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Dad Back in the Hospital Again

11 years 3 months ago #24186 by harleygirl
Dad was released from that joke they call a hospital yesterday. The night before he was to be dismissed, he was supposed to get some anti-fungal medicine by IV. Since he was to administer this IV medicine to himself at home, it was important to see if he had any adverse reaction to this new med while he was in the hospital so they could deal with any reactions.

The next day at the hospital, I was on the phone with the Home Health nurse discussing the medicine that Dad was to get at home. I walked over to the IV pole to verify the name on the medicine hanging there and I noticed two things: First, the medicine was still there! The night nurse (don't get me started about her!) did not ever release the clamp to start the IV. Second, it was not the medicine that the doctor had ordered! The pharmacy had substituted a different drug since they did not carry the drug the doctor prescribed. I specifically asked the doctor to prescribe a certain anti-fungal that I had been researching. She agreed, then the hospital substituted a different drug!! So, if Home Health was going to provide the drug that was prescribed, we wouldn't know if Dad could tolerate it since he did not get the prescribed drug while in the hospital. Talk about a mess! I was furious! Not only was Dad now behind one day in his medication, it was not even the medication the doctor ordered!

Dad was dressed and ready to go when I discovered the meds had not been given. The doctor wanted him to have the first dose in the hospital, so that meant that they had to call the doctor (at 4pm) to ask her what she wanted them to do. The doctor ended up just prescribing what they had in the hospital for Dad to take at home. So, Dad is not getting the medicine the ID doctor wanted him to have simply because the hospital did not carry the drug. Home Health had access to the proper drug. Why didn't the hospital???

The Home Health nurse came today to "train" Dad on how to mix and administer the drug to himself via IV. I can't believe they would expect an 82-year-old man to give himself IV drugs! He even has his own pole now. I'm still unclear as to why the home health nurse does not come each day and give Dad the medicine. It takes an hour for it to be given and he has to be on this medicine for 4 weeks at $2500 per week. Yikes! However, before he was giving himself Zosyn 3 times a day and Vancomycin once a day. My Dad is amazing!

He has a yeast infection and my thought is that the yeast have colonized his ureteral stents and formed a biofilm that the meds can't penetrate. He just had his stents changed out about 10 days ago, but I think he should get them changed again in case the yeast has taken up residence on the stents. He has been on IV Diflucan for about 2 weeks with no results. Once they stopped the blood thinner (Lovenox) and aspirin, Dad's bleeding seemed to stop. The dose of Lovenox they had him on was astronomical! His blood pressure is still high in spite of the 13 meds he takes twice a day.

The nephrologist has him on fluid restriction of 2000cc per day (about 67 ounces) which is much less than he usually drinks. He has dry mouth, most likely as a side effect of all the meds he's taking. I worry that he will become dehydrated. His output is reduced but so is his input. He is on oral Lasix, but so far he has not noticed that it has had any effect. He does not have to empty his pouch nearly as often as he did before the fluid restriction was implemented. His feet and ankles are swelling a little again. I am going to ask him to put the TED hose back on.

I'm glad he is home and not at the mercy of others to finally bring him his meds or anything else for that matter. Needless to say, we have added yet another hospital to the "don't go" list!

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11 years 3 months ago #24159 by Patricia
Harley...why not take your dad to UTSW emergency room? Your uro is probably there anyway. Have you made any contact with him at all.......? Tell him you're coming and bring his discharge papers............Lord what a mess.

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11 years 3 months ago #24158 by harleygirl
The saga continues. Dad has been bleeding into his pouch for about 5 days now. The internist who is the lead doc on Dad's case here called a urologist last Friday to come in. Turns out that this urologist DOES NOT SEE PATIENTS ON WEEKENDS!! To make matters worse, he didn't show up today either (Monday). The internist (who I think is an idiot) said he is going to release Dad tomorrow, bleeding and high blood pressure notwithstanding, and that Dad should go see his own uro. Unbelievable!

His blood pressure is still not controlled and the nephrologist is sending him home with about 13 different meds to take twice a day for his blood pressure. He also wants Dad to limit his daily fluids to about 64 oz. He usually drinks much more than that as someone once told him to "drink lots of water since he has a urostomy"! Luckily, the chest pains that put him in this place have never occurred again.

The infectious disease doctor finally visited (only her second visit in a week!) and said she thought Dad had been released last week. Huh? I would think she could come up with a better excuse than that for failing to see her patient or even check on him. She did discontinue the Zosyn and Vanco but said the yeast is not responding to Diflucan. I had been doing some research about yeast infections, so I suggested a drug and she is changing Dad to that one. Downside is that it is an IV drug that, she says, Dad will have to take for 4 weeks. Guess he will be keeping his picc line for a while longer and give the new drug to himself!

I can't tell you how many reservations I have about his release with the bleeding and high blood pressure. However, none of his urologists have privileges at this place, so I guess it is just as well. He just told me he doesn't feel any better than when he got here and that he feels "crummy." I'm hoping getting off the heavy duty antibiotics will help him feel better.

He had severe pain in his left kidney area early this morning so they did a CT scan of abdomen and pelvis and found nothing that could be causing bleeding or pain. They did see some fluid under the lungs which the kidney doc says most likely was left from when Dad had so much adema and will reabsorb when dad starts moving around again and breathing deeper. There was some hardening of the arteries noted on the scan.

