Minimor
Well-Known Member
Here's why I've been too busy to take photos or get them posted, why I haven't been able to reply to half the threads I've wanted to (haven't even gotten to read many of them on here) and why I haven't gotten to reply to a few PMs or e-mails I've received....
This year has not been a good one. 5 years ago my mom had a knee replacement, and it never really worked for her. I always said she had gotten the wrong size of replacement, because the knee was huge--it looked like she had a big donut in the middle of her knee. The joint never worked well for her either--it was always so stiff, no matter how much she exercised it. It would limber up for a few minutes, and then suddenly be as stiff as could be again. The last couple years she's had a lot of pain, and was getting to the point where she could hardly walk on it again. She kept going back to her doctor and he kept telling her it was just inflammation. Even when she said she could feel things moving in there--things that shouldn't be moving--he just blamed it on inflammation. He wouldn't even send her for x-rays. finally this spring he did order x-rays, and next thing she knew she was being sent for bloodwork by the orthopedic surgeon--bloodwork, and then a CT scan. In one phone call her doctor told her that she had fluid on the knee, and so he'd sent her to the surgeon to have it drained. Imagine her shock when she saw the surgeon and he informed her that her entire replacement was loose and the x-ray and scan showed serious bone damage around that replacement. He said he hoped that he'd be able to save her leg! He'd have operated the next day, but had to wait on some parts to come from the US--he was going to have to remove so much bone that he was needing to put in something called a tumor prosthesis in addition to doing a new replacement.
She had the surgery on August 5th & it actually went well, though it was a long surgery. She had no bone infection so there weren't any complications but post-surgery she had a lot of heat & redness in the knee, even with strong antibiotic therapy while in hospital. She came home on Aug. 13th. A week later she went for her check up with the surgeon, and he felt that she had infection in the leg, so sent her to the hospital's STEP unit for antibiotic therapy. This is where things got hectic. She had to go in twice a day, 7 days a week, for IV antibiotics. I'd get up at 5 to do chores, then take her in at 8 am, drop her off, go to work until she was finished at 10, then pick her up & drive her home (we're 12 miles out of town) then drive back into work, rush home after work to do some chores, take her back for 6 pm, wait around town until 7:15 then drive her home & finish chores then eat supper & fall into bed...after one week the doctor prescribed a second week of treatment, and the knee was looking no better. By then I was worn out. I managed to get some family related leave so that at least I didn't have to make that extra trip to/from town to go back to work, but I was still spending 5 hours a day driving and waiting around the hospital.
Mom went back into hospital on Sept. 4th & had surgery to open the knee & clean/flush it out. After that the leg looked much better, but she was also on double the antibiotics--a 2 1/2 hour infusion (vancomycin followed by rocephin) in the morning and a 2 hour infusion of vancomycin at night. She was in hospital for 3 weeks this time. After the first week they put a PICC line in her arm so she didn't have to be poked with needles all the time....vancomycin is very hard on the veins and so the placement had to be changed frequently--she was getting to the point where she had no useable veins lefts in her lower arms/wrists/hands. She could have come home after the first week, except they couldn't get anything set up for home treatments. Because the doubled dose of Vanco meant it was a 2 hour infusion the STEP nurses couldn't do it (they're allowed to give only 1 hour infusions) and the day treatment center at the hospital was full. Home Care could do it but they didn't have enough staff, so couldn't fit her into their schedule. They said they could teach me to do the evening infusion, which was fine--I even said that I'd do the morning ones too, but was told that wouldn't work because of required blood work. A nurse had to come out to draw blood for the vanco trough and for routine kidney function tests. Sigh. So, while I was on vacation for all of September I was driving in daily for afternoon visiting hours....after the 2nd week I started going in at 9:30 & picking Mom up & bringing her home on a day pass, then would take her back in time for her evening infusion of Vanco. It meant more driving, but overall more time at home so I was able to get a few extra things done here...hoof trimming, fencing...routine things, plus extra things I would normally be working on during my September holidays. Plus Mom could have a good lunch....a break from hospital food!
At least home care was set up, and Mom came home on Sept. 23rd. One of the nurses at the hospital showed me how to set up the IV and flush the PICC and everything--I chose my time carefully so that I'd get the nurse I wanted to learn from. Some are not so careful and I wanted to learn it the right way! The first nurse that came out to our home showed me how to mix the drugs and then we were all set. As it turned out Home Care couldn't be depended on, and I am now doing all of the infusions--I'm a little ticked because that was my original suggestion, and if they'd gone along with that Mom could have been home at least a week sooner, and it would have saved me a lot of running back & forth...I take my supply order into the home care office every few days & then the nurse brings the stuff out when she comes to draw blood. We did have a disagreement over the bloodwork--they wanted her to come into the lab for that & I said no, we're not coming to the lab. The lab techs cannot use the PICC to draw blood, they have to stick a needle in a vein the usual way, and Mom's been stuck with enough needles. A nurse was supposed to come out & draw blood, and a nurse will draw the blood--or, I told them they can give me the tubes & I will draw the blood & take it in to the lab. First they told me I couldn't do that, I didn't know how. Hogwash, I said, getting blood through the PICC is easy, no different than setting up the IV, and after all my years of treating horses & helping my vet....who has taught me to draw blood...I know all about filling the tubes with blood. Oh well, they had to admit I could do it then, but there was surely a law against it....I have no idea if there's any such law or not, but it doesn't matter, I got my nurse--one comes out Thursdays to draw blood for the routine sample (creatinine & CBC) and Mondays to draw blood for the Vanco trough. Otherwise, I do all the infusions--in hospital I learned to use the pump, but home care doesn't have pumps, it's just the old gravity feed so I have to count drips to get the drug in at the right rate....easy enough, but it can take a few tries to get the right number of drops per 15 seconds....a pump would be easier!
