Day 5

Mummy finally moved out of the ICU on Monday. She likes her new room. She was happy to see the family. Ram brought her phone, glasses, etc. I spoke with her on Monday evening for 30 seconds and she sounded very tired.
 
Dr. Vidya Sagar visited her said that she should be standing up in 3 weeks and surgery a few weeks later is likely for her shoulder.
 
This morning she was a bit more energetic. She is able to only move her right hand and the rest of her body is immobilized.
 
I plan to be in Hyderabad late Friday. I have updated her contact information with her phone#/room#.
 
Raksha aunty and Sulochana aunty's sister visited her yesterday.
Shashidhar and Bhavani visited her yesterday.
Jagdish chacha called and inquired.
 
Nivedita is with her this morning (Tue). Nivedita gets dropped at Dilsukhnagar bus stop, from there she takes a bus to the hospital.
 

Day 4

According to Ratna, Mummy will be kept in icu for one more day. She is talking little bit more today.
I passed Gautam Gandhi's cautions to her:
1. Make sure she does not get blood clots. It is likely the doctors may put her on blood thinner.
2. Keep the acid level build up in her down. Otherwise, it might get very uncomfortable. Again, there appear to be medication to take care of this.
3. Get her to sit up and move as soon as she can.
 
Mummy is in lot of pain. Her spirits on are not high.
 
Maya visited her today.   She told Mummy that she is not in "the queue" and that she needs to eat well. She helped her eat.
 
Bina said that her bed has been changed to a water bed.
 
I am trying to leave for Hyderabad this week. Hansa will try to come a few days before I leave so that we can help Bina as much as we can.
 
My tennis partner, Munish, who is an orthopedic surgeon said that her conditions are not significant and Mummy will make a good recovery. The trick is to prevent bed sores by getting her back moving and to get her sit to up or put pillows to raise her a bit so that she breathes better and does not get pneumonia. He is helping me get a breathing gadget and stockings.

Her Favorite Spot - this is where she does her reading writing, tv watching, yoga, breathing exercises. Her plan for this year is to whitewash the house. The way she is recovering, she might just do it! Although, we are all going to ask her to take it easy for while.

Mummy's Puja Room - 4

Mummy's Puja Room - 3

Mummy's Puja Room - 2

Mummy's Puja Room - 1

Our home - Barkatpura

Mummy's friend

Backup Support Team in Front Row: Priyanka, Supriya, Nivedita, Kritika, and Ratna

Hansa, Mummy's motivator

Bina, Mummy's Primary Care Giver

Contact Information

Home Address:
16-11-511/D/393  (Mega# 462)
Shahli Vahana, Moosaram Bagh
Hyderabad,  AP  500036
India 
 
Hospital Contact:
(40) 2402-2272 through 2276; Ask for room # 108
www.kaminenihospitals.com
 
Phone at home:
(40) 2454-5477 (Bina - upstairs)
(40) 2454-4337 (Mummy's Quarters - when she returns home)
 
 
Cell (Bina):
986 620-8108 - difficult to get through on international calls
 

Day 3

Some bad news: Bina says that she has become diabetic. Her heart had become quite weak.

She is on traction for orthopedic related fixes.

She was moved out of the ICU today.
 
Kali recommended that:
 
1. She do deep breathing even if she has pain to overcome because of shoulder fractures. This would prevent pneumonia.
 
2. Watch out for clotting problems because of her immobility.
 
3. Her osteoperosis problem should be addressed after the emergency situation is addressed.
 
 
 
 
 
 
 


 

End of Day 2

Mummy is doing much better today.
She is awake a little bit longer. She spoke with Bina who is staying with her during the night in the ICU area. She is likely to be moved out of the ICU after one more day.
She drank a glass of milk today.
 
She will not be operated upon.
 
Mummy has four fractures:
pelvic area:
Pubic Ramii
Sacrum
 
upper body fractures:
Proximal Humeral
Scapula
 
http://www.merck.com/mrkshared/mm_geriatrics/sec2/ch22.jsp
 
 
 
Pubic ramus fractures are usually caused by a fall on level ground. The pubic and ischial rami on one or both sides of the symphysis pubis may be fractured. Normally, the pelvis bears weight mainly on the strong bony arches in the ilium, with the pubic and ischial rami acting as secondary tie arches. When trauma to the pelvis occurs, the rami tend to fracture first, leaving the iliac arches intact. Patients present with groin pain that may prevent them from walking. However, because the rami are not needed for structural support for walking, weight bearing need not be restricted when the pain eases. The clinical appearance mimics that of a proximal femoral fracture. Localized tenderness in the groin and pain during leg movement suggest the diagnosis; x-rays confirm it.
 
Prognosis and Treatment
Pubic ramus fractures typically heal without causing permanent functional disabilities. Most patients feel considerable pain when standing or sitting and should be admitted to a hospital or skilled nursing care facility for monitoring of Hct and vital signs. Analgesics and nonsteroidal anti-inflammatory drugs help relieve pain. To avoid the complications associated with bed rest, patients should begin to walk, bearing weight fully, as soon as possible. Most can walk short distances with a walker by 1 week and are moderately comfortable in 1 to 2 months.
 
 
 
Proximal humeral fractures are most commonly caused by falling on an outstretched arm. Patients present with shoulder pain and inability to move the arm. ...
Prognosis and treatment depend on the number of fragments and the extent of displacement. Regaining the ability to perform overhead activities (eg, combing hair) may take several months.
If the alignment and position of fragments are satisfactory, the arm may be immobilized in a sling. If they are unsatisfactory, an orthopedist may attempt closed reduction. If closed reduction is unsuccessful, open reduction with internal fixation or insertion of a prosthesis may be indicated. Patients should be told to expect considerable swelling and discoloration, which will spread to the lower arm and hand.
For stable fractures, the patient should be encouraged to use the hand and wrist immediately.

 

Dadi on Vibha's Birthday

Mummy - July 15, 2004 - Thursday

Early this morning, Mummy was heading for the special pooja held each Thursday at the Shiridi Sai Baba temple, a twenty five minute walk from her home.  Around 5:45AM she was hit by a car and was left unattended for 30 minutes. A police jeep helped bring her home. Ramgopal, decided to take her in the same jeep to Kamineni Hospital (http://www.kaminenihospitals.com) , about 8 km from her house.
 

Treated so far:
surgery to repair torn urethra was completed to stop the bleeding. She was given two bottles (500 ml each?) of blood.
Scans/xrays showed four fractures:
pubic ramii bone
Sacrum (tail)
Scapula (left shoulder blade)
Proximal Humerus Fracture (ball and socket joint of the left shoulder)
http://orthopedics.about.com/cs/generalshoulder/g/humerusfracture.htm


Because of her condition (low bp, loss of blood) the doctors have told Bina that they will be providing her conventional (sling, ) treatment and they will not be operating on her.
 

Bina has advised us not to come until we hear more from her over the next few days.
Mummy wanted to get up and leave. Bina asked her to stay back. She said she was in pain.
Hopefully, she will recover well.
 
3:33 PM IST  -  3:03AM PDT

Shashi Bhushan, my class mate from Osmania, wrote the following email. The previous night his father in law passed away and he was yet to be cremated when he wrote this email.
 
I am extremely fortunate to have some very good friends. 
 
****
from Shashi
Dilip
I just had a discusion wit Dr.Ramanath orthopedic specialist who had evaluated aunty's condition. Following are the points
!) She suffered fracture of shoulder joint
2)she suffered pelvic fracture
3) she is concious at the momnt
4)There was loss of blood on account of external injuries which drove her BP down and further loaded cardiac function heavily.

First she has to be stabilzed systemically inluding heart beat,BP..etc (which is progresing well. there need not be any concern on that account) It would take couple of days to have her stabilized...

As far as surgery is concerned, in both the the fractures she suffered,surigical intervention (implants have to be placed for shoulder ball socket. In case of pelvic fracture implants will be put in temporarily till its fixed and healed and later through another intervention, they will be taken out),  is the most effective and quickest way to fix her problems. That means, she has to under go three operations; one for shoulder joint and two for pelvic bone fracture. This won't be easy bacause of her age. Other option is to leave the patient as she is and let the natural healing take place.

This is a long drawn process and older patients develop several complications like lung infections, heart problems and above all bed sores which is the nastiest thing that can happen to one. Older patients have much lower tolerance to bedridden condition compared the younger ones. On the other hand there is also risk in going for surgery, again because of the age.
 
Tolerance to anasthesia and foriegn bodies, loss of blood and heart resrve are the issues of concern. But these days, things are considerably improved in India and statistics show much favourable success rates(above 80%). Real problem will be that physical excercises to be systematicallly carried out after operations. They take out a lot from best of the strong will powered patients. Once that's through, life is almost the same.
 
But being bedridden, frustaration and accompanying depression is often the real killer. Probably her shoulder operation may be deferred as it does not cause movements arrested.

We may have to weigh all the factors (I may have missed some) and take a decision for or againist SURGERY. ...

Think it over.

Let me know if ther is any thing I can do.

All these years aunty had God uppermost and innermost in her mind.  now God has to shake a bit and do the best for her.
 
Lets be cheerful
Love
Shashi
****

Bina had been keeping us updated all day through my nieces who in turn passed the information to Lalita, who im'ed us on yahoo.
 
Narayana who drove all the way back from a business trip to Vijayawada called my at 10pm (ist), 930am pdt, to say the following:
 
****

Narayana called and spoke for 10 minutes. 
 
 - Mummy is still in icu 
 - she spoke with Bina 
- she is under sedation for pain management 
- they won't be doing anything on her for another  month. Because of her age, they don't want to do  anything. 
- her shoulder thing is minor and a clean break  and will heal by itself. 
- pelvic is also not a complicated fracture and they hope that the bed rest for a month will heal it. 
 - she is getting an intravenous drip. 
- under worst case conditions, what they are concerned about is pneumonia and bed sores. 
- i told him that i would like to come to help. he said, there is nothing i could do that he and shashi cannot do. He will call again tomorrow to update. 
 
 I  told him i am ready to leave this weekend. 
- i told him about coming to give her some moral support. He said there is nothing one can do while she is in icu. I told him that i want to come when i can be of help to her and not arrive only when she is in an end state. He will call again tomorrow (evening our time or am tomorrow).

 I am in a wait and see mode. 
 
Dilip 
 
****