Thursday, February 04, 2016

Yesterday in King's

Most of the day at King’s from 10.00 to 16.00. The transport department had been asked to provide oxygen but tried to pretend he had said it wasn’t needed.

Kidney function bad, deteriorated a little but not to the extent that it required action. Haematologist had not seen the complete blood results but enough to tell us there had been further deterioration over the 5 days since our last visit. “Leukaemia is taking off”, she said. She made arrangements for me to have a blood transfusion next Tuesday. I only had a magnesium infusion through the wonderful PICC line which allows most transfers of fluids to be made via a semi-permanent line in the arm. The only medication suggested was hydroxycarbomide, but that was of doubtful benefit, so we agreed not to bother with it.

First half of last night went well, but after midnight, Stripey the cat kept jumping up on the bed and trying to sleep on my feet which is fine in the daytime but not at night. As he makes a habit of it, I need to find a solution that allows me to have a peaceful sleep without cats jumping up and down on my feet. The whole point of getting out of hospital was to have a peaceful sick room environment, and after midnight, this is not it!

Discharge Summary:

Lord Avebury, an 87 year old gentleman with known myeloproliferative disorder,  presented with deteriorating renal function. Prior to admission he had suffered from nausea and vomiting for 2 weeks and diarrhoea for 7 days. Creatinine was 293 on admission from a baseline of -110 in December and he was clinically dehydrated. During the admission his renal function improved (creatinine) and he was clinically well.

Lord Avebury has previously required bilateral renal artery stenting for stenosis. Repeat renal artery Dopplers demonstrated in-stent re-stenosis (severe on the right, moderate on the left). His case was extensively discussed during the radiology MDM and it was decided that repeat angioplasty and stenting would give long-term benefit. The improvement of his renal function allowed this procedure to be organised as an elective case and was therefore not possible to be completed during this admission. It will therefore be re-scheduled as a routine outpatient procedure.

During his admission he required multiple transfusions of platelets and blood for his transfusion dependent myeloproliferative disease. Hb was 83 and platelet count 22 at discharge. Regular transfusion will continue to be required after discharge and this will be arranged under the care of the haematology team. To support the provision of blood products a PICC line has been inserted.

Sat 30 Jan 2016

No comments: