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.