After fifteen hours on the trach collar yesterday, the CO2 concentration in Cathy's blood was a little better than the day before - a baby step in the right direction.
No word yet on a new room. I think Cathy is ready for a change of scenery. Today was day 32 in the ICU.
The respiratory therapist waited until I arrived today before putting the speaking valve on Cathy's trach. It was very emotional to have a real conversation with Cathy again. She was not able to wear the valve for very long (less than an hour). It became to hard for her to breathe.
The physical therapist got Cathy out of bed today and had her do a lap, back and forth, in front of her bed - several big steps in the right direction.
Thursday, July 31, 2008
Wednesday, July 30, 2008
Looking For New Digs
Yesterday evening when it came time to be put back on the ventilator, Cathy insisted on staying on the trach collar. The doctor let her remain on the collar until around 2:30 this morning when the results of a midnight blood gas draw were available. Once again, Cathy's CO2 saturation was high.
Cathy remained on the ventilator until around 5:30 this morning when she was put back on the trach collar.
They are looking for a regular hospital room (outside of the ICU) for Cathy. We were informed that since the new hospital has more ICU beds than medical observation beds, it may take a few days to find a place for her. When Cathy does get moved to a regular room, it will be without a ventilator. This hospital's protocol will not allow patients on ventilators outside of an ICU. Therefore, when Cathy needs to be rested, they will use the Bi-pap machine. This is the same machine that they tried to use on July 13, when they attempted to extibate Cathy the first time. However, this time instead of forcing air in and out of Cathy's lungs through a face-mask, the machine will be connected to her trach. This machine is noisy and looks very 'old-school'. (Kinda scary). After Cathy is moved out of the ICU, she will be attended to by a completely different team of doctors.
Cathy wore the talking valve for only a few minutes today. Unfortunately, they removed the valve just before I arrived, so I was not able to hear Cathy's angelic voice. Jessica was in the room at that time so she was able to hear her mom's voice again.
Cathy remained on the ventilator until around 5:30 this morning when she was put back on the trach collar.
They are looking for a regular hospital room (outside of the ICU) for Cathy. We were informed that since the new hospital has more ICU beds than medical observation beds, it may take a few days to find a place for her. When Cathy does get moved to a regular room, it will be without a ventilator. This hospital's protocol will not allow patients on ventilators outside of an ICU. Therefore, when Cathy needs to be rested, they will use the Bi-pap machine. This is the same machine that they tried to use on July 13, when they attempted to extibate Cathy the first time. However, this time instead of forcing air in and out of Cathy's lungs through a face-mask, the machine will be connected to her trach. This machine is noisy and looks very 'old-school'. (Kinda scary). After Cathy is moved out of the ICU, she will be attended to by a completely different team of doctors.
Cathy wore the talking valve for only a few minutes today. Unfortunately, they removed the valve just before I arrived, so I was not able to hear Cathy's angelic voice. Jessica was in the room at that time so she was able to hear her mom's voice again.
Tuesday, July 29, 2008
Rock and Roll
The doctors are going to keep Cathy on the trach collar for 15 to 16 hours today. They had her put on it around 5:30 this morning, so she has one or two more hours to go. Cathy's feeding tube was also changed. What makes this event so notable is that this occurred during the earthquake that struck this area this afternoon.
Cathy passed the speech therapist's test (she said the alphabet) so she was able to wear the talking valve for a few hours today. She will be able to wear this valve for only a few hours each day. There are warning notices for the nurses posted throughout Cathy's ICU room - "Valve must be removed when patient is sleeping"; "Suction patient before installing valve and deflating trach cuff"; "Suction patient before removing valve"; and a few more.
One more milestone to note: Cathy has only one IV medication remaining that is still being given to her (this is an anti fungal medication). This is a huge difference from four weeks ago.
Cathy says "God bless another day. Thank you, everyone, for your thoughts and prayers."
Cathy passed the speech therapist's test (she said the alphabet) so she was able to wear the talking valve for a few hours today. She will be able to wear this valve for only a few hours each day. There are warning notices for the nurses posted throughout Cathy's ICU room - "Valve must be removed when patient is sleeping"; "Suction patient before installing valve and deflating trach cuff"; "Suction patient before removing valve"; and a few more.
One more milestone to note: Cathy has only one IV medication remaining that is still being given to her (this is an anti fungal medication). This is a huge difference from four weeks ago.
Cathy says "God bless another day. Thank you, everyone, for your thoughts and prayers."
Monday, July 28, 2008
UCLA Spa and Hair Salon
Cathy has been up and sitting in a chair since 11am. She has been on the trach collar since breakfast this morning.
The speech therapist did make it by today, but other than drawing Cathy a few pictures of how the trach fits in her throat, she didn't do much. For now, the talking valve sits in a container on the shelf.
Today was a workout day: the physical therapist made a visit. Cathy says that after working with the PT, she has learned that she has become weaker than she thought.
There is not much else to update. Jessica is here with me this evening. She is giving Cathy's hair a much overdue brushing. Now, if only I knew how to do facials and manicures.......
The speech therapist did make it by today, but other than drawing Cathy a few pictures of how the trach fits in her throat, she didn't do much. For now, the talking valve sits in a container on the shelf.
Today was a workout day: the physical therapist made a visit. Cathy says that after working with the PT, she has learned that she has become weaker than she thought.
There is not much else to update. Jessica is here with me this evening. She is giving Cathy's hair a much overdue brushing. Now, if only I knew how to do facials and manicures.......
Sunday, July 27, 2008
Turkey and Cranberries
Cathy was on the trach collar for twenty-three and a half hours yesterday. She was put back on ventilator support around 5:45 this morning. Blood was drawn just before returning her to ventilator support and, unfortunately, the results were not good. Her blood CO2 concentration was 80.
Dr Saggar stopped by a little bit ago and discussed the situation with Cathy and I. He said "That's OK, now we know where we are, she is just not ready for being off the ventilator for 24 hours without resting (they call putting her on ventilator support - resting her lungs). She is improving and it won't be long and she will be able to do it".
They put Cathy back on the trach collar for a little while this afternoon so she could eat her lunch (pureed open-face turkey sandwich with gravy and jellied cranberries) and drink some diet coke. She will be returned to ventilator support for the rest of the day.
Dr Saggar stopped by a little bit ago and discussed the situation with Cathy and I. He said "That's OK, now we know where we are, she is just not ready for being off the ventilator for 24 hours without resting (they call putting her on ventilator support - resting her lungs). She is improving and it won't be long and she will be able to do it".
They put Cathy back on the trach collar for a little while this afternoon so she could eat her lunch (pureed open-face turkey sandwich with gravy and jellied cranberries) and drink some diet coke. She will be returned to ventilator support for the rest of the day.
Saturday, July 26, 2008
The Voice of Celine
It has been a very pleasant Saturday morning and afternoon with Cathy. She was on the trach collar until after 11:30 last night, thirteen and a half hours. She was put back on the trach collar at 6:30 this morning: only 7 hours on the ventilator. We have been sitting together (in real chairs) watching the tube.
Cathy was a little disappointed when I came in this morning. Evidently the speech therapists do not work on weekends (imagine that).
A little while ago I took a few moments to stretch my legs and go down to the cafeteria and grab a cup of coffee. Wouldn't you know it, while I was gone Dr Saggar dropped by to see Cathy. As it turns out, it was Dr Saggar that put the smaller trach tube and speaking valve in Cathy the previous day. He was 'upset' to see that the valve had been removed. When I returned to Cathy's room she was sitting in the chair with the 'cat who ate the mouse' grin on her face. Then she spoke, in a high pitched and squeaky voice, but she spoke. She was so tickled with being able to talk, it was like watching a little child with a new favorite toy. She even serenaded me with a few "la la la la's".
Just when I was feeling overjoyed with being able to really talk to Cathy again, I was reminded of the reality of the situation. While sitting and chatting, Cathy began to "desat" (her blood-oxygen saturation began to drop). The nurse began to scurry about, increasing the oxygen flow, attempting a little bit of 'bagging', and attempting to suction out the trach tube and her lungs. It was discovered that, since the trach tube was switched to a smaller diameter, they did not have a catheter small enough available in the room to fit down the smaller trach tube. So, off the nurse dashes to get the proper supplies. Cathy was not struggling, but she was beginning to feel a little lite-headed. The nurse returned with small catheters and more trach tubes. It turns out that, not only is the new trach tube smaller, but it is also replaceable. It just snaps out and a new one slips back in. The nurse popped out the old trach tube and there was a clot of blood blocking the tube. Within moments of putting the new tube in, Cathy's blood-oxygen saturation returned to 100%.
So, its been a pleasant day, broken up by moments of extreme joy and heart-stopping concern. We are still on that roller coaster, the inverted loops and sudden drops are just getting smaller.
David
Cathy was a little disappointed when I came in this morning. Evidently the speech therapists do not work on weekends (imagine that).
A little while ago I took a few moments to stretch my legs and go down to the cafeteria and grab a cup of coffee. Wouldn't you know it, while I was gone Dr Saggar dropped by to see Cathy. As it turns out, it was Dr Saggar that put the smaller trach tube and speaking valve in Cathy the previous day. He was 'upset' to see that the valve had been removed. When I returned to Cathy's room she was sitting in the chair with the 'cat who ate the mouse' grin on her face. Then she spoke, in a high pitched and squeaky voice, but she spoke. She was so tickled with being able to talk, it was like watching a little child with a new favorite toy. She even serenaded me with a few "la la la la's".
Just when I was feeling overjoyed with being able to really talk to Cathy again, I was reminded of the reality of the situation. While sitting and chatting, Cathy began to "desat" (her blood-oxygen saturation began to drop). The nurse began to scurry about, increasing the oxygen flow, attempting a little bit of 'bagging', and attempting to suction out the trach tube and her lungs. It was discovered that, since the trach tube was switched to a smaller diameter, they did not have a catheter small enough available in the room to fit down the smaller trach tube. So, off the nurse dashes to get the proper supplies. Cathy was not struggling, but she was beginning to feel a little lite-headed. The nurse returned with small catheters and more trach tubes. It turns out that, not only is the new trach tube smaller, but it is also replaceable. It just snaps out and a new one slips back in. The nurse popped out the old trach tube and there was a clot of blood blocking the tube. Within moments of putting the new tube in, Cathy's blood-oxygen saturation returned to 100%.
