Still Improving

I apologize that I haven't updated this since Thursday night, but it has been a little crazy for me trying to get caught up with everything from spending every night at the hospital last week. I know there are many of you who depend on this blog to stay apprised of what's going on with Dad, so I'll try to keep it more up to date.

Dad has been struggling with sleep since about Tuesday of last week. He usually falls to sleep at around 10 or 11 and sleeps for an hour or two and then wakes up. He then looks over, smiles and mouths, "I think I slept better." I then inform him that it has only been a little bit and he scowls. Part of the problem is that he has had a lot of anxiety and panic attacks that don't allow him to relax.

Last week they gave him a sleeping medicine on Tuesday night called Cyroquil (spelling?) that allowed him to sleep for about four hours. However, Dad wanted to take Ambien so they gave that to him on Wednesday and Thursday. Unfortunately, it didn't help as much as the first drug so my mom was able to talk him into going back to it for Friday night. Unfortunately, it wasn't helping much either. They also started him on Haldol to help with the anxiety and panic attacks, but it seemed to have no effect whatsoever. So yesterday they discontinued the Haldol and started giving him Lesoprin (or something like that, I can't remember the exact name, sorry). They also double his dose of Cyroquil last night, and this morning the nurse told my mom that he slept much better last night and that Dad actually had a smile on his face this morning - something he hasn't had for a few days. So it sounds like the new drugs are starting to help.

Mom has been sick since Sunday with a severe cold, and the nurse on Sunday gave her several hints that she shouldn't come up on Monday, but instead stay home and get feeling better. She is also home today, and hopes to be better by tomorrow so she can start going back up and seeing Dad each day. Since Mom couldn't go yesterday, I went up and spent a few hours with him, and today Dad's aunt Jill is spending the day with him. Even though he is the one who is sick, he still worries about everyone else. He knew that I needed to leave by 5:00 p.m. yesterday to meet with a group for school and he started falling asleep around 4. But, he couldn't sleep because every few minutes he woudl wake up and ask me, "Don't you need to go?" He didn't want me to miss my meeting. So, in order to let him sleep, I decided to leave about 30 minutes early.

Dad's vent settings continue to slowly improve, as he completely controls the breaths now, and his PEEP setting was at 6 yesterday. Unfortunately, his kidneys still arent' really working at all and he will have dialysis today. He hates physical therapy because it is so draining. All day yesterday he kept asking me when they would come because he wanted to get it over with so he could relax. The anticipation was horrible for him. All of the doctors, nurses and other care givers say it will still be a long haul, but that he will definitely get out of there and go home eventually - a big turnaround from where we were a week and 1/2 ago.

Thank you to everyone for all of your support in whatever form it comes: prayers, donations, visits, bringing food to my mom, Clayton and Makell, etc. We truly appreciate everything you do and may God bless all of you for your kindness and generosity.

Thursday Night

My mom said that she felt today was the best day Dad has had since this hospital stay started 2 and 1/2 weeks ago. For example, he currently has no IV drips going – it's absolutely unbelievable. His kidneys also started working on their own a little bit today, which I don't think anyone expected, and he is no longer on 24/7 dialysis. Tomorrow he will be started on standard dialysis, which lasts about 4 - 5 hours per day. The standard dialysis will begin to take a lot more fluid out of his system, which should help his lungs to start working better.

Uncle Derek, thank you for volunteering for Saturday night, I really appreciate it. All the numbers I have for you are disconnected, so I hope you read this :-). Thanks to Enrique as well, he is going to stay tomorrow night. My wife is very excited to have me home for two nights!

Dad still has a long way to go, but things are definitely looking up.

Thursday Morning

Dad has made some great progress today. He is now off all of his heart medications, so the only IV drips he is on now are antibiotics and calcium (due to the fact that the anti-coagulant for the dialysis binds to calcium and clears it out of him). His vitals are much improved with a pulse of about 75 and a blood pressure of 160/65. They were also able to reduce one of the settings on his vent today, which is another good sign.

