Sunday, November 9, 2008

LaShunda alert enough to make “OWN" medical decision

“This is a blessing that she (LaShunda) woke up and was talking – she was able to make her "OWN" medical decision – this will be a life changing decision – for someone else (Sonya)- it is hard to make”. "Keep Positive” “Keep Praying” and Keep-in-touch”. Sonja Rundles, sister of the 2008 WCPS, LaShunda Rundles

“Final Surgery - Monday Nov 10, 2009 at 11:00 AM – (Dallas Time)”

Photo of LaShunda & Sonja taken from her My Space page
http://viewmorepics.myspace.com/index.cfm?fuseaction=user.viewPicture&friendID=275547716

Sonya just returned my call that I made to her earlier today. I REALLY wanted to “check in” on LaShunda’s progress and at a time like this – I am not sure if “being too busy” is an excuse. However, as the current District 31 Lt. Governor of Education & Training I was very BUSY hosting my District 31 Fall Conference. But I DID make sure to buy several get well cards and I announced LaShunda's current condition at my D31Conference and invited my members to sign her “get well wishes” cards – I am mailing them out tomorrow.

I did the best I could to take notes when Sonja spoke to me. I tried to keep up and even recapped what I thought I heard. I even looked on the internet for term a she used TPN. I hope I got it right – but please excuse misunderstandings if I didn’t. Here is what I believe I heard.

Sonya began by explaining that “the intestine is not a viable organ” – “the doctors performed surgery and kept it open – her intestine has six holes – and there is nothing else they can do”. They can’t keep doing surgery every five days – the body just can’t take it and the holes do not rehabilitate themselves”. Sonya went on to say the “situation is not getting better and this will be the FINAL surgery – from the medical stand point the doctors are going to try and “REDIRECT” the veins with tubes”.

“She can have a life” – “This surgery is YES or NO”. She will be on a TPN (this is where I had to google – Total parenteral nutrition – TPN) LaShunda will not be able to feed her stomach (the way we normally feed our stomach – through our mouths) – she will need to use a feeding tube through her veins making sure she can eat through a TPN Drip to get all of her nutrients as food.

“This is not a surgery where you can say take the kidney out – not that simple – you want to be able to eat” “Maybe eat some food” – “From a psychological standpoint – we all want to be able to order a lobster tail every once in a while”. Sonya joked and giggled a little bit here – and I tried to make light too and responded with a “You Got That Right Sist’ha”. She giggled again and then I wished her well.

I thought about how dedicates Sonya is to her sister LaShunda and I can certainly relate to losing a mother (even though mine is alive). I remember when I went into labor it will be 11 years ago on November 13th and after 20 hours of labor and an unplanned cesarean section on November 14, 1997 at 10:00PM I had Sabrina. Although my older sister Mary was there by my side for as long as she could and she really helped me as most sisters would. My mother never visited me during my five day stay (probably for the best in my case).

BUT honestly I am not sure I know anyONE person who would spend both day and nite and day by my side the way Sonya is doing with LaShunda. (although I AM sure I would have a few visitors – maybe NOT as many as LaShunda. teehee) just noONE person as dedicated to me as Sonya is to LaShunda.

What a great bond they have – a special sisterhood. God Bless both of them! I bet their mother would be VERY proud – (may I add as a mom – I sure am)!

I will call her tomorrow and keep you posted!


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TOTAL PARENTAL NUTRITION - TPN

http:///

Total parenteral nutrition (TPN), is the practice of feeding a person intravenously, bypassing the usual process of eating and digestion. The person receives nutritional formulas containing salts, glucose, amino acids, lipids and added vitamins.

Total parenteral nutrition (TPN), also referred to as Parenteral nutrition (PN), is provided when the gastrointestinal tract is nonfunctional because of an interruption in its continuity or because its absorptive capacity is impaired (Kozier et al, 2004). It has been used for comatose patients, although enteral feeding is usually preferable, and less prone to complications. Short-term TPN may be used if a person's digestive system has shut down (for instance by Peritonitis), and they are at a low enough weight to cause concerns about nutrition during an extended hospital stay. Long-term TPN is occasionally used to treat people suffering the extended consequences of an accident or surgery. Most controversially, TPN has extended the life of a small number of children born with nonexistent or severely deformed guts. The oldest were eight years old in 2003.

The preferred method of delivering TPN is with a medical infusion pump. A sterile bag of nutrient solution, between 500 mL and 4 L is provided. The pump infuses a small amount (0.1 to 10 mL/hr) continuously in order to keep the vein open. Feeding schedules vary, but one common regimen ramps up the nutrition over a few hours, levels off the rate for a few hours, and then ramps it down over a few more hours, in order to simulate a normal set of meal times.

Chronic TPN is performed through a central intravenous catheter, usually in the subclavian or jugular vein. Another common practice is to use a PICC line, which originates in the arm, and extends to one of the central veins, such as the subclavian. In infants, sometimes the umbilical vein is used.
Battery-powered ambulatory infusion pumps can be used with chronic TPN patients. Usually the pump and a small (100 ml) bag of nutrient (to keep the vein open) are carried in a small bag around the waist or on the shoulder. Outpatient TPN practices are still being refined.

Aside from their dependence on a pump, chronic TPN patients live quite normal lives.

Parenteral nutrition is indicated to prevent the adverse effects of malnutrition in patients who are unable to obtain adequate nutrients by oral or enteral routes. Other indications are short gut syndrome, high-output fistula, prolonged ileus, or bowel obstruction. However, the decision to initiate TPN needs to be made on an individual patient basis, as different patients will have differing abilities to tolerate starvation.[3]

The nutrient solution consists of water and electrolytes; glucose, amino acids, and lipids; essential vitamins, minerals and trace elements are added or given separately. Previously lipid emulsions were given separately but is becoming more common for a "three-in-one" solution of glucose, proteins, and lipids to be administered.[4][5]

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