A tale from a nursing home

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Russell Williams

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Couple of quick suggestions. Ask for a bedside commode. For her hip wound have they considered a wound vac? Also if she is not in a nursing homes Transitional Care Unit, she needs to be on one. Lower staff to patient ratios and nurses more qualified in post surgical wound care.
I offered to bring in my own bedside commode and they refused. I was in the short term "rehabilitation" unit after I transferred from the luxury unit that cost an extra $150 per month.

Thanks for the advice. Louise Wolfe
 

Russell Williams

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(Is the nursing home run by Moe, Larry, and Curly or by Simon Legree?)[/QUOTE]

We.re not sure since her title was simply "The Aministrator". Despite all my many complaints I never met her.

Thanks for all your valuable information. Louise Wolfe
 

Russell Williams

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Yes, gowns, gloves, and handwashing until the course of vanco is complete and there are three days of negative stool samples in a row.
But the problem with C Diff is once its under control, they will not test any samples that are no longer watery diarhhea. Just like Russell and I had to wait 3 days after we were sure I had C Diff before my stool was watery enough to be tested. Louise Wolfe
 

Russell Williams

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I am finally home again and feeling much safer under the loving care of my dear husband, Russell.

Thank you so much for all of your helpful advice and support. You have all built up a lot of good karma.

I do plan to pursue an official complaint (no, compaints!) against the nursing home. Will keep you posted.

Louise Wolfe
 

Russell Williams

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Last night I used my hands to hold the inside of Louise's upper arm and joyously snuggled my face into the outside of her upper arm. I commented to Louise i worked very hard to keep her healthy. With a loving and mischievous smile on her face she said that I deserve to enjoy the benefits of my hard work.

Russell Williams who has the honor of being married to the beautiful brilliant and wonderful Louise Wolfe.
 

Russell Williams

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An update on Louise as of July 10.

Louise is now been out of the nursing home for two weeks which of late is, unfortunately, a record.

She did not tell me that addition to having MRSA in her leg wound she also had MRSA in the abscess over her new hip joint and she had MRSA in her blood. I found out this information on a visit with Louise to the wound clinic. Louise was getting a very strong antibiotic but it was only prescribed for 10 days because it is not only hard on MRSA it is also hard on many body parts. They are now prescribing a different antibiotic but it has been tested and found effective against the type of MRSA that Louise has in the three places.

For the last two weeks she has had no fever, her blood sugars are about normal, and her white cell count, as far as I know, is not elevated so she probably no longer has MRSA in her bloodstream. When we went to the wound clinic yesterday the doctor said that the abscess over top of her new hip joint seems to have completely healed. The only remaining wound is one on her calf which is a little smaller than a quarter and is about two quarters deep. A week ago the widest circumference was 1.7 (I think it was 1.7 and not 2.7) and yesterday the widest circumference was 1.3 cm. I am changing the dressing twice a day and putting Silvidane in each time I change the dressing.

She is doing her exercises and gaining strength daily. Sunday for the first time in perhaps three years she was able to leave her scooter at the back of the church and use a cane to walk down to the front of the church were Louise and I and Lori usually sit. After church we went to a place called Pen Mar where they have ballroom dancing. When the song "I just called to say I love you.", was being played Louise and I stood up and I pulled her close to me and we swayed back and forth. It felt wonderful. Later on, two different times, when faster ballroom music was being played, we both stood up and, facing each other while holding onto the Walker, we proceeded to move our feet more or less in time with the music.

It was wonderful to be able once again to hold her close and to dance with her.
 

Yakatori

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Just awesome....

But what about the probiotics and fiber and such? Did the doctor get into any of that?
 

CastingPearls

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Russell, you need to check with the infectious disease specialist whether Louise is colonized or not. That means that anytime she would have a wound or infection, MRSA would jump in because it's living on her body. You can battle it, knock it back, etc. but it remains on the body even after a wound is healed. You need to know this info; knowledge is power and if she is colonized you both have to be very careful even with innocuous things like papercuts.
 

CastingPearls

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Why not just assume that she is? I mean, isn't like 1/3 of the population?
I think it's smarter to not assume anything, don't you?

MRSA is prevalent in nursing homes and hospitals so it could be the environment and not the individual. If you remove the individual from the environment and they're recovering, (as I was) there's a risk that they're colonized but it's also possible they weren't. I wasn't, thankfully. I was sent home with active MRSA but pretty much kept isolated and everything was virtually sterilized (as much as possible in a home, it's not like the cats walked around in spacesuits) but visiting nurses had to suit up. In fact, my medical team told me I was safer at home with the infection than in the hospital.

It wasn't until I had small cuts and scrapes that the scare was over. More recently (three years later), I had another scare involving my original illness and there was no infection present at all.
 

Yakatori

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Some risks are worth taking. Practically speaking, we have to rely on certain assumptions every day. Besides, if being colonized just means being extra careful, why not just be that careful anyway?

Yeah, it is more common in hospitals and nursing homes. But it's not like it's this alien-strain from another dimension. If she had it before, why couldn't it be somewhere else in house? Or that he's been colonized from taking care of her for so long? Lots of possibilities/opportunities to be "colonized" with or without institutional stay.

"..my medical team told me I was safer at home with the infection than in the hospital."
Yeah, that's pretty much the consensus. Once you're out of surgery, emergency care, etc...it's like you're an infection waiting to happen or worsen. But folks expect things out of these facilities that they're just not prepared to deliver...

"..It wasn't until...that the scare was over. ...(three years later), I had another scare..."
To me, this problem is born out of the idea that the solution to everything is in a bottle of pills (antibiotics) that you can wash down with some bleach. I don't think of it as a problems that's "bombed" to be solved; it's more of something that has to be managed day by day. You know, de-cluttering the house, starting with some regular household cleaners, etc...steady wins the race. But I'm no expert.
 

CastingPearls

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No, you're not an expert. I think someone who has had MRSA and has extended hospital stays might know a wee bit more than you on this.

It's not an alien from another dimension but MRSA and superbugs that hang out in hospitals and nursing homes are the result of overuse (and under-use, not finishing the full dosage) of antibiotics, among other things. They've evolved from weaker germs, not to mention viruses can mutate (this was a big concern when AIDS was first being researched-could it mutate to become airborne, could it mutate to be transmitted via mosquito) so we can sit around and casually dismiss strong concerns and say throw more bleach at it but we don't know the full picture which is why I recommend Russell speak with an infectious disease specialist for real answers rather than rely on rhetoric from forum regulars.

If you've been following Louise' story, she's been in nursing homes pretty regularly so yes, while it's possible that there may be some MRSA hanging around at home, her spending a great deal of her time (a month in, a week out, another month in, a few days out, another month in, lather rinse repeat) in the nursing home where Russell and Louise have witnessed some abysmal waste management and biohazard nightmares in her room and bathroom would strongly suggest it IS probably the nursing home environment.
 

Yakatori

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I don't really mean for anyone -NOT- to talk to whatever specialists, I'm just seizing on that we all have be on guard against the solutions that ask the least of us. Support staff will always make for a convenient scapegoat.

Note: Russ still hasn't followed up on the probiotic/fiber angle....
 

Russell Williams

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The state inspector went to the Julia Manor nursing home and three different people at the nursing home told her that, because Louise had C diff, while Louise was there she had a bedside commode that she was using. This of course meant that was no bathroom problem at all because Louise was using the bedside commode rather than the bathroom.

So it appears that Louise and I both had hallucinations about all the events that occurred in the bathroom and traumatic amnesia because neither of us is the slightest memory of the bedside commode. Any other explanation would involve libeling or slandering the nursing home.

Earlier this week I saw the family Dr. and told him about my episode of hallucinations and traumatic amnesia. For whatever reason he did not see the need to either give me any antipsychotic medicine or to refer me to a psychiatrist or psychologist.
 

moore2me

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The state inspector went to the Julia Manor nursing home and three different people at the nursing home told her that, because Louise had C diff, while Louise was there she had a bedside commode that she was using. This of course meant that was no bathroom problem at all because Louise was using the bedside commode rather than the bathroom.

So it appears that Louise and I both had hallucinations about all the events that occurred in the bathroom and traumatic amnesia because neither of us is the slightest memory of the bedside commode. Any other explanation would involve libeling or slandering the nursing home.

Earlier this week I saw the family Dr. and told him about my episode of hallucinations and traumatic amnesia. For whatever reason he did not see the need to either give me any antipsychotic medicine or to refer me to a psychiatrist or psychologist.
You and Louise were not psychotic or blind, perhaps you were smoking some of that illegal green, leafy vegetable matter. Or walking on the wild side by using fungal hallucinogens.

Is now 25. I am not happy.
Russell, I give up. What is GFR? Glomerular Filtration Rate?
 

Russell Williams

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Russell, I give up. What is GFR? Glomerular Filtration Rate?[/QUOTE]

If I have the initals correct yes that is what GFR is.

Last Dec it was about 60.

In the spring it was about 45

In the early summer it was 38

Now it is 25.

We have been told that if it hits 15 the roof caves in.

Does a GFR rate ever go up and what can help it do so.

My GFR is greater then 60.
 

moore2me

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Dear Russell,

I have done some research and it appears that the GFR can go up. It would do this if the kidney heals from a disease, or if the owner takes better care of his/her kidneys, or if something changes (such as a kidney transplant).
The kidney is an organ just like any other organ (heart, lungs, skin, stomach, liver, etc,). If they are damaged, most of the time they can be healed (unless too far gone).

I did some research and found the following info. Some drugs cause kidney damage (called nephrotoxic) and some drugs can heal kidney damage. Just a few examples below. Also note that the length of time the drug is taken and the dose is also important in this consideration.

