[GeoStL] Re: (No To: geocaching@freelists.org
- From: "Barbara Hunt" <barbarastl@xxxxxxxxxxx>
- To: <geocaching@xxxxxxxxxxxxx>
- Date: Wed, 16 Apr 2003 21:46:53 -0500
-
Jim,
Thank you for all of this valuable information. I'm sorry to hear about your
father. It certainly does sound as if the treatments are advancing at a
rapid pace, and that is a very positive thing to read. Thanks, again.
Barbara
----- Original Message -----
From: "Jim Bensman" <jbensman1@xxxxxxxxxxx>
To: <geocaching@xxxxxxxxxxxxx>
Sent: Wednesday, April 16, 2003 5:18 PM
Subject: [GeoStL] Re: (No To: geocaching@xxxxxxxxxxxxx
> -
>
> > Laura has now developed pneumonia and adult
> > respiratory
> > distress syndrome.
>
> Actually it is Acute Respiratory Distress Syndrome. It is what my Dad
died
> of back in November. This is very serious. Only 60% survive and full
> recovery can take over a year. However, 10 years ago no one survived
ARDS.
> Today they have new ways to treat it. If you survive it, you have to have
> lots of therapy so you can walk again. There are lots of up and downs
> dealing with it. It is very rough and people can use lots of support.
>
> Here is some info I had from when my Dad had it.
>
> WHAT IS ARDS?
> Acute Respiratory Distress Syndrome (ARDS):
> Acute Respiratory Distress Syndrome (ARDS) is an acute, severe injury to
> most or all of both lungs. Patients with ARDS experience severe shortness
of
> breath and often require mechanical ventilation (life support) because of
> respiratory failure. ARDS is not a specific disease; instead, it is a type
> of severe, acute lung dysfunction that is associated with a variety of
> diseases, such as pneumonia, shock, sepsis (a severe infection in the
body)
> and trauma. ARDS can be confused with congestive heart failure, which is
> another common condition that can also cause acute respiratory distress.
The
> term Acute Lung Injury "ALI" is sometimes used in the same setting as
ARDS,
> but also includes less severe instances of generalized, acute lung injury.
> UNDERSTANDING ARDS
> To understand ARDS, it is important to review how the lungs work. Air,
which
> contains oxygen, is inhaled through the nose and mouth, and passes into
the
> windpipe (trachea). From the trachea, air flows through tubes called
bronchi
> into microscopic air sacs called alveoli. Very small blood vessels
> (capillaries) are imbedded in the walls of these air sacs. Oxygen passes
> through the thin walls of the alveoli into the bloodstream. Carbon
dioxide,
> a waste product of cellular function throughout the body, passes from the
> bloodstream into the alveoli and then is exhaled.[Image]
> At the onset of ARDS, lung injury may first appear in one lung, but then
> quickly spreads to affect most of both lungs. When alveoli are damaged,
some
> collapse and lose their ability to receive oxygen. With some alveoli
> collapsed and others filled by fluid, it becomes difficult for the lungs
to
> absorb oxygen and get rid of carbon dioxide. Within one or two days,
> progressive interference with gas exchange can bring about respiratory
> failure requiring mechanical ventilation.As the injury continues over the
> next several days, the lungs, fill with inflammatory cells derived from
> circulating blood and with regenerating lung tissue. Fibrosis (formation
of
> scar tissue) begins after about 10 days and cam become quite extensive by
> the third week after onset of injury. Excessive fibrosis further
interferes
> with the exchange of oxygen and carbon dioxide. The sequential stages of
> ARDS are described in further detail below.
> WHAT CAUSES ARDS?
> The cause of ARDS is not well known. Current scientific information
supports
> several theories about its development, but the precise reason ARDS occurs
> remains unknown. What is known, however, is that ARDS can come about by
> either of two basic mechanisms.
> The first is a direct physical or toxic injury to the lungs. Examples
> include inhalation of vomited stomach contents (aspiration), smoke or
other
> toxic fumes, and a severe 'bruising' of the lungs that usually occurs
after
> a severe blow to the chest.
> The second mechanism is more common, but less understood. This is an
> indirect, blood-born injury to the lungs. When a person is very sick or
the
> body is severely injured, some chemical signals are released into the
> bloodstream. These signals reach the lung, and the lung reacts by becoming
> inflamed, thus causing lung failure. Examples of this type of indirect
lung
> injury include the presence of severe infection (sepsis) and severe injury
> (trauma) - the two most common factors in ARDS cases. Other examples are
> severe bleeding (resulting in massive blood transfusions), severe
> inflammation of the pancreas (pancreatitis) and some types of drug
> overdoses.
> Not everyone who has these problems, however, develops ARDS, which is
> fortunate, since all of the above problems are common. There are no easy
> answers as to why some patients with sepsis or trauma develop ARDS and
> others do not.
> Studies have identified that recent cigarette smoking and chronic alcohol
> abuse may be associated with ARDS, but these actions are not considered to
> be causative factors. The presence of other lung diseases such as asthma,
> emphysema, chronic bronchitis or lung cancer, does not seem to be a factor
> in causing ARDS, although these may complicate the course of the syndrome.
> No one can predict with any certainty who will get ARDS and who will
escape
> it. This unpredictable nature makes ARDS a complication of other illnesses
> that may be serious enough by themselves.
> THE STAGES OF ARDS
> ARDS has generally been characterized into three stages. In full-blown
> cases, these three stages unfold sequentially over a period of several
weeks
> to several months.
> 1 Exudative stage: Characterized by accumulation in the alveoli of
excessive
> fluid, protein and inflammatory cells that have entered the air spaces
from
> the alveolar capillaries. The exudative phase unfolds over the first 2 to
4
> days after onset of lung injury.
> 2 Fibroproliferative (or proliferative) stage: Connective tissue and other
> structural elements in the lungs proliferate in response to the initial
> injury. Under a microscope, lung tissue appears densely cellular. Also, at
> this stage, there is a danger of pneumonia sepsis and rupture of the lungs
> causing leakage of air into surrounding areas.
> 3 Resolution and Recovery: During this stage, the lung reorganizes and
> recovers. Lung function may continue to improve for as long as 6-12 months
> and sometimes longer, depending on the precipitating condition and
severity
> of the injury. It is important to remember that there may be and often are
> different levels of pulmonary recovery amongst individuals who suffer from
> ARDS.
> Some experts recognize a fourth phase of ARDS. This is the period longer
> than six to twelve months after onset, when some patients experience
> continued health problems caused by the acute illness. These problems may
> include cough, limited exercise tolerance and fatigue. Others experience
> anxiety, depression and flashback memories of their critical illness,
which
> are very similar to post-traumatic stress disorder. This fourth phase is
> incompletely characterized, and is very much in need of research.
> ARDS TREATMENT
> Treatment primarily involves supportive care in an intensive care unit
> (ICU), including use of a mechanical ventilator (vent) and supplemental
> oxygen. The goal of mechanical ventilation is to support the patient's
> breathing during the time needed for the patient's lungs to heal. Good
> progress has been made recently in improving the use of ventilators. For
the
> most recent information regarding lower tidal volumes used in ventilation
> you will want to discuss with your physician an article titled,
"Ventilation
> with Lower Tidal Volumes as Compared with Traditional Tidal Volumes for
> Acute Lung Injury and the Acute Respiratory Distress Syndrome" which was
> provided by the ARDSNetwork. This article was published in the New England
> Journal of Medicine in the May 4, 2000 issue and you may find this journal
> in your hospital library. Using this technique has shown a decrease in
> mortality.
> ARDS patients frequently receive medications to reduce anxiety and
> discomfort and help conserve energy. Sometimes, these medications make
> patients very sleepy.
> The use of paralytic drugs has been substantially reduced in recent years.
> Only a small percentage of ARDS patients need this treatment. The use of
the
> many adjuncts to ARDS management are tailored to the individuals and
depend
> on severity of illness and other factors.
> Medications are used to reverse the underlying condition if possible, to
> prevent and treat complications of critical illness, and to alleviate
> patient distress, such as pain, air hunger, anxiety and severe confusional
> states. Antibiotics are commonly used to treat confirmed or suspected
> infections. Vasopressors (""pressors"") such as dopamine or Neosynephrine
> may be needed to maintain adequate blood pressure. Pain relievers such as
> morphine and fentanyl and anti-anxiety drugs such as Ativan or Versed are
> usually required to improve patient tolerance of mechanical ventilation.
> Other medications may be used to prevent bleeding from the stomach or to
> reduce the risk of blood clot formation in the veins of the legs or arms.
> After the first 2 or 3 days, patient nutrition is resumed, if possible.
> Until the patient can eat again by mouth, food is given in liquid form
into
> a central vein (total parenteral nutrition ""TPN"") or into the stomach or
> intestine through a feeding tube (total enteral nutrition ""TEN"") If
liquid
> feeding is required for longer than one or two weeks, a surgical procedure
> may be performed to place a tube through the abdominal wall directly into
> the stomach or intestine (""G-tube"", ""J-tube"", or ""PEG"").
> MORE ABOUT VENTILATORS:
> A mechanical ventilator delivers breaths of oxygen-enriched air to the
body
> and removes breaths of carbon dioxide produced by the body, to help the
body
> maintain enough oxygen in the bloodstream while patients recover from ARDS
> and their other injury(ies) or illness(es). A ventilator can breathe
> completely for a patient or assist a patient's own breathing. The 'vent'
> delivers breaths through an artificial airway or endotracheal tube. Since
it
> passes between the vocal cords, the tube interferes with the patient's
> ability to speak. Positive end expiratory pressure (PEEP) is a special
> setting on the ventilator that keeps the lungs expanded to help get oxygen
> from the lungs into the bloodstream. Another important setting is tidal
> volume control, which measures the amount of air used for inflating the
> lungs. Usually the tube is inserted through the mouth or nose. Sometimes,
> tracheostomy is performed (an opening is cut through the neck into the
> trachea and the ventilation tube is inserted through this opening),
ensuring
> a safe airway. Many patients get tracheostomies to avoid tracheal injury
> from an orotracheal or nasotracheal tube. Although the timing and
necessity
> of tracheostomy for this purpose are controversial, oftentimes it is the
> practice to undergo tracheostomy after several weeks on the vent if it
> appears that the patient will require long-term ventilation.
> A decision to proceed with a tracheostomy is not an indication of a
> worsening of the patient's condition, but rather that mechanical
ventilation
> is not being optimized by other means. A tracheostomy might afford the
> patient a better pattern of breathing, hence a better possibility of
> surviving ARDS.
> WHAT TO EXPECT
> The seriousness and unpredictability of ARDS can emotionally devastate
> patients, family, friends, as well as doctors and nurses, especially since
> very few cases of ARDS are alike. Some patients get better quickly within
> several days, and others take weeks or months to improve. Some patients
have
> no complications and others seem to develop every possible complication of
> ARDS. Finally, some victims die quickly, while others die after a long and
> trying illness.
> While ARDS is a very serious syndrome, people can and do survive! It is
> important family and friends of the patient remain hopeful, and seek
> guidance from others, including ARDS survivors, families and friends of
> survivors.
> The course of events after ARDS has developed is determined, in part, by
the
> degree of abnormality in lung function and by the illness or injury that
led
> to the development of ARDS. If the underlying medical condition(s)
> stabilize(s) and no new complications develop, the lungs may begin to
heal,
> allowing the patient to breathe more on his/her own. In about one third of
> ARDS cases, the ventilator may be removed within a week. In another third
of
> ARDS cases, the underlying conditions are so severe that even treatment is
> unable to reverse the abnormalities. Such patients may have or develop,
> progressive or irreversible damage to other vital organs. Sometimes the
> healing process is further compromised by chronic illnesses or advanced
age.
> Although intensive medical care is sometimes able to prolong survival by a
> few days, such patients often die within the first week. Those who survive
> the first week, but whose ARDS has not yet improved, usually remain on the
> 'vent' for an average of 2-4 weeks, though it could be significantly
longer.
> Even upon satisfactory response to treatment of the underlying conditions,
a
> small number of patients have persistent inflammation in the lung(s) and
> seem unable to begin the healing process. The outcome of patients who
enter
> this chronic stage is dependent on reversing the inflammation and
preventing
> or treating complications, especially infection. In any case, unusual or
> experimental treatments may be considered. About one half of patients with
> extreme cases of ARDS get better and leave the hospital, but recovery is
> slow and may be incomplete.
> ARDS COMPLICATIONS
> Each patient's course with ARDS will be an individualized process. The
> following are some of the complications which may be encountered:
> Barotrauma (injury caused by pressure), or Volutrauma (injury caused by
> volume of air used for inflating the lungs.) In ARDS, the lungs are
> weakened, making them at risk of a rupture (pneumothorax). This leads to
> accumulation of air in the pleural cavity, partially collapsing the
lung(s).
> A chest tube (sometimes more than one) is inserted to remove the air,
> allowing the lung(s) to re-inflate.
> Bacterial infections are a common complication of ARDS and contribute to
> continued lung injury. Lung infection or pneumonia may be difficult to
> diagnose in a patient with ARDS because the chest X-ray is already very
> abnormal.
> Abnormal organ function may involve the liver, kidney(s), brain, blood or
> immune system. Organ dysfunction may be related to the underlying illness,
> to treatment, or may occur through the same inflammatory process which
> injured the lungs. If kidney failure occurs, the patient is given dialysis
> (treatment to remove waste products from the blood by circulating the
blood
> through a special machine). Liver failure is a difficult problem to treat,
> since there is no replacement for the many functions the liver performs.
> Ongoing infections, despite appropriate antibiotic therapy, may be due to
> dysfunction of the immune system. Patients may become unconscious or
> confused when they previously have been alert and oriented due to
> dysfunction of the brain or central nervous system.
> Blood transfusions or replacement of certain elements of the blood, such
as
> platelets, which are needed for clotting of the blood, may be required.
> Delirium (also sometimes known as ""ICU psychosis""). The process that
> injures the lungs in ARDS also often affects brain function. Many
> medications, including pain relievers and anti-anxiety drugs, also
adversely
> affect thought and behavior. As a consequence, many victims of ARDS become
> agitated and confused or disoriented after several days, especially as
they
> reawaken. Severe episodes are called delerium. In this condition, memory
and
> concentrating ability are impaired and awareness of time and place may be
> lost. Many patients experience visual or auditory hallucinations.
> Consciousness and confusion typically fluctuate over the course of the
day.
> For unknown reasons many patients are most agitated and confused in the
> evening. Physical restraints and certain medications such as Haldol are
used
> to protect patients from themselves during periods of severe agitation.
> Delirium generally resolves after several days as a patient continues to
> recover from ARDS.
> SURVIVAL AND MORTALITY
> Thousands and thousands of Americans suffer from ARDS each year. Many more
> suffer throughout the world. Until the recent past, this devastating
> condition was uniformly fatal. However, since ARDS was first described in
> 1967, steady progress has been made in reducing mortality. Today, as many
as
> 60% of ARDS victims recover to leave the hospital. More than ever before,
> survivors are returning to productive and rewarding lives. Medical doctors
> and scientists still have more work to do to further improve mortality and
> functional independence after recovery.
> FAMILY AND FRIEND SUPPORT
> Choose the Doctor and Hospital Carefully. Hospitals differ in their
ability
> to care for patients who require intensive care. The best-equipped
regional
> referral hospitals have specialized ICUs for patients in severe
respiratory
> failure. These ICUs are staffed with around the clock and calendar by
> doctors, nurses and therapists who are devoted exclusively to the care of
> critically ill patients. These hospitals accept patients in transfer by
> ground or air ambulance from other, smaller hospitals. Thus, it is
important
> to consider carefully the most appropriate place for the care of a loved
one
> in ARDS.
> Participate actively in Medical Decision Making. Get to know the doctor in
> charge early on. Convey your desire to remain informed and to participate
in
> medical decision making as appropriate. Many experienced doctors admit
that
> they work hardest for patients who are closely accompanied by concerned
> family members who are constructively engaged in critical care.
> Do They Know We're Here? Always gain permission from doctors and nurses
> before attempting to interact with an ARDS patient. Many ARDS survivors
> attest that even though they were on a 'vent', in a sleep-induced state,
> they were, on some level, aware of the people and events around them. Many
> family members and practitioners find that triggering the patient's senses
> plays an important role in his/her recovery (i.e., talking, bringing in
> pictures, playing soothing music, aroma therapy - if conducive to
> environment, and touch; such as rubbing lotion on the patient's body).
> Dreams: Many ARDS survivors recall vivid dreams, while in the
sleep-induced
> state. By stimulating the senses the dreams may be based on reality, which
> might be helpful. Some dreams can be calming and others frightening. Talk
to
> your loved one about fun things you did together, laugh with your loved
one
> about silly things you did. Request that nurses explain to the patient
> exactly what they are doing and why, when they clean the 'vent' and
perform
> other procedures.
> Ban Negativity! It is vitally important that family and friends remain
> positive in the patient's presence - leave fears and worries at the door.
> Conduct all consults with the doctors/nurses away from the patient's
> hospital room since patients may sense and be affected by stress dispersed
> in their presence. Keep your faith and your hope strong, making sure that
> everybody is encouraging and hopeful while with your loved one.However, it
> is also important to be realistic. The mortality rate of ARDS has been
> reduced in recent years but a significant number of ARDS patients succumb
to
> the syndrome.
> Prepare to Tell Them. Start a journal. ARDS survivors have a great need to
> know every detail of what happened while they were asleep. All family
> members can contribute. A separate journal of 'good things' that are
> happening in each person's life can also be used to read back to the
patient
> when he/she shows signs of alertness.
> Prepare Yourself Daily. Prepare yourself for setbacks. ARDS is a roller
> coaster ride. Like the patient, it is normal for family and friends to
have
> both good and bad days. Concentrate on the steps taken forward and view
the
> steps backwards as hurdles that can be overcome.
> Take care of yourself. While a family member or close friend requires
> intensive care, be sure to get enough sleep. Eat well. Attend to the basic
> and emotional needs of others in the family. Preserve yourself for a
> prolonged period of recovery when your critically ill love one will
> especially need your strength and support.
> A WORD ABOUT TERMINAL WITHDRAWAL OF LIFE SUPPORT.
> Despite the best effort of the best doctors, nurses and family members,
> approximately 40% of ARDS victims succumb to their acute illness. In most
> instances, death can be anticipated. The patient does not heal from acute
> lung injury. Multiple organ failure may ensue. Sepsis may becomes
refractory
> to antibiotic therapy. The brain may be irreversibly damaged by stroke or
> other injury. Today, terminal withdrawal is a legal and medically
> appropriate alternative to indefinite intensive care for some patients who
> cannot recover from ARDS. By this approach, intensive efforts to forestall
> death are replaced by comfort care aimed at allowing a peaceful, dignified
> death. At some point, either you or the doctor may raise the question as
to
> whether continuation of life support best serves the wishes and interests
of
> the patient. Frank, open discussions should follow focused on the
question:
> ""what would the patient want us to do now?"" In search for answers to
that
> difficult question, turn first to written documents such as living wills
and
> medical advanced directives that the person may have written. Consider
also
> conversations they may have had with others about continuation of life
> support. Engage close family members in these discussions. Many hospitals
> also have Ethics Committees to assist families and care givers in
> considering difficult decisions. Hospital chaplains or other members of
the
> clergy can be helpful as well.
> RESEARCH ON ARDS:
> Clinical and laboratory scientists around the world are engaged in
research
> aimed at improving the survival and functional recovery of patients who
are
> victimized by ARDS. Family members of patients in ARDS and survivors can
> support the research effort by considering carefully requests to
participate
> in clinical research trials and requests for information. Some may wish to
> contribute money to the research effort as well.
> FOR MORE INFORMATION:
> Please visit the web site of ARDS Support Center, Inc. at
> http://www.ards.org (This site includes articles, FAQs, memorials, stories
> and journals, links, and much more.)
>
> > -----Original Message-----
> > From: geocaching-bounce@xxxxxxxxxxxxx
> > [mailto:geocaching-bounce@xxxxxxxxxxxxx]On Behalf Of Dan Henke
> > Sent: Wednesday, April 16, 2003 3:14 PM
> > To: undisclosed-recipients:
> > Subject: [GeoStL] Re: (No To: geocaching@xxxxxxxxxxxxx
> >
> >
> > -
> >
> > She will be in my prayers along with her husband and
> > the new baby.....Thanks for keeping us informed
> > Barbara...
> >
> > Dan (Thunder)
> >
> > --- Barbara Hunt <barbarastl@xxxxxxxxxxx> wrote:
> > > -
> > >
> > > As you know, Laura (who you know as "purple") had
> > > her
> > > first baby on April 2. Right now, she's in
> > > Barnes-Jewish
> > > hospital in St. Louis in serious condition. Her
> > > family has
> > > requested prayers.
> > >
> > > After returning home from having the baby, her
> > > C-section
> > > incision site got much worse, then she developed an
> > > abcess
> > > and a high fever. By the time she returned to the
> > > hospital
> > > last week she had septicemia that would not respond
> > > to
> > > antibiotics.
> > >
> > > Laura has now developed pneumonia and adult
> > > respiratory
> > > distress syndrome. She is on a respirator in
> > > intensive
> > > care. Antibiotics are not helping so far, but she IS
> > >
> > > receiving the best care possible. Barnes-Jewish is
> > > internationally known for excellent respiratory
> > > care.
> > >
> > > Pray, if that's what you do. If you do something
> > > else,
> > > please do that.
> > >
> > >
> > >
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