Apologies...

I realized this evening with several phone calls that we have been remiss in updates causing some level of concern. Mia Culpa, Mia Culpa....

TJ saw his internist/endocrinologist on Thursday morning. He checked many things including heart issues, clot issues, lung issues, took 6 vials of blood and EVERYTHING was normal! The pulmonologist who admitted TJ last year who said there was no reason for him to see him. As a nurse this is very weird. Nobody I have seen gets so sick so fast and nobody gets better this fast without sequel from being so sick!

We have been laying low. Running a few errands as an excuse to get out in our lovely weather (cough, cough) and to stay awake during the day to get our schedules turned around. We are tired, cranky, feel disorganized and incredibly humbled and grateful. TJ is coughing still, but no fever, and up and about combined with resting.

Jon has been getting my laptop ready to send into Dell (the hard drive died) and Chip is learning how to make chicken soup from scratch in preparation for an outdoor overnight tomorrow. Only supposed to be -7'. It is a "shelter project" for an art class and he is the TA/den-mother for the mostly freshman group.

I will try to put together more thoughts on this whole deal in coming days. There are many layers and we only see a few of them.

Blessings to all!

MA

We Are Home!

The flights went well and we are all exhausted and going to bed!

Jon is alive and well, also beat after his moving adventure.

TJ sees his own doc at 9 am tomorrow-will blog more tomorrow. Now thanks to a very good friend we are fed and I am hitting the tub in a well scrubbed bathroom.

Love you all!

MA

Heading Home Tomorrow!

TJ passed all the last checks at the hospital today and was given an updated "Fit to Fly" form so we will be on our way EARLY tomorrow morning. The hotel has arranged a car (at 3:30 am!) and expedited transport through customs and check- in. Also wheelchair transport through airports. For someone who likes to fly "below the radar" this will be interesting. TJ is feeling remarkably well as he was extubated only one week ago. Still tired and coughing a lot. His chest x-ray today showed some limited diffusion in the right lower lobe and the left was totally clear.

We brought some gifts to the staff today which RG personnel in Chiang Mai put together for us. They included some literature in Thai. The nursing staff seemed very excited about the gifts and told TJ that he was a "good patient" and different than what they usually deal with. We have been praying for illumination for the staff and doctors through this experience.

Jon is driving the final 300 miles to Oakdale after unloading in Knoxville. He is really beat so please pray him home safely!

Staying a few days to get some rest was the right thing to do. The trip tomorrow is tiring when one is feeling well. Please pray that TJ's stamina holds up and all goes well tomorrow. We just finished dinner and will head to bed early. Chip is out trying to do one more deal on a copy watch.

To God be the glory!

We are grateful beyond what words can adequately express for all of you!

Much love.

MA

Brief Update

TJ and I have had a quiet day enjoying the hotel. TJ had a couple naps today where he really slept- a rare thing in the recent weeks. We decided that it would be easier to manage his blood sugars using the insulin pump so we switched to that this morning and TJ is having much better success keeping them in range. The docs here are not comfortable with the pump, but TJ sure is.

Chip went to the weekend market and made some very fun purchases. He is a very good bargainer. His body is shaped like a Thai person's so he is finding very good deals on clothes that fit his unique tastes.

We had a nice dinner this evening- celebrating TJ's 3rd birthday- but told him he can quit now. (Last year he decided that his discharge date would be his second birthday).

It looks good for coming home on Wednesday and the travel assist was able to get us all in business class which will help a lot with the ability to rest on the plane.

Time for us to turn in as many of you are getting up.

Blessings and gratitude!

MA

Hotel Day one

We have had a quiet day. TJ is really fatigued. We are having problems controlling his blood sugar- running too low- and don't really understand why that is the case. I did a grocery store run today so we have appropriate snacks to take care of it. I went to the Big C- like a Walmart super center.

We are working with the travel assist company to arrange flights back to the US. The hospital did not send all of TJ's meds home with him so I called this morning and they sent a messenger this afternoon. Between the Travel Assist and the hospital it all seems very complicated, but it is all getting done!

The hotel is lovely and restful. Chip and I just had a light supper by the pool and had it all to ourselves. The food definitely tops the hospital cafeteria. The staff had flowers sent to the room after TJ got here- they are so thoughtful!

Jon made it to Knoxville in the 24 foot Ryder truck. I thought it would be a good opportunity to thin out junk from home, you know, just send it to Knoxville since he has such a long truck. Too bad I was not home...

Not much else to report for now. Please keep up the praying for healing, rest, and smooth travels.

Blessings!

Mary Ann

Sprung!

TJ has been discharged from the hospital. He is fatigued, but doing well. Able to walk around the hotel without assistance (like up to the room). He is still coughing quite a bit which is to be expected. We will go back and see a couple of the docs on Tuesday before we fly home, hopefully on Wednesday. Still have to hear from AIG about what tickets they have been able to secure.

Chip is off the the local IMAX this evening. TJ and I are off to bed hopefully for a long night's sleep without the disturbances inherent in a hospital.

Blessings and good night!

MA

Discharge planned for tomorrow!

The doctors tell us to plan on being discharged tomorrow. We will remain in Bangkok for a few more days for Tim to rest and gain more strength before hitting the airport again. A flight doctor has to fill out a "Fit to Fly" form; this is a different doctor than the treating physician but they work hand in hand.

Please continue to pray that things go smoothly for the discharge and all the details of getting tickets rebooked, escort through airports, etc.

Jon is moving to Knoxville TN this weekend. We decided that it would be less commotion at home for him to move while we are still away. Please pray for safety as he goes- he is really tired.

Chip had a killer migraine again today, but is feeling better this evening and out bumming the city.

Personally, I am going to bed early to be ready for our big day tomorrow.

Blessings and deep gratitude to all of you.

Mary Ann

From TJ

From TJ

Thank you for your prayers. God was so good in again sparing my life. After ten days in the ICU, they removed my breathing tube, feeding tube and two arterial lines yesterday. Today I go to a step down unit for a few days while we make arrangements for the trip home when advisable.

Being awake the whole time this time provided some good spiritual lessons. I gave up asking God to take the pain away, why should I be exempt? Or, to be with me, (he was). I just ended repeatedly asking for his closeness and thought a lot about his suffering. The hardest thing was getting my breathing tube cleaned multiple times a day which triggered involuntary spasms and huge pain. Just breathing was something that took a huge effort (an hour on a vent when not in a coma is like twenty four hours). Often I felt like I was trying to breathe through mud or fluid.

My companion has been CNN news and I have done a lot of reflecting on the vast majority of our world, in Gaza and elsewhere who are caught in the political crossfire or just the ravages of disease and poverty and who have none of the health care advantages that I have had. I cannot imagine being in those circumstances having lived through the over 60 days I have been in the hospital since December 4, 2007. Most of them in the ICU.