So, its been a pleasant day, broken up by moments of extreme joy and heart-stopping concern. We are still on that roller coaster, the inverted loops and sudden drops are just getting smaller.
David
Friday, July 25, 2008
Friday, Fish For Supper
Cathy has been on the trach collar since around 10 am and is still going strong. Earlier today, her trach tube was switched out with a smaller tube. At that same time she was fitted with a 'swallowing and speaking' valve. The nurse said she immediately began chatting up a storm. Unfortunately, the doctor that placed the valve was a little premature. One of Cathy's doctors (the new resident or the fellow, I am not sure I was not here) made them remove the valve. Cathy cannot use this valve until a speech coach works with her. After glancing and the instruction manual and the stack of warning messages, I appreciate this doctor's concern. The speech therapist is supposed to drop by tomorrow.
If all that were not enough for one day, Cathy was able to eat real food this evening (if you can call pureed fish, corn and broccoli real food, mmmm yummy). Cathy had one small bite of the fish and broccoli. She ate several bites of the corn. She also had a few bites of vanilla yogurt and a few sips of warm tea (apple cinnamon, Cathy hates cinnamon).
I am so looking forward to tomorrow. It looks like I am going to be able to have a real conversation with Cathy for the first time in almost four weeks. No more lip reading, although I think I am getting pretty good at it.
Cathy is sleeping peacefully at this moment, still on the trach collar. During the past couple days I have been watching a miracle.......... Front Row.
If all that were not enough for one day, Cathy was able to eat real food this evening (if you can call pureed fish, corn and broccoli real food, mmmm yummy). Cathy had one small bite of the fish and broccoli. She ate several bites of the corn. She also had a few bites of vanilla yogurt and a few sips of warm tea (apple cinnamon, Cathy hates cinnamon).
I am so looking forward to tomorrow. It looks like I am going to be able to have a real conversation with Cathy for the first time in almost four weeks. No more lip reading, although I think I am getting pretty good at it.
Cathy is sleeping peacefully at this moment, still on the trach collar. During the past couple days I have been watching a miracle.......... Front Row.
Thursday, July 24, 2008
Let's All Make a Diet Coke Toast To Cathy's Health
Cathy could hardly wait to let me see her take a drink of a diet coke as I walked into her ICU room this afternoon. I don't know what choked me up more: seeing her take that drink or seeing the big green grin on her face afterwards (the dye they used for the swallowing test turned her lips and mouth a bright green).
Evidently Cathy also made it almost twelve hours on the trach collar today. From sometime around 4 am this morning until sometime before 4 pm this afternoon she was on the trach collar. Cathy was put into the chair before noon and the swallowing test was given around 2pm. She has been sipping diet coke since that time. Before being put in the chair the physical therapist came by and 'gave her a work-out'. She has earned that diet coke.
The next step is to work on having Cathy eat pureed foods. Until she can take in enough calories to support herself, they are going to leave the feeding tube in.
So, everyone pour themselves a tall-cold diet coke and (clink) here's to Cathy's health.
David
Evidently Cathy also made it almost twelve hours on the trach collar today. From sometime around 4 am this morning until sometime before 4 pm this afternoon she was on the trach collar. Cathy was put into the chair before noon and the swallowing test was given around 2pm. She has been sipping diet coke since that time. Before being put in the chair the physical therapist came by and 'gave her a work-out'. She has earned that diet coke.
The next step is to work on having Cathy eat pureed foods. Until she can take in enough calories to support herself, they are going to leave the feeding tube in.
So, everyone pour themselves a tall-cold diet coke and (clink) here's to Cathy's health.
David
Wednesday, July 23, 2008
A Care Giver Moves On
Cathy is doing much better tonight. She has been awake and alert since before I arrived just after 5 pm. She was up in the chair for a little over three hours today and she was on the trach collar for nine hours. Tomorrow morning a swallowing test will be performed and, who knows, maybe tomorrow evening we will be sipping diet cokes together.
The resident physician that has been caring for Cathy since she was brought into the ICU, informed us this evening that tonight is the last night of her ICU rotation. We will miss her. She is taking a rotation at another hospital (Cedars-Sinai) in their well baby program.
Cathy has asked me to tell everyone "Thank you for your prayers and I am trying as hard as I can".
Cathy & David
Cathy did need another blood transfusion today. Only one unit this time.
The resident physician that has been caring for Cathy since she was brought into the ICU, informed us this evening that tonight is the last night of her ICU rotation. We will miss her. She is taking a rotation at another hospital (Cedars-Sinai) in their well baby program.
Cathy has asked me to tell everyone "Thank you for your prayers and I am trying as hard as I can".
Cathy & David
Tuesday, July 22, 2008
A Kink In The Trach
After Cathy was returned to her bed, her breathing became easier. The doctor believes that when Cathy was moved into the chair a kink (pinch) may have developed along the trach tube. The blood coming from around the trach tube is likely from some excessive movement that occurred at the same time.
Cathy will be left on full ventilator support (AVP mode, as I learn the lingo) over night to allow her to rest. They are going to apply a special gauze around the trach for tonight. This gauze is treated with a coagulant to help stop the bleeding. There is a small concern for blood to fill and/or block the trach tube. An ENT (ear, nose & throat) doctor will be in to look at the trach tomorrow and determine if it will need to be replaced.
Cathy is now resting peacefully.
Cathy will be left on full ventilator support (AVP mode, as I learn the lingo) over night to allow her to rest. They are going to apply a special gauze around the trach for tonight. This gauze is treated with a coagulant to help stop the bleeding. There is a small concern for blood to fill and/or block the trach tube. An ENT (ear, nose & throat) doctor will be in to look at the trach tomorrow and determine if it will need to be replaced.
Cathy is now resting peacefully.
I Spoke To Soon
When I returned to Cathy's room after posting the previous update, I came upon Cathy struggling to breath. There was also a significant amount of blood coming from her trach (there was a small amount earlier, but the nurse acted as if this was normal). I paged the nurse who summoned the respiratory therapist. Cathy was put on full ventilator support. This did nothing for her. The respiratory therapist then began 'bagging' Cathy (using a clear football shaped balloon to pump air and oxygen into the trach). Cathy responded positively to being bagged. All this was occurring while Cathy was in the chair. Cathy was moved back into her bed and the doctor was summoned. While moving Cathy back into her bed, a little bit of a mess was created (one of the tubes that is used for Cathy's bodily functions came out - sorry, any more detail would be inappropriate). They asked me to leave the room while they are cleaning Cathy up. As soon as I see the doctor go in the room I will return. As I learn more, and have a few moments, I will update the blog.
David
David
A Slow News Day
There is not much to update everyone on this evening.
Cathy made it three hours on the trach collar this morning. So far this evening she does not want to attempt any more. She appears very tired. The nurse said that Cathy turned the physical therapist away this morning and asked her to come back tomorrow afternoon.
Cathy has been sitting up in the chair since around 5 pm. She will probably stay in the chair until around 8 or 9 this evening.
That is about the extent of things for today. If anything develops before I leave the hospital tonight, I will surely post an update.
David
Cathy made it three hours on the trach collar this morning. So far this evening she does not want to attempt any more. She appears very tired. The nurse said that Cathy turned the physical therapist away this morning and asked her to come back tomorrow afternoon.
Cathy has been sitting up in the chair since around 5 pm. She will probably stay in the chair until around 8 or 9 this evening.
That is about the extent of things for today. If anything develops before I leave the hospital tonight, I will surely post an update.
David
Monday, July 21, 2008
Craving Diet Cokes
They are not Lazy Boys, but Cathy and I are kickin back watching TV and enjoying each others company.
Cathy was only able to make it two and a half hours on the trach collar this morning. Tomorrow they are going to try for three hours in the morning and three hours in the afternoon. If Cathy can make it for for six hours on the trach collar (three plus three), they will perform a swallowing test. If she 'passes' this swallowing test they will remove the feeding tube and Cathy can have a diet coke (as well as real food).
The resident physician said that, other than having to be on a ventilator, Cathy is not really an ICU patient any more - HOW ABOUT THAT!!!! Her health is stable and she is close to being on her home dosages for her medications. With the exception of her heart rate, all Cathy's 'numbers' are good. The doctors do not appear to be overly concerned with the elevated heart rate.
The medical observation rooms here at the hospital are not set up to care for patients on a ventilator, so Cathy will have to remain in the ICU for the time being.
The current goal of Cathy's medical treatment is to give Cathy the best quality of life possible while she waits for a transplant. The resident also said that in a few days, it may be time to start looking into other options for Cathy's care: rehabilitation facility or possibly even home care (insurance coverage will be a critical deciding factor influencing this path). Home care is the medically preferred route because of the risk of getting exposed to bacteria and virus in a hospital or rehab facility. Home care may require in-home nursing care during the day when no one is home.
Well, that's the update for today. I am going to go home tonight and put some diet coke in the frig - just in case.
David
Cathy was only able to make it two and a half hours on the trach collar this morning. Tomorrow they are going to try for three hours in the morning and three hours in the afternoon. If Cathy can make it for for six hours on the trach collar (three plus three), they will perform a swallowing test. If she 'passes' this swallowing test they will remove the feeding tube and Cathy can have a diet coke (as well as real food).
The resident physician said that, other than having to be on a ventilator, Cathy is not really an ICU patient any more - HOW ABOUT THAT!!!! Her health is stable and she is close to being on her home dosages for her medications. With the exception of her heart rate, all Cathy's 'numbers' are good. The doctors do not appear to be overly concerned with the elevated heart rate.
The medical observation rooms here at the hospital are not set up to care for patients on a ventilator, so Cathy will have to remain in the ICU for the time being.
The current goal of Cathy's medical treatment is to give Cathy the best quality of life possible while she waits for a transplant. The resident also said that in a few days, it may be time to start looking into other options for Cathy's care: rehabilitation facility or possibly even home care (insurance coverage will be a critical deciding factor influencing this path). Home care is the medically preferred route because of the risk of getting exposed to bacteria and virus in a hospital or rehab facility. Home care may require in-home nursing care during the day when no one is home.
Well, that's the update for today. I am going to go home tonight and put some diet coke in the frig - just in case.
David
Sunday, July 20, 2008
A Routine Day
Cathy was on the trach collar for four-hours today. It has been a little over two hours since she was placed back on the ventilator, and she appears to be recovered, but very tired. When I left her room a few moments ago, she was about to be bathed and then put into a chair. Last night she was sitting in the chair until almost 9 pm.
