Yesterday was a full day. The hospitalist (what kind of word is that, anyway?) was sort of rude and accusatory yesterday morning. I called Kyle because I was flustered and Kyle always comes across so collected and reasonable. Dad was incredibly weak and not making much sense and then the doc left me feeling discouraged. As the day went on, things began to feel more hopeful. A physical therapist did an eval, made dad get up and walk a bit and then broke the news to him that he absolutely can't go home like this. He can't get out of bed without help, so home just isn't possible. I was glad for someone else to say it. Dad's not thrilled over spending a few weeks in a rehab facility, but receiving that intensive physical therapy will help him gain some strength so he can safely return home.
One of the doctors from dad's liver doc office came by to consult. He laid it out about as bluntly as I could ever imagine. He got on to dad pretty hard for not taking the Lactulose (it's a laxative, but more importantly it grabs on to the bad bacteria that accumulate in his body since his liver can't keep up... Leading to increased ammonia levels and possible infections). It's not a fun med to be on, which is why dad chose to try and manage without it.
Doctor: lactulose isn't the only option...
Me, Kyle, dad & grandpa: (silence)
Doctor: the other option is death
Yep. That's the truth. It's sucks to have to take it (imagine taking a strong laxative 3 times a day... Forever), but the alternative is severe. A person with Dad's diagnosis could take it faithfully and do okay, but if they stopped then they could go from functioning to a coma or dead in 5 days. The truth? Dad got lucky. The first signs of haptic encephalopathy are 1) shakiness (check) 2) weak and unsteady, leading to falls (check) 3) incoherent or significant loss in mental function (check) 4) coma 5) death. Getting to number 3 is plenty far for me. In all honesty, one more day and this may not have been treatable.
Prognosis and plan... Take the lactulose!!! They are giving it to him 3 times a day here and I can already tell a difference. When I got here this morning he had fed himself (couldn't do that yesterday) and we had a rational conversation (again, yesterday's conversations were hit & miss in the making sense department). We just visited with the hospitalist and he is sending a case manager to help arrange rehab. If all can go smoothly then we could be discharged tomorrow and begin the recovery with physical therapy. If it doesn't go smoothly (the red tape portion), then it could be Monday.
Thank you for praying with me and I ask that you continue. Specifically, prayers of thanksgiving for this ugh information and that today is better than yesterday... And for continued improvement, gained strength & balance, the proper rehab facility & therapists to have an opening immediately and that going home safely is in the near future.
One more thing... Grandpa is doing okay through all of this. I brought him up to the hospital for a while yesterday because he wanted to visit Dad. He gets lonely at home alone and we will all have to pitch in to make sure he's okay at home alone for the coming weeks, but I am hopeful that all is on the right track for now.