The first day was the most difficult day that I can "remember." I know I was in more serious situations a year ago and closer to death but I had the advantage of sleeping through the worst of it. This time as I listened to them talk about severe pneumonia, septic shock, Acute Respiratory Distress Syndrome and a lot of the past year came flooding back, including the question as to whether I would live through this again.

Fortunately, Steven was able to provide a lot of medical history so from the first hours they treated me with everything they could throw at the pneumonia in case MRSA had reappeared. It was interesting to have my son giving them permission to do all kinds of things, but he was in touch with Mary Ann and had been through this before. I was quickly developing sepsis so was lucid but like through a fog.

By the way, the neurologist has ruled out a seizure on the plane, although that is what it looked like to the flight attendant. I did lose consciousness and vomited and was disoriented after the cabin was pressurized and was heading for the runway. My blood pressure was dangerously low for some reason and speculation is that an infection was already brewing.

Also, unlike many of the events last year, I was awake for everything this year including the difficult and potentially dangerous procedure of putting a central line right into my neck since they were not successful in doing to in my chest. I told Mary Ann that there was merit to either a coma or heaven and she made it clear that the coma was an option but not heaven. I was also amazed once again at how quickly I was in such trouble.

I thought initially that the admittance to the hospital was a formality but I was already in septic shock and going downhill very rapidly – and I was fully aware of the danger I was in and wondered if I would survive this time. Mary Ann was not here till I had been in the hospital for three days although a number of awesome RG staff dropped everything to be here and to help.

I am sure I will be learning through this experience as I did from my prior hospital stay. I figured today that I have spent 60 days in the hospital, almost all in ICU since December 4, 2007. Thank you for your prayers and love. I am overwhelmed that others would care, but we are deeply grateful.

Blessings!

TJ

Extubated!

TJ has just been extubated!

The plan so far is to keep TJ in the ICU for another 24 hours for observation and then move him to a "regular" floor, more or less for more observation.

Also great, the doctors are going to try feed him at noon; TJ was intubated a short enough period they think his gag reflex and whatnot are still fine.

Best, I was actually have to talk to my dad, kinda. It was about 15 seconds -- he does have a face mask on which makes it sound like he is in the middle of a strong wind -- but I did get to hear his voice.

That is all I have right now.

High Hopes & "Bad Feelings"

As was noted yesterday (Thailand time) hopes are that TJ is able to get extubated today.

I spent most of my afternoon scanning in all of TJ's medical records from his MRSA battle in case they are need quickly. I also spent time putting blog entries from the same time into some three ring binders.

As I started reading through this blog from the beginning (I didn't make it too far, it is kinda long...) there were a couple of entries that stood out to me in particular.

The first was from early on, December 6th, two days into TJ's hospital stay (about 3 days before we found out it was getting bad, longer before we would find out just how bad) where we wrote:

"As a family we believe in medicine (MA is a nurse and [TJ's father was the chief surgegeon at United Hospital in Saint Paul, MN), but we believe more strongly on the power of God and intercessory prayer...

We believe in a God with a father's heart who has always been faithful, and so believe in God's healing hand."

The second was was titled, A More Specific Prayer Request, which contains the mantra we carry now:

A consensus has been reached among the family and our most trusted friends and prayer partners. We are *not* praying for doctoral wisdom regarding the heart, we are praying for a miraculous healing. Plain and simple.

We also asked for, "passages that support (and some demand) such prayers." Out of 274 posts not one generated as many comments.

We are again asking you to pray for such healing over TJ. I (Jon) have been having a "bad feeling" since I came across that second entry and I can't tell you why. But at the advice of my mother (who may put something up herself soon, I don't know) I am putting it out there anyway; "if we feel nudged we have a responsbility to share."

So that is what I have, a feeling (nudge?) that today, at the very least, there is the possibility for stuff to turn as ugly as it did last year. And so, as a family we ask for renewed prayer, especially on a day with such high hopes.

-Jon

Hopeful for extubation tomorrow

The intensivist was just in and said they are hoping to extubate tomorrow. YAY! The vent settings are being turned down and TJ is doing well with it. It will be a few more days in the hospital, either ICU or a regular floor, then discharge. If the treatment plan is to discharge him to home we may have the option of staying in Bangkok for a few days to rest. If the treatment plan is to go to another hospital we would fly home immediatly and go directly to a hospital in MN. Either way we will be flying with a medical escort.

Tubes and IV lines are being pulled one by one. It is very encouraging as each one is gone- it also makes it alot easier to move around when you are not connected to so many tethers.

Chip is supposed to take the day off today (once he wakes up). He has places he wants to explore in Bangkok, including checking out a kayak that seemed relativley cheap. He would love to kayak the canals around here. He found a chat room of American expats in BKK and was asking about kayaks. The reaction ranged from "awesome idea" to "Are you crazy?? Do you know what is in that water??" I think a lot of the fun for him will be just to check it out and sort of ignore the hospital for a while. As a 21 year old he had to sign consents for all the treatments, including intubating his dad in a foreign country. He is due for a break. BTW for all you Bethel classmates, your facebooking, etc. has been a huge encouragement to him.

We are grateful for all your prayer and encouragement and cannot thank you enough. We feel amazingly surrounded by friends!

MA

Sunday Morning Medical Update

It has been one week since TJ was pulled off the plane. Chip reviewed some of the story for DaveR and me last evening. The plane was taxiing for take off and Chip, who was sitting a few rows behind TJ, noticed some passengers pointing at TJ and calling for the flight attendant. Chip went up to check on things. TJ was sort of jerking, not conscious, then puked and came around. Chip checked his blood sugar (OK) and then things started moving fast to get him off the plane. Chip did an amazing job in those first critical moments and hours.

In talking to the Infectious Disease Doc today I was pressing him for why he was ruling out MRSA based on negative cultures and not every other bacteria. He said that if it were MRSA it would have caused some inflammation of the heart and been circulating throughout TJs blood stream. The cultures have shown "normal throat flora"- or the normal critters that live in all of our throats, which would be consistant with aspiration pneumonia- or choking on puke which would pick up the normal flora on it's way down the wrong pipe. The ID doc is satisfied with his progress.

I did a little reading today on ARDS and found an article from NIH (National Institute of Health) in the US and they are following all the recommended protocols as well as being on the top of the curve for recent recommendations. For you medical types this includes ventilator settings of peep and tidal volume, acid base balance in blood, albumin for pulling fluid off the lung and back into the blood vessels, and enteral nutrition support (formula via NG tube).

TJ observed today that once you get on a ventilator it seems hard to get off. Indeed. Please pray for patience and stamina for him- it is a very taxing position to be in.

Last evening DaveR (a good friend from a creative access country) took Chip and I to an Outback Steakhouse for dinner. It was good to get out of the hospital for a bit and have a change from the cafeteria selections.

That is all the news from Lake Wobegon for now.

MA

Ponderings..