Early Wednesday morning, Dad's hematocrit was at 19 (which is low) so they gave him two units of blood and the number jumped up to 28, which the nurse Jill said was a big jump, so that was positive as well. Because the hematocrit keeps dropping, the care team is assuming that he is still bleeding somewhere, but they did another CT scan today and couldn't see anything which would be causing the number to drop like that. The resident on tonight, Dr. Millar, said that it is possible the dialysis is causing the problem, so they will just keep monitoring him and see what happens.

The CT scan did reveal that Dad's NG tube (which drains fluid, mostly bile, from the stomach so it doesn't seep up through the esophagus and go into the lungs) was too far down, which may have been the cause for the issues with his pancreas. They pulled it out a little, and we are currently waiting to hear back from the lab to see if the pancreatic enzyme numbers have improved. If they have, then they will be able to start feeding him through his feeding tube again, which I know will make Dad happy.

When Dr. Millar came around tonight he started talking to my Dad about the priesthood blessing he received on Saturday night (the 21st). For those of you who aren't aware of it, we are members of the LDS faith and believe in the anointing of the sick and afflicted as spoken of in James 5:14. So, on Saturday night, when things were bleakest, my brother-in-law Enrique did just that, with the aid of one of the doctors here in the SICU. He was anointed with oil and given a blessing that he would be able to have the strength to make it through the night and the procedure he was going to have the next morning. Dad was also given a blessing by his bishop (local church leader) a little bit later, in which he was told that he would be here long enough to complete his mission.

Anyway, doctor Millar was trying to tell Dad something about the blessing, but Dad started talking about having a care conference for all of the patients that he would lead, so the doctor wasn't able to finish. A few minutes later I went out and asked the doctor what he was going to say. He said that he and the doctor who helped Enrique on Saturday (his first name is Matt) are both LDS as well, but that it is very hard for them to participate in blessings sometimes b/c their education and training sometimes overshadows their faith. He said that the expectation of the doctors on Saturday night was that Dad wouldn't survive until the next morning – medically it looked like he didn't really have a chance. So, it was a somewhat difficult task for Matt to have the faith to participate in a blessing for Dad to get better when he didn't really think that would happen.

Dr. Millar continued to tell me that because he had been asked to help, Matt was happy to, despite his reservations. Then, miraculously, Dad started to improve – against all odds. The medical team hadn't done anything different to help him, he just started to improve on his own. Dr. Millar said that ever since Matt told him the story of what happened that night, Dad's experience has been a source of spiritual strength for him and helped renew his faith in the power of priesthood blessings. I can only say, "Wow!" Dad continues to touch so many people's lives, many of which he doesn't even know about. We're sincerely grateful for the priesthood and the Lord's continued sustaining of Dad and the family.

I also had a frank discussion with Dr. Millar about what we can expect going forward. He said that Dad is still very sick, and actually used the term, "pulmonarily disabled". It will be a minimum of "weeks" before Dad will be able to get off the respirator and breathe on his own – assuming everything continues to improve as it has been over the last few days. Any setbacks could obviously change the time frame. He also said that he has renal failure, and that it is fairly likely that Dad will never regain the full functionality of his kidneys. The doctor also said that Dad is extremely weak, and it will be a long time before he can stand up on his own, or even sit up. When I asked about what kind of quality of life Dad could expect, he said that as long as they can get him off the respirator and home Dad should still expect to have a high quality of life. As far as predicting anything else, Dr. Millar said it was anyone's guess. So, we'll just continue to take each day as it comes and hope for the best.

I noticed that Pam Slade (one of my parents' neighbors) left a comment to the effect that they would like to come see him, but can't. Well, you can! The SICU is open to visitors 24/7, with the exception of shift changes which occur every twelve hours from about 6:30 to 8:30. If you would like to come visit Dad, it would be best to come between 8:30 a.m. and 6:30 p.m b/c that is when he is most likely to be awake. We would only ask that if you are sick with a cold or the flu that you wait until you are better to visit, and that you keep the visits short (5 - 10 minutes), as communicating is difficult and tiring for him. But, I'm sure he would be happy to see any of his friends, family, neighbors, etc.

