Another Year Another Blood Transfusion

About three weeks ago, after Muddear's respite stay at Brookwood Retirement Community, it was time for a doctor's appointment. Thank goodness! I was worried that she was coming down with another upper respiratory infection - Muddear had been complaining of a severe sore throat and coughing.

We utilize visiting physicians - what a blessing to have doctor's come to your home instead of the cumbersome job of transporting a wheelchair bound person from home to doctor and back again. The doctor - Dr. Amin - ordered chest x-rays, which thankfully came back negative. Additionally, I requested blood work, because it had been a few months since Muddear had blood tests. This is critical due to the sheer number of medications she has been prescribed. Surprisingly, Muddear's hemoglobin levels came back extremely low. As you know, Muddear is normally anemic, nevertheless I was quite surprised when the doctor advised that I should take Muddear to the hospital for a possible blood transfusion. Surprised, but not alarmed - we went through this same "exercise" in March of 2009.

Typically, we take Muddear to Mercy Hospital - this time was no different. Let me take a moment to say kudos to Mercy's new ER check-in process. Within 30 minutes Muddear had a room and had been seen by an aide, her nurse, and the doctor! Never before have I received such speedy and attentive service in the emergency room. Kind of like an episode from Gray's Anatomy!

So fast forwarding this account...

Muddear did in fact receive a blood transfusion. For those of you with small veins, be advised that if a small IV needle is used for your IV it is not large enough to accommodate a blood transfusion. A PICC Line (pictured in the beginning of the post), by definition and per its acronym, a peripherally inserted central catheter. It is long, slender, small, flexible tube that is inserted into a peripheral vein, typically in the upper arm, and advanced until the catheter tip terminates in a large vein in the chest near the heart to obtain intravenous access. It is similar to other central lines as it terminates into a large vessel near the heart. However, unlike other central lines, its point of entry is from the periphery of the body the extremities. And typicallythe upper arm is the area of choice. (This information was pulled from the website, PICC Line Nursing: http://picclinenursing.com/.

Once inserted an x-ray must be conducted to confirm accurate placement - see picture to the right. I was once again surprised - this time to discover from the x-rays - that Muddear now had pneumonia. That is, however, a story for another day. With the PICC Line in position, Muddear was ready to receive her two units of blood. The procedure went incredibly well and Muddear was subsequently treated for pneumonia and later discharged, but not without some drama. That will be the subject of another post.

Grandma's Gone Wild

The last couple of weeks have been incredibly trying for Muddear. Her behavior became increasingly odd. It is not unusual for Muddear to be confused, sometimes hallucinate, or even become verbally aggressive. However, we knew something was seriously wrong when Muddear became physically aggressive. Needless to say, after several days passed and she intentionally hit Mariah several times, little Mike at least once, and the aide... well, I contacted her doctor's office.

A nurse practitioner was sent to the house to draw blood samples. The results... dehydration. Apparently, dehydration can cause erratic behavior, especially in those with Dementia and/or Alzheimer's Disease. We decided to aggressively push fluids for a couple of days while keeping a close eye on Muddear with the hope the dehydration would subside. It didn't and we ended up in Mercy Hospital's emergency room. 

Six hours later and after numerous tests, including chest X-rays, Muddear was admitted into Mercy Hospital. Prognosis - severe dehydration, caused by severe anemia, caused by internal bleeding.  Muddear has always been anemic with a baseline anemia of 9.52 - I really don't know what that means, but the doctors say that the normal baseline for women is 12. A "normal" baseline for anemia is between 10 and 11. When tested at the hospital, Muddear's anemia level hovered around 7. Treatment - blood transfusion.  After receiving two pints of blood, Muddear's levels increased to 13 - above the normal range for women. The conclusion was that Muddear's internal bleeding was slow at best. Based upon her age and medical condition, any further treatment for internal bleeding would probably be more intrusive than what she would be physically able to handle.

After two days in the hospital, Muddear appeared (she didn't realize she was sick) to be feeling and looking much better. Thankfully, she was no longer hitting, but still thoroughly confused. I'll keep you posted on her progress.