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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)

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

The Quick Summary

I am working on summarizing the family/doctor conference we just had with the pulmonologist (sp?) and intensevist (sp?).

Highlights:

• The main issue at this point is controlling the infection (MRSA)
  
• Aside from his lungs, the rest of TJ's organs are doing ok
• He is still recoverable (Dr.: ""There is no reason to feel hopeless right now.")
• There have been small victories, progress is being made
  
• But he is still in a very dangerous place. Mary Ann said, "He is probably sickest person in hospital, probably has been for a few days."
  

Today's Requests

This is an important day for TJ and the medical staff. At 8:30 am the cardiologist will be placing a scope and camera down to the heart to determine if there is an abcess on the heart valve. Pray that this procedure would go well and that they would see a clean heart valve. The second request is that today the infection would be brought under control. At the moment blood pressure is holding steady,heart rate is 124. The doctor just reported that the pulmonary edema is improved. The temp is presently 101.6 and needs to come down.

Some Encouraging Numbers

The last several hours have been encouraging in several ways. For the last couple days tj has been on 100% oxygen, but his oxygen saturation levels have hovered between 79 and 88 most of the time. That number has been steadily rising through the night and hit 100% at 2:00 am. An hour ago they lowered his oxygen input to 90% and his sats stayed level. So now they have been able to lower his oxygen to 80%. We haven't been able to do this for at least two days - this is awesome news. So far @ 80% his oxygen saturation levels are holding steady. His temp had been high all of yesterday, but has dropped to 99.9. Heartrate is down to 110 and blood pressure has also improved. Praise the Lord for this wonderful progress!