Wednesday, April 28, 2010

Live from the ICU (again)

Never a good sign when the nurses from the ICU remember your name when they see you.  As some of you know, Elana had to have another procedure this week that also required a 48 hour stay in the ICU.  Because, it is almost impossible to find a vein to start IV's, Elana had to have a MediPort installed on Monday.  A MediPort is a permanent IV that is inserted just below the skin.  Elana's MediPort is just below her right shoulder.  The other reason she needed the MediPort is that the RSD has spread to her right hand as a result of all the IV needles that were required there during her last stay in the ICU following her gall bladder surgery in early March.

Although the procedure is relatively straightforward and is usually done outpatient, for Elana there is no such thing as a simple procedure.  Because there is an incision and a trauma to the skin, in order to prevent the RSD from spreading to the MediPort area, Elana requires a 48 hour ketamine infusion.  While it is not necessary to have an infusion in an ICU setting, Mt. Sinai Hospital requires that Elana have the infusion in the ICU because it does not have any experience with ketamine infusions (except for Elana).  As a result they want to have maximum control and support during the infusion.  Therefore the safest place for her to be is the ICU.  I don't have a problem with it and I am just happy that they are providing the infusion in the first place.  Although, it adds a sense of unneeded alarm when I tell someone that Elana is in the ICU.

Like, everyone of Elana's medical treatment and procedure's this one required enormous amounts of coordination between several doctors.  At the head of the coordination effort was one of my closest friends, Dr. Michael Rogoff.  As the doctor who performed the procedure he had to coordinate the anesthesia and ICU in addition to managing the various hospital administrative obstacles.  From the very beginning, Michael took control and never showed anything but optimism and resolve as the different hurdles were placed in his path.  Thanks are not enough for his work to make sure this procedure happened in the short window of time that we had to perform the procedure.  As I have played golf with Michael nearly every week for the past 10 years, I am sure that he knows I am still going to try to kick his ass the next time we play.  I am also certain that he would not want it any other way.

As always, Dr. Brett Kandell provided the anesthesiology support and has become an integral part of Elana's permanent medical team.  For sure, this procedure and every other procedure that Elana has had at Sinai since the onset of the RSD could not have happened without Brett's consistent support and continuous effort.

Lastly, Dr. Farcy of the ICU once again offered his support to this procedure by permitting the ICU to open its doors to Elana after the surgery.  That would seem like a given, but I can assure you that there are no givens when it comes to treating RSD and only with Dr. Farcy's active support could we have provided Elana the essential post surgical care.

Today (Wednesday 4/28/10), Elana's infusion will finish at 10:00 am and she will transferred to a regular hospital room the rest of the day.  Elana will sleep at the hospital tonight as a precaution, and if all goes well, will come home tomorrow morning.  Next Thursday, Elana will return to Monterrey, Mexico for a another series of ketamine infusions with Dr. Cantu.  After a very stressful last three months following the Coma, the hope is that this infusion will help Elana get back on track with her recovery and will lead to significant improvements going forward.

One final comment.  As anyone who has dealt with an ongoing medical issue, there is no auto-pilot or cruise control when it comes to managing care.  I am personal friends with nearly everyone of Elana's doctors.  We are fortunate to have access to major supporters of both Mt. Sinai and University of Miami who can provide access otherwise not usually available.  I have the personal cell phone of everyone of Elana's doctors and can call them 7 days a week without issue.  However, even with all that, every single  procedure and treatment requires enormous amounts of coordination and follow up.  Without fail there are miscommunications and inadvertent mistakes made by administrators and sometimes even doctors too.  You can never take anything for granted and every commitment needs to confirmed and reconfirmed several times.  I mention all this because I know there are times when I am not myself when I am talking with friends or family.  Sometimes, I may appear to be aloof or not concentrating on the conversation I am having at the moment.  I ask for your patience and understanding because I assure you the only thing I am thinking about at those particular times is what do I have to do next for Elana's care and treatment.  It is very hard for someone like me, who always wants to be in control of a situation, to have to cede control to others when it comes to such a critical issue like my wife's treatment.

Thank you all for your continued love and support.  It is always welcome and appreciated at all times.

Friday, April 2, 2010

Mexico Round 2

Tonight I am writing this post from home while Elana and Abby (My Mom) are spending their first of four nights at Hospital San Jose in Monterrey, Mexico.  Yesterday morning (Thursday 4/1), Elana and Abby flew to Monterrey and after a delayed departure from Miami, a missed connection in Dallas and a suitcase mishap in Monterrey they eventually arrived around 9:00 pm last night.  By the way, if you are wondering, I don't call my mother Abby when I am speaking to her but it is just easier to write Abby than my Mom every time I refer to her.

After staying at a hotel last night, they checked into the hospital this morning and were quickly brought to their hospital room where they will be living for four days.  They are actually right next door to Jessica Stevens.  I am happy to report that according to Jessica's mother, Sarah, there has been some improvement but unfortunately they are still at the hospital going on eight months.

Dr. Cantu came by around mid-day to get the ball rolling but unfortunately they were unable to start the IV in Elana's arm.  Because of all the IV's that Elana has had in the last few months in addition to the fact that it has always been very difficult to find a good vein in Elana's arms, Dr. Cantu had no choice but to start a central line in her upper chest area.  A central line is not as simple as an IV and must be done in a procedure room with the patient knocked out.  Elana will probably have to have a Medi-Port inserted in her chest when she comes home so that she can receive future infusions without the problems of starting an IV.  One of the other problems that all the IV's in her right arm has caused is RSD like pain and redness in her hand.  We are hopeful that the ketamine infusions will beat down any onset of RSD in that part of her body before it gets a chance to settle in permanently.

Dr. Cantu decided rather than do a standard infusion tonight, that Elana would be served best with a continuous, low-dose infusion of ketamine during the night (15 mg/ hour).  Tomorrow he will administer the first of three 2 hour infusions where Elana will receive approximately 750-1000 mg of ketamine.

While things have not gone exactly as planned, Elana is in good hands with Abby and Dr. Cantu.  I spoke with her earlier this evening and she was in good spirits.  Obviously, I miss her terribly and don't like the fact that I am not there taking care of her and controlling the situation.  However, Elana and I decided that it was best for me to stay home to be with Jesse as he has been without both of us for a good part of the last two months when you combine the first stay in Mexico, the 10 days Elana spent in the hospital after her gall bladder surgery and the near week spent in Rhode Island after Elana's father passed away.  We have been very fortunate that Jesse has continued to thrive and remain a happy little boy the whole time. We know we HAVE to do everything that we are doing, but it does not alleviate our concern about how this whole ordeal has and / or will affect Jesse.  Jesse knows mommy has a boo-boo in her foot and that she has to go to "sleep" in Mexico.  We look forward to the day when this is all in the past and maybe he does not even remember that mommy ever had a problem to begin with.