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Family Emergency Update
8 years ago
Kiss me once and I will surely melt and die
I've finally gotten the time to sit down and explain what my little family has been going through lately.
Saturday May 27th my husband alerted me to swelling and pain in his scrotal area. The swelling was enough that i noticed it easily. We got him to the ER within the hour and signed in around 2:50pm. We figured it was an abscess that had gotten infected. They ER agreed that's what it was by palpating and we were admitted into the ER treatment area and were quoted a probably 3 day stay with surgery to remove the actual abscess.
While in the ER they required 3 CTs and an ultrasound. One with contrast and two without. After about 4 hours they let us know the doctor saw something "Fishy" and wanted another look. So more scans later we have a doctor come in and tell us that my husband's sugar is far too high (had no idea he was diabetic at this point but he eats a keto diet which probably helped him stay mostly healthy all this time) and that all his back pain was revolving around a irritated ureter that he's most likely been passing small stones through. About 14 hours go by in the ER where we find out he's allergic to Morphine, he's got a dangerously high PH and passing ketones in his urine and a 16,000 white cell count.
They decided to admit him into the ICU. They start him on Linezolid, Piperacillin, IV fluids and regular doses of insulin to bring him down to a safe level. the second day he's there they bring him a "Diabetic" breakfast of buttermilk pancakes, hash browns, syrup, a whole orange and milk. These are all things that he does not eat normally with his keto diet. I talk to the nurses about having a talk with dietary that the meal wasn't safe for someone they want to regulate the sugar on.. Lunch, they brought him a small chunk of chicken, over a cup of potatoes roasted, a big roll, creamy soup and crackers.. Yet again not realizing the amount of carbs in said meal is detrimental to his health. Dinner was a huge plate of pasta and various non diabetic friendly items.
The next morning, they came in and dosed him with his levemir (slow acting insulin) and fast acting but refused to feed him his breakfast because they didn't "Want to stress him out" So at this point i get a call that he's in dire need of food that they've given him his meds and no food. So i had to rush into the kitchen and make him a big serving of scrambled eggs with sausage and rush it in. I then found out that they were more than likely going to continue this. So I was forced to be able to bring him in EVERY single meal he'd need. So i had to make and bring breakfast, visit, and leave in time to make and bring in lunch, visit, and leave in time to make dinner and then visit for a bit before i needed sleep or to find time to take care of the pets and house.
That second day in ICU i ended up having to have a fight with the nurses. My husband's infection was localized mostly to his scrotal area with bad swelling getting worse. A doctor came in, glanced at him, asked if he had insurance and that was really it. Didn't palpate the area or really look into the problem of why he was there.. only decided to call a Urology Consult. A couple hours later i was checking his area (which i did regularly) and i saw that he had ascending redness that was spreading up towards his abdomen.. which was his infection spreading. I first started with begging the nurses to come look. They wanted to put hydrocortisone on it. I then requested they get a doctor in to look at it (we're in the ICU, there's a doctor near by right?) They said they'd call the doctor. They came back an hour or so later and let us know that the doctor wont condone changing his meds up without looking at him first, but won't come in to look at him? At this point i was a little miffed and demanded a permanent marker so that we can outline the spreading infection so we could gauge the speed at which it was spreading.
They argued for a while before agreeing to outline the redness. By the 6th hour without a doctor coming in and him looking like death, I was irate, and angry and ready to start a fight. They apologized and told me that the On-call ICU doctor had left and didn't want to come back in. I was dumbfounded at this point. An ICU with no doctor available.. They proceed to tell me that 4-5 doctors will come check and no one ever came. at about 10-11 hours later, the Urologist came in from surgery and see's the issue and looks around and asks why no one told him it was an emergency. He switches his meds around.. and then proceeds to tell us that this could progress into fornier's gangrene which he said had a 99% mortality rate. He decides that he's going to give it 24 hours, wants the nurses to check on it every two hours and outline the redness (also complimented them on outlining it before he got there) and watch to see how it's doing. If it wasn't doing better, he wanted to transport him to another hospital, if it was getting better, he'd keep him there.
I went outside to yell, scream, cry and generally lose my mind. I was very certain that if something happened to him because of this facilities inability to get a doctor to come look at him, i would be the most dangerous person on the planet.
The next morning, the surgeon came in and was happy to announce that he saw a 25% reduction in spread of the infection. He spent a full 4 days in ICU before being moved to Med/Surge ward.
Once moved there we had tallied up the following allergies: Morphine, Dilaudid, Norco, and because he was on linezolid he couldn't take tramadol or else suffer serotonin syndrome and we would later find out that he had a reaction to another medication.
Now that we found he can't take any pain meds except ibuprofen, he's basically in agony at all times and no one can help and they'd only give him a motrin every 8 hours.
