Dad

Questions for Mark

Belinda's: - Does yesterday's incident push back the timeframe for doing the next cath procedure?

- Strictly for planning purposes, can he give us any indication on what we're looking at for Dad being out there? A week? A month? Will they need to wait until they do a cath to make that determination? I fully understand if the answer is 'we don't know yet'

- Jennene covered a lot of good info about the flight back. What else will Dad need to have, and what symptoms do we watch for. This is probably a question best left for later.

- Are they waiting for a particular creatinine level before they do another cath procedure? or just overall waiting for both kidney function and BP levels to be stable?

Barry's: - What caused the sudden change last night? Is this an allergic reaction to the ACE inhibitor or other drug, or was this a real possibility that could reasonably be expected?

- What are some key target numbers we are looking for? This would help when Mom calls. Heart rate, B.P., oxygen levels, kidney output, E.F.

- What is the plan and expectation over the next 24 hours, 3 days, a week. What are the biggest concerns and obstacles during this same period? This will really help us with planning. What indicators, milestones, goals, whatever should we be cognizant of so we can evaluate his improvement or decline.

- What information did the sonogram provide on the condition of the heart and kidneys? Level of short term or long term damage.

- Is a pacemaker a possibility?

- How would you categorize the progress since Friday night?

- His opinion on one of us joining mom...he could help us plan based on response.

--Cheryl 11:11, 4 March 2008 (EST) I just got off the phone with Dad's nighttime nurse, Terry. He said that Dad was awake and feeling a little better and that he had gotten some sleep last night. He is still having an irregular heart beat, but his blood pressure is doing better. He said they have Dad scheduled for an echocardiogram today.

Terry said Dad's EF number is 45. According to Jennene, 55% or higher is normal, at 30% his prognosis is better because he can regain 10-15%. At 10-20% you're looking at definite long term symptoms.

Terry said Dad is on Digoxin (slang, "didg") to help his heart contract. Jennene's email mentioned Digoxin.

Thanks, Barry, for the link for info about Atrial Flutter: Atrial Flutter

Bad news - if you read through that info, it says that having Atrial flutter adds a greater risk of stroke.

We should know a lot more after talking to Dr. Mark Weston and getting the results of the echocardiogram "echo".

As I said in email I'm going to start looking into flying out there. --Cheryl 11:11, 4 March 2008 (EST)

Jennene's email about Congestive heart Failure

HI. Yes, it does sound like he is having congestive heart failure (CHF) right now. That can be something that is temporary, secondary to the shock of the initial insult to his heart muscle. I am sure they are treating it (the treatment protocols are fairly standard). It sounds as if he may have suffered a significant heart attack. Some of this function may come back, particularly if treated aggressively. Long term, he'll need to have an echocardiogram (like a sonogram for the heart) to determine how well his remaining heart muscle is squeezing. In medicial terms, we refer to this as "EF = ejection fraction". Normal is 55 % or greater. Anything less than that is a sign of CHF. They may have already measured this and know his current number, but remember, it may improve over time. The current number may be helpful in determining his prognosis in the following terms: if the current number is in the 10-20% range -- he most definately is going to have long term symptoms and has a poorer long term prognosis. If the current number is closer to 30%, his prognosis is better, because he may gain back 10 - 15% of that, getting him to close to normal function.

He is probably on digoxin, but is likely on some other drugs (like dobutamine) via his IV, if his blood pressure is low. His body is likely trying bery hard to divert what good blood flow it has to places like brain, kidneys, major organs, etc. (His gut is one of the last, so it makes sense that he has no appetite.) He is probably also on some blood thinners and hopefully on a beta-blocker, which is important in the short term (although if his blood pressure is very low, they are limited on how much of this they can give). Anyway, they try to approach it from several directions and it sounds like he is at a decent place with standard protocols. The important thing is that he is improving.

In terms of going out there -- that's a judgement call more related to whether you think he and your Mom can understand what is being said and will follow through. It sounds like he is relatively stable and has a good chance of getting back to Tampa soon. When they do travel, he should do that with several precautions -- a wheelchair for the airport, nitroglycerin tablets in his pocket (with instructions about how/when to use) and an extra supply of all his drugs in case of delays. He needs to carry a copy of his medical record back with him for his doctor in Tampa. If he has had an echocardiogram, a copy of the study (in the form of CD or videotape is better than a paper report) should be made available to him -- to much of a pain to get it sent from Hawaii later. If he is short of breath at all, they might consider portable oxygen for the plane (or at the very least, let the airlines know when he arrives that he has just been hospitalized and to please check that oxygen is available on board if he feels poorly).

Mortality rates are very dependent upon the "EF" number. Once you know that, I can give you a better idea. In regards to the short term, he has made it out of the initial 48 hours and is improving, therefore, he has a decent short term rate -- provided nothing else happens. The kidney stuff should resolve -- you can live on less than one kidney, so they are probably just watching that. And they are already being careful about not assaulting his kidneys more by doing an angiogram, introducing contrast material that they kidneys have to filter out. The only real reason to push for an angiogram (catheterization) now is if they feel that he has more heart muscle at risk and they could balloon it and prevent more damage. They can tell that from EKG's and the echocardiogram. Anyway -- that's a lot of information. Call me if anything is confusing