On Tuesday, a bed became available in the intermediate ICU in the afternoon, so Reg was moved out of SICU up to the IICU. We didn't realize it, so when Andy and I went to visit at about 9.30 after our hockey game (I got an assist), we had to grovel a bit as we were there after visiting hours. They let us in for a few minutes so we spent the time talking to Reg about our game, his new digs and other matters of great importance.
On Wednesday afternoon around 5.30, Reg's blood pressure dropped. The number one thing to think about in this situation is, could he be bleeding again? So they took him down for a CT and then brought him back to SICU. After a wait of several hours, they finally let Kirk and Andy in, albeit briefly and not to Reg's bedside. Turns out they didn't see any signs of bleeding on the CT, so there is likely another cause for the drop in blood pressure. The next most likely culprit might be sepsis or infection, though he had been afebrile for a couple of days (finally).
And today they actually managed to culture something from his PICC line (which is sort of a big IV intended for longer-term use). It was pulled today and I'm assuming that they put another one in at another site. He's back on antibiotics again.
Thursday, May 24, 2007
Saturday, May 19, 2007
still nothing much to report
Not much is new with Reg these days. Neurologically, he opens his eyes at times but so far I personally haven't seen him really look at anything or anyone. He may be doing it at other times; Kirk and Miyuki have noted some instances where he seems more aware of them. He moves his limbs quite a bit but still doesn't seem to be doing a lot of purposeful movements as far as I've seen. His right side moves more than his left, although he's moving his left arm enough that they've had to restrain it as well (his right arm has been restrained for a while now).
His breathing has improved slightly. They've actually taken him off the ventilator for a few brief periods here and there, although those episodes seem to really tire Reg out. They've managed to turn the FiO2 down to 45% (normal room air is 21%). Reg managed to find a way to snore! That's not supposed to be possible with the trach, because all the air is supposed to go in and out of it and bypass the upper airway and nose, but there you go. It didn't seem to affect his breathing, so carry on, I say. It's such a normal thing to do that I'm kind of happy Reg is doing it, even though it doesn't mean anything in terms of recovery.
They are planning to move Reg out of SICU and into the intermediate care unit when a bed is available. There are two ways to look at this. On the one hand, this is a good sign as it indicates that he's stable enough that he doesn't need "intensive" care anymore. On the other hand, it also indicates that he still needs a lot of care -- more than can be provided on a regular ward. The main reason he can't go to a regular ward at this point is mainly because he's still on the ventilator, but his neurological status is also a factor.
His breathing has improved slightly. They've actually taken him off the ventilator for a few brief periods here and there, although those episodes seem to really tire Reg out. They've managed to turn the FiO2 down to 45% (normal room air is 21%). Reg managed to find a way to snore! That's not supposed to be possible with the trach, because all the air is supposed to go in and out of it and bypass the upper airway and nose, but there you go. It didn't seem to affect his breathing, so carry on, I say. It's such a normal thing to do that I'm kind of happy Reg is doing it, even though it doesn't mean anything in terms of recovery.
They are planning to move Reg out of SICU and into the intermediate care unit when a bed is available. There are two ways to look at this. On the one hand, this is a good sign as it indicates that he's stable enough that he doesn't need "intensive" care anymore. On the other hand, it also indicates that he still needs a lot of care -- more than can be provided on a regular ward. The main reason he can't go to a regular ward at this point is mainly because he's still on the ventilator, but his neurological status is also a factor.
Saturday, May 12, 2007
nothing new to say, really
No posts for the past couple of days, because there really hasn't been much to say. Neurologically, Reg is occasionally opening his eyes and moving his right hand and foot spontaneously, but he doesn't really respond to commands. He isn't moving his left side.
His hemoglobin has stabilized after a total of 4 units of blood, indicating that the bleeding has stopped. They put him back on a low dose of heparin to prevent further clots from forming. (The filter is not an ideal solution because it only protects against large clots coming from his legs; small clots can still get through -- though they aren't all that dangerous, relatively speaking -- and clots that form elsewhere, such as in Reg's arms, wouldn't be stopped by the filter at all.) His breathing hasn't changed very much -- he's still needing 50% oxygen (normal is 21%) plus some help from the ventilator. Some kind of weird bug was cultured from the trach tube -- the nurse couldn't find the culture report but she said it was something unusual and not thought to be a contaminant; he's on Septra for it and it seems to be controlled.
So yeah, nothing really new here.
His hemoglobin has stabilized after a total of 4 units of blood, indicating that the bleeding has stopped. They put him back on a low dose of heparin to prevent further clots from forming. (The filter is not an ideal solution because it only protects against large clots coming from his legs; small clots can still get through -- though they aren't all that dangerous, relatively speaking -- and clots that form elsewhere, such as in Reg's arms, wouldn't be stopped by the filter at all.) His breathing hasn't changed very much -- he's still needing 50% oxygen (normal is 21%) plus some help from the ventilator. Some kind of weird bug was cultured from the trach tube -- the nurse couldn't find the culture report but she said it was something unusual and not thought to be a contaminant; he's on Septra for it and it seems to be controlled.
