( ESNUG 528 Item 9 ) -------------------------------------------- [10/30/13]
Editor's Note: This blog entry was originally on the ARM Community
web page in the open this morning -- but some time this afternoon
somebody inside ARM decided to put it behind a login wall. WTF???
Anyway here is Lori Kate's blog WITHOUT a login required. - John
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Thurday, Oct. 31st: I got a surprise call from Gary. He's still in
the ICU. They are working on releasing him directly home. He will
have a picc line with IV medicine to fight the strep infection which
will take a couple of weeks. He may go home with oxygen. He'll be
working with a respiratory therapist to help him train his lungs to
fully work.
Market Trends is still planned for an end of November release date.
He was pleasantly surprised that Sean Murphy, who he hadn't seen in
over 10 years, had visited.
Humor: conversations with Lori Kate's Mom:
Doctor: "Who are you?"
MIL Mom: "I'm his mother-in-law. Yes, I'm younger than he is."
Doctor: [pause] "Are you Gary's mother?"
Nurse: "Who are you?"
MIL Mom: "I'm his mother-in-law."
Nurse: [walks away. A few minutes later she asks Gary] "Is she
your wife's mother?"
Gary: "Yeess"
Gary and Lori Kate say "Please thank everyone for their well wishes."
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Subject: Gary Smith Medical Update -- What A Journey It's Been
Gary Smith Medical Update: What A Journey It's Been
Posted by lorikate in Lori Kate Smith's Blog on Oct 28, 2013 9:23:00 PM
We are in the ICU at Good Samaritan hospital. I imagine that many are surprised by this information. Believe me, Gary and I are surprised too. It's been a very long and short journey to get here.
Gary had accumulated multiple pockets of pus and blood in his chest and lungs. They had mangled his lungs, especially the right one which was limiting his breathing. Some of the lobes of his lungs had stopped working. (Gary's lung capacity was reduced 10 years ago during radiation treatments with his cancer, so he didn't start with full capability). In addition, the pus was generating phlegm, which had been increasing recently.
How did the pus get there? They don't know for sure, but they think it was caused by silent aspiration. That means that Gary may have been swallowing bits of food and/or liquids into his lungs and he didn't know it. It may have been caused by the radiation and chemotherapy from his cancer that weakened his system. They will test more shortly to confirm.
This was all further exasperated by pneumonia which he likely got because of his weakened immune system.
Gary had surgery Friday October 25 and it went very well. The lungs are expected to heal fully and the unexpected great news is that the removal of the pus will greatly reduce the phlegm he will generate.
How can you find out more?
We are blessed that there are many people in our lives who care about us and want to know how Gary is doing. We are grateful that you do.
For those who are lucky enough to not know about how time can be in the ICU, let me share a bit. It's 2:30 pm on Sunday and it's the first time that I've opened my computer. ICU can feel like Grand Central Station. There are a stream of doctors, nurses and technicians that come through on a regular basis to do tests, give updates, check in, breathing exercises, blood work every 6 hours, etc. Trying to keep up with the amount of information being asked and delivered is a challenge.
Gary's daughters and I have split time between being with Gary and supporting Casey. We are in regular communication with each other to keep us abreast of what the other is doing. I have never sent so many texts in my life. We only got around to calling his brother on Sunday. It's been a bit busy.
However, I also know what it's like to care for someone and not hear anything. So I wanted to find a way to give updates that was easy to communicate and easy on me. I've used some of the Care websites with other family members. I didn't want to use one of those for 2 reasons: it's another system for me to login to and I didn't like the memories that each time I've been a part of those sites that those people have died. As I'm on the new ARM community site every day, it's the easiest way for me to broadly communicate. Anyone can read the posts once the site gets launched on Tuesday. If you want to add a comment or be updated on my posts, it's a simple registration process. You can also easily share it with others.
How can you help?
Many of you have sent good wishes and prayers. We thank you for all of them. They are a wonderful source of support. Here are some things that can help us more:
- Prayers and well wishes are gratefully received
- While I will read them all to Gary, please understand that at this time, I'm not able to respond to them. We appreciate them all!
- Ask me how Gary is doing, after you read the blog. ;-)
- I'll do my best to update the blog frequently. It'll have lots of details.