The good thing is we're almost done with this--the last dose is the morning of Friday Oct. 16th, and later that day Mom can go into Day Treatment and have the PICC removed. She sees the doctor again this Tuesday and as long as he's satisfied with how her leg looks, that is the plan....then she will be on oral antibiotics for a year. We've been eating a lot of yogurt the last few weeks...
I'll be SO glad when she's off the vanco--she is having side effects from it, but hopefully nothing that won't go away soon after she's off of it. The thing is, vanco can cause permanent hearing loss or kidney failure, even some time after treatment has been discontinued. I don't think either is a common side effect, but the possibility is there, and it's more likely to happen in elderly patients....my mom is 77. So far her blood work has all been where it's supposed to be--quite perfect in fact--so hopefully that continues and means that she won't have a problem. Her leg is looking quite good, and it's working very well for her--much better than it did after that surgery 5 years ago--much less swelling, and much less stiff. So please everyone, keep your fingers crossed and maybe say a little prayer that this works and she will be mobile again, without the need for any further IV treatments...oral antibiotics will be easy after this!!
Funny thing, every single person has been quite amazed that I can run these IVs for her. Initially people would say oh no, you don't want to do that, I wouldn't be comfortable with that, and now they're saying wow, I could NEVER do that. Ah, seriously, there's nothing that hard about it. I mix up the drugs....syringes and needles and sterile water....and then add it to a bag of saline, hook up the line, prime it and attach it after the proper saline flushes and such. I've mixed so many horse meds in my life that I'm perfectly comfortable with needles and drugs, and I can count drips as well as anyone...and I'm much more careful than some of the nurses in the hospital. One of the home care nurses asked me if I were going to take up nursing after this. I had to say no, first off I just don't like people all that well and secondly I'm not good with body fluids! My mom says I'd make a better vet than nurse and I'm quite sure she is right!
This year has not been a good one. 5 years ago my mom had a knee replacement, and it never really worked for her. I always said she had gotten the wrong size of replacement, because the knee was huge--it looked like she had a big donut in the middle of her knee. The joint never worked well for her either--it was always so stiff, no matter how much she exercised it. It would limber up for a few minutes, and then suddenly be as stiff as could be again. The last couple years she's had a lot of pain, and was getting to the point where she could hardly walk on it again. She kept going back to her doctor and he kept telling her it was just inflammation. Even when she said she could feel things moving in there--things that shouldn't be moving--he just blamed it on inflammation. He wouldn't even send her for x-rays. finally this spring he did order x-rays, and next thing she knew she was being sent for bloodwork by the orthopedic surgeon--bloodwork, and then a CT scan. In one phone call her doctor told her that she had fluid on the knee, and so he'd sent her to the surgeon to have it drained. Imagine her shock when she saw the surgeon and he informed her that her entire replacement was loose and the x-ray and scan showed serious bone damage around that replacement. He said he hoped that he'd be able to save her leg! He'd have operated the next day, but had to wait on some parts to come from the US--he was going to have to remove so much bone that he was needing to put in something called a tumor prosthesis in addition to doing a new replacement.
She had the surgery on August 5th & it actually went well, though it was a long surgery. She had no bone infection so there weren't any complications but post-surgery she had a lot of heat & redness in the knee, even with strong antibiotic therapy while in hospital. She came home on Aug. 13th. A week later she went for her check up with the surgeon, and he felt that she had infection in the leg, so sent her to the hospital's STEP unit for antibiotic therapy. This is where things got hectic. She had to go in twice a day, 7 days a week, for IV antibiotics. I'd get up at 5 to do chores, then take her in at 8 am, drop her off, go to work until she was finished at 10, then pick her up & drive her home (we're 12 miles out of town) then drive back into work, rush home after work to do some chores, take her back for 6 pm, wait around town until 7:15 then drive her home & finish chores then eat supper & fall into bed...after one week the doctor prescribed a second week of treatment, and the knee was looking no better. By then I was worn out. I managed to get some family related leave so that at least I didn't have to make that extra trip to/from town to go back to work, but I was still spending 5 hours a day driving and waiting around the hospital.