The uro he is seeing tomorrow when he is released from the hospital is the one who, according to my brother, told Dad that if Dad were in just a little worse condition (when he was admitted to the hospital in the middle of January with an infection), he would not treat him and would just let Dad "expire." Can you believe that??!! He said that to my Dad! I want to get Dad back to Dallas to UT Southwestern to see his uro there, but Dad thinks it is an inconvenience on the family to drive the 30 miles to Dallas. Doesn't matter if he can get better care with a better doctor there. He thinks it is too much trouble for us. The UTSW doc is only in the office one day a week so it would mean another week or more of bleeding before he could be seen.

I misspelled the name of that drug. It is Imdur and is used to treat angina. He is off the Lovenox and aspirin and on two new drugs to treat gout. It is clonidine that he is taking for bp but he didn't get it today because his heart rate was below 60. So many of the drugs he is taking for bp lower the heart rate so what do they expect?! He now has headaches and a cough, also noted side effects of many of the meds he is taking.

It will certainly be good to get out of this hospital.

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11 years 3 months ago - 11 years 3 months ago #24128 by Patricia
Well his systolic pressure is coming down which is good and the diastolic is within normal now.........pulse rate not terrific......and my lord so many drugs.......and i wonder what they're shooting into his belly? aah i know the Lovenox.... you would not give aspirin along with another blood thinner......i really have to sort this out.......I know what my gut reaction would be but i want to confer with a few of my fellow pharmacists first just to watch their jaws drop.
just check the bottom of page...check interactions
Do not know what Emidura is..thats a new one ..sure of the spelling?
Also i noticed that you mentioned Clonodine which i hope they're not giving him as thats a drug for painkiller withdrawal..some drugs sound so much alike...i've seen the slipups all the time when doctors call in drugs...i hope the drug they're giving him is Clonidine which is another for hypertension.

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11 years 3 months ago - 11 years 3 months ago #24127 by harleygirl
These are the BP drugs I know about. Dad says the guy on call for the nephrologist today changed the dosage on some of them. I'm very concerned as Dad's pressure they just took was 143/76 which is down about 40 points just during the day shift! His pulse rate has dropped to 49 and he is dozing and lethargic. The night nurse has put a call into the cardiologist (not really the one who prescribed or changed doses of the meds). The nephrologist is the one she should call, in my opinion. At least she had the common sense to call the doctor instead of just pushing the meds. And, she was going to draw blood for a Vanco trough and could not get blood from the picc lines! That's why you are supposed to flush with both saline and heparin!! DUH! Still no word from the ID doc. To the best of my knowledge, she has not even called to check on him. Inexcusable, especially considering renal function, vanco and Dad's age.

Here are the BP meds: (not sure if the names are generic or brand)

Lopressor - 25mg x3
Lotensen - 20mg x 2
Hydralazine - 25mg x 2
Tekturna - 300mg x1
Clonodine - .2mg x 3
Emidura - 120mg x 2
Norvasc - 10mg x 1

Also daily:
Lasix - 40mg x 3
Lovenox injection x 2
Zosyn - 3 x daily
Vancomycin - 1 gram daily
Diflucan IV - 1 x daily
Aspirin (not sure why since he is getting blood thinner shot)
Gout medicine (in case leg pain experienced today was gout)
Prilosec - 1 x daily
Potassium - 2 x daily by mouth

He also has had 3 bags of IV iron, one bag of potassium and one bag of magnesium. Also, 2 units of blood which only raised hemo by 1 point.

The cardiologist just called back and stopped the Lopressor that the nephrologist had doubled this morning. Apparently Lopressor slows heart rate. Yikes! One doc negates what another one did just this morning. Scary, isn't it? Does the right hand not know what the left hand is doing? Apparently not. If Dad gets out of here without any more damage it will be a miracle!

I have emailed his uro at UT Southwestern regarding all this and am awaiting a reply.

I'm not sure about input/output charting. They told me to keep a list of how much he drinks during a shift. He is not drinking much and his output has decreased but at least the urine is not blood tinged at this moment. I plan to bring a measuring cup up here tomorrow. He is allowed 2000ccs so that's equal to about 2 of the water pitchers here or one pitcher and one 36 oz. bottle of Gatorade. I suppose they are measuring output.

I keep asking why he is still getting antibiotics when no bacteria shows up and his white count is normal. The docs who do show up tell me I have to talk to the ID who never shows up. Frustrating. I asked the internist today if Dad could take probiotics to help put some good bacteria back into Dad's gut.

I think we may have lucked out and actually got a really good nurse tonight. She seems very competent and experienced. We'll see what tomorrow brings on the medication merry-go-round.

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11 years 3 months ago #24125 by Patricia
Harley........aaaaaaaaargh......what are the blood pressure drugs they are giving him.......get the names and dosages of everything.
Lasix (furosemide) and vancomycin (Moderate Drug-Drug)

MONITOR: Increased adverse effects are possible when glycopeptide antibiotics are administered concomitantly with other potentially nephrotoxic and neurotoxic drugs.

MANAGEMENT: If these drugs must be used together, renal function, auditory and vestibular function, and serum drug concentrations should be monitored.

I think they're causing most of the problems.

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