Not too surprisingly yesterday was a big day - thank goodness for Carol. I will report on the bits and pieces of the day but the important outcome was that Helen was readmitted to the Mater Private at 6.30 last night. She is in Ward 8 South, Bed 890, under Dr C. The reason for the admission is that as well as becoming progressively slower , weaker, sleepy and more confused in the last few days Helen's blood tests yesterday show that in 7 days her sodium has fallen from 130 (which is low but tolerable) to 122 (which is barely tolerable particularly as a rapid change). In terms of what has caused this - well as doctors often like to say - it is probably multifactorial. The underlying pathology is probably SIADH - a para-neoplastic syndrome caused by the cancer producing a hormone that causes the body to retain water and thus dilutes your sodium. This is what has been being addressed with the evil fluid restriction of 1 L a day - which she has been absolutely rigorous about. In fact over the last week I think she has actually been erring on the side of quite a bit less than 1L a day. She has also been having salt supplements for the last several weeks - not particularly effective but something.
The idea is that in hospital they can give her intravenous salt supplements and at least rectify the biochemistry and then see what is left in terms of the mental clouding etc.
The new variable over the last week has been increasing the citalopram (anti-depressant) to 60mg - a well known culprit for lowering sodium. Dr C thinks that the depression is still a significant factor to how she is - as do I and Dr A the psychiatrist - so it's hard to know what will be the best approach if they decide this did cause the rapid sodium drop. Plus it's not a good drug to stop all of a sudden.
Now for some more positive news. The scans are really very good and so are the other blood tests apart from the sodium. The brain metastases (which were admittedly very small) are no longer visible, the lung lesion has significantly decreased in size. She still has fluid around both lungs and the heart but it's not a lot - more on the right than the left not too surprisingly. There are some patchy changes in the right lung that might indicate infection although she has not had any coughing, nor fever that we have identified.
Still as Dr C says - a good scan is no comfort when you are not "good" in yourself.
Overall I am really glad she has been admitted. She has been deteriorating very rapidly in the last few days and not only do I have some hope they may improve her state, she really is not well enough to drive all over the city for appointments - which is the routine we had planned for the next few days. Not to mention the fact that I am really not coping that well with any of it right now and it is a huge relief to have other carers available to her and watching out for her in hospital.
Visitors - maybe not just yet - she is too slowed to talk and probably couldn't get much pleasure from them at this stage.
More news as it becomes available.
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