Tuesday, May 31, 2011

PT Day 8, by David

My Little Darlin, PT day 8

She remains in critical care on the ventilator heavily sedated.  She has antibiotics pouring in that should cover just about any bacterial infection she may have.  She was having fever yesterday.  An antifungal drug was added  just in case her fever was fungal in origin.  Intermittantly a cooling blanket was placed on her to keep the temp down.  One thought was that her temperature was up from the extra work she was doing by fighting against the ventilator.  I don't know, just a thought.  Yesterday Jan had a tracheostomy(trach) placed which is a tube into her windpipe through a small incision in her neck (TIGT).  The endotracheal tube which was the breathing tube through her mouth needed to come out.  Leave these in too long and it can case chronic problems after it is removed.  Getting this out of her mouth  and having the trach will be more comfortable for her and a better way to manage her airway in the long run.  The scar from the trach is a small thing.  Don't sweat the small things there are too many large things to sweat.

She was fighting the ventilator more and more yesterday afternoon so much so that it required increasing her oxygen concentration to 100%.  Long term this high a concentration can damage the lungs so you want to get that down.  The heavy doses of sedatives were not doing the job so she was placed on a paralytic.  There was some hesitation because of prolonged muscle weakness after taking her off this medication but risk vs benefit dictated that TIGT.(a physician will always take into account risk versus benefit.  Any procedure, medication or pretty much anything else a physician does to a patient has potential risks.  If the potential risk is greater than the benefit expected you do not do it.  If potential risk is less than the benefit then do it.  There are still risks no matter how simple, if it happens to you it is 100%,  a little insight on how I think from a physicians perspective).

She had a good night after being given the paralytic.  This morning she was not fighting the ventilator, she could not, she was medically paralyzed.  The sedation keeps this from making her uncomfortable.  Her temperature remained good.  Her white blood count was decreased this morning since yesterday.  The oxygen concentration (FiO2) being given to her was 80% down from 100%.  The oxygen concentration in her blood was very good so I suspect her pulmonologist will decrease her FiO2 further.  Hope so.  Shooting for below 60% FiO2 so that it does not start damaging the lungs and 40% to start weaning off the ventilator.  Got to get her lungs to heal form the trauma, pneumonia and mucous plugging for this to happen.  Small steps.

While writing this my good friend who is a radiologist here texted me that Jan's chest X-ray showed definite improvement since yesterday (TIGT)

I want to thank all of you for the support.  If you texted, emailed, placed a message on Facebook or left a message in any other way I have seen it . I try to answer them all.  Some times I am not sure if I did or not.  You may get more than one response from me or not get one at all.  I hope the not get one at all has not happened but I frequently will start typing (I type with one finger but I can use that finger on each hand) get distracted and am not sure if I sent the message or not.  Please keep them coming.  For my friends and family that have visited,  not to lessen the notes, thoughts and prayers, your visits whether short or long are very comforting.  One of our boys, Derek and Sean, is always with me.  Man they are good guys and I could not love my own son more.  I do not tell them this often enough.  One of my brothers, sisters of my father and step mother are usually here.  I have had many close friends here.  Our dear friends Mike and Kay came over from Waco, TX.  They knew how down I was the night before last, showed up late and stayed the night here in the waiting room with me.   I know I can call any one of my friends day or night.  I heard you Boomer.   I do not think anyone that has gone in to see My Little Darlin  came out without shedding tears.  It is hard to see that normally vibrant, beautiful, smiling woman lying there like she is.  Family and friends (TIGT).  Many who have only briefly met Jan or do not know her at all have relayed their concern and prayers.  Thank you all.

I still cry often, can not help it.  Can not predict when except in the morning when I wake up, at night just before I go to sleep (if I do and I did last night, TIGT) and every time I go in to see her helpless on the ventilator.

To all,  do not forget how Jan got here,  do what you can to keep this from happening to someone else.  Stay the course. Please!


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