Mom went back into hospital on Sept. 4th & had surgery to open the knee & clean/flush it out. After that the leg looked much better, but she was also on double the antibiotics--a 2 1/2 hour infusion (vancomycin followed by rocephin) in the morning and a 2 hour infusion of vancomycin at night. She was in hospital for 3 weeks this time. After the first week they put a PICC line in her arm so she didn't have to be poked with needles all the time....vancomycin is very hard on the veins and so the placement had to be changed frequently--she was getting to the point where she had no useable veins lefts in her lower arms/wrists/hands. She could have come home after the first week, except they couldn't get anything set up for home treatments. Because the doubled dose of Vanco meant it was a 2 hour infusion the STEP nurses couldn't do it (they're allowed to give only 1 hour infusions) and the day treatment center at the hospital was full. Home Care could do it but they didn't have enough staff, so couldn't fit her into their schedule. They said they could teach me to do the evening infusion, which was fine--I even said that I'd do the morning ones too, but was told that wouldn't work because of required blood work. A nurse had to come out to draw blood for the vanco trough and for routine kidney function tests. Sigh. So, while I was on vacation for all of September I was driving in daily for afternoon visiting hours....after the 2nd week I started going in at 9:30 & picking Mom up & bringing her home on a day pass, then would take her back in time for her evening infusion of Vanco. It meant more driving, but overall more time at home so I was able to get a few extra things done here...hoof trimming, fencing...routine things, plus extra things I would normally be working on during my September holidays. Plus Mom could have a good lunch....a break from hospital food!
At least home care was set up, and Mom came home on Sept. 23rd. One of the nurses at the hospital showed me how to set up the IV and flush the PICC and everything--I chose my time carefully so that I'd get the nurse I wanted to learn from. Some are not so careful and I wanted to learn it the right way! The first nurse that came out to our home showed me how to mix the drugs and then we were all set. As it turned out Home Care couldn't be depended on, and I am now doing all of the infusions--I'm a little ticked because that was my original suggestion, and if they'd gone along with that Mom could have been home at least a week sooner, and it would have saved me a lot of running back & forth...I take my supply order into the home care office every few days & then the nurse brings the stuff out when she comes to draw blood. We did have a disagreement over the bloodwork--they wanted her to come into the lab for that & I said no, we're not coming to the lab. The lab techs cannot use the PICC to draw blood, they have to stick a needle in a vein the usual way, and Mom's been stuck with enough needles. A nurse was supposed to come out & draw blood, and a nurse will draw the blood--or, I told them they can give me the tubes & I will draw the blood & take it in to the lab. First they told me I couldn't do that, I didn't know how. Hogwash, I said, getting blood through the PICC is easy, no different than setting up the IV, and after all my years of treating horses & helping my vet....who has taught me to draw blood...I know all about filling the tubes with blood. Oh well, they had to admit I could do it then, but there was surely a law against it....I have no idea if there's any such law or not, but it doesn't matter, I got my nurse--one comes out Thursdays to draw blood for the routine sample (creatinine & CBC) and Mondays to draw blood for the Vanco trough. Otherwise, I do all the infusions--in hospital I learned to use the pump, but home care doesn't have pumps, it's just the old gravity feed so I have to count drips to get the drug in at the right rate....easy enough, but it can take a few tries to get the right number of drops per 15 seconds....a pump would be easier!
The good thing is we're almost done with this--the last dose is the morning of Friday Oct. 16th, and later that day Mom can go into Day Treatment and have the PICC removed. She sees the doctor again this Tuesday and as long as he's satisfied with how her leg looks, that is the plan....then she will be on oral antibiotics for a year. We've been eating a lot of yogurt the last few weeks...
I'll be SO glad when she's off the vanco--she is having side effects from it, but hopefully nothing that won't go away soon after she's off of it. The thing is, vanco can cause permanent hearing loss or kidney failure, even some time after treatment has been discontinued. I don't think either is a common side effect, but the possibility is there, and it's more likely to happen in elderly patients....my mom is 77. So far her blood work has all been where it's supposed to be--quite perfect in fact--so hopefully that continues and means that she won't have a problem. Her leg is looking quite good, and it's working very well for her--much better than it did after that surgery 5 years ago--much less swelling, and much less stiff. So please everyone, keep your fingers crossed and maybe say a little prayer that this works and she will be mobile again, without the need for any further IV treatments...oral antibiotics will be easy after this!!
Funny thing, every single person has been quite amazed that I can run these IVs for her. Initially people would say oh no, you don't want to do that, I wouldn't be comfortable with that, and now they're saying wow, I could NEVER do that. Ah, seriously, there's nothing that hard about it. I mix up the drugs....syringes and needles and sterile water....and then add it to a bag of saline, hook up the line, prime it and attach it after the proper saline flushes and such. I've mixed so many horse meds in my life that I'm perfectly comfortable with needles and drugs, and I can count drips as well as anyone...and I'm much more careful than some of the nurses in the hospital. One of the home care nurses asked me if I were going to take up nursing after this. I had to say no, first off I just don't like people all that well and secondly I'm not good with body fluids! My mom says I'd make a better vet than nurse and I'm quite sure she is right!