Saturday, July 19, 2008
Establishing a Routine
There is not much to update you on this evening. Cathy did get out of the bed and sit in a 'chair' for several hours this afternoon. We are waiting for the lift team to come back by to lift her back into bed. Today was mostly about establishing a routine for Cathy. It looks like they (the doctors) are going to have Cathy exercise her lungs on the trach collar every morning, attempting to add one-hour every day. Then they will get Cathy out of bed, into the chair, every afternoon. As the trach collar exercises get longer, these two events will eventually overlap. Three days a week a physical therapist will drop by her room to work on some physical exercises.
Cathy was offered to wear the trach collar for a while this afternoon. She declined the offer. I think she was just to tired.
Thank you for your continued thoughts and prayers.
David
PS. Tomorrow's first update will not come until the early afternoon. I need to get some laundry and other household chores done.
Cathy was offered to wear the trach collar for a while this afternoon. She declined the offer. I think she was just to tired.
Thank you for your continued thoughts and prayers.
David
PS. Tomorrow's first update will not come until the early afternoon. I need to get some laundry and other household chores done.
Three Hours and Twenty-Five Minutes
The doctors wanted Cathy to be on the trach collar for three hours this morning. Well, she exceeded this goal by twenty-five minutes. How about that!!!
I had a brief conversation with the resident this morning (the ICU team has not made their rounds yet). During this conversation I heard a new term. The doctor referred to Cathy's current status as her "new baseline". I am still digesting this term, and I will pursue further clarification as I get the opportunity. My initial impression is that Cathy's lungs are about as good as they are going to get. The point of the trach collar exercises are to condition Cathy to be able to get as much as she can out of what lung capacity she has left. The doctor also mentioned 'rehabilitation facilities'. (The attending also mentioned this a few days ago). Their goal appears to be to get Cathy to a point where she can go throughout the day off of the ventilator and to be able to move around a little on her own. At that point she may be transferred to a rehabilitation facility. (I think rehabilitation facility is the new PC term for a nursing home).
Cathy has asked to sit in the chair again today. She is also expecting visits from her friend Dianna from Ventura and Donna and Floyd from Oxnard. Her dance card looks pretty full today.
David
I had a brief conversation with the resident this morning (the ICU team has not made their rounds yet). During this conversation I heard a new term. The doctor referred to Cathy's current status as her "new baseline". I am still digesting this term, and I will pursue further clarification as I get the opportunity. My initial impression is that Cathy's lungs are about as good as they are going to get. The point of the trach collar exercises are to condition Cathy to be able to get as much as she can out of what lung capacity she has left. The doctor also mentioned 'rehabilitation facilities'. (The attending also mentioned this a few days ago). Their goal appears to be to get Cathy to a point where she can go throughout the day off of the ventilator and to be able to move around a little on her own. At that point she may be transferred to a rehabilitation facility. (I think rehabilitation facility is the new PC term for a nursing home).
Cathy has asked to sit in the chair again today. She is also expecting visits from her friend Dianna from Ventura and Donna and Floyd from Oxnard. Her dance card looks pretty full today.
David
Friday, July 18, 2008
Noticeable Improvements
When I arrived at Cathy's ICU room this evening, I was pleasantly surprised to find Cathy sitting up in a hospital chair (a gurney that folds into a chair). There she was, just kinkn' back watchn' the flat screen.
I spoke with Cathy about today's exercise with the trach collar (Or trach cuff, I am confused. Different doctors and nurses refer to it differently). When I say I spoke with Cathy, I mean that I speak and then try very hard to read her lips. I think I am getting pretty good at it. Anyway, Cathy said that the first hour and a half went OK. She did not start struggling until after that. Cathy also 'said' that she does feel a little better today. The charge nurse came into the room while we were talking and said that they are going to shoot for three hours on the collar tomorrow. The goal is to get Cathy to the point where she can go throughout the day off of the ventilator, and only need the ventilator for support through the night.
The dosage for one of the three sedatives that Cathy is taking was cut in half today. I am a little apprehensive about this. The doctor's tried to reduce this before and Cathy's anxiety was more than what she could handle. It was Cathy's request to be sedated while she is on the ventilator. The doctors want to reduce the sedation because they believe Cathy will improve faster if she is more alert and working consciously on her breathing.
Today was Bonnie's last day with Cathy. We will both miss her support. I know Cathy's spirits were lifted by having her around.
Jessica and Becky are coming down this evening. Kaitlyn will be down tomorrow before she heads back up to San Francisco.
(knock on wood....) I believe that during the last two days, Cathy has made some noticeable improvements. I will be here tomorrow morning to listen in on the doctor's as they make their rounds. I will press them for their opinion on Cathy's improvements and the reduced sedation.
I spoke with Cathy about today's exercise with the trach collar (Or trach cuff, I am confused. Different doctors and nurses refer to it differently). When I say I spoke with Cathy, I mean that I speak and then try very hard to read her lips. I think I am getting pretty good at it. Anyway, Cathy said that the first hour and a half went OK. She did not start struggling until after that. Cathy also 'said' that she does feel a little better today. The charge nurse came into the room while we were talking and said that they are going to shoot for three hours on the collar tomorrow. The goal is to get Cathy to the point where she can go throughout the day off of the ventilator, and only need the ventilator for support through the night.
The dosage for one of the three sedatives that Cathy is taking was cut in half today. I am a little apprehensive about this. The doctor's tried to reduce this before and Cathy's anxiety was more than what she could handle. It was Cathy's request to be sedated while she is on the ventilator. The doctors want to reduce the sedation because they believe Cathy will improve faster if she is more alert and working consciously on her breathing.
Today was Bonnie's last day with Cathy. We will both miss her support. I know Cathy's spirits were lifted by having her around.
Jessica and Becky are coming down this evening. Kaitlyn will be down tomorrow before she heads back up to San Francisco.
(knock on wood....) I believe that during the last two days, Cathy has made some noticeable improvements. I will be here tomorrow morning to listen in on the doctor's as they make their rounds. I will press them for their opinion on Cathy's improvements and the reduced sedation.
Today's Exercise
Cathy was 'exercised' off the ventilator again today. She was off the ventilator for two-hours and ten-minutes, they were shooting for three hours. No blood was drawn at the end of today's exercise, so we will not know what her blood CO2 levels were. Cathy is currently recovering from this activity.
I will be back down to the hospital this evening and will provide a more detailed update at that time.
David
PS. Sorry for making everyone wait so long for an update yesterday.
I will be back down to the hospital this evening and will provide a more detailed update at that time.
David
PS. Sorry for making everyone wait so long for an update yesterday.
Thursday, July 17, 2008
Five Foot-Two and Three-Quarters
Cathy's day has been an eventful one. First, this morning the physical therapist had Cathy get out of the hospital bed and stand for a few moments. Unfortunately I missed this exciting event. Bonnie was here to give Cathy encouragement. Later in the morning the respiratory therapist took Cathy off the ventilator again and put her on the 'cuff' (a device that fits over the trach and supplies Cathy with a moist oxygen and air mixture). This was the same exercise that was performed on Tuesday evening. This time instead of one-hour, the goal was two hours. Cathy made it one-hour and fifty minutes. However, this time the blood gas tests indicated that Cathy's blood CO2 levels were much better than after Tuesday's exercise. Cathy's blood CO2 was 56 after today's exercise, it was in the 70's after Tuesday's exercise. (I do not know the units for these CO2 readings). The resident told me that normal for a healthy person is 30 to 40. Normal for Cathy, because she has limited lung functions to begin with, is in the low 50's. When Cathy was brought into the ICU on June 28th, her blood CO2 levels were approaching 100.
This evening, the goal was to have Cathy get out of bed again and sit in a chair. Cathy was to exhausted to attempt this feat. As a 'plan B', her hospital bed has been adjusted to 'chair' configuration, putting her in a sitting position.
David
This evening, the goal was to have Cathy get out of bed again and sit in a chair. Cathy was to exhausted to attempt this feat. As a 'plan B', her hospital bed has been adjusted to 'chair' configuration, putting her in a sitting position.
David
Wednesday, July 16, 2008
One Less Thing to Worry About
To wake myself up before my ride home, I went down to the cafeteria and grabbed a cup of coffee. In the cafeteria I ran into the fellow physician. I asked about Cathy's need for so much blood and if we should be concerned. His response was that they are certain that Cathy is not loosing blood by bleeding (internally). Her body is just not producing enough blood. This is a known effect of some of the medications she is receiving (primarily some of the antibiotics). They are switching some of these medications to see if they can improve upon her body's blood production. He also stated that we should not be concerned about this issue for now.
One less thing to worry about for now. Boy, this is a good cup of coffee!
One less thing to worry about for now. Boy, this is a good cup of coffee!
A Comforting Day
There is not much to update you on since the previous post. Cathy is trying to rest. She is alert, but appears very tired. Currently the ventilator is in the 'pressure support' mode (10 units of support). They will switch it into the full support mode again later this evening. Blood samples were taken earlier to check her blood-gas levels on pressure support.
She said that it was a comfort to have Bonnie with her today. Jessica also came down this afternoon.
I am hoping that I have a chance to speak with the resident or fellow physician this evening. If I do I will update you on anything I learn.
David
She said that it was a comfort to have Bonnie with her today. Jessica also came down this afternoon.
I am hoping that I have a chance to speak with the resident or fellow physician this evening. If I do I will update you on anything I learn.
David
Perseverance
Last night Cathy persevered and held on for one hour off the ventilator, being supplied with only the moist air and oxygen mixture. After being put back on the ventilator, she appeared to recover from the experience.
Bonnie stayed with Cathy through the night and this morning she reported that Cathy had a rough night. Cathy did not get much sleep. During the night problems developed with the ventilator and it had to be changed out. Additionally Cathy's blood pressure dropped to a level where the nurse would not give her any more sedation or medication for her headaches, out of fear of causing her blood pressure to drop even lower. This morning Cathy's blood pressure was high enough for her to receive some headache medication.
This morning Cathy is also receiving two more units of blood. The doctors say that Cathy is not producing enough red cells for herself due to the antibiotics and steroids she is receiving. However, at least one doctor has expressed other concerns (to Bonnie) regarding the need to give Cathy so much blood (six unit now). Additionally the results from the blood gas analysis taken at the end of last night's 'exercise' were not good.
