This week Dennis’s therapist have been concentrating on strength training. He is working on strengthening his core and his quads, but still having problems with his blood pressure dropping when he is standing for long periods of time. His BP before standing is 121/59 and his BP five minutes in standing frame is 88/60 and his BP seated for five minutes is 101/62.
On Thursday, Dennis was fitted for his wheelchair. The process was very overwhelming. There are several options for the different bells and whistles that a wheelchair offers. Dennis chose a bright red wheelchair (IU colors) and thankfully one that I can easily put in the back of the car. We should have approval in 45 days and will get the wheelchair in three months. Yes, I wrote that correctly. Three months! All I have to say is insurance companies. Dennis also went on his first outing outside the hospital grounds. The poor guy has been in the hospital for 46 days. Brooks took a group of four people from different floors to Panera to ease the anxiety of going out in public once discharged from rehabilitation. Dennis set a few goals on the way to the restaurant 1)navigate the ramp, 2) steer & navigate through the door with his wheelchair, 3) navigate the bathroom, and 4) order, get his drink, and navigate through the tables which he did successfully the first time. I was leery about the door, but Dennis just breezed right up to the door, opened it, and steered his wheelchair right through the door. I don’t think there is anything he can’t do on his first try. ;-)
Today was the Mayo appointment and it was very informative. The neurologist was very impressed with Dennis’s mobility and strength in his legs. He still needs to work on trunk control and obviously strength in his left leg. We looked at the MRI’s that were done at St. Luke's Hospital and I was under the impression that Dennis’s lesion on his spine was horizontally across the spinal cord in the middle of his back. It actually is vertical and spans from the middle of his back all the way up to the base of his neck. The neurologist was very intrigued that Dennis’s was not paralyzed in his chest region due to the length of the lesion and how inflamed his spinal cord was. We were shocked when the neurologist was pointing out the difference in the lower and upper spinal cord. His upper spinal cord was triple the size of the lower spinal cord due to the inflammation caused by the transverse myelitis. The neurologist did suggest we go ahead with the plasma exchange and we were admitted to the Mayo hospital at 12:30pm today. The neurologist said that there is a 40% chance that the plasma exchange will work, and that we should see improvements in three days if the therapy was going to work. Dennis is scheduled for five treatments done once a day. He has already had his first session of the plasma exchange therapy around 4:00pm and has been really tired since.
A lot of people have been asking me exactly what plasma exchange is. It is a procedure that separates and removes plasma from the blood in order to remove a disease substance circulating in the plasma. The red blood cells, white blood cells and platelets are returned to the patient, along with a prescribed replacement fluid. The plasma exchange is necessary because some diseases create substances which circulate throughout the body in the plasma portion of the blood. In certain diseases these substances are called “autoantibodies,” which attack healthy cells or tissue. These autoantibodies are created by a mix-up in the body’s immune system. Other diseases cause an overproduction of protein which results in slowing down the blood flow (in the same way that thick liquids move more slowly than thin ones). Only in a few diseases is it possible to remove the specific substance causing the disease. However, it is possible to remove the plasma which contains the substance. The plasma is replaced with donated fresh frozen plasma.
Plasma exchange is accomplished with a medical device called a blood cell separator (looks a lot like a dialysis machine). It uses a centrifuge to separate plasma from cellular blood components. Blood is drawn from the patient through a catheter in the neck. Some issues which may arise is sleepiness, dizziness, sour taste in the mouth, tingling around the lips, or sharp pains, like pins being stuck in the fingers or toes.
Only 300,000 plasma exchange procedures are performed worldwide each year. Another one million procedures, which are similar to plasma exchange, are performed each year on volunteer donors to collect plasma and platelets. There are approximately 6.9 billion people living on earth so these facts kind of put things in perspective on how rare this procedure is.
Yes, I already feel the jokes coming on. No, I am not going back to school to be a nurse. My knees buckled today while watching Dennis get this procedure and I had to go sit down. The catheter in his neck is making my queasy so I have to sit on the opposite side of the bed. Nursing school is definitely out of the question for me.
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