I have not been over to TJ's room as yet- moving kinda slow this morning-so I do not have any medical updates. I wanted to put some things out there that have been stirring in my mind since Chip's first phone call, but between jet lag and the challenges of the situation it has been hard to articulate these thoughts.

This is a spiritual battle. Please continue to keep up praying in that mode. I think that I have sort of a warped view of things because it has not been as terrifying as last year and TJ is awake- so he just seems a lot better. However, he is still on a vent and not out of danger by a long stretch. During the conference that TJ and Chip were a part of here there were prayer teams and they felt like they did " a lot of damage". The enemy is fighting back. The following is from an email I received today:

" I went over to get more stuff from my old house a few days ago and was talking to my old landlord who is a Christ follower. I told her about my dream. She said, "I had a dream too. There was a man in a hospital in a foreign place. There was evil and people going throughout the hospital releasing flies (infection/illness) everywhere and draining blood of patients." I told her about TJ and asked her to pray."

Bangkok is one of the darkest cities one earth with the highest concentration of the sweetest and kindest people on earth. A word that has come to several peoples minds is illumination. Please pray that God's light emanates from TJ's room and our lives to the staff here. It would be quite a coup if the enemy was trying to take TJ out of commission and we gained some family members instead!

Finally, it has been impressed upon me that God will not share His glory with anyone else. Last time we said that if TJ had not been at United Hospital, if Dr. Corbett had not been around, if I had not been around, if TJ's dad had not been around things easily could have turned out differently. I think God is proving that He can do miracles in our lives without our help.

Now I am going to finish the way too strong coffee i made in a press mug I bought at Starbucks in the Tokyo airport, shower, and head over to his room.

May God bless you and keep you, make his face shine upon you and give you peace.

MA

on a side note (main post below)

k so i have adopted a unofficial theme song (kinda) for this whole little skirmish check it out its "between the cherubim" by misty edwards. it seems to speak to what where dealing with extremely well)

download it its an awesome song (if you really want ill spot you the buck later for your itunes purchase) (ok that was a lie... to many people check this blog for me to say that)

We will awaken the dawn with a song in the night
For a new day will come just as sure as the sun will rise
Though deep darkness prevail for the night weeping endures
Yet the light will not fail He won't rest until His righteousness shines

You who dwell between the cherubim to You we cry
O Shepherd of Israel restore and cause Your face to shine
Don't remember our former sin Let Your mercy speedily come
O Shepherd of Israel restore and cause Your face to shine

Though we're feasting on the bread of affliction
And the water of tears is our wine
We won't draw back but we'll run to
You for we know it's just a matter of time
You will answer the cry of Your people and
Your ear is attentive to their sighs
So we lift up our voice to You and we sing in the dawning light

For the glory of Your name for Your glory and your fame
Though the earth be removed we lift our hands to only You
For the glory of Your name for Your glory and Your fame
Though the nations rage toward You let our love remain true

immmmmmmmprooooving (slowly)

Ok so we just talked to the infectious disease doc, and looked at today's chest xray. the news is good the xray is considerably more clear, but still shows some infiltrate.This is an improvement. In addition TJ has not been running a fever, so everything continues to improve.

they attempted to begin to ween him of the vent yesterday, but staff observed this caused a drop in his blood oxygen level, which isn't serious but dose mean that they have to take it more slowly. the doc said he thought it would be "a few more days." This means a longer time with an extremely uncomfortable tube down pop's trachea, and more days of torturous suctioning.

so the prayer request for this week is that the tube would come out ASAP, and that he would be discharged on Jan 14th. (this is the day he was discharged last year and has been dubbed his second birthday.) this is highly unlikely, medically speaking. However we have all seen and been part of miracles that have been highly unlikely medically speaking, so we pray in faith. this would also be an excellent display of Gods power to the Thai staff here. for the glory of His name.

Not to mention thanking the Lord for how well this has gone, and that there hasn't been any serious complications.

Chip for all

Evening Update

As you can tell updates are starting to get a little fewer and farther between. This is definately a good thing. Updates I got from MA:

The pulmonologist said the most recent X-ray showed the lungs looking a little bit better. The vent settings are being tweaked, mostly in a good way. The pressure is down but the O2 level up. What this does mean is that it is easier to take TJ off the vent but keep the O2 up via a C-PAP or BiPAP. At any rate, TJ is mostly breathing on his own despite still being on the vent.

The doctors are also trying regulate TJ's blood gases. As my mom didn't get any details this means pretty much nothing beyond what it says, e.g., what eactly they want to regulate and why, etc.

I'll update when I know more, there may not be anything to add anytime soon.

Friday Afternoon in Bangkok

TJ was not extubated today. The pulmonologist explained that he does not want to be in a situation where he has to re-intubate. He is satisfied with TJ's progress and explained that TJ's lungs are becoming more pliable. Part of ARDS is that lungs get stiff so they don't work well. His chest x-ray in unchanged which is fine. Once again the pulmonologist explained that this is lagging indicator, behind improving symptoms. I asked the pulm. to order morphine to help with the pain of suctioning and the drowning feeling that TJ has had. That has been successful today. He has been able to sleep a short time after receiving the morphine. He told me (via his legal pad) a couple of minutes ago that he cannot believe he rested even for a bit. I will go back to the room in just a minute and he is planning to get up in the chair. TJ's temperature remains normal.

The endocrinologist came by and explained the insulin regime- it is basically what would be done in the states. She said that she will consult with the endocrinologist in the US about not using the insulin pump speculating that it could have been the source for MRSA. That leaves some questions-how could such a small port of entry that only goes into subcutaneous tissue cause the infection, and is it MRSA???

Staffing was better this afternoon, sadly because of a crash cart for the room across the hall and grieving family.

Chip has a migraine after basically being up all night in TJ's room. The RG family with the baby who was ill are planning on flying "home" this evening.

Much appreciation to all!

MA

Evening Requests (P.S. 15 Minutes Later)

Just spoke with MA again and she has two concerns and prayer requests.

First, TJ says that he can't take being intubated much longer, so he/we again ask for prayer that he is successfully extubated today. For better or for worse my mom has noticed that the Thai medical staff are more "stingy" with pain meds than the U.S. tends to be.

Again, imagine having a garden hose going down your airway for a week. Every time you move you feel a gag reflex starting to kick in and have to hold it back as best you can. And it is constantly up against your throat.

While this is MA's analogy I've seen what it looks like and have no doubt this is accurate. It was obvious that TJ was having trouble taking it a year ago when he was so far out of it it took over a week for him to completely recover from his coma. It really is bad.

Second, the hospital staffing appears to be under some duress. We don't know why, MA is just noticing that for the first time the attentiveness to TJ is dropping, dropping to an uncomfortable point (if not life-threatening etc., less than we would expect in the U.S.). So you can pray that whatever is causing this (perhaps something as simple as the hospital gaining more patients than they expected in a 24 hour period) that this is resolved.

