FYI: Jon's Phone is Down

Jon's phone is recieving text messages correctly but not calls in the event anybody attempts to contact him.

"Scrapbook"

Jon has been printing all the comments left on this blog and TJ's sisters are putting them into a book so when TJ gets out of ICU he can read about his own miracle. I know it sometimes is hard to try to say something on a blog like this, but all the comments are super encouraging and really keep us trusting and encouraged. Would never want to do this without you all!

Love, MA

Layers of Added Complication

This afternoon the docs did another bronchoscopy after seeing a new "infiltrate" (area of pneumonia) in the right upper lobe. The major pneumonia to this point has been in the left lower lobe. During the bronch they pulled out pus and sent it for cultures. The pulmonologist seemed to indicate that he thought that this could be a different bug that was introduced by the ET (breathing) tube.

The cardiologist, who is responsible for monitoring his hemodynamic status (blood pressure and blood flow) came in again just a bit ago. The mitral valve seems to be functioning decently, however, TJ's blood pressure has been very low. It was low last night and they added a drug to correct it (vasopressin). He is receiving the maximum dose but his pressure is low again after seeing an intitial bump up. This is because he has the infection in his blood (septicemia) as well as his lungs and all his blood vessels are dilated. They will add another medication to help the blood pressure. This med will put more pressure on his mitral valve but the cardiologist feels that the valve can handle it.

Last evening they placed a Swan Ganz line (deep IV that goes in through his right juggler vein in his neck) from this line they can do a number of direct measurements that very accuratly reflect his hemodynamic situation (how the heart is working, how hydrated he is in general, blood pressure directly off the heart, etc). Based on those readings he is a bit dehydrated so in addition to the new medication they will give him more IV fluids. A lot of this will leak out of the veins (due to the septicemia) so he will get rather puffy.

Current Prayer Needs:
1. Effective and rapid treatment to the new pneumonia and the septicemia
2. No complication for the added med, particularly for the mitral valve
3. That his blood pressure return to normal values
4. That his lungs (specifically pulmonary edema, that is a lot of extra fluid in the lungs kind of like drowning in your own body fluids) and kidneys would be protected. His kidney function has been a little abnormal but they are not overly concerned at this point.
5. The prayer requests we have already mentioned (some overlap)

I would also add to pray for our fellowship, Rockpoint. A board member and good friend or ours mother died today. Also G. N., who has been our rock here and also a board member, mother was just admitted to the hospital with a possible blood clot in her leg.

This is a battle for TJ and our fellowship members that is fought in realms that we cannot see but can and do directly impact through prayer. We are requesting a day of prayer and fasting tomorrow for TJ's situation and our fellowship. Fight hard! I feel like Reepicheep (from Voyage of the Dawn Treader) who sails off to adventures off the end of the world. I feel like I am sailing off to what life after miracles looks like.

Rose also passed away today, so, again, although this isn't the Reach Rose blog, keep her family in your prayers.

We are deeply grateful to all of you.

MA and the guys

P.S. We have done our best to make sure that the medical jargon is translated into plain English. If you have questions on something we said let us know.

Last Night

Uncle D tried to post this earliar this morning but it didn't go through. Probably because I gave him the wrong instructions. Though I'd post it now anyway:

TJ had a good night, though his temp - hovering about 100.3 is a concern because it is one of the indicators of how effective the vancomyacin is working. The radiologist just commented on how well he looks compared with yesterday. Blood pressure is a bit low. Please continue to stand in the gap because from a human standpoint things are still very fragile. The combined prayers are allowing Mary Ann, Jon & Chip to get needed rest because they know others are standing in the gap for them. The hospital is presently short critical care beds and staff so continue to pray that TJ would be surrounded by just the right medical and nursing staff.

Things haven't changed too much since then, you can see this post for the latest update, but Mary Ann is speaking to the cardiologist so hopefully we'll have another update soon. If, then everything is probably the same.

Questions 2

Chris writes:

What are you doing for food? Would it be helpful for me to bring something homemade?
I am a friend of TJ's parents.

For the most part we have had friends taking us out to eat, but we also have a guest apartment across the street where we can make sandwiches etc.

You can see this post for asking questions.

Most Recent Updates

For all the readers (last I checked a little over 3,200) I'm sorry for the late post. I took time to really sleep in. The good news is nothing exciting enough happened that someone had to give me a call and get me up.

TJ's vent has been turned up a bit, the plural effusion only drained 40 cc's or so overnight bringing the total since the last chest tube to 80 cc's. This is about half as much as we need at this point.

