UK B!tches Unite!

[TBoneTX 45,288]

No, you have an USgraine. Because we all feel the effects.

And, you're both in the U.S., so it is an "US"-graine. Good thinking, si man.

But the help we could give let her know that we her

Tell her that from me + Mrs. T-B., si man.

[Ban Hammer 13,336]

Right now, the wife has a migraine. And there's nothing I can do to help or cheer her up.

and all this time i thought you was female.

[Justine+David 218]

Sorry about the my-you-me-mi-graines

I am completely wired at 2am because I took the wrong nasal decongestants (daytime) for this stupid cold I have. I cannot fall asleep for the life of me!!

[MelissaJulian 30]

I can't sleep because Julian is in the line at the Embassy and he is hungover! I am taking tomorrow off and right now I am drinking some White Zinfandel to help take the edge off.

[elmcitymaven 9,712]

I can't sleep because Julian is in the line at the Embassy and he is hungover! I am taking tomorrow off and right now I am drinking some White Zinfandel to help take the edge off.

I don't know whether to or or , Melissa. I'm sure he'll do fine. Shame I'm on the other side of town from you now, I would have been over there to help you drink that White Zin -- did you know it makes an amazing slushie? I found that out by accident this summer when I put a bottle in the freezer to make it cold and forgot about it for an hour. Good times. Seriously though, Julian will make it through, I am sure of it. You'll be posting on here later today about what an anti-climax it was, just like everyone else. Try to get some sleep and wait for his call.

[MelissaJulian 30]

I don't know whether to or or , Melissa. I'm sure he'll do fine. Shame I'm on the other side of town from you now, I would have been over there to help you drink that White Zin -- did you know it makes an amazing slushie? I found that out by accident this summer when I put a bottle in the freezer to make it cold and forgot about it for an hour. Good times. Seriously though, Julian will make it through, I am sure of it. You'll be posting on here later today about what an anti-climax it was, just like everyone else. Try to get some sleep and wait for his call.

Thanks Maven. I am so worried, but I know you have told me many times to try to relax more. I'm trying, really! I can't believe he went to this stupid work thing ON A SUNDAY NIGHT!?!?!!

[Krikit 1,164]

[MelissaJulian 30]

False alarm -- WE MADE IT!!!!!!! :D :D

[Nik+Heather 121]

Latest dad-related ######: So, as part of the events of the code thing on Tuesday, the tracheotomy tube was changed (it was blocked, that's what caused the emergency) with the spare tubes which were on hand at his bedside. Wednesday, the Dr in charge of his lungs/breathing etc. did a bronchoscopy to make sure it was a good long term solution. We emphasized our concern that it be the "right size" because they had previously wanted to change it, and ultimately decided the one he had originally was the best thing for him. After inspection, the Dr determines all is OK. phew. But then dad has trouble getting off of the ventilator again, which seems strange, because it was a mechanical blockage, not that he was unable to breathe on his own. Then during a chat with another Dr on Saturday, it comes out that the new tracheotomy tube is slightly smaller in diameter than the one he had previously.

We do some thinking on our own and become more concerned that this change has restricted the flow area - no wonder he has trouble breathing on his own again, they have reduced the flow area by ~30% with the new tube! OMFG! So, angling to speak with lung Dr yesterday, and I sort of casually ask the respiratory tech to please look in his records and tell me the size he had previously and the size he has now. Begin 15 minute "spirited" discussion about how much affect the size of the tracheotomy tube has. Him: It doesn't matter, the size difference isn't significant, drop the subject, stop trying to hurry his recovery, it will be slow, I've been doing this for 20 years, don't tell me how to do my job. Me: How can 30% reduction in area NOT matter? I understand that we can't hurry things, but I am afraid that this change will hinder his progress. Him: Your dad was THIS close to DYING last Tuesday. (yes, this was thrown in my face just as starkly several times) Me: I'm thankful for the swift and successful response of the staff, and I understand that what may be an appropriate selection in an emergency situation may also not be the correct one for a long term fix. I am merely asking for a review in less urgent situations to ensure that all is well. Him: You have no say in these decisions unless you want to take him to a new facility. The Dr. will decide. Me: Well fine, I'll talk to the Dr! Surprisingly, the conversation went on for some time after that. Obviously we weren't going to agree.

Evidently they had a little meeting about me at the nurses' station, because another guy RN, who used to be a respiratory tech came by and was like "Oh, so I hear you have some questions about the tracheotomy tube?" More arguments about how "one little millimeter" couldn't possibly be a huge deal. More arguments about how unhealthy he is, how badly he's doing, how close he came to dying - OMFG! Even if we don't compare him at all to the spectrum of healthy/unhealthy people, just compare him to his specific condition a week ago and to his condition and breathing performance NOW, there is a significant relative decline.

I'm thankful that his main nurse didn't enter the fray. I was really trying to rein myself in (honest!) but I was really steamed. I know (hope?) they are professionals and that it won't affect the care they give dad...His nurse did promise that although visiting hours were over, the lung Dr was expected in 30-45 minutes and he would get us together to talk if we waited in the ICU waiting room, and followed through with that. Lung Dr arrived and did actually hear me out, and in the end agreed to 1. Verify the current diameter of tube dad has and 2. If not 8mm, he would change it this morning. I'm pretty sure he agreed more to shut me up than because he understood my concerns. I feel also like I was really fighting a "math is hard" mentality. Area calculations and percent change and the relationship of flow area to pressure and volume - All parameters I deal with in my daily professional life and am comfortable with. I am SO RIGHT!

