Tuesday, November 30, 2010

Off The Vent All Day

Much progress since my last post.  They started weaning dad off the vent yesterday.  Today, he's been off the vent all day (I'm not sure what time they took him off, but sometime early morning).

When I say "off" the vent, I don't mean they totally turned off or disconnected him from the vent.  So far, what they've done is put the vent in a pressure only mode, where they blow a little bit of air in his lungs to help keep his air passages open, so he can do the actual breathing himself.  In this mode, the vent does not breath for him by forcing an entire "breath" of air into his lungs.  We don't think (or we hope) it won't be hard to wean him off the pressure only mode when the time comes.

Dad still has pain in his back.  He's pretty uncomfortable, but doesn't seem to be suffering intensely.  Getting him off the vent is a big step, but dealing with his back problem in earnest hasn't really even begun yet.  Still, we found out that a physical therapist has already stopped by and helped him sit up in bed for a few minutes, and even stand up (not sure how long, but sure it wasn't much).

Dad is in pretty good spirits all things considered.  He wants Mom by his side at all times, and the hospital has been letting her stay with him even when visitation hours aren't in effect.  Dad's been showing his sense of humor, and has been awake most of the time.

This is all encouraging and welcome news, although we still have a lot to go through before he's back home and moving about in his electric wheelchair.  We hazard to guess that that he could be home in a couple of weeks.  Hopefully we're not being wildly unrealistic.

Monday, November 29, 2010

Mixed Bag

Dad was awake a lot today. It's clear that his back pain is not a secondary issue, but rather the issue. He needs meds to handle it. Unfortunately taking those meds is not conducive to getting him off the vent. It's a catch 22. We're hoping to find a way. We don't feel all the pain management options have been explored. Other than finding another option though, he's probably just going to have to dig deep. Currently his breathing and vitals are generally good as long as he's getting painkillers. We'll see what tomorrow brings.

Sunday, November 28, 2010

Awake

I saw Dad about a half hour ago. He was awake, his breathing was good, and his heart rate was good. He recognized me and mom and Steven and was answering our questions by nodding. We got a couple of smiles out of him.

He's still groggy and they are still bringing his sedatives and painkillers down. Also at some point today they're supposed to start weaning him off the vent.

We still have a long way to go but we're off to an encouraging start this morning.

Saturday, November 27, 2010

Progress, More Sedation, Big Day Tomorrow

When I got to the hospital this morning, Dad was awake and struggling to breathe.  He had just gotten some things taken care of by the nurses though, which had left him short of breath.  Before long he settled down to a good heart rate and respiration.  Then he fell asleep.  Earlier, he had responded to some commands from the nurse and Steven by squeezing their hands and blinking.  The rest of the day, though, Dad was sedated and unconscious.
 
Dr. Xenopolous paid a visit and was not pleased with the progress that had been made in getting Dad off of the sedatives and the vent.  The nurse later told us that the doctors ordered Dad's sedatives to be cut by 35% per cent by tomorrow, and that tomorrow they will try to take him off the vent.  I don't think anyone knows how long Dad will stay off the vent tomorrow, but they're at least going to give it a try to see where things stand.

Friday, November 26, 2010

Some Good News

Just got this from Steven at the hospital...
 
Doing better. Woke up and followed instructions vital signs tolerated it and are currently stable . His arms and legs are warmer his face is better color and he's less swollen . Plan to keep pain and sedation meds alone and let him rest. Let others know, I type with one slow finger. Steven. Moms ok too.

Sedated Again

Last night when I left the hospital Dad was waking up periodically and squeezing the nurse's hand when asked.  After I left, though, thing went downhill.  Dad started struggling to breathe, and his heart rate and blood pressure went way up.  This continued for about an hour and a half with Dad gasping for air the entire time.  The nurse then gave him something to sedate him.  We're not sure if it was anti anxiety medication, or more of the sedative that they had been tapering.  In any event, since then, Dad has been unconscious.
 
Dad's heart doctor, Dr. Xenopolous came by tonight to check on Dad.  When he left he stopped by the waiting room to talk to us.  He told us that Dad's heart is fine.  He told us that Dad's problem is having trapped air in his lungs.  My interpretation is that with such limited lung capacity, Dad's having difficulty getting air out of his lungs.  Dr. X wasn't sure why this happens when Dad becomes conscious, although he seemed to feel that it could be due to anxiety.  Additionally, Dr. X told us that he doesn't have in his head what the strategy is to get dad conscious and get him off the vent.  He made a note to talk to the pulmonologist that's in charge of Dad, Dr. Haller, early next week.  Mom's hoping to talk to Dr. Haