Posts by Scott Allen10

Kimberly Watson said:I'm heading in for a procedure soon—fingers crossed everything goes smoothly! 🙂I was actually just thinking about this because I had to get some work done at the Mayo Clinic last month, and honestly, it’s always a bit of a toss-up when you're trying to manage pain levels before a procedure. If you're planning on taking some ibuprofen a few hours ahead of getting your local anesthetic, you might want to double-check with your doctor first, just to be safe, since everyone reacts to things differently. 😳

Look, just a heads-up from someone who's been there—please don't go popping any pills or starting anything new without checking in with your doctor first, because honestly, you really don't want to mess around with that kind of stuff.

Brenda Stewart59 said:Quick question.
Is it actually okay—or are there any downsides—to take Normabel about 8 to 10 hours before getting an epidural?

Thanks!

Usually, yeah... just make sure you clear it with your anesthesiologist or whatever doctor is handling your case first... definitely don't go rogue on this one.

northernhound17 said:Thanks, Scott Allen10... I just got back from the hospital and the news isn't great... they're saying the chances of recovery are slim because, much like when you stop meds during a medically induced coma, if the patient doesn't wake up within a 72-hour window, things look pretty bleak. He was without oxygen for about 12 minutes, so now we're just left wondering what happens next... :S

Honestly, all this talk about specific timelines really gets under my skin because life just doesn't work like a clock. Everyone’s situation is so unique, and trying to squeeze medical outcomes into some rigid schedule feels totally wrong. You can talk about probabilities being high or low, sure, but making definitive claims about exact hours is just impossible.

But man, looking at the situation, it's clearly heavy. Just my two cents—try to take it one day at a time... don't let go of hope, but you've also gotta keep your feet on the ground as much as you possibly can.
Good luck.

When someone’s in the ICU for any reason, my best advice is really just to take it one day at a time and try not to spiral thinking about what life looks like once this phase passes.
Regarding your dad, it’s honestly pretty irresponsible to suggest anything specific or claim to know what's happening on a random internet forum without knowing the actual clinical details. He needs real answers from his doctors, so definitely keep pushing them for clarity.
Basically, if we're talking about a genuine cardiac arrest—and that distinction is huge—resuscitation needs to happen immediately. One thing I didn't see mentioned, which is super important, is whether they've identified why the incident happened in the first place. Every single minute lost makes the prognosis much worse. Also, if he was successfully resuscitated, the big question is how much oxygen deprivation occurred during all that chaos; how long was the brain without oxygen? Some people pull through without any neurological issues at all, while others, unfortunately, deal with varying levels of brain damage due to prolonged hypoxia.
In your situation, from what I can gather, both outcomes are still very much on the table. You won't be able to see signs of potential ischemia on a CT scan right away. If there is ischemia, it usually doesn't show up on a CT until a day or two later when the damaged tissue starts to look different from the healthy parts. Ugh... sorry, I'm rambling and probably just making things more confusing for you.
As far as I can tell, there isn't much more you can do right now other than watching him closely and seeing how things evolve day by day. Please keep us posted if you hear anything else.
Hang in there.

Amy King said:God! I’m the second daughter, and I just wanted to let you guys know that my dad actually made it through. 🙂 You all were such a huge help to us, and honestly, hearing from someone who actually knows what they're talking about meant the world during a time when we were totally flying blind. Up until he ended up in the hospital, we thought he was perfectly fine... but it turns out he has a heart defect—mitral insufficiency (I actually have it too, though mine was caught way back when; whenever doctors asked if there was any family history, I’d always just say no, not knowing). When they did his brain CT, they found a 1.5cm ischemic lesion in the frontal lobe, though they couldn't pin down exactly when it happened—whether it was during this hospital stay or something from before. Since the cardiac tests showed the heart issue is an old problem with some scarring already present, it's possible that happened a while ago. He’s just not the type to talk about health stuff; he’s never been a fan of doctors or hospitals, so unfortunately, things had to get this serious before we realized how bad it was.
Since you guys seem genuinely interested, I’d be happy to snap a photo of the discharge papers for you, but I don't want to overwhelm anyone with all the medical details... Anyway, he's home now and recovering slowly but surely. 😉 I just wanted to drop in and let you know—in case you remember us—that we got our happy ending. 🙂 Thank God, and thanks to the doctors and everyone else who helped make this happen! 🙂

🙂.....

I definitely remember you, and I am just so incredibly relieved to hear that things turned out okay for your family. And please, don't feel like you need to bother me with updates unless you want to. I'm just glad we could clear some things up and offer a little bit of guidance along the way. Honestly, what we do is nothing compared to the massive wave of chaos you guys are navigating right now as you try to find solid ground, and any family going through something like this deserves so much respect.
Wishing your dad nothing but the best moving forward, and please give my best to your mom and sister.

Regarding the ischemia... if I had to go by gut feeling, I’d guess it might be a result of everything that went down during this recent hospital stay. But, if I can be a little dark about it—if someone *has* to deal with an insult or ischemia, the frontal region is probably the "best" spot to land. It’s not exactly a win, but most other locations carry much higher risks for all sorts of complications...

Best of luck!🙂

🙂.....Alright, that definitely shifts things around a bit.....Usually, whenever people start talking about "detoxes" or those kinds of sudden spikes, they jump straight over to an alternative.....but hey, I guess we'll just have to wait and see how it plays out...

🙂Man, please... don't start coming at me with all that "detox" nonsense and those other little gimmicks. Just purely out of curiosity about where this whole thing is heading, I'll leave this right here... but honestly, the trajectory of this thread seems pretty obvious to me already.

You definitely won't find any answers here... those gym rats over at Gold's Gym are probably obsessed with all that stuff, so they'd likely be your best bet if you're looking to dive deep... whew...

Laura Kelly7 said:Thanks for getting back to me, I'm just really curious about what kind of complications could actually pop up if you don't?
I've been doing a bit of Googling, but honestly, I'm coming up totally empty

I also noticed that they usually recommend taking out contact lenses before an epidural, but I know plenty of people who went through with their epidurals while wearing them and nothing ever happened 🤷

🤷....I mean, when you go to bed, you probably take your contacts out....when you head in for surgery, you strip off your clothes and shoes....you take out your dentures....you wipe off the makeup and nail polish.....

Basically, stripping off all those extras, including your contacts, falls squarely into the category of precautionary measures! It's just about making sure there aren't any hurdles if things suddenly get chaotic in the OR.

Think about it this way: say you're getting an epidural, and right after they insert the catheter and the block starts working, you suddenly have a cardiac arrest and the doctors have to jump on you for resuscitation....it's total chaos....grab this, do that, move fast, check the vitals....check pupil reactivity quickly....beeping everywhere....and then it's like, sorry doc, I can't see anything because of these contacts, and even if I could, there's no way I'm messing with them while you're performing CPR or whatever else is going down....

So yeah, just strip everything off and don't overthink it.....there’s definitely a reason behind the rules....🙂

It can definitely cause some issues... but if you go at it with a horse dose....

Honestly, terms like "the kidney is retaining blood" just leave me totally spinning... it’s just as nonsensical as saying someone was "given a third of new blood"... or talking about being "treated with homeopathy." When you throw all that in there along with the fact that we're missing so much of the actual medical history, it makes it pretty much impossible to offer any kind of sensible advice at all.

I really think we need a bit more info to go on here...

Just to clear things up, they don't actually put balloons in during a coronary angiogram. An IABP is a completely different thing altogether. When people throw around the term "balloon" during an angiogram, they’re usually talking about PTCA—percutaneous transluminal coronary angioplasty. Basically, they slide a catheter into the coronary artery, navigate past the blockage, and try to widen the area by inflating a tiny specialized balloon. The idea is to essentially "squish" that atherosclerotic plaque against the vessel wall to clear a path for blood flow. Once they're done, everything gets pulled back out, so nothing stays inside. That's one type of intervention (which is what happened in your case), though whether it helps depends on the situation. The other option is when they go back in through the catheter and, if it makes sense clinically, leave a stent—kind of like a tiny metal mesh scaffold—to prop the artery open and keep the blood flowing. There are plenty of variations on that, but we don't need to get bogged down in the weeds right now.
In your situation, the most important takeaway is that the angiogram provided the visual map of the coronary arteries, which is the absolute foundation for deciding on any surgery. The procedure they might be looking at is called CABG, or coronary artery bypass grafting—basically installing a "bypass." Deciding how many, where, and what technique to use is entirely up to the cardiac surgeon, assuming all the indicators show that surgery is the right move for your dad.

