Bozgratch

Dad and I got an early start in advance of Diana’s visit. He was awake at 7 — quite an accomplishment for him when he’s WELL, but he gets so little consistent undisturbed sleep that it’s not all that unual here.

No big plans for him today. And that’s prolly good. I shaved him shortly after arriving, the nurse checked his vitals shortly thereafter and he’s out like a light again.

Usually early in the morning he has a little more energy but not so much today. No marked change, just no energy.

Dr. Salim, his GP was in this morning with not much to say, except to me which was “too bad, too bad, too bad…” This guys bedside manner is something appalling. Dad did see and acknowledge him, raised his arm to shake hands and sort of smiled. Dad clearly has confidence in him but I sure don’t understand why.

One of Dr. Whelan’s associates (the vascular guys) was in. We signed off on the consent form and talked about risks. His bp has been consistently low – 80’s / 40’s — with occasional elevations to as HIGH as 105… for one day. The surgery will run 3-4 hours — longer than a simple vein job — because they are actually relocating the vein to the other side of his arm. There is serious concern about his pressure being so low. At these levels there are risks of both losing circulation to various other body parts as well as concerns that the fistula they are going in to construct could clot up and be unusable. Of course at his age and energy level the risk of death is NOT something to sniff at.

We discussed anesthetics, I’ve been wondering if there is any hope doing a block, but with a surgery so long the ability to remain at ease and immobile while awake for the duration is questionable. So, it sounds like they will have to do a general. The alternative risk is that he fidgets being awake and causes problems with the ongoing surgery.

One of the GI guys was in being concerned about his rectal bleeding. There are several things going on down there and the simple answer: hemorrhoids & ulcer do not take into account the ischemia. He is concerned that if there is any additional bleeding we will need to call in a Colo-Rectal specialist (yeah — just what he needs to see, another specialist) to address that issue. (Peter Klein’s group).

They are giving him more albumin — this has happened before.  With a history of Congestive Heart Failure they use albumin as a volume increaser — not wanting to add more fluid to the body, but because albumin has a larger molecule it just takes up space.

So, that’s the morning rundown.

Today’s Nurse: Robin