- Pass on the blog to anyone who you think might want the update.
When will Gary Get Out of the Hospital?
The original estimate before the surgery was 5 days. After the surgery the surgeon said it would be longer. No time frame was given, but I guessed 7-10 days by the way he said it. I'll keep updating this section.
Can Gary Receive Visitors?
Presently Gary's in ICU and only immediate family are invited. We're not sure when Gary will get out of ICU, but I'm guessing Tuesday at the earliest. Gary can receive cards in ICU but not flowers. I'll keep updating this section.
Will Lori Kate be at ARM TechCon?
Yes, that is the plan. ARM is encouraging me to do what I need to do for my family. They would be fully supportive of me missing TechCon. There's a lot of really exciting things that are happening at TechCon that I want to be a part of. (Ok, yes, I was more excited about them before 10:15 on Thursday, but I still want to be there.) Gary is fully supportive of my going. Gary's daughters and my Mom will be keeping Gary company.
How is Casey Doing?
He's doing ok. It's been hard. Thursday Casey went to school with his Dad at home. Thursday I picked him up to tell him that his Dad was in the hospital. We did a quick trip to say hi while Gary was still in the ER. ICU doesn't permit visitors under 14. So Casey's seen his Mom for about an hour a day and his Dad for about 10 minutes since this started. He's loved seeing the family and he's been doing lots of fun things, but he misses his parents and is worried about his Dad. He's 8 so it comes out in different ways. His school is looking out for him and we are grateful for that. We're looking forward to having him go back to school on Tuesday (teacher training on Monday) because it's the only normal thing in his life right now.
Now How did Gary Get Here?
As his granddaughter said, how did he not know he was that sick since April? Yes, April. Well hindsight is 20/20 of course.
Phlegm
From Gary's cancer, he lost 2/3s of his esophagus. They took his stomach and tied it to his shortened esophagus. One of the natural results is acid reflux. Gary's been searching for years to fix the phlegm and he's see a bunch of doctors about it.
Pneumonia
With a 7/8 year old at home, Casey may be healthy as a horse, but he brings home colds frequently. Gary regularly gets them. He'd get sick then better then sick again.
In April, we recall that Gary got sick, but we don't remember the details. At DAC, he was sick and extra tired, but again we figured it was some bug he got. He went to China 2 weeks later and he definitely came back weakened.
During this time, Gary saw different doctors: more than I've shared here, and more symptoms and illnesses than I've mentioned. Again, he'd get better and then worse. We thought it was a cold and then the flu. When Casey's birthday hit (end of September), he turned for the worse. We thought it was the flu that turned to pneumonia and got a chest X-ray. He went through a round of antibiotics and went back to the doctor at 4 weeks as directed. He wasn't any better. He got another chest X-ray on Wed Oct 23rd. By Thursday at 10:15 am, Gary's doctor told him to go to ER.
**I'll add updates after Monday afternoon here**
Tuesday
Thank you again for all the well wishes that I've received throughout the day. I saw Gary tonight and have started sharing them with him.
So the family wanted me to express how great we think all the Good Sam staff are. Gary is being well taken care of. Thank you!
Gary had a tough night due to 2 big coughing attacks, so he was tired today. The good news is that he has to have these big coughing attacks to get well, so they are a double-edged sword. Gary also is really hitting the boredom issue. The great news on that is it will encourage him to get better faster.
They continue to update his medication. They are moving from IV to pill medication to transition him to being able to leave.
Gary walked twice as far today as yesterday. Again, the nurses had to keep up with him.
The breathing treatments continued. My Mom commented: "Amazingly stoic and cooperative response from Gary." She's amazed at how cooperative and willing he is to take these difficult treatments.
Great news #1: They took out the chest tubes and the catheter. Funny part of the story was that one of the nurses was trying to give my Mom a hard time:
Nurse: "So they kicked you out of the room when they took the tubes out. If you stayed, they might have asked you to take them out. "
Mom: "Well I used to be paramedic so I could have done it, but I thought it might make the doctor feel uncomfortable."
Great news #2: Gary's being kicked out of ICU!!!!
Now the bummer is that they don't have a room, so they can't move him until tomorrow. Do you think I can claim that I should be charged for a regular room instead the ICU when I get the bill?
We still are celebrating that he's well enough to move and he'll get better treatment in ICU.
My Mom asked when Gary will get out of the hospital. Here is her text reply I got that really made me smile:
"I got a dirty look even though I asked really nicely. Look kinda said you really asked a stupid question, do you have any more stupid questions?"
With as smart as my Mom is, it made me laugh.
Speech therapy was a good session. They are helping Gary learn how to swallow correctly. Sometimes thin liquids were going down the wrong pipe. Then it comes back up through spitting.
Infection: they think it's one kind of strep. They continue to try and fight the infection.
Casey continues to struggle. This is perhaps the most difficult part of this journey. When I discussed it with one of Casey's former teachers, she said that eight year olds just don't know how to process these feelings. Anything out of the routine is really hard for him right now. My Mom was about to take him to soccer practice and she asked him to put on his second cleat in the car. He immediately teared up and said "No Mommy says to do it here. It's too hard to do it in the car." Now the last several times we've gone to soccer practice he's put his cleats on in the car in my Prius. My Mom was taking him in the van so it would be much easier in that car. I got down on the ground and chatted with him. In a proud Mom moment I said to him, "Now Casey, Nana is asking to go outside in your sock only. Every other time when you try to run out in your socks, we remind you to put your shoes on. Don't you want to go outside with your sock on while you can?" He got his devilish, sheepish grin on his face. (He had a great soccer practice.) Then he asked if I was going to soccer practice too. (Ugh) I said no, I was going to see Dad.
Tomorrow plan: Move to regular room and visit from Casey!
Monday afternoon and evening
What about Market Trends?
Yes the team is working on updating Market Trends. It will be published the end of November.
Another Classic Gary positive outlook on the situation
We had a lovely visit from Gary's brother and sister-in-law this afternoon. Watching the look on their faces while we explained what lead up to this event and what was going on reemphasized why I wrote this blog. It's just not simple to explain and we lived it. Part of me does wish it was a simple diagnosis and clear path for next steps. But Gary doesn't like to do it simply. Had to share one more example of his good spirits:
Brother: So Gary, looks like you're tied up there.
Gary: No they are all gone.
Me: You have 2 IVs with 4 medicines, 2 chest tubes, O2 and a catheter, but yes, it is much less than you had a few days ago.
Infection
Gary has some sort of Strep (not Staff) infection. The blood work shows that he's still fighting an infection. So they are continuing to monitor the antibiotics. The infectious disease doctor stopped by tonight.
Walk
Gary walked again tonight. Not as far as this morning (that had as much to do with the amount of equipment that he was carrying while being ready to support Gary.) However, his breathing while doing it was much better. His O2 remained between 96 and 98 whereas it was in the high 80s during the last walk.
Breathing treatment and exercise
Gary had another breathing treatment and his breathing exercises reached 1000. Yeah, continued progress.
Plan for tomorrow
Plan is still to remove both the chest tubes and the catheter. Let's hope that it comes to fruition!
More walking; more breathing exercises and treatments
Casey
Casey is still struggling a bit. He's doing well most of the time, but he's still really sensitive to things that usually wouldn't upset him. He talks about his Dad in one-offs.
This morning: (while we were snuggling) "I want my whole family back to snuggle. I wish Daddy was here." (We played a fun game about missing him afterwards.)
This afternoon: "I wish I had Super Powers to heal Daddy....and I wish I was Sonics brother." The view from an 8 year old. Broke my heart and made me cheer at the same time. Really glad that he has school tomorrow. Routine will be welcome.
Other
Gary took some more pain medication and ate half of his dinner.
A friend visited Gary today and said, "After reading your blog and seeing Gary, he looks a lot better than expected."
Thanks for all the support.
** End of update Monday evening**
Thursday October 24
At this point, it was believed that it was just a heavy dose of pneumonia that needed to be treated with IV drugs that you can only get in the hospital. We arrived around 12 in ER. After more blood work, X-rays and CT scan, the ER doctor thought it was a bad case of pneumonia and one or two possible pockets of pus that was resting on the right lung. It was an obstruction that prevented the lung from expanding fully. They thought it might be removed by a scope or surgery. Gary started receiving antibiotics and breathing treatments. Then in the late afternoon, they came by to ask if we wanted to do surgery at 9 am on Friday. Yup, it all happened pretty fast.