Kimberly Young63 said:He’s had a tracheotomy, and this is how things look now—though I’m guessing the oxygen concentration is at 70% because of the procedure. I haven't been able to get through to the cardiac surgeon yet, but they passed along his word: my husband's condition is extremely critical right now. He isn't in any shape for surgery at the moment. They have his heart stabilized with medication for now, and they need to keep him on that until his overall condition improves and he can breathe on his own; only then will they consider a coronary angiogram or anything else. The only window for emergency surgery was immediately after the heart attack, but too much time has passed and we just have to wait. Ugh, honestly, every single day feels like a month.

If that’s what the cardiac surgeon thinks, then it actually makes total sense, and you should at least find some peace of mind knowing you explored that path—especially since the illness went unrecognized and untreated right from the jump. When dealing with a heart this fragile, there are a few ways to help it function while waiting for stabilization, or if things take a turn for the worse: an IABP (intra-aortic balloon pump) is an option, or potentially a VAD (artificial heart). The first one is invasive but a real possibility; the second would mean major surgery in NYC, opening up the chest, which is much less likely. Just stick close to the cardiology team in the coming days. Don't be afraid to keep asking the cardiologists, surgeons, and anesthesiologists about diagnostic options or potential interventions. Be... how do I put this... "persistent." Who cares if they get annoyed? They are there for you and the patient, not the other way around. I know that might sound a bit dramatic, but it really bugs me when medical staff act impatient with people who are already in shock because of a loved one, especially when the hospital rules make getting information feel like being in a prison camp. If you feel like they aren't communicating well... just push back! Things often change for the better once you do. I’ve mentioned before that in my experience, a tracheotomy is usually the best way to start weaning a patient off the ventilator. Since he’s been in the ICU for days, you’re seeing it firsthand—even without being a pro, you can tell you just have to be patient. Try not to spiral thinking about "what ifs"... just take it one day at a time. Don't get too high on the tiny improvements, but don't lose hope if things get complicated, either. Honestly, the fact that he’s still hanging in there after more than two weeks in this state is a huge win in itself.
Spending two weeks in extreme intensive care with mechanical ventilation and in shock carries a massive risk of complications... that’s just the reality of it. Pneumonia, hospital-acquired infections, UTIs—if you haven't seen them yet, expect them. No one in the world has completely wiped out infections, so we certainly haven't; most of the time, these happen not necessarily because of the staff (though that happens), but due to bacteria moving from the digestive tract into the blood, long-term ventilation via tubes and cannulas, and the body's immune system being totally wiped out...
Keeping up with good urine output, providing enteral nutrition through a tube (or by mouth if possible), plenty of physical therapy (turning him, repositioning in bed, massage, percussion), maintaining strict hygiene, and excellent oral care (which is huge), keeping fluids balanced, monitoring hemodynamics (blood pressure, CVP, pulse, cardiac output), using antibiotics as needed, and making sure the airway stays clear (using closed suction systems, gentle ventilation modes, etc.)... I'm just throwing out all the standard stuff they do for critical patients in the ICU. I'm sure that's exactly what's happening with him.

fadedheron14 said:I wanted to jump in and build on what Timothy Newman3 was saying earlier—it just hit me that the ventilator model they're using is a Puritan Bennett 7200. If anyone could point us in the right direction regarding what we should actually be watching for, like how to track tidal volume or things like that...

Also, there’s been a little bit of progress over the last few days: the kidney issues and trouble urinating have cleared up, and that swelling in the limbs from fluid retention is totally gone now. It’s a small win, but it's the kind of positive sign we're clinging to while hoping everything keeps moving in the right direction.

thanks

The PB7200 is a solid, reliable machine, but let's be honest, it's an older model that lacks some of those high-end modern ventilation features. Honestly, if I were you, I wouldn't stress too much about all those shifting numbers on the screen. Seeing something like a 2L contribution doesn't really tell you much because those settings can flip in five minutes flat. You won't be able to put the numbers into any real context, and frankly, they'll probably just end up confusing you more than helping. Now, modes like CMV and SIMV are standard volume-controlled ventilation modes, and I used them for years back in the day. They aren't bad—they get the job done—but they aren't necessarily the most comfortable option for lungs that have been "bruised" by illness and long-term vent support. At least, that's my take on it, though that’s probably a conversation better suited for a specialized medical forum.
But since you brought up the PB7200 and what's going on with your dad... a really encouraging sign regarding his breathing would be seeing the "flow by" and "pressure support" options enabled at the top level, and seeing that green light lit up next to the third option, CPAP, where it shows CMV and SIMV. That would mean the patient is doing a lot of the work themselves, with each breath being supported by a steady amount of pressure, and that the oxygen mix is sitting somewhere between 30-50%. On the monitor, you'd want to see a minute volume of around 5 to 7 liters, even if the tidal volume is as low as 0.5L, with a respiratory rate between 15 and 20. On the patient monitor, he should ideally have decent blood pressure—maybe around 90 to 100—a steady pulse under 100 or 110 without major arrhythmias, and SpO2 staying at 90% or higher. Most importantly, the patient himself shouldn't look like he's struggling to breathe, sweating, or showing other signs of distress.
Anyway, my advice is the same I gave her... just take it one day at a time and try to stay patient. Good luck!🙂

