Tuesday, November 10, 2009

Groggy Chemists

A little update on the situation.

I went back down to Florida this past weekend to try to be of use. I managed to see my brother Friday night, Saturday, Sunday, and a little bit on Monday. His condition has improved although he is still acutely ill and still on dialysis.

He has made some progress by being able to urinate a little bit and by continuing to take walks with the assistance of a walker and a companion. His urine output is low but it is way better than nothing at all. He has regained some sensation in his feet but it comes in pins and needles now and the motor control of his feet isn't great.

His kidney function tests, BUN and creatinine, are still greatly elevated but dialyis can take care of that while his kidneys repair themselves. The numbers are a bit, well I wouldn't say alarming at this point, but they still kind of take my breath away. The rest of his electrolytes are fairly stable because of the dialysis and some medications by mouth that he is taking.

He requires infusions of IV iron supplementation because his red blood cell counts are low. The kidneys are partially responsible for red blood cell formation. Added to this is the act of dialysis itself on filtering the blood and the subsequent mangling of a portion of the red blood cells as they travel through a filter outside of your body. Inevitably some of those RBCs are going to get smooshed and be unable to do their job, which is mostly carrying oxygen to the cells.

His blood pressure has been high but this is not terrible given the fact that his heart is only twenty-seven years old and a stress test showed that it is, in fact, a strong heart that can handle a bit of an extra load. He has not had any notable cardiac events at all in the last few days.

He had a porta-cath inserted on Monday for his dialysis treatments. Prior to that he had an access device placed in his jugular vein which is good temporarily but more prone to infection that the kind he has now. The portacath was placed during a quick surgery that he tolerated well. He went straight to dialysis after that to flush out the anesthesia, contrast dye used during the procedure, as well as the excess waste of the past day or so that the kidneys still couldn't deal with. A while later he requested food, which he ate some of and tolerated well.

But let's talk about the more human aspect now.

I washed and massaged my brother's feet. He was starting to regain sensation which feels like pins and needles. I was focused on making him aware of where sensation began and where it stopped. I used everything I knew from previous training in massage.

Interestingly enough, the area of most muscular weakness corresponds with part of the kidney meridian that runs through his lower legs and feet. I refreshed myself on that topic and gave him a great massage on his feet, calves, and shins. He was able to identify what he could feel, and couldn't feel and I think it made him more aware of the progress he has made in the past two weeks. Nerve tracks can grow by 1 millimeter per day so we have a way to go but we're getting there.

Coincidentall later on tha dayhe also was able to release 200 milliliters of urine, fairly normal in color. He called me around 10:30 that night to tell me so. What a change from about 30 ml of urine he produced, black as coffee two week ago before the well ran dry. Healthy kidneys put out about 30 ml of urine per hour. So something good is happening.

I didn't see him too much on Sunday because I was helping my mother pack up some stuff for their move. Right before they went on their cruise and events unfolded, my parents had sold their house in the Orlando area and signed a contract on a house near the Gulf. Ironically, my brother is in a hospital about 20 minutes away from the new house.

It's a better area for them. I had mixed feelings at first because it's near where I lived, where Rob died. In the face of this new phase my family is going through, I could care less. What seemed important three weeks ago is suddenly not important anymore.

Jordan and I spent some good, quality time with my brother in the early part of Monday. My brother's surgery to insert the portacath was 1 PM. My parents had to take care of matters related to the move, like setting up accounts with utilities. My brother was picked up around noon and we followed him down to the holding area for the operating room. My parents said their goodbyes and took Penny with them to run errands.

We had about an hour to talk about things before surgery and spirits were high. I was feeling a certain de ja vous being in that environment, a cross between nursing school and the moments before Rob's catheterizations and surgeries. I was not at all uncomfortable, it almost felt natural and the conversation reflected that.

Still, the unknown always hangs above. Will he tolerate the anesthesia? Will he tolerate the post-operative phase?

He wound up tolerating everything. He wound up dreaming about running during his surgery. The little boy that I loved all while I was growing up, the one that was always running, bouncing balls, making noise, he was dreaming about running again. That boy who had a moody older sister, dressed in dark colors and constantly ruminating over the unfairness of it all; that boy was dreaming about his wide open future.

1 comment:

~~Free said...

You are brilliant, and the best sister ever.