Thursday, 12 September 2013

Visit from GP

Rachael called her GP to come for a home visit because she was struggling to clear her chest and the Cough Assist machine was not helping. Dr H checked Rachael's chest and he recommended that Rachael should increase the dosage of Erythromycin from 2.5ml to 4ml.
Dr H said that Rachael should contact the surgery if the condition gets any worse.

Tuesday, 10 September 2013

Visit from Palliative Care Nurse

C visited Rachael to monitor her progress. C and Rachael discussed Rachael's well-being over the last week.
Rachael told C that she still had not received her anti depressant medication. C phoned the GP's surgery and arranged for another prescription to be left for collection.
C also phoned the MacMillan team to arrange  another visitor for next week. C will call again in two weeks time.

Monday, 9 September 2013

Follow up letter from Dr P

Rachael received a follow up letter from Dr P after her appointment with him at S Hospice. He wrote about the problems that Rachael is having with her feed and that he recommended Erythromycin to help with these problems.
He then mentioned that Rachael's ventilation seems to inflate her stomach and he thinks that this is contributing to her discomfort when she tries a feed.
He then wrote about the discussion that he and Rachael had had regarding her bowel problems. He thinks that Movicol would be helpful for Rachael in the long term.
Dr P was also concerned about Rachael's sleeping problems but after some discussion he and Rachael came to the conclusion that they could not resolve this problem at the moment as Rachael is worried about the effects of night sedation.

Thursday, 5 September 2013

Appointment at S Hospice

Rachael attended her appointment with Dr P at S Hospice. Dr P asked how things are with Rachael. They then discussed Rachael's ongoing problems with her stomach pain, saliva and feed. 
Rachael told him that she will be having investigations into her stomach pain and that the suction machine helps with her saliva problems.
Dr P tried said that he doesn't know the answer to the feed problem but he said that there is some medication that will move the feed from the stomach to the intestine.
Dr P then asked if Rachael would like something to help her to sleep. Rachael was not sure if this would help. She said that she worries about her alarm not working or that her PAs will not hear it. Dr P suggested that Rachael could build some sleeps into the daytime. Rachael told him that she catnaps. She also has some feed if she goes to sleep in the daytime.
Dr P said that an antidepressant such as Prozac in liquid form may help to improve Rachael's mood in general which may help her to sleep.
Dr P asked if Rachael wanted to discuss anything else. Rachael said that was all and it is just good to go over things.
Another appointment was made for a month's time.

Wednesday, 4 September 2013

Phone Call from Lung Clinic Specialist Nurse

D rang to discuss Rachael's bowel movements and feed. She requested Rachael's GP's telephone number. D will be writing to Rachael's GP requesting an enema.

Monday, 2 September 2013

Visit from Occupational Therapist

A visited Rachael to see if Rachael could still use her bed. After Rachael was hoisted onto the bed it was very clear that the bed was not safe as it does not provide any support to prevent her from falling out.
A said that she will investigate the possibility of getting a chair for Rachael to sleep in. She will be in touch about this as soon as possible.
A also said that she will order some small slings to replace Rachael's old ones.

Visit from Lung Clinic Specialist Nurse

D visited Rachael to monitor Rachael's progress with her NIV and her feed. Rachael said that the NIV is invaluable and she is happy with it. She told D that she is still having problems with her feed and is becoming scared that she will starve to death. D assured her that this is unlikely. D will try to arrange a hospital visit to look specifically at Rachael's stomach problems.
D agreed with C's diagnosis that Rachael's bowels are probably blocked and the diarrhoea is actually just leakage from behind the blockage. She advised the continued use of Movicol.
D also brought some new and smaller masks for the NIV.