good news and bad news for BBB

Good post, thanks for the update.

Sounds good. Sorry about the nausea though.

How are you doing?

Thanks for the news. Sorry about the terrible pain and the unsympathetic nurse.

You take care of you.

I posted this on Facebook while A2K was down. I'll copy it here for those who don't do FB.

BBB is doing much better today. Still wasn't able to put any weight on the leg yet but she's been able to tolerate the machine that exercises it a bit being put back on her leg for a few hours. The nausea has subsided and she's been able to keep a little food down today.

Yesterday her blood pressure was extremely low, and the blood chemistry was very low today, so they've given her two units of blood. The INRs were off the charts this morning before the additional blood.

I had steak last night. First one I've had in about two years. It was quite tasty. The night off did me some good. Slept with an air filter going in my bedroom and got rid of the headache, wheezing and foggy feeling I've had for a couple days. Need to water the gardens today, everything is wilting. Will be going back for a visit later this evening.

Next update will be tomorrow unless there is some news to pass along.


Updated: Just made arrangements for the discharge to the rehab facility in a few days. She'll be there for about 7 days. It will either be Kaseman or Advanced in ABQ, depending on which has a bed available.

Glad to hear that things are improving. Also glad you posted this here.

Glad you're feeling better too.

Good and healthful wishes to both of you.

Thank you for the update, Butrflynet.
It's sounding like you are both doing better today.
Very good to hear!
I'm glad you've managed to have a good rest & also your first steak in 2 years. Excellent.
And I'm very relieved that BBB will be spending a week at the rehab facility!
I obviously misunderstood your earlier posts & imagined she was heading home straight after the hospital stay!
And was very worried about that, as you might have imagined!
Phew. So glad that isn't happening!

Mom was able to stand and put weight on her leg for a few seconds for the first time today.

I just got word that they are moving her to the rehab facility today at 5pm. It will be at Kaseman. I don't yet have phone numbers or room numbers.

She got an email from Izzie yesterday, so however Izzie addressed it, that's what works. From what I could see on it, it looked like it was addressed to [email protected] and had my mom's name and room number in the subject line.

I won't be making a visit tonight and will wait to do so tomorrow when she is settled in at Kaseman.

Good to read that things are improving.

Standing is very good.

You rest up, kid.

Waiting to hear about the rehab.

Trust me, Roberta, when you start rehab, you are standing at the bottom of a long, steep hill.

Just in case you didn't know.

Of course, I trust you, Roger. Not easy? Not surprised.

BBB is now settled in at Kaseman Rehab (a part of Presbyterian Hospital). I'll be leaving in a few minutes to go see her and take a bunch of paperwork to them.

I believe emails can be sent via the same method: [email protected] with a subject line of Luella Hanberry Unit 300/Room 324.

Just spent 6 hours at the rehab with BBB. She's doing much much better. She was able to walk about 8 feet before she got too weak to go further and she's able to bend her leg up to about 50 degrees. That's a big improvement for her. Her skin is getting some color back, though I am still concerned about her daily lab results.

I'll do some screen prints and paste them here so maybe Osso or JPB can help me interpret what I'm seeing.


Here's the two charts I've been looking at. One is CBC and the other is a metabolic panel. Remember that two days ago, she was given 2 units of blood so there should be some improvement showing in the results by now. I included previous lab results so you can see it from a historical perspective. It looks to me as if she is still very anemic among other things.

Could these low results be due to the high doses of warfarin they have her on or is there something else going on that is being overlooked? Here's the labs on her INRs.

I'll wait on better interpretation, but the most recent metabolic panel looks good on the items I'm familiar with. Notice that the letters H & L indicate results Higher and Lower than normal ranges. .80 on Creatinine is excellent, and is an indicator of kidney function. Earlier results indicating that 1.1 is High is a very conservative assessment.

Likewise, 82 on glucose is quite good, especially since injury and trauma tend to cause above your own body's norm.

I'm on more shakey ground with the electrolytes, but again, they fall within normal ranges or they would note the variance with either H or L.

I'm a long time gone from basic lab work, like bun numbers, et al. Don't see anything very startling.

