Powerful Times

There were a couple of questions on the last (informative and optimistic post), so here are my best answers.

Not to be nosy, but will they allow Tim to have a popsicle or a hard sucker. Those are sometimes what we use to give throat relief with an NG tube and they exercise your mouth :-)

No, not until he can swallow, which he cannot yet.

Have you all considered the thought that this has been an amazing way to bring all of us us 'out there' here in CA and around the world to share in a Concert of Prayer? It is one of the most immediate 'Ask for according to my will...' prayer vigils I have ever been part of...

We've had at least 9,200 different people check out the blog from at least 75 different countries and every US state and territory (see below for why both of these could be higher). Even as I write this post more comments that foreshadow this post are being posted.

TJ often is a guest speaker at churches around the country. The one he most often gives on missions is called Powerful Times. He gave it as recently as October 28th, and was scheduled to give it two days before he entered the ICU. Gaithersburg Community Church has a synopsis of it on their website (so I don't have to write one up!):

When we watch the news, there are so many bad things going on it’s a challenge to stay optimistic. It’s amazing to remember that God created all people and determined their time on earth. [TJ] encourages us in Acts 17:24-27 that there is no event in our world- good or bad- that does not first pass by the hands of God and that He does not use to build His church. (Emphasis added)

Having heard this sermon it occurred to me rather early on that this whole event could be part of a much larger going-on than we know of, or could ever imagine. I certainly didn't think that when I started this blog there were going to be thousands of people reading it, many every day, from all over the world.

From a young teenager speaking on behalf of his missionary father (TJ was 15 when he started public speaking) to the pasterhood, to his current position it has been his mission in life to glorify the Father. I'm positive that this would not be TJ's first choice to build the Church, it certainly isn't his family's first choice! But I am equally sure that he would submit to the Father's will for this reason.

If you are interested you can download the sermon courtesy of Gaithersburg Community Church here. The first five minutes are very telling considering TJ's current situation. It should play with just about any audio player. Sermon notes are here (PDF).

I am learning quite a bit about my father and mother from the outpouring of prayers, and offers to help in anyway possible. When my mom's mother passed we learned how many lives she had touched that we never knew about through the funeral. Similarly, but thankfully less morbidly, I am learning the same about my parents.

Technical Notes on Counting Blog Visits
Technically the hit counter (as it is called) tracks individual computers, i.e., it has no way of knowing whether one person is viewing the website from a computer or 10 (which I know is the case in my extended family). So the number of people that have visited this blog exceeds 9,200. There are also people that stay updated over the phone or through email that I know of. I don't think I'll ever know the exact number of people who are keeping track, but 15,000 wouldn't surprise me (anymore!) and 20,000 is possible.

Furthermore, for security reasons a lot of workers in sensitive countries go through an internet proxy which reroutes them through the US so their host country can't see where they are actually going. So the number of countries that have visited may also be undercounted.

Here is a non-specific example. Saudi Arabia filters their internet traffic so their citizens can't visit anywhere they please (as do other middle eastern countries and China). To get past this, or to visit a site you don't want Big Brother to know about you can go through an encrypted connection to a freer country (France, the US, Britain, whatever) so the only thing they see is that you are connecting to that country. From there, you are free to visit whatever you want. Therefore a visit from such a country would show up as a visit from France, the US, whatever. So the number of countries might exceed 75 because of this as well.

Slight Updates made 2:56 PM CST January 1st, 2008

Progress and Prayers, and ICU Confusion

TJ is continuing to improve generally but very slowly, with both praises and prayer requests today. The biggest news for the day is that TJ is ready to leave the ICU. As soon as a bed becomes available in a special care unit (between ICU and a regular unit), he will be moving. As the doc was relating this news, he blanked on Mary Ann’s name, and Tim was able to croak out “Mary Ann” to correct him! That made Mary Ann’s morning.

Another highlight of TJ’s morning was spending some time looking at pictures on his computer that he had taken in Lebanon. The fun part was having the Lebanese nursing assistant present to talk about the pictures, and TJ was able to interact non-verbally with her, recognizing people and places from his travels.

TJ’s morning also involved both OT and speech therapy, and those left him exhausted. That leads us to our biggest prayer requests for today:

• TJ’s tongue is weak, which makes swallowing nearly impossible. He needs to be able to swallow before his feeding tube can be removed (the NG tube).
• He is still very weak overall. The smallest efforts leave him wiped. Gaining strength will be essential to his recovery.

It is very possible that TJ will improve more rapidly once he is out of ICU, as Jon explains below:

ICU Confusion
There is actually a fairly wide spread medical condition for people coming to after being under in the ICU called ICU psychosis. First, I need to make this very clear, TJ is not exhibiting signs of psychosis. He is not going mad. However, some quick reading on the subject may help explain why TJ's mental status isn't progressing as quickly as we had hoped.

Dehydration, low blood oxygen levels (sats), infections, constant light in the room, and constant stimulation (IVs beeping, people talking outside, nurses and PCAs checking on the patient every hour -- or less) all contribute. In TJ's case he has had varying levels of all of these.

He probably was slightly dehydrated for a time in order to get the fluid out of his lungs, his sats have never been bad, but they have been lower than most healthy people. (Healthy is 97, he has been sitting anywhere between 90 - 97 depending on the day.) There is always a light on in the room, and even if there wasn't, there isn't a way to shut the light out from outside the room (the room will become dim at night, but not dark).

Most of the time he's been in the ICU (27 days) he's been checked on every 30-60 minutes, and the first two nights I spent there, IVs and the ventilator were constantly beeping. It was like three cell phones going off at once every two seconds.

Finally, he obviously had a pretty bad infection.

What this all adds up to is some significant confusion from organic and multiple environmental factors. Simply moving TJ out of the ICU may clear much of this up, we'll see. But we thought it was worth explaining this. I have no doubt that this adds to his slow mental recovery, I just don't know how much.

Sources: New York Times, http://query.nytimes.com/gst/fullpage.html?res=9A0CE3DB113BF93BA35751C1A96E958260&sec=&spon=&pagewanted=1

MedicineNet, http://www.medicinenet.com/icu_psychosis/article.htm

Visitor Policy

We have been getting some queries about seeing TJ now that he is getting better. The answer for almost everyone is a stronger "no" than before. If you want to stop by and see a family member that is different, but TJ is awake enough to simply become more tired out and anxious by visitors.

We are sorry for all of the close friends we have that would like to see him, but he simply is not in a position to do so. (There is some evidence that too much stimulation can slow down progress when coming out of a coma.)

Genesis of a Blog

We'll try to post a real update soon, in the meantime I thought I'd put this up.

I've had many comments regarding the blog, so I thought I would share how it came about.

The day after TJ entered the hospital I realized that there would be hundreds of people simply within his organization that would want to know what was going on. Because I already had a Blogger account I knew it would take about three minutes to set up a new one. In fact, the longest parts were coming up with a name and the look for it.

The basic idea was to provide a way to communicate with lots of people (TJ's organization and family) without sending out six to twelve emails a day. The idea of the blog was basically a whim - minimal energy to try.

I wasn't sure whether it would be helpful or not, so the next day (Thursday) I threw up a hit counter to figure out whether people were visiting or not. Within 24 hours there were over 500 people visiting it -- a pretty strong sign that it was worth keeping up.

Since that day, we have yet to have dip below 1,000 (in fact, I think 1,500) hits in a day. None of us had an idea of what was to come. Even on Christmas we had 1,600 hits (somebody looking at the page), I was sure it would dip down to 500 give or take that day.

As of right now we have had 9,200 different people visit the blog, and this does not include situations where couples or families have one computer and visit it at once. After considering the "family factor" we might be above 15,000 different people. Moreover, we have had people visiting from 75 countries, I suspect more for countries that go through the U.S. for security reasons.

I don't know why what is happening is happening, or what 'higher' purpose this blogs serves, but it's difficult to believe that there isn't a reason we can't see yet. That I can't see yet.

Many people have commented that the blog is a blessing to them in some way or another. Honestly, the number of people and the huge number of comments are an enormous blessing to us, as we know how many people petition the LORD to support us through prayer. Blogging has become our privilege.

As an econ major numbers make sense to me, and they say that more is going on than we can realize. And that means a lot when you walk in to see your dad or husband barely able to respond to the simplest of questions.

My dad's life life mission had been to glorify God and to build the church. I am sure we would not have chosen this path, but if this serves to build the church and glorify the Father, we'll take it. We'll argue, we might be upset (and that is ok), but we'll take it if it accomplishes God's will.

So to return to the topic, the blog was a whim, and has blessed us enormously. To all those who tell us it has been a blessing to them, I am glad. The truth is, I don't think any of us really know why (in a higher sense) the blog was started.

P.S. The highest number of hits we had was on December 13th, 5,400, I am trying to figure out why it spiked that day. Any ideas?

P.P.S. To Jon and Mandy who thought I might be being facetious, I'm not. That wasn't the only day bad things were happening to TJ. 12/12, 2,600 hits, 12/13, 5,400, 12/14, 4,500, 12/15, 3,100

Sunday Evening

I went in a little later today and saw the pulmonologist, the infectious disease doc, and the family practice doc who all said that there is slow steady progress upward. I asked the Family Practice doc what the chances would be that TJ could do rehab right at United Hospital on the floor run by the Sister Kenny Institute, and he said, "about 100%." Yeah!

The highlight of the day was when four very close friends visited and showed TJ a photo album of black and white pictures he had taken as a kid in Hong Kong and another picture book of Hong Kong. The bed was in the Lazy-Boy sort of position and he focused on all the pictures and reacted non verbally to each picture and the comments of our friends who have been to Hong Kong with us. I am hoping he decides to be as interactive with the speech therapist tomorrow! He was very tired after that exertion.

I have printed off a sheet of Winston Churchill, one of TJ's heroes, quotes to start reading to him. Someone asked about reading to him. I have been assuming that he has heard everything and talk to him every day about the date, the news, and what God is doing, and how he is doing. We have been reading scripture and try to vary the stimulation with CNN, CD's, and talking to him. Thank you for the suggestions -- it is helpful and encourages us to do what needs to be done.

The evening nurse commented on what a strong person he must be because "he surprised us all". I think she meant by surviving. I told her about this blog the thousands praying (and that he is the most self defined person most of us know!).

The specific prayer requests would be for continued progress with general physical strength and healing, and increasing mental clarity. Second for our family as we all have had that "hit by a mack truck" feeling the past couple of days. We are amazed about stories we are hearing about how God is using this whole situation in other people's lives. I am amazed when I think about what He is doing in my life and my faith in Him alone (being in a hospital that I know and trust is huge, too!). The verse that came to mind today is 2 Corinthians 12:9, " "My grace is sufficient for you, for my power is made perfect in weakness." Therefore I will boast all the more gladly about my weaknesses, so that Christ's power may rest on me." Amen!

This will be the last update for tonight.

Blessings and gratitude,
Mary Ann

Overnight Update

The good news: TJ's vitals stayed good all night, and his sats were staying up even after he was off the CPAP and not on any O2.

The bad news is even with two shots of morphine and valium he didn't start sleeping until around 5 AM, around the same time I konked out.

The PT came in and tried to get him to move his arms and squeeze her hand. Of course he did neither for her, but promptly moved *both* arms to scratch his face.

The doctor that made it in while I was still there said his lungs sounded good.

When I left an hour ago or so he was still sleeping as best as one can with people poking you and sticking you. Basically, he has ICU jet lag. Not helpful at the moment...

For Those of You Still Up

TJ isn't really sleeping yet, light rest at best. He looks restless and opens his eyes every couple of minutes.

Pray that he gets some real rest tonight. That could be the biggest factor to boost his mental status.

Night Update

The night nurse asked TJ if he was in pain or if his legs were bothering him because he was looking a little restless. He shook his head no (a good sign) to both. She asked if he was anxious and he nodded. So after a small morphine shot he's geeting to sleep.

Vitals are all looking good, with the only aid being the CPAP machine, I don't even think he is on the blood pressure medicine anymore.

So you can all pray that he rests well, and that tomorrow brings us more blessings.

Overnight Update

Uncle Jon spent the night with TJ again and emailed me about it. To his credit, it was emailed long before it is getting posted.

I'll try to give a more timely report today.... At 10PM when I came in TJ had just been given a little morphine and Tylenol, as he had indicated to Deb that he was feeling some pain - she thought in his neck. The CPAP was put on at 10PM. Deb and I talked with TJ for about an hour; he was responsive with head nods and some expression. He was lifting his arms - like he was trying to stretch. At 11 we left TJ alone and he has slept most of the night. He was given another dose of Tylenol at 5AM. He is starting to wake at this point, so I predict today he will be more alert than yesterday. His temp has stayed been between 99 and 100.

A few minutes ago I asked him how he was doing. He started talking.. minus the vocal cords... I'm not sure what he was saying but it was so good to see him communicating. The miracle of healing continues to unfold before us. Praise the Lord.

PS: Thanks to whomever point out the name thing... cut and paste bit us back this time...

An attempt at a word picture

I have not been down to the hospital yet, but it occurred to me this morning that it could be helpful to do a non medical overview. TJ has been in bed for 25 days, and after he was intubated on 21 days ago did not even have his feet touch the floor except for a few minutes the day before yesterday. The physical therapist thought is was great that he could support himself
sitting for a whole 15 seconds! His arms a legs look thin, his right arm is still a little swollen from the clot, and his face looks gaunt because the whole time he was intubated he did not use his facial muscles as well as any other surface muscle in his body. The ET tube looked to be to be about 3/8 inch outer diameter and that was through his vocal cords so when he tries to speak he croaks and it hurts. The inside of his mouth hurts from being open due to the ET tube for so many days and repeated suctioning which was required. When he tries to smile it fades quickly but his eyes still twinkle when he tries to do that. He has not lost the TJ eyebrow lift and uses it generously with the nursing staff. For about 22 days he was on a insulin drip and therefore every hour finger sticks to check blood sugars. He has had 4 deep IV lines (the genesis of the clot) and a thoracentesis and a spinal tape, plus numerous arterial sticks to check for blood gas readings. Since he has a working PIC line most of the blood draws can be done through that. He also gets several medications subcutaneously so by a small shot. He once had a total of eight drips each on an individual pump, a chest tube attached to a water vacuum devicewith a scar on the side of his chest to remember it by, an NG tube, 2 feeding tubes with a feeding pump, oxygen support ranging from a nasal cannula to a variety of masks to the ventilator. He occasionally has a racking cough that is obviously painful. He has been on a cooling vest that is chilled by a small refrigeration unit. Every piece of equipment in the room has an alarm. There is another tube that we don't need to discuss. His poor nose is pretty raw and extremely tender and stuffy to boot. When rehab starts in earnest it will include gaining strength and coordination to sit and walk and do stairs. Speech therapy to work on swallowing and speech, and probably OT to get his hands functioning again. I put a diet coke in his had the other day and he did not even move it! Turning, working with PT, or when I mess with him to wash his hair with no rinse shampoo leaves him visibly fatigued. He has an automatic blood pressure cuff continually attached to his arms with two tubes coming from it, 4 monitor leads with wires, and and oxygen saturation monitor taped to a finger. He has had at least 4 echocardiograms, 3 MRIs, 4 cat scans, a doppler study of his arm, a sigmoidoscopy, an endoscopy and almost daily chest xrays. In his room it is never quiet and some light is always on. Either a pump is beeping or staff are in and out, or there is noise at the nurses station (it is a circle unit). This is simply life in the ICU.

The final analysis of all this is that GOD IS GOOD! TJ has gotten the best care available in modern medicine and even with that, he is alive due to God's intervention. We are so thankful to be where we are today and are trusting in God's grace for the long road ahead to FULL recovery. I am so grateful for the support from all of you. It seems that when I get discouraged just the right message or comment comes through and gets me refocused on our God and not the stormy sea around me. Without exaggeration, I do not think we would be at this point without the earnest prayer of so many of God's faithful servants. I am humbled and grateful. When I tell TJ about the blog and the numbers of people praying he really cannot get his head around that yet and looks really puzzled. I can't quite get my head around it and at least in theory, I have been conscious! We have had incredible support from family, our church, RG, friends and neighbors, and the staff at my school.

Grace and blessing to you all.

Love, Mary Ann

Evening Update, Phone Update and Prayer Requests

TJ's MRI showed that everything was normal, so that is good. The apraxia is still a concern, and Mary Ann thinks that it is likely, but we'll see.

It's possible that TJ is doing better today than we realized. I just left the hospital and he was watching the news again, and nodding to (some) questions asked. He looked like he had a better idea of what was going on around him, but it's hard to say for sure.

A note from TJ's younger brother Jon is especially encouraging, as it speaks to why TJ was so tired today:

Jon,

Just read the blog and the comments on TJ's sleepiness. I was with him through the night and my observation was that he couldn't sleep. Most of the night his eyes were open and he was responding with head nods. He was a little restless, consistent with how I would feel if I was confined to a bed with nothing to do. They put on his CPAP at 2AM, and he finally seemed to sleep at about 4AM. He was sleeping when I left at 7AM.

Mary Ann has a new working phone. She can get texts but doesn't know how to respond yet.

Before we get to the prayer requests I want to mention how great the nurses, doctors, and PCA's (personal care attendants, they have CNA degrees) have been to us. They really have been nice, sometimes prayerful, very accommodating in general, and especially to us constantly bugging them about this and that. It's one thing for Mary Ann, an RN, to ask questions, it's another for me to be asking them about every different thing in the room and what it does, means, and how to read it. (At this point I think I can read the vitals monitor as well as anyone else.)

So our prayer requests are that TJ is able to get some real rest, that the apraxia would be resolved, and that TJ's neurological status would improve in general.

Thank you again for all your prayers, they mean the world to us!

FYI: Mary Ann's Cell Phone is Down

Which is mostly irrelevant to this blog but most of the people that need to get a hold of her read this blog regularly. Will let you all know when it is back up.

Wrench Updates

The doctors are becoming concerned that TJ isn't becoming more alert more quickly. He is going down for another MRI this afternoon.

The speech pathologist thinks it TJ may have apraxia, which means that TJ might be trying to move or speak but is unable to due to neurons not fully transmitting.

The doctors have said that the fever isn't clinically significant at this point.

I'll put up MRI results when we get them (probably tomorrow). He already has had an MRI recently, so I'll be a little surprised if they find anything new, but then again, I'm not the doctor ordering a couple thousand dollar (give or a take a thousand) procedure.

Note: I took off word verification for the comments to make it easier to comment. They'll remain off as long as the blog doesn't started getting spammed from all sides (problems I have faced in the past).

Another Wrench In the Mix

TJ has developed a general rash for unknown reasons, I don't have all the details yet, but suspect this is probably not just from laying in bed for so long, as they would be a pretty good reason.

Second, and perhaps more importantly (we'll see what happens with the first wrench) is that TJ looks sleepier today than he did yesterday, e.g., he is regressing in his mental status. Again, not much on the details, but I'll post them as soon as I know.

Evening Update

With things moving closer to the rate that they ought to (which is slow, in a good way) our updates per day will continue to decline, as long as nothing big happens -- either way. (Decline meaning once or twice a day instead of twelve.)

I just got back from the hospital and thought it was worth noting that TJ looks noticeably better than yesterday, e.g., more than "just a little bit." He was watching the news, looked like he was absorbing most of it, actually sleeping (a coma is not the same thing!) and able to nod to questions, which he only kinda did yesterday.

When asked how he felt, he actually said in a whisper to one of the doctors "A little better." Although all in all, he is still uncooperative with anybody medical.

They come in to prick his finger, suction his mouth, or do other things that wouldn't make anybody more comfortable. While we try to help convince him its worth cooperating, I'm not sure I'd act any differently without knowing about the last three weeks. The only experiences that are remembered right now are bad ones.

I really wonder what he is thinking. Of the 23 days he has been in the hospital, he was officially in a light coma for 13 days, and effectively in one for 18. I am guessing most of the first few days aren't remembered either.

So basically, you start gaining your cognitive abilities back, you know you are in a hospital, and despite people briefly telling you why you are there, you really aren't sure. You know hospitals generally are for sick people, but the only thing you are sure of is this: you felt better before you went than you do now, and as far as you can tell, the medical staff isn't helping you feel any better.

Right now your throat hurts worse than it has in your entire life, you can't really talk, and coughing only makes you feel worse. You can tell that something is still slowing down your thinking, and you can barely move. You are also tired all the time. While people come and ask permission before they do something that adds to the pain, they don't really mean it, they'll do it anyway*. I guess you know another thing for certain: life sucks right now.

Oh, and you are vaguely aware that three weeks or so (23 days to be precise) are gone and you can't remember them.

Yeah, I am pretty sure I wouldn't be very cooperative either...

*To make things better they all smile when they do these things. What you don't know, is they are all smiling because you look so much better than have in the last weeks. You aren't daily brushing up against death. But of course, you don't know that you ever were...

Update and Q & A

TJ is about the same as yesterday, doing a little bit better, he is still not responding to doctor's commands ("squeeze my hand," "wiggle your toes") but will for the family occasionally.

He is coughing less, in a good way, he has managed to get some stuff out of his lungs. His vitals are all good, although he still running a fever of over 100 and has been put back on the cooling blanket for that.

He is on to one liter of O2, which is good, and the PT came in a for a little while today, and TJ was able to support himself for a short time. This was encouraging, the PT didn't think he'd be able to at all after being in bed for that long. The PT's expectations do help illustrate the point that this will be a long recovery however.

Finally, he does appear to be aware enough to watch and udnerstand the news. We had CNN on for awhile earlier today and he soberly nodded at the story of Benazir Bhutto's assassination.

So aside from the question below, that is all the news we have for today.

Jay Emails:

Hi Jon. Hope your finals are done and you can rest up after a grueling period with TJ’s hospitalization and your exam period coinciding. May God restore your energy. I was hoping you all could just give us a bit more info as to the clots: ballooning in the arm gone down? Any word on the effectiveness of the heparin? Any more info concerning additional clots or if any have already gone away? Thanks so much for the blog and the updates to this point. May God bless you.

We haven't heard much on the clot. Just doing the math of how big is has to be gives us an idea that it is quite large, even without the doctors saying as much.

Some of the factors that can cause a blood clots include staying a single positions for long period of timing (both traveling and staying in bed for over three weeks), sepsis, and catheters (or swan lines) into the veins, of which TJ had a couple of big ones. So the doctors were not surprised or seemingly worried about it at this point. After the the clot has had a chance to adhere to the vein wall it is unlikely that it will break apart. TJ will be on blood thinners for about six months.

That is all the info we have, the swelling has come down but is still noticeable. If we remember to ask, we'll probably get a clearer picture of it after it is all done and gone. If you have more questions, feel free to ask a follow up, or even something entirely unrelated.

Afternoon Update

TJ's temperature has climbed up to 101.3', but really is the only bad news to report. The doctors think that the DVT (the blood clot) is the source of the fever.

TJ is actually looking better as the afternoon wears on, not more tired as we more or less expected. He still can't talk, but (occasionally) smiles, lifts eyebrows, and holds eye contact.

In fact, things are good enough right now that unless there is a significant change, either for better or for worse, this will probably be the last update for the day, a good feeling.

Thank you all for your prayers, this has been a really good day for us. He's not out of the woods yet but he is really close. (We'll just call the ICU the woods...)

Addendum: It is worth adding that he is breathing fine on his own, with the help of a little oxygen, which is a great sign. He'll be on a CPAP again tonight, but should be on his own again in the morning.

Update

TJ is up and moving (in bed). He is really tired after the extubation and probably another painkiller.

He is looking a little confused, and can't do much more than grunt in terms of oral communication. When briefly told where he was and why he is here he didn't look all too impressed. He is managing some half smiles however.

In terms of vitals he is doing well except for a rising temperatue, which just hit 100' F. He is also working hard on coughing stuff up.

Extubated

Just now, finally for real!

On O2 only, doing well!

By the way...

I am still confident that God will FULLY heal TJ's mitral valve. In the mean time I am happy that all 13 cardiologists in the group won't feel a need to look for themselves! Heading to the hospital in a few minutes. An informational update my be late. I have a sense this will be an active day for TJ so I suspect I will not have a chance to update until later or when Jon will come out of hibernation!

Pray hard today!

Mary Ann

Christmas Evening Update

It has been a quiet day for TJ. Temps have stayed below 100.5'. Other VS are good. Levophed for keeping B/P up continues at a low rate. The nurse this evening said the only thing preventing extubation is his decreased mental status. He has been breathing through the ET tube longer than they normally let someone go without doing a tracheostomy. Usually they look at placing a trach 10-14 days after intubation- TJ is on day 18. An Endotrach tube goes through one's mouth and into the lungs. A trach is a more "permanent" tube placement at the base of the throat. Along with the other specifics mentioned, this would be a matter for prayer- if they put a trach in they are likely not to be in a hurry to take it out. (Added layer of complications and he won't be able to talk for at least a week after it is placed.)

It was a beautiful Christmas Day here with snow gently falling most of the day. Chip and I went to some dear friends for a truly gourmet Christmas dinner. Jon hibernated; Tim too.

Blessings to all.

Mary Ann

Q & A

Somebody asks:

It just struck me that this whole thing started with TJ's tooth being pulled. Has anyone looked at that hole to see if there is an infection there? With the ET tube in, it's hard to look at the inside of the mouth. Maybe nothing, but just wanted to ask.
(Another nurse who's wondering about the source of TJ's fever)

At the suggestion of a non-medical yet astute relative we did have the doctors check and nothing was found.

Christmas Day Update

TJ is a little bit more alert and responsive today.  Does not follow commands, but making eye contact and occasionally nodding.  Had to start a small dose of medication to keep his blood pressure up during the night, all other VS and sats look great.  Started another ventilator wean around 8 this morning.  An ENT doc was called in to be sure he does not have a sinus or ear infection, and he does not.  The neurologist said the spinal tap results were good and all the other tests to check for brain damage are good so he thinks that the decreased mental status is due to the severity and longevity of his illness and should slowly clear.  The Family practice doc said that the mental status is "main thing" and that while TJ is "not out of the woods" he is definitely getting better.  I asked the cardiologist what the final conclusion about the mitral valve is and he said that what they know is that a cordae tendanae is ruptured so he will eventually need a valve replacement but the ventricle is completely compensating so there is no hurry.  He does not want to consider surgery until TJ is fully mentally clear or it "would tank his brain."

TJ's nurse put his bed in a full sitting position and he sat up for an hour.  This seemed to help his confusion since he could focus on his surroundings.  He was able to acknowledge a couple good friends who visited during this time. That was a pretty big work out for him and he is sleeping now.

Our specific prayer requests for today would be for clearing mental status so they can extubate and for the temp to stay down (100.5) this morning.

Have a wonderful Christmas Day!

Mary Ann

Brief Christmas Eve update

The Spinal tap went well-no results but the spinal fluid was clear which is a good thing.  Temp still at 101.6.   No change in mental status.

Philippians 3:10  "I want to know Christ and the power of his resurrection and the fellowship of sharing in his sufferings, becoming like him in his death, and so, somehow, to attain to the resurrection from the dead."  I am so thankful for that babe in Bethlehem who came to walk with us pain, give meaning to suffering, challenges us to trust in the power of his resurrection.  I hope you all have a truly wonderful Christmas!

Mary Ann

Post - TEE

Now fifth cardiologist looking at TJ's heart, and he had his own opinions about the amount of leakage from the mitral valve, but nothing conclusive. We do know that TJ's overall heart function is good, but the docs will have to round table and discuss how well it's working and whether anything needs to be done.

Otherwise, TJ has still been spiking fevers, up to 102' today. However, other vital signs are good, including his oxygen sats.

Finally, they are performing a spinal tap right now to rule out any kind of infection in the brain or spinal cord. Results will be not be too quickly forthcoming (it's not a big deal).

Our prayer requests for the rest of the evening are:

• TJ's mental status increases enough to extubate - soon!
• We reach a final conclusion on this mitral valve.
• TJ's temp goes and stays down.
  

Lunchish Update

TJ is running a fever of just over 101' F, and is back on the pain meds. He was getting quite "squirrelly." The time he was off was enough to confirm that he is becoming responsive, although not following directions yet.

They are doing the TEE right now, we'll put up results whenever Mary Ann talks to the cardiologist.

Quick update

Tj is waking up more quickly as they have stopped the pain med that was running. I asked them to do this since we really don't know if anything hurts and it is making it hard to assess mental status. White count down to 13,000. Other VS and sats look good. Will update later after TEE and chat with Pulmonologist. Infectious Disease doc is happy.
Love you all so much!
Mary Ann

Praises praises

For a sweet believing nurse at bedside until 7 am, for vital signs staying in acceptable range, for temp staying below 100' (99.9 now), white count coming down to 15,000, and for TJ continuing to wake up. This evening he was making and holding eye contact, trying to lift his arms, looking puzzled about everything, and still so very very weary. When I tried to explain what has been happening he gave me the "whatever" brow lift and closed his eyes. His nurse wants to keep his Christmas and praise music going during the night to help orient him.

Prayer specifics:
That the clot would stay intact while dissolving
That the wakeup and weaning process would continue to go gently forward
That when the cardiologist does the TEE (Transesophgeal echo) tomorrow he would be surprised at a NORMAL MITRAL VALVE again- new cardiologist.

Fun stuff- 23 years ago on Christmas Eve TJ and I were blessed with a tiny Christmas present named Jon. Hate to tell you honey, but this one might tie with that best Christmas ever!

Blessings and gratitude,
Mary Ann

Beats it. -- Jon

FYI: The Evening Update Tonight Will Be Late...

Hoping for a Quiet Day

One of the cardiologist stopped in and they are scheduling another Transesophogeal echo for tomorrow. TJ's pulse is higher that he likes, still has a murmur, and concerned about the slow wake up so he wants to check the size of TJ's heart to be sure he is not going back into heart failure. He also said that they are seeing more large clots in patients with multiple lines and they rarely break apart. Like that news! The neurologist said the MRI results were "negative"- that's good, and he is not too concerned about the slow wake up.
TJ is more responsive, but still uber groggy. He opens his eyes and looks puzzled but will relax when we tell him what the scoop is. I am so thankful that he is not choking on the ET tube as he wakes up-that is hard to do. His B/P is running a bit low, pulse running a bit high, Sats looking good. Plan for today is to have him on a wean until 10 pm, out him back on vent settings overnight to rest, and come up with another plan for tomorrow. They put him back on a regular ICU bed this morning. I did not see the pulmonologist, but I kind of hit the wall so I am going to take a long winter's nap as it snows and blows outside, and most of all, TJ seems to be in a holding pattern and comfortable for now.
Thank you for continuing to pray.

With much gratitude for your battling on our behalf,

Mary Ann

Prayer & Fasting / Early Evening Update

This might be the final evening update if nothing major changes for the new several hours.

TJ is still only minimally responsive, but we are less concerned about that for the moment than we are about the clot.

As noted in the last post, this is the largest clot Mary Ann has ever seen, spanning three different veins, including the right jugular. If it were to break up it would truly be life threatening.

It is difficult to communicate the risk of this situation, it is very high. So we are asking for people to fast and pray tomorrow, from sun-up to sundown. We do still stand confident in Christ that TJ will be completely healed. But he isn't yet.

Finally, he is running a fever again, of 101.6, which hopefully come down within an hour or so with the assistance of the cooling jacket. However, we still don't know what is causing his temperature to continue to spike.

Prayer Requests

• That the clot goes away
• That his fever goes away -- for good -- or we find and effectively treat the cause
• That he continues to gently wake up

Answer to a Question
Somebody asks:

In re: to the jugular blood clot...is there a reason they cannot just go in and get it OR put a 'catch net' (cannot remember what it is called) ahead of it to snag it if it breaks loose?

They still might yet, we haven't discussed the issue with the doctors.

P.S. Mary Ann says that the diagram in this Wikipedia article is excellent -- just imagine it in three veins. Two really big and important ones. The diagram more or less speaks for itself in terms of why it causes the arm to swell.

P.P.S. TJ was put back on the vent as he went down for his MRI, per standard procedure for someone who is still being weaned (all transports go back onto the vent). They simply left him on for the rest of the night.

"Having a Clot in the Jugular Just Isn't a Good Idea"

The doppler results are back and TJ has a very big clot, "the biggest clot I've ever seen," according to Mary Ann. It is in his inner right jugular at an intersection between another vein running down his right arm, and a third sub-clavian vein.

They have put TJ on heparin -- a blood thinner -- to dissolve it. If it dissolves, things are ok. If it breaks apart -- which is possible -- it is life-threatening as parts of it make their way to the lungs and heart.

Prayer Request

• That the clot dissolves or miraculously goes away. (We'll take either)
  

The post title comes from another Mary Ann quote.

Going Down For MRI Now

Details whenever the doctors decide to share them.

MRI Scheduled For... Soon

The neurologist did a check and didn't see anything that was problematic but scheduled an MRI for today anyway. The feeding tube (ng tube) is weighted, meaning it has metal in it, so they have to get it out first.

They finished the dopplar scan of the arm but no word on results yet.

New Concerns

[Ed: The "Rest" of the Story and it's Follow Ups are below this post]

Just saw the pulmonologist and a couple new concerns are on radar. He is not waking up as fast as he "should" so they are doing a neuro consult. I also asked to have a pharmacist review ALL his meds to be sure that we do not have unintended consequences from having at least 10 different doctors writing orders at various times. He opens his eyes but is not following commands. This could be a simple as having had too much ativan earlier or it could signal a major neurological event (ie, brain damage from lack of oxygen). The second new issues today is a swollen right arm. This is the arm that was affected by the neck issue, had a PIC line, peripheral IV and jugular line leading to concerns of a blood clot in that arm. They will be doing a dopplar ultrasound to check this. He is doing well on the vent wean which started at 6 am.

Prayer for today:

• Neuro status- pray that there not a neurological reason for him not waking up
• Swollen arm: Please pray that they find the cause of the swelling and are able to solve the problem without further complications like throwing a clot to his lungs or brain.
  

I am still standing in confidence that God is good and will heal completely. Could use the treadmill to stop at any time, however!

Mary Ann

Follow Ups to 'The "Rest" of the Story'

(12:31)
Dawn Asks:

So, on which day was TJ put in the coma? Was he aware that he was being put into a coma, etc?

He was put into a coma Saturday (12/8) to intubate him, to rest his lungs and allow for a bronc wash (bronchoscopy). To the best of my knowledge, TJ knew about it (and probably had to give consent), but none of us expected it to last two weeks.

The "Rest" of the Story

Dr. Shari Emails:

THE REST OF THE STORY...
I've been hesitant to ask before and give you more to write about, but now that TJ is improving, I wonder if you could tell us how this all began, I.e. Events before hospitalization and intubation.

Stay with me as I throw out some seemingly random facts.

Through November, TJ had spent approximately 150 nights away from home. In late November (I believe the week of the 18th, but don't hold me to it) TJ got a slipped disk in his upper back. On November 29th TJ went into the dentist with a sore tooth, they found it was infected and pulled it.

All of us have bacteria sitting and growing in our mouths, not a big deal. About a third of us in the US have staph bacteria on or in us, and 0.84% carry MRSA. (Mary Ann probably has a greater chance of contracting and spreading MRSA due to her job as a school nurse.) Still not a real big deal -- until you throw all of these together.

For TJ to come down with MRSA he first needed some sort of opportune entry point into his body, we believe that he actually contracted MRSA when he had his tooth pulled. The wound left from the tooth was an open door.

Next, his immune system had to be running at less than 100%, traveling half of the time (literally, half) will do that to you.

For those of you counting, there is a four day break between when TJ is thought to have contracted MRSA and when he entered the hospital. Due to the slipped disk TJ was on a fair amount of pain meds, which would have masked initial symptoms of an infection. He might have been running a fever over the weekend between the dentist and the hospital (or should have been) but we wouldn't know. Also, pain in the chest or sides would have been masked to a certain degree.
By Monday TJ was feeling ill enough that he agreed to go see a doctor the next day (this is a big deal, it means he really wasn't feeling well). By Tuesday morning, Mary Ann took a look at him, suggest the ER and TJ agreed.

The initial diagnosis was congestive heart failure, and then pneumonia after an MRI. By Thursday we lacked a working a cause for the pneumonia but thought we were turning a corner. Friday things didn't look as rosy, on Saturday he was intubated.

Also on Saturday the doctor of infectious diseases was confident that TJ had a fungal infection causing the pneumonia so they did a bronc wash. Initial results were negative, but he was put on an anti-fungal antibiotic just in case. By Monday, however, we had the cultures back and it was obviously not fungal.

Finally, Monday (12/10) afternoon he was officially diagnosed with (CA)MRSA.

From there it has been a wild ride, with at least one near-death scare (at least it was at the time), heart rates of 235 combined with a fever of 103.2, a torn then miraculously better mitral valve, and more.


Addendum
MRSA is already something of a "superbug" in and of itself. This case has been weird enough that some of the doctors are wondering if this isn't a new mutation of MRSA. E.g., an überbug (über means "super super"). Doctors have been waiting for the überbug, but have yet to find it.

Time and labs will tell.

Morning Update

TJ's night was nice and quiet - he slept peacefully, although he did spike a fever around 3am, requiring the use of the cooling blanket. The vent settings were switched to CPAP for approximately 8 hours yesterday, making it an extraordinarily successful first attempt at weaning, and then it was switched back on to assisted breathing to give his lungs a rest through the night.

At 6am this morning they again switched the vent to CPAP, and so far his O2 saturation has been between 98% and 99% (and this is breathing through a very uncomfortable, large tube in his throat)! Please continue to pray that his vitals remain stable as he learns to breath again on his own.

We have 2 specific requests for today: Pray that TJ's fever will disappear, and pray for a successful extubation. The sooner TJ gets off that vent, the better he will feel. We are so appreciative of everyone's prayer! We will update again later in the day.

Delaware Joins!

I should be asleep, but obviously am not. Delaware -- the final state to visit the site -- brings us up to all 50 states, 72 countries, and just under 8,000 visitors. By morning here it will have surpassed 8,000 visitors, where visitors mean different people.

I can tell you all, this exceeded what we expected, by a lot. It's pretty cool.*

Four hours and three minutes until TJ goes back on the CPAP (MdT of course...)

*I actually threw up a tracker more or less on a whim to see if anybody was looking at the site, hence whether it needed to be updated or not. Uhm, yeah. Guess so.

Evening Update

Unless something dramatic happens tonight this will be the last post. TJ is doing well, vitals are all good, and he should be taken off the CPAP and put back on the ventilator soon. He has done very well weaning off the ventilator so far.

Our requests for prayer are much the same as they were earlier in the day:

• That future weaning also goes well (starts at 6:00am CST tomorrow)
  
• That TJ's anxiety stays down as he wakes up (Mary Ann wants you to understand that the anxiety comes from waking up and feeling a garden hose down your throat).
  
• Prayer and praise for amazing healing! (E.g., that his lungs continue to heal)
  

It would be great to have TJ off the vent tomorrow.

Notes on Breathing Gadgets

Every now and again I realize that something made it up here that might not be as obvious to some readers as others, so here is a quick run-down on the relevant breathing gadgets.

BiPAPS are quickly becoming more common and well-known as they are used to treat sleep apnea at home. It is usually the mildest form, and has two levels or pressure that it puts on the lungs, one for inhaling and one for exhaling.

A CPAP puts a single, constant pressure on the lungs. The pressure may or may not be higher than a BiPAP.

In contrast, a ventilator actually does the breathing for you. Neither the BiPAP nor the CPAP normally involve being intubated whereas a vent requires it. It sends air down the lungs, and the patient passively exhales.

All of the "gadgets" allow varying amounts of O2 (oxygen) in the air, (the air you and I breath is about one fifth O2) and pressure. The PAPS are merely assistive in contrast to the vent, which is meant to do all the heaving lifting. The vent also lets you set the respiratory rate (breathes per minute), whereas the PAPS let you completely breathe on your own.

By far the most obtrusive part about the vent is a tube down your throat. The PAPS never need the tube, although they can be used with. So currently TJ is still intubated even though he is on a CPAP. It is likely that after being extubated he will be on a CPAP or BiPAP without the tube, just a face-mask (which have varying degrees of comfort, but are all better than a tube!)

So there is a quick rundown on all the fun breathing things TJ is on.

Extubation Plan

The plans for the extubtation are to keep TJ on the C-PAP until 8:00pm tonight, then put him back on the vent overnight, and again put him back on the C-PAP tomorrow at 6:00am.

This, of course, depends on how well TJ tolerates being off the vent. He could be put back on the vent earlier if his toleration of the C-PAP declines. To wit, as long as his sats and respiratory rate stay in an acceptable range they'll keep him on the C-PAP.

Hallelujah!

Well, nobody expected this...

TJ's white blood cell count is at 18,000 - getting closer to normal. His hemoglobin is a little low, so they are going to be giving him 2 units of red blood cells (I understand this is a relatively common procedure and will just help him feel better). His temperature is also normal without tylenol or a cooling jacket (Mary Ann suggested it was a good time to turn the cooling jacket off when his temp hit 97.9). He is also off all blood pressure medication, and the doctor says his chest xray is clearing. Right now he is slowly beginning to wake up and open his eyes, but he is not completely aware yet.

The wean from the vent is going *very* well. The peep is at 5 (less pressure than he gets through his CPap at home to sleep) and his oxygen sats are holding steady. The nurse commented that if he were more awake, he would be doing well enough to extubate (which just doesn't ever happen on the first wean). This process is exhausting for TJ, as his lungs work to breathe for themselves for the first time in almost two weeks. They will need to turn the vent back on later when he gets tired, but will continue with future weaning as he continues to wake up.

Our prayer requests for the rest of the day:

• That future weaning also goes well.
  
• That TJ's anxiety stays down as he wakes up (Mary Ann wants you to understand that the anxiety comes from waking up and feeling a garden hose down your throat).
  
• Praise for amazing healing!
  

New Stats, Looking Forward

As the doctors make their rounds this morning, TJ's vitals continue to make slow, but good, progress. His temperature is still not normal, but continues to trend downward. His white blood cell count is at 18,000, so also continuing downward. The pressure on his ventilator is the same, but his sats are staying up consistently. His chest x-ray also looks better this morning. They are removing his sedation, but he is not waking up very quickly.

