This morning the dialysis tech came in the early hours of the morning and did a session of dialysis. I was a bit surprised to wake up and see the machine gone because I thought they were doing a different type of dialysis called CRRT (continuous renal replacement therapy) and not hemodialysis like we did five years ago. CRRT is a slower dialysis that is run 24 hours instead at a slower pace. It's great that he was able to tolerate the other kind and I was hopeful that he would start to "wake up". But it was not so. I spent part of the morning trying to clean the glue and medical tape out his hair. Last night when they removed the leads they used acetone, but I just used patience, some washcloths and a napkin. There is still quite a bit to be cleaned, but we at least made progress. While he struggled to open his eyes, it was surprising to me how helpful he was in trying to brush his teeth. It was clear that he was participating and it probably felt so good. Since he has a feeding tube for all of his food and meds, his mouth looks so uncomfortable.
We also had a visit from a new set of doctors, liver doctors (hepatologist). They had been asked to consult because Chris has high levels of ammonia (hyperammonemia) in his system, which is yet another thing that can cause confusion. They talked a lot, but didn't say much. Essentially the ammonia is concerning and a sign that there could be issues with his liver (like cirrhosis or fatty liver disease) but it could also be attributed to his failing kidneys or myeloma. When his nurse was doing shift change she summed it up as "his levels are concerning but could be attributed to other things, but they were brought in to see if would be safe to do chemo". No word from Dr Sborov today, so I'm think they are working hard to make sure they can do so safely.
They decided to start CRRT dialysis this afternoon which didn't go all that well. They hooked everything up and tried to get started, but there were issue with his central line which caused the machine as a safety to stop. They did a large IV of heparin to thin his blood, and albumin to plump up his veins and arteries. The line which they placed yesterday wasn't quite long enough (sound familiar) and didn't quite go deep enough. The vein or artery (I can't remember which) is also a bit "floppy" and whenever he coughs or rolls his head it suctions to the side wall and stops the machine. They have to pull or push the line to get it to unstick and then restart the machine. It has to happen quickly or the blood that is in the various parts of being filtered will clot and the entire filtering system and his blood in it has to be discarded.
His poor nurse, Amber, became the third wheel to our anniversary party. When he started the CRRT he became her only patient. But anytime she tried to get anything done, he would move or cough and she would have to fix the line. At one point I stood and held his head and kept him from moving. I'm pretty sure she was so relieved to be done for the day.
However, I think we may have finally found the magic combination. Along with a couple other things, I suggested that we let gravity do some of the work and put pillows under one side to encourage his head to stay put. To try and avoid bed sores they have been trying to move him every few hours, but the importance of cleaning his blood trumps bed sores so hopefully tonight the machine can do it's thing and help clear up the gunk in his system.
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