Not so fast

I had a good plan to get Avery home on friday but he had other plans......

I was feeling pretty good about what came out of the morning rounds.  The attending agreed with giving Avery an enema for the constipation, a new gj tube and IV lasix to bring down the swelling.  We we on track with everything by 11am.  Which is pretty good for hospital time,so I thought!!!!! So when the attending came into my room asking to speak to me for a minute, I knew the whole plan was bust.  They did a chest x ray which showed pulmoray edema (fluid in the lungs) but would explain why he has been so respiratory the past few weeks.  When you have pulmonary edema then it is suspected that there is an issue with his heart.  Avery had an echo of the heart during the last admission which apparently showed a bright spot on his right atrium of the heart.  So the attending wanted to do a full cardiac workup to figure out what was going on.  The echo they did yesterday showed a gradient in the Superior Vena Cava.  What is could explain is the swelling in his face and neck area.  Which could indicate either a blood clot or some restriction in the vessel.  UGH.

So the plan is to do a Angio CTscan to look at the vessels.  Because it is a longer test and Avery is so hard to sedate, they will do the test under anesthesia in the next couple of days.  Depending on what they find or don't find will decide the course of treatment.  If it is a blood clot then blood thinners and if its a restriction then a stint could be placed.  Hopefully it is just nothing. 

This problem is not related to the pulmonary edema which is another issue.  His continues to put out low urine amounts and is needing lasix so that is also something that needs to be addressed.  He continues to be respiratory b/c of the fluid in his lungs. 

Guess the only good thing he got is he got a new gj tube and it went smoothly.  We will see what the next couple of days bring.  At point, I will no longer believe that Avery can come in for just an overnight stay.  He just much too complicated at this point.  Like my friend Susanna said, I just have to take it day by day.