Summary Part One: The Facts

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.

BUT, TJ may be responding to the antibiotics, as a lowered white blood cell count indicates. But the count is still incredibly high. The downward shift does indicate that they have control over the pulmonary edema. At the very least we don't know, and he needs to start responding. Now

His heart valve is still looking better, better than they thought it was looking on Monday, which is why they put the TEE off (scope and camera). The doctors don't want to do anything that they don't have to do at this point. To quote, "He's not going to get a new valve in the near future." Basically, the heart is functioning well enough at this point.

He does have congestive heart failure (CHF) due to the sepsis. Basically, the sepsis dilates the blood vessels and makes the lungs "leaky." This leads to CHF, 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 chest tube has not drained as much as the radiologist had hoped it would, but they probably won't do anything more about it for now; they don't expect that it would help things a whole lot. At any rate, they would probably have to do another CT scan first.

However, overall a significant amount of the total volume of fluids has been moved out of the blood supply and body tissues, a good thing.

The chest X-Rays haven't shown any change in the last few days, but they are a lagging indicator.

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 in the lungs (see below in this post, they think they have control over the PE.) ARDS can lead to complete respiratory failure, so it is very dangerous. However, the pulmonologist did not indicate that this was imminent (as far I as I could tell he left this topic pretty quickly).

While TJ's need for (supplemental) 02 has gone down, it is still "tremendous" and the pressure on the vent is much higher than the doctors want it to be.

The response time can be anywhere between 48 hours and 7 days for MRSA, but it depends on the patient, etc., etc.

Overall the doctor said there have been no surprises, some disappointments, and some victories.

Finally all the blood cultures have been negative, which is a good thing. It suggests that the MRSA is not currently circulating throughout the body -- it is concentrated in certain places, like TJ's lungs.

Up next: Summary Part Two: The Possibilities