November 30, 2007 - 7:15 p.m. Karin is still recovering from yesterday's vascular surgery to make a new fistula in her left arm. Our Wonder Woman says this one hurts more than the previous fistula so she is taking her pain pills on schedule. The surgeon dropped by today and said he was satisfied with how the new fistula looks. As reported yesterday, the surgeon said this fistula is smaller than they would like and he doesn't think it is going to be usable as is, but they are out of choices - they cannot do another one. When it matures and heals in 6 to 8 weeks, they plan to insert a balloon, similar to angioplasty, to attempt to enlarge it. Karin had dialysis today, and they took her for a barium swallow test, which she failed, of course, because she still has the old-style large trach tube installed, not her custom fitted trach. Chaplain Carol stopped by to visit and pray with Karin and she left a note. The really good news is that the bronchoscopy and biopsy confirm that Karin has NO REJECTION! Praise the Lord! In fact they said her lungs looks pretty good right now. Karin got a very pleasant surprise today in the mail. She received a letter from Santa Claus. Brandon said he wished he had his camera with him to capture the magnificent smile it brought to Karin's face. She was so happy reading it that it brought tears to Brandon's eyes - he wept because of her joy. The letter was typed on specially decorated stationary. It assured Karin that Santa and Mrs. Claus were both praying for her up at the North Pole. They mentioned that they know she will be going to Disney World after she is discharged, so they included some special Disney stuff, too. Santa told Karin he and Mrs. C. read the updates on her web site and they know how much effort she is putting into her recovery and how much support her husband and family are to her. In fact, Santa wrote that Karin has "the best family, which is as important as having the best doctors and nurses." He said he has "been very busy writing letters to many boys and girls, but had to include YOU." Karin checked the return address on the envelope and, sure enough, it was from the North Pole. But he must have had one of his elves in " 'da Burgh " mail it for him because the postmark was from Pittsburgh. Karin also had a visit this evening from Uncle Jack and Aunt Kathy. . . exactly what she needed to take her mind off the pain.

November 29, 2007 - 8:15 p.m. Karin was taken to vascular surgery around noon and was just returned to her room eight hours later. According to the surgeon someone wrote the wrong "orders" about "reconditioning" Karin's fistula. He told Brandon he never intended to attempt a "recondition" but planned to make a new fistula for Karin all along. So that's what was done today - she got a new fistula in her left arm. The surgeon said it is smaller than they would like and doesn't think it is going to be usable as is, but they are out of choices - they cannot do another one. When it matures and heals in 6 to 8 weeks, they plan to insert a balloon, similar to angioplasty, to attempt to enlarge it. Karin has been able to have some ice chips during post-op recovery. Brandon will be staying with her throughout the night.

November 28, 2007 - 10:00 p.m. Karin was moved out of the CTICU at 6 p.m. and took up residence again upstairs in room D-928. She made the transition in a chair with wheels and Brandon personally carried her custom trach tube, back brace, and "moon boots" to make sure nothing got lost or left behind. Karin was able to stand and do some walking between the bed and the chair during the transition upstairs. Prior to the move she underwent dialysis, which was cut short by 25 minutes because of clotting. Speaking of clotting, Karin is supposed to undergo a procedure around 10:30 a.m. tomorrow (Thursday) where a vascular surgeon will try to "recondition" her fistula. Brandon only learned about it around 5 p.m. this evening, making it too late to have his questions answered by Vascular. He is staying in Karin's room overnight (sleeping in a chair) so he can be there first thing in the morning to talk with Vascular and get some information about the planned procedure. The procedure is supposed to require Karin to receive general anesthesia. Brandon was able to speak briefly with one of Dr. Ferson's assistants in the elevator and she indicated that they hope to re-install Karin's custom trach next week. That'll be a huge improvement for Karin.

November 27, 2007 - 8:00 p.m. Karin celebrated nine months with a new heart and lungs today! Although she is in the Cardio-Thoracic Intensive Care Unit for the fourth time since the transplant surgery, the good news is they are still talking about moving her upstairs to "9D" this week. It was another good day for Karin. She had her gastric feeding tube replaced successfully and is receiving nourishment again. The drainage tube was removed and they also topped her off with a unit of blood. Karin spent a large part of the day in her chair breathing with a trach mask. Her "numbers" are great and she is doing quite well without the ventilator. When we think back to the tremendous stress and effort Karin experienced weaning off the ventilator initially after the surgery and remember how very long the process took, we certainly can see how far Karin has come and how truly improved she is. Karin had a pleasant visit this afternoon from Gram and Pap Freund. The nurses plan on getting Karin back into bed around 9 p.m. (If you haven't seen the 2nd paragraph in yesterday's report, we invite you to read it).

November 26, 2007 - 8:00 p.m. The CTICU was a very busy place today - Brandon says they did three more lung transplants today. Karin had a rather busy day herself. All in all, it was another good day for her. They came in her room at midnight last night to take her off the trach mask (she had been on it since 8 a.m.) and hook her up to the bi-pap and she asked if she could go for another hour on the trach mask! They let her continue until 1 a.m., then Karin spent the night breathing with the bi-pap instead of the ventilator. Because of all the procedures that were scheduled for today and considering how well she did yesterday, they decided to let Karin rest in bed and breathe with the bi-pap all day. Karin was taken to the bronchoscopy lab at 1 p.m. for a scope and biopsy. She did fine. They reported seeing nothing to concern them and that it will be a few days before the lab results are available. Karin was undergoing dialysis at the time of this report. They postponed taking her to Interventional Radiology to replace her feeding G-tube until Tuesday, which, by the way, will be the nine-month anniversary of Karin's transplant surgery! That's a L-O-N-G time to be confined in the hospital. We had reported last week that they intended to build a new fistula for Karin on Wednesday. That has now been postponed indefinitely because her kidneys seem to be functioning better and they want to test her renal function before they subject Karin to fistula surgery again.
      Brandon received a wonderful sign from heaven that Our Lord is still actively watching over Karin. On the way to the hospital today he stopped at a little local hardware store along the route. The clerk at the checkout asked him if he had a "TrueValue" card. He said, "No, I'm not from around here." He explained,"My wife is in the hospital." The clerk asked him if she was a nurse. "No," Brandon replied, "She had a heart-double lung transplant." The clerk said, "Really - my church has been praying for a young woman who had a heart-double lung transplant." She reached into her purse and took out a church bulletin, and sure enough, there was Karin Marks Bordner listed on the Prayer List!! This encounter was not a "chance coincidence," it was a "God-incidence" to give Brandon and Karin and the rest of us assurance the He is very much in control and all our prayers are indeed being heard by Heaven.

November 25, 2007 - 10:30 p.m.   Brandon reported that Karin had a good day today. She started breathing with the trach mask at 8 a.m. and was still going strong at 9 p.m. Tonight, instead of putting Karin back on the ventilator they are going to connect her to the bi-pap machine overnight. If she can get through the night without the ventilator, the Critical Care doctor said Karin could possibly be moved back upstairs by mid-week. This is definitely good news and good progress. In fact, Brandon made a trip up to the ninth floor and requested they reserve "the Bordner suite" for Karin. Right now there are four rooms vacant up on 9-D, however there were four or five lung transplants this week, with three performed in one day. Karin's spirit were higher today than in past days, partly because she was able to watch a lot of figure skating on TV. It happens to be her very favorite programming. Monday promises to be a very busy day for Karin if they can accomplish all the procedures that are scheduled - replacing her feeding G-tube, a bronchoscopy and biopsy, and dialysis. Please pray all goes well for our Wonder Woman.

November 24, 2007 - 9:00 p.m. Brandon was on his way home a little early tonight because he is having some recurring problems with his van and will need to send it back to the shop for repairs. He said that when he left Karin had been on the trach mask since early this morning. They did not want to get Karin out of bed today because there was a problem with her gastric feeding tube. The gastric doctor came in and removed the tube and replaced it with a temporary one which is more like a catheter. Brandon said it was interesting to see the process which he accomplished at bedside without any discomfort to Karin. He said because Karin has had a tube for so long there is a well established path for him to follow to do a temporary placement. However, they will check placement later by using a contrast medium in a sterile saline solution and X-ray to determine if it is situated correctly. It will probably be replaced with a standard tube on Monday. Meanwhile it will only be used to give Karin medications. Since she will not receive nutrition until then, Brandon hopes they will put her on the schedule as a top priority. A bronchoscopy and biopsy had also been scheduled to take place on Monday and it is a day of dialysis so it will be a challenge to get all of these procedures accomplished in one day. Illness prevented Karin's parents from making a visit today and that was a disappointment for all of them. However it is always prudent for visitors to consider the possibility of being contagious and to decide on the side of caution. Karin's immune system is suppressed by the anti-rejection drugs she must take and it would be foolish to expose her unnecessarily to any sort of infection. Pray especially that Karin's procedures on Monday go well and also that Brandon can get the van repaired. Thank you.

November 23, 2007 - 10:45 p.m. Karin got an early start today and began weaning off the ventilator by breathing with a trach mask shortly after 6 a.m. this morning. When Brandon called tonight she had been using the trach mask for about 16-1/2 hours straight! He anticipates that she will continue on trach mask until about 11 p.m. tonight. They will plan to restart her again early tomorrow. Karin needs to be able to demonstrate that she can do this for 18 hours straight before she can move out of CTICU and back upstairs to the post-transplant floor. Although she is usually most successful doing this upright in a chair, Karin was still was able to breathe using the trach mask during dialysis today that she received while lying in bed. When she has nothing else to think about it is especially hard for her. If she focuses on how hard it seems, it causes her to lose confidence and doubt that she can continue. It is not easy to keep her occupied in direct conversations or activity since this particular trach tube doesn't allow her to speak right now. But Brandon said even other people's conversations going on in the room around her serve as helpful distractions. Perhaps visitors over the weekend will help her to go over the 18 consecutive hour target.

Thanksgiving Day, 2007 - 10:20 p.m.   Karin was down in the dumps and reluctant to get out of bed this morning until her nurse reminded her that lying in bed invited pneumonia. So Karin got up and into her chair at 11 a.m. and remained there until 9 p.m. She logged an amazing 9-1/2 hours breathing with a trach mask today. Karin's spirits were lifted further by a visit from her cousin Chris, his wife Jan, and their son Hunter who had just came off a Disney cruise to a private island. They brought back a bunch of Disney memorabilia for Karin, including a stuffed Mickey Mouse to add to her collection. Brandon took a short break during the quite time on the unit and went out in the Pittsburgh snow to Aunt Marilyn's for some turkey with all the traditional trimmings. Karin was able to receive good wishes from her family via speakerphone as they were gathered at Uncle Dan's for their holiday feast.

November 21, 2007 - 7:30 p.m. Karin sat up in her chair today until about 2 p.m. when she had to get back in bed for dialysis. To use the trach mask she really does best in a sitting position so for most of the day she has been on C-Pap and doing well. Dialysis went well and the kidney doctors told Brandon that they will be doing a 24-hour collection of urine soon to run tests that will tell them more about how her kidneys are filtering what they need to. Brandon said Karin's serum creatinine levels have been running between 1.4 and 1.6 which indicates an improvement in her renal function. He feels they have actually come a long way even if that level is still well above normal. Karin spent some more time reading her website today and overall had a pretty decent day. She especially enjoyed the holiday "decorations" and messages.

November 20, 2007 - 9:45 p.m. Karin spent a whopping 9-1/2 hours today out of bed and sitting up in a chair. She started off the day by breathing with the trach mask but later moved back to C-Pap when her respiration rate and heart rate began to rise too high. This is not unexpected and is all part of the weaning process. As you may recall, weaning off the ventilator involves transitioning to gradually stepped down modes of assisted breathing. As Karin's heart and lungs can function with less assistance. eventually she will be able to breathe on her own without any support again. Brandon admitted that Karin was feeling a little upset last night and again this morning. The isolation in CTICU had her down. She said she had been feeling especially low -- alone and forgotten -- before he arrived this morning. He got out his computer album of family photos and showed her pictures of nephews Hunter and Gage and gave her a long pep talk. He said they then spent a long time reading post-its and cards and emails that people had sent to encourage her. Chaplain Carole stopped by today and they appreciated her visit. Karin was back in bed on C-Pap when Brandon called this evening during quiet time in the unit. When he goes back in tonight he plans to give Karin a shampoo since it one of those small pleasures she really enjoys. I am sure you will agree Karin's emotional feelings are certainly understandable. Her birthday is coming up on December 14th and once again she is facing the prospect of "celebrating" her birthday in the hospital. In fact this will be the third year in a row she will be in Presbyterian Hospital for her birthday. She hasn't been home in over nine months. It is only natural that she misses her home, neighbors, friends, family and pets and the small pleasures of daily life that we take for granted. The approaching holidays and birthday surely awaken deep feelings and tender emotions and it is probably healthy that she is expressing them now. Brandon stressed how grateful he is and how much he really values visitors and emails, cards, and post-it notes as an encouragement and distraction to help Karin through these low moments. They let her know that she is not fighting this battle alone and they help her muster the strength she needs to keep fighting. So in the spirit of Thanksgiving, Brandon and Karin want to thank everyone who has taken time to visit her in person, or visit her web site, and for praying, caring, and supporting them in so many other ways throughout this year. May you and your family enjoy a wonderful time of Thanksgiving this year as you gather to recall and give thanks for all of God's abundant and bountiful blessings.

November 19, 2007 - 7:45 p.m. Not much new to report today. Karin slept really well last night and felt good all day. They are no longer keeping the glass door to her room closed. She was already undergoing dialysis when Brandon arrived. The session lasted for 3-1/2 hours and it had it's usual tiring effect on Karin, so she slept most of the rest of the visiting period. Naturally when visiting hours were over and Brandon had to leave her side, she was finished napping and was ready to get up. During the next visiting period later tonight Brandon plans to get Karin out of bed so she can commence breathing with a trach mask and wean off the ventilator some more. Currently she is on 33% @ 15.2 liters of oxygen when on the trach mask and doing well. Finally, as Brandon was leaving to go have some dinner during the evening quite time, Karin complained to Brandon, "I'm HUNGRY!" He gently reminded her. "Hon, it is 'Nothing By Mouth' while you're on this particular trach tube!"

November 18, 2007 - 10:45 p.m. Brandon left Karin's side late this evening, so it is a late report tonight. Karin was moved to bed #3 in the CTICU which has given her a window that she can look out when she is sitting up in her chair. It'll also let her keep track of the days and nights. And speaking of sitting in a chair, Karin sat in her chair today for the first time after 12 straight days in bed. Surprisingly, she still had a good bit of strength and did well standing and transitioning. Karin spent three hours in the chair. Another good thing was that she was able to breathe using the trach mask for the two hours she spent in her chair. She had already used the trach mask for an hour while lying in bed, but it was uncomfortable for her and her lungs hurt. Nevertheless Karin toughed it out and persisted in spite of the discomfort, but she was completely comfortable on the mask while in the chair. Today Karin received the last dose of Thymoglobin, concluding the 10-day course of treatment to reverse the lung rejection. Her oxygen stats looked really good today. Karin was so cooperative and compliant today that tomorrow they intend to get her up in the chair early and extend her time breathing with the trach mask. The sooner she gets off the ventilator the sooner they will put her custom trach back in and she will be able to talk and eat food by mouth again, and get out of the CTICU. We found out today that the new fistula that is supposed to be made on Wednesday will be somewhere in her left arm again. It is good to report the small but positive progress Karin made today and that her morale was better today, too. Thank you for your prayers and cards and words of encouragement.

November 17, 2007 - 9:00 p.m. Karin is doing fine today. She breathed using the trach mask for about an hour. Dialysis conducted another session today and they removed two liters of fluid. Karin was tired this evening, which is not uncommon following dialysis. In fact, she slept through most of the OSU victory over Michigan football game. Karin is supposed to get a new fistula on Wednesday, which they intend to place in one of her legs, as we understand it. Her spirits have been a little low these last few days in CTICU, so please keep Karin in your thoughts and prayers.

November 16, 2007 - 10:45 p.m. Brandon reported tonight that Karin was much more alert today. She is now completely off the Fentynal for pain that had made her drowsy. She has being more inquisitive, asking about things beyond her four walls and wanted to know who might be visiting this weekend. Dialysis was effective and they removed about two liters of fluid. Karin weaned off the ventilator by breathing using the trach mask for two hours prior to dialysis, when they put her back on the ventilator. She did really well while off the ventilator and using the trach mask. Karin has been experiencing very restless legs, perhaps as a result of coming off the pain medication. Finally, the person responsible for sticking Karin in the fistula last Friday came by and apologized explaining that he misunderstood where they wanted the blood drawn from.

November 15, 2007 - 8:55 p.m. Brandon reports that Respiratory medical staff did a bedside bronch exam of Karin's lungs today. They will be culturing some samples of a brownish mucous secretion they found there. This will enable them to be sure Karin receives the antibiotics which will best target any infection that is still present. Because the bronchoscopy is an invasive procedure they also decided that breathing with a C-Pap machine would require tax Karin less than using a trach mask today. Brandon said she said she was doing fine on the C-pap and that was encouraging since she began using it about 3 p.m. and she was still using it when he had to leave for unit quiet time at 6:30 p.m. He thinks Karin will have a lot less anxiety as she goes through the weaning process this time. Since her medications are delivered in a kind of saline solution, Karin's increased fluid intake now requires more frequent dialysis and she will have another session this evening. They have reduced Karin's Fentynal medication so she was more alert today, especially this afternoon when she remained awake for most of visiting time.

November 14, 2007 - 8:40 p.m. When Brandon got there today he noticed that Karin's new back brace had been delivered and they had tried it on her.  Brandon laughed and said he wished everything went as fast as the brace making.  But it doesn't.  There are good reasons why they call people in the hospital "PATIENTS"!  Karin's cousin Jeff swears it's because NOTHING takes more PATIENCE.  Because it was another dialysis day they did not get Karin out of bed today nor did they begin the trach mask weaning.  Brandon did get to review Karin's current situation with her transplant surgeon, Dr. Kenneth McCurry.  Brandon wanted to verify and summarize bits of information he had been given by other staff.  They are treating the rejection vigorously, treating the bacteria in Karin's lungs also, and planning a 10-day course of medication with the Thymoglobin.  Yesterday because her white cell count was too low they did not give her a dose but will resume tonight.  They will probably re-evaluate her again in two weeks with a biopsy and a bronchoscopy.  Brandon asked if they planned to increase her Progaf since this is the fourth time her biopsy showed moderate rejection.  Dr. McCurry said yes they would likely need to do that, too, but it is a double-edged sword they are dealing with.  It means suppressing her immune system even more to do so.  The vascular doctor also came in today to check on Karin and the fistula that was created in her arm to serve as a permanent port for dialysis.  He said it cannot be used.  You may recall it was compromised and a clot formed when someone drew blood from it prematurely.  Karin will need to get another fistula now in another place - perhaps her groin area.  The implications of this in retarding her recuperation time are significant.  She experienced soreness and tenderness in her arm for all four weeks after the surgery that created this first fistula and the site had to be protected which meant she was unable to use that arm while it healed.  To go through this surgery again will involve being anesthetized one more time and then another six weeks to let it heal/mature before it can be used.  When I asked if he has been given any explanation about how the fistula came to be compromised in the first place Brandon said, "Not really."  He's been advised it would probably be Monday before he hears anything from the critical care doctor, Dr. Arthur Boujoukos, about that.  Hopefully, there will be some review of the incident to try to prevent this kind of thing from happening again.

November 13, 2007 - 7:50 p.m. Tests results reported today from the broncoscopy last week confirm that Karin's lungs are showing signs of moderate rejection. The anti-rejection drugs which they had already started before getting these test results have already begun to have a significant effect. As a result Karin's white blood cell count is down also. So because her immune system is being suppressed so aggressively right now they are now closing the glass door to her room and visitors must wear masks. That didn't keep Gram & Pap Freund from enjoying their regular Tuesday visit to Karin. Brandon said he woke up in the middle of the night last night when something made him realize he hadn't seen Karin's back brace in her room yesterday. When he got to the room today he realized it wasn't a dream or just his imagination. It was no where to be found. Brandon asked Karin's nurses about it. No one seems to know what became of it. The nurses made inquiries, searched her room and spent about an hour making phone calls. Finally it was declared officially MIA. The orthopedics shop sent over someone to fit Karin for a new brace. If they are as efficient as they were with the first one it could be ready for her to wear tomorrow. Pray that it is a good fit so Karin will get the back support she needs without pain. The ventilator settings were successfully reduced last night and today and are now at the minimum settings. So if Karin continues to do well at those settings tonight, Brandon anticipates that they will try to transition to the trach mask tomorrow. This will require Karin to use her chest muscles to initiate inhalation and exhalation As Brandon said, "Tomorrow the marathon will begin again." It will be hard work for Karin's muscles to begin this weaning process. Karin had another session of dialysis today to give her an advantage of not carrying any extra fluids. That will help her lungs to do their job more effectively and efficiently as she is weaned off the ventilator.
     Even as we continue to ask for your prayers for Karin we realize that there are others among Karin's many supporter's who may also be hurting. So as we begin this holiday season and look forward to the celebration of Thanksgiving with our loved ones we also pray especially for those families among us whose holidays may be overshadowed by illness or loss and feelings of grief or sadness.

November 12, 2007 - 10:00 p.m. Brandon reports tonight that Karin had a fairly quiet day today. Dialysis went well. They performed a doppler ultrasound on both of her arms to check for any blot clots. Karin spent most of the day resting feeling a little sleepier than yesterday. Dr. Murray said they will try to bring down the "PEEP" on the ventilator overnight tonight. That involves dropping the pressure/oxygen levels and monitoring Karin's numbers to determine if she can continue to maintain acceptable levels with less external support. Karin continues to receive encouragement from nursing staff, friends, and family to hurry up and get back to 9D then into Rehab again soon. We know it works so please continue to pray for Karin's recovery.

November 11, 2007 - 6:50 p.m. Karin is doing much better today, praise God. The medications seems to be kicking in and doing their job. She spent the day in bed, but was awake and alert enough to watch the kick-off of the Steelers' game with the Browns and especially the fourth quarter when Cleveland snatched defeat from the hands of victory. She and Brandon thought the game was a "nail-biter," The CTICU staff have Karin's ventilator turned way down to 35% (from 70% on Friday) while her oxygen saturation level is hovering around 94%. Karin had a special visit today from Katie, one of the nurses who took care of her in the CTICU back in May (see picture), who came to tell Karin she had become engaged and wanted to show Karin her ring. They had a very nice visit even though Karin cannot actually speak using her voice because of the old-style trach tube she has currently. Eventually they will reinstall the custom trach tube once she is off the ventilator and she will be able to talk and eat by mouth again. Brandon's parents visited again today and they brought Karin a sculptured figurine set of Mickey Mouse that she had ordered. Karin was overjoyed to see and handle them. Regarding the CMV infection, Brandon seems to think that Karin actually has not shown any symptoms, but her blood work contains antibodies for CMV so that is why they have begun treating her for it as a prophylactic measure. There is supposed to be a meeting this week with hospital administrators concerning the blood drawn from the site of Karin's fistula when her fistula was clearly marked NOT to be stuck with needles. The fistula was working fine up until then and the clot that resulted could have serious consequences for Karin. Please pray that all these matters will be resolved satisfactorily.

November 10, 2007 - 3:00 p.m. Karin's Dad, Tim, reports: "Arrived this morning and Karin seemed to be resting comfortably. They had reduced the percentage of oxygen being pushed into her lungs by the ventilator and her vital stats were fine. The oxygen saturation was fluctuating in the high 80's; like 87, 88, 89! They seemed pleased with that but hope to be able to continue to drop the percentage of oxygen down to 40% or 30% and keep the saturation level high. Right now the oxygen setting is at 50%. When I left her room at 1:45 p.m. her saturation levels where in the low 90's. Last evening the doctors conferred after looking at the slides of the biopsy and decided to start her on a ten day (most likely) dose of ATG (anti-Thymogobulin). This is the same treatment they used to treat rejection one other time, but only for five days. The doctor did say that they would check her "Tee" cells early in the week to determine for sure if they will continue through for the ten days but he suspected they would. He also assured us as soon as the clinical signs are right, they would work to wean her from the ventilator. Karin seems to be rather puffy even after having dialysis last evening and we asked the doctor about that and he said it may simply be from the ventilator, and we tend to agree. We seem to recall she always seemed puffy while on the ventilator before, but never put the two together! Doctor Ferson stopped in to see Karin this morning and we had a very good talk with him. He was able to answer many of our questions and we are now more comfortable with and have a better understanding of the condition of the trachea and her tracheostomy. Brandon's mom and dad, Pat and Jack Bordner, got here about 1:30 p.m. and visited with Karin until they had to leave at quiet time. We are all getting ready to go eat now. We don't expect a whole lot of change in Karin's condition until the medicines have a chance to kick in, but we are confident she is heading in the right direction again. Thank you for your prayers and support. "  

November 9, 2007 - 7:45 p.m. Karin's Dad, Tim, writes tonight: "Got in here this morning and when we called back to see if we could go in to see Karin we were told that they were doing an ultrasound and they would let us know when they were done! When we got in to see her and inquired as to why they had done an ultrasound and on what was it done, the nurse told us that the fistula had been compromised and there was a clot there. Needless to say were were not happy! The fistula was not supposed to be used for about 8 weeks until it had matured, but yesterday when they were drawing blood for cultures someone used the fistula. (The fistula was made in Karin's arm four weeks ago on October 12th). We were not in the room at the time but when we returned we saw a bandage at the fistula site and inquired of the nurse and she told us the person who drew the blood from that site was authorized and qualified to do so. At this time we are not sure if anything will need to be done but there is a possibility that they may need to actually go in and remove the clot! Not a good way to start the day. Karin was still not too comfortable and her stats were not the greatest. The doctor requested a preliminary result from the lab on the biopsy and was told there is some sign of rejection, so the course of action is to begin a dose of steroids. Once the final results come in they will have a head start on fighting the rejection. In the meantime they kept Karin mildly sedated throughout the day and dialyzed her and removed about 1 liter of fluid. At 6:30 p.m. when we left her room she seemed to be resting a little more comfortably and her vital stats were the best they have been all day. As I write this we are waiting to talk to someone to address some of our concerns!!!"  

November 8, 2007 - 12:55 p.m.   Brandon sent this mid-day report "Tim and Linda arrived at the hospital earlier than I did because Linda needed to use the internet service. When I arrived I called back to CTICU. What good timing! The nurse said the doctors were making rounds on Karin and to come back immediately for any questions. So we all went in and received a plan of action from the Critical Care doctor. Karin's chest x-ray looks worse than the previous one, she had a fever of 102.6 degrees, and her breathing was very labored. She had been on bi-pap all night. She is going to have a bronchoscopy and biopsy later today. They are going to remove her trach tube and intubate her. Karin requested to be asleep for her trip to the bronch lab at Montefiore. They are thinking she may have pneumonia, but the procedure will answer questions definitively. We will keep you updated as much as possible whenever we can. We ask for your prayers and continued support. This is just one more obstacle for Karin, but she is determined. She has battled every other obstacle and showed us all how strong-willed she is. "
9:50 p.m. update:   At 6:30 the nurse called us and said we could come back and when we went in she told us that Karin already had the tube removed and a new Trach in and was resting comfortably! But the elusive Dr. Ferson was already gone so we didn't get to talk to him. We made sure they placed "post-it-note" right on the computer screen to let whoever is there when Dr. Ferson returns know that we need to talk to him. They have started Karin on a dose of general antibiotics (Vancomycin) for pneumonia as a precaution and will await results of the cultures before taking a more specific course of action if needed. This is all speculation at this point because we haven't talked with Dr. Ferson yet but the Trach they put in now is a larger one than she had so I am wondering if scar tissue in the Trachea may be the cause of her shortness of breath. But then again they may have just had to put the larger one in to accommodate the ventilator which she will be on for a day or two. If we understand this correctly, the extra pressure of the ventilator allows the alveoli in her lungs to expand optimally and permit the antibiotic to be used more efficiently. WE REALLY NEED TO TALK TO DR. FERSON!!!! I doubt we will have any more information this evening but we will let you know if anything changes. Otherwise I think it is safe to say that she really did seem to be resting comfortably when we came back out to the waiting room about 6:45 so as not to interrupt the shift change and to allow Karin the much needed rest she deserves! Of course she was still somewhat sedated and feeling the affects of the "Milk of Amnesia". One of Karin's extended family members who works here at the hospital, Sheryl, who is actually off this week and enjoying time with her grand kids but still taking the time to keep up with Karin's progress via the web-site, called one of her co-workers ,and asked him to stop by to see us. He did and his name is Mike. He seemed like a really nice guy! Thanks Sheryl and Mike! We certainly appreciate all the support Sheryl has generated. It was Sheryl who initiated the candy sale! Megan Marks stopped in and brought a salad and some fruit which we enjoyed as well as the time we had to spend with her. Carole, one of the hospital Chaplains stopped by too and prayed with us prior to Karin going to the Bronc lab. One of the PST's from the ninth floor, Lori, stopped by to see how Karin was doing, too! Since yesterday and throughout today as CTICU staff who know Karin from her initial stay here see that she is back here we assure them that she is just here for a short visit! I don't think we will really ever know just how many lives Karin has touched. She really is a HERO! Speaking of heroes, this isn't where we had hoped to be this Veterans Day week-end but without the sacrifices of all veterans, past and present, being here might not even be an option! Thanks to all who have or are serving!

November 7, 2007 - 11:00 p.m.   Karin's condition has stabilized and she seems more comfortable since they have her breathing with the aid of a bi-pap machine while in the CTICU. The bronchoscopy has been delayed and is being rescheduled for Thursday. The original plan was for the bronchoscopy to be administered in the CTICU, but on further consideration the doctors felt that Karin should not receive the procedure until after dialysis. They have further decided not to do the bronchoscopy in her room in the CTICU, but to do it in the bronch lab where the facilities are better for dealing with a possible stenosis in the right lung, which may require inserting a stent in her lung. Brandon said that Karin's morale is a little down, affected somewhat by the mention of the possibility of putting her back on a ventilator, which has not happened. At the time Brandon called this evening, Karin had almost completed dialysis and had done well.

November 7, 2007 - 1:00 p.m.   Brandon called Tim & Linda this morning to let them know that Karin is experiencing some level of increased distress. Tim & Linda are on their way to Pittsburgh now. Brandon just called us to let us know, too, that Karin has been moved back into CTICU. I could hear the concern in his voice as he told me that Karin's breathing is more labored today than it was last night when they moved her out of Rehab and back onto the post-transplant recovery floor (see Nov 6th report below). He is very concerned that there have been so many moves in the wrong direction so quickly. The last X-ray of her lungs showed something different on her right lung and the doctors decided that it warranted a move into CTICU where they will do a bronchoscope. That is an examination which lets them see inside her lungs to try to determine just what this spot on the X-rays is. It is an invasive procedure so Karin especially needs your prayers today along with your prayers about the CMV (cytomegalovirus) infection reported yesterday.