So yeah, nothing really new here.
Tuesday, May 08, 2007
maybe... just maybe...
So for the first time in ten days, Reg has maybe improved a bit.
I say maybe because this whole situation has been such a roller coaster over then past couple of days that it's too early to say definitively that Reg is getting better. However... these are the first positive developments since the accident.
Last night, Reg was bleeding a lot, required 2 transfusions plus 100% FiO2 (100% oxygen, and that's as high as you can get) plus vasopressors (meds to help keep his blood pressure up) and had a Greenfield filter put in to prevent any further clots from getting to his lungs. That's a pretty serious situation. Plus they had to paralyze and sedate him again because he was fighting the tubes a bit. Can't say that I blame him, but those tubes are pretty important right now!
Today, they managed to stop the pressors, meaning that his blood pressure is okay; they've weaned him down to 50% oxygen, which means that he's breathing a bit better; his hemoglobin is stable, so he's not bleeding anymore; and they've stopped the paralytics and sedatives again, and he seems to be remaining relaxed.
PLUS we were visiting tonight and... Reg opened his eyes! He'd done that a few times today, but this time he did it when the nurse asked him to! (Bad grammar there. Sue me.) It may have been a coincidence, but it didn't seem that way to me. Plus I was holding his hand and asked him to squeeze, and he did! Again, hard to say for sure what that means... but finally something that could be actual progress.
There's still a long wait ahead of us, to be sure. Anything could happen, because Reg is still very sick and requiring a LOT of support. But it sure is nice of him to throw us a bone once in a while.
P.S. Tried to donate blood today, but got turned down because when we were in Mexico in January we left the malaria-free Cancun resort area to go to Isla Mujeres, which is a shopping district on an island just offshore. But apparently that puts me at risk for malaria, so I'm not eligible to donate for a year. (First of all, Isla Mujeres is really an extension of the resort area of Cancun. Second, I live in WINNIPEG, where there are twelve thousand mosquitoes per square foot for five months of the year, and yet that doesn't pose a problem -- it's Mexico, where I didn't see a single mosquito all week, that's the issue. Ah well. Better safe than sorry, I guess.)
I say maybe because this whole situation has been such a roller coaster over then past couple of days that it's too early to say definitively that Reg is getting better. However... these are the first positive developments since the accident.
Last night, Reg was bleeding a lot, required 2 transfusions plus 100% FiO2 (100% oxygen, and that's as high as you can get) plus vasopressors (meds to help keep his blood pressure up) and had a Greenfield filter put in to prevent any further clots from getting to his lungs. That's a pretty serious situation. Plus they had to paralyze and sedate him again because he was fighting the tubes a bit. Can't say that I blame him, but those tubes are pretty important right now!
Today, they managed to stop the pressors, meaning that his blood pressure is okay; they've weaned him down to 50% oxygen, which means that he's breathing a bit better; his hemoglobin is stable, so he's not bleeding anymore; and they've stopped the paralytics and sedatives again, and he seems to be remaining relaxed.
PLUS we were visiting tonight and... Reg opened his eyes! He'd done that a few times today, but this time he did it when the nurse asked him to! (Bad grammar there. Sue me.) It may have been a coincidence, but it didn't seem that way to me. Plus I was holding his hand and asked him to squeeze, and he did! Again, hard to say for sure what that means... but finally something that could be actual progress.
There's still a long wait ahead of us, to be sure. Anything could happen, because Reg is still very sick and requiring a LOT of support. But it sure is nice of him to throw us a bone once in a while.
P.S. Tried to donate blood today, but got turned down because when we were in Mexico in January we left the malaria-free Cancun resort area to go to Isla Mujeres, which is a shopping district on an island just offshore. But apparently that puts me at risk for malaria, so I'm not eligible to donate for a year. (First of all, Isla Mujeres is really an extension of the resort area of Cancun. Second, I live in WINNIPEG, where there are twelve thousand mosquitoes per square foot for five months of the year, and yet that doesn't pose a problem -- it's Mexico, where I didn't see a single mosquito all week, that's the issue. Ah well. Better safe than sorry, I guess.)
damned if you do, damned if you don't
Sometimes you just can't win.
Andy's dad, Reg, developed a PE (pulmonary embolism, where a blood clot forms in the legs and then breaks off and gets stuck in the blood vessels in the lungs, making it harder for the lungs to oxygenate the blood; this is a potentially life-threatening complication) over the weekend, so he was put on heparin (a blood thinner) to stop more clots from forming while his body breaks down the clot that's already there.