And, honestly, the staffing thing applies to everyone in the hospital. If TJ (in serious, if not critical condition) does not have adequate nursing staffing, then it is a good bet that very few -- if anybody -- else in the hospital does.

Again, thank you all for your prayers! We are seeing God listen to them in a more tangible way than the vast majority of people do in a lifetime. Please, keep it up!

P.S. To clarify a previous post, it is not clear whether TJ has MRSA or not. This is another major area of concern; we need an answer to prayer as to finding out what the underlying infection is. A sky-high WBC of 28k means there was a bacterial infection (viruses won't shoot up the WBC). And we need to know what it was/is.

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For those of you receiving, or interested in receiving, feeds of our updates, we have a couple beta options here for your consideration.

Renewed Request

TJ again is personally asking for prayer that he is extubated today. Being extuated, he wrote down, "is challenge." Which is quite the understatement.

Specific Prayer Request from TJ

It is Thursday evening Bangkok time. It has been a very decent day. TJ was up in a chair for a total of 5 hours. They have started to wean off the vent- PEEP 14 and O2 at 40%. The Infectious Disease specialist stopped by and said that he does not think we are dealing with MRSA since nothing has shown up on cultures. I could not really get an answer on what he thinks caused all this, but he said that they will discontinue one antibiotic but keep the ones that were used last year going.

Tonight I was having some trouble communicating with the nurse about his blood sugars- they have been running higher than we would like, but she was not really understanding what I was trying to say so TJ and I said not to do anything and asked to talk with the endocrinologist tomorrow. What we do NOT want to happen is that she over compensates and he goes too low overnight. Please pray that communication does not become a problem with this issue.

TJ's specific request is that he can be extubated tomorrow. Suctioning is really an ordeal- his whole body is wracked with coughing when they put the suction catheter down. It also is very uncomfortable to have the tube in at all. It is tied on with twill tape, rather than a more stable adhesive pad that is used in the states so the tube gets pulled and wiggled with every move.

TJ also wanted me to thank all of you for your persistent prayer and support. Amen to that!

Chip had some stomach issues today-seems to be better now. At the conference TJ and Chip were at last week there were several viral things going around. A family from a country north of here has a baby hospitalized in the room right above us and their 3 year old is sick, too. They are exhausted and if everyone is better will be flying "home" at midnight tomorrow so please keep them before the throne as well.

Sodexo runs the food service at Bethel University and the nutrition department and cafeteria here. I told Chip I will never accuse him of exaggerating about the food choices and tastes again. There is an Au Bon Pain and a Smoothie Bar for back up. What it lacks in taste is made up for by the sweet lady who dishes up the food.

I started a list today of all the ways God has shown His faithfulness and goodness in this situation. It is difficult to be so far away from home while TJ is so ill, and some times the communication can be frustrating-especially for those of us with "time zone challenge." (TJ says he does not get jet lag- he is just time zone challenged). It is amazing to see all the ways God works even in tough situations. GIGATT!

Mary Ann

Late Evening Update (1/7/09)

K, just got off the phone with MA again, all good news today. TJ's WBC is down to 6,000, an actual normal place to be. His platelets are also down 150k, which is also good.

The intensivist told TJ that if he is up and moving around the pulmonolgist is more likely to extubate sooner rather than later. TJ wrote back, "Never underestimate the power of my resolve." He has been sitting up and looking relatively comfortable, e.g., as comfortable as one can be in the situation.

They also put a "cough" around his ET (vent) tube so he doesn't have to be suctioned as often, which is more comfortable than suctioning, not sure how good it feels to be coughing while intubated though.

TJ is currently sleeping and wanting his computer as soon as he wakes up. For all I know the next post will be by TJ, we'll see.

MA continues to be impressed by the nursing staff, which are ever so attentive to TJ. Also, TJ's orgranization has been great in keeping someone around -- again, very nice.

So keep up your prayers! And thank you, as always!

Early Afternoon Post

I am kinda on Bangkok time, so I just listened to a couple of voicemail messages left for me from MA and Chip.

They are planning on keeping TJ on the vent for the net 24-48 hours, but they will still be weening him tomorrow (in the next few hours). They are keeping the pressure on the vent high to continue to push fluid of TJ's lungs while preventing a pulmonary edema.

The intensivist expected a 7-10 days stay in ICU -- again it wasn't clear whether this is from now or altogether.

Finally, a quick note on the comments. Feel free to use mine or Chip's name, please use MA or TJ on the blog. If you work with TJ or a similar organization it is best for you to not to actually use the name of the organization. This is especially true if you or your coworkers live or work in a CAC country. A couple of comments have been rewritten for the sake of security.

I am sorry to come down hard on this but the internet is a good place to be paranoid.

Early Morning Update

Latest update: very little.

The cultures came back with no growth. Meaning that they aren't negative -- which take up to a week before they are called such (or show growth) -- but didn't tell anybody anything either.

TJ is running a low grade temp, but nothing huge and is very tired.

I am going to bed (finally) but first, prayer points for the day:

• Pray that the cultures would start growing, e.g., come back with something. We really want to know what TJ has. If it is not MRSA again, "it is like getting struck by lightening twice in a year." (MA)
• Still, and always, pray for complete healing of TJ and his body and mind. That he would be fully restored by the time he flies home again.
  

Thursday afternoon (I think)

TJ is improving. His white count is 7,000, fever low grade, and they are making plans to wean the vent. His blood is a little low and they are ready to transfuse if needed (sepsis really beats up on blood cells). His chest x-ray is about the same, but that is a lagging indicator. The ARDS is the biggest issue as his lungs are still quite inflamed and producing a lot of thick mucous causing a need for frequent suctioning. They did add a pain medication today which has helped. Cultures have not come back yet, but the treatment would not be changed as it seems to be working.

I am super impressed with the nursing and medical care. The nurses are competent, kind, and gentle and the docs seem really sharp. The nurses shaved TJ today (with a straight edge). When they were done I showed them a picture from Thanksgiving and they laughed and apologized to him so he gave them "the look."

This is discouraging for him and it makes for VERY long days laying in bed in an ICU breathing through a tube. Yet, we continue to be confident in God's goodness and faithfulness to us!

GIGATT!!

With much appreciation,

MA

Late Evening Update

Alright, I spoke with MA a few minutes ago, here is that latest.

Overnight they had to suction TJ every hour. While it is good that they are doing this, as I think was posted, TJ says (or rather writes on a pad) that it feels like he is having a heart attack every time.

TJ's white blood cell count (WBC) is down another 1,000 or so to 7,000, just above the target of 5k-6k. On a similar note, as the WBC suggests, the intensivist still thinks that the infection is under control.

TJ's hemoglobin and another word I can't type (MA said it was basically the same thing) is running low, and so TJ may end up with a blood infusion to take care of that.

