Hi, it’s Patrik Hutzel from INTENSIVECAREHOTLINE.COM where we instantly improve the lives for Families of critically ill Patients in Intensive Care, so that you can make informed decisions, have PEACE OF MIND, real power, real control and so that you can influence decision making fast, even if you’re not a doctor or a
nurse in Intensive Care!
This is another episode of “YOUR QUESTIONS ANSWERED” and in last week’s episode I answered another question from our readers and the question was
My Mother Had Surgery and is in ICU for Pneumonia. Are Standards of Care in ICU Neglected?
You can check out last week’s question by clicking on the link here.
In this week’s episode of “YOUR QUESTIONS ANSWERED” I want to answer questions from one of my clients Laura as part of my 1:1 consulting and advocacy service! Laura’s mother has a history of
myxedema and in the ICU for kidney failure and she is asking if artificial dialysis will improve her mum’s condition.
My Mother Has a Terminal Illness in the ICU. Will the Artificial Dialysis Get Her Better?
Laura: Hello.
Patrik: Hi, this is Patrik here.
Laura: Hi.
Patrik: Hi Laura, How are you?
Laura: Great.
Patrik: So, you’ve been to the meeting, have you?
Recommended:
Laura: I’m going to get situated here. I have to plug in my phone. It looks like it’s a little low. Can you hear me okay?
Patrik: I can hear you. Can you hear me?
Laura: Yes, I put you on speaker, it seems to cut the line.
Patrik: Okay, no, I can hear you. I can hear you.
Laura: Okay, well I did go and I’m going to this care meeting because I wanted to speak with her specialist, the Urologist, and they said I had to ask the doctors in order to see him. So, I said, well, I’ll just go to the care meeting myself. And basically, they say… this is a Catholic hospital, it’s two total care right, she has a multi-organ issue, she’s on a breathing tube, she’s on Levophed and blood pressure to keep it up. She’s had a septic shock, she had a kidney infection, which they drained in the bag since about nine, 10 days ago. And then about a week or more ago, they put a biliary stent in because she had biliary obstructive jaundice, due to some enlarged lymph nodes pressing upon the biliary duct.
So she’s been draining all that out, but then they’re telling me that her body is failing and you know, they say I have to make a decision by Monday to either A, try to transfer to a hospital which sounds almost impossible, two, that we extubate her here in the hospital and then she goes home like hospice, or three, that she has “dignified death” in the ICU.
Patrik: Okay. Okay. So, they have given you the options to send her out if need be to another hospital? They have given you that option?
Laura: Well, I said we’re the fighting type and I said I’d like for her to have a little more time. He said, well, they’re saying no, you can’t have the time here, but he said if you can get a doctor to… there’s a nearby hospital, if you could get a doctor to admit her… excuse me, excuse me. Sorry, I have somebody interrupting.
So yeah, they said if you can get a doctor to admit her, get his name and his phone number, then we will let her go to that, but I tried that hospital. I tried you know talking a little bit, just to try to talk to an admittance person, admitting. She said well, you know, you have to go case manager to case manager. And so, I had this case manager at the hospital phone another case manager at the other hospital. And that lady told me, she said, oh, they said
no.
Patrik: Okay. Okay.
Laura: They said no. And then the lady at the new hospital was saying well, who was that person who said no? I’d like to know. But I haven’t found out yet.
Patrik: Okay. Just give me some timelines again, Laura. How long ago did your mom go into ICU?
Recommended:
Laura: She went into ICU on the night of December 6th. Wednesday night, December 6th. And she was presenting at home. She was a bed-bound patient for the last three years, she had myxedema coma and came back from it nicely, but had a lot of swelling, you know, legs, and some dementia. And she had a pretty fruitful life. She’s in her beautiful home. She did her artwork, did music. But some about a month or more ago she started having some
stomach issue with the vomiting and nausea. And then when I saw that this is much more than a stomach ailment, we got her into the emergency Wednesday, December 6th.
Patrik: Okay. And she’s been in the ICU since December?
Laura: Well, she was in the ICU initially, and they did the relief of the kidney. They made the cut in the kidney, the bag draining the infection. The 1.2-centimetre stone in there, in the tract somewhere in the line and but they drained that out, and then she was getting more… they transferred her down to the lower skilled nursing, to what they called telemetry, where she started to get more and more yellow, jaundice.
Patrik: It’s the jaundice, yeah.