So today it was noted that his hemoglobin was dropping, indicating that he's bleeding somewhere. This was likely caused or at least exacerbated by the heparin, and a CT this evening showed some retroperitoneal bleeding (blood pooling in his back; the exact source of the bleeding is unclear). So the heparin was immediately stopped and they are now putting in a Greenfield filter, which is a filter that goes into the big vein going up from his lower body towards his heart, and should catch any clots from his legs that might break off and head north. Reg is also receiving a blood transfusion.
To quote Reg's sister Sharon, this is a complication that he didn't need. However, they can still help support Reg with blood transfusions while his body -- PDQ, hopefully -- stops the bleeding.
And the uncertainty continues.
P.S. Andy's brother Kirk also has a blog which he is updating frequently.
P.P.S. Andy and I have decided that we're going ahead with the wedding. We figure we still want to be married, and everything is pretty much arranged, so what the hell.
P.P.P.S. I'm going to donate blood this week. Feel free to join me.
Andy's dad, Reg, developed a PE (pulmonary embolism, where a blood clot forms in the legs and then breaks off and gets stuck in the blood vessels in the lungs, making it harder for the lungs to oxygenate the blood; this is a potentially life-threatening complication) over the weekend, so he was put on heparin (a blood thinner) to stop more clots from forming while his body breaks down the clot that's already there.
So today it was noted that his hemoglobin was dropping, indicating that he's bleeding somewhere. This was likely caused or at least exacerbated by the heparin, and a CT this evening showed some retroperitoneal bleeding (blood pooling in his back; the exact source of the bleeding is unclear). So the heparin was immediately stopped and they are now putting in a Greenfield filter, which is a filter that goes into the big vein going up from his lower body towards his heart, and should catch any clots from his legs that might break off and head north. Reg is also receiving a blood transfusion.
To quote Reg's sister Sharon, this is a complication that he didn't need. However, they can still help support Reg with blood transfusions while his body -- PDQ, hopefully -- stops the bleeding.
And the uncertainty continues.
P.S. Andy's brother Kirk also has a blog which he is updating frequently.
P.P.S. Andy and I have decided that we're going ahead with the wedding. We figure we still want to be married, and everything is pretty much arranged, so what the hell.
P.P.P.S. I'm going to donate blood this week. Feel free to join me.
Friday, May 04, 2007
the whole system is breaking down
Some of you know about this; some of you don't.
Andy's parents were in a car accident last weekend. They were in southern Manitoba working on the upcoming provincial election and were returning home Saturday night when they were hit by a semi. Andy's mom is okay -- she has a concussion and is pretty sore, but nothing too serious and she came home from the hospital in Morris on Monday.
Andy's dad is another story. He has a severe head injury including, for you medical types, an epidural bleed, multiple small intracerebral bleeds as well as what seems to be a diffuse brain injury. He also has a bad aspiration pneumonia (he vomited shortly after the accident and choked), a fracture of one of his vertebrae (it's a stable fracture, so it will heal on its own and won't cause paralysis or anything like that), as well as a small laceration of his kidney (which is healing up on its own too).
Reg has been unconscious since the accident. He makes some movements of his limbs, trunk and face, but they are more like reflexive movements rather than purposeful ones, so they don't necessarily indicate improvement. He had a feeding tube inserted into his stomach yesterday and they are doing a tracheostomy today (moving the breathing tube so that it goes into the base of his throat rather than into his mouth).
There is no way to know what is going to happen. We don't know if or when Reg is going to wake up, and we don't know what degree of brain damage he might have.
Andy and I have our wedding next month; we haven't decided whether or not we're going to change our plans.
So much uncertainty.
Andy's parents were in a car accident last weekend. They were in southern Manitoba working on the upcoming provincial election and were returning home Saturday night when they were hit by a semi. Andy's mom is okay -- she has a concussion and is pretty sore, but nothing too serious and she came home from the hospital in Morris on Monday.
Andy's dad is another story. He has a severe head injury including, for you medical types, an epidural bleed, multiple small intracerebral bleeds as well as what seems to be a diffuse brain injury. He also has a bad aspiration pneumonia (he vomited shortly after the accident and choked), a fracture of one of his vertebrae (it's a stable fracture, so it will heal on its own and won't cause paralysis or anything like that), as well as a small laceration of his kidney (which is healing up on its own too).
Reg has been unconscious since the accident. He makes some movements of his limbs, trunk and face, but they are more like reflexive movements rather than purposeful ones, so they don't necessarily indicate improvement. He had a feeding tube inserted into his stomach yesterday and they are doing a tracheostomy today (moving the breathing tube so that it goes into the base of his throat rather than into his mouth).
There is no way to know what is going to happen. We don't know if or when Reg is going to wake up, and we don't know what degree of brain damage he might have.
Andy and I have our wedding next month; we haven't decided whether or not we're going to change our plans.
So much uncertainty.
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