 
     

Update on Margaret

Margaret spent a comfortable night on Friday.  I met the specialist who was looking after her on Saturday morning.  She has had a mild heart attack and it appears that one on the chambers of the heart has been damaged.  She would be transfered to a specialist Cardiac ICU about 45 km away asap.

The transfer was made a 1.00 pm and I followed her to the Sunshine Coast Private Hospital where she was placed in an isolation ward in the Cardiac ICU.  I stayed until 5.00 pm but had to leave to avoid driving home after dark and to give Louis a brief walk as he had been on his own for nearly two days.  At 6.00 pm I was phoned by the Cardiac Specialist now looking after Margaret.  He told me that there appeared to be blockage in the blood supply to the heart.  Normally he would confirm this with an angiogram and treat the problem with stents or bypass surgery.  Margaret is to frail to stand an angiogram and certainly not surgery.  The only treatment is to try and increase the blood flow using blood thinners and to reduce her cholesterol level which was over 15 (in Australian Units 4.5 is normal) using increased medication.  This should reduce the chance of another attack.  In the next couple of days when she was more stable he would carry out a non invasive examination of her heart using ultrasound techniques.  When stable she would be sent home with increased medications.