November 6, 2007 - 8:45 p.m.   After one great week in Rehab, Karin is back in the Cardio-thoracic transplant unit now. They moved her into room D-953 after experiencing a high heart rate during dialysis last evening. Her heart rate is now back down to a more normal 112 beats per minute. She spent the day in bed and did not eat all day except for some Jell-o with fruit for dinner. Because she did not eat yesterday either, they have increased the amount going through the feeding tube in her stomach, She is not experiencing any nausea. Karin received blood tests, a chest x-ray, and echocardiogram. Her Nurse Practitioner advised them that Karin's body has not been absorbing all the Prograf anti-rejection drug (probably because of the previous bouts of nausea) so they gave Karin a double dose of Prograf this evening. They have determined that Karin has CMV (cytomegalovirus) infection. CMV infection is commonly found in immunocompromised patients, including organ transplant recipients, and patients undergoing hemo dialysis. Karin's CMV infection shows a low count so they think they have caught it early. In September, Karin's "transplant twin" Karen Arrowood was hospitalized in Georgia with CMV and thankfully she is completely over it now and is doing quite well (www.karenarrowood.com). Karin did have her usual Tuesday visit from Gram & Pap Freund today.  Please pray that Karin will be able to kick the CMV quickly and completely and get back to Rehab.

November 5, 2007 - 10:50 p.m.   Karin had another active day in Rehab, completing all the O.T. and P.T. exercises as directed. She was taken to dialysis this evening, which was started around 9 p.m., but during dialysis her heart rate increased to the point of concern. When it got to 162 beats per minute they terminated the dialysis around 10:30 p.m. and decided some medical tests were needed in order to find out what was causing the high heart rate. So they have re-admitted Karin back to the 9th floor of UPMC-Presbyterian. Her new room is D-953. Karin's Nurse Practitioner was on the scene immediately and all the doctors were contacted in order to confer on a course of action. They have gotten her heart rate down to 140 bpm and have ordered blood tests and other test to try to identify what's happening. Brandon will be staying with Karin in her new room though the night. Please pray for Karin's heart rate and for her medical team to have wisdom and insight in diagnosing and treating this problem with her heart.

November 4, 2007 - 10:30 p.m.   Linda reported that although P.T. let Karin sleep a little later today thinking she was still on restriction like yesterday, O.T. showed up at 10 a.m. to collect her and she had a 2 hour Occupational Therapy session until noon. Linda said once Karin is dressed and out of her room she has not been anxious to return. She is ready to do some gallivanting preferring to go to the atrium or the lounge between therapy sessions. In the lounge Karin can choose to sit in a regular straight backed chair at a table to put together jigsaw puzzles, have a snack and on Sundays enjoy some featured movies. By 3 p.m. however, Karin was back to work with P.T. She did some rowing with her feet, practiced pushing off to get up and down out of a chair, and took two walks for a total of about 70-80 feet. Still feeling game to have some fun, Karin chose another visit to the lounge for about a half hour before returning to her room to get ready for the evening and to spend some time resting in bed. Linda also noted that Karin doesn't say no to anything she is asked to do. When asked if she wants to do something new she simply answers, "Sure, I'll try." Or "Yeah, I'll do it." While they were killing some time waiting to set up the next activity she requested some Silly Putty to be able to use that time productively working her hands. She also has a gripper exercise to do daily and Linda says she is getting stronger. She is obviously able to do more when she is feeling better. But even when she is not feeling at the top of her game she doesn't give up . Right now she is still getting sick when she tries to swallow pills or exceeds her stomach's tolerance for small amounts of food or drink. Her breathing this morning was still a little labored but that seems to have subsided. Even the liquid nourishment she gets has to be cut back from time to time because she feels full very quickly. The Heparin drip she is on for clotting needs close monitoring for adjustments but is the only medication she is receiving by I.V. right now. So it is still a bit of a challenge to keep her levels of nutrition and medication balanced and to still keep up with the demands of therapy but Karin is not complaining. By the way, if you have tried to call Karin in her new room W-1133 you may not have been successful. Only today did Linda and Karin realize that there is in fact no phone in her room. They had been out of the room so much they hadn't noticed its absence. There may be one by the time you read this so do try again if you want to talk to her at those times she is not at therapy or dialysis.

November 3, 2007 - 7:30 p.m.   Linda writes: "Karin called me this morning before 8:30 a.m. to see when I was going to get to the hospital.  The doctor had been in to assess Karin and her breathing was labored, coupled with a higher than normal heart rate.  They were suspecting a blood clot in her lung.  I hurried to the hospital and was there when the doctor returned to say that they would not do a CAT scan because it would require using a dye that may potentially harm her kidneys and they don't want to do anything to cause her unnecessary problems.  Her kidneys are still working some and they don't want to cause more damage.  The course of action for the blood clot would be a Heparin drip and they began the testing to start that I.V.  In the meantime, Physical Therapy for today was put on hold.  Karin was ready to be out of her room then, so we got in the wheel chair and moved on up to the lounge.  She got out of the wheelchair (with help, of course) and sat in a regular chair.  That is where she remained through lunch, up until 4 p.m. when we went back to her room.  During our lounge visit, she put together two jigsaw puzzles, played a game of Scrabble, which she kicked butt at by the way, and a game of Yahtzee.  Also this morning, Carol Patterson, who worked with Karin's dad and recently retired, stopped in to see Karin and sat with us during the morning's jigsaw puzzle session.  Karin's room was changed today.  She was moved to a "luxury suite" room #W-1133.  It is a much bigger room and is better suited for some of her equipment needs. Thanks to everyone for the good wishes, prayers and encouragement for Karin in her rehab efforts.  She looks so much better; maybe it is just the fact that she is wearing sweats rather than the "lovely" hospital "gown," but I don't really think it's the clothes at all."