I have a favor to ask. I have a new nephew who is being blessed in church on Sunday morning, and I would like to attend. If someone would volunteer to stay with Dad on Saturday night, from 8:30 p.m. to 6:30 a.m., I would greatly appreciate it (my wife would also like to have me home at least one night this week :-). It's a pretty easy job, as he sleeps the majority of the night. You would just have to be here to help him when he is awake, with things like more blankets, suctioning out his mouth, listening to his iPod and watching TV. Just post a comment here on the blog, or call or email me if you're interested.

Thanks to everyone for all the help and support. We know Dad wouldn't be doing as well as he is without your collective faith and prayers.

The Fight Goes On

I want to thank my wife Jen for the fantastic job she did on the last post. I was way too tired to write anything at that point, so I really appreciate her help. The doctors were able to turn down the settings on Dad's ventilator ever so slightly today, and he is almost all the way off Milrinone, a medicine used to dilate the blood vessels.

Because Dad hadn't slept for two or three days straight after they stopped sedating him, he has been extremely tired yesterday and today. A few hours ago, he was so exhausted that he started to cry a bit when he was having a hard time telling me something he needed. It is so frustrating for him to not be able to do anything for himself. I asked him if he would like something to help him sleep, and he said yes. The doctor's prescribed him 25 mg of a combination sleeping and anti-anxiety medicine that starts with a "c" (sorry I can't remember the name). When he woke up just a few minutes ago, he said that he feels like he slept better, so it seems to be working.

Dad's pancreas (which produces insulin, among other things) is not working correctly; it is producing too much of a couple of enzymes that aid in digestion. Because feeding him would only cause the pancreas to produce more of the enzymes, they have stopped feeding him through his feeding tube. If the enzyme levels don't go down in the next day or two, then he will have to receive his nourishment through an IV. Hopefully the levels will go down so he can get something in his stomach, as he told me last night that he felt famished.

His biggest request continues to be for water, and the nurses have started to allow him to have four or five swabs (small sponges the size of a die on the end of a stick) worth of water at a time – but he still wants more. His mouth and throat always feel dry, and nothing would make him happier than to take a big swig of water. Unfortunately he can't, because his esophagus is currently pinched closed by his tracheotomy tube, so the water just goes right to his lungs. They try to limit the amount that goes to the lungs to try and prevent infections. Dad's blood pressure and pulse are pretty much normal now, and he only has to receive insulin once or twice a day after he is given steroids (which raise blood sugar).

While he is making progress in the right direction, all of us wish it was at a faster pace (him most of all). Unfortunately, we just have to be patient and let his body heal as fast as it can. When I told him yesterday about the AFPPA scholarship that had been created in his name, he just started shaking his head and mouthed, "Wow!" I could tell he was very touched. Thank you to his fellow PA's who deemed him worthy of such an honor, and to all of those who continue to pray for him and the family. While this is a difficult and trying time for him, we know that Dad can get through it with your support.

What a Weekend!!!

Hi everyone, this is Jen, Jim's daughter-in-law. Clint asked me if I would just give you a quick up date of what has happened since Saturday. I only know basics, so once Clint has rested enough, he'll fill you in on anything I miss.

On Saturday they turned Jim's SICU room into a make shift OR seeing he wasn't stable enough to move. He had a temperature of 104 and they thought that his central lines where the cause of his infection so they were able to successfully move all of the lines to the other side of his body.

Unfortunately this didn't help much and his blood pressure seemed to still struggle. The only thing that seemed to control his blood pressure was to give him more blood. They decided that he was loosing blood somewhere, they just weren't sure where the problem was. They had wanted to do a scan, but seeing he was so unstable they weren't able to move him. The Doctor was very concerned and Jim kept mouthing, "No more medicine!" When he was asked if it was his time to go, he just rolled his eyes and said, "No I have more of a mission."

Patti asked the doctor if it would be a good idea to get the rest of his family up to see him, and he highly recommended it. The doctor wasn't sure if he was going to make it through the night and told us if there was anyone who wanted to see him, they should come now. All of his siblings were able come up to the hospital, except for his sister Mel who is on vacation in the Philippines.

