Wednesday, 20 December 2017
FR DICKSON: UP-DATE and Summary POST DISCHARGE
taking a leaf from Father's book I ask that you excuse any errors in this post as I am writing and posting it in a rush before attending Mass and continuing my preparations for Christmas... He has seen this post and allowed me to publish it as it is!
As you know, Father was admitted to hospital on 17th of November with “a very nasty pneumonia” and discharged on December 11th. On admission a temperature of over 38.5oC was accompanied by a high respiratory rate and a low blood pressure of around 80/60. Intravenous (i.v.) fluids to raise the blood pressure resulted in marked oedema of the legs and feet, but successfully raised the systolic pressure to above 100. Additionally, he was told that “although the white cell Count is high as expected, the cells themselves are malformed; they look a bit leukaemic, and we don’t know if this predates your pneumonia and led to it occurring or if it is the result of the pneumonia. We have to wait to see if the haematology team show concern”. Three days of i.v. Tazocin brought some positive change to his condition and his vital signs improved, so his medication was changed to oral co-amoxiclav. Unfortunately this resulted in a deterioration in his condition, and the i.v. Tazocin had to be recommenced. Culture and sensitivity of sputum showed Tazocin should have been effective, but it became necessary to change to seven days of i.v. Meropenem when a third sputum sample showed he had a pseudomonas infection, which is probably sitting in the portion of his lungs where Bronchiectasis was noted early last year. A CT of chest was then taken which showed ‘lung cavities’ (abscess formation).
From day three of his admission, heavy diarrhoea began and continued for ten days. Samples showed he was free from Clostridium Difficil, so the diarrhoea probably resulted from the heavy use of antibiotics. Sadly, even though Father was never a big man, his weight has gone from 11 stone (c.155 pounds) to just over 9 stone (c.131 pounds), so he is quite debilitated.
His mood was very low in hospital as all the ‘news’ seemed to be going in the wrong direction: “you have a nasty pneumonia…the oral antibiotics are not having the expected effect…your white cells look a bit leukaemic…you have a pseudomonas infection…you have lung cavities…you need a bronchoscopy so we can determine what is going on…you need seven days of i.v.’s”. He says his mood was mostly low as he saw what he (formerly a registered nurse himself) described as “failures in nursing care and asepsis”, so when it was suggested he could have his i.v.’s at home from the district (community) nurses or stay in hospital, he chose to go home.
For his discharge the antibiotic was changed from Meropenem, which is given three times daily, to Ciproflaxacin as this can be given twice daily. These seven days of i.v.’s have now ended; he has had his midline removed (interestingly, he says he is not aware of having any pressure applied to the site of insertion during removal of the line, so he is now watching for bleeding, swelling of the arm, pain, redness and heat in the arm) and his bronchoscopy was carried out on 18th of December, the results of this will be made known to him at his follow-up appointment on January 22nd.
Father says he will let you know the result of the bronchoscopy when he has it. Meanwhile please keep up the prayers. Father says “for my spiritual health rather than my physical health, though both would be good!”. He is not well but hopeful that the bronchoscopy will provide for some positive direction in terms of treatment.
At present he is feeling drained, is breathless on minimal exertion, experiencing some upper back pain which he thinks may be due to his cough, and having some soreness around his midline site. That said, he is looking forward to spending Christmas with his siblings, though he has over the last couple of days notices an increase in breathlessness and sputum production (which is now yellow) so despite his observations being quite stable he has commenced his rescue Doxycycline).
His COPD and bronchiectasis will never resolve, and the damage done during exacerbations tends to bring about permanent structural alterations in the lung and thus predispose to permanently worsened airflow, so he will never be as ‘well’ as he was three months ago, but there is every hope of improvement in his condition as it stands today.