Yesterday, Sarah had follow-up visits with her vascular surgeon who operated on her right leg and with her infectious disease specialist who continues to manage the treatment of her bacterial endocarditis. The vascular surgery visit included an ultrasound imaging of her femoral artery around the location of her surgery and blood pressure readings in her left arm and both legs. The good news was that the circulation to her right leg seems to be nearly completely restored to normal. In the very old days, this would have been determined by the fact that both of her feet were warm and pink, but the new technology allows us to recognize "warm and pink"with far greater precision. No further follow-up will be needed from the vascular surgery standpoint. The pain around Sarah's knee does seem to have been due to temporary injury to her femoral nerve as a necessary consequence of her leg surgery. It seems well-controlled by the amitryptilene, and her surgeon was confident that it would disappear in a relatively short time.
The infectious disease specialist was pleased to see how well Sarah appears at this time. Her blood cultures remain negative (no more bacteria in her bloodstream), and her blood counts don't show any signs of infection. There are no signs of harm to her liver or kidneys at this time. The one loose end is a slight rise in one enzyme (protein) in her blood called alkaline phosphatase compared to a week ago. The "alk phos" can be an indication of a problem with liver function, but other liver enzyme tests were normal. It can be an indication of a bone problem, but there are no symptoms to suggest that. The plan is to re-check this test in a week. If it does not continue to increase, then it is unlikely to indicate a problem. However, if the level of this enzyme continues to rise, then "further investigation" will be needed. (One day at a time....right?)
So, tomorrow Sarah will be seeing her primary care physician, that is, visiting her primary care medical home. In the work in which I have been involved related to trying to increase the value of primary care in our health care system, the primary care medical home becomes the headquarters or "home base" for an individual's health care. This usually involves a team approach in which both physicians and "mid-level professionals" (nurse practitioners or physician's assistants) are involved. Increasingly, the physician's role should be to lead the team, assure the quality of the care provided to all patients, and directly manage the care of the most complex patients. Sarah is unfortunately now firmly and maybe permanently in the class of the most complex patients, and we are expecting that her primary care physician will make herself as accessible as possible in the on-going monitoring of her health and well-being. Her primary care practice has been recognized by the National Committee on Quality Assurance (NCQA) as a Level 3 (highest level) medical home. We are about to test that recognition.
Sarah seems to be doing well in general. She tends to sleep through the night without painful interruptions of her (and our) sleep. She is needing less strong and less frequent pain medication. Her appetite has improved. Her main complaint lately has been lugging around the 2 to 3 pound "purse" containing her IV pump and bag of IV fluid. I think she is also getting a little bored. But whose complaining...
I have to return to some of the travel obligations associated with my work in the coming weeks with a three day trip to Washington starting on Sunday and a four day trip to southern-most Texas the following week. This is all assuming that things continue to go well. In any case, this will complicate life at home for Seddon as she also tries to return to some of her work. One day at a time...
The infectious disease specialist was pleased to see how well Sarah appears at this time. Her blood cultures remain negative (no more bacteria in her bloodstream), and her blood counts don't show any signs of infection. There are no signs of harm to her liver or kidneys at this time. The one loose end is a slight rise in one enzyme (protein) in her blood called alkaline phosphatase compared to a week ago. The "alk phos" can be an indication of a problem with liver function, but other liver enzyme tests were normal. It can be an indication of a bone problem, but there are no symptoms to suggest that. The plan is to re-check this test in a week. If it does not continue to increase, then it is unlikely to indicate a problem. However, if the level of this enzyme continues to rise, then "further investigation" will be needed. (One day at a time....right?)
So, tomorrow Sarah will be seeing her primary care physician, that is, visiting her primary care medical home. In the work in which I have been involved related to trying to increase the value of primary care in our health care system, the primary care medical home becomes the headquarters or "home base" for an individual's health care. This usually involves a team approach in which both physicians and "mid-level professionals" (nurse practitioners or physician's assistants) are involved. Increasingly, the physician's role should be to lead the team, assure the quality of the care provided to all patients, and directly manage the care of the most complex patients. Sarah is unfortunately now firmly and maybe permanently in the class of the most complex patients, and we are expecting that her primary care physician will make herself as accessible as possible in the on-going monitoring of her health and well-being. Her primary care practice has been recognized by the National Committee on Quality Assurance (NCQA) as a Level 3 (highest level) medical home. We are about to test that recognition.
Sarah seems to be doing well in general. She tends to sleep through the night without painful interruptions of her (and our) sleep. She is needing less strong and less frequent pain medication. Her appetite has improved. Her main complaint lately has been lugging around the 2 to 3 pound "purse" containing her IV pump and bag of IV fluid. I think she is also getting a little bored. But whose complaining...
I have to return to some of the travel obligations associated with my work in the coming weeks with a three day trip to Washington starting on Sunday and a four day trip to southern-most Texas the following week. This is all assuming that things continue to go well. In any case, this will complicate life at home for Seddon as she also tries to return to some of her work. One day at a time...
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