Why is this so damned difficult???

[Justine+David 218]

Heather, I don't know anything about the hospital or your dad's situation, but a couple of things struck me. It is normal to have a smaller sized trach at the bedside for emergencies in case the patient's throat swells and the health care worker can't get another regular-sized one inside.

As far as changing it back to the original size, perhaps they are concerned about changing the trach tube again because of his coding the other day. For a patient in the hospital, airway comes first and if they are concerned about his airway closing while they change the tube (especially if it's an un-established trach, less than a week or two since it was originally cut), I am sure that is a major reason why they wouldn't. New airways like that are very fragile. They are trying to keep him alive...the progress may be slower, but keeping that airway open is more important than anything else whether he has to stay on the vent longer vs going to CPAP or trach collar. The math part of the equation may not even enter in this situation...

You absolutely did do the right thing by voicing your concerns, as you should in any hospital-patient situation. You are being your Dad's advocate and that's exactly what he needs. It sounds like the hospital staff didn't take your concerns seriously as they had other reasons for not changing the tube out sooner but didn't bother to explain them to you. Of course maybe they were just being lazy...

Wishing your Dad and your family well

[Nik+Heather 121]

Thanks Justine - I think you bring up some good points, and if that had been something which was said (that it would be detrimental at this point to change) I would have accepted that, no problem. I'm glad for the explanation why a smaller size would be there at all if it wasn't the right kind. It makes a lot of sense to me. It's probably apparent that even 24 hours later I'm still quite worked up! Really it's not that I go around questioning every decision they make. Overall I think they are taking pretty good care of him (maybe hard to believe, but this is the b!tch thread...so). It's just how it got brushed off, and no adequate explanation given aside from the repeated "1 mm makes no difference" both of those guys were using a tone of "Not THAT question again!"

We are well into week 6 after his emergency AAA surgery and still at this ^^ point in ICU (though we've moved him to a long term acute facility a couple weeks back) all of us are going a bit with the constant cycling of 2 steps forward, 1.5 steps back and the frequent close calls.

[Pooky 3,784]

and all this time i thought you was female.

Dude ... you funny!

Edited October 26, 2010 by Pooky

[Justine+David 218]

Thanks Justine - I think you bring up some good points, and if that had been something which was said (that it would be detrimental at this point to change) I would have accepted that, no problem. I'm glad for the explanation why a smaller size would be there at all if it wasn't the right kind. It makes a lot of sense to me. It's probably apparent that even 24 hours later I'm still quite worked up! Really it's not that I go around questioning every decision they make. Overall I think they are taking pretty good care of him (maybe hard to believe, but this is the b!tch thread...so). It's just how it got brushed off, and no adequate explanation given aside from the repeated "1 mm makes no difference" both of those guys were using a tone of "Not THAT question again!"

We are well into week 6 after his emergency AAA surgery and still at this ^^ point in ICU (though we've moved him to a long term acute facility a couple weeks back) all of us are going a bit with the constant cycling of 2 steps forward, 1.5 steps back and the frequent close calls.

Wow, 6 weeks. It's no wonder you guys are stressed all of this stuff is normal to be on edge. I mean, it's your Dad

You can ask the person to explain it in more terms so that you can have it be understood better, but unfortunately some folks will brush you off, as infuriating and unprofessional as it may be. I'm lucky because I usually have no more than 2 patients at a time, sometimes up to 3, and I can spend a lot of time talking with parents about their concerns. I'm sorry that those folks didn't seem to have much patience with you...if it's any consolation, I bet they're taking excellent care of him because you've let your concerns be known and he'll probably be mentally flagged as a keep an extra eye on this one.

I think you're brave to be going through all of this and I'm glad Nik is over here with you.

[TBoneTX 45,288]

False alarm -- WE MADE IT!!!!!!! :D :D

Congratulations, si man! I'm trying to picture Julian as a mere Colonist.

Area calculations and percent change and the relationship of flow area to pressure and volume

You have an honest face; I trust you. As far as I'm concerned, Algebra is the national language of Algeria, si man. Also, 5 out of 4 people are bad at math, and I'm at least one of them, aargh man.

[elmcitymaven 9,712]

Still unwell from earlier this month when I ended up in the ER. I'm slowly getting better, in that I have not had a new hive in over a week and my legs are nearly healed, but I am still SO itchy on my arms. I hate taking my meds because they knock me out most of the day, which makes working really difficult -- I have little stamina for about four hours after I dose up. I've had so much on during the past three days I have actually skipped taking the full dose so I can get work done. I also have a sneaking suspicion what this is all about, and it's making me nervous. There are quite a few people (including my brother) who have auto-immune disorders in my family, and the mid-30s seem to be the time when they start manifesting. I'm scared that I might have something like my brother does -- sarcoidosis. I need to see the doctor soon again and get all of this investigated, but in the meantime, I'm just itchy and snoozy with a super-dry mouth.

Sorry for the whinge -- it's just that it's been three weeks of feeling like utter shite.