The way things run at JLL is pretty straightforward—the attending physician takes care of everyone on shift. When the next day rolls around, a new doctor takes over and keeps the momentum going. Honestly, that’s how patient care should work. It drives me crazy when people talk about one specific doctor "managing" a critical patient, because then the moment that doctor heads home or the weekend hits, nobody even glances at them. I know from experience that this happens way too often in various wards. By the way, which unit is the patient actually in? In the ICU, the anesthesiologists handle their own percutaneous dilatational tracheotomies (PDT), which is much gentler than the classic ones ENT surgeons do in the OR, so the setup here sounds a bit unusual to me. On the other hand, since they mentioned SIMV and ventilators, it definitely sounds like an ICU placement. The choice of ventilation mode usually comes down to what the attending doctor prefers, but SIMV—being a volume-controlled mode that allows spontaneous breaths—isn't necessarily the most lung-friendly option. Using BiPAP as pressure-controlled ventilation, or combining CPAP with ASB, helps prevent those sky-high pressures that can really mess with the lungs... though I guess we're splitting hairs now. Those numbers you mentioned are definitely trending in the right direction, though. If you can, try to dig into how much the patient is actually doing the breathing themselves (specifically looking at spontaneous minute volume and tidal volume if they're on Draeger Evita machines). If they're hitting a significant percentage there, that's a really great sign. From what I've seen, things often start looking up once the tracheostomy is done. Fingers crossed everything goes smoothly.

As for those guys... regarding the referral... whether they show up or not... honestly, forget it. It doesn't feel like that guy is going to offer much insight anyway. You should really try to push for whether a bypass surgery is being considered and see if you can get a second opinion from a cardiac surgeon. I totally get the whole thing where cardiologists, surgeons, and internists all stay in their own lanes and don't want to step on each other's toes, but if you insist on getting some clarity, at least you'll know you did absolutely everything in your power. Good luck.

You really need to push for an opinion from a cardiothoracic surgeon—think someone like Dr. Bullard or Dr. Nenadic. A regular cardiologist just isn't cutting it here, because those two specialties are worlds apart! It’s also worth sitting down with the cardio-anesthesiologists, maybe Dr. Karanovic or one of his colleagues. I know it feels risky to judge based on how the patient is doing right now, but honestly, you should insist on getting a coronary angiogram done regardless of how unstable things look. It's not impossible to pull off. That’s the only way you’re going to get a crystal-clear picture of what's actually happening with the coronary arteries and the myocardium. Sorry if this is a bit rushed, I'm running a little short on time today, and obviously, I have to say it again: this is all just forum speculation and can't take the place of the actual doctors treating the patient. I'm just sharing what I would personally demand based on everything you guys have shared here. Good luck!

Kimberly Young63 said:So, my Neurologist told me today that his clinical picture is looking a tiny bit better, but he still can't breathe on his own without the ventilator to keep his oxygen levels up. There's this constant edema building up that makes everything so much harder, mostly because a huge part of his heart was damaged during the infarct, so we're stuck in this brutal loop between the heart and lungs right now. They'll probably have to do a tracheotomy tomorrow—I think that's the right term—since he's been intubated for way too long. The cardiologists and the rest of the medical team are meeting tomorrow to figure out the next steps. If anyone has any advice before they ask me to sign off on the procedure, please let me know if you've dealt with something similar...

If by "signing off on the procedure" you mean the tracheotomy... honestly, just go for it. A tracheotomy is pretty much necessary once someone's been on mechanical ventilation for about ten days without showing signs of weaning off. Plus, patients usually find it way easier to transition away from the ventilator after a tracheotomy compared to staying on the tube.

