MYSTERY of a CHRONIC COUGH

My brother has had a chronic cough for many weeks.  He waved it off to old age, allergies, whatever.  It was bothersome and finally his wife (a nurse) asked him to get it checked out.

On Monday, June 28 he reluctantly went to the doctor.  Who sent him immediately to the closest hospital with the worst case of double pneumonia.  They took 18 vials of blood.

WEDS, June 30 (text from his wife):

Wanted to let you know … it’s after 5:00, Mike’s nurse just checked his chart, and there are no results back yet on the sputum and blood work ☹️😡. If anything comes back tonight I’ll let you know. 🙏🏻🤞🏻for tomorrow. Mike is mostly sleeping and has less pain since they started the Oxycodone. The Echo of his heart looked good. So it’s all about his lungs. We appreciate your thoughts and prayers

THURS, JULY 1

Hi ... Around 5:00 this morning Mike became unresponsive, his O2 level wouldn't stay up so they intubated him. He was just worn out from breathing. So now he's on a vent. I talked with his doc who said all the tests that were done were negative. The only result not back, because they sent it yesterday, was the test for histoplasmosis. The ICU and infectious disease doc still think he has TB or a fungus and it just didn’t show up in the sputum. So they are getting ready to do a bronchoscopy. They will be able to see better what’s going on and get better samples. We should have those results tomorrow. I’ll keep you updated. Mike is sleeping peacefully and not having to work so hard to breathe.

JULY 2

Hi JB, Here's the update on Mike for today ...

They have weaned him from 100% to 50% O2 and he’s tolerating that. Now we found out his creatinine is way too high, which means his kidneys aren’t functioning properly, so they are working on that. He may need dialysis. He’s slightly more responsive today … raised his eyebrows and raised his hand off the bed. They are pretty convinced it’s TB. We won’t get more results until today or tomorrow and then more results on Tuesday. The final result, when the TB organisms show up in the most definitive test, doesn’t happen for 4 weeks 😡. I’m really learning more than I want to know. They are treating him for Histoplasmosis (fungal infection) with Difucan. They’re not sure he has it (result from that test won’t come back until Tuesday). At Eric’s (their adult son) request I’m currently working on getting Mike transferred to OSU. Mike’s been here 5 days and still no diagnosis so no treatment for it. OSU is a research and teaching hospital so they might have more answers. Not sure the transfer will happen, I’ll let you know.

Additional text:  Mike is being transferred to OSU hospital around 4:30. Room 1135 (ICU).

JULY 6

No big changes with Mike to report today. They tried to take him off the vent again but couldn't. Instead they turned his O2 down to 35 so that's good to wean him off. He's tolerating the decrease just fine. They are putting the line in right now so he can start dialysis... yeah!

JULY 7

Hi ... So Mike’s making progress. The dialysis started last evening and his BUN and Creatinine have already decreased. They will continue with that today and then put him on intermittent dialysis tomorrow. They are planning on taking him off the vent tomorrow. 🙏🏻🤞🏻that it goes OK. He has the bronchoscopy today at 3:00. Five physical therapists came in this morning. They actually got him up and he sat on the side of the bed for 5-10 minutes. He opens his eyes a little more, nods his head yes/no and is a little more responsive today. They are still waiting on the fungal test results. We still don’t know what caused this but they’re working hard to find out. So things seem to moving in the right direction 😀 Eric is back from Texas, came to the hospital today and will be here with me. That's it for now. 

JULY 8

His vent tube has been taken out!!! Yea! They have Mike on a mask (CPAP). His breathing is still labored but his O2 sat and vitals are  good. Still no test results that tell us what caused this but at least he’s off the vent 😀

Additional text:  Guess I should have waited to give the "good news". Mike is back on the vent. After they took him off the vent his breathing became VERY labored even with having O2 with the CPAP. His vitals and O2 sats were good but his CO2 was in the upper 60's (too high). We had to try. He's breathing much easier now. 

JULY 9

Hi ... today's update ... Mike is a little more responsive today than yesterday. Opens his eyes more, nods his head for yes/no, squeezes my hand more when I talk to him. He's getting his tube feed. His kidneys are doing better so dialysis will be held off until tomorrow. 2 lymph nodes were biopsied. One was fine. They other was suspicious for cancer but the sample wasn't very good so they will follow up with possibly a PET scan of his lungs after getting the results of the lung fluid test. His histoplasmosis (the fungus in bird poop) test was negative. He only gets the pain med, Fentanyl, as needed now. His last dose was almost 8 hrs ago 👍🏻. We appreciate your thoughts and prayers! 😘

Additional text: A couple lymph nodes in his lungs in the effort to try and find out what caused the cavities in his lungs. Yes he got the bronchoscopy again. Actually it was a bronch with another name attached this time. Can't remember the name 🤪. That's when they biopsied the lymph nodes and got the fluid that they're still testing. 

JULY 10

Good morning. Here's the info from rounds today ... Mike's was little more short of breath this morning but that's better now. He had 1 prn dose of Fentanyl last night at 9. His BP is coming down closer to normal range with the Amlodipine. His BUN and Creatinine are up some some he'll get dialysis at noon today. Still on the vent and tube feed. All fungal tests were negative. They're still waiting for the lung lymph node biopsy result. If that shows nothing they'll do a PET scan. Today's the last day for the Zosyn (antibiotic). The thing I see today is that he's less responsive and not moving his hands and feet much but that could be because of his elevated BUN and Creatinine. 

