Evening Update

Unless something dramatic happens tonight this will be the last post. TJ is doing well, vitals are all good, and he should be taken off the CPAP and put back on the ventilator soon. He has done very well weaning off the ventilator so far.

Our requests for prayer are much the same as they were earlier in the day:

• That future weaning also goes well (starts at 6:00am CST tomorrow)
  
• That TJ's anxiety stays down as he wakes up (Mary Ann wants you to understand that the anxiety comes from waking up and feeling a garden hose down your throat).
  
• Prayer and praise for amazing healing! (E.g., that his lungs continue to heal)
  

It would be great to have TJ off the vent tomorrow.

Notes on Breathing Gadgets

Every now and again I realize that something made it up here that might not be as obvious to some readers as others, so here is a quick run-down on the relevant breathing gadgets.

BiPAPS are quickly becoming more common and well-known as they are used to treat sleep apnea at home. It is usually the mildest form, and has two levels or pressure that it puts on the lungs, one for inhaling and one for exhaling.

A CPAP puts a single, constant pressure on the lungs. The pressure may or may not be higher than a BiPAP.

In contrast, a ventilator actually does the breathing for you. Neither the BiPAP nor the CPAP normally involve being intubated whereas a vent requires it. It sends air down the lungs, and the patient passively exhales.

All of the "gadgets" allow varying amounts of O2 (oxygen) in the air, (the air you and I breath is about one fifth O2) and pressure. The PAPS are merely assistive in contrast to the vent, which is meant to do all the heaving lifting. The vent also lets you set the respiratory rate (breathes per minute), whereas the PAPS let you completely breathe on your own.

By far the most obtrusive part about the vent is a tube down your throat. The PAPS never need the tube, although they can be used with. So currently TJ is still intubated even though he is on a CPAP. It is likely that after being extubated he will be on a CPAP or BiPAP without the tube, just a face-mask (which have varying degrees of comfort, but are all better than a tube!)

So there is a quick rundown on all the fun breathing things TJ is on.

Extubation Plan

The plans for the extubtation are to keep TJ on the C-PAP until 8:00pm tonight, then put him back on the vent overnight, and again put him back on the C-PAP tomorrow at 6:00am.

This, of course, depends on how well TJ tolerates being off the vent. He could be put back on the vent earlier if his toleration of the C-PAP declines. To wit, as long as his sats and respiratory rate stay in an acceptable range they'll keep him on the C-PAP.

Hallelujah!

Well, nobody expected this...

TJ's white blood cell count is at 18,000 - getting closer to normal. His hemoglobin is a little low, so they are going to be giving him 2 units of red blood cells (I understand this is a relatively common procedure and will just help him feel better). His temperature is also normal without tylenol or a cooling jacket (Mary Ann suggested it was a good time to turn the cooling jacket off when his temp hit 97.9). He is also off all blood pressure medication, and the doctor says his chest xray is clearing. Right now he is slowly beginning to wake up and open his eyes, but he is not completely aware yet.

The wean from the vent is going *very* well. The peep is at 5 (less pressure than he gets through his CPap at home to sleep) and his oxygen sats are holding steady. The nurse commented that if he were more awake, he would be doing well enough to extubate (which just doesn't ever happen on the first wean). This process is exhausting for TJ, as his lungs work to breathe for themselves for the first time in almost two weeks. They will need to turn the vent back on later when he gets tired, but will continue with future weaning as he continues to wake up.

Our prayer requests for the rest of the day:

• That future weaning also goes well.
  
• That TJ's anxiety stays down as he wakes up (Mary Ann wants you to understand that the anxiety comes from waking up and feeling a garden hose down your throat).
  
• Praise for amazing healing!
  

New Stats, Looking Forward

As the doctors make their rounds this morning, TJ's vitals continue to make slow, but good, progress. His temperature is still not normal, but continues to trend downward. His white blood cell count is at 18,000, so also continuing downward. The pressure on his ventilator is the same, but his sats are staying up consistently. His chest x-ray also looks better this morning. They are removing his sedation, but he is not waking up very quickly.

This afternoon is really going to be critical for TJ as he begins to wake up, so that is our biggest prayer request for today, as well as yesterday's requests. This afternoon could be "exciting and quick-moving" as changes happen and decisions need to be made about TJ's ability to breathe on his own. Your petitions have brought him this far, and they will be critical this afternoon! Keep up the fight!

Comfort

There is no news regarding the overnight yet, waiting for that to come in, but there is something else worth addressing here.

In addition to last night's prayer requests, one should be added, that TJ can be relatively comfortable during the extubation.

To extubate they have to take him almost entirely off sedation; TJ will be alert enough to realize that he has a tube going down his throat his mouth, and another down his throat through his nose. He won't like either of these. At. All.

So pray that he can be as comfortable as one can be, as a tube is being yanked out of one's throat. To make matters even better, it will probably take more than one try. I don't know if this mean re-intubating, I suspect rather that it means weaning TJ off the vent and seeing what the sats do until they are ok, but either way it won't be a fun process...

P.S. It is worth noting that they may not be able to wean him off the vent today, that is not abnormal, just painful.