He's had two chest x-rays and show possible pneumonia in the upper part of his right lung (practically all of the pneumonia has been in his left lung), which is new development. This is nothing serious at this point, it could turn into it.

A bronc was performed on the right lung in order to get a specimen.

The doctors increased the sedation by a little bit, e.g., they put him in a deeper coma. From what I understand it wasn't much deeper.

His vitals have been good and he had a restful night, the only vital sign that is not really where we want it to be is his sats (O2 blood saturation) which is at an ok level for the ICU, only a little lower than what one would usually want it at.

Finally, his fever went up this morning a little bit, and has fallen back to 100 even.

P.S. You can see this post for asking questions.

Quicky on the Heart

The cardiologists are increasingly less cautious about the mitral valve, a good sign (not great, but good). They also decided that an angiogram is not necessary for the moment.

Questions 1

Sarah writes:

Was everyone able to get a good night sleep last night? I hope so. Did they actually end up bringing him out of the induced coma yet? How are you and the rest of the family holding up, what is something we can specifically be praying for you whether its directly related to this or otherwise? Sorry if that is too many questions, I figure others would be interested too.

I can't say whether everyone got a good night's sleep or not, I know I did. I am sure that Uncle D (who stayed with TJ) is tired.

TJ is still in an induced coma, there isn't any new word on when they are thinking of extubating him.

Our family has been holding up well (all things considered), the prayers and letters of encouragement have been great. Obviously this is a stressful situation, but so far I think we have been doing better than what actually should be expected.

Per prayer requests I am going to refer you back to last night's post on prayer requests.

You can see this post for asking questions.

Stable

Just so you all know TJ is stable right now, I am waiting for confirmation before I post more detailed information due what I can only call an editing snag. Nothing big, but basically I don't wish to violate any of Mary Ann's wishes.

Against My Better Judgement

I am going to open things up for questions for a little bit as I am still waiting to hear anything definitive. So if you have a question, post it on this entry and I'll try to give an answer. Please shy away from most of the personal stuff, or, at least, don't get too personal. Basically, if you wouldn't ask the question in public don't ask it here. Otherwise, heh, whatever. No drama at the moment means it is a good time for questions...

What Are the Vitals?

I'll be posting an update soon when I get a hold of someone with a medical background from the hospital. I slept in super late (and it feels good!) so I am not down there writing down exactly what the doctors say. I am waiting for Dr. Addington (Md., TJ's father and formerly chief of staff at United) to give me a call and confirm what I have heard second hand.

In the meantime I realized that there are probably some things that could be clarified when it comes to the language used on this blog, especially vitals.

There are three vital signs that we watch carefully, heart rate (usually mistakenly called the pulse), oxygen saturation, and blood pressure.

There is a resting heart rate and an active heart rate. According the American Heart Association a "normal" resting heart rate is between 60-80, but it rises as you get older. A "true" resting heart beat can only be measured while one is asleep, which is close enough to TJ's condition. Active (or target) heart rates depend on the physical activity you are undertaking (walking, running, swimming, whatever) and age.

The oxygen saturation ("sats" as they are called around the hospital) is aka measure of how much oxygen the blood is carrying. To quote WebMd:

O₂ content measures the amount of oxygen in the blood. Oxygen saturation measures how much of the hemoglobin in the red blood cells is carrying oxygen (O₂).

This is actually measured by putting a glowing red thing around TJ's finger. In the ICU they like this number around 92, Mary Ann says in normal circumstances it is 97. So when I say his "sats" are doing ok, it means it is at least 92.

Finally, the blood pressure. Historically (and still at most doctors' offices) you'll get a number somewhere around 120/70 (the "target" number, like most things, it changes from person to person). The top number is the pressure when they heart pumps, the bottom number when it doesn't. In the ICU they take the mean number ([120 + 70 * 2]/3 = 87)* called the mean atrial (sp?) pressure mean arterial pressure. In the ICU they worry when it drops into the 50's, and get increasingly worried as it approached 50.

They also measure breaths per minute (as opposed to Beat per minute for the heart rate, they are both bpm), which hasn't been a problem so I haven't asked a whole lot about it.

I hope that this give you all some idea on how to quantify and understand the vitals that are often posted. It also should give you a very good idea why we were scared when we watched the sats drop to 65 in a manner of seconds. Mary Ann thought we were watching a total repository failure. Follow the previous link if you aren't sure what I am referring too.

Hopefully more updates will follow soon. I am just waiting for confirmation, but so far things have been pretty good (on the ICU scale of good to bad).

*Updated 12/31/2007 to correct formula.