JULY 11

Hi ... Mike's more awake today, eyes slightly open more, nodding his head when I talk to him. No pain or distress. Tests that came back are negative for pneumonia and fungal infections. The only other test  result we're waiting for is the test of the fluid in his lungs. They weren't able to do a biopsy on the lung lymph node tissue. The sample was compromised (not good enough). They will do the PET scan if the lung fluid test doesn't show anything. His vitals are good. I told Mike you all are thinking of and praying for him. He nodded his head so I know he heard me and appreciates that. 

JULY 12

Mike's about the same today. Still opening his eyes and responsive. All the test results have come back and they're negative. They may be doing a chest X-ray today. They still don't know what caused this. They will be doing a scan of his abdomen. They said it's to check for any issues. I don't think they'll find anything. He's putting out a good amount of urine but his kidneys aren't clearing the toxins from his blood. He gets dialysis today. Physical therapy came in this morning, sat him on the edge of the bed, exercised his arms and legs. After being on his back for 2 weeks he's incredibly weak. It's going to be a long road ahead. 

JULY 14

He's stable, no big changes. They couldn't do the PET because his sugar was too high. It's rescheduled for Friday. I will text when there's changes or updates. 

JULY 15

Hi ... Mike was unable to get his PET scan yesterday because his blood sugar was too high. They continue to work on correcting that and it's been rescheduled for tomorrow. The last 2 days he's been more awake and alert but he had dialysis today so is sleepy this afternoon. He has pneumonia now (D/T the vent) so they're treating it with an antibiotic. His vent settings have been changed so that he has to breathe more on his own and is doing well with that. He passed his breathing test the last 2 mornings. That's why they changed the settings but don't feel he's ready to come off the vent. They will be placing a trach tube soon so that they can pull the vent tube out. It can cause problems if left in too long and they told me it's easier to be weaned off the vent with the trach. That's it for now. I will text you with changes. So if I don't text everyday it's because things are the same. Love you all 😘

They allow 2 visitors per day. Since I'm always there he can have 1 more. Visiting hrs are from 8a-7p. You can stay as long as you want and both people can be in the room at the same time. The only other visitor he's had besides me is Eric. Eric doesn't come everyday and has told me if someone else wants to come that's fine. So yes, Mike can have visitors. As long as he's on the vent he can't talk but he nods his head yes/no. You can let me know if and when you want to come and we'll go from there. 

JULY 17

Hi ... Mike didn't get his PET scan yesterday 😡 One of his sputum cultures they are testing for TB was suspicious for TB. They put him on isolation, it was retested and came back negative. But by then it was too late to do the PET. So it's rescheduled for Monday, they don't do them on the weekend. The big news is ... Mike pulled out his vent tube around 2:30 this morning. His hands had been restrained. The last couple days, because he was oriented and calm, they said he could have them off when I was in the room to watch him. So we did that and he never made any movements to pull the tube out. The nurse left him out of the restraints overnight and he took matters into his own hands (literally). He was off the vent for about 6 hrs, became too short of breath and got really tired so they put him on a BiPap (mask). He's working a little harder to breathe but it's not bad enough to put the tube back in. If he continues to do OK, the tube can stay out and he won't need the trach 🙏🏻That's it. I'll let you now if they have to put the tube back in.

JULY 18

Our brother (two years younger than me ... Mike is three years older) Dave went to visit today.  He confirmed the hospital IS going to do the tracheotomy. 

JULY 22

Our sister went to visit:

I saw Mike & Cheryl yesterday. Cheryl said he was much more alert than he had been. 

From my observations, his eyes were about 1/2 open and he turned his head a bit when I spoke. He lifted his left hand/finger a little. I just held his hand and spoke in general to him & Cheryl, but I didn't ask him specific questions.

His trach site looked good, and I know Cheryl is thrilled to be able to see his face, and I'm sure this is more comfortable for him to have the ET tube out. He's still on the vent, 40% O2. 

He was getting dialysis while I was there, and by the time they finished he was zonked--Cheryl said he's always wiped out afterwards. Cheryl & I got to talk a lot and catch up. We went to lunch...same place you two went, Dave! 

I think Cheryl is holding up remarkably well. She's very informed and is an active part of his care. Mike, and Cheryl, both have a long road ahead as he recovers. Not sure when the new antibiotics will noticeably kick in, but he has lung damage (the cavities she mentioned) that had been in process, plus everything over the past month...and all complicated by his diabetes and other issues. Cheryl is very realistic. There is a strong possibility that Mike will have to move to a rehab facility before being discharged home. He will have access to more therapy in rehab than he would have at home. There's a chance he might even still be on some level of ventilator there. It's still far too early to know, but they're already bringing up that as a possibility.

I think it would be easy to overwhelm her with communication...she has lots of family & friends & coworkers to keep informed. I'd say mostly wait for her updates, but an occasional text just to show your support is fine. Or mail a card!

JULY 25

He apparently now has a different pneumonia ... caused by e Coli. Contracted in the ICU in a hospital?!!  They really need to wash their hands more and sterilize more frequently.  Good golly!  WHAT NEXT?  And only one PT visit this whole time ... because they are short staffed!  He's only been helped to sit up in his bed ONCE in all this time.

He now has a feeding tube, percutaneous endoscopic gastrostomy (PEG).  Poor guy is going to have so many battle scars from this weird sickness.  They have ruled out TB, thank goodness.

JULY 31

Nothing has changed.  His daughter finally got up the courage to go visit.  She said he doesn't look like her Dad, more like a skeleton.  He is not any better although the pneumonia is gone.  Still has two huge cavities in his lungs and still in ICU.