Thursday, October 20, 2011

Decision Time

Dr. Goswami and Donita Schrey were in before noon to see Mom. CT scans from yesterday showed that the previous clot and hemorrhage in her brain are stable. Dr. Russell, her neurologist, cleared Dr. Goswami to do whatever he thought was needed. The scans also showed the large IVC clot in her abdomen and pelvis and a small clot in her lung. The clot in her lung was, most likely, a pulmonary embolism.  Dr. Goswami ordered an echocardiogram today to be sure no clots have made it to her heart or arterial system. We do not have those results yet.  Her platelets dropped from 68,000 yesterday to 66,000 today. Her sugar seems to be improving (which Samantha attributes to the unavailability of Milano cookies in the hospital :).

Dr. Goswami thought a long while today about his plan for Mom. Ultimately, he decided to start an IV drip of Bivalirudin (Andgiomax). It is a direct thrombin inhibitor, whereas heparin (what he used last time) is an indirect thrombin inhibitor. Bivalirudin should not affect her platelets as the heparin did. The obvious risk is that thinning her blood could cause another hemorrhage in her brain. It could also cause more pulmonary embolisms.

They started the Bivalirudin about an hour ago. Dr. Goswami has ordered that Mom have a PTT in four hours to check her blood's ability to clot. They will call him with results after the test tonight, and he will adjust the dosage of Bivalirudin appropriately. Donita, the nurses, and Dr. Russell will keep a close eye on Mom. Hopefully if her brain does start bleeding, they will catch it very early. At this point, the risk of hemorrhage nearly equals the risk of the clots; benefits of one mean risks of another. Six of one; half dozen of another.

Please pray for Mom's continued safety and recovery. Pray that her entire team of doctors and nurses are cognizant and diligent over the course of the coming days. She needs everyone to be on their 'A-game'.

Most notes taken by Samantha.
Written/Posted by Jenn.

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