David
Bonnie stayed with Cathy through the night and this morning she reported that Cathy had a rough night. Cathy did not get much sleep. During the night problems developed with the ventilator and it had to be changed out. Additionally Cathy's blood pressure dropped to a level where the nurse would not give her any more sedation or medication for her headaches, out of fear of causing her blood pressure to drop even lower. This morning Cathy's blood pressure was high enough for her to receive some headache medication.
This morning Cathy is also receiving two more units of blood. The doctors say that Cathy is not producing enough red cells for herself due to the antibiotics and steroids she is receiving. However, at least one doctor has expressed other concerns (to Bonnie) regarding the need to give Cathy so much blood (six unit now). Additionally the results from the blood gas analysis taken at the end of last night's 'exercise' were not good.
David
Tuesday, July 15, 2008
Bright Eyes
Upon my return to Cathy's ICU room this afternoon I was greeted with a set of bright eyes and a wide smile. Cathy was more alert than she has been in almost three weeks.
Cathy has been on pressure support from the ventilator, through the 'trach', all day. Her last blood gas measurements (~3 pm) were good, even the CO2.
Tonight the respiratory therapist is going to begin 'exercising' Cathy's lungs off of the ventilator. At 8 pm Cathy will be completely removed from the ventilator. She will be connected (by her trach) to a flow of a moist air and oxygen mixture, without any pressure. Cathy will have to do all the inhaling and exhaling herself. They are planning on leaving her like this for one hour. After that time she will be returned to the ventilator on pressure support mode (as she is now). After an additional hour, the ventilator will be switched to full support mode to allow Cathy to rest and sleep comfortably tonight.
Cathy sends her love and thanks everyone for their thoughts and prayers.
David
Cathy has been on pressure support from the ventilator, through the 'trach', all day. Her last blood gas measurements (~3 pm) were good, even the CO2.
Tonight the respiratory therapist is going to begin 'exercising' Cathy's lungs off of the ventilator. At 8 pm Cathy will be completely removed from the ventilator. She will be connected (by her trach) to a flow of a moist air and oxygen mixture, without any pressure. Cathy will have to do all the inhaling and exhaling herself. They are planning on leaving her like this for one hour. After that time she will be returned to the ventilator on pressure support mode (as she is now). After an additional hour, the ventilator will be switched to full support mode to allow Cathy to rest and sleep comfortably tonight.
Cathy sends her love and thanks everyone for their thoughts and prayers.
David
A Smile
When I left Cathy last night she was still under the effects of the sedation. She was starting to respond to questions and was aware of where she was. At one point she did manage a smile for me. This was her first smile in over two weeks without a tube coming out of her mouth. She was still being given a small amout of continuous sedation to keep her calm and let her body get used to the 'trach'.
Today the doctors will be focusing on helping Cathy adjust to the trach. A physical therapist will be visiting with her to work on talking with the trach as well as starting her on an exercise routine. Cathy needs to maintain some physical conditioning so she can handle a transplant operation. The transplant surgeon will be visiting Cathy sometime in the near future to evaluate her for this surgery. This surgeon's opinion is critical to Cathy's being re-listed for transplant. One of the benefits of being on the trach is that eventually Cathy should be able to spend some time out of bed. This will help with Cathy's mental attitude as well as physical conditioning.
I will not have another update for you until this evening (~7 pm California time). I went home last night and am going to work this morning. Bonnie is on her way down from Seattle to stay with Cathy for a couple days.
Today the doctors will be focusing on helping Cathy adjust to the trach. A physical therapist will be visiting with her to work on talking with the trach as well as starting her on an exercise routine. Cathy needs to maintain some physical conditioning so she can handle a transplant operation. The transplant surgeon will be visiting Cathy sometime in the near future to evaluate her for this surgery. This surgeon's opinion is critical to Cathy's being re-listed for transplant. One of the benefits of being on the trach is that eventually Cathy should be able to spend some time out of bed. This will help with Cathy's mental attitude as well as physical conditioning.
I will not have another update for you until this evening (~7 pm California time). I went home last night and am going to work this morning. Bonnie is on her way down from Seattle to stay with Cathy for a couple days.
Monday, July 14, 2008
A Smooth Procedure
The doctors have reported that the tracheotomy procedure went well. Cathy will be 'sleeping off' the sedation for an hour or two. She was also given a drug to temporarily paralyze her. The effects of this should be wearing off before she wakes up.
Cathy spiked another fever last night. As a precaution, earlier today the nurse collected samples for bacteria cultures. The infectous desease doctor came by to let me know that he believes the fever is associated with the extibation and intibation procedures yesterday. He also said that the strain of virus that Cathy 'caught' is one that has been around all year. Nothing exotic, therefore they know how to attack it. They are pretty sure it is gone, but they will continue to monitor Cathy as a precaution in case some of the virus is 'hiding out' somewhere.
David
Cathy spiked another fever last night. As a precaution, earlier today the nurse collected samples for bacteria cultures. The infectous desease doctor came by to let me know that he believes the fever is associated with the extibation and intibation procedures yesterday. He also said that the strain of virus that Cathy 'caught' is one that has been around all year. Nothing exotic, therefore they know how to attack it. They are pretty sure it is gone, but they will continue to monitor Cathy as a precaution in case some of the virus is 'hiding out' somewhere.
David
Alert and Responsive Again
Cathy is reporting that she slept well last night. This morning she is alert, responsive, and watching her morning TV shows.
Overnight Cathy's blood gasses returned to normal parameters. This morning the ventilator was set to the pressure assistance only mode at the lowest settings (5) and Cathy is handling it well.
The resident reported this morning that this pneumonia may have damaged enough of what good lung tissue Cathy had remaining to prohibit her from exhailing the CO2 effectively. She still has enough 'inhail' capacity, she just can't get the stuff out. The ICU team will be consulting with the pulmonary/transplant team to see if they have any ideas (medications) or if their experience tells them that she still may recover more. I should learn more when the ICU team makes their rounds in about one hour.
David
Overnight Cathy's blood gasses returned to normal parameters. This morning the ventilator was set to the pressure assistance only mode at the lowest settings (5) and Cathy is handling it well.
The resident reported this morning that this pneumonia may have damaged enough of what good lung tissue Cathy had remaining to prohibit her from exhailing the CO2 effectively. She still has enough 'inhail' capacity, she just can't get the stuff out. The ICU team will be consulting with the pulmonary/transplant team to see if they have any ideas (medications) or if their experience tells them that she still may recover more. I should learn more when the ICU team makes their rounds in about one hour.
David
Sunday, July 13, 2008
Cathy Has Been Reintibated
The doctors have completed the reintibation. I was briefly allowed back in the room. The nurses are getting Cathy cleaned up and comfortable, so I stepped back out for a few.
Cathy is heavily sedated. Earlier today, while Cathy was still coherent, she asked for constant sedation while she is intibated. Therefore, she will be pretty much 'out of it' until tomorrow, after they perform the tracheotomy.
Over the next several hours the doctors and nurses will be working to bring Cathy's blood gasses back in-line. During this time the ventilator will be providing Cathy full support. It may be left in this mode until after the procedure tomorrow.
The doctors have told me not to look at re-intibation as a set back. Cathy is still better today than she was two weeks ago.
Cathy is heavily sedated. Earlier today, while Cathy was still coherent, she asked for constant sedation while she is intibated. Therefore, she will be pretty much 'out of it' until tomorrow, after they perform the tracheotomy.
Over the next several hours the doctors and nurses will be working to bring Cathy's blood gasses back in-line. During this time the ventilator will be providing Cathy full support. It may be left in this mode until after the procedure tomorrow.
The doctors have told me not to look at re-intibation as a set back. Cathy is still better today than she was two weeks ago.
Reintibation
Change of schedule. Cathy is going to be reintibated in a few minutes, then the tracheotomy will be performed tomorrow.
She Tried
Cathy did not tolerate being off the ventilator. The CO2 in her blood is remaining high and Cathy is once again non responsive.
The doctors will be performing a tracheotomy this afternoon.
It seems that our hopes now lay with Cathy regaining strength and receiving a transplant.
I will give more details as I learn them.
The doctors will be performing a tracheotomy this afternoon.
It seems that our hopes now lay with Cathy regaining strength and receiving a transplant.
I will give more details as I learn them.
The Plan In Motion
Cathy was extibated at 10am this morning - one hour and twenty minutes ago. Since that time the doctors have tried two different oxygen mask set-up on her. The latest is called a 'Bi-pap' machine. This machine is forcing air into Cathy's lungs through a mask over her nose.
The doctor is standing by to re-intibate Cathy..........
The doctor is standing by to re-intibate Cathy..........
The Plan For Today
Cathy has been on the ventilator for two weeks. The doctors are becoming concerned that she may start developing 'complications' from being ventilated for this amount of time. (They did not expand too much about what the complications are other than problems with the throat and larynx). Therefore, today they are going to extibate her. If Cathy does not tolerate breathing on her own, she will be reintibated with a smaller tube. If Cathy must be reintibated, tomorrow they will perform a tracheotomy.
During the night Cathy's anxiety medication was switched. This one appears to be working well. Her blood pressure is holding at good levels and her respiration rate is low (maybe a little to low occasionally).
The doctors asked for permission to give Cathy another unit of blood (she was given three her first day in the ICU). Her red cell count is low. Adding this blood will allow her body to carry more oxygen and possibly give her a little more strength.
The doctors have laid out this plan, however, as always, they will not commit to a time. The unit of blood has not been started yet. Therefore I assume the process will not begin for a while yet. The respiratory therapist is preparing his 'stuff'. If extibation is successful, Cathy will be on a pressurized mask that will provide both oxygen and a cool water mist. The water mist is used to keep her throat moist and reduce swelling. For now all we can do is wait. and pray.
David
During the night Cathy's anxiety medication was switched. This one appears to be working well. Her blood pressure is holding at good levels and her respiration rate is low (maybe a little to low occasionally).
The doctors asked for permission to give Cathy another unit of blood (she was given three her first day in the ICU). Her red cell count is low. Adding this blood will allow her body to carry more oxygen and possibly give her a little more strength.