The SICU staff was kind enough to let bigger groups into see Jim, usually they only allow two people in the room at a time. Everyone was able to tell him that they love him and spend a little time with him. The immediate family was able to spend most of the night with him.

Despite Jim's condition Saturday night, I am pleased to tell you that he is still Jim. All night he was still cracking jokes and making funny comments. Even though it's hard at times to read his lips, we definitely know he still has his sense of humor. When Patti came back from the restroom once, he told her to not leave him again and that she should get a cathater put in her so she wouldn't have to leave again.

By 2:00am nothing major had changed, so we tried to get some sleep. All of his children and his spouse stayed the night, along with Melody's son Jordan. We slept (if you call it sleep) in the waiting room, some of us on chairs and other's on the floor. We all wanted to be there in case something happened. Patti stayed by his side all night and when she woke up from a little 30 minute nap, Jim told her not to do that again. He hasn't been able to sleep much since they took him off the sedation meds and he doesn't want to be left alone.

At 5:30 a.m. Jim was stable enough to move to get a CT Scan where they found the source of his bleeding. If I understand right it was in his thoracic cavity. The doctors were afraid to take him into surgery in case he couldn't handle it, but decided that it was better to take the risk then not.

We're so thankful that they did! Dr. Bull cauterized 50 capillaries on his lung which took care of the bleeding. He also took a look at his lungs and is very pleased with how they are healing. He said that usually when people have gone through what Jim has, the lungs are purple and not healthy looking. Jim's were pink and looked very healthy.

As Sunday went on Jim continued to get better and better. His blood pressure is higher than it has been since his last lung surgery, they have turned down the ventilator and he is breathing more on his own, and they have taken him off two of the four heart drugs he has been on (this is very good news because the drugs he has been on are damaging after long time use). By the end of the day they hope that he will be off all four meds.

We are just so happy that this miracle has happened. We know that things still aren't over, but being at the bottom and now working up, is a much needed change. We just hope that he keeps continuing to climb and that we don't see the bottom for a long time.

Thank you, thank you, thank you for everyone who has prayed for Jim and the family. We know that it's because of you that we've all been able to handle this situation. I have to apologize that I'm not as eloquent or as informative a writer as Jim or Clint. Clint spent the night in Jim's room last night so Patti could get some sleep and I offered to give an update so Clint could get some rest. Once he wakes up, and has received more information, I'll have him update you with the latest and correct any of my mistakes.

Thank you again for everything!

A Bad Night

Despite the successful tracheotomy yesterday, and the fact that we were able to communicate with him after a week and a half, Dad is still not doing very well. His blood pressure was very low again last night, even though they are giving him steroids on a regular basis. His white count is up to 29,000 (meaning the infection is getting worse), and he continues to have a GI bleed.

During the procedure yesterday the team only removed and replaced the external parts of two of his three central lines. Since the infection is just getting worse, they have decided to sterilize his room today and completely replace all three of them right there in his room. They will most likely also being doing a scope of his GI system to see if they can find the source of the bleeding. For whatever reason, it just seems like Dad can't have two straight days of improvement.

We continue to hope and pray for the best, and thanks to all of you for doing the same. Here are a few more pictures my mom asked me to post.

Dad and his current setup

The dialysis machine

This machine delivers medicine through the ventilator which helps the right side of Dad's heart pump better

My parents' friends, Richard and Kasey Elkins, flew up from Texas last week. Thank you!

Quick Update

Dad's tracheotomy is complete, and he has been back in his room for about an hour. They keep telling us that we can't come back for a few more minutes because they are getting him settled. We were told that the procedure went well, and they also replaced the three different central lines he has, as they believe one of them is a source of infection. I'll post any other info as it becomes available.

12:21 p.m.: We're back in Dad's room now and he is actually interacting with us! The SICU doctors wanted to see how he would do without the paralytic (although he is still under heavy sedation) and he seems to be doing very well so far. We were able to talk to him and he squeezed our hands three times for "I love you". He kept mouthing the word "water" because his mouth is so dry from having the tube down his throat and his mouth open constantly. Now that his mouth has been swabbed a few times he seems to be happy. When I told him he was in the hospital he also mouthed, "I know." When I said that it was great to interact with him and that we had missed him he cried a little and shook his head. It makes such a huge difference to be able to communicate with him! I'll let you know if anything changes, but things are going very well right now.

