Does this look familiar? If you have been a faithful reader of this blog you will have seen a similar photo on June 12th, June 19th, and June 22nd; 4 of them in less than a month!
This morning Mom got so winded walking from their bedroom to the kitchen, she had to lie down on the couch to catch her breath. She asked me what was wrong, she also was nauseous and the edema in her right leg was all the way up to her knee and the left leg was also swollen. She also had difficulties when they were in Las Vegas, including one incident that had Curt so concerned that he almost called 911. When I went to call Kaiser to see if I could get an appointment for her today I discovered the Honolulu clinic no longer had Saturday hours so I had to call the After Hours Care line. After a bunch of questions they advised me to take her to the Moanalua ER. In the past, they told me to either call the next business day and have her make an appointment with her PCP or to make an appointment through the After Hours Care line and take her in that way; never the ER, so it sounded pretty serious to me. It took Mom about 45 minutes just to change her clothes because she was having such a difficult time breathing.
The triage nurse at the Kaiser Moanalua ER asked a bunch more questions and checked her in to a room. He was back about 15 minutes later to do a “proactive” blood draw. (His term, no doctor had reviewed his intake and conclusions.) The ER doctor came in and also sent her for a chest x-ray and echocardiogram because they suspected congestive heart failure. When the results came back from these they determined her heart was somewhat enlarged due to having to pump more because she had extremely low red blood cell (rbc) counts as well as low white blood cell (wbc) and platelet counts. They sent another technician in later to do another blood draw for typing in preparation for a transfusion. At this point they had no definitive cause, they just knew she was staying overnight. The nurses, technicians, and doctors are down-to-earth, friendly people. I even like the way they improvised the fix for the mouse, I did a similar thing at work with a chopstick!
They have gave her 2 units of blood plus lactated ringers solution because she was also dehydrated; the transfusion is about 3 hours per unit. The also gave her anti-nausea meds and a diuretic to get the fluids out of her tissues. They also did an ultrasound on her leg but determined that there was no clot. Tomorrow they are doing a second echocardiogram and a bone marrow biopsy. There will also be a consultation with a hematologist and an oncologist.
In between all this the nausea subsided and she got hungry. The nurse gave us a menu and told us to choose what she wanted and call it in from the room phone. It was basically room service with a dietician taking your order at the other end and telling you if you are allowed to have whatever you ordered or if it needs to be revised. I can even call her breakfast order in from outside the hospital!
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| Notice the local dishes that are available |
She told the internal medicine doctor that will now be treating her that she wants to go to the Big Island on Tuesday. He told her he would do his best to have all the tests done by then, though he may not have a conclusion or treatment plan at that time. He told her she would feel better than when she came in but not good enough to dance for all of the
bon odori. He also advised her to take advantage of someone pushing her around in a wheelchair, when she needed to just walk somewhere, so she could save her strength for activities that were more fun than walking. (Tomorrow I will check in to wheelchair rentals from the Kohala Hospital.)
He also said this condition did not develop over the past few days, it has been developing at least since January of this year. At that time her platelet count was low and her rbc count was at the low end of normal. He said the low oxygen (caused by low rbc count) would eventually start damaging organs if not treated, so it was a good thing she came in to find out what was wrong, rather than thinking all of her symptoms were just because she was getting old.
This explains a lot of the things that have been happening over the last 6 months or so and especially over the last couple of weeks. In January I had noticed that she has a lot of bruises on her arms and in Vegas she also had a bruise on her shin that ruptured and bled in to her sock. The low platelet count means she does not clot normally so bumps that rupture small blood vessels would leak for a longer period causing a large bruise. Her complaints of being tired or not being able to breathe or legs feeling “heavy” are from lack of oxygen in her tissues due to the lack of rbc’s.
Of course, during all of this my phone had to get temperamental. (In fact, it only got me to the freeway on ramp. So it was a good thing I had been to the Moanalua clinic 2 previous times in the past 3 years and knew the general vicinity.) Even though my phone was fully charged I was having to run it in the ultra power saving mode in order to get it to work at all, which eliminates a lot of functions. The ones I have available are texting and calling, but I limit the calls I will take and use Mom’s phone to make calls.
I will go back tomorrow morning to consult with the doctor. Curt and Lori will also be back there some time tomorrow. Dad said its a good thing I came back when I did! For Mom, the jury is still out; sometimes she likes that I am back, sometimes she doesn't.