This afternoon is really going to be critical for TJ as he begins to wake up, so that is our biggest prayer request for today, as well as yesterday's requests. This afternoon could be "exciting and quick-moving" as changes happen and decisions need to be made about TJ's ability to breathe on his own. Your petitions have brought him this far, and they will be critical this afternoon! Keep up the fight!

Comfort

There is no news regarding the overnight yet, waiting for that to come in, but there is something else worth addressing here.

In addition to last night's prayer requests, one should be added, that TJ can be relatively comfortable during the extubation.

To extubate they have to take him almost entirely off sedation; TJ will be alert enough to realize that he has a tube going down his throat his mouth, and another down his throat through his nose. He won't like either of these. At. All.

So pray that he can be as comfortable as one can be, as a tube is being yanked out of one's throat. To make matters even better, it will probably take more than one try. I don't know if this mean re-intubating, I suspect rather that it means weaning TJ off the vent and seeing what the sats do until they are ok, but either way it won't be a fun process...

P.S. It is worth noting that they may not be able to wean him off the vent today, that is not abnormal, just painful.

Call to 24 Hour Prayer

This is purposely dated to remain at the top for a couple days.

In order to encourage consistent and continual prayer for TJ, the Addingtons are asking all of you who are praying to also join the Pray4TJ 24 Hour Prayer Watch. Here is how it works.

Participants around the world will spend some time in prayer for TJ and the items listed on the blog for prayer, during the hours of 6am to 8am in their OWN TIME ZONE.

Since there are at least over 7800 known persons from 71 nations checking on TJ, if everyone is at least praying for TJ during THEIR OWN TIME ZONE WATCH, we will have continual and overlapping prayer around the world, 24/7.

Of course we ask you to continue to pray whenever you are prompted by the Holy Spirit to pray. We believe that our Heavenly Father knows when TJ needs prayer and He will continue to prompt you to pray or bring TJ to mind at specific times both day and night. This is very important that you continue to pray as prompted.

Our goal is to encourage more and continual intentional prayer around the world for TJ.

Thank you to all of you who are already faithfully praying. It is sooooo appreciated.

So pass this along to others you think want to know and encourage them to participate in the Pray4TJ prayer watch.

-Arthur Ellison for the family

24 Hours, 1440 Minutes, 86,400 Second, A Million Moments: All the Difference

Because this is worth repeating: The next 24 hours (really down to 18 now) could result in a major turning point for TJ. These hours will determine whether he can breathe for himself, or whether he remains on a vent (possibly through a tracheostomy*) .

The critical factors for prayer are:

• Temperature: This needs to stay down, and stay down on it's own (e.g., without Tylenol and a cooling jacket)
• TJ's ability to breathe on his own, without the help of a ventilator
• TJ's ability to cough up the junk that is crowding his lungs, without being re-intubated (NOT a fun experience)
• That the medical staff are vigilant and wise
• That God would continue to heal TJ, above the wisdom of the doctors and the work of the medicine, and that He would make it clear to us that He is working.

Thank you all for your prayers. I have been hesitant to put this up because it seems to be bragging or something of the like, but over 7,600 different people have viewed this site from over 70 countries. Thousands of people have been praying for TJ. It is hard to come away with any conclusion other than that this is God's doing and God's hand. It wouldn't have been my choice, and it wouldn't have been TJ's, but if it is God's will, we will take it as humbly as we can -- though that's not always easy.

You hold us up before the LORD. Please continue to do so.

*Which, amazingly, I hear is actually more comfortable. It is a possibility.

TJ Writes...

This came in to me over email today:

Donna’s mom [ed: I don't know who this is] was a writer, especially of poetry. As a writer herself she also collected the writings of others, especially those who were not renown, at least at the time she collected them. [Donna’s mom] died in the summer of 06. Donna took all of her writings, both those she wrote and those of others she had saved, with the intent of going through them. Well, after our move, and not yet back to work, she has taken the time to begin to go through all of that. And to her surprise, in the midst of the concern over [TJ] Addington she ran across a poem that he had written when he was 15 years old, and which was published in the "Beacon."

Here is the poem:

Morning Prayer

Lord, I want to ask you,
To be with me through this day.
Keep me from the evil one,
And keep me safe, I pray.

Lord, I know I’ll fall,
Many times today.
But lift me up in love,
And set me on my way.

And when the evening comes,
O Lord, And I review my day.
Help me to be thankful,
That you guided me today.

[TJ] Addington, age 15, February 8th, 1972

TJ later edited the Beacon, now called EFCA Today

Baby Steps

The family met with the physicians again this morning, and received a clearer vision of TJ's condition. First the highlights:

*His temperature continues to trend in the right direction, from 103 a few days ago to under 100 today (temp is being assisted by occasional use of the cooling blanket)
*His blood pressure is more stable today than in past days
*They are continuing his current antibiotic regiment
*In the doctor's words "There has been a significant move in the right direction".

TJ is making baby steps in the right direction, however it was made clear that he is still critically ill. His chest x-ray shows no major change from the past few days, he still has significant infiltrate throughout his lungs, and he is still breathing with considerable assistance from a ventilator. The physicians described his recovery process as very lengthy (months vs. weeks).

It was communicated to the family that the next 24 hours will be a critical junction in the direction that TJ's caregivers will take - a decision will need to be made regarding his breathing assistance; will he be able to be successfully weaned off the ventilator, or will he need his current ventilator to be replaced with a tracheostomy?

Please pray with the family that as he is slowly weaned from the ventilator, he will be able to breath and will be able to cough up the crud that he needs to cough up, without any need of reinserting the ventilator. Pray for vigilance for TJ's caregivers as they make this critical decision. Pray also, that there will be very clear evidence of God's healing throughout this process.

Thank you for continued prayer for TJ! We will continue to update as we get further information.

Brief Morning Update- more to follow later

We will be having a family meeting with the doctor around 10am and will put up a more detailed post after that meeting. The night was good. Things are creeping in the right direction. Temps continue to work downward with less use of the cooling vest. Docs are trying to do more meds via the feeding tube. O2 at 40%, peep still at 10 but sats 97-100. Keep fighting!

December 19 evening update

TJ's situation continues to be basically unchanged for which we are grateful. As Jon pointed out we have gone about 48 hours without a major crisis. The chest tube was removed today as it was not producing any drainage. The medication to control the heart rate has been cut in half with TJ's heart remaining in a normal sinus rhythm and a good heart rate. Ventilator support remains the same. Vital signs look decent and temp is trending down although TJ still requires use of the cooling vest several times a day to keep it down. Here is a link that has a good description of ARDS:

http://www.lungusa.org/site/pp.asp?c=dvLUK9O0E&b=35012

Since Jon is not here to create a hyper link you will need to cut and paste it into your browser address bar.

We covet your continued prayers. While TJ is taking baby steps in the right direction the situation is still very fragile. I cannot imagine going through this without all the incredible support we are getting from around the world! it is truly humbling.

Prayer requests for this evening;
Another uneventful night for TJ
Infection continuing to respond to the antibiotics and the temps, white count, and Chest Xray reflecting this.
That God would continue to work in many many ways through this situation and that He would be glorified.
A good rest for the family.

Chip finished finals today and only has one paper to write to be finished for the semester. Jon has a very challenging load with upper level business/economics and philosophy classes (that is a triple major-makes me tired just thinking about it!). Please also pray for Jon's ability to get his classwork done by mid January. The profs have been very supportive and understanding.

Much love and gratitude,
Mary Ann

Evening Update Will Be Around 7:00 CST

Another Encouraging Morning

TJ had yet another good (read: quiet) night, and the family was able to get some rest. TJ's white blood cell count is down again (I don't know the exact number) and his vital signs are good - which is making the infectious disease doctor happy (and we like happy docs!). As of now the plan is to try to lighten the sedation again today, so that is also very promising.

Doctors' rounds are still happening, so we will keep you posted as we know more. The pulmonologist especially is who we are waiting to hear from today.

We are literally watching and living the answers to your prayers right now. TJ's lowered temperature this morning is a specific answer to prayer (and don't forget the normal mitral valve!). Keep fighting the good fight - you are holding us up!

Prayer Requests for Tuesday Night

• That TJ's fever would come down
• That his lungs claer up significantly or completely
• That his vitals remian in a good range -- without lots of meds

Thanks to all who are lifting TJ up! That is the only reason he is doing as well as is he is doing!

Evening Update; What is a Secondary Infection?

