Friday, March 6, 2015

Update # 179

8 Years

23 hours off the vent! Jeff was put back on at 11:00 AM. What a difference a day makes.

Jeff had a relatively quiet night but did not sleep. Not due to any problems – just excited and counting down the hours till the speech therapist came for the swallow test.

The morning BMT doc talked to Jeff about how fantastic he was doing. He told Jeff he knew Jeff would do well on the swallow test.

Twenty-five minutes later, Jeff had me call the nurse due to pain on his right side. He said the area where the chest tube was located was bothering him. This was his first complaint of pain. 

Ten minutes after that, the morning doc returned and said today’s x-ray showed a small pneumothorax on that right side again. He wondered if maybe the chest tube was blocked since Jeff had mentioned the pain.

A little after 9:00, the pulmonary doc stopped by to say that with that little pneumothorax, she wanted Jeff to do lots of coughing today. She also wanted him to sit in a chair for a while. And she was signing off on the case again.

Almost 15 minutes later, Jeff’s favorite person, the speech therapist, showed up for the swallow test. She had him do the usual tongue exercises, answering questions, counting, chewing ice cubes, sipping water from a spoon and cranberry juice with a straw, some applesauce and graham cracker bites. Yes, he passed his test!

While she was finishing the test, the thoracic gal came and checked the chest tube. She felt there was no blockage. She changed the dressing and said the area looked good. She wanted Jeff to begin using the spirometer again to exercise his lungs.

Not long after she left, I noticed Jeff’s blood pressure rising, his temperature rising, and his breathing becoming more labored. I called the nurse in who had the doc return. Within 10 minutes, another x-ray was done and showed Jeff’s bottom right lung collapsing again. They did some blood work, put Jeff on more oxygen, and called the pulmonary and thoracic people back in.

So for the 3rd time, Jeff was intubated. Now to find the cause of the problem. The morning doc noticed all this began with 30 minutes of Jeff drinking again. Maybe he did too much and aspirated some into his lungs. Maybe there was a pulmonary embolism. The infectious docs wondered about a mucus plug. Jeff was then taken down for a CT Scan to identify the problem.

Results came back fairly quickly – mucus plug. Jeff is still so weak and has no strength to cough hard enough to clear his lungs. The pulmonary doc returned and once again did a bronchoscopy to remove the mucus plug. Remember the other day, she said the secretions were thin, well it rapidly changed to a thick mucus.

The pulmonary doc recommended the time has come for Jeff to have a tracheostomy. We had been told the first week of Jeff’s hospitalization, that depending on how long Jeff might be on the vent (a couple of weeks), a tracheostomy might be a possibility. The tracheostomy would give Jeff the freedom of being off the ventilator, not being under sedation, and the opportunity to do rehab. The docs are concerned with how often Jeff has been intubated and the length of time. Monday will be 18 days. The ENT team has scheduled Jeff as an add on for Monday so surgery time is unknown. The surgery should last about an hour. Jeff’s blood counts are fine so they have no concerns with that. This tracheostomy will be temporary. As Jeff improves medically, then he can begin more aggressive rehab (maybe Barnes, maybe some other StL facility), and should have the throat tube removed he returns home. Jeff will not be able to talk or eat/drink for 7-10 days, then work towards doing those 3 things with the tube.

This afternoon, they also did Doppler's on both of Jeff’s legs to be sure he has no blood clots.

It was a perfect day for 4 ladies from Jeff and Meridith’s church to visit. How wonderful of them to drive six hours each direction to spend time with Meridith and pray for Jeff. Thanks so much for showing love and support!

This morning and afternoon definitely did not go as we had all assumed it would. A day of eating, drinking, rehabbing, turned into a day of working to keep Jeff on this road of recovery. We can only do this with all of you, whether near or far. Prayers are the most important request we ask from you. Our continued thanks.

love,

Marcia