TJ's lungs are still inflamed but the doctors are still planning on trying to start weening him tomorrow.

This morning (Thailand morning) TJ seemed pretty discouraged, according to MA, but was looking better after the doctors made their rounds, who are obviously optimistic.

MA continues to be impressed by the medical staff and the attentive care TJ is recieving. It is certainly up to par with Western hospitals.

You can continue to pray for:

• The pain TJ is in, particularly when they suction
• For compelete healing of TJ's body, so he returns as healthy as he was before his first round with MRSA.
• Energy for the rest of us, most specifically for MA (who is feeling better after getting some rest) and Chip, who got to run ground ops initially mostly by himself, and is obviously still there on the ground.

Again, thank you to all of you!

Friends in odd places and God in all places

D 'Roff-garr'* (read it phonetically and it should ring a bell, (security, creative access so on and so-forth) just showed up, to meet any needs that we as a family may run into. The nurses had to post a sign on pop's door that says "do not enter without talking to the nursing staff," and as I was walking out of the room with 'D' it struck me that even on the other side of the world from home we have had so many visitors and so much support that they had to post a sign in an attempt to control traffic. God is good, all the time, and in all places.
Chip

*Edited for Jon to make it look less like the last name.

Morning Update

Today TJ has been feeling pretty well (again, given the circumstances). Just a few minutes ago he was sitting up working briefly on one of his books. All of his symptoms being watched are trending in the right direction. Let's pray that this continues. Every day, several times a day, the staff has to "suction" his lungs; essentially using a vacuum to pull fluids out of his lungs via his breathing tube. This is vital and has helped his lung function considerably, however it is extremely painful and uncomfortable. He said he feels like he is going to have a heart attack when they are suctioning. TJ wrote today that its during that time that a coma of heaven sounds appealing. They will start a low dose of IV sedation for the night (in addition to the light sedation he is already on) so he can sleep.

He was up in a chair a couple of times today and did quite well with that.

Prayer requests....

continuation of the upward trends.

comfort during suctioning, and that it would no longer be necessary, ASAP.

energy and strength for the family - we're all a bit on the worn out side.

Evening Update

I was able to speak with MA about 30 minutes ago (took me a bit to write this), here is her preliminary take on the situation:

• She is very impressed with how proactive and cautious the doctors have been at the same time. That proactiveness probably is saving us from a lot of pain, waiting, and close calls that we had last year. She also said she was impressed with the nursing staff.
  (On a side note, I called the hospital to get ahold of her; every person I spoke with knew two phrases: first, they understood, "Do you speak English?" and second, "Just a moment," as I was transferred to someone who did if they did not)
• The intensivist said that they had a really hard time getting the central line into his left side (basically a big IV-like line that all the IV's go into) which was the same deal last time. They were able to get it in, just not where they were hoping to.
• TJ's white blood cell count has been dropping rapidly; 28k when he was admitted, 18k yesterday and ~8k today. 5-6k is normal. This indicates that the infection is under control.
• In the event that he does not have MRSA (not all the cultures are back) they started TJ on another broad-spectrum antibiotic. With the antibiotics he is on, he should not come home with so much as a flu!
• His kidney functions are back to where they were early December 2008, not great but not bad either. Very good in our current situation.
• The doctors said he came in with bacteria in his bloodstream which they believe spread to his lungs, the cause of the sepsis.
• TJ has endured quite a bit of suctioning today and a lot of bad stuff is coming out. This is, of course, a double-edged sword: it is great that so much is coming out, but it is difficult to imagine something more uncomfortable (other than perhaps being intubated).
• TJ's "peep" (vent pressure setting) is at 16 (max, I believe, is 20) in order to keep forcing stuff out of his lungs. In contrast, last time around the vent was set as high as it would go (including oxygen) when he was doing much worse than he is now. This is part of the proactiveness
• The medical staff is going to try to get TJ into a chair today, while being on a vent.
• Tomorrow, depending on what happens today ICT (ICT meaning Thailand time), they are going to try to ween him off the vent. Given that he was intubated 18 days last time round this is pretty amazing.
• TJ is hypercoagulating, meaning that he is clotting faster than normal and is on a Heparin drip for that. They will cut that down after the central line is pulled and essentially treating him for DVT (deep-vein-thrombosis: clotting in major veins, usually in the legs or arms, hence "deep.")
• The cardiologist who has been watching him thinks everything looks good so far (anyone remember a mitral valve problem last time around? Yeah, apparently not there as far as the cardiologist as seen.)
• Finally, the rest of us (MA, Chip and myself) get to have nasal swabs done! Basically, checking to see if we are carriers of MRSA and if so, what strand. MA most likely is, Chip & I are also a high liklihood.
  
  Some 25-30% of people in the US carry a similar form of Staph, about 1% of the overall population carries MRSA specifically. Both numbers vary depending on the geography and population, health care workers are especially high, which is why MA probably has it. While MRSA isn't airborne spread, Chip & I have had enough close contact with both our parents that between TJ (a known carrier) and MA (a lifetime RN) we get up there in terms of probability.

And that is it! What you can take away from this is that almost everything is going well (great, compared to last year!)

You can:

• Give praise for the continued progress. I don't think anyone expected things to be going so well ~48 hours after being admitted to the ICU.
• Pray for comfort for TJ -- again, the suctioning process is pretty painful (a vaccum being shoved down your throat into your lungs).
• Pray for rest, most specifically for MA & Chip.
• Pray for complete healing. That TJ would be fully restored to his younger self (at least by a 14 months, before this started for the first time!)

Thank you all! Your prayers mean the world to our family.

MA Arrived

MA just arrived at the hospital ten minutes ago. No new news, just an FYI that she made it.

There should be some updates either this afternoon or later this evening (as morning greets Bangkok) after my mom has a chance to talk to doctors and the doctors make their rounds.

Brief Update

Spoke to Chip briefly who is at the airport waiting for my mom, NWA.com says the flight has arrived but there is customs and luggage to deal with. I'll post when I hear from her.

Yesterday (last night for those of us in the US) they were suctioning fluid of TJ's lungs most of the day. This is a good thing, but again, incredibly painful. Last time round it was obvious that TJ was in pain even though he was in a coma. I cannot imagine what it would be like to be awake as they shove whatever it is into your lungs.

More good news, the intensivist (sp?) there thinks that they have the infection under control. So that is a huge spot for praise.

Please pray for the pain, and continue to pray for complete healing of TJ.

It's the Bug that Never Ends

Sorry all, I took some time to sleep in this morning. I'll have two morning updates, this first one is from the same guardian of TJ that I quoted yesterday:

We're here in the room with [TJ].

The Docs here in Bangkok are saying [TJ] should plan for a two week stay before they would certify him as 'fit to fly'. [Name withheld] came to the hospital this morning and went over ALL medical files with the Thai Doc. She was very impressed with the quality of the care.