Gary's daughter had come down earlier and offered to stay with Casey while I stayed with Gary. Hospitals are busy places as you may know. Between the alarms going off, samples being taken, and breathing treatments, it wasn't a quiet night.
Friday October 25
Casey's always good for a laugh
Gary's daughter called just before she left to take Casey to school. They had been having an entertaining morning.
Daughter: "Casey got a devilish smile on his face and went into the bathroom. He flushed a banana down the toilet."
Casey: "No Mom, I didn't; I ate it."
Daughter: "He was only in the bathroom for 2 secs, he couldn't eat it that fast, could he?"
Me: "Did you find the banana peel?"
Daughter:" Yes, I threw it away."
Casey: "Mom, I ate it; I ate it!"
Me: "Well, he really can eat fast so he probably did."
It made Gary and me really laugh.
9 am
Just before Gary's daughter and I dropped Gary off, we saw Gary's primary doctor. It made us feel good. The anesthesiologist stopped by and said that Gary looks better. That's good for the surgery. We went to wait in the waiting room.
11:15 am
The surgery was supposed to last a few hours, so we were getting
excited that the surgery may be over soon. Unfortunately the
hospital volunteer came out to ask if we had heard that the
surgery had been delayed. Nope. It had only started at 10:42.
(Equipment issue.) So the wait was just starting. She also
shared that the surgery was slated for 2 1/2 hours.
2:00 pm
He's out of surgery, skipping recovery and going straight to ICU. We are waiting in the waiting room for the doctor or nurse to give us an update.
2:25 pm
Still no word. Chased down and found out that Gary had just arrived at ICU. They asked me to call them back in 15 minutes. It had been a long day. We hadn't heard from the doctor.
2:40 pm
We got to go into ICU. Gary was hooked up to the ventilator. It was hard to see. He started to wake up. When someone wakes up on a ventilator they typically panic. It's a horrible feeling to have a machine breathing for you and a tube down your throat. I held back the tears as best I could and talked to Gary letting him know that it was ok; the surgery had gone great; and he was on a ventilator. They quickly gave him some more pain medication. They wanted him to rest.
Wife vindicated
Gary's daughter and I walked back to the desk in the ICU and saw the doctor. He was a bit surprised to see us because he was pulling together information to share with us including pictures of his lungs. (I'm still waiting to see those pictures.) I wanted to tell the surgeon that after 4 hours of waiting since the surgery started, I only wanted to see my husband and not wait for the thorough report at that moment.
Doctor: "What I don't understand is how Gary could have been sick for so long."
Me: "Was it June?"
Doctor: "No, it was earlier."
Me: "Then it was April."
Doctor: "I just can't believe that he was managing with the pain he must have been in. His right lung was mangled. There were multiple pockets of pus. There was blood there too. It was worse than we expected. It was a long and complicated surgery. The pus pockets were creating much of the phlegm. When we would drain the pus sometimes it would fill up the tube and the anesthesiologist would have to clear it.
[Gary later learned from the doctor that they almost lost the bottom third of the right lung. Fortunately they did save it. They moved a lot of material and part of his lung during the surgery.]
What I really want to talk to him about is that he shouldn't go this long with the pain. He shouldn't be so stoic."
Me: "Yes, he went to the Naval Academy."
Doctor: "Yes, the military types can be too strong sometimes. He really needs to take better care of himself."
Me: Deadpan I say "I think that it would be a great idea for you to talk to him about that. Even call his primary."
Doctor: "Yes I will. I'm going to talk to both of them."
One of the best and worse qualities of Gary is his attitude toward his health. As his daughter said, "The glass is always half full with Dad." There are multiple examples of classic lines:
Gary: "I had cancer with a little c."
Me: "Honey, are you going to the doctor today?"
Gary: "No, I'm too sick to go to the doctor today. I'll go tomorrow."
Me: After I finish laughing, "Honey, the point of going to the doctor is to go when you are sick."
Gary and I have few areas of friction, but his health is one of them. Some of the conversations have been:
"Honey, are you going to see the doctor today or ER?" [He made it to the doctor.]
