How High is High?

Yesterday I had the opportunity to go in and visit with my sister-in-law through the midday.  Usually I am in during the evening shift and there is not a lot of technical work being done.  When I was in yesterday I was able to observe one of the breathing exercises that they are conducting to prepare her for the removal of her tracheostomy.  It’s quite simple really, they remove the trach hose and loosely fit an oxygen mask over the trach opening to ensure oxygen flow.  She is then forced to breathe on her own while being monitored by the technician and the machines.  Although she did quite well and wasn’t in any obvious distress with respect to her breathing, I left the hospital feeling very uncomfortable with what I saw.

Going into the breathing exercise her resting blood pressure was around 160-170/100.  Her eyes were quite dark and she presented as being in some sort of discomfort.  During the actual exercise her blood pressure rose significantly, to a point where I didn’t think it was possible without all sorts of alarms going off.  I’m talking 250/120.  Can you imagine what her head must have felt like – it must have been like jackhammers pounding in there.  I finally had to speak to the nurse, no one seemed overly concerned at this potentially lethal blood pressure.  In discussion with the nurse, she advised that my sister-in-law had a headache earlier on and that she would administer some more Tylenol to help with that.  She also stated that it was time for some blood pressure medication and she would get that into her too.  The nurse also stated that these breathing exercises do tend to put my sister-in-law’s blood pressure up.  If they are aware of this can’t they do anything prior to commencing the exercises to ensure that she doesn’t face any additional unnecessary risk?

It was all very clinical and detached.  Too detached I’m afraid – it bothered me all night.  My sister-in-law cannot lobby for herself, she’s voiceless at this point in time.  I wonder what the protocols are for this type of situation?  Her son has the same worry as I do in this regard and was going to speak with the doctor this morning.   It seems to be pushing the boundaries a bit unnecessarily allowing her blood pressure to go so high.  We don’t need any more complications, she has been through too much already.

An Unsettling Day

I use this blog to write about my husband’s cancer experience.  Recently I’ve broadened it to include my sister-in-law’s challenges post surgery to remove a tumour.  Today I write one blog that covers both.

Today started off with my husband withdrawn and non-communicative.  Physically he had no real issues, that is, he wasn’t in pain, wasn’t nauseous – he just was not “present” in the way he usually is.  We had an appointment in the afternoon and it took all I had to get him ready and out the door to get there.  When we got back home I made him a cup of tea and left to visit his sister. An hour later he was exactly where I left him, teacup still full, face still troubled.  I wonder about an unconscious connection between siblings.

His sister was experiencing one of the “down” days in this up and down battle of sepsis.  Her temperature was up a little and her blood pressure was up as well.  When her son had arrived in the morning, he found one of her wrists restrained against the bed rail.   How long she had been restrained no one knows but we do know it came off as soon as her son arrived, especially since he noted that it had pressed quite firmly into her skin.  The nurse on during the night explained that he’d restrained my sister-in-law because apparently she kept pulling off her finger clip used to measure her hydration.  It seems remarkable that in such close quarters and with a 1:1 patient nurse ratio that they would find it necessary to restrain her, let alone leave the restraint on for the duration of the shift. When I was there today they were quick to increase her level of sedation because she was getting agitated and could dislodge something, but during the night they restrain rather than sedate?  I don’t understand it and probably never will.

We had a nurse come in and explain some of the challenges my sister-in-law was presenting them with while sedated.  For example she continues to chew on the intubation mouth piece and the nurse with us reprimanded her several times about it while we were in the room.  She moved the tube around and then suctioned her.  I suspect the nurse was trying to reassure us with respect to the level of care but it did the opposite, and my sister-in-law’s blood pressure reflected her objection as well.  This same nurse advised us that my sister-in-law tends to get agitated when moved, “she doesn’t like being moved,” she says.  Then, in the next instant, proceeds to move my sister-in-law’s arm who, guess what, gets agitated.

So I left the hospital feeling rather let down by the medical staff and one particular nurse.  She’d presented me with a new challenge – what and how to tell my husband about his sister’s current status.  Somehow though I think he knew and his present state reflects his frustration because he feels powerless to do anything.  My husband has done so well with his chemo but can’t appreciate it or won’t until his sister is well.  Regardless, the day did end on the upswing when some close family friends dropped by unexpectedly. Was it a coincidence that they stopped by when they did?  It certainly did wonders for his state of mind – thank you.