Laura: Yeah, I started getting upset. I said wait a minute, you guys are just… from the beginning, it was all negative, doom and gloom, no chance. I said, wait a minute, I want to see a specialist now. I want to see a GI doctor, what we can do, she going to die of this jaundice, right? So, they said the GI doctor put the stent. And I said, let’s put the stint. So, she had the procedure on Tuesday December 11th. And she came out of the general
anaesthesia in the post-op saying I can’t breathe, I don’t feel good and then she… you know, there as a lot of craziness getting her back down to the telemetry, and she was still saying I can’t breathe, including the oxygen line. There’s a lot of confusion where with the telemetry she wasn’t hooked up and all that. But finally, she seemed to rest, had the oxygen line in her nose. I said, well, I can slip away for lunch. I got called about 20, 30 minutes later with a code blue, respiratory failure after the post-op.
Patrik: Right, and that’s when…yeah, and that was which day? Was it all on December the 6th day?
Laura: That was December 11th. It was right after the procedure the bile stent. Yeah. So, then she had the stint. I mean, she had the stint… I mean she had the tube like overnight. And then in the morning, I think they said we’re going to take it off. I was like oh, so soon? So, they took it off. She had just the line in her nose and the nurses watching, it was 95%. She would kind of knock it out a little bit, you know. And a couple times it
went down to 85% oxygen. And they weren’t too worried until that night, the way she was inhaling and exhaling, it was a little bit laboured. So, one of the RT came in and gave her the bypass mask, right?
Patrik: Yeah.
Recommended:
Laura: And the bypass mask, she had maybe about six, seven hours until in the morning, you know, they take the blood sample and then the doctor in the hospital makes his rounds, he says no, no, no, no, no. She’s got to have the tube. I guess the blood gas with the sealed tube and the oxygen was not that good, so they put the tube back in on like the 13th. So, she’s had it all till now. And you know, they just want to say-
Patrik: When they’re saying they’re referring to multi-organ failure, have they specified… so we talk about the lungs, of course, because she’s on a ventilator, so that’s one organ, the lungs are potentially failing. What other organs are they referring to
when they refer to multi-organ failure?
Laura: The kidney because… well, they had her on the diuretic. They had a light diuretic Lasix, and then another kidney doctor took his place because he’s on break. He said no, let’s give her a diuretic and it produced like two days of pretty good urine. More yellow, not so rusty red. And the colostomy bag was producing more. But all of a sudden, today I started to worry a little bit because I saw the input. And I asked the nurse, I said are
you still giving the diuretic? And she said yes. But so, the kidney, I guess.
And you know, it’s funny because we had two different kidney docs. The first one had a more positive attitude. He said well, elderly has 75% kidney function, right? And your mom has about 35% right now. She has 1.6 creatinine a couple days ago and 1.7, and now it’s like almost 2.0, so it’s gone up. And that guy went on break. He seemed to be a little more positive, wait and see. But then we got another, his associate, and he was just very negative, saying it’s not
good. So, the kidneys.
Patrik: So, the kidneys, so just the lungs and the kidneys? No… the heart is fine? The liver’s fine?
Laura: Never gave out.
Patrik: Okay. Heart, liver is fine. The brain? You mentioned about dementia.
Laura: She has dementia, but even with being delirious with two big incisions, she was still telling people I can’t breathe. She was sill communicating all the time. I think she still has her brain. And they did, I think, a scan of something. I don’t know what.
Patrik: Right-
Recommended:
Laura: During the respiratory event it’s not stroke.
Patrik: Right. Did they mention, as part of the multi organ failure, did they mention the brain as failing as well? Did they mention that?
Laura: No, they did not.
Patrik: Good, good. Okay. So then let’s break this down, Laura So if they’re not mentioning the brain as a failed organ, we’re talking about double organ failure, which is number one, the lungs. And number two, the kidneys. So why is this important? Most patients in Intensive Care have temporary multi organ failure. And that, I believe, is happening there. Your mother, most likely, has temporary double organ failure.
So, what does that mean, right? Number one, a lot of patients in Intensive Care go into kidney failure. And again, into temporary kidney failure. The kidneys often recover, okay? Has your mother been on a dialysis machine since she’s been in Intensive Care?
Laura: No. They say that that’s probably not a possibility because of her condition.
Patrik: That’s rubbish. That’s rubbish. That’s just a whole load of crap. Of course-
Laura: Can I add one more thing in the timeline-
Patrik: Please.