The doctors have laid out this plan, however, as always, they will not commit to a time. The unit of blood has not been started yet. Therefore I assume the process will not begin for a while yet. The respiratory therapist is preparing his 'stuff'. If extibation is successful, Cathy will be on a pressurized mask that will provide both oxygen and a cool water mist. The water mist is used to keep her throat moist and reduce swelling. For now all we can do is wait. and pray.
David
Saturday, July 12, 2008
Much Needed Rest
Cathy has been sleeping almost constantly since I made the previous post (although she is now awake and asking for something for her headache). Her blood pressure has dropped below the 'alarm' levels.
The attending physician on call this weekend stopped by and said they may try to extibate tomorrow if her blood pressure remains stable.
Pray for a peacefull and uneventful evening and night.
David
The attending physician on call this weekend stopped by and said they may try to extibate tomorrow if her blood pressure remains stable.
Pray for a peacefull and uneventful evening and night.
David
High Anxiety & Blood Pressure
Well I've stalled about as long as I can with today's first update. I was hoping to be able to report that Cathy was extibated. However, that is not the case. The ventilator assistance has been reduced to 5 units. Cathy is working hard to breathe and remain calm. This morning the doctor's said that they wanted to observe Cathy a little longer before they extibate her. "One more day is not much in the grand scheme of things".
Cathy's blood pressure has been above 170 most of the morning (top number). they are alternating sedatives with morphine as well as giving her a new medication for anxiety. She has not slept well for the past two nights.
On a positive side of things, when Cathy first came into the ICU she was set up with medications and fluids on seven IV poles. At one time they were using twelve different IV pumps. Today there are only four IV poles and three pumps. Cathy has completed all the IV 'courses' for the antibiotics and antiviral medications. She is still receiving at least one oral antiviral medication(through the feeding tube) .
...... Shhhhhhhh, she just fell asleep.........
Cathy's blood pressure has been above 170 most of the morning (top number). they are alternating sedatives with morphine as well as giving her a new medication for anxiety. She has not slept well for the past two nights.
On a positive side of things, when Cathy first came into the ICU she was set up with medications and fluids on seven IV poles. At one time they were using twelve different IV pumps. Today there are only four IV poles and three pumps. Cathy has completed all the IV 'courses' for the antibiotics and antiviral medications. She is still receiving at least one oral antiviral medication(through the feeding tube) .
...... Shhhhhhhh, she just fell asleep.........
Friday, July 11, 2008
Unanswered Question and A Look Ahead
The attending physician for the ICU performed a bronkoscopy on Cathy about 1 hour ago. Unfortunately she was not able to see what she wanted to see. She was able to see down as far as Cathy's vocal cords, which looked fine. She was not able to pass the scope down the airway far enough to answer the question about swelling. She did say that "swelling is not typical in this setting". She is going to have a surgeon from the head, neck & throat group look to see what he thinks about the tightness around the vent tube. The attending is still fairly confident about being able to extibate Cathy tomorrow. They are going to reduce the assistance pressure to 6 in the morning (I was wrong about stopping at 10). After Cathy adjusts to this setting they will extibate her (knock on wood). Cathy is still struggling to get comfortable with the current ventilator setting (8). Her blood pressure has been elevated most of the day. The doctors believe the high blood pressure and Cathy's discomfort with the current setting can be attributed to anxiety. They are now having to give Cathy more sedation & morphine than what she has received the past couple days.
The infectious disease doctor from the transplant team also stopped by just before the bronkoscopy. He confirmed that for two sets of cultures in a row (taken 5 & 6 days ago), no more virus has turned up. In two or three weeks they will draw more cultures. (Since I assume we will be long discharged by then, I assume that these cultures will be taken at a clinic visit). If these cultures are negative for virus, Cathy will be re-listed for transplant.
The infectious disease doctor from the transplant team also stopped by just before the bronkoscopy. He confirmed that for two sets of cultures in a row (taken 5 & 6 days ago), no more virus has turned up. In two or three weeks they will draw more cultures. (Since I assume we will be long discharged by then, I assume that these cultures will be taken at a clinic visit). If these cultures are negative for virus, Cathy will be re-listed for transplant.
Increased Hopes and Struggles
When I arrived at Cathy's ICU room this morning, the ventilator assistance was already reduced to 10. Cathy was still fighting to quiet herself, but was definitely winning the battle. Apparently, the RT did not wait until 5 to make the change.
Around 7:30, the RT for the day shift came in and made a few simultaneous adjustments. First, she reduced the pressure assistance to 8. Then immediately following, without giving Cathy time to adjust, she deflated the 'cuff' which seals the ventilator tube within Cathy's larynx. The cuff is a balloon-like device at the base of the ventilator tube that, when inflated, forces all air in and out of Cathy's lungs to pass through the vent tube. This was done to check to see if they could get air to flow around the outside of the tube. This checks for swelling of the larynx. No air was detected flowing around the outside of the tube. After approximately 10 minutes, the cuff was re inflated. By this time Cathy was struggling hard, her blood pressure was holding above 200 (I saw it over 260 over 110 a couple times). Cathy was given a sedative and a medication to reduce this pressure. It took Cathy almost 45 agonizing minutes to recover.
The doctors are going to perform a bronkoscopy (look down her throat with a viewing scope) to see if there is significant swelling to worry about or if Cathy just has a small larynx. The doctors also stated that "Cathy will be extibated this weekend". How about that!! It sounds like they are not to worried about the severity of the swelling.
Well, I am here for the day. I will provide additional updates as things progress.
David
Around 7:30, the RT for the day shift came in and made a few simultaneous adjustments. First, she reduced the pressure assistance to 8. Then immediately following, without giving Cathy time to adjust, she deflated the 'cuff' which seals the ventilator tube within Cathy's larynx. The cuff is a balloon-like device at the base of the ventilator tube that, when inflated, forces all air in and out of Cathy's lungs to pass through the vent tube. This was done to check to see if they could get air to flow around the outside of the tube. This checks for swelling of the larynx. No air was detected flowing around the outside of the tube. After approximately 10 minutes, the cuff was re inflated. By this time Cathy was struggling hard, her blood pressure was holding above 200 (I saw it over 260 over 110 a couple times). Cathy was given a sedative and a medication to reduce this pressure. It took Cathy almost 45 agonizing minutes to recover.
The doctors are going to perform a bronkoscopy (look down her throat with a viewing scope) to see if there is significant swelling to worry about or if Cathy just has a small larynx. The doctors also stated that "Cathy will be extibated this weekend". How about that!! It sounds like they are not to worried about the severity of the swelling.
Well, I am here for the day. I will provide additional updates as things progress.
David
Thursday, July 10, 2008
A Day of Great Improvement
Cathy was doing so well this morning, I felt comfortable enough to leave the hospital and go into work again. Once again, a day away and Cathy made TREMENDOUS progress. To my amazement, when I returned this evening the pressure assist on Cathy's ventilator had been reduced three times!!! She is now using only 12 cmH2O of pressure assist. The respiratory therapist said she was going to let Cathy rest at this setting through the night and then reduce the pressure assist to 10 in the morning (5 am). It has been my understanding that 10 was the goal that needed to be achieved for extibation. I will confirm this understanding with the doctors in the morning.
Cathy did have some discomfort and chest pains during the day. Jessica was here to make sure the doctors and nurses gave Cathy the proper attention. Apparently the ventilator tube shifted a bit causing the pain.
Cathy has asked me (in a note) to tell everyone that she is finally resting, however not to comfortably at the moment. She also wrote "thank you for your thoughts and prayers".
It won't be long and she will be able to post these updates herself.
Cathy & David
Cathy did have some discomfort and chest pains during the day. Jessica was here to make sure the doctors and nurses gave Cathy the proper attention. Apparently the ventilator tube shifted a bit causing the pain.
Cathy has asked me (in a note) to tell everyone that she is finally resting, however not to comfortably at the moment. She also wrote "thank you for your thoughts and prayers".
It won't be long and she will be able to post these updates herself.
Cathy & David
Missed Communication
By the time I left Cathy's room last night, she had adjusted well to being on ventilator assistance only. All her 'numbers' were good. She also did very well through the night, although she did not sleep well.
When I arrived at her ICU room early this morning, the respiratory therapist has just reduced the assistance pressure on the ventilator. She had been told by the previous respiratory therapist that the assistance is to be reduced by two units every day. However, after making the change, the RT was double checking the doctor's orders and could not confirm the order. Therefore, the vent-assist setting was reset. I appreciate the RT's diligence. During the several minutes that Cathy was at the lower setting, I could again see the stressful expression on her face as she struggled to re-adjust herself to the additional work she must perform in order to breath. She was however, appearing to become comfortable about the time the RT re-set the ventilator. This is a good sign for when they do reduce the setting later today after the orders are confirmed by the doctor.
During the past 24 hours Cathy has made tremendous progress. Keep those thoughts and prayers coming.
David
When I arrived at her ICU room early this morning, the respiratory therapist has just reduced the assistance pressure on the ventilator. She had been told by the previous respiratory therapist that the assistance is to be reduced by two units every day. However, after making the change, the RT was double checking the doctor's orders and could not confirm the order. Therefore, the vent-assist setting was reset. I appreciate the RT's diligence. During the several minutes that Cathy was at the lower setting, I could again see the stressful expression on her face as she struggled to re-adjust herself to the additional work she must perform in order to breath. She was however, appearing to become comfortable about the time the RT re-set the ventilator. This is a good sign for when they do reduce the setting later today after the orders are confirmed by the doctor.
During the past 24 hours Cathy has made tremendous progress. Keep those thoughts and prayers coming.
David
Wednesday, July 9, 2008
The Brave Struggle
The amount of assistance the ventilator is providing Cathy was reduced a little bit this afternoon (~5 pm). Cathy must inhale and exhale on her own for every breath. The ventilator is only assisting by providing a little pressure behind the air as she draws it in, and a little suction as she blows it out. She has told me that she notices the difference from this morning's settings. She is struggling to keep it up. The anxiety is showing in her facial expressions and she has been a little 'moody' this afternoon. The Doctor's are saying that as time progresses, Cathy's diaphragm is strengthening and the breathing should become easier.
It was determined the the pressure and pain in her abdomen this morning was caused by a blockage in her foley (A catheter placed in her bladder to drain urine). All is better now.
Please pray for a restful evening and night for Cathy.
David
It was determined the the pressure and pain in her abdomen this morning was caused by a blockage in her foley (A catheter placed in her bladder to drain urine). All is better now.
Please pray for a restful evening and night for Cathy.
