January 12, 2011

We wanted to update everyone on Sarah.  Most of you are aware that Sarah has been at DHMC on the Cardiac Care Unit since Friday for treatment of a bacterial endocarditis with embolism to her leg that compromised her circulation.   The infecting bacteria has been identified as Staph Lugdenensis, a very virulent and invasive bug but one which is sensitive to many medications.  She has been receiving multiple IV antibiotics for several days, has a normal white count and no temperature at this time.   Blood cultures are mostly negative.  She has had very significant intermittent pain in the right leg and multiple other discomforts and malaise, but these have for the most part been controlled with medications...

Sarah had the embolus removed from her right leg today in an operation that was more complicated than expected due to the aggressive and invasive nature of the organism ..there was significant active infection that had defied the antibiotics which was carefully evacuated... her artery remains intact and her leg circulation restored by removal of the obstruction.  The finding of much more infection than expected-along with a trans esophageal echocardiogram (ultrasound or TEE) done while she was under anesthesia which showed a large  clot of bacteria adhering to the left atrial wall and mitral valve leaflet of her heart, which is at risk for further embolization- led to consideration of open  heart surgery sooner rather than later to avoid further damage to heart tissue or further emboli which could damage brain, heart or other organs.  She will have open heart surgery tomorrow morning (today probably when most of you open this) to remove the clotted material and likely replace her mitral valve.

The good news is that five hours after her three hour surgery today, Sarah was awake, loquacious, joking, charming the nurses, drinking fluids, insisting on sitting up and doing facebook for while, then asked the nurse if she could go for a walk.  With 8-10 tubes coming out of her and recently operated on leg, she walked around the room and marvelled at the snowy pastoral scene outside her window.  She was more animated all night than we had seen her in days (likely due to a reduction pain -or maybe an increase in dilaudid?- and a decrease in the infectious burden in the leg...In any event her resilence, spirit, and sheer will tonight inspired us to be a little more optimistic about tomorrow's surgery.  There are many very serious risks, but we are hopeful.

Carl and I are doing okay...filled with concern but taking one day (one hour) at a time...alternating nights at the hospital with the other staying at the nearby Days Inn, so at least one of us is somewhat rested each day.  It is wonderful to have Eliza here having arrived from Honduras last night.  Reed is on his way back from what was to be a short medical mission serendipitously also in Honduras (thinking Sarah's course would be more routine, we encouraged him last weekend to continue with his plans ), he should arrive Saturday early am...