A couple of things came out this morning. First, [TJ] would never have made it to the states. He would have died enroute and all the Docs agree on that. Second, while he is now stable, the MRSA is back and they are throwing antibiotic cocktails into him hoping that something gets it. The first of the dozen or so blood cultures comes back this afternoon. These are hoping to identify the specific culprit in order to try to design something to kill it. It just goes latent in the body until a trigger sets it in motion like yesterday.

This email mostly speaks for itself. I cannot believe TJ came down with MRSA again. If you recall from last year, many people carry it rarely actually develops into an infection. You would be surprised at all the gross and nasty things your mouth carries in it. The odds of it developing twice in TJ are extremely slim, almost nil, as the antibodies should have been built up.

I'll update again when I know more. MA should be arriving in about 15 minutes according to NWA.com

Evening Update II

I just got off the phone with Chip who had just finished speaking with the doctors. This is what he had to say:

The overall prognosis is good, TJ is alert -- even smiling and "chuckling!" Although, for obvious reasons he isn't in a great mood.

This morning's chest X-Ray show improvement over yesterday. The doctors think that may have come from the pressure of intubation. However, they also had him on 100% oxygen yesterday, which is now turned down to 60%. As a side note, they are really staying on top of things. Normally you wouldn't start someone on 100% O2 right off the bat, but staying ahead of the curve is great and could significantly speed up the recovery process (in the hospital and out).

His white blood cell count is down from yesterday (I don't know by how much) which is another good thing. His kidneys are also functioing better than yesterday although Chip says they were never bad (amazing, given that they have been an issue even in the last few months).

I'll probably head off to bed again soon, so expect this to be the last update for the evening. Feel free to leave questions if you have any as always.

Prayer Points:

• Pain: TJ was feeling pretty crappy before he "left," and is feeling worse now. It's great that he is not sedated past what is necessary but everything else aside, being intubated is not a fun thing. In my mom's words, "it's like having a garden hose shoved down your throat." Ouch. So pray that he is as comfortable as can be.
  
• Wisdom/Safety: The doctors may increase the pressure on the ventilator to try to continue to "push" the pneumonia out. With ARDS this does carry a risk of rupturing the lungs, no good. Pray that the doctors make the best deciscion, and that if the pressure is increased there are no negative side effects.
• Complete Healing: We continue to ask God to completely heal TJ, and to bring him back to his level of health he had before MRSA (which he never fully regained).
• Praise: I can't say this now with confidence, but we may already be at the turning point (although last time around we had a few of those, or thought we did). I can't say it with confidence because if we are there we are in the middle of it and can't see it yet. Still, we thank the Lord for all He has done so far.
• Patience for the family: All of us had the same reaction as the news came in: you've got to be kidding me! Again??? Patience is not coming quickly. We thought we were "over this." There is a sense of bewildermant. How does this happen twice? So please pray that we are patient through this process and that we wait upon the Lord while praying boldy at the same time.

A Couple of Notes on the Evening Update (Update 8:10 CST)

There are a couple of things I feel like I should have fleshed out a little bit more.

First, as pneumonia, ARDS and Sepsis are both collections of symptoms there is going to be some overlap between the three. My guess is that the doctors could have said TJ has ARDS yesterday. The fact that they are only calling it that now isn't as big of a deal as it may seem. Of course, I'll be able to speak with at least a little more confidence on the matter when I hear from Bangkok.

Second, even if the recess of fluid in TJ's lungs was slight it is a very good sign. It suggests that the antibiotics are kicking and working, even if all they have done is stall the pneumonia that is great. This post from yesterday explains why even small steps can be big wins. We don't need the antibiotics to "heal" TJ so much as help his immune system step up to the plate and swing harder.

Third, MA and I were discussing whether TJ was actually in septic shock or not. Without having all the facts, being there, etc., one can't say for sure, but our conclusion was that TJ probably had sepsis which got translated into, "the first stage of septic shock." It is the precursor to septic shock, but again, there is a world of difference between the two.

Sepsis is bad, don't get me wrong, but it means that while TJ's body is under incredible stress it is dealing with it still. Septic shock, as I said yesterday, is when the dominos start falling. Thus I mostly see encouraging signs at this point.

Finally, if you do Skype you can find me at madjon84. A screen name that I was starting to let drop until I realized how handy anonymity can be (my last name is not on my profile). Calls are accepted by default and will go to a Skype voice mailbox if I am not around. I may end up getting an online number through Skype so anyone without it can call and leave a message. (The advantage is basically giving myself an emergency number [the one currently posted] and a non-emergency number.)

This just came in from one of TJ's guardians who took the night shift (I think he meant "AM" below):

I left [TJ] last night around 4pm Bangkok time. He had just been bathed and the nurses had given him some sleeping pills, so they said they would wake Chip in the apartment (there are apartments for family only right on the same floor as the ICU) if they needed to. However, the BP has been in the ‘low normal’ range (105/65) and the sats are in the mid 90s, but again he is intubated. I took a taxi back to the hotel where the conference was and just woke up (8:20am here in Bangkok).

[TJ] is aware of the events surrounding him. I talked, he nodded or shook his head to communicate. A couple of times he wanted a pad to write on.

Evenening Update (Updated 7:36pm CST)

I got to Chip once since I've been up, I think I caught up right as he was getting up. The good and the bad:

TJ is stable and alert. "He knows what's happening." Another member said that he could communicate with winks and nods, write a note from time to time. This is drastically different than last year.

The same person said that his blood pressure was stable and pretty good overnight, and that TJ's O2 sats were in the mid 90's throughout the night as well. Granted, TJ is vented, but last time round we had a hard time keeping them in the upper 80's. For at a least a couple of days the vent was set at "full blast."

The pneumonia has made a small recession since the last chest X-Ray (done yesterday afternoon Thai time, early yesterday morning U.S. time).

He has been diagnosed with ARDS -- Acute Repository Distress Syndrome. We've been down this road as well (December 15th, 2007):

He has also developed acute respiratory distress syndrome (ARDS) from the MRSA. The most important part about this is that it can lead to increase pulmonary edema, , e.g., more fluid [and/or inflamation] in the lungs... ARDS can lead to complete respiratory failure, so it is very dangerous...

In essence, his lungs are being pounded once again and developing an inflammation which in turn impairs the breathing process and again in turn impairs the rest of the body as oxygen levels drop. Fortunately, last I heard his O2 Sats were still good.

This time we don't know from the ARDS -- or the pneumonia or anything -- is from yet. Chip heard that blood cultures were coming back today, however they normally take 72 hours. Thus my ever so thorough medical knowledge (look it up as we go along) makes me think that what is coming back today must be a pretty narrow sample, that is, only testing for some specific things. I imagine there are more culturals being done that will take 72 hours.

I'll probably have one more update this evening, but it may be a couple of hours. Thank you all for reading. As I know longer have an Rn of 20+ years besides me anymore, anyone with medical expertise is more than welcome to contact me if anything I post is innaccurate or needs to be clarified.