David
Two Teams, Two Approaches, One Goal
Cathy did well overnight on ventilator assistance only. The ICU team is planning on reducing the ventilator assistance a little more today, and a little more each day, until gradually Cathy will be doing all the breathing on her own.
A fellow physician from the transplant team stopped by early this morning. It sounds like the transplant team is of the opinion that Cathy should be extibated soon, if not right away. "The worst thing that could happen would be for Cathy to need re-intibation". The fellow stated that his school of thought is: "if you are not having to re-intibate patients, you are not extibating enough".
During the ICU team rounds, the resident reported that the cultures taken a few days ago did not grow any virus or bacteria. This is more good news.
Cathy is reporting that she has begun to have pain and tightness in her abdomen. She has also begun to pass a little blood. The doctors are on it, I don't know much more than that at this time.
Cathy is having the line that runs through her neck into a vein removed at this moment. They will replace this line with a 'pick' line. A pick line is a similar line, but this one will enter from her arm, pass up the arm through a vein to a point close to her heart. The current line has been in for about as long as the doctors want. This pick line can be in Cathy for an extended time (for up to a year if needed).
Cathy is progressing every day. The "Cathy team" has the same goal as the ICU and transplant teams. Our approch is through the use of good thoughts and prayers.
Three teams, three approaches, one goal.
David
A fellow physician from the transplant team stopped by early this morning. It sounds like the transplant team is of the opinion that Cathy should be extibated soon, if not right away. "The worst thing that could happen would be for Cathy to need re-intibation". The fellow stated that his school of thought is: "if you are not having to re-intibate patients, you are not extibating enough".
During the ICU team rounds, the resident reported that the cultures taken a few days ago did not grow any virus or bacteria. This is more good news.
Cathy is reporting that she has begun to have pain and tightness in her abdomen. She has also begun to pass a little blood. The doctors are on it, I don't know much more than that at this time.
Cathy is having the line that runs through her neck into a vein removed at this moment. They will replace this line with a 'pick' line. A pick line is a similar line, but this one will enter from her arm, pass up the arm through a vein to a point close to her heart. The current line has been in for about as long as the doctors want. This pick line can be in Cathy for an extended time (for up to a year if needed).
Cathy is progressing every day. The "Cathy team" has the same goal as the ICU and transplant teams. Our approch is through the use of good thoughts and prayers.
Three teams, three approaches, one goal.
David
Tuesday, July 8, 2008
It Must Have Been Me All Along
Boy, I spend one day away from the hospital and things take off on a new course.
When I returned to the ICU this evening, I discovered Cathy breathing with only 5 cmH2O pressure, and an additional 20 cmH2O of pressure support on the ventilator! (Edited 7/9 @ 6:45 am. I wanted to make sure I was providing everyone with the correct information. This is still a great thing). And just to top that off, I learned that she had been breathing with these settings since just after 8:30 this morning (within one hour of my leaving the ICU). Cathy was given medication for her anxiety, which did the trick.... I sure hope it wasn't me :-( . After almost 14 hours, Cathy is doing great! All her numbers are great. Even the CVP2 value is good, a steady 5.
More specimens were collected this evening for cultures.
The nurse gave Cathy something to help her sleep and increased her sedation. Cathy was also given some morphine for her headache just before I left her this evening. She should sleep pretty good with that much 'pharmacy' in her.
I am hoping to catch the resident early tomorrow morning. If I get any notion that they may attempt to extibate Cathy tomorrow, I will stick around the ICU all day. Otherwise, I am planning to go to work again tomorrow. If I do, tomorrow's updates may be as sparce as today's.
Keep those good thoughts and prayers coming.
David
When I returned to the ICU this evening, I discovered Cathy breathing with only 5 cmH2O pressure, and an additional 20 cmH2O of pressure support on the ventilator! (Edited 7/9 @ 6:45 am. I wanted to make sure I was providing everyone with the correct information. This is still a great thing). And just to top that off, I learned that she had been breathing with these settings since just after 8:30 this morning (within one hour of my leaving the ICU). Cathy was given medication for her anxiety, which did the trick.... I sure hope it wasn't me :-( . After almost 14 hours, Cathy is doing great! All her numbers are great. Even the CVP2 value is good, a steady 5.
More specimens were collected this evening for cultures.
The nurse gave Cathy something to help her sleep and increased her sedation. Cathy was also given some morphine for her headache just before I left her this evening. She should sleep pretty good with that much 'pharmacy' in her.
I am hoping to catch the resident early tomorrow morning. If I get any notion that they may attempt to extibate Cathy tomorrow, I will stick around the ICU all day. Otherwise, I am planning to go to work again tomorrow. If I do, tomorrow's updates may be as sparce as today's.
Keep those good thoughts and prayers coming.
David
Complaining is a Good Thing
Cathy had a hard time with the weening attempt again this morning. She has started to become very anxious every time she sees a respiratory therapist. Before they even get close to the ventilator her blood pressure will raise and her pulse will quicken.... she knows what is about to happen.
The resident physician stopped by early this morning to check in on Cathy. I took this time to share some 'complaints' Cathy was having: not being able to sleep; the tube in her throat was bothering her; headaches, and so on. The doctor addressed these issues but also said something that I took comfort with. She said that when a patient starts to provide them with complaints, it is typically a sign that the patient is doing better. So complain on Cathy!!!!
Cathy was fairly stable this morning (per the numbers and per her emotions). I took this opportunity to check back in with life and jetted off to work. I will return to the hospital this evening. Kaitlyn and Jessica are with her this morning along with Donna, a close friend from Oxnard. Becky will be with her later this afternoon.
The resident physician stopped by early this morning to check in on Cathy. I took this time to share some 'complaints' Cathy was having: not being able to sleep; the tube in her throat was bothering her; headaches, and so on. The doctor addressed these issues but also said something that I took comfort with. She said that when a patient starts to provide them with complaints, it is typically a sign that the patient is doing better. So complain on Cathy!!!!
Cathy was fairly stable this morning (per the numbers and per her emotions). I took this opportunity to check back in with life and jetted off to work. I will return to the hospital this evening. Kaitlyn and Jessica are with her this morning along with Donna, a close friend from Oxnard. Becky will be with her later this afternoon.
Monday, July 7, 2008
Ignorance is Not Bliss
The afternoon attempt at weening Cathy from the ventilator was no different than this mornings attempt. I do not know exactly how long Cathy was able to breath without assistance (or with reduced assistance). The respiratory therapist adjusted the settings without letting us know. I was not aware that things were changed until Cathy's blood pressure was through the roof and she began struggling. By not advising Cathy (or myself) what she was doing (we assumed the therapist was just in the room to give Cathy a routine respiratory treatment), I think she was trying to remove any anxiety buildup in Cathy as she anticipates what is about to happen to her.
The therapist said that she was going to try again around 5:30 in the morning. (I am going to be in the room before 5).
Good night to all....
David
The therapist said that she was going to try again around 5:30 in the morning. (I am going to be in the room before 5).
Good night to all....
David
Just When We Thought It Was Safe
Cathy 'spiked' a fever a little bit ago. This has raised concerns again for bacterial infections. They have restarted the antibiotic (vancomyacin, again who knows about the spelling). They sent samples from every orifice into the lab for cultures. We now must wait a couple days for these results.
David
David
Options
Dr. Ross stopped by and spoke with Cathy this afternoon. Dr. Ross is the director of the UCLA Lung Transplant program and managed Cathy's double lung transplant in 2004.
Dr Ross expressed concern about Cathy being in bed on a ventilator for one week now. Cathy's inactivity introduces concerns for developing weakness throughout her body. He would prefer if she were a little more ambulatory. However, it is impractical for Cathy to get out of bed while on the ventilator. One option presented was for Cathy to be given a tracheotomy. A 'trach' would make it possible for Cathy to be connected and removed from the ventilator as needed. It would also make it possible for Cathy to get out of bed and get some exercise (we all know how much Cathy enjoys running around the block). With any option, there is an associated decision. Please pray for guidance to help Cathy with this decision.
We are still waiting for the doctors to conduct their afternoon attempt at weening Cathy from the ventilator. Since we are rapidly coming up on 4 o'clock, I suspect it will happen soon.
David
Dr Ross expressed concern about Cathy being in bed on a ventilator for one week now. Cathy's inactivity introduces concerns for developing weakness throughout her body. He would prefer if she were a little more ambulatory. However, it is impractical for Cathy to get out of bed while on the ventilator. One option presented was for Cathy to be given a tracheotomy. A 'trach' would make it possible for Cathy to be connected and removed from the ventilator as needed. It would also make it possible for Cathy to get out of bed and get some exercise (we all know how much Cathy enjoys running around the block). With any option, there is an associated decision. Please pray for guidance to help Cathy with this decision.
We are still waiting for the doctors to conduct their afternoon attempt at weening Cathy from the ventilator. Since we are rapidly coming up on 4 o'clock, I suspect it will happen soon.
David
Over Steering
This morning I watched as Cathy's blood pressure 'numbers' shot up to 231 over 98. A short while later these numbers were 68 over 47. During both occasions the doctors and nurses 'moved briskly'...... More fluids, less fluids; more pressure, less pressure; increase medication A, decrease medication A..... I sense that the care that the doctors and nurses are giving Cathy is like driving a car using only the shoulders of the road as a guide.. you don't know where you are until you run off the shoulder.
During the past several days, one of the goals for the treatment Cathy is receiving was to remove fluids from her system. Well, it appears that they have removed fluids to the point where Cathy can no longer maintain her blood pressure. They are now pumping fluids back in. Another treatment Cathy has been receiving the past several days are insulin treatments to control the blood sugar increases caused by the steroids she receives. This morning I was a little 'surprised' to see the nurse giving Cathy IV sugars - they had reduced her blood sugars to much......... quick, hard left... no, no I mean hard right...
I have met the new captain of the ship. The attending physician that took over Cathy's care this morning wants to try another ventilator weening trial this afternoon. However, this time they are not going to completely take away all the assistance the ventilator provides. (Sounds to me like the captain wants to make only a slight course correction, I like that). She also stated that "the swelling of the throat is not a contraindication for extibation". (Interpretation: The swelling of the throat is no reason to not remove the ventilator tube from Cathy's throat). Consistent with the previous attending physician, she stated that they will attempt to ween Cathy from the ventilator daily. One day (maybe tomorrow, maybe next week) Cathy will be OK and the tube will come out.
