Malnourished, Plot twists

I'm very tired & going to be lazy. Big points are that a doctor that visited Denise considers her critically malnourished and said that we could still lose her. She needs to get more real food into her. She needs to elude infections associated with the TPN IV feeding. We're sitting & waiting to see what decisions will be made about where she goes next. Here's a copy & paste from my aunt the nurse, who spoke to the USC doctor that came to see Denise today. Very interesting plot twists...

The USC doc thinks she needs to be on TPN (total parenteral(IV)
nutrition) for a month to 6 weeks.
He states there are risks involved of yeast and bacterial infections,
deep vein thrombosis, and liver failure. He says to expect an
infection. But we have no other options to try to get nutrition in
her if she is unable to hold food down. If she continues unable to
hold food down her chances of survival are remote. He will talk to
her hospitalist and try to talk with the Medical Director of the HMO
about his recommendations. His first choice is to become her primary
and try to get her into Holy Cross SNF near his clinic. Holy Cross is
a high level SNF that cares mainly for patients on respirators etc.
She may not fit the criteria of Holy Cross to get her in even if the
HMO approves it. 2nd would be to go to the HMO SNF and see him once a
week in the clinic. Feels home care in her present state and with
TPN would be questionable.

Now, Denise's spirits are pretty good. Today did have some positive aspects mixed in with the reminder of sick Denise is, the risks associated with the only currently reasonable treatment, and the stress of sitting on pins & needles waiting to find out what the HMO will decide and where she'll go next. She looked and sounded a little better today than yesterday, and was awake & alert more. The neuro doctor came in while a friend was visiting and said that the CT scan showed no meningitis and the anti-seizure meds were stopped. The hospitalist also said this previously, but it's always nice to hear good news again. A GI doctor thought that since there's no rhyme or reason to what Denise is holding down, maybe we could start to vary what Denise is eating according to her cravings. Hopefully the dietitian can also kick in some thoughts. After walking with me she decided to take it easy. This wasn't due to fatigue, but because she thought that maybe she should save up those calories instead of pushing herself to walk farther. At breakfast she ate a couple spoonfuls of yogurt & only gagged up some thick saliva. At lunch she ate about half her tomato soup but about half of what she ate came back up. At dinner she had about 150ml of vanilla Ensure and it stayed down nicely. She said it actually tasted good this time (she hated the stuff for most of the hospital stay). She wanted more, but also wanted to stop while she was ahead. And of course the chocolate truffle stayed where it belonged this afternoon, as well as several sips of water.
So there are lots of ways to pull for Denise tonight. Health (get food in, keep infections out). HMO decisions. Facility availability. Meeting the criteria. We don't know where Denise's next stop is, but we're eager to find out.

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