None of TJ's immediate family is down at the hospital at the moment (we have taken part of the evening off for some rest) so the details are a little scarcer than usual, but:

TJ's temp is back to 101, more or less straddling the line of "ok" and "getting dangerous," depending on where it goes, or doesn't.

His heart rate is in the low 90's, which is good. At a temp of 101 I (Jon, the non-med guy) would expect it to be in the 100's (I have spent enough time watching him to know how things normally go.)

His sats are down a little bit at 93, but good by ICU standards, and considering that the percent of oxygen he is getting through the vent is at 45, the sats are quite acceptable.

Finally, the sedation has been dropped a little bit and the nurse says he is tolerating that quite well.

To sum up, things are pretty good -- by the last week's standards -- not "healthy" standards (probably not even ICU standards)

Secondary Infection
I thought that it would be good to briefly explain what the secondary infection is, as I don't think it's been touched on much here.

A secondary infection is one that develops after the first one, generally in the hospital. E.g., MRSA would but TJ's primary infection, and, well, something else, is the secondary one.

We don't know for sure that he has one, but it is very reasonable to believe that he does. A bacterial infection results in a temperature (leading to a higher heart rate), and noticeable spike in the white blood cell count, all of which are occurring.

Thus, in the terms of one doctor, "it is a reasonable conclusion." More pointedly, something is causing the temperature and white blood cell count and the MRSA is being treated; the trends are reversing course after both going downward. We don't know for sure that TJ has a secondary infection because we can't find it (e.g., all the talk of looking for an abscess), but all the signs are there for it.


By 9:00pm CST the (Hopefully) Final Post for the Night with prayer requests will be up.


Finally, thanks for all your prayers! We have needed them, and continue to do so! They are both encouraging and efficacious!


Edit: One of my medical advisors does not believe that the white blood cell count is as significant as I seem to think it is. We'll call it a draw for tonight.

News and Miracles!!!

The family practice doctor just stuck his head in the room to let us know that the transcribed report from the TEE yesterday showed a normal mitral valve! Hallelujah!

Other news for this morning is also encouraging: his temperature is trending downward. White blood counts and kidney function are about the same as yesterday. They were able to decrease his levophed (used to keep his blood pressure up). His oxygen is at 50% and the pressure on the vent at 10 (same as it was), but his blood oxygen sats are holding at 97.

Quiet Night

TJ had a quiet night last night, with no major incidents. Mary Ann also was able to get a solid 6 hours of sleep, so praise God for good rest!

As doctors rounds get going and we learn more (we hope to learn more!) we'll keep you posted.

As always, continued prayers are our biggest request.

CT Results (Last Evening Post?)

Looks like this will be right on time.

The CT showed no fluid in TJ's pleural cavity.* This is especially interesting as the second to last showed approximately two litres worth of fluid. At most, TJ has drained one liter through invasive methods (like chest tubes).

The scan also didn't return any signs of an abscess. This is both good and bad. It's good that there isn't another infection in the lungs, bad in that the doctors are sure that there is a second infection and still can't find it.

Both lungs showed "significant" inflammation which may be either pneumonia or
ARDS (acute respiratory distress syndrome) of which there this is a difference, but I am too tired to go into detail.

Prayer requests would be:

• Rest for the family
• Finding the secondary infection
• And the complete healing of the mitral heart valve

As of now TJ is stable thanks to a numerous drugs, which means he is only kind of stable.

This is probably the last post for the night.

*There actually might be a small pocket of fluid, but this is a might and of little importance at this point.

P.S. Someone asked if TJ was still in an induced coma, yes, he is, and has been since December 8th.

Q & A

Soembody Asks:

I was just wondering if we should also disable our Blogger connections if they connect to certain entities and just use nicknames or if you are not concerned about that?

I had a discussion with someone who used to work with TJ, especially on the issue of internet security. To be honest, the cat is already out of the bag, and I don't think we can get it back in as TJ has been quoted -- with a title -- in a newspaper, and there are websites that have cached pages of him with his current title.

I am not going to tell you what websites these are, but if you know his full name you can Google them and find them.

So no, you can use you blogger entity or whatever nickname you want. At any rate, comments on prayers, etc. are expected for anybody in this condition so I don't see this as being a red flag.

Results on the CT will be up by 6:30 CST, 00:30 UTC (London)

P.S. If you have questions see the link on the upper right column of the page.

CT Finished

TJ has just come back from the CT scan*. He's back in his room, but we haven't heard any conclusive results just yet. We'll keep you posted as we find out more**.

*The purpose of the CT was to check the lungs for the source of the secondary infection that was not found in the heart this morning.

**Getting results may take a little while - the doctors need to assess the scan, and then come talk to us. The fact that the doctors are not rushing to give us information is a good sign for now. So, no worries if this takes a bit. Just pray in the meantime!

Overheard...

One of the cardiologists to another nurse -- not to us -- after the tee, "[last week the mitral valve] was wide open..." It's not anymore! (It's not completely healed yet either)

Kevin writes:

With the clear connection of "issues" coming up at around 3:30am I am committing to pray each day from 3:00-4:00am CST for TJ. Do you think we should put out a call for others to join in concerted prayer at that time? It seems that there is a significant spiritual battle that is happening at that time. (My personal experience has been that this time of day is when the Enemy seems to often be active in attacking God's people.)

We are working on setting up another prayer deal here. Specifically, one of our bestest family friends is working on it.

However, please continue to pray as you are prompted. The Holy Spirit has and will wake you up as needed.

TEE Done

First, Tom writes:

My comment is only a slight correction. The trans-esophageal echocardiogram (TEE) is a long tube that goes part way down the esophagus, but does not enter the stomach. Its purpose is to visualize the heart from right behind the heart, as opposed to the regular echocardiogram which tries to see it from the front of the chest wall where things like ribs get in the way. Check out: http://www.heartsite.com/html/tee.html for some diagrams.

The cardiologist just came back and said that the valves look fine, no abscess. He described the mitral valve leak as "moderate," not severe. (c.f., this post)

One of the doctors confirmed that there is a secondary infection, somewhere. It is the white blood cell count and temperature that point things this direction.

So you can pray that we find it, and preferably, find it quickly. We -- the family, and our closest friends -- are praying that we find it today.

TEE About to Start

They are finishing setting up the TEE and going to start soon. They'll be looking at the mitral valve to see if there is an abscess (infection) there.

TJ will also be going down for a CT scan sometime later today.

His white blood count is up again enough to indicate a secondary infection, but not enough to worry at this point.

P.S. If you don't know what a TEE is, see the newly added glossary to your right.

Morning Update 1

I realized that there should probably be two morning updates, at least to the extent possible. A wrap-up of the overnight and then the doctor's rounds, at least if anything comes up.

Forgive me if any of these thoughts seem disconnected, I got about two hours of sleep and am starting to slow down in the head...

Summary
Jon (me) spent the night, everything went pretty well. From midnight to 1:00am (until I fell asleep) the vitals were just about perfect. TJ's sats fell to a low of 84 (bad) around 3:30am and his fever started rising. To counter this, the percentage of oxygen going through the ventilator was turned back up to 75 (it had gotten down to 60 again yesterday evening) and the cooling jacket* (called a cold jacket in the last post). TJ also got another chest x-ray around 5:15, but it will be partly obscured by the jacket.

Finally, they turned off the food going down the ng tube slightly before midnight. The reason they put off the TEE from yesterday to today was because he needed to be off of the food for at least six hours beforehand.

Vitals Summary
I've actually been writing this post for about the last hour when I stepped out to let them do the x-ray and things have changed in a good way. TJ's heart rate is sitting around 83 bpm (it had gotten up to the upper 90's around, you guessed it, 3:30ish), his temp is 99.7' F, his sats are an amazing 100 (it literally doesn't get any better), so hopefully the O2 will be turned back down to 60 or so. His blood pressure is a little low, but in the "watch" range as opposed to the "worry" range. So compared to some of yesterday's issues, things are much better.

Meds & The Heart
TJ is on a beta blocker to keep his heart rate down, which is not entirely uncommon, I was on one at 21 for a month. He is also on another drug, amiodarone, that is meant to work with fast heart rates to help with the arrhythmia.

Perspective
An extended family member recently noted that on the blog we haven't used the term "stable" it is usually used in the media. When you read "stable" in the newspaper it means someone is doing well over a long period of time, when you read it here, we usually mean that we got the vitals back into a normal range.

Even for us -- the family -- it is easy to start losing the sense of urgency. TJ has been in the ICU for 13 days now, and seems to have fallen into a pattern: relatively good night, crisis at some point during the day, resolution of crisis, rinse, wash, repeat. So I wanted to put up some stuff to put his condition in perspective.