Well, time to go check on Cathy. Keep the good thoughts and prayers coming.
David
During the past several days, one of the goals for the treatment Cathy is receiving was to remove fluids from her system. Well, it appears that they have removed fluids to the point where Cathy can no longer maintain her blood pressure. They are now pumping fluids back in. Another treatment Cathy has been receiving the past several days are insulin treatments to control the blood sugar increases caused by the steroids she receives. This morning I was a little 'surprised' to see the nurse giving Cathy IV sugars - they had reduced her blood sugars to much......... quick, hard left... no, no I mean hard right...
I have met the new captain of the ship. The attending physician that took over Cathy's care this morning wants to try another ventilator weening trial this afternoon. However, this time they are not going to completely take away all the assistance the ventilator provides. (Sounds to me like the captain wants to make only a slight course correction, I like that). She also stated that "the swelling of the throat is not a contraindication for extibation". (Interpretation: The swelling of the throat is no reason to not remove the ventilator tube from Cathy's throat). Consistent with the previous attending physician, she stated that they will attempt to ween Cathy from the ventilator daily. One day (maybe tomorrow, maybe next week) Cathy will be OK and the tube will come out.
Well, time to go check on Cathy. Keep the good thoughts and prayers coming.
David
Rough Night for Cathy
Cathy did not have a good night. She did not get much sleep, her headaches were very bad, and during the night they attempted to remove the vent-assist again. I do not know how well she did, but I got the impression from the respiratory therapist and nurse that it did not go well. Shortly after I arrived at 6:30 this morning, they removed the assist again. This time the respiratory therapist remained at Cathy's side. Cathy was given several breathing treatments during this trial, her lungs were suctioned, and her sedation was increased to relax her a bit. Her blood oxygen saturation fell and rose with the treatments, her CO2 concentrations spiked and fell, her blood pressure rose to 200 over 90. After 70 minutes the ventilator was returned to providing full assist. I don't know what happened, but this did not appear to help. Cathy continued to struggle..... After several agonizing minutes Cathy's 'numbers' started to settle down. The thought that this might be a reflection of what happened during the night makes my stomach knot-up.
During the 70 minutes Cathy was breathing without ventilator assistance, the respiratory therapist performed several tests. She informed us that Cathy's throat is too swollen to attempt to remove the vent-tube. If this tube were removed, Cathy's throat would close off and she would not be able to breath anyway. No extibation today.
A different attending physician took over responsibility for the ICU this morning (normal shift rotation for the doctors). This doctor appears to run the ICU rounds at a slightly different schedule from the previous attending. She stopped by and said she would be by Cathy's room sometime after 11 this morning. Until then I will not know what the actual plan will be for today and tomorrow, how they are going to address the swollen throat, or where we stand on the battle with the virus.
Cathy's sedation was increased some more, she is now sleeping.
David
During the 70 minutes Cathy was breathing without ventilator assistance, the respiratory therapist performed several tests. She informed us that Cathy's throat is too swollen to attempt to remove the vent-tube. If this tube were removed, Cathy's throat would close off and she would not be able to breath anyway. No extibation today.
A different attending physician took over responsibility for the ICU this morning (normal shift rotation for the doctors). This doctor appears to run the ICU rounds at a slightly different schedule from the previous attending. She stopped by and said she would be by Cathy's room sometime after 11 this morning. Until then I will not know what the actual plan will be for today and tomorrow, how they are going to address the swollen throat, or where we stand on the battle with the virus.
Cathy's sedation was increased some more, she is now sleeping.
David
Sunday, July 6, 2008
Please Wait One Week for Your Answer
One week ago tonight, I brought Cathy in to the emergency room. What an experience! Valet parking, a brand new facility and no waiting. Cathy was whisked straight into an observation room. At that time I had one over-riding question in my mind. I am sure it is the same question everyone else had when I called letting you know Cathy was in the hospital....
"What is making Cathy sick?"
The doctors have been saying viral, bacterial and fungal infections. Well, it seems that doctors like to hedge their bets. (If they say everything is making her sick, then somewhere in that statement is the correct answer).
After seven days we have a specific answer. The fungus that they have cultured, aspargillis (don't count on that being spelled correctly) is the one Cathy was exposed to sometime during her transplant. She has 'always' had that fungus in her and it has not "bloomed". Also, they have not been able to culture any bacteria. They are now confidant that Cathy does not have any bacterial infections. They are consistently seeing virus in the cultures. The virus they are seeing is a common one this season (although they thought it was a little late in the 'flu season' to still be seeing it). So.... Cathy was brought into the emergency room because she has viral pneumonia. It has taken a week, be we now have an answer to our over-riding question.
The doctors are going to continue with the antiviral treatment regimen until they do not culture any more of the virus (however, no more IVIG). One target, one tactic, one answer. I don't know about everyone else, but as someone who prefers to deal with absolutes as opposed to pie in the sky generalities, this brings comfort to me.
Next Question: When will Cathy be able to go home?....
Please wait one week for your answer.
David
"What is making Cathy sick?"
The doctors have been saying viral, bacterial and fungal infections. Well, it seems that doctors like to hedge their bets. (If they say everything is making her sick, then somewhere in that statement is the correct answer).
After seven days we have a specific answer. The fungus that they have cultured, aspargillis (don't count on that being spelled correctly) is the one Cathy was exposed to sometime during her transplant. She has 'always' had that fungus in her and it has not "bloomed". Also, they have not been able to culture any bacteria. They are now confidant that Cathy does not have any bacterial infections. They are consistently seeing virus in the cultures. The virus they are seeing is a common one this season (although they thought it was a little late in the 'flu season' to still be seeing it). So.... Cathy was brought into the emergency room because she has viral pneumonia. It has taken a week, be we now have an answer to our over-riding question.
The doctors are going to continue with the antiviral treatment regimen until they do not culture any more of the virus (however, no more IVIG). One target, one tactic, one answer. I don't know about everyone else, but as someone who prefers to deal with absolutes as opposed to pie in the sky generalities, this brings comfort to me.
Next Question: When will Cathy be able to go home?....
Please wait one week for your answer.
David
Extibation
The doctors say Cathy will be ready for extibation (removed from the ventilator) soon! Maybe even as soon as tomorrow!! How about that for exhilaration!!! It appears the doctors read more into those extra 6 minutes than I did.
They are focusing on 'dialing in' her electrolytes - potassium, magnesium and all those other 'esiums. Her blood pH is still a little out-of-whack (my words, I don't think you will find that one in any medical dictionary). They are also still concerned for the CO2 in her system, but it must not be a great enough concern to stop them from trying to extibate her. (I know, it sounds kinda nasty doesn't it?).
..... I just grabbed a moment with the attending physician in the hallway outside of Cathy's ICU. He stated that he is "confident that they should" be able to remove the breathing tube tomorrow. (He is confidant in a possibility. I guess that is something you learn in medical school). However you want to read it, We'll take it....
They are focusing on 'dialing in' her electrolytes - potassium, magnesium and all those other 'esiums. Her blood pH is still a little out-of-whack (my words, I don't think you will find that one in any medical dictionary). They are also still concerned for the CO2 in her system, but it must not be a great enough concern to stop them from trying to extibate her. (I know, it sounds kinda nasty doesn't it?).
..... I just grabbed a moment with the attending physician in the hallway outside of Cathy's ICU. He stated that he is "confident that they should" be able to remove the breathing tube tomorrow. (He is confidant in a possibility. I guess that is something you learn in medical school). However you want to read it, We'll take it....
Cathy is resting very peacefully at the moment. I am confident that tomorrow should be a good day.
David
Exhilaration!
Sixteen minutes.... eighteen if you go by my watch.....
That is how long Cathy was able to breath on her own this morning. During that time her blood gasses held good values (her CO2 did go a little above the comfort level). Again, the limiting condition was her blood pressure (per the numbers). For Cathy the limiting condition was her temperature. She became uncomfortably hot.
Cathy is very alert today. She has asked me to bring her glasses so she can read each of your post for herself. She will be reading them this afternoon.
Thank you all for your prayers.
David
That is how long Cathy was able to breath on her own this morning. During that time her blood gasses held good values (her CO2 did go a little above the comfort level). Again, the limiting condition was her blood pressure (per the numbers). For Cathy the limiting condition was her temperature. She became uncomfortably hot.
Cathy is very alert today. She has asked me to bring her glasses so she can read each of your post for herself. She will be reading them this afternoon.
Thank you all for your prayers.
David
Westwood CA @ 3:45 am
It is a rare peaceful moment in the metropolis. As the city sleeps, I cannot.
Cathy was also awake when I arrived at her ICU room @ 3:45 this morning. I believe we are both anticipating another attempt at turning down the ventilator.
On my walk to the hospital this morning I was recalling a moment almost four years ago when the doctors turned off the ventilator just after Cathy's transplant. At that time I was very inexperienced with all these miracle procedures that the doctors employ, so I don't know, they may have attempted turning it off before I saw it, but I didn't notice. I remembered the exhilaration I felt as I watched Cathy breath freely for the first time in years. This morning I realized that I was looking for that same exhilaration the past two days as the doctors were again attempting to ween Cathy off the ventilator. I must get off that roller coaster. Today they will again turn down the ventilator. Today we will pray only for an improvement.....11 minutes?.... and be exhilarated when it happens.
The doctors, nurses, and respiratory therapists are all about the numbers and raw data....blood pressure, blood oxygen saturation, blood CO2 concentration, potassium, calcium, temperature, and on and on and on...... As of yesterday, the majority of the "raw data" for Cathy was "in-line with Cathy's baseline". That's doctor's speak for normal for Cathy. There is one number that they say still must improve. On the monitors it is displayed as "CVP2". It has something to do with the pressures somewhere deep inside Cathy. I believe it is a pressure reading from a vein in or around her heart (they have a tube entering from the side of her neck that I believe leads to her heart, or close to it). On Friday this number was in the high 40's, yesterday it was in the teens, this morning it was floating between 8 and 10. I was told that this number should be below 6. That's a steep curve.
Well, I need to find some coffee before I head back in to see Cathy. In the old UCLA hospital I knew all the nurse's stations and waiting rooms where you could find a late-night cup of joe. I haven't found any yet in the new hospital. There isn't even any vending machine coffee to be had. I think I'll take another peaceful stroll through Westwood and find a cup of coffee.... before the city awakes.
