Please see updates to Funeral arrangements below

Mindy Sussman Lubin: 6/17/31 – 12/12/11

Funeral is at noon on Wednesday, Dec. 14, 2011; arrive at chapel 11:15-11:30.

Shiva at Mindy’s condo #2818, 200 Winston Drive, Cliffside Park, NJ  07010

Drive up to the front entrance to get a parking pass, then park in the visitor lot in front of the building

Shiva hours (to be confirmed) are likely to be as follows:

Wed, 12/14	shiva starts; people will come back to condo after the burial service; 7-9pm Minyon
Thurs, 12/15	noon-5pm, 7-9pm Minyon
Fri, 12/16	noon-5pm, services 7-9pm at Temple Israel, 207 Edgewater Rd., Cliffside Park, N.J.
Sat, 12/17	7-9pm
Sun, 12/18	noon-6pm

CHAPEL

Wien & Wien Inc. / Gutterman-Musicant

Memorial Chapel / Funeral Directors

402 Park St., Hackensack, NJ  07601

(a little northeast of Hackensack Univ. Medical Center)

Driving Directions to Chapel:

1) from Cliffside Park

Take I-80 West (local lanes), get off at exit 64-B (Route 17 South – Polify Rd.)

At base of ramp, turn Right onto Polify for 6 traffic lights to end (Polify becomes First St.)

Turn Right on Passaic St., cross railroad tracks to chapel on right side at corner of Park St. and Passaic St.

2) from George Washington Bridge

Take I-80 West as above, OR, take Route 4 West  to Hackensack Ave. Business District Exit; South on Hackensack Ave. (which turns into River St.) to Passaic St.; turn Right on Passaic to chapel at corner of Park and Passaic.

3) from NJ Turnpike

Take Turnpike North to I-80 West (local lanes); then follow #1 above

4) from Garden St. Pkwy

Take Pkwy North to Exit 160 (Passaic St.); bear Right off exit onto Passaic; stay on Passaic for 3 miles; chapel is on right side at corner of Park and Passaic.

5) from West New Jersey

Take Route 208 East to Route 4 East to Hackensack Ave.; South on Hackensack, then follow #2

OR, take I-80 East to the Garden St. Pkwy exit, then follow #4

CEMETERY

United Hebrew Cemetery

122 Arthur Kill Rd.

Staten Island, NY  10306

Driving Directions to Cemetery:

From New Jersey – take I-95 South; exit 13 to I-278 East (Goethals Bridge); exit 7 to Richmond Ave.; Right on Richmond Ave., in 2 miles make a Left onto Richmond Hill Rd. which becomes Arthur Kill Rd.; cemetery is on your left.

Update Dec 11, 10am NJ time

Spoke with Dr. Santomauro (Pulmonologist), , Mom has
Polyneuropathy chronic illness.  That is a neurological disorder that occurs when many nerves throughout the body malfunction simultaneously.

She is so weak and mostly listless.  Aggressive PT will be needed to get her to a point where she’ll have any quality of life.  Not sure how feasible that’s going to be. 

No PT yesterday.  Results of 2nd cytology STILL not back; Dr. said this problem is rampant.  But Mom’s pneumonia is in check; that’s good news except it could mean she’ll be released from hospital to rehab soon (maybe not so good news.)

Not as alert as before; more sleepy.

Update Dec 10, 4pm NJ time

Quiet day at the hospital i.e. much fewer people; you’d think there’d be more people on Saturday.

Mom is awake but somewhat listless; this is now a consistent pattern.  She did perk up when I got her more chocolate ice cream, and then again later when Dr. Ackad came by; Mom likes him very much.  He has kind of a “Dr. Welby” demeanor.

Incredibly, the results of the 2nd cytology are still in progress (Grrr!)  Ackad said there is pleural effusion in both lungs but more pronounced in the left; that’s still quite a concern.  PT was ordered for every day but had not yet arrived as of 4pm.  He also said that if it shows a malignancy, there’s no way she could withstand treatment.

Mom is so weak; she can’t lift her arms or hands to feed herself.  She responds, but only slowly; sometimes you have to repeat the question to her.  Yet she’s not as sleepy as before.  She started watching tv today and she shows interest.  There was a show on about a DVD offer for “Street Games of New York” including stickball, slapball, and stoopball.  She smiled and when I asked her if she played any of those games as a kid, she nodded.

Despite the slowness in response, her memory seems intact.  When I asked her about a cheque she wrote over 2 months ago, she hesitated but then remembered what it was for.  I’m still not sure she understands all that is happening, however.  For instance, she forgot that she was no longer in the ICU.  She has no interest or understanding about the various legal issues concerning the sale of her condo which we are going to put on hold until we find out more about her prognosis.

I’ve been asked to provide information about the various medications that Mom is on – that is a great idea.  However, I realize that these posts are possibly too detailed and lengthy for many people so I would advise them to stop reading at this point.

Phenylephrine is a decongestant that shrinks blood vessels in the nasal passages. Dilated blood vessels can cause nasal congestion (stuffy nose). Phenylephrine is used to treat nasal congestion and sinus pressure caused by allergies, the common cold, or the flu.

Pravastatin is in a group of drugs called HMG CoA reductase inhibitors, or “statins.” Pravastatinreduces levels of “bad” cholesterol (low-density lipoprotein, or LDL) and triglycerides in the blood, while increasing levels of “good” cholesterol (high-density lipoprotein, or HDL).

Aspirin is in a group of drugs called salicylates. It works by reducing substances in the body that cause pain, fever, and inflammation. Aspirin is used to treat mild to moderate pain, and also to reduce fever or inflammation. It is sometimes used to treat or prevent heart attacks, strokes, and angina.

Atenolol (Tenormin) is in a group of drugs called beta-blockers. Beta-blockers affect the heart and circulation (blood flow through arteries and veins). Atenolol is used to treat angina (chest pain) and hypertension (high blood pressure). It is also used to treat or prevent heart attack.

Epoetin alfa is a man-made form of a protein that helps your body produce red blood cells. The amount of this protein in your body may be reduced when you have kidney failure or use certain medications. When fewer red blood cells are produced, you can develop a condition called anemia. Epoetin alfa is…

Famotidine a histamine-2 blockers. Famotidine works by decreasing the amount of acid the stomach produces. Famotidine is used to treat and prevent ulcers in the stomach and intestines. It also treats conditions in which the stomach produces too much acid, such as Zollinger-Ellison syndrome.

Heparin is an anticoagulant (blood thinner) that prevents the formation of blood clots. Heparin is used to treat and prevent blood clots in the veins, arteries, or lung. Heparin is also used before surgery to reduce the risk of blood clots.

Ipratropium inhalation is used to prevent bronchospasm, or narrowing airways in the lungs, in people with bronchitis, emphysema, or COPD (chronic obstructive pulmonary disease). Ipratropium inhalation may also be used for other purposes not listed in this medication guide.

Midodrine is a vasopressor. Midodrine causes constriction (tightening) of the blood vessels which leads to an increase in blood pressure. Midodrine is used to treat low blood pressure. Midodrine may also be used for purposes other than those listed here.

Dextrose is used for: Providing fluids containing various amounts of sugars to your body when you are not able to drink enough liquids or when additional fluids are needed.

Glucose is used for: Treating reactions caused by low blood glucose (sugar). Glucose Chewable Tablets are a monosaccharide (simple sugar). It works by quickly raising the glucose level in the blood.

Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID). Ibuprofen works by reducing hormones that cause inflammation and pain in the body. Ibuprofen is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, cramps, etc.

Trypsin – The combination of balsam Peru, castor oil, and trypsin topical (for the skin) is used to treat bed sores and other skin ulcers. This medication can help promote healing and relieve pain caused by these conditions.

Update Dec 9, 4pm NJ time

Mom was moved from the CCU to an intermediate care floor.  That’s good because it means her blood pressure, which had been dangerously low, has stabilized.  She’s in a semi-private room but at least she’s by the window.  She actually had a bit of breakfast and is able to keep food down.  She passed her barium swallow test and it looks like she will not need a feeding tube.  Great news.

I took Mom’s dear friend and neighbor, Norma, to see her this morning; Mom really perked up when she saw her as she was receiving dialysis.  Mom’s responsiveness was about the same today as yesterday.  She’ll nod to questions; she may speak a couple of words or so in response to questions, but that’s all.  She’s still in quite a bit of discomfort.  Mom smiled quite a bit when her main doctor, Dr. Ackad (Nephrologist) gave her the ok to have ice cream!  When the ice cream was delivered, Mom really perked up and enjoyed every spoonful as Liz fed it to her.

Dr. Ackad told me that the cytology results from the 2nd thoracentesis were still in process; hopefully, they will be ready tomorrow.  He also told me how he hates computers because it makes life more difficult for doctors although easier for collecting of information and for hospitals to bill patients and to shuffle patients out of the hospital as soon as possible.  Apparently, when a consensus is reached by a team of doctors such that they believe nothing more can be done for a patient, that’s when they will discharge the patient.  Basically, Ackad said the hospital “doesn’t care” about the patient at that point.  Even if the main doctor goes against the consensus, the patient will still be discharged.  Cruel but true it seems.

Mom will likely start some light PT (physical therapy) tomorrow and, hopefully, every day following.  So in a few days, we should have some indication of how well Mom is responding to PT and what kind of improvement we think she’s going to be able to make.  I’m still quite concerned about Mom’s mental state.  At times, she seems all there, but too often, she seems somewhat “out of it”, i.e. maybe just at 60-70%.  I’d like to think this will improve over time but, then again, I can’t imagine how difficult it must be to be in her position right now.

Update Dec 8, 4pm NJ time

This morning I found Mom looking a bit better; she said she was feeling a bit better also.  However, I also found her to be not as lucid as she had been prior to today, even with those intermittent and brief episodes of confusion.  She was responsive to questions but only barely so.  When asked if she understood an important , but easy, point I was making, she nodded her head slowly but I had the clear impression that she either did not really understand or would soon forget it or simply didn’t care.  Dr. Yu (sr. resident) explained again that this is not unexpected, especially in the CCU, when one is doped up on so many strong meds and have 4 miles of tubes attached and inserted and is unable to move from a prone position, 24 hours a day for well over a week.  Mom is often uncomfortable from being in this position and while I’m sure we all understand that and sympathize, we cannot really appreciate what she is going through.

Dr. Yu also said there is still excess fluid in the lung and the results of the 2nd cytology is expected hopefully tomorrow.  If it is negative, there may still be a 3rd thoracentesis.  There is also the problem of keeping food down; when she eats simple foods such as applesauce or pudding, it is supposed to go down her esophagus into her stomach; instead, it is going down her trachea (windpipe) into her lung, causing gagging and coughing.  The epiglottis (cartilage tissue flap) is supposed to prevent this from happening, but it’s not.  So even though Mom had passed previous swallow-reflex tests, she was given a special barium swallow test so the process can be more closely examined.  The results of that test are not yet available.

I also spoke with the current CCU attending physician, Dr. Mapitagama who was very nice and forthcoming.  She echoed what had been said earlier and when I asked her when she thought Mom would improve enough to get on a plane to California, she said she would need aggressive therapy.  Indeed.

Mom may move to intermediate care room today; this is because her blood pressure has stabilized to the point where it has been consistently above 90-95 (systolic.)  This was one of the principle reasons why she was in CCU vs. intermediate care to begin with.

Update Dec 7, noon NJ time

Mom is looking a little better today; coughing a bit less.  She had breakfast this morning without gagging for the 1st time – applesauce, vanilla pudding, apple juice, and half a graham cracker!   Dr. Santomauro (Pulmonologist) saw Mom early this morning and gave her a swallow reflex test which she apparently passed – yay!  Mom is alert and responding better, although there are still small, infrequent episodes of confusion.

Unfortunately, the fluid drainage from her lung (thoracentesis) was supposed to have taken place yesterday but I was told they couldn’t fit her into the schedule, so they will do this procedure today.  As well, dialysis did not happen yesterday so that will be today too.  Dr. Abdelhadi (attending) is not on the floor this week so I spoke with the sr. resident, Dr. Yu.  She said the lung xray again showed fluid buildup on the left; this was also confirmed last night by a voice message left from Dr. Ackad.  Based on previous info given, it looks like a 3rd test will also be necessary in order to eliminate any false negatives.  With today’s 2nd test, then 2 days or so to get the results, we’re looking at Friday or Monday next week.  Then a 3rd test, maybe Tuesday or Wed and the end of that week before Mom is even released from CCU.

We’re trying to figure out the best course of action amidst all this uncertainty.  There are 3 possible outcomes from Mom’s stay in hospital:

(A) she’s well enough to get on a plane, so we take her to LA where it looks like we have a pretty good facility lined up for her and she’ll be near Liz, Alan, and Lianna.

(B) she’s not well enough to get on a plane, so she comes back home and we get full-time home health aides to help her with everyday activities and anything else she needs until she is well enough.  Problem with this is that home health cannot administer any meds or perform any nursing services – that would have to be by private nursing care.

(C) she’s not well enough to get on a plane, so we need to have Mom at a skilled nursing facility until she is well enough; this will be necessary if home health care is insufficient for her needs.

As such, we’re trying to figure out if we should sell Mom’s condo now or wait until we know more about which option above is best.  Obviously, option (A) is preferred, therefore, we could sell the condo.  Option (B) would be next, because it’s less expensive than option (C), but only if she can get by without skilled nursing care.  However, we’d have to wait to sell her condo.  Option (C) is last, and hopefully only for a short time until Mom is well enough to get on a plane.  And how long that may take is anybody’s guess.

Update Dec 6, noon NJ time

Dr. Ackad called early this morning to say that the cytology of the lung fluid came back negative, i.e. no malignancy.  Obviously, wonderful news (relatively speaking.)

However, later on I spoke to the sr. resident again (Dr. Abdelhadi) who cautioned about false negatives.  He was very forthcoming with information which I greatly appreciate.  He showed Liz and I the xrays of Mom’s lung since she was first brought into the CCU.  Initially, the left lung showed a cloudy haze across almost the entire lung; this was the pleural effusion – build up of excess fluid.   Yesterday, the lung showed some definite clearing of the fluid.  However, today, the lung was showing almost the same as it had initially, i.e. the pleural effusion had returned – not a good sign.

Dr. Abdelhadi said at least 2 more tests would be conducted whereby fluid will once again be drained from the  lung and a cytology done to check for malignancy; it takes at least 2 days for the results to come back from the lab.  The 2nd test would be done today, either before or after dialysis.  A 3rd test would be done presumably after that if considered necessary.  Three tests coming back negative is a good indication of no malignancy.  I believe that would point to pneumonia as the cause of the lung infection, but hopefully, this can be managed fairly effectively.

The guess at this time is that Mom will need up to another week in the CCU, then she’ll be transferred to an intermediate care unit in the same hospital.  Impossible to tell how long she’ll need to be there, perhaps 1-2 weeks.  Then…?  A sub-acute rehab center such as  Prospect Heights where she was at last month.  I was told that Medicare pays 100% of rehab for the 1st 20 days, then 80% for the following 80 days.  However, the rehab facility determines how long she needs to be there.  If they consider that she has plateaued, i.e. they don’t think there’s anything more they can do for her, she will be released.  Hopefully, at that time, she will be strong enough to travel and we will take her to Los Angeles to a wonderful skilled nursing care facility where she can be close to Liz and her family.  If she’s not yet strong enough to travel, we will have a similar care facility in New Jersey lined up for her until she is strong enough to travel.

 

Update Dec 5, 8pm NJ time

Mom is coughing more regularly now – that’s more of a concern than before.

The good news is that she had her first real food in several days – applesauce, pudding, and apple juice; just a little bit but she enjoyed it.  But the speech pathologist administered a swallowing test which is still difficult for mom, though not unexpected after having been intubated previously.

Update Dec 5, noon NJ time

Mom seems less comfortable today.  Coughing is more frequent although she says she feels better after she coughs.
Ackad was by early before we got to the hospital so we were waiting for lab results.

Dr. Abdelhari (sr resident) said cytology (examination for malignancy) won’t be ready for possibly another day.  Even if negative, it could be a false negative so there may be more tests re: draining of fluid in the lung for confirmation.  Drainage is done by needle.

Dr. Ackad came into Mom’s room; said she is looking better.  But nothing definitive until those lab results come in.  Mom’s getting dialysis again today;   hopefully it will also help get rid of the excess fluid in the lungs and relive her coughing a bit.

Update Dec 4, 2pm NJ time

Dr. Rho (Ackad’s partner) said Mom may need more frequent dialysis in order to get rid of the blood toxins.  Blood  pressure is still low but being treated with phenylephrine.

Mom is still alert at times but other times a little confused.  She asked this morning “Where’s Mommy” referring to Kay, her own mother.  Dr. Yu said that’s to be expected on occasion when a  patient is under so much medication.

She’s sleeps often and rests comfortably otherwise.  I turned on the Giants game for her and when they scored on the opening drive against the Packers, she perked up a bit!  Tomorrow we may get results from lab tests on the fluid build up in the lung as well as the bladder infection.  Hoping for news as good as possible when we get it.

Update Dec 3, 8pm NJ time

Arrived from AZ and went with Liz to see Mom.
She’s alert and talking, although it is barely a whisper given that her breathing tube was only just removed a few hours before. She is very tired of being in her bed all the time and who could blame her? Initially, after we walked into her room, she wanted to go home, but of course that’s not possible right now.

The nurses (Heidi and Christine) are very nice and highly professional.
I spoke with Dr. Yu (sr. resident) and she says Mom’s doing better than she was but blood pressure is still low although she had dialysis yesterday and today and may again tomorrow. Lab results from the urinary microbiology and lung fluid (separate results are expected by Monday?) will be key to the prognosis.

In contrast to the last couple of days, I consider things to slightly encouraging. Mom was interacting ok and she will watch some tv for the first time. She may be given some applesauce tomorrow which will be her first “real food” for a few days now.

Update Dec 2, 11:30pm AZ time

Spoke with Christine in the CCU.

Mom had dialysis; finished at 8pm.  She’s a little more responsive now than before.  Still has breathing tube but they may try to remove the tube tomorrow, if possible.  She’s resting comfortably.

All Mom’s doctors are expected to see her sometime on the weekend.

I have moved my flight up to tomorrow.

Update Dec 2, 4pm AZ time

Dr. Ackad called – Mom’s in the ICU, getting dialysis now; was fluid overloaded.

Her responsiveness is not so good, not sure why that is happening at the moment.  CT Scan shows no hemorrhaging in the brain; taking it day by day; she is being closely monitored.  The next 48-72 hours will tells us in what direction we’re headed – either good or bad.

Update Dec 2, 1pm AZ time

Dr. Ackad examined Mom; chest xray shows lung looking better; some fluid left in lung – might come out in dialysis today if they do it.  Lab results not avail till Monday.

Spoke with ER resident, Dr. Yu.  I gave consent for a Triple Lumen/Central Line which is a catheter inserted into a vein in the neck (on the other side from where she already has a shunt in her neck for dialysis.)  This line is necessary for providing medications and fluids and is also used to obtain and test blood.  She said I can call her for continued updates.

Spoke with Dr. Santomauro – Pulmonologist.  Mom had septic shock from urinary tract infection; should get microbiology results on urine this weekend.  Combination of Mom’s bladder, lung, and kidney failures, along with some cardiac implications, is cause for great concern.  But the results on the fluid coming Monday should give a real indication of prognosis.

I will likely fly to NJ Monday or Tuesday to join my sister Liz.

Update Dec 1, 8:45pm AZ time

Spoke to Nicole (very nice nurse at CCU)

Mom had a CT Scan of the lung; there is significant consolidation (empyema – infection) of the excess fluid (pleural effusion) in the lung; this may be in addition to pneumonia (inflammation of the lung) and could complicate her condition.

Tomorrow she’ll get a chest tube insertion to drain the infectious fluid; she’s getting antibiotics now as well as blood pressure medication to treat her lowered BP which can be more harmful than good.  Until the BP responds to treatment, may delay dialysis a day or 2.

The results from taking a culture of the drained fluid may take a couple of days from the lab.  I will keeps tabs with Dr. Ackad regardless.

Update Dec 1, 7:30pm AZ time

There is rising concern as Dr. Ackad says the pleural effusion (fluid buildup in the left lung) may be due to pneumonia or cancer.  Fluid was drained and sent to lab; results expected tomorrow.  I will speak to Ackad when he has the results.  Bad either way but obviously worse if cancer.

Mom was resting most of today and Liz said she was doing relatively ok earlier when awake, although she can’t speak with breathing tubes down her throat.  Ackad said she would skip dialysis today but resume it tomorrow.

Update Dec 1, 9:30am AZ time

Mom in Coronary ICU

I spoke with the ICU nurse this morning.

Mom is stable and resting but she’s very weak and may have pneumonia; she’s been intubated to help her breathing.  Several doctors have seen her already and she is being constantly monitored.  I expect to speak with her main doctor (Dr. Ackad – Nephrologist) later today.