Ups and Downs

The marathon and drama continue, unfortunately. Every day there seems to be a few small improvements along with a few small setbacks (or sometimes large ones). The net result is that not much has changed since the last post. His blood pressure and heart rate are fairly stable, most of the time, but every once in awhile his blood pressure falls to 50/30, which is obviously not good. The nurses then give him a quick shot of steroids or other medication and it usually returns to a more stable number shortly thereafter.

There are two big things which have changed. The first is that on Tuesday the doctors discovered that Dad had developed a bleed in his gastrointestinal tract. He was given some blood and platelets and it seems to be under control now. It was a little scary when he passed a blood clot the size of a fist on Wednesday, but their hasn't been anything since then.

The other major development is that Dr. Bull thinks it would be beneficial for Dad to have a tracheotomy, which is when a hole is cut in a person's throat (I apologize for the blunt way of putting that). This will hopefully allow the ventilator pressure to be turned down to a more normal level, and will allow them to more easily remove the tube for short periods of time once Dad is ready to start being weened off of the ventilator. Additionally, I noticed today that his lips have become quite dry – despite the nurses very regularly placing cream on them – even to the point that there was some dried blood on them. Having the tube go through the "trach" will allow his mouth to be closed and moistened more naturally.

In order to get the tracheotomy, Dad will be going to the operating room at 7:00 a.m. tomorrow morning. Please pray for the procedure to go smoothly. Again, thank you to everyone for your prayers, visits, donations, food, and everything else everyone is doing to help our family. We couldn't have made it this far without all of you.

The Marathon

Over the last few days, several of the doctors have been talking to my mom about what is going on with my dad, and how long we should expect his recovery to take. They have been using phrases like, "it's going to take a long time," or "we just try to make small, incremental improvements each day, and somedays there will be set backs." Dr. Bull was talking to my mom about trying to take care of herself, telling her she needs to eat and get plenty of sleep, etc. He said that this process is like a marathon, so she needs to pace herself and make sure she takes care of herself. So, I guess the point I'm trying to make is that Dad is going to be in the SICU for quite some time, and most days there probably won't be much significant change.

Friday there was a bit of a scare when the doctors found a large white mass on the right side of Dad's chest in an x-ray. They weren't sure whether it was fluid or air, but knew they needed to get it out of there by inserting a chest tube on that side. They were thinking of just doing the procedure right there in his room, but Dr. Bull said it would be too dangerous not to know exactly where it needed to go. They decided to do a CAT scan so they could get the tube precisely where it needed to go. It took six people to move Dad, his bed and all of the equipment that had to go with him. They were able to get the scan and insert the tube successfully, and as soon as they did there was a big whooshing sound, so it turned out to be air. However, the doctors have no idea where it came from, as there is no leak in his lung or any other obvious source. But, getting the air out made it easier for the respirator to function correctly and for Dad to breathe, so overall it was a positive development.

Saturday was fairly uneventful, with the doctors continuing to try and slowly wean Dad off of the ventilator and his medicines. Sunday they began to switch his sedation medication from Verced (spelling ?) to Propolol (or something like that, sorry) which is a more mild sedative and will make it easier for him to wake up. The only problem is that changing the medication also caused his blood pressure to go a little crazy and his heart rate to go back up into the high 100-teens, when it had been down around 100 prior to the change. They also took Dad off of the paralytic medication for about an hour-and-a-half yesterday, which he seemed to tolerate very well. After that time he began to fight against the respirator again so they had to restart it. But, my Mom said that during the time he was off it he did raise his eyebrows once while she was talking to him.

