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