November 3, 2007 - 9:30 a.m.   Karin had a good day on Friday. After Physical Therapy she had Occupational Therapy and they gave her a shampoo - now THAT's good therapy! She spent about a half hour sitting and talking in the atrium and enjoying some of the fall splendor. Karin's nausea was not too bad yesterday and she enjoyed soup for dinner, before going for dialysis. Dialysis ran late again last night, until about 10:45 p.m. Karin is experiencing a little difficulty breathing this morning. Although her oxygen levels are OK, her heart rate is high and they have ordered a C.T. ("CAT") scan to rule out a blood clot. Hopefully we will be able to post another update today if we learn more.

November 1, 2007 - 9:00 p.m.   You could hear it in his voice tonight - Brandon is so proud of Karin!  She was nauseous almost all day but still went through all her therapy.  He said you could tell she was really pushing it and giving it her best shot.  For example, she has a machine which she pedals with her arms.  She pedals for two minutes and then has a five minute break until she pedals again for two minutes and rests for five.  This sounds easy to most of us but for Karin this is challenging.  Her oxygen levels drop while she is exerting herself but they bounce back during the five minute breaks.  Another activity involves wheeling herself in a wheelchair.  Brandon excitedly reported that she was able to actually wheel herself for 20 ft.  Right now everything Karin does for herself is therapy because her body has been debilitated by being in bed and in the hospital for so long (8 months).  In fact, they have added a third therapy for her - Recreational Therapy. Playing on the computer, getting out of bed, and tying her gown all involve a challenging level of effort for her.  It is like going to work and putting in a full day of hard labor for her right now.   She has only been in Rehab for two days but Brandon is really excited by everything she is doing.  He announced proudly that there is nothing she has refused to do.  She is not fussing or complaining that anything is too hard to do, even though he knows it involves a struggle.  Her attitude is: "I will try!".  Brandon says he just stands nearby and watches her in awe.  "I have to put my hands in my pockets and just offer words of encouragement for each effort she makes."  The hardest thing for them both is the increased ratio of patients to nurses in rehab compared to the transplant recovery floor.  Each nurse has seven patients in rehab.  Brandon says he thinks Karin was ready for Rehab, but isn't sure Rehab was ready for Karin.  Basically he means that they haven't had a chance to get as familiar with her case as the nurses were on 9D.  For example dialysis called for Karin at 6 p.m. yesterday but by the time transport got there and moved her it was 7 o'clock before they actually started the procedure in the dialysis lab.  Some of Karin's meds, like her antibiotic I.V., cannot be given before dialysis because they would be dialyzed out too quickly.  Likewise her feeding tube could not be connected until afterwards.  So Brandon was concerned about making sure she got those things before he left for the night.  That made for a long day for both of them and it was after midnight before he left the hospital.  Karin's Nurse Practitioner visited her and promised to consult with the experts on how to get her nausea under control again.  Karin is a trooper but she is going to need our continued encouragement and support, so please remember to be praying for her daily.  By the way, Brandon wanted those of you aware of another patient's situation to get an update.  The nun who had been on an artificial heart in CTICU when Karin was there and who eventually got her transplant is also in rehab.  She got her new heart in June but has been in the hospital since January.  Brandon said he can see big changes in her since they first observed her there about a week ago.  He said she seems so much more full of life now!  So pray for "Sister," too, as you remember Karin.

October 31, 2007 - 8:00 p.m.   Karin's first day in Rehab was a VERY busy day. They got her up at 8:20 a.m., got her dressed, then took her to Physical Therapy and Occupational Therapy. Brandon was not present to observe so we don't have the details about the morning sessions. Karin was brought back to her room at noon for lunch. Because he had to make a run to pick up more Sarris chocolate andy for the fundraiser, Brandon arrived at 1 p.m. in time to accompany Karin to her afternoon P.T. & O.T. sessions. He said she was dressed comfortably in her "sweats" with her brace on over them. She went to Occupational Therapy first where they had her work out with dumbbells. Brandon was allowed to observe from afar. Then she worked out with a physical therapist who had her up and walking and then doing seated exercises for her thighs, calves, and buttocks, The afternoon sessions lasted until around 3 p.m. When Karin returned to her room she was exhausted and "went out like a light!" Brandon said it made him tired just watching Karin work out. The atmosphere in the Rehab Unit is really different, according to Brandon, The nurse-to-patient ratio is seven-to-one, but she has her own therapist for P.T. and for O.T. Today being Halloween, the therapists were decked out accordingly: Karin's was made up in blue and white face paint like a rabid Penn State fan. Another difference in Rehab was evident when Karin's dinner tray came. The menu has many more choices. And Karin was VERY hungry! She ate a hot roast beef sandwich with mashed potatoes, passed on the carrots, ate the jello with peaches, and a half a slice of apple pie for dessert. Following dinner it was time for dialysis. In deference to Karin's tired condition, they wheeled her in her bed over to the renal clinic across the street in "Presby" for dialysis. In the future they will probably take her to dialysis in a wheel chair. As far as visitors, Brandon suggests people hold off until after 3 p.m. and also realize that Karin will have dialysis after P.T. & O.T. on Mondays, Wednesdays, and Fridays.