Me: "Gary, did you call the doctor today to go see him? [Friday, October 25]
Gary: "No I was feeling better today. So I had nothing to tell the doctor."
Me: "Honey, you haven't slept in a bed for a month. You throw up once a day from phlegm. And you had one of the worst coughing attacks yesterday. "
Gary: "Oh, yeah."
One of his friends said yesterday: "The next time he sneezes, I'm taking him to the doctor."
So yes, Gary minimizes pain. And, much as he likes to deny it, he's very stubborn [he almost lost part of his lung!] So I'll work on being a bit more vocal when he's not getting better. And the doctors are going to work on reminding him to not let it go so far.
However, I do believe that while we might have found Gary's illness a bit earlier if he'd been more proactive, it wouldn't have been months earlier.
As the medical team stated that the plan was to keep Gary medicated until the morning, I decided to go pick up Casey from school.
4 pm
I pulled up to school and saw Casey's main teacher and she said that Casey had a challenging day [he wasn't the only one.]
The toughest part of my day
While the waiting for the results of the surgery was difficult and seeing Gary panic with the ventilator tore at my heart, the toughest part of the day was when a few minutes later I picked Casey up from the playground and he was crying. By looking at his sleeves, he had cried several times that day. He was just really upset. His first complaint about his bad day was the fact that a friend wasn't being nice to him. Then he was very upset because he wasn't going to see his sister again that night. He just cried in my arms on the playground. I held him, barely not crying myself and said I was sorry that he had a bad day. I was happy to share that Daddy was doing better. We went home and had a very quiet evening.
10 pm
I called to check in to see how Gary was doing. The nurse said he had woken up two more times and was upset each time. They upped the dosage each time so he went back to sleep right away. [I wanted to say. Haven't you figured out that he has a high tolerance of pain and that's how we got in this mess?] Fortunately, as they said, Gary didn't remember any of this.
It was incredibly tough for me -- guilt. One of the big differences between the cancer that Gary had 10 years ago, which medically was much more serious, and this time is Casey. Last time, I didn't have a major pull of my heart about where I should be. This time I do with Casey. While in this case, Casey needed me more on Friday. He needed at least one of his parents present after he was struggling so much. And the staff had said he wouldn't wake up, so there was no reason to stay. It still didn't make it easier that I wasn't there to help talk to Gary when he woke up.
Saturday October 26
6:30 am
They gave Gary his 2nd blood transfusion (1 immediately after surgery because he lost blood) to raise his blood cell count. He's been awake and the nurses say he's not been in pain. They are slowly weaning him from the ventilator and he is tolerating it. They took another chest X-ray and are waiting for the results (they take one on a daily basis to see how much stuff is still in his lungs.) Gary has 2 chest tubes in his side for the drainage. They are also acting as a pump and balancing the pressure in his chest. They plan to take out the ventilator today. They continue to monitor his blood work every 6 hours.
8:30 am
I stopped by to see Gary in the morning for about 45 minutes. He's still on the ventilator but he looks better than before. Casey waited with his sister in the cafeteria.
First trip to ICU
Nothing prepares you for your first trip to ICU. I remember mine and I was in my 20s to see my grandfather. This was Gary's youngest daughter's first trip.
Gary's only question
Gary was still on the ventilator when his youngest granddaughter and I arrived in his room so he couldn't talk. We visited for a while and then he started motioning that he wanted to tell us something. His granddaughter figured out "Boo" so I thought Gary was asking about the Halloween decorations. (We had discussed that Gary's daughter's family would help Casey with the Halloween decorations as a fun project in the afternoon.) But he shook his head no. That wasn't it. We got him a pen and he wrote:
"Boots"
Gary just wanted to know when we were going shopping with his granddaughter for her Christmas present: Gary wanted to buy her some cowboy boots.
Yup, that's the only question that he had. That's Gary. Not worried about the surgery, when the ventilator would get out, when he could go home, etc. He wanted to know about a Christmas present. That's the positive side of his attitude towards his health.
Soccer game
Casey, Gary's granddaughter and I left for Casey's soccer game. To give you an idea of my functioning level, we drove to the park, but I couldn't find the field. There are two sides of the park and I was across the street and I didn't remember. I was afraid I was at the wrong park for the game.
