Trachestomy Tomorrow?

Dad has remained about the same the last 2 days. The best thing that is happened is that the fevers overnight have stopped!! Two nights ago, he only spiked to 101.4, and last night he did not spike a temperature at all. He seems much more comfortable when is does not have a temp, so we are happy for this improvement. They cultured him again for the flu and he still came back positive, which was not completely unexpected as the stem cell doctors and infectious disease doctors both said that a stem cell patient with a new immune system may continue to test positive for the flu for up to 4 weeks, even if they are no longer have symptoms. His blood pressure has been stable for the past 2 days and they have not had to use the medication to keep his blood pressure high enough, plus they have been able to use the medication to help take the excess fluid off (a diuretic called Bumex) without him dropping his blood pressure. Yesterday, they were able to take over 3L of fluid off of him, which should definitely be helping his lungs. The biggest problems remain sedation and weaning of the vent. He continues to make progress, however, it is very slow. Yesterday, they were finally able to get him down to 45% FiO2 (oxygen), which is almost to a place where he can be weaned from the vent. However, when they lightened his sedation he became very agitated and started fighting the vent again, which caused him to desat (drop his oxygen levels) and eventually required the vent to be turned all the way back up to 70% FiO2. So, we basically had to start all over with the weaning down to 45% again. This time, they were unable to get him to 45%, and instead have had him hanging out at 50% since last night and all day today. They were hoping that his oxygenation (exchange of oxygen from his lungs to his blood) would have improved more than it has. Because he has been intubated (with the breathing tube down his throat) for almost 2 weeks, the decision was made today to place a trachestomy tomorrow. A trachestomy is a small hole surgically created in the neck to help a person breath. It is often done for patients who are having difficulty weaning off of a ventilator. The hole is not permanent- when it is no longer needed, it can simply be allowed to close up again on it's own. The doctors are hopeful that my Dad will only need it short-term in order to help him wean more comfortably off the vent. Being intubated is very uncomfortable, and unfortunately, every time they try to decrease his sedation and wake him up more, he gets agitated. The doctors are hopeful that he will be more comfortable with the trachestomy and therefore they will be able to lighten up the sedation and wean the ventilator without him getting as agitated. They can do the procedure at the bedside in his room. The bad thing about having a trach and being on a ventilator is that you are unable to talk. If the trach is needed long term, a speech therapist can work with the patient to help them learn how to use a special speaking device for their trach (but we are hopeful Dad will not need it for that long!!). I am attaching a link to the Mayo Clinic website regarding trachestomies for those interested in more information: http://www.mayoclinic.com/health/tracheostomy/MY00261

Occupational therapy has also started working with Dad by making him splints for his arms and legs to prevent foot drop and contractures (shortening of muscles because they are not being used). We want to make sure that he is able to walk on the beach again this summer! He wears a splint on alternating arms and alternating legs for 4 hours at a time each day. Again, thank you for your continued thoughts and prayers. I told Dad that once he is feeling a little better, I am sure that there are many people that would like to come visit. Until then, please keep sending your emails and I will continue to read them to him. He is on a little less sedation and occasionally we see little responses to things like him squeezing his eyes when we are talking to him. I know I was reading him an email from a friend from his old office the other day and he definitely had a few eye squeezes in there. :) I know Dad appreciates all the kind thoughts and well wishes. I can't wait for him to be able to read them all on his blog again.