P.S. My travel plans are to probably stick it out another day here.

P.P.S.: UT sent in this link on ARDS. It is more readable than anything else I've come across so far.

Brief Update (Updated at 12:45 CST -- See P.S.)

I don't have much in terms of real news but thought I'd update a couple of small changes.

Earlier this morning TJ's blood pressure was back into a normal range. As I assume many of you remember this was a major problem last time around and the only good news to emerge out of the last 24 hours.

TJ is also not in a coma; apparently they completely sedated him for the intubation but is only partially sedated at the moment.

Chip managed to convince the doctors that TJ could have MRSA again (not likely, but possible, especially given that the type he had before appeared to be a new strand of MRSA.) All in all, the Thai doctors have been listening closely to whatever MA or Chip have said, which is good.

Chip also managed to get some rest, or at least so I hear. Hopefully he is sleeping now.

MA is at the airport and the flight is schedule to leave at 1:oopm CST. She is completely exhausted. While she tried to get some rest last night all she managed was to lay down for a couple of hours.

Finally, I am going to get some sleep myself. Feel free to email me or leave a message over IM (GoogleTalk, madjon@gmail.com) or, as always, leave a comment. I am reading them all.

I believe that is it. Thank you all for your prayers, I speak on behalf of the entire family: we firmly believe in the power of prayer, we saw it a year ago like few people ever do. And we ask that you continue to pray for complete, miraculous healing once again. We know in a very personal, tangible way that God can and does bring people back from the dead. And we really want to see it again.

-jon

P.S. One year ago today, around 6:00pm CST, TJ was discharged from the United ICU (not the hospital, that would come ten days later). There is an irony here -- I think. In another way, it is like December of 2007 picked up just in time, as if it is not over. I am too tired to grasp whether that is profound, stupid, just a random thought, or a combination of all of the above, but it does come to mind. At the very least the story is not yet over.

P.P.S. My plans for travel are still up in the air. I'll decide whether I fly out 24 hours from now or not later this evening, depending on changes, if there are any.

Intubating and Going Under

To clarify, after a question, this does mean TJ is going into another induced coma.

Intubating

They are currently intubating TJ.

Please continue to pray for Chip (Steven) who has been handling just about everything over. He has been the go-between for the doctors and my mom, and all the information that we have. He also get to sign all the consent forms. While he is a tough young man, I don't know anyone who would want to be signing consent forms for their parent.

Probably Intubated

TJ is probably going to be intubated. Probably meaning, "the odds are greater than not." Another specialist is apparently being consulted first.

Getting Worse

I just got a text from Chip, TJ appears to have pneumonia in both his lungs now, the left one bad.

The pneumonia is spreading now -- very bad. His lungs looked better this morning than they do now. As always, there will be updates as soon as I have them.

Please pray that the antibiotics kick in and the pneumonia starts retreating. If it does not, than we have hit 2007's level of seriousness.

Update 5 minutes later: TJ is also being switched from his C-PAP to a BiPAP. This post from our last major health battle explains the difference.

Message from the Field

Message from the field so to speak. I was just talking with the doctor and as of right now things are looking up. TJ's stats are good, and his BP is closer to normal and he is coherent. The doctor is optimistic, which as many of you may know is a pleasant break from the norm. (And yes find it a little odd that we have 'norms' for this kinda thing) thanks, keep praying. (specifically that...)

• The antibiotics would take hold and eliminate the infection
  

• His lungs would clear quickly so they do not have to ventilate him
  

• Protection in the spiritual side of things, bangkok can be a pretty dark place

-Chip

Another Answer/Important Update

TJ was just put on another drug, Rifampin, a strong anti-biotic. MA says, "Basically he is on the same drugs that worked last year. But that could change when they get cultures back [in order to determine what the infection is] which can take up to 72 hours." Depending on what the cultures show that drugs he is on may change.

In good news, his SATS are at 97 (remember that a glossary was setup last time round) with his C-PAP (a machine for sleep apnea that keeps a continuous pressure on the lungs, as opposed to actually being put on a ventilator which forces the lungs to stay at a certain pressure).

Someone I was chatting with asked:

Are we in the same stage we were last year but this is attacking more rapidly?

I am just going to give you the transcript of the chat for the answer:

(1:24:29 AM) jon-lappy: No
(1:24:34 AM) jon-lappy: There are a couple of differences
(1:24:51 AM) jon-lappy: Odds are he doesn't have one of the worst viruses in the world at this point [aka MRSA, pretty much a once in a lifetime thing]
(1:25:11 AM) jon-lappy: We are still about half a step away from the blog entry I assume you are referring to. [The last blog entry] [He also is not in a coma, dealing with a failing mitral valve, among other things.]
(1:25:30 AM) jon-lappy: In a few hours (probably under 24) we'll know whether things are getting really bad or not.
(1:25:54 AM) jon-lappy: Septic shock does not move slowly. It comes in fast and goes out fast when you get out of it.
(1:26:23 AM) jon-lappy: In essence, it is all of your vital organs shutting down as the body hits the point where it cannot deal with the infection anymore.
(1:26:35 AM) jon-lappy: So the infection either gets cleared up or it doesn't.
(1:27:08 AM) jon-lappy: When any organ starts going haywire the rest start to follow in general, so going the bad way it is like dominos.
(1:27:26 AM) jon-lappy: Going the good way everything just starts working again as the immune system kicks in again.

To give some analogies:

• If you have a heart attack everything else shuts down rapidly due to lack of oxygen.
• If you get pneumonia everything else becomes less effective as your body fights the pneumonia while not getting as much oxygen as it needs in the first place, which can lead to more problems.
• If you have liver or kidney problems, the rest of the body starts getting poisoned as the toxins that are normally filtered out start to recirculate.

Like these examples it can be a vicious circle. When any vital organ fails to operate normally it puts more stress on the rest of the system -- including the immune system -- which causes greater stress and so on. However, when the antibiotics start to work the body has extra help fighting the infection, hopefully giving it enough power to restore normal, if minimal, function to everything else.

Answers/Up All Night

Given the pace at which events are changing I'll probably be up all night and probably on a plane Monday.

To answer Abby's question:

Do the docs still think he has pneumonia as well as septic shock??

Yes, both of those things are symptoms, which leads to Arthur's question:

Jon, how can it be septic shock without serious infection? Can you explain?

Odds are that there is an infection. We just don't know what it is yet.

We've been here before, and going back helps outline what we are looking at. On December 12th, 2007 we wrote:

The main issue so far is controlling the infection. So far TJ may not be responding to the antibiotics that he has been given, and, as noted, the pneumonia has started moving into the right lung.

[...]

Basically, the sepsis dilates the blood vessels and makes the lungs "leaky." This leads to [congestive heart failure], which means that the heart isn't pumping enough blood and can lead to a drop in blood pressure. An analogy, the blood vessels are pipes which have expanded, but have the same amount of fluid is flowing through them so they no longer have the pressure that they should.