Definitely make sure to ask what the cardiac surgeon thinks about jumping straight into surgery. There isn't really a way to "stabilize" someone when they're in this kind of condition. If there's an indication for emergency surgery, the patient is flagged as critical and they move forward with the procedure. You should definitely try to hash this out with the surgeon. In my opinion, it’s not even a "vicious cycle"—the issue is the heart/pump itself, and the lung trouble is just a side effect of the pump failing.

Honestly, you shouldn't even be losing sleep over whether they'll end up dependent on some medication or not. Everything else is way more pressing, especially since this sounds like an incredibly intense situation—and frankly, none of the guesswork we do here on the forum can ever replace the actual guidance from the doctors treating the patient.

I’m a little confused about the timeline, though. If I'm reading this right, symptoms started on December 19th—which clearly pointed to a diaphragmatic myocardial infarction—and then by December 28th, a new infarct was confirmed "with scarring from old ones." Was nobody picking up those old scars on a standard ECG during that window? I really hope it's not the case that they weren't running regular 12-lead ECGs or checking troponin levels in the lab, because those markers should have been obvious.

Also, looking at your description where the heart pump itself is clearly failing, I don't quite follow why they're telling you the lungs are the main issue. From what you've written, this looks like a textbook case of decompensated heart failure. Basically, because of the infarct, the heart can't pump enough blood, so it starts backing up—it pools in front of the right side (causing peripheral edema) and in front of the left side (leading to pulmonary edema). In these cases, the lung issues are a direct consequence of the heart's inability to function. The damaged heart just doesn't have the strength to push blood forward, so it builds up in the lungs. This causes the pulmonary capillaries to get overloaded with blood, and through certain physical processes, "water" essentially leaks out into the pulmonary alveoli. That buildup of fluid in the alveoli is what we call cardiogenic pulmonary edema. Having a lung full of water makes it nearly impossible for oxygen from inhaled air to reach the bloodstream, which explains the low oxygen saturation and all that shortness of breath. Treatment usually hits several angles at once with the goal of helping the pump work and ensuring oxygenation. They'll use heavy doses of diuretics, like Lasix, to try and force the kidneys to flush that excess fluid out of the system. If that doesn't cut it, they might move to CVVH or a similar type of artificial hemodiafiltration. To get enough oxygen to the patient, they'll use mechanical ventilation with a high oxygen concentration, but they try to be as gentle as possible with the settings to avoid "acute lung injury" (ALI)—basically preventing the ventilator itself from damaging the lung structures. Then there's supporting the heart pump and stabilizing hemodynamics. This often involves constant infusions of dopamine, norepinephrine, or dobutamine/milrinone, and sometimes even using an IABP (intra-aortic balloon pump) to help the heart maintain blood pressure and volume. This is usually accompanied by heavy sedation just to keep a restless or struggling patient calm so they aren't fighting the machine. We could go on about this forever, but it's not the point right now...

First off, you mentioned the crosses, so you must be from Miami. Since I'm a bit of a cardiac surgery nerd, I'm puzzled as to why treatment isn't happening right near the local cardiac surgery hub or the intensive care unit at Furlong. I wonder if a surgeon was consulted regarding emergency bypass surgery in this case? Forget about stents for a second; you've described a situation where the patient is basically "suffocating" due to a cardiac event. Things like IABP implantation or considering emergency surgery should definitely be on the table. It wouldn't be out of line to suggest a transfer to a major center like Mayo Clinic or Cleveland Clinic, where they specialize in working with VADs (ventricular assist devices) that can support or even replace heart function for a time, provided there's an indication for it.

But like I said at the start, nothing written on a forum carries the weight of a doctor's bedside opinion. I'm sure in your case, every single option has been weighed, and the treatment is moving along as it should. Good luck!

The whole idea of having "thick blood" is just some layman's term that doesn't actually mean anything unless you're looking at a real blood panel. Honestly, there might not even be an issue at all.

You should really take a look at this thread, because there are several points being made here...
Honestly, your doctor isn't the one you need to convince; just sit down and tell your family how you really feel.

It’s just your run-of-the-mill TENS unit, honestly. The kind people have been using forever without much fuss. Nothing fancy here.

EDIT:
I'm linking this back to that older thread where Casey Palmer5 was breaking things down for us. Anyway, sending some love your way, Casey Palmer5!👋