Duke 2012 – Day 4
Saturday, January 7, 2012
Today’s blog will be two things: earlier and shorter than it has been so far. Earlier so you don’t have to stay up past midnight or be anxious until tomorrow to get the update (and so I can get in bed earlier). Shorter because there isn’t anything new to report.
The doctors told us again this morning what we thought we understood yesterday – that the excess fluid has been taken care of by the IV diuretics and that Tami’s heart is slightly weaker than it has been previously. They are going on the assumption that this episode of fluid retention is just a hiccup, not a dramatic change in her condition. So we are going to try the new diuretic for a couple of weeks to be sure that it keeps the fluid off. Then we will come back for a follow-up and for Tami to do the special treadmill test that she has done several times and that is used as one of the primary indicators of he need to consider heart transplant. You may recall that the last time she did this test she did so well that she was told she didn’t need to do it for a while. So, now, since they think her heart has weakened some, they want to re-check it on the treadmill.
Now we just have to stay until her anti-coagulation medicine (warfarin or Coumadin) becomes therapeutic. That is, it needs to be working to achieve the desired result, namely, that the blood does not clot like normal. This anti-coagulation treatment is used in many conditions, but, for Tami, it is used to prevent the formation of blood clots on her mechanical aortic valve. In the hospital, they manage this a different way, with the fast-acting IV drug heparin that can be stopped so that there is good clotting (i.e., not excessive bleeding) during procedures or surgeries. After the procedure, however, it takes a few days of taking the warfarin by mouth to reach the desired effect, measured by what is called INR. There is the possibility that we may get to come home before the INR reaches its desired value (at least 2.0 if you really care, and Tami’s today was 1.2) by doing a couple of days of injections at home. We are also going to ask in the morning if they can’t give her a larger dose of warfarin tomorrow to speed up the process (when she is at home and the INR falls below the normal therapeutic range, she takes an extra dose or two to bring it back up – that’s not what they are doing yet, so we are going to ask – there’s really no point in just sitting here extra days just for one pill and one blood test per day – really!).
That’s all – I’m going to bed – you can pray either that we get to come home tomorrow (I even said I’d give the shots if that would help us go home sooner! 
) or that we don’t get totally stir crazy and come home Monday. Good night.