Several times over the last few days they have tried to set the dialysis machine to start removing the extra fluid which has been accumulating in Dad's body, but each time they try he doesn't react very well. So, the dialysis is currently only removing the amount of fluids they are putting into him. As a result of the extra fluid, he has a somewhat swollen appearance. Because of the high blood pressure (190/90) after changing the sedative yesterday, they wanted to make sure that Dad hadn't had an aneurism or anything, so they checked his aorta and it was the correct size, so everything looked alright.

As you can see, there hasn't been a whole lot of progress over the last few days, just a little bit here and there. This whole process really is like a marathon and is going to take a long time. As more changes occur or information becomes available we will keep you up to date. Thank you once again to everyone who has been praying and fasting for my Dad and our family, we can't thank you all enough or tell you how much it means to us. Thank you also to my dad's sisters Karyn and DeAnn, and my parents' friends from Texas, Richard & Kasey. They have all been spending quite a bit of time at the hospital with my Mom over the last few days when us kids couldn't be there, we really appreciate it.

Slow and Steady

I apologize to all of you who were anxious for an update Thursday, but I was severely behind on school work from being at the hospital Monday through Wednesday and had to do some catching up. The post tonight comes from an email that my sister Mariah sent me a couple of hours ago. She was at the hospital with my mom most of the day and knew everything that had been going on. Thanks Mariah!

This morning the hospital called and obtained Mom’s permission to put a feeding tube in Dad, and to also put a tube in for dialysis. When we got up to the hospital, we were glad to find out that Dad had a much better night. They had started to give him a new medicine last night directly through his ventilator and it had started to help the right side of his heart pump better. Throughout the day it continued to help, and all of his heart numbers have improved.

Since all the monitors were showing that his numbers had improved slightly, they wanted to confirm it with an echo to see if they should continue on the same course or try a different medicine. Dr. Lou came in and told us that the echo did show some improvement in the heart. The right side looked better than yesterday, but is still dilated; his left side showed that it was getting more of the blood that it needs.

All the doctors told us that the dialysis machine is going to be his best friend for awhile. They started him on Continuous Veno Venous Hemodialysis (CVVHD). There are two types of dialysis and this one is the lesser of the two evils, so to speak. It will run 24/7, and is much gentler on the body vs. the other, which runs 4 to 5 hours at a time and is very harsh on the body – which he couldn't handle right now.

I think that they started the dialysis around 2 p.m. At first they were just taking out the fluids they were putting in to see how his body would handle it, and it did very well. About 5:30 p.m. they started taking out a very minimal amount of excess fluid to see how he handled that, and when mom left at 7 he was still doing well with it. Once they can start getting out more of the fluid, the more his heart and lungs will start to improve. Hence the reason dialysis is going to be his best friend.

They have also been worried about his kidneys, since their function hasn't been normal, so they did an ultrasound on them today. Dr Lou just had the preliminary report, but said that from what he could tell the kidneys look fairly normal. He feels that they haven't been functioning properly due to lack of blood flow, which is caused by the low blood pressure, which is caused by his heart not working correctly, which is caused by the water retention. It is just one big circle.

The kidney specialist team (nephrologists) came to check on Dad. They told us that with Dad’s diagnosis his kidneys have an 85% to 90% chance of fully functioning again, but that first the heart and lungs have to heal, and then the kidneys follow. As of right now, the dialysis machine is doing the total function of his kidneys. With the dialysis they have to use citrate to keep the blood from clotting in the machine. It also has dextrose in it, which has caused Dad’s glucose levels to go up again, but they aren't too worried about it because that is to be expected and have simply increased his insulin to regulate it.

Things on the ventilator are slightly improving. They were able to lower his oxygen to 40%, which is the lowest they put it at while a patient is on a ventilator. There is also a PIP number and a PEEP number which has to be met in order for him to be off the ventilator. It needs to be 5/5 and today when we left they had it at 28/12 vs 36/12 yesterday. Throughout last night and today they were able to lower it in small increments. Dr Lou was happy with this progress, saying that even though he is just making baby steps, at least they are in the right direction. His main goals now are to get the excess fluid off of his lungs, to continue to slowly decrease the numbers on the ventilator, and also get him to a point on it that they will be able to start taking him off sedation and paralysis. They have to make sure that he will be able to be comfortable and relaxed so that his body won't try to fight it again. But they really want to get him awake so that he can start interacting again.