Casey was struggling as well. During warm up, he was goalie. He's a good goalie and enjoys playing the position. He missed a few goals and the coaches were asking why he was missing them. Casey looked like he was going to cry. He was so upset that he missed a few warm up shots. This is not his normal reaction. I walked over to the coaches and let them know what was going on. (No I'm not that kind of soccer Mom usually.) Everyone started encouraging him and by the time the game started he was in a good mood and did a great job as goalie in the first quarter. He let one goal past him, but he took it with stride. He was fairly focused for 3/4th of the game. By the 4th period when they were down 5-0, he wasn't. I let it go.
Again it was an easy decision to be at the game instead of the hospital. Casey needed me there (and loved having his niece there) but it didn't make it easy being away from Gary.
Ventilator comes out
Meanwhile, they started weaning Gary off medication to make him sleep. They began testing his O2 and CO2 levels and did some breathing tests. After some review, they decided to take the ventilator out. Gary was so happy that he punched in the air.
They took it out without incident and Gary started talking. He was much happier. We called during half time so he could talk to Casey and cheer him for the game.
Noon
Gary looked so much better without the ventilator in. Both his granddaughter and I were much relieved. Gary's daughter and I switched and she took to kids for an amazing day of fun.
Since Gary was doing better, they had him sit up in a chair. I shared a picture with the daughters and my parents. My parents remarked how much better he looked than a month ago when they saw him during Casey's birthday. Yup, a day after surgery he looked better than the month before.
2:30 pm
Started breathing exercises to expand the lobes in his lungs. Should do 10 times per hour when awake. Nurse was pleased with his first round.
He needs to see a speech therapist to evaluate his swallowing.
4:00 pm
New nurse is not waiting for Gary to ask for pain killers. She's giving him low dosage ones because chest tubes are painful.
5:00 pm
They've been trying to grow cultures from some of the materials that they pulled from Gary's chest to tell exactly what kind of infection that he is fighting to provide the best antibiotics. It takes a while to grow.
5:44 pm
Nurse: "So Gary, what's your pain level now with the medication?"
Gary: ".5"
Nurse: "So, what was your pain level before the medication?"
Gary: "Oh, 1.5"
Nurse: "So, are you some kind of engineer?"
Gary needs to cough up some of the stuff still left in his lungs. He needs to force the stuff up and train the sacks in his lungs to work again. He's struggling to cough. Now anyone who's been around Gary, especially in the last 6 months, won't believe that he can't cough. I teased him that it's actually a bit funny. He smiled about it.
After Gary did some more breathing exercises. The purposes of the exercises are to induce coughing and train his lungs to expand again. Gary sucks into a chamber and it measures how steady the flow of his O2 is and how strong. The higher the better. The first time he did it earlier today, he hit 250. This time 500.
6:00 pm
Gary's getting a breathing treatment now. (They stopped by earlier, but we were both asleep.) He really likes these -- they help. Essentially it's an oxygen mask with some medicine attached that they vaporize into him as he breathes (or something like that.:) )
7:00 pm
A happy Nurse
Gary moved his arm on the side where the incision is and his two chest tubes are. His eyes popped out and he said "Now that hurt. It was a 5." So the Nurse was happy to raise the pain medication.
Gary also did the breathing exercises. Now he raised his level up to 600. No coughing though.
She also reported that the machine doesn't allow .5 so she had to round up.
8:00 pm
Gary got another breathing treatment. He's happy. Even happier to go to sleep.
Sunday Oct 27th
8:00 am
Spoke with the nurse and his night was "boring" which they always like in ICU. Pain is up a little after the breathing exercises. They switched to a more powerful breathing exercise to force more air into his lungs and encourage him to cough more. He's still not coughing much. They are thinking of taking the chest tubes out today.
9 am
Speech therapist discussion.
Speech: "Gary, have you had a heart attack or stroke before?"
Gary: "No"
Daughter: "Dad, remember the strokes you had in June?"
Gary: "Yeah, but they were just mini ones."
Speech: "Ok, let's try again. Have you had a stroke before Gary?"
Gary: "Yes"
Speech: "Gary, do you have trouble swallowing?"
Gary: "No"
Speech: "I've just watched you swallow an ice cube and it took you 4 times. Let's try again. Do you have trouble swallowing?"