Laura: I might add to the picture, please. I’m sorry to interrupt you. When they went and did the endoscopy to do the biliary stent, they also saw these big, bulky lymph nodes down there. It was pressing on the bile duct, that’s why it was blocked. So, they think that those big, bulky lymph nodes in there are probably some kind of a lymphoma (cancer) pressing on the bile duct, as well as maybe a small spot or two small spots on the colon. So,
they’re saying that… I don’t know if I explained that to you as well.
Patrik: No, no, I’m following. This makes sense. It makes sense. As part of this, your mother would have also been in what’s called sepsis. Have you heard of that term? Sepsis?
Recommended:
Laura: Oh, I know about sepsis. Septic shock, yeah.
Patrik: She would have been septic whether she had a septic shock or not. Do you know whether she had either?
Laura: Yes, they say that she did. The GI that performed the endoscopy and the stent said that she had Urosepsis, and the doctors were telling me sepsis and septic
shock.
Patrik: Okay. Again, why is this important Laura? Many patients who go into septic shock, go into kidney failure Why is this? It’s simple. When somebody goes into septic shock, their blood pressure drops significantly, right? They end up on vasopressors like the Levophed you mentioned earlier.
Laura: Yeah.
Patrik: Right? When patients go into septic shock, their blood pressure is so low that the kidneys aren’t getting perfused because the blood pressure is so low. The kidneys shut down and patients go into kidney failure. Okay. This happens all the time in Intensive Care, especially after septic shock, but it could also be a cardiogenic shock. Doesn’t matter. After any type of shock, one of the biggest risks and biggest side effects is kidney
failure. So, you know, what they’re not telling you is that a lot of patients in intensive care go into kidney failure, into temporary kidney failure. They haven’t said that. They’re just painting this doom and gloom picture without actually tell you hey, and a lot of patients in intensive care go into kidney failure. It’s often reversible. Right? That’s the part they’re not telling you.
Laura: Right, right.
Patrik: Right? So yes, your mother… I agree that your mother, at the moment, is in multi-organ failure, or in double organ failure. But again, that is temporary.
Another thing that they haven’t told you Laura is, over 90% of patients survive Intensive Care. Over 90% of patients, 9-0, of patients in intensive care survive Intensive Care. So, my question to them would be, why would your mother be in the 10% bracket? Why? Why would she be in the minority of patients, not surviving Intensive Care? They haven’t-
Laura: Yeah.
Recommended:
Patrik: I can’t see any reason why she wouldn’t survive Intensive Care at this point in time, if they, for example, started her on dialysis. That’s number one. If she’s in kidney failure, she most likely will need dialysis, especially if the Lasix hasn’t worked. Right. How many days has she been in kidney failure now? Since the beginning? Since the 11th of December?
Laura: Well, I don’t know for sure how to answer that.
Patrik: That’s okay.
Laura: I remember having… she’d had house call doctors before that did some blood work. And she had the creatinine levels within normal. That was November 7th they took blood. But when we came up to the ICU, there was 1.6 creatinine, 1.7, now it’s almost 1.9, 2.0.
Patrik: Okay.
Laura: I don’t know exactly how to answer that.
Patrik: No, no. That’s okay. That’s okay. So where to go from here? How old is your mom, if I may ask?
Laura: She’s going to be 79 on the 24th of this month.
Patrik: Oh, on Monday.
Laura: Yep.
Patrik: All right, wow, that’s great.
Laura: On the day they want to throw her out. Her deadline dates.
Patrik: That’s terrible. That’s terrible. Okay. So, you now understand that number one, most multi or double organ failure in Intensive Care is temporary, right? They haven’t told you that. As you said, they’re painting the doom and gloom picture without actually saying okay, let’s treat the kidneys by putting your mom on dialysis for a few days.
Recommended:
You know what’s another encouraging thing, Laura? When patients go into kidney failure one of the first organs that’s affected is the lungs. Why? Why are the lungs affected? Because if the body can’t excrete
urine, fluid will push up on the lungs. Fluids will accumulate on the lungs, right? Hence, it’s more difficult to get somebody off the ventilator. Right? So, your mom has entered a vicious cycle. Right? So, and again, please, I repeat certain things because they are so important to understand. I say that
again. When somebody goes into kidney failure, one of the first organs that’s affected is the lungs. Because, right, because fluids can’t… because urine can’t be excreted, and therefore fluids will push up on the lungs. Hence, making it more difficult to get somebody off the ventilator.
Laura: Yes.
Patrik: Right? So and that’s why your mom most likely has entered a vicious cycle they can only break by treating her appropriately. Do you know if your mom is still in an induced coma,or is she awake?
Laura: They took her out the Precedex.
The 1:1 consulting session will continue in next week’s episode.
