Update 9/20/2011

So, things were fairly quiet the last few days. Dad is still in the hospital, fighting an infection in the incision made to replace the pump. The put a wound vac on it after doing a surgical clean-out and debridement and we thought he was over the hump. Turns out he's now got another injection just above the first one. He's going back to the OR today for another clean-out and debridement.

Not sure when he'll be coming home. The main doctor seems to want to get him home ASAP, even though his family, therapy and most of the nursing staff think he needs to stay until he's at least over all these infections. Especially the last couple of days where he's been very tired and no energy from his body fighting the infection. Whenever he's tired, his mental confusion goes up, which makes him potentially be home by himself a bad idea.

We are waiting to find out today what the doctors find in the OR. Not sure we'll get any resolution to the apparent stalemate, but at least we should have more information to debate.

Update 9/14

So, Dad had to have minor surgery last night to clean up an infection. The infection was in the incision made during his pump replacement. They had tried lots of antibiotics, but it wasn't going away so they had to open him up and clean it out. Now he has a "wound vac" on it and hopefully it will heal properly.

Not sure when he's going home yet. He thinks Friday at the earliest, the family is hoping for a few days more than that so that he regains as much strength as possible. That's about it for now.

Update 9/10

Dad is doing good today. He woke up with minimal confusion and is definitely more awake. The pain in his abdomen is better, so hopefully the blood clot in his spleen is clearing. They haven't done another CT and they won't unless his symptoms change or the pain comes back.

They are continuing the antibiotics for the infection. His incision is oozing quite a bit, so hopefully the meds will start working soon.

That's about it for today. Good news for the most part so hopefully we are further along the road to full recovery.

Update 9/9

Just talked to the nurse. Dad is doing ok. Dr. Joyce was just in and said everything is looking good. He's up in a chair right now. Still has the chest tube for now. The nurse thought the confusion was a little less today. He got a little agitated and restless last night,but they think that was from pain. They got that under control and now he seems calmer.
Update 11:30am: Dad is pretty out of it. He hasn't really eaten anything and is in a considerable amount of pain. Infectious disease has found bacteria in his blood. His WBC count is normal and he does not have a fever. It does not appear to be sepis at this point, but there are blood results pending for that. They have also cultured his urine.
Because of pain in his abdomen and the infection, he will be going down soon for a chest and stomach CT. More as we find out.

Update 8:30pm: So, Dad does have a blood infection. He's not septic yet thankfully, and they have started him on super powerful anti-biotics. The other thing we learned is that he has a spleen infarction. Basically, there's a blood clot cutting off the oxygen to his spleen. It's very painful. At this point they are keeping a close eye on it and hoping the clot dissolves on its own. They really don't want to have to do another surgery.

They've also removed the chest tube, so the PICC line is the only thing he's "hooked up to". They can use that for giving meds, drawing blood, etc.

He's still pretty confused and sleepy. Tonight he couldn't remember how to feed himself. Hopefully this will all pass very soon as it's very hard to watch (or even hear about).

Update 9/8

Guess I forgot to update last night. They got the PICC line in with no problems and removed the central line.
He had a bit of a rough evening at first because he can't verbalize asking for pain meds. Once the nurses figured that out, he did better as they were able to keep meds on board. He didn't sleep much last night as he's easily stimulated with activity in the room. They are considering moving him to the step-down unit where it's a little quieter.
Right now they're taking him for a CT of his head to check for signs of a new stroke. It's precautionary only at this point. He's still not able to communicate very well and not really able to follow commands. That is not surprising as we knew the anesthesia would aggravate the stroke symptoms. We won't know results until this afternoon.
I'll try to post more frequently, but I'm at work so it's not as easy.

UPDATE 1:40PM: CT came back clear. No new stroke or bleed!

Update 9/7/2011

Dad is doing well. They removed the vent about 1pm and put him on a CPAP as he was getting pretty agitated from the breathing tube. He's much calmer now.

His vitals continue to look good, and his kidneys appear to have recovered at this point.

Right now they are putting in a PICC line and possibly removing the central line they put in yesterday.

Final Surgery Update

First and most important, the surgery is done and they are working on closing him up. Dr. J. said that the surgery was challenging, but obviously successful. They did not go through the sternum like last time, they did something called a "subcostal" incision, which means they went in under the ribs. There was a fair amount of scar tissue already built up in the ribcage, so they had to put the pump in at an angle and the first time they did it they broke an o-ring on the pump. That is why he had to go back on bypass - so they could fix it. They found a large clot around the cuff that attaches to the heart. They suspect pieces of it were breaking off and getting into the pump, causing the problems he's had for the last few days. They can't see inside the pump right now, but they suspect the company will find a piece of the clot inside it and stuck. During the surgery he started producing urine and it was clearing up. That's not to say that his kidneys are completely ok at this point, but it's encouraging. He may still need dialysis, but they won't know for sure until things have settled down more from the surgery. Dr J. said he was confident that whatever his kidneys might need right now is only temporary. This whole thing could happen again, although it's not common for this model of pump. Dr J. felt that the clot started to form when they had to back down his anti-coagulation meds to account for the GI bleed he had a month or so ago. This time around they will be more aggressive with the anti-coagulates and not as sensitive to the GI bleed. "It's all a balancing act" was the quote. He's on a vent until probably tomorrow. They'll also hopefully get a mental evaluation tomorrow, or whenever they get him off the vent. Dr J. did tell us to expect him to act like he did the first time, if not a little worse. Apparently the affected parts of the brain from a stroke hold onto the anesthesia longer than the rest of the brain. It should clear up in a few days though. Recovery in the hospital will likely be longer than last time, but it's way too early to know for sure. Dad got back to his room about midnight and looked pretty good all things considered.

Message from @Zeeke75: "He's fine. Working on update. Surgery done. More soon."

WOOOOOOOOOOOOOOT! Tears of JOY HERE PEOPLE! Now? I sleep so one of us does and we will post more when the dust settles. Thank you so much for the prayer and support and positive thoughts sent our way. Truly.

Love, Jo

Surgery Update

So, Dad was taken down to surgery about 2:30 and the procedure started at 4:07pm. He was on bypass at 6. We got a call from the nurse about 7:15pm saying that they had removed the old pump, put the new one in and were checking out the LVAD. They figured he'd be back up to the room in a couple of hours and we'd be able to talk to the doctor within an hour. At 8:05pm we got another call saying that they tried to take him off bypass and had to put him back on so they could "fix some things". They didn't say what things or anything, but said that the doctor wouldn't be able to talk for at least another hour.

Update: 2:45pm

They just wheeled Dave out of the room. He will go directly to the OR. We probably won't hear much for the first 3 - 4 hours. More as we know it.

Please keep those prayers and positive thoughts coming. Dave really needs them.

Thank you!

Jo

Update 1:30pm

Just got the notice that Dad should be prepped for surgery. He should be going down within the hour. That is, if anyone believes what they say at this point.

Update 12pm

So...nothing really new to report. They still haven't taken Dad down to surgery. He's "next" on the list, but nobody can say when that will be. The best estimate is at least a couple of hours. Then the REAL waiting begins.

Update: 10:00am

Dad just had a central line put in as a backup to his pump. They're worried about his pump failing since it is working so hard. Still waiting to hear when they are going to take him down to surgery.

Update:10:00am

Dave is still waiting to go to the ER. He was suppose to be first case, but was bumped due to an emergency. His kidneys are still doing okay and his hemoglobin is up. The doctors are looking at his kidney function as a sign of how strong his body is. They are encouraged that his kidney's are doing okay, which is a good sign that his body overall is doing well. They are currently putting in a central line (rather than waiting to do it in the OR). The watts on his pump are increasing and they are afraid that the pump might stop completely. They want to have the central line in now so that if the pump does stop they have a way of keeping his heart beating until they can get him down to the OR. Will update as I can.

Replacement Surgery

Dave is in ICU. Early Friday morning, he developed a large blood clot within his LVAD pump. He was admitted and several hours later he went to the Cath lab, in an attempt to break up the clot with TPA, a high powered clot buster. He came through very well. Saturday, he formed yet another clot within the pump. He's very jaundiced from his liver objecting to the number of red blood cells going through it, his urine is black, he is running a temp, and is in pain. He can't return for more TPA, because he's at great risk for a brain bleed. Options right now - remain on Plavix, Heparin, Coumadin, and aspirin and wait it out. If absolutely necessary, the old pump will be removed and a new one will be placed.

On Sunday, the serious discussions about replacing his LVAD began because something has to be done. The pump is no longer working as it should and it is obvious by the readings that it’s working too hard because of the clots and causing Dave pain. He's trying to hold his own, sleeping mostly and is not very aware of people around him. His liver and kidneys are suffering also. He's receiving units of blood as his hemoglobin levels dictate. He can’t keep going on like this.

On Monday the decision was officially made to replace the pump because the pump he has is now officially "making him sick", not helping. The doctors were fantastic about explaining his options and everyone is at peace with Dave’s choice.

During this open heart surgery to replace the pump, if there is too much damage then they will remove the pump and not replace it. This is not what we are hoping for at all but we trust the doctors will make the right decision for Dave. Also, he is at high risk for strokes due to all of the blood thinners he takes, ironically to prevent the blood clots that he ended up having anyway.

Right about now, Dave will be going into surgery to replace his LVAD pump. We are so very worried for him because he’s so weak right now from all his body has been through since Friday.

Despite Dave’s stroke that occurred after his last procedure, Dave has seen MUCH improvement physically with the insertion of the first LVAD. We are hoping that replacing it will work.

Today we ask for prayers and every positive thought you can throw Dave’s way. Specific things to think about are that he makes it through the procedure safely, the pump is able to be replaced AND that he does not suffer another stroke.

Thank you so much. Your support means the world to us.

Jo