If things keep slowly improving, Dr. Lou also wants to gradually start taking him off some of the 11 medicines that he is getting. All of the doctors say that they are happy with his progress today and that if he continues to improve a little more each day, or at least stays stable for a day or so in between days with improvements, then they will continue to be happy. Dr. Lou said that he isn't walking such a fine line as he was on Tuesday, and he has more leeway to move numbers around (on the ventilator, etc.), which is a good thing. I again asked him his opinion on the probable outcome, and he still wouldn't give a certain answer, just that there will be more waiting and seeing.

Also today, they were able to take out his tube for the spinal block (which was used during the surgery on Monday for pain management). At first his clotting factor (INR) was too high, meaning that his blood was to thin and wouldn't clot, so they had to give him two units of FFP (fresh frozen plasma) to bring it to a normal level. They then took it out, so now he has one less tube. Dad also ended up having three units of blood yesterday to help hydrate the left side of his heart and raise his blood pressure, which together with the new medicine they are giving through the ventilator, helped his blood pressure to be up and his heart rate to be down. They said that although they are happy with his improvement, Dad is still very sick and his situation is still very serious.

Thank you again to everyone who is keeping Dad and the rest of us in their thoughts and prayers. It is making all the difference.

SICU Day 3

Good morning everyone. I want to take this opportunity to thank everyone who visited, called and commented on the blog yesterday, and to all those who kept Dad in their thoughts and prayers and continue to do so today. I also want to especially thank Jordan and Jane Putnam for their hospitality in allowing my mom and I to stay with them overnight. I would also like to thank all of the doctors, nurses, aids and everyone else who have been taking care of my dad over the last year, and the last couple of days. Almost without exception, they have been extremely kind, caring and willing to answer any of our questions and explain everything they are doing to us. It makes such a big difference to be able to at least understand what is wrong, what they are doing to fix the problems, and what all the machines that are plugged into Dad are doing and measuring. Thank you!

Last night around 8:30 p.m. we were told that Dad had spiked a fever of 104ºF, and his white count was at 19,000 (it should be between 4 and 8K) due to the infection in his body. The theory is that he had a latent infection prior to the surgery on Monday, which the body was fighting until all of the stress of the procedure compromised his ability to do so. They are currently treating him with a powerful broad spectrum anti-biotic as well as an anti-fungal, and then as soon as the blood cultures return (hopefully some time today) and they know what the infection is they will start treating it with a more targeted medicine. When we arrived this morning, the nurse informed us that his fever was gone, his white count was at 12,000, and gave us some other good news which I will address below.

One of the main problems Dad has is what is called Adult Respiratory Distress Syndrome, which means both of his lungs basically completely deflated and couldn't function properly. In order to get them back to normal, the doctors put him on a respirator at a very high pressure in order to re-inflate them. Because the pressure is so high, and because the respirator is set to such a high number of respirations per minute, it feels very unnatural to Dad (or anyone) and the body naturally tries to fight it. So, in order for the respirator to do its job, Dad had to be sedated and paralyzed chemically so he wouldn't fight against it anymore. It is very interesting to see the different perspectives all of the doctors and nurses have about what is going on and what to expect. Some are optimists and others are more realistic in their expectations. Basically, we can expect Dad to be under sedation for at least two to three more days, and on the respirator for anywhere from one to three weeks - depending on which estimate is correct. While yesterday the respirator was set to 100% oxygen most of the day, it was turned down to only 50% O2 today, which means it is progressing in the right direction.

Because of all the problems he's been having with his lungs, his blood pressure and heart rate have not been ideal. Yesterday his blood pressure was around 80/50, and his heart rate was up in the 140's most of the day. The SICU team tried several different medicines to normalize them, but unfortunately, Dad's body didn't really react very well to any of them, so they kept hovering around those numbers most of the day. However, during the early morning hours he was started on a new medicine that helps the right side of his heart function better, which has been working quite well and his blood pressure this morning is around 100/60 and he has a heart rate of about 117, both moving in a positive direction.