His wonderful surgeon had an emergency and had to leave the country and transferred his care to another surgeon. The attending and surgeon decide to put him on 2000mg of vancomycin every 6 hours i believe.. and have him on constant blood tests to make sure his kidneys weren't shutting down from it. After a few days, the surgeon puts his foot down and schedules him for surgery to drain the scrotal area and hopefully get the infection out. 7 days of medications weren't touching it at this point and it was turning into a mass around his pelvic area.
The next day we go in and my husband's RN loses her shit because the ICU hadn't listed his Allergies in his paperwork so that anesthesiology could prevent a massive fuck up. We go in for pre op and are told to wait in the waiting room, no one else was there, just us. nothing but emergency surgeries that day and ours. it was supposed to be a 30 minute surgery. we waited almost going on two full hours before an OR tech came in and noticed us and asked "... uh are you ____ _____s family?" and we said yes.. he was amazed the surgeon didn't come to talk to us.. and let us know he was being moved back to his room.
When i got back to med/surge i found his RN and told her i absolutely needed that surgeon to come up to the room and explain what the hell happened. She was pissed that he didn't come talk to us.. and called the OR.. only to find out that he did the surgery and just left. Flat out left. And took him off ibuprofen for some random reason.
They couldn't reach him on his phone, office line or any other way. They said they were going to file a formal complaint against him for his conduct.
Later that day we notice he's turning bright red and itchy and totally covered in hives.. a couple days later the surgeon claims it's more than likely red man syndrome from the vanco and they stop the meds.
So after a couple days of packing/repacking the wound, the surgeon decides to take the packing out, cancel home care and wound care and they sent us home with scripts for tramadol, clindamycin (only 6 days worth wtf) levemir, novolog, lisinopril, and a meter/strips..
Apparently the surgeon forgot to write the dosing info on the pain meds but the pharmacist was a champ and called him directly to get the info. The hospital wrote a script and forgot that they can't get insurance approval for fast acting insulin without a pcp script, so we couldn't get the novolog and because they wrote the script for 3 pens, and the pharmacy didn't carry them.. we only got one vial of the levemir.. which was only about 20 or so days worth at the 25 units morning and night. So we had to call the med/surge doc and get her to call in another refill until his doctors appt the 20th. The pharmacy was out of lisinopril so they gave me three days worth for free until they got their full supply in.
So far, we've been logging all his sugar tests in a tally book along with his bp test results. He's eating keto and taking his meds. I'm watching his drainage from his open incision and somewhat unsure what i should really be looking for, the drainage is thin and mostly clear with a tinge of pinkish yellow.. but mostly lymph fluid with a little blood.
Luckily he's got PTO and his bosses have already told him to not worry about work and such. My back is killing me and i've been running ragged lately. I lost 20lbs in 11 days from not being able to eat due to stress..
Now things are getting back to normal and i await the bills from insurance. Once he's in the care of his PCP i will be filing a complaint with the joint commission on his care/dietary issues and other things.
This has not been fun. But i have him now and that's all that matters.
Back to work when i have down time when he's sleeping.
Saturday May 27th my husband alerted me to swelling and pain in his scrotal area. The swelling was enough that i noticed it easily. We got him to the ER within the hour and signed in around 2:50pm. We figured it was an abscess that had gotten infected. They ER agreed that's what it was by palpating and we were admitted into the ER treatment area and were quoted a probably 3 day stay with surgery to remove the actual abscess.
While in the ER they required 3 CTs and an ultrasound. One with contrast and two without. After about 4 hours they let us know the doctor saw something "Fishy" and wanted another look. So more scans later we have a doctor come in and tell us that my husband's sugar is far too high (had no idea he was diabetic at this point but he eats a keto diet which probably helped him stay mostly healthy all this time) and that all his back pain was revolving around a irritated ureter that he's most likely been passing small stones through. About 14 hours go by in the ER where we find out he's allergic to Morphine, he's got a dangerously high PH and passing ketones in his urine and a 16,000 white cell count.
They decided to admit him into the ICU. They start him on Linezolid, Piperacillin, IV fluids and regular doses of insulin to bring him down to a safe level. the second day he's there they bring him a "Diabetic" breakfast of buttermilk pancakes, hash browns, syrup, a whole orange and milk. These are all things that he does not eat normally with his keto diet. I talk to the nurses about having a talk with dietary that the meal wasn't safe for someone they want to regulate the sugar on.. Lunch, they brought him a small chunk of chicken, over a cup of potatoes roasted, a big roll, creamy soup and crackers.. Yet again not realizing the amount of carbs in said meal is detrimental to his health. Dinner was a huge plate of pasta and various non diabetic friendly items.