The sepsis can also evolve into septic shock, which is mostly simply defined as sepsis that is severe enough that fluid starts leaking into the lungs, the person becomes confused, and eventually myocardial dysfunction will occur (heart attack). If septic shock occurs it can clear in as little as 24 hours, or stay for days. Depends.

The next day we wrote:

Tj is in septic shock and a primary concern here is the loss of blood pressure. During the night his blood pressure dropped below 80 several times. The doctors are very concerned with the pulmonary edema (fluid in the lungs) because it can lead to respiratory failure.

We will be looking at the same things here, hence why he was so rapidly put on Vancomycin, to control whatever infection is there. TJ's blood pressure has not dropped below 80 so far (at least so far as I know) but it wasn't far from it last time I had a number (around 6:00pm).

A moving pneumonia would be quite scary here (all we have is the baseline right now, so whether it is moving or not is undetermined) possibly indicating a move further into septic shock, which has a mortality rate of about 50%.

So, yeah, we are officially into the "very concerned/scary" stage of things. Past this we are getting to the "scared of death" stage. I made such a remark a year ago and was later chastised for it, it made a lot of people upset. But it was the truth. We aren't there yet today, but only moving in that direction and rapidly.

Possible Intubation

K, just got this text from Chip in Thailand:

If he doesn't respond well and quickly to the antibiotics they will have to intubate him.

This is not going well... Please pray that they do not have to intubate him. We really don't want that. Again.

Little More on Bad Things

TJ has been put on Vancomycin again and the hospital's infectious disease doctor there has been brought in. He does have pneumonia in his left lung. The doctors in Bangkok were able to call TJ's doctor here (the one that pretty much walks on water). MA has a flight booked for tomorrow and is getting concerned because, "they are pulling in the big guns fast." It takes a bit for MA to get concerned.

We are also working on getting her an international cell phone within 11 hours (from now). Don't know if that is going to happen.

The link to hospital's website is http://www.samitivejhospitals.com/srinakarin/aboutus_en.aspx they probably are the best hospital in Bangkok.

This post may be updated in the next 10 minutes as I get MA to look it over (she just got off the phone with Chip, there may be updates that I didn't hear).

And for everyone asking, no, I (Jon) am not getting a flight at this point. I am planning on waiting another 24 hours or so, or at least waiting for more concrete information to fall into place.

K, Things Are Now Getting Bad

I've been asked by more than one person how I am doing, compared to last year this has largely been an annoyance, until now.

The doctors think that TJ is in the first stage of septic shock. Very bad. His urine output is low, probably due to that. He is running a fever of 37.9'C, which equates to 100.2'F, and is feeling cold. His blood pressure remains low.

There are placing a central line in now (more or less like the pic line he had in last year).

MA is working on travel arrangements as I write.

Feel free to comment with questions, I'll answer as soon as I can.

Update on Previous Post

First, if you didn't read the post below, do so.

Second, MA just got off the phone with the Thai pulmnologyst who said that TJ either has pneumonia or a scar from his last plural effusion. It is most likely pneumonia. It is also worth noting that pneumonia is a symptom, not a disease. So why TJ has pneumonia is up in the air.

TJ does not have a fever, but his blood pressure is low and his on five liters of oxygen. He and MA were able to talk over the phone a few minutes ago.

Finally, the CT scan has been put off for the time being. Which means almost nothing other than that they are not doing it now.

Possible scenarios...

I was just able to speak to the doctor in Thailand. Tim was not feeling well on the plane, got very sweaty, and then does not remember exactly what happened, although another passenger reported that he was shaking. The CAT scan of his brain was fine, his pulse and heart rhythm are good. The doctor thinks that it may have been a syncopal episode (low blood pressure leading to passing out and sometimes shaking) vs. a first time seizure. They may do an EEG tomorrow. He is getting a cardiology consult and an endocrine consult for the diabetes. He does not want to add a medication for possible seizures since TJ is pretty complicated medically and the doctor does not want to add unnecessary medication. The doctor is concerned that his blood pressure is remaining low and on a chest x-ray it looks like he may have pneumonia. That part makes me nervous!

Chip has a room down the hall-like a hotel room that is part of the hospital and a couple men who work with Tim are also with them.

MA

Admitted

So TJ has now been admitted to a hospital three times in his life, and has managed to be in the ICU every time!

The doctor that checked him over didn't like something he heard in TJ's heart (not really a surprise) and checked him into the ICU for 24 hours and ordered a CT scan as well. It would be a surprise if the staff there found anything new. His neuro checks (strength equal on both sides, oriented, etc.) were good. The doctor was wondering if it could be a clot (hence the CT scan), but he seemed to be throwing possibilities out for consideration.

There have been some Thai people from a similar organization that have been helping to translate, but the doctor speaks English well enough for Chip to understand him. Also fortunately, there is a hotel at the hospital where Chip is getting a room.

Two other people from TJ's organization -- one who lives in Hong Kong currently, previously in China -- will be on hand as soon as TJ actually gets his room. The staff did not want them in the ER (again, not surprisingly).

We'll update as things come back to us. You can pray for Chip as well, who apparently is going on a mere three hours of sleep and no food as yet. Guess he wasn't expecting a crisis at the airport.

On the Way to the Hospital

Chip just called and they are on the way to a hospital in downtown Bangkok (they were told this is the "best"). He has an IV and on o2- pretty standard. The medical staff wanted Chip to take care of passports before leaving for the hospital and they did get their luggage. Chip thought that they were not in too great a hurry. TJ will need a signed certificate from a doctor to fly.

Without seeing him and just guessing, I am speculating that he was exhausted, dehydrated, and perhaps getting sick..He seems to get food poisoning every other time he is in Bangkok.

He is stable right now and this does not appear to be anything life-threatening. Everything we know has been posted so far and there is no a diagnosis from Thailand yet or how sick he is or whether there was an actual seizure or not is unknown.

Please pray that everything is cleared for them to get a flight home tomorrow and all the details of getting sick in a foreign county get worked out.
MA

A Major Concern in Thailand

TJ and Chip (his younger son) are at the Bangkok airport right now where TJ may have had a seizure on the plane, and the were subsequently deplaned.

The details are scarce for me at the moment, but TJ did black out on the plane, possibly due to low blood pressure (which can look like a seizure without actually being one). The airport medical staff are checking him out right now and giving him a IV flush in order to make sure he is hydrated.

I'll update as soon as I know more. Thankfully Thailand is one of the better places in Asia to have something like this happen. With travel health insurance it is common to have a plan in place to medivac someone out of another country, such as China, to Thailand.

P.S. (6:08CST) TJ is conscious and does not appear to be in a serious condition at this moment. But, again, the info is coming through slowly. Thank God for international cell phones!