Sky Ridge - Two Thumps Up!

Jo came home from the hospital today with a good plan for getting through the next couple of weeks. Overall, she said her experience at Sky Ridge was tremendous, second only to the NIH, which isn't even a fair comparison. At the NIH, each nurse has only 2 patients and every patient on the floor as the same health problems and the same treatment.

Sky Ridge is a great example of progress in the world. Many of the things that none of us like about hospitals have been eliminated. Almost every room is a private room, the rooms are as nice as a hotel and the food is actually very good. When we got home today, Jo got into bed and the first thing she said to me was, "This bed isn't as comfortable as my bed at Sky Ridge."

Now, I am still trying to wrap my brain around the Amenity Suites. These are special rooms on each floor that you can only get if you pay a fee over and above what your insurance covers. Jo and I took a walk one afternoon to sneak a peak and the room was very nice. If you are interested, here is a little info that might push you over the edge when the time comes for your next hospital stay...

A New Drug of Choice

Last night Jo was given a Fentanyl patch for her pain. This is a patch that she wears on her chest for 72 hours which slowly releases Fentanyl into her system through her skin. Fentanyl is another very powerful drug in the same family of drugs as Dilaudid and Percocet, both of which we are very familiar.

Jo isn't feeling much pain and she seems to be doing really well. Her headaches are pretty well masked by the Fentanyl, but they do come and go.

Today, the nurses unhooked Jo from all of her IVs so that we could work toward getting out of the hospital. If Jo can go 24 hours with her pain under control, we will head home - most likely with a handful of Fentenal patches. Then we'll give her body time to hopefully repair the spinal fluid leak on its own. In a couple of weeks, if the headaches are not gone, the "blood patch" procedure will have to be considered.

The End of a Tough Week

I wish I had some good news, but I don't. Jo is having a very tough time dealing with her headaches. Now and then, the pain medication relieves the headache, but then Jo usually feels nauseous.

There is no good solution to this problem in the immediate future. It is possible that the intrathecal morphine shot that Jo received two weeks ago has cause a spinal fluid leak, causing the headaches. The treatment for that is a procedure to attempt to patch the hole. The anesthesiologists are unwilling to attempt that procedure because Jo would have to come off of her blood thinners, which would put her at risk of more blood clots. Since she already has a blood clot, it would be extremely imprudent to put her in a situation where she risks even more blood clots.

The best solution seems to be to tough it out until her body repairs the leak on its own (if there is indeed a leak). How long that will take is unknown, but it could be a couple of weeks. Our primary concern right now is identifying what kind of medication will get Jo through the rough times ahead.

The Headaches Continue

Jo spent another tough day at Sky Ridge today. I did get a chance to talk to Dr. Alvarez and get his thoughts. They have found 2 small blood clots in veins in the back of Jo's neck. According to the neurologist, the blood clots look to be a couple of months old, but Dr. Alvarez thinks they are related to her hip surgery two weeks ago. Jo is always at risk when it comes to blood clots, but especially when she has her surgery since she has to stop taking her blood thinners and then start again after the surgery.

The other possibility is that the headaches are spinal headaches that have been caused by a problem with the Intrathecal Morphine she received two weeks ago. As I understand it, the needle that delivered the Morphine to her spinal cord may have caused a "leak" and her spinal fluid is slowly leaking out. There is a procedure that can be done to attempt to "plug" the hole, but Jo cannot have that procedure until the blood clots are addressed.

Jo has been receiving medicine to break up the blood clots all day. Off and on, she feels some relief and other times the headaches are pretty intense. These blood clots are extremely serious and Jo will most likely stay in the hospital for anywhere from 3 to 4 more days or even a week.

A Bump in the Road

Last Sunday, Jo started to have headaches and by Monday night her head hurt bad enough that we needed to go to the Emergency Room at Sky Ridge Medical Center, Spa & Resort. If you haven't been to the new Sky Ridge facility in Lone Tree, you really should go and take a tour. It is more like a hotel than a hospital.

Monday night, Jo was admitted to the hospital and tonight she will spend her second night there. They have done lots of tests, but so far they have not figured out what is causing the headaches. Anybody that knows Jo, knows that she has a pretty high pain threshold, so her pain has to be pretty bad for her to be in the hospital.

Now, That's Not Natural

At 5:45pm last night, Jo took some pain medication - 5 days and 6 hours after surgery. At noon today, she called me to let me know she slept through the night, she had forgotten to take her pain killers and she was quitting, cold turkey! I told her that nobody would ever give her a hard time if she wanted to at least use the pain medication through the one-week point tomorrow morning. She says she can tough it out. At first, this speedy recovery thing was really cute, but now she's just showing off.

My Sacrificial Spirit...

Jo had another good day of recovery, but I don't want you to think that this hip has been a complete walk in the park. Well, yesterday, we did go for a walk in the park, but you know what I mean.

