Today I am very thankful that my brother Bill is home from the hospital and seemingly out of harms way. He fell off of the porch and lacerated his spleen. Since he has stage 4 liver damage, he bleeds w/o easily clotting, so he was in intensive care for a few days because of the internal bleeding. To be perfectly honest, I didn't think he was going to survive this one.
We took him to the ER on Friday night right after he fell, and they checked for broken bones, concussion, and internal bleeding. Nothing was apparent, but his blood pressure was very low - something like 100/46. They sent us home w/ orders to come back if there were any changes.
On Saturday morning, he had a headache and was dizzy. It seems that that would just go along with falling on your head (his hands weren't even scratched up - I am going to talk to the doc about reaction time w/ liver failure.....), but since he hadn't had a headache or dizzy the night before, I called a clinic and was going to take him in.
But then.... as he was getting ready to go, the dizziness increased and he actually blacked out and fell as he was walking to the car. The doctor was bypassed and we headed for the hospital.
They checked his hematocrit, and it was down to 23 after being 30 the night before. More ct scans - but w/o contrast, because that would have ruined his one working kidney - and x rays. The doc couldn't see where the bleed was because of the ascites in Bill's belly from the liver failure, so he decided Bill needed to be admitted for observation. We chose to go to the same hospital that he had gone to when he had his cancerous kidney removed in case he needed surgery they are more ready for someone with as many heath issues as he has.
The scary part was that when we took him to the hospital at 1:30 Saturday afternoon, he was perfectly coherent. By 4 he was confusing things a little; by 5 it was more; at 6:30 they took him by ambulance to the other hospital; by 8:30 when I got there w/ him he was lying flat on his back talking very little and was very out of it - no meds had been given. For the next couple of days, he was mostly disoriented, though he could remember his name,birth date, and what month it is which made the docs feel comfortable, but to those of us who know Bill, we were all very concerned.
He spent Saturday night until last night in the hospital, and they felt he was ready to discharge last night. Steve, Matt, and I went to pick him up. He was eating his dinner. And I realized something was wrong. Whenever his ammonia levels are high, he eats incredibly slowly... and he was. I talked to the nurse who talked to the doc who ordered an ammonia level to be taken. I was surprised when it was only 45 - usually when there are problems his level is 100+. Then I was left with the idea that perhaps it was his pain medicine making him confused....
I called the liver doc who said that 45 shouldn't be that noticeable, but more lactulose (which he takes to control ammonia levels) wouldn't hurt him. I convinced him to take 10 ml more - he usually takes 30 ml and I reduced his pain meds just a tad. He woke up hurting and had to take more early this morning.
He seems a bit better this morning. He has a doctor's appt in a couple of hours that I'm taking him to, so I'll get to hang out with him more and see more clearly if his confusion is subsiding.
Oh, one more thing: when they discontinued his IVs, they took out the IVs, put gauze on the openings, and wrapped coban around his arm. About 5 minutes later, he said, "What is wet on my arm?" and as he lifted his arm blood dribbled onto the bed. The nurse came in and pushed on the gauze and blood poured off. Oh.my.heck. Things like that used to happen to my mom after dialysis, but I was never with her and only heard about it.
I have concluded that valium should be ordered for caretakers when so many worrisome things happen... but then would would take care of the sick patient? The song "Designated Drinker" by Alan Jackson kept going through my head this morning. Even though I believe strongly in not drinking, there sure are some days that push me to the edge!
Anyway, I know I spilled my guts, whined and complained, but all in all, I am so very thankful that he made it home alive. 20 months to go before he can be evaluated for a liver transplant.....
(P.S. I have ran out of time and can't edit this post. Please forgive any spelling mistakes, grammar mistakes, etc. ;)