The next morning, they came in and dosed him with his levemir (slow acting insulin) and fast acting but refused to feed him his breakfast because they didn't "Want to stress him out" So at this point i get a call that he's in dire need of food that they've given him his meds and no food. So i had to rush into the kitchen and make him a big serving of scrambled eggs with sausage and rush it in. I then found out that they were more than likely going to continue this. So I was forced to be able to bring him in EVERY single meal he'd need. So i had to make and bring breakfast, visit, and leave in time to make and bring in lunch, visit, and leave in time to make dinner and then visit for a bit before i needed sleep or to find time to take care of the pets and house.
That second day in ICU i ended up having to have a fight with the nurses. My husband's infection was localized mostly to his scrotal area with bad swelling getting worse. A doctor came in, glanced at him, asked if he had insurance and that was really it. Didn't palpate the area or really look into the problem of why he was there.. only decided to call a Urology Consult. A couple hours later i was checking his area (which i did regularly) and i saw that he had ascending redness that was spreading up towards his abdomen.. which was his infection spreading. I first started with begging the nurses to come look. They wanted to put hydrocortisone on it. I then requested they get a doctor in to look at it (we're in the ICU, there's a doctor near by right?) They said they'd call the doctor. They came back an hour or so later and let us know that the doctor wont condone changing his meds up without looking at him first, but won't come in to look at him? At this point i was a little miffed and demanded a permanent marker so that we can outline the spreading infection so we could gauge the speed at which it was spreading.
They argued for a while before agreeing to outline the redness. By the 6th hour without a doctor coming in and him looking like death, I was irate, and angry and ready to start a fight. They apologized and told me that the On-call ICU doctor had left and didn't want to come back in. I was dumbfounded at this point. An ICU with no doctor available.. They proceed to tell me that 4-5 doctors will come check and no one ever came. at about 10-11 hours later, the Urologist came in from surgery and see's the issue and looks around and asks why no one told him it was an emergency. He switches his meds around.. and then proceeds to tell us that this could progress into fornier's gangrene which he said had a 99% mortality rate. He decides that he's going to give it 24 hours, wants the nurses to check on it every two hours and outline the redness (also complimented them on outlining it before he got there) and watch to see how it's doing. If it wasn't doing better, he wanted to transport him to another hospital, if it was getting better, he'd keep him there.
I went outside to yell, scream, cry and generally lose my mind. I was very certain that if something happened to him because of this facilities inability to get a doctor to come look at him, i would be the most dangerous person on the planet.
The next morning, the surgeon came in and was happy to announce that he saw a 25% reduction in spread of the infection. He spent a full 4 days in ICU before being moved to Med/Surge ward.
Once moved there we had tallied up the following allergies: Morphine, Dilaudid, Norco, and because he was on linezolid he couldn't take tramadol or else suffer serotonin syndrome and we would later find out that he had a reaction to another medication.
Now that we found he can't take any pain meds except ibuprofen, he's basically in agony at all times and no one can help and they'd only give him a motrin every 8 hours.
His wonderful surgeon had an emergency and had to leave the country and transferred his care to another surgeon. The attending and surgeon decide to put him on 2000mg of vancomycin every 6 hours i believe.. and have him on constant blood tests to make sure his kidneys weren't shutting down from it. After a few days, the surgeon puts his foot down and schedules him for surgery to drain the scrotal area and hopefully get the infection out. 7 days of medications weren't touching it at this point and it was turning into a mass around his pelvic area.
The next day we go in and my husband's RN loses her shit because the ICU hadn't listed his Allergies in his paperwork so that anesthesiology could prevent a massive fuck up. We go in for pre op and are told to wait in the waiting room, no one else was there, just us. nothing but emergency surgeries that day and ours. it was supposed to be a 30 minute surgery. we waited almost going on two full hours before an OR tech came in and noticed us and asked "... uh are you ____ _____s family?" and we said yes.. he was amazed the surgeon didn't come to talk to us.. and let us know he was being moved back to his room.
When i got back to med/surge i found his RN and told her i absolutely needed that surgeon to come up to the room and explain what the hell happened. She was pissed that he didn't come talk to us.. and called the OR.. only to find out that he did the surgery and just left. Flat out left. And took him off ibuprofen for some random reason.
They couldn't reach him on his phone, office line or any other way. They said they were going to file a formal complaint against him for his conduct.
Later that day we notice he's turning bright red and itchy and totally covered in hives.. a couple days later the surgeon claims it's more than likely red man syndrome from the vanco and they stop the meds.
So after a couple days of packing/repacking the wound, the surgeon decides to take the packing out, cancel home care and wound care and they sent us home with scripts for tramadol, clindamycin (only 6 days worth wtf) levemir, novolog, lisinopril, and a meter/strips..