Gary: "Yes"
Also found out that Gary's squealing noise the esophagus made was an indication that there was a swallowing problem. (Now we know.)
10 am
The co-surgeon is on call this weekend and he says the chest X-ray looks better.
11 am
Gary had a cardiologist stop by. They are watching his atrial fibrillation. He has a natural one. However, the surgery can exasperate it. That increases the risk of stroke. The want to put him on blood thinners to reduce the risk of another stroke. Whenever you do surgery on the lungs, there is concern for the heart. The lungs drain out into the heart and they were doing significant work on the lungs. (Gary had had a full workup by a cardiologist in March and a checkup in September.)
Noon - 2 pm
Infections Disease Dr stopped by. Good news is that the cultures grew and they think it's some kind of strep. The antibiotic that Gary's on is good for this type of infection. They'll continue to monitor.
Gary did some more breathing exercises. Therapist is pleased with his progress. He's not coughing anything up though.
Epidermal is coming out and they are changing the pain medications because they are putting him on blood thinners. He know needs to lay on his back for 4 hours flat. (He hasn't done that in months.) Good news is that it induced coughing. Best coughing yet.
Chest X-ray continues to improve, but more progress needed.
Gary's being switched to a face mask for O2 because he's not getting enough O2. Will make it difficult to cough, but O2 is the priority. Unfortunately, he hasn't been coughing much.
O2 is back up so they are going back to nasal cannula.
Now he has to get a subcutaneous shot once per day. They continue to monitor his blood count and they want better numbers for his red blood cell count. Electrolytes are low so they are supplementing through IV.
Chest tubes are being changed from suction to water seal. They'll do another chest X-ray tomorrow again to make sure the chest is ok. If so, the chest tubes come out. The chest tubes are uncomfortable, painful and make it difficult to cough.
Bed raised again and back to nasal cannula for comfort.
Anesthesiologist stopped by and discussed new pain medications due to removal of epidermal and change to blood thinners. Thinks Gary will be fine with the new medication because he's tolerating things so well.
3 pm
Gary's reading the paper. Always a good sign. He's also complaining about how the paper is being folded.;-)
He's doing some more breathing exercises. Then they want to try walking around. He did 750 on the pump last time.
He says he's hungry and wants some cheese & crackers.:) Good sign although he's not allowed anything right now.
He'll get an echocardiogram tomorrow of his heart. They want to see how the heart is functioning.
Coughing increasing -- good sign! He thinks he smells and is looking forward to a bath. Good signs.
Sitting up in bed and 900 on breathing exercises.
Gary walked! He did a great job. And he did it without O2. He's definitely ready for a nap.
Internal medicine doctor stopped by again. Things look good. More coughing -- good news.
8 pm
He had a good sleep. They woke him up because his O2 dropped. They had him cough and it went back up. Good coughing.
Another breathing treatment. Respiratory specialist thinks he's doing better. They are trying to prevent another infection and help cure the current one.
He even agreed to a little pain medication.
Monday October 28th
He rested well overnight. He took some pain medications at 4 am. Vitals are good. He's still losing electrolytes, but they are replacing them.
8 am
Electrocardiogram and chest X-ray completed.
Cardio doctor came by and things look good. They may evaluate other medications to regulate rhythm.
Breathing treatment. Sitting up in chair. Chest tubes may come out today. Lungs sound better but still bunch of stuff. Gary's in good spirits and waiting for swallow test. Had already read the paper by the time I arrived.
Breathing exercises are up to 900.
Gary walked again. Did a great job and walked 4 times farther than yesterday. Would still like to see much higher O2 levels. Did breathing exercises. Off to get swallow test.
Lots more doctor visits. Swallow test showed that thin liquids are going down the wrong pipe. He's been approved for thickened liquids and ground food. He's very much looking forward to real food again.
Occupational Therapist came by as well. She thinks he looks good. She'll see him again when he goes upstairs. Sat up and stood up.
Breathing treatment and exercises.
Surgeon came by. He's going to hold off giving him a hard time. (I wanted to encourage him not to wait.) He's going to hold off on removing the chest tubes. Will hold off discussing going home and leaving ICU until tomorrow.
Food arrived!
- Lori Kate Smith
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