Saturday, April 9, 2016

Joan Casey - Health Update #3 [4/9/2016]

Mountain Bliss in Happier Times

This will advise Joan’s present condition, the steps taken that lead to this point, and the hopes, expectations and goals we are working toward in the future:

Earlier Health updates will give the background for this one; these are available from those who received them previously, as well as my blog - BellinghamHamsterTalk - at this URL:

Presently, Joan is in ICU Room 2039 at Shasta Regional Medical Center in Redding, CA, where she has been since March 22, and is receiving excellent care. 
This hospital has won recognition as one of America’s 100 best hospitals each of the last 2 years, and we are confident she is getting the very best care possible under the circumstances.

Our plan is to get her well enough to transfer to another hospital closer to home, including either University of Washington Hospital in Seattle, or University of California Hospital in San Francisco.
Recently, a Hospital to Hospital Transfer application to the University Of Washington Hospital was rejected because Joan was too weak and ill to meet their criteria. This was disappointing, but has given us the opportunity to reassess our options, more realistically. 
With the choices available, Joan must remain here until she is deemed well enough to leave.

Here’s what we have decided to do, with Joan’s and our Doctors’ concurrence:

1. Joan will remain in ICU indefinitely, until she improves sufficiently to move or be released. Here she will receive maximum care and attention. She retains a strong will to survive and live her life as fully as possible, event though that may entail constant supplemental oxygen and/or walker or wheelchair. Her first wish is to live her life in our Bellingham home, using private care as may be needed.

2. Joan agreed to being intubated under sedation, understanding fully the implications and complications that may result. She does not wish to remain on a ventilator for the rest of her life, and does not want become a ‘vegetable’ in the event of cardiac arrest or other adverse event. In those cases, she does not want to be revived. In the possible event she doesn’t survive, her wish is to be cremated with remains sent to her family cemetery in Westchester County, NY.

3. Here is our mutually agreed rationale for proceeding with intubation:

a. She was not improving under the earlier treatment; for a while she did, but this improvement plateaued and stalled, which increasingly caused her pain, anxiety and weakness, all not good for her recovery goals, including meeting the criteria required for her release or transfer.

b. Her condition proved more serious than initially assessed, due to the added complicated of an unknown infection possibly in her lungs, which was being treated without observable improvement. The intubation allows a better assessment of this infection, which could lead to more effective treatment and improvement. 

c. Joan has a respiratory disease known as Interstitial Pulmonary Fibrosis [IPF], for which she has been under treatment for a few years with Pulmonary Specialists in Seattle and Bellingham. 
This a lung impairment that makes her susceptible to other lung ailments. She has been using a CPAP machine at night to assist her breathing, supplemented with oxygen from an INOGEN device. 
She also wears an oxygen nose tube to assist her breathing while walking or during other exercise. There is no known cure for this disease, which is progressive in nature. Treatment does help slow down the adverse effects of IPF, but sometimes produces harmful side effects, such as diarrhea, etc.

d. Joan had become very fatigued recently, in pain from chronic lower back discomfort, anxious about her condition, and possibly unnamed infections, all of which combine to result in her current weakened state. The diarrhea in particular has caused or contributed to severe dehydration and depletion of necessary electrolytes. This condition, alone, may require hospitalization.

e. The lack of truly restful sleep has exacerbated all of the above difficulties. The more she tries to relax, the greater the anxiety and frustration with her condition grows, making it difficult former to improve her quality of life. Too much activity and excitement is not good for her.

All of the above conditions have combined for us to seek early intubation. We are viewing this as a step that had to be taken anyway if she were to be moved. An added bonus is that intubation with sedation allows the improvements necessary to proceed better. The other steps toward release or transfer can be taken once she improves.

This is our plan; Get Joan well and return her to a more normal life!

During the time she has been hospitalized, Joan has been greatly blessed by the enormous response from friends and family members who love her dearly and pray former recovery. 
This really helps!

This Update helps me to convey what has happened more clearly and widely. 
I can send copies to those who wish them, remember better what this summarizes, and provide a website for others to read for themselves.

Instead of having a circle of friends, Joan truly has circle of circles of friends! 
She loves you all and greatly welcomes your prayers, best thoughts and encouragement!

Sorry to have taken so long to say all this, but now its done……

Joan sends her love to all of you.

Bye for now,

Her Husband John Watts
360 961-4579