Apparently the surgeon forgot to write the dosing info on the pain meds but the pharmacist was a champ and called him directly to get the info. The hospital wrote a script and forgot that they can't get insurance approval for fast acting insulin without a pcp script, so we couldn't get the novolog and because they wrote the script for 3 pens, and the pharmacy didn't carry them.. we only got one vial of the levemir.. which was only about 20 or so days worth at the 25 units morning and night. So we had to call the med/surge doc and get her to call in another refill until his doctors appt the 20th. The pharmacy was out of lisinopril so they gave me three days worth for free until they got their full supply in.
So far, we've been logging all his sugar tests in a tally book along with his bp test results. He's eating keto and taking his meds. I'm watching his drainage from his open incision and somewhat unsure what i should really be looking for, the drainage is thin and mostly clear with a tinge of pinkish yellow.. but mostly lymph fluid with a little blood.
Luckily he's got PTO and his bosses have already told him to not worry about work and such. My back is killing me and i've been running ragged lately. I lost 20lbs in 11 days from not being able to eat due to stress..
Now things are getting back to normal and i await the bills from insurance. Once he's in the care of his PCP i will be filing a complaint with the joint commission on his care/dietary issues and other things.
This has not been fun. But i have him now and that's all that matters.
Back to work when i have down time when he's sleeping.
I know, I'm on it, too, and I specifically studied ketogenesis metabolism before switching.
It completely, like 100%, alters all diabetic stuff and most of kidneys related. And lots of drugs, too. And very few docs actually have any idea how it works.
One of the most important things, if he actually got diabetes -- not high sugar because he's on keto -- he needs to get off ketogenic asap. Like, yesterday.
They said that he's basically been managing his diabetes with the keto diet and that the blood tests after they got his sugar in check was showing improvement with me bringing his meals. The food they were providing was not diabetic friendly at all and was skyrocketing his sugar levels.. They told me that they have numerous issues with dietary in the hospital and couldn't get them to listen to their wishes of a low/no carb diet. The chief nurse noted that they had no idea of a difference between type one meals and type two meals.
They approved him staying on keto now that he's released as he's on long acting insulin and it will help him lose weight in the long run.
When we went into the ER we told him he's on Keto and inquired if the ketones in his urine were from his diet or if he was really having issues.. You would not believe how many health care professionals have no idea what keto is.. So we had to get them information and basically teach them about it. But because of all his other issues they decided it wasn't keto related but actual diabetic issues.
As his Diabetes is Type 2 they have no doubt that it'll help him lose weight and help him maintain a healthy sugar level even without insulin, but for the current term while fighting an infection they want him to stay on his long acting until his body gets to a point where he can safely fight infection and be healthy. If it had been type 1, it would be very different.
As far as everything went, they said his sugar could be raised from the infection and stress on his system. or the infection could be a symptom of the high sugar.. His PH went back to a normal range and once we cut the horrible diet out they were putting him on it stayed at the right range and in a safe zone for him to get out of ICU.
The chief dietitian seriously had no idea what Keto was and once it was explained they approved me bringing his meals.. but still brought him meals for every occasion, mind you he couldn't eat them..
For a type two, keto is safe and actually recommended, but for type one, it's not recommended and can be dangerous.
I am monitoring his sugar much more than a normal to watch for hypoglycemia with the diet and his insulin.. which is pretty standard in the beginning of the diet but now that insulin has been involved i'm making sure to log all his tests and what he's eaten to make sure he's in a safe zone. His slow acting is pretty awesome and not anywhere near a risk as fast acting meal related novolog.
His new PCP has given us his full approval for his Keto diet as long as with his insulin we test regularly and often to make sure he's not dropping too low and we come in for regular blood tests and checks to make sure things are going well. He said as he gets better and keto makes a difference he'll more than likely lower the dosage needed if it works out that way.
As of right now, he's doing Keto mostly but we're easing him back into it until he's fully healed and his new Doc runs some more blood work on the 20th. Once he gets a full evaluation and he signs off on it all and he's done taking antibiotics he'll give the green light to go fully into the diet again.
Contrary to what you'd expect, it is /bad/ at diabetes. I rather won't go into details lest I state something wrong, but essentially, diabetes gets ketone levels out of check much the same way it does glucose, so it is really easy to get them dangerously high, even to ghe point of ketoacidosis. Anx unlike glucose, there is no (known) way to slap it into normal. Insulin doesn't, even though ketogenesis triggers on low insulin levels. At the very least, it doesn't affect ketones quick -- to the point that a person in ketosis can get several lethal doses of insulin injected with no neurologic effects whatsoever.
Thanks for the info! i'll do more research and find something that's safe for him!
I don't think there is really anyone "trained in keto" well enough because our civilization has been promoting carbs, carbs, carbs for a few hundred years so ketogenesis was considered not even an anomaly but pathology -- and it takes decades if not longer to really figure out how things work...
... Twenty years ago, everyone was convinced that Northern peoples can live on keto because of different genetics. Jusf think how little could have been really learned since then...