I remember more re 'crits et al than reg chems, but defer to JPB who is both younger, smarter, and more recently cognizant of all this stuff. I passed the boards, and then went into immunology, all a long time ago, mid sixties to 1980, and a lot of my brain has been taken over by latin names of plants.

I do remember that my father's hemoglobin was 2.8 something, when he fell at a stationery store in Beverly Hills.. turned out to be a very bleeding ulcer. 1959, what a quiet family was mine.

My own got down to 8? I don't remember, but that due to the bleeding fibroid, I had "virtually no iron stores". So, ask re looking at her iron?

I'm spoiled in that I've been lucky with doctors, who generally talk straight to me as a patient, so far, except for the odd bozo or two.

Anyway, I see the swing in the data but am not able to say what to watch.

I assume the results from 6/27 were post-op. Her 6/6 pre-ops were all good except the glucose, but it looks like she lost quite a bit of blood during surgery on the 27th. I think the 6/29 CBC was pre-transfusion and they ordered two units of blood because she fell below the transfusion trigger of 8gm/dL Hbg. You can see that it jumped up to 9.1 gm/dL after the transfusion so the transfusion had the desired result. She's still running a bit low but not so low to warrant more blood. Her 7.5 gm/dL Hbg is actually in the grey zone for transfusion. Less than 8 is indicated if she's weak and no longer actively bleeding. Less than 6 is the new critical standard for transfusions and 7-8 is optional. Her RBC and plt counts are both low but not critically low, especially if she's getting IV fluids. Today's results will tell you if her counts have started to improve or if she shows signs of additional blood loss.

I'd guess that her electrolyte levels were being influenced by IV solutions given in conjunction with the transfusion, although her BUN is erratic over time. Does she have a history of kidney problems?

I have no idea why her glucose is bouncing all over the place unless they're giving her some IV glucose or the labs were taken on non-fasting blood samples. Was she fasting on 6/6 when she had her pre-op blood drawn? Those 150 glucose levels are more typical in a non-fasting sample in someone who doesn't have a problem with diabetes. The glucose results in the 80s are perfect.

What a great reply! Applause to JPB.

I'll just add that when my mom recently had the same surgery (knee replacement), she had some fairly serious hemoglobin issues, that were resolved with a few transfusions and time. She's now doing very well.

JPB, thank you for taking the time to educate me on these lab results. I haven't had much time to do some Googling to learn what it all means so I appreciate your help. I'll mention to her doctor the various things you've indicated and ask for explanations and further monitoring.

Regarding kidneys, for the last several doctor visits, people have been asking if she has a history of kidney problems. She doesn't. However, it sounds as if it should be looked into more closely since something in the labs seems to be pointing in that direction.

She does have a several decades history of chronic diarrhea that has yet to be resolved by any of the numerous doctors she has seen for it. Would that give similar symptoms of kidney problems in lab tests?

Here are today's results. They've also started a new test that I'm unfamiliar with.









Her INRs are much improved, as are some of her blood panel. Some look like they are still slipping lower. Her CBCs are still low but are on the rise.

Can you explain to me what the following items are looking at in the blood?

TSH
Anion Gap



Regarding the glucose history, some of them are non-fasting and some are not. She went into emergency a few weeks ago with chest pains and they did a lot of lab work then. In the last 3 months she also has had a bone scan of her knee, a colostomy and a chemical stress test on the heart. I know that some of those involved fasting and lab work.

I believe the 6/6 lab work was the last blood work required for pre-op and those were non-fasting. She just went into the drop-in clinic in the afternoon after lunch.

I'm heading over to the rehab in a few minutes to take her some lounge gowns to wear instead of the hospital rags and will check back later this evening.

Sounds like our moms are following the same path toward healing the knees.

When I think back to BBB's first knee surgery in the late 60's, I remember the only physical therapy she was given was a 5 pound bag of sugar to balance on the top of her foot while she bent and straightened her knee. I remember my brother and I sitting on the floor on either side of her trying to help keep the bag on her foot while she did the exercise.

It seems rather barbaric compared to the advances they have for knee surgeries now. It has taken 30 years for the techniques and skills to advance far enough to be able to repair the damage in her knee from her first knee replacement.