David
Cathy was also awake when I arrived at her ICU room @ 3:45 this morning. I believe we are both anticipating another attempt at turning down the ventilator.
On my walk to the hospital this morning I was recalling a moment almost four years ago when the doctors turned off the ventilator just after Cathy's transplant. At that time I was very inexperienced with all these miracle procedures that the doctors employ, so I don't know, they may have attempted turning it off before I saw it, but I didn't notice. I remembered the exhilaration I felt as I watched Cathy breath freely for the first time in years. This morning I realized that I was looking for that same exhilaration the past two days as the doctors were again attempting to ween Cathy off the ventilator. I must get off that roller coaster. Today they will again turn down the ventilator. Today we will pray only for an improvement.....11 minutes?.... and be exhilarated when it happens.
The doctors, nurses, and respiratory therapists are all about the numbers and raw data....blood pressure, blood oxygen saturation, blood CO2 concentration, potassium, calcium, temperature, and on and on and on...... As of yesterday, the majority of the "raw data" for Cathy was "in-line with Cathy's baseline". That's doctor's speak for normal for Cathy. There is one number that they say still must improve. On the monitors it is displayed as "CVP2". It has something to do with the pressures somewhere deep inside Cathy. I believe it is a pressure reading from a vein in or around her heart (they have a tube entering from the side of her neck that I believe leads to her heart, or close to it). On Friday this number was in the high 40's, yesterday it was in the teens, this morning it was floating between 8 and 10. I was told that this number should be below 6. That's a steep curve.
Well, I need to find some coffee before I head back in to see Cathy. In the old UCLA hospital I knew all the nurse's stations and waiting rooms where you could find a late-night cup of joe. I haven't found any yet in the new hospital. There isn't even any vending machine coffee to be had. I think I'll take another peaceful stroll through Westwood and find a cup of coffee.... before the city awakes.
David
Saturday, July 5, 2008
A Comforting Visit
This afternoon Dr. Saggar dropped by and spoke with Cathy, Jessica and I for a few moments. Dr. Saggar has been involved with Cathy since before her transplant in 2004. He is currently the attending physician overseeing her next transplant. Cathy respects Dr Saggar greatly. This simple visit from Dr Saggar brought a twinkle to Cathy's eyes and a smile to her face.
Dr. Saggar was very reassuring. Cathy is going to recover from this pneumonia and receive her transplant. The main concern is for her to not catch a different bacteria, virus or fungus (one they have not identified in her so for) while she is recovering....... "You are hanging on by a string, you cannot afford any more. This is just going to take some time".
These few prescious moments out of Dr. Saggar's very busy schedule means the world to Cathy. It raised her spirits and has allowed her to get some much needed rest.
Dr. Saggar was very reassuring. Cathy is going to recover from this pneumonia and receive her transplant. The main concern is for her to not catch a different bacteria, virus or fungus (one they have not identified in her so for) while she is recovering....... "You are hanging on by a string, you cannot afford any more. This is just going to take some time".
These few prescious moments out of Dr. Saggar's very busy schedule means the world to Cathy. It raised her spirits and has allowed her to get some much needed rest.
Another Attempt
This morning when I arrived at Cathy's ICU room she was awake and in good spirits. The overnight nurse said she slept well though the night. The only incident to note was a very brief depression of her heart rate (below 60 beats per min). The doctors do not appear to be concerned with these events.
When the doctors came by for their rounds, they all gave very "positive vibes" (but I guess that's what they are supposed to do.....). Her blood gasses are good. They now know what specific virus and fungi they are dealing with. They still have not nailed down the specific bacteria (and they may never). They are going to stop her IVIG (intravenous immunoglobulin.... I am sure that is spelled wrong). These are the antibodies that they have been giving her to fight the virus infection (since her body makes so little immunogobulin ... read antibodies... on its own due to her immunosuppression to prevent rejection on her transplanted lungs). I got the impression that giving her this IVIG for more than four days may start to damage her kidneys, liver or muffler bearing. Something like that.
Towards the end of their discussions the attending physician (head honcho of Cathy's care) decided to make another attempt at backing down on the ventilator's support. The ventilator was providing Cathy with 18 cmH2O (centimeters of water pressure... just a way to measure pressure, like PSI in a car tire). The doctor had the respiratory therapist reduce the pressure assist to 8 cmH2O. Again, within 10 minutes Cathy was struggling. This time it was her blood pressure that was the limiting factor. Her blood pressure shot up to over 180/110.
The ventilator was reset and Cathy recovered..... physically. Cathy has become well aware of the situation. I watched as her eyes filled with emotion as she realized her body was not ready to support itself........
One of the resident physicians responsible for Cathy's care took a few moments with me after finishing her rounds. She explained that with Cathy's viral pneumonia there are still lots of fluids in all parts of her lungs. They will continue to work to remove these fluids through medications and evacuations through her breathing tube.
I caught the respiratory therapist before he left the room (I saw the Attending consult with him so I figured he knew his stuff.....). He said this was not unusual. They will keep trying and eventually she will be able to support her own breathing. He explained that when they reduce the pressure and make Cathy drawn in the air on her own, she must do this through the breathing tube...."It's like breathing through a straw".
A little while later, I took a moment to go down to the cafeteria and grab a cup of coffee. While there I ran into the attending physician. He was reassuring. He said they will try it daily until she is able to hold her own.
That's about it for this morning. Jessica came in a little bit ago and is providing some needed comfort to her mother. Becky will be back down this evening and Kaitlyn will be down tomorrow.
Thank you everyone for your prayers.
David
When the doctors came by for their rounds, they all gave very "positive vibes" (but I guess that's what they are supposed to do.....). Her blood gasses are good. They now know what specific virus and fungi they are dealing with. They still have not nailed down the specific bacteria (and they may never). They are going to stop her IVIG (intravenous immunoglobulin.... I am sure that is spelled wrong). These are the antibodies that they have been giving her to fight the virus infection (since her body makes so little immunogobulin ... read antibodies... on its own due to her immunosuppression to prevent rejection on her transplanted lungs). I got the impression that giving her this IVIG for more than four days may start to damage her kidneys, liver or muffler bearing. Something like that.
Towards the end of their discussions the attending physician (head honcho of Cathy's care) decided to make another attempt at backing down on the ventilator's support. The ventilator was providing Cathy with 18 cmH2O (centimeters of water pressure... just a way to measure pressure, like PSI in a car tire). The doctor had the respiratory therapist reduce the pressure assist to 8 cmH2O. Again, within 10 minutes Cathy was struggling. This time it was her blood pressure that was the limiting factor. Her blood pressure shot up to over 180/110.
The ventilator was reset and Cathy recovered..... physically. Cathy has become well aware of the situation. I watched as her eyes filled with emotion as she realized her body was not ready to support itself........
One of the resident physicians responsible for Cathy's care took a few moments with me after finishing her rounds. She explained that with Cathy's viral pneumonia there are still lots of fluids in all parts of her lungs. They will continue to work to remove these fluids through medications and evacuations through her breathing tube.
I caught the respiratory therapist before he left the room (I saw the Attending consult with him so I figured he knew his stuff.....). He said this was not unusual. They will keep trying and eventually she will be able to support her own breathing. He explained that when they reduce the pressure and make Cathy drawn in the air on her own, she must do this through the breathing tube...."It's like breathing through a straw".
A little while later, I took a moment to go down to the cafeteria and grab a cup of coffee. While there I ran into the attending physician. He was reassuring. He said they will try it daily until she is able to hold her own.
That's about it for this morning. Jessica came in a little bit ago and is providing some needed comfort to her mother. Becky will be back down this evening and Kaitlyn will be down tomorrow.
Thank you everyone for your prayers.
David
Friday, July 4, 2008
July 4, 2008
Independance Day..... almost.
At 4:13 this evening Cathy's ventillator setting was changed so that it was no longer breathing for Cathy. Cathy breathed with the ventillator providing only a little assistance. Unfortunately, after only 10 minutes the oxygen saturation in Cathy's blood fell below safe levels and the carbon dioxide levels rose above what the doctor's consider safe for her. (I was told that it was the high carbon dioxide levels in her system that caused the mental non-responsiveness on the prior Monday). ... The ventillator was switched back to providing full support.... no independance from the ventillator for Cathy tonight.
On the positive side of things.... Cathy's health has improved enough for the doctors to feel she should be able to breath on her own again.
Cathy has been off all sedation since around noon today. I am currently sitting in the ICU room with her watching TV and blogging. Cathy is able to communicate through finger gestures (no, not that one) and notes.
...... The nurse just came in and said she was going to restart the sedation so Cathy could get a good rest tonight. They are going to attempt letting her breath on her own again tomorrow...... it is now 7:18 pm
Fireworks should start soon. There is a nice view from the window in Cathy's ICU room. To bad the sedation will probably be taking over before they start. We should be able to see the fireworks at the Santa Monica Pier from here..........
Well, I guess this is about it for my first ever blog. I will post again as things progress.
Please post your thoughts, prayers and wishes for Cathy. I will share them with her as I can.
David
At 4:13 this evening Cathy's ventillator setting was changed so that it was no longer breathing for Cathy. Cathy breathed with the ventillator providing only a little assistance. Unfortunately, after only 10 minutes the oxygen saturation in Cathy's blood fell below safe levels and the carbon dioxide levels rose above what the doctor's consider safe for her. (I was told that it was the high carbon dioxide levels in her system that caused the mental non-responsiveness on the prior Monday). ... The ventillator was switched back to providing full support.... no independance from the ventillator for Cathy tonight.
On the positive side of things.... Cathy's health has improved enough for the doctors to feel she should be able to breath on her own again.
Cathy has been off all sedation since around noon today. I am currently sitting in the ICU room with her watching TV and blogging. Cathy is able to communicate through finger gestures (no, not that one) and notes.
...... The nurse just came in and said she was going to restart the sedation so Cathy could get a good rest tonight. They are going to attempt letting her breath on her own again tomorrow...... it is now 7:18 pm
Fireworks should start soon. There is a nice view from the window in Cathy's ICU room. To bad the sedation will probably be taking over before they start. We should be able to see the fireworks at the Santa Monica Pier from here..........
Well, I guess this is about it for my first ever blog. I will post again as things progress.
Please post your thoughts, prayers and wishes for Cathy. I will share them with her as I can.
David
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