Surgery Update #5

Yesterday was not a great day for my sister-in-law.  Unfortunately they had to increase her level of support on the respirator as well as provide some medication to stabilize her blood pressure.  Earlier in the day apparently she had become quite agitated so they also had increased her sedation to settle her down a bit.  I spoke with a good friend about this and she mentioned that it could, in part, be caused by nicotine withdrawal.  My sister-in-law has a long history of smoking and has tried on numerous occasions to quit – unsuccessfully.  She’s not a heavy smoker but certainly she can be called a long time smoker.  The hospital can prescribe a patch to address this – if we think it is an issue.  This decision will have to rest with her son – I’ve put it forward and that’s all I can do.

This morning she woke up with a bit of a fever.  They have administered some medication and it appears to have brought everything down, but the concern is why does she have a fever?  The surgeon who performed her surgery has been in and done a physical review and is satisfied in that regard, however, he has asked for a CT scan on a priority basis to determine if there is something else going on that is not visible to the eye.  She has been wheeled down for a scan and now we wait to see what the results are.

Post Chemo Treatment 3 – Day 2

It’s been two days since my husband had his third chemo treatment.  His response after this treatment has not been as severe as after his second treatment.  I have to say the second treatment must have been distorted by the developing blood clot and thrush.  So far this treatment appears to have been better, however, it is still too early to tell.

Yesterday my husband was able to take a litre of hydration given over the course of 5 hours.  Today he was not so lucky.  When the visiting nurse arrived to set up the drip his blood pressure was remarkably high, we felt it was too high for him to take the hydration.  He’s had heart issues in the past and the saline solution might put too much strain on his heart.  We opted to forgo the treatment for today and try again tomorrow.  This meant that we had to focus on getting him to drink around 2 litres of clear fluid on a day when he felt quite nauseous.  The day is almost over and I am afraid we have missed the mark by between 1/2 to 3/4 of a litre.  The visiting nurse will come by in the morning so we have to hope that his blood pressure is at a more respectable rate.  The hydration is key to flushing out the chemo drugs and improving how he feels.

The blood clot continues to be a concern in his leg.  The swelling is still significant, however, it has not moved to any other area of his body as far as we can see.  He was not able to get much exercise in today at all.  He has very low energy and feels under the weather – which is normal for this point in the chemo cycle.  So a day where very little was said or done but where he has managed to get a lot of rest.  Tomorrow is a new day.

Chemo Treatment #3

One of the stations for chemotherapy at our local hospital.  Lots of windows and natural light.

One of the stations for chemotherapy at our local hospital. Lots of windows and natural light.

We are back at it again today. At the hospital in the Chemo Suite. Interesting how next to no one here wears a mask and yet all around us people are sneezing and coughing. Not my husband – he wears his mask throughout the whole process. It is cold and flu season so why take chances?

My husband woke up with very high blood pressure – remarkably high 172\94. He slept poorly and it showed. He is more anxious this time than for any other treatment. This is because of the blood clot and the fact that he had three weeks of feeling lousy after treatment 2. It was hard to get him going and out the door this morning needless to say.

Fortunately we have a very professional nurse today – very informative. You can tell she loves her job. We spoke about the blood clot and his concern about some slight swelling he has had in his other foot – could it be another clot? The nurse said it was likely just some fluid retention and would be highly unlikely that another clot had formed since he is on a high dose of Fragmin which should prevent the existing clot from worsening and the body from making more.

I watch as the chemo drug flows into his body and see his colour go from healthy to an ashen waxen colour.  His body language is remarkably telling too, his shoulders slump and he appears very fatigued.  By the time the treatment is over it has been five hours and he is beat.  We pack up and head home.  No formal dinner tonight, whatever I can get into him I feel lucky about.  So two bowls of soup, one slice of bread, a couple cups of tea and that’s about it.  I’ve got jello ready for later if he fancies something.  It’s likely fluids for the rest of the evening – but at least it is some sort of nourishment.

We have the visiting nurse coming to the house tomorrow to do a litre of hydration – very slowly, at least a five hour drip.  This is in deference to the blood clot.  To allow his body to process the fluids a bit better.   As always I am thankful when we successfully get through each day (and night).