Last night Dad's blood sugar, potassium and creatinine levels shot up, so they have been treating those with medications as well. At its peak, his blood sugar was at 200, but this morning it is back down to 121, and Stewart (his nurse today) said that anything between 60 and 120 is considered good. The potassium and creatinine levels are still too high, even though he has started having more urine output from his kidneys. He may have to have dialysis to take care of those two levels if they don't turn around on their own soon.

An ultrasound was also performed on Dad's heart this morning, just to make sure everything is functioning properly, and the ultrasound tech seemed to think it was. Although my mom had a bit of a scare when the tech mentioned to the nurse that it didn't look like he had endocarditis or anything like that. Well, all my mom heard was "endocarditis" and I could see the instant panic on her face, because that is what my dad's mom had that eventually took her life. I quickly reassured her that the tech had said he didn't have it, and the color soon returned to her face.

Below are some pictures for your viewing:



Here is a picture of most of the tumors that were removed by Dr. Bull and his team from Dad's left lung on Monday

This is a picture showing his vitals at about 11:00 a.m.

This picture and the next are for a general idea of the setup of machines that surround him right now

As you can see, the "tree" of IV medicines is quite large - a total of 11 different items at the moment

Please Pray

Update: After we gave Dad the blessing, the SICU team came into his room on their morning rounds and told us what is going on. Basically, Dad's lungs aren't working efficiently enough on their own. They're retaining too much carbon dioxide, which is unbalancing his pH levels and making it too acidic. Because his lungs aren't working correctly on their own, he has been put under heavy sedation and paralyzed from the neck down so that the respirator can take care of breathing for him.

His lungs are also retaining too much fluid. In order to offset the fluid, he is being treated with Lasix, but his kidneys aren't functioning properly either so that's complicating matters even more. When I asked one of the doctors if he was optimistic about the outlook, he said that he just can't tell right now. He said that Dad is walking a very fine line right now, and they are just trying to find the balancing point. The next 24 to 48 hours are critical and the doctors will be able to tell a lot more after they have passed.

Original Post: We know that there are many of my dad's family members, friends and colleagues who continuously pray for him and have him in their thoughts. We are asking that you especially do so today, as things aren't going as well as hoped after the surgery. All day yesterday, Dad's heart and breathing rates were much higher than the doctors would have liked them to be, and the trend continues today. In order to better measure what is going on, and to help them get the rates back down where they need to be, the doctors are inserting a catheter into Dad's heart this morning. Mom, Mariah, Enrique and myself are heading up to the hospital and I'll let you know as we learn more. Thanks to everyone for your unbelievable generosity, love and support through this entire ordeal.

Lung Surgery #2

10:45 a.m. – Dr. Bull just came out and said that the surgery is complete. Everything went well, but they had to remove approximately 50% of his left lung in order to get all of the nodules (about 15 of them). The doctor actually said that if his right lung had been whole he would have rather just removed the entire left lobe, but since that wouldn't leave him with enough capacity b/c of what he lost in the last surgery, just cutting out the individual tumors was the best option. We're now just waiting for him to recover enough for us to go see him in the SICU, which will take about an hour and a half. He'll also wake up with a tube down his throat as he isn't awake enough to remove it yet.

9:40 a.m. – The nurse called again and said that it would be at least another hour. She also mentioned that they have already removed several "specimens", and that every thing is still going smoothly.

8:45 a.m. – One of the nurses in the surgery room called and said that it is underway and everything is going well so far.

7:45 a.m. – Hello everyone. Today's surgery started very early. Jim, Patti, Clayton and Makell had to get up at 4 a.m. this morning to make it to the U of U hospital by 6 a.m. Coleton and I (Clint) arrived at about 7 and Mariah just arrived. Jen is working, and Enrique is staying home to take care of Boston and Roman. Dad was taken from his prep room at about 7:30 a.m., basically right on time, and we'll hear from the nurse in the surgery room in about an hour. One positive change from last time is that Dad was able to receive a nerve block, so his pain should be much more manageable this time around.