TJ is on 6 drips, that is, 6 different IV's, 6 different drugs. This doesn't include the "food tube" (the ng tube delivering what looks like chocolate milk). He is on a ventilator, of which there are approximately a total 3,000 1,175** in the state of Minnesota (out of 4.9 million people in the state; e.g., not many vents), and in a cooling jacket to control his temperature.

In other words, TJ is a pretty sick dude.


*This is what looks to be a white plastic bubble-wrap type thing that goes around the chest and upper abdomen. Water flows through it at set a temperature (currently 96' F) to keep the body at a desired temperature.

**Correction thanks to Dr. P from Bethel University

(Hopefully) Final Evening Post

TJ has another transesophageal echocardiogram* (TEE) scheduled for tomorrow MdT (doctor time), and Mary Ann has specifically asked that we pray for peace for her during this time.

Currently his heart rate is hovering in the upper 70's, perfect, and his temperature is 99.7, still dropping from 103.2.

To answer Jeff's questions, TJ was put on an antibiotic for fungal infections, then taken off of it after they cultured the MRSA. There are some pretty bad side effects of whatever that antibiotic was (Jon doesn't remember what it was called), so he won't be put back on it.

The first TEE showed a leaking mitral valve, which seems to be getting better.

If I have time I'll get the night nurse to explain how they are keeping TJ's heart rate in check with some medications, if not, well, you won't know!

So in addition to peace for Mary Ann for tomorrow pray that:

• TJ's temp continues it's downward trend (it took quite a bit to get him into the 99 range, including ice baths and a cold jacket [it's called something like that]**)
• TJ's heart rate stays in 70's to 80's.
  
• TJ's mitral valve does not show a secondary infection, but has healed completely.
  

We'll try to do regular updates like this in the morning by 9:00am and at night by 9:00pm-10:00pm, and a noonish update if needed.

*An echocardiogram done through the stomach. The advantage of it over a regular echocardiogram is that you can get closer to the heart.

See this post for a correction on what a TEE is.

Edit (10:48pm): I forgot to mention this, but the temperature and high heart rate with a dropping white blood cell count suggest the possibility of a secondary infection. That is, an infection that developed during the hospital stay.

I might do a short update again if I am up and the vitals have changed.

**Correction: It is called a cooling jacket

Prayer Results

TJ's fever is down to 101.3 and his heart rate is in the 90's. Good signs! Thank you for your prayers, and please continue the fight...

Temp

Currently, TJ's hemodynamic status is stable (see the previous post), but his fever is the enemy at 103.2. We *NEED* our armies praying that fever down now.

Phew!

TJ's heart rate has come back down to 110 and is in a normal rhythm. The doctors honestly don't know whether it was the medication or prayer that brought it down!

Thank you warriors!

New Trials

The doctors have tried two electric shocks so far, and TJ's heart rate has not converted back to normal. At this point they are going to try medications to achieve the same end.

Jon Adds: More meds are not what we need right now. The more that are added the higher the chance that some interact poorly, or have side effects that we just don't need right now.

235, NOT a Good Number

TJ's heart rate has increased further to 235. His approximate maximum target heart rate (the rate you want more or less while exercising) is 170. Right now he is in atrial fibrillation. They are going to administer an electric shock to convert him to a normal heart rhythm.

This is the same thing that happened to vice president Cheney earlier this year.

It ought to be a low risk procedure. (IMHO: "Low risk" is always a bad phrase when dealing with the heart...)

New Wrinkles, Progress and Prayer Requests

TJ is having pre-atrial contractions, which are premature beats in the atrial. In addition to this, his heart rate has been high again, as high as 175 bpm (remember, it should be around 80).

His temperature also reversed the downward trend and has come up to 102.8.

On the better side of things his chest x-ray is looking slightly better (and is a lagging indicator) and his lungs sound better. His kidneys are not functioning at 100%, but are also trending towards better.

Prayer Requests

• That he continues his trend downward on depending on the vent
• That his temperature trend goes back to this morning, going down
• That his heart rate comes back down
• That the mitral valve miraculously heals

We still don't have room for margin.

Finally, a note not specific to TJ, but the comments received on the post Comments on Comments are worth reading, to see how many people are getting the same thing from the Lord, around the same time.

Early Morning Update 2.0

In the last two hours TJ's heartrate has improved to 114 and temp to 100.7. The Infectious Disease Doctor just made his morning rounds and is quite encouraged by the steady progress of the last 48 hours. He said a number of key indicators are improving including white blood count (now at 20K, down from 26K yesterday and 32K Friday).

Early Morning Update

The night has gone quite well. Since reducing oxygen intake to 60% at 12:30 am his oxygen sats level has maintained at 96. Blood pressure is 109/57. Heartrate is a bit high (124) as is his temp (102.0).

Make That Five

Some comments from the post Comments on Comments let us know that at least four five people were led to pray between 3:00-4:00am on Friday night.

Strong spritual aspect anyone? (See Daniel chapter 10)

(Edited 3:56am CST)

Meta-Post

This post is intentionally pre-dated so that it stays on top. It is basically a table of contents to the other posts as soon as I can get them up.

First, The Summary
Second, Summary Part One: The Facts
Third, Summary Part Two: The Possibilities
Fourth, Summary Part Three: The Caveats (Sickest Man in the Hospital)
Fifth, Prayer Requests

Evening Update

Not to much to update. T.J. is about the same as earlier, his stats are up a little but the quote about being the sickest man in the hospital still applies.

Comments on Comments

First of all, thank you again to all the people that have left us prayers and notes of encouragement, it really helps keep us going, and we truly believe that the prayers are physically lifting TJ up right now. So here are a few interesting things:

• Last night two people were woken at 3:30am with the need to pray for TJ
• A couple nights ago (I forget which) four people were woken at 3:00am with the need to pray for TJ
• Two ICU nurses -- one from Rochester, one from Dallas -- who both said we don't know them, commented that we are having a huge impact on the staff
• Psalm 41:1-3 came up on Monday during prayer, and twice (separately) last night. It reads (NAS):
• How blessed is he who considers the helpless;
  The LORD will deliver him in a day of trouble.
  The LORD will protect him and keep him alive,
  And he shall be called blessed upon the earth;
  And do not give him over to the desire of his enemies.
  The LORD will sustain him on his sickbed;
  In his illness, You restore him to health.

Prayer Requests

• That the MRSA is eliminated
• That no secondary infection develops
• That TJ can breathe with decreasing help from the ventilator
• That we get the right staffing. This can make a huge difference in how fast things are noticed, treated, etc.
• Praying and declaring Psalm 41:1-3

Our previous requests are here, and still relevant.

Summary Part Three: The Caveats (Sickest Man in the Hospital)

Most of the news that has been posted today has been good news, and we praise the Lord for that. However, we want to make sure that you still properly understand TJ's position.

TJ has no margin whatsoever, a fever could be enough to set him off balance send him spiraling downwards. As could any other development that adds stress to his system.

The mitral valve could still be a big problem (although the doctors are more optimistic now than they were at the time of that post.) Hence our request for a miraculous healing of the heart.

Septic shock, secondary infections, spreading pneumonia, or not controlling the infection are still real possibilities, all of which negatively affect the balance. Right now, we just have to wait and see what happens.

We were trying to come up with the appropriate words to describe TJ's condition, I'll just list them instead of trying to tie them all into a sentence:

• fragile
• delicate
• dangerous condition
• sensitive balance

Really, to summarize, Mary Ann says, "He is probably sickest person in hospital, and probably has been for a few days."

Next post, Prayer Requests

Summary Part Two: The Possibilities

This is a rough roadmap for the different ways things could go. Nothing here is for certain, this is simply the way things could go.

A tracheostomy might be prudent at some point. This would allow TJ to cough (get stuff out of his lungs) and be taken off sedation. After a week or so they might be able to put him on a version of the trache that would allow him to talk.

They might have to repeat a CT scan to look for fluid in the plural cavity (the plural effusion thing again) and either reinsert the chest tube, or operate. All of this depends on how things develop.

If there is a ring infection they will need to operate, but this isn't a priority at this point -- they haven't even taken time to look yet. If he has one it would be an infection around the mitral valve. My medical adviser says this is incredibly technical and it's not worth saying much about, especially as they doctors are less worried about the mitral valve at the current time. (See the previous post.)

There is a more significant possibility that TJ can develop a secondary infection, an infection of another organism. At this point, he is quite vulnerable to that.

There is another antibiotic they can put him on, but it is not thought to be "synergistic" with the current antibiotics, so, for now, that is off the table.

Next Post, Summary Part Three: The Caveats (Sickest Man in the Hospital)