Cyclosporine – can damage kidney or nephrotoxic
Ifosfamide – can damage kidney or nephrotoxic
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Since diabetes can damage the kidney, controlling diabetes & blood sugars is one way to control kidney damage. Drugs for this include Glucophage, insulin, and diet management to lower sugars. Monitoring blood sugars regularly (daily) is also important – as is exercise and proper diet.

We can also help our kidney by lowering the burden on its work. We can do this by drinking plain water instead of carbonated drinks, alcoholic beverages, etc. However, if the doctor recommends you reduce your water intake due to congestive heart failure or some other problem – follow the doctor’s orders.

Check with the kidney organizations for more information
National Kidney Foundation
http://www.kidney.org/
also most states have their own branch of this organization, here is just one example - Maryland’s http://www.kidneymd.org/

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How to improve GRA.
The definitive diagnosis of the type of kidney disease is based on biopsy or imaging studies. Biopsy and invasive imaging procedures are associated with a risk, albeit usually small, of serious complications. Therefore, these procedures are often avoided unless a definitive diagnosis would change either the treatment or prognosis. In most patients, well-defined clinical presentations and causal factors provide a sufficient basis to assign a diagnosis of chronic kidney disease. .

Diabetic kidney disease is a type of glomerular disease, but it is singled out here because it is the largest single cause of kidney failure. Both type 1 and type 2 diabetes cause chronic kidney disease. Because of the higher prevalence of type 2 diabetes, it is the more common cause of diabetic kidney disease. The clinical features, natural history and treatment for diabetic kidney disease are well known because it has been the subject of numerous epidemiological studies and clinical trials. Diabetic kidney disease usually follows a characteristic clinical course after the onset of diabetes, first manifested by microalbuminuria, then clinical proteinuria, hypertension, and declining GFR. Clinical trials have established a number of effective treatments to slow the development and progression of diabetic kidney disease, including strict glycemic control, angiotensin-converting enzyme inhibitors and angiotensin receptor blockers, blood pressure control, and perhaps dietary protein restriction.

A variety of diseases, including other glomerular diseases, vascular diseases, tubulointerstitial diseases, and cystic diseases, are often grouped together under the label “nondiabetic kidney diseases” for the purpose of epidemiological studies and clinical trials. Amongst these, hypertensive nephrosclerosis and glomerular diseases are the second and third most common causes of kidney failure. The various diseases in this group differ widely based on history, clinical presentation, risk for progression, and response to treatment. Differentiation among the diseases can be difficult, often requiring kidney biopsy or invasive imaging studies.. Specific therapies are available to reverse abnormalities in structure and function for some types of chronic kidney disease: for example, immunosuppressive medications for autoimmune glomerular diseases, antibiotics for urinary tract infections, removal of urinary stones, relief of obstruction, and cessation of toxic drugs. A thorough search for “reversible causes” of decreased kidney function should be carried out in each patient with chronic kidney disease.

Kidney disease in the transplant is probably the fourth largest cause of kidney failure. Both immunologic and non-immunologic factors appear to play an important role. The most common causes are chronic rejection, toxicity due to cyclosporine or tacrolimus, recurrent disease, and transplant glomerulopathy. In addition, differential diagnosis includes all the diseases that can occur in the native kidney. For a variety of reasons, especially the ease and safety of kidney biopsy, there is generally a much lower threshold for performing invasive procedures to establish a definitive diagnosis in kidney transplant recipients.


I have a couple of charts to go with the above info. However, they are lost temporarily in my computer. I will look more this afternoon and send them later. M2M
 

Russell Williams

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I have printed out what you said and gave it to Louise. We thank you for taking the time to collect and post it.
 

Miss Vickie

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Russell, I assume that Louise sees a nephrologist (kidney specialist)? If not, she should. Yes, the GFR can increase, but the concern I have is that hers is trending down. As M2M pointed out, there are many diseases that can cause kidney damage; some of them are manageable and the GFR can improve with treatment. I don't know what Louise's other health problems are but long term hypertension and diabetes are really, unfortunately, hard on the kidneys. Ultimately, despite numerous heart attacks, it was kidney disease that went untreated that led to my brother's death two years ago.

One of the people I know who had Sarcoidosis like me had a really nasty hit to her kidneys due to hypercalcemia. (Sarcoid can throw off vitamin D metabolism which affects calcium levels; calcium in excess is hard on the kidneys as the body tries to get rid of it). Her GFR was very low, her serum creatinine was incredibly high (another measure of kidney function). But once they treated her excess calcium, her kidneys returned to normal function.

I'm glad they're continuing to evaluate it, but they need to have a fall back condition if it continues to fall despite treatment. That may include dialysis which -- from my limited experience with my brother's experience -- should be started sooner, rather than later. He ignored his symptoms, refused to see his doctor, and paid the ultimate price. Louise is lucky that you're looking out for her.

Get her to a kidney specialist if you possibly can.
 

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