In one way, this hip has been 10 times worse than the first hip. Because Jo needs her surgical hip toward the outside of the bed, we have had to switch sides of the bed. If you have ever slept on the wrong side of the bed, you know how tough this has actually been on me. It's hard to believe how sore you can get by morning when you sleep on your "other" side.

I guess if that's the worst thing we are dealing with, we should consider ourselves pretty lucky. By the way, I've only asked Jo three times today if she thinks she is up for switching back.

It's All About Priorities

Jo got a lot of rest today, but there was also time for a Sunday morning drive with a stop by Starbucks. You'll have to go back and read the blog entries from the first hip surgery to really understand how dramatically different this one has been. For all of you out there that have been procrastinating having joint replacements, don't read any of that stuff from November. I probably embellished the entire first experience anyway. This 2nd hip is how your experience will probably be. Trust me.

I did get a call from a home health care nurse today that wanted to speak to me and find out how my mom was doing with her hip replacement. Jo and I got a good laugh out of that one. I told the lady that we don't need her to come by. Jo will be going in to see Dr. Alvarez tomorrow and they will take care of checking everything that needs to be checked.

Anna is 4 1/2 months older than she was in November and she is stronger and faster than she was back then. She is having to learn how to be gentle with mommy. She likes to hold on to the side of Jo's walker and pull to try to get mommy to walk faster. She regularly points to Mommy's "boo boo" which is covered with a huge bandaid that covers Jo's entire hip and half of her backside. By the way, at the hospital they call it a "Texas Bandaid". How appropriate.

Has Anybody Seen My Wife?

I think every new parent secretly worries that their newborn baby will accidentally be switched with another baby in the nursery and they will end up with the wrong kid. I'm not sure how it happened, but I think I brought the wrong wife home from the hospital today.

My wife supposedly had a total hip replacement 3 days ago. The woman I brought home is already walking all over the house, sometimes with her walker and sometimes not. She has unpacked and put away all her things, made herself an evening snack and put her little baby to bed. I was expecting slurred speech, a little drooling and incoherent speech for a couple of weeks.

Percocet appears to be a much better match for Jo as far as controlling her pain. I hate to count any chickens before they are hatched, but so far, so good. We'll see how the night goes.

A Day of Experimentation

If the next 12 hours goes well, Jo will be coming home by noon or so tomorrow. Today was another very good day, although not without some minor hiccups. Jo had a fever for part of the day and she had some redness around her incision. The hospital staff will just need to keep an eye on her over night.

Today was mostly about experimenting with different pain medications. Jo would like to come home with some pain medication that would allow her a little more sleep at night, even if she had to deal with a little more pain during the day. Dilaudid was the pain medication of choice last November and it did it's job, but it also came with some not so desirable side-effects - slurred speech, constant nodding off and a fair bit of nausea.

Jo did quite a bit of walking today. She made at least 2 or maybe even 2 1/2 laps around the hospital floor today. The therapists absolutely love working with her. Their normal patients are between 70 and 80, so of course, the progress is normally much slower.

A Speedy Recovery

So far Jo's progress appears to be moving along much quicker than the first hip. About 24 hours after coming out of the recovery room, Jo walked an entire lap around the hospital floor with her walker. Although the pain medication does make her sleepy, she seems much more coherent than last time.

The only thing we can come up with is that in November, she literally didn't have a leg to stand on. This time around, she has one really good hip and a significant amount of her "referred pain" went away after the first hip replacement. Then too, wouldn't a person just want to recover faster with summer coming up as compared to the first time around as we were heading into winter?

I do have to admit that I may have been a little too detailed in my documentation of the first hip surgery. I feel like there isn't anything new or funny to report...on the Jo front anyway. Now Anna is a different story. She has figured out how to get her pajamas unbuttoned and then off comes her diaper. I can deal with her wanting to take her pajamas off, but little babies need to keep their diapers on when they sleep. Tomorrow, we bring out the duct tape!

A New Right Hip

Jo went into the Operating Room at about 9am this morning and she was finished by 11:30am. She is now in her room resting. According to Dr. Kelly, everything was pretty routine. Jo did get "intrathecal morphine" today. That has something to do with the morphine going directly into her spinal cord, which from the look on Jo's face, seems to be quite effective.

Spring is in the Air...

and by noon or so, Jo will start to get some spring back in her right hip. We are headed down to Presbyterian St. Luke's for hip surgery #2. Jo has received a ton of well wishes over the past couple of days and she wants to make sure you all know how much your thoughts and prayers are appreciated. Thank you!

Happy St. Patrick's Day

3 more days and a wake-up until hip surgery #2. We have pre-game at 6am and kickoff at 8:30am. If all goes as planned, Jo will be back home from the hospital by Saturday. Meema will fly in on Monday to help hold down the fort for that first tough week. Oh, by the way...I do plan on taking a swimsuit or two to the hospital for Jo...just in case.

2 Years, 3 Months and 18 Days Later...

Main Entry: nor·mal
Pronunciation:\ˈnOr-məl\
Function: adjective
Etymology: Latin normalis, from norma
Date: circa 1696

2 a: according with, constituting, or not deviating from a norm, rule, or principle
b: conforming to a type, standard, or regular pattern

synonyms see regular
— nor·mal·i·ty \nOr-ˈma-lə-tē\ noun
— nor·mal·ly \ˈnOr-mə-lē\ adverb

For the first time in over 2 years, Jo's platelet counts today were in the "normal" range. If you look at her CBC report above, you will notice the absence of the "L" next to the Plt count that we have become so accustomed to seeing. This is probably the biggest news we have had in the entire 2+ years!

You can also see the three "L"s next to the RBC (Red Blood Cell), Hgb (Hemoglobin) and Hct (Hematocrit). These are all measurements associated with Jo's red blood cells and all three are still in the low category due to the PNH. However, keep in mind that her Platelets have always been the primary source of source of concern due to the critical level to which they dropped. At Jo's 8 week pregnancy checkup in November, 2004 her body was not producing enough platelets to support everyday life.

We've been waiting a good while now to see that little "L" disappear. There have been a couple of times that Jo's counts got close and then they backed off, dashing our hopes. Today we bask in the sweet thrill of victory!

One Year Checkup at the NIH

Jo had another lovely bone marrow biopsy done today at the NIH and I was scolded for harassing the patient. It's just hard not to play with the patient when she is sedated and can't remember anything she says from one minute to the next. Keep in mind that Jo doesn't remember one single thing from the procedure, but my life will go on with even more memories of that giant needle going into her hip. Oh, the emotional trauma I have endured...

We saw Dr. Schienburg and Dr. Childs today. Even though we haven't spent a lot of time with Dr. Scheinburg, he is the primary physician in charge of this particular protocol, under the watchful eye of Dr. Young, of course. Each of the doctors talked about Jo's Aplastic Anemia as if it were "gone" and the primary source of concern now is the PNH problem. Jo will always have to be monitored in case her bone marrow relapses, but for now the Aplastic Anemia has been pushed into remission.

Jo began having another PNH episode yesterday or today, which is maybe good since the NIH doctors will get some blood samples first hand. Our #1 question for today was in regard to the miracle drug that was supposed to come out last fall to solve the PNH problem. It is still on the way. Dr. Childs expects it to be available in early 2008. Dr. Scheinberg said it could be 3 months or it could be 15 months. I think the real answer is that they are not allowed to give us their real thoughts due to the sensitivity of that kind of knowledge.

We did find out more about the miracle drug though. Jo would have to get it administered intravenously every two weeks...for the rest of her life. Those were not the best words in the world to hear. After some thought, it doesn't seem as bad as at first. More than likely, they will continue to improve the drug and develop it into oral form as some point. As for today, they are probably just hoping to get it to market the fastest way possible.

Another thing the miracle drug will do is allow Jo to stop taking Coumadin every day to thin her blood. The primary issue caused by the PNH clones is the potential for blood clots due to the cell debris in Jo's blood. The miracle drug will stop the destruction of the red blood cells - the reason that clotting is a concern.

By the way, yes I do know that I spelled Dr. Shein "Ice" berg's name 3 different ways above. I have no idea how he spells it.

The Love Bug Visits Highlands Ranch

As has become customary at the Szymanski household, Anna has had her holiday photo shoot for tomorrow's Valentine's festivities. Keep an eye out around Denver tomorrow for the Love Bug spreading holiday cheer and maybe a chocolate kiss or two.

The mystery of the fluids of last week has now been revealed. Jo had an "episode" in terms of her red blood cells. For no apparent reason, her body was destroying red blood cells at a very rapid pace, creating a massive amount of cell debris to be processed by her kidneys. Dr. Alvarez had Jo come to his office for extra fluids 3 days to "flush" out her kidneys and she got a red cell transfusion to boost her counts.

What triggered all of the excitement was Jo's blood test on Monday. It was the first time in 2 years that her blood count report ever indicated an "alert". The report shows an "L" or an "H" and sometimes even an "LL" indicating low and high levels. The alert was for a measurement of her kidney functions. All is back to normal now. In less than two weeks, we head out to the NIH for Jo's one year follow-up and hopefully we'll get more information about the miracle drug that is supposed to solve her red blood cell problem.

Jo saw Dr. Kelly today and she confirmed the March 21st date for hip replacement #2. Dr. Kelly is extremely pleased with Jo's progress and she feels like everything is right on track. Jo did also have the opportunity to talk to Dr. Kelly a little bit about what will happen after this hip is done.

Jo's shoulders and knees still have pockets of necrosis that need to be treated. Jo has not had any increase in the pain in her shoulders and knees, which indicates that the joints are not collapsing like the hips. Dr. Kelly's plan is to use the "core decompression" technique on her shoulders next to try to reverse the progress of the disease. Little Miss Overachiever asked Dr. Kelly if both shoulders could maybe be done at the same time. Dr. Kelly replied, "Not if you want to be able to brush your teeth."

"Gearing" Up for Hip #2

All right already! A guy doesn't do a blog entry for 6 weeks and everybody is ready to send him to the gallows. I thought the old saying was, "No news is good news." Plus, I've been shoveling snow nonstop for 6 weeks. Now that the normal Denver winter is back (60+ degrees today), I guess I don't have an excuse anymore.

Emily is now back from England and she and Anna have gotten reacquainted quite quickly. Emily was very excited to get back to the land of Milk and Honey. She said the snow in Denver even made the news in England! Fortunately for us, Emily's memories of the M*A*S*H unit of last November have all but faded completely away.

My mom is already scheduling her flight into Denver to help for that first week or so after Jo's surgery, which is still set for March 21st. My father will pick her up on his drive back from Arizona to Minnesota for the summer.

Jo and I head out to the NIH in Bethesda on February 26th and Jo will have another bone marrow biopsy on the 27th. We will now only be required to go to the NIH once per year. Hopefully we will get some good news about the "miracle drug" that is supposed to take care of Jo's red blood cell problem.

Jo's red blood cells have actually been low for the last week or so and Dr. Alvarez is considering a red cell transfusion later this week. He called her into his office today for fluids and she has to go back tomorrow and get more. We are not 100% sure what the fluids are for, but they may very well just be to make Jo feel a bit better. Low red cell counts also mean fatigue and Jo has definitely been feeling run down.

As for that new left hip, it feels great according to Jo. The range of motion she has in her left hip right now compared to her right hip is amazing! She says it really does feel as good as new and she cannot wait to get the 2nd one finished.

A Serious "Pat Down" at DIA

Jo, Anna and I traveled from Denver to Texas today, narrowly escaping the remnants of the blizzard earlier this week that wreaked havoc on Holiday travelers trying to get out of Dodge for the Holiday. With many of those travelers trying to get rescheduled on flights this weekend, the lines for check-in and security were at all-time highs sometimes wrapping from one end of the terminal to the other and then around a corner and out of sight.

For many of the weary, this morning was an exercise in extreme patience. For the Szymanskis, it was an opportunity to see the glass half full instead of half empty. This was, of course, our first time to travel since Jo's hip surgery. The baggage guys must have noticed Jo trying to navigate the crowd on one good hip and one bad hip and me carrying the baby and all the luggage...or maybe Jo was secretly waving a much larger wad of money than I had in my hand. Either way, their gracious offer to take us straight to the front of the line was much appreciated!

Of course, with one bad hip, it would still be next to impossible for Jo to walk all the way from the main concourse to our departure gate. The only real option is a wheelchair...which does also mean that we cut straight to the front of the security line via the "airport employee/wheelchair only" security entrance.

Anna and I quickly jumped through security and began gathering our bags when the metal detectors started going off louder than I have ever heard. For a second, I thought that maybe Snoop Dogg or P Diddy had just tried to come through security after refusing to remove any jewelry. I turned around to see my lovely wife, lighting up the security machine like a Christmas Tree and a screening agent saying, "So, Mrs. Szymanski, what exactly are you hiding under your clothing?"

Oh well...all's well that ends well, right? To all of our other friends from Denver that I know had to battle those long lines this weekend at DIA, we (almost) felt your pain, but having a metal hip has to come with a few perks.

Merry Christmas everyone! We love you all!

A Tentative Date for Hip #2

Jo has decided to set a tentative date to have her second hip replaced - March 21st - the first day of SPRING! When we saw Dr. Kelly for Jo's follow-up appointment, Jo was given a perfect score on her report card. She does still need to gain weight, but having a point on the horizon to focus on is good motivation (to eat more ice cream).

Jo has her final appointment with the physical therapist tomorrow who says Jo is the strongest patient they have ever had. Dr. Alvarez thinks it will be 6 months before Jo has her next hip done. Good old Dr. Alvarez, always taking the most conservative approach when Jo's health is on the line.

Anna went to the mall to have her picture taken with Santa and she screamed her head off. Can you blame her? Without the ability to really understand Christmas, the big, fat man in the tight red suit is actually quite scary.

Since I am back into one-blog-per-month mode, I want to pass along our wishes for a Happy Holidays for you all! Have fun, eat a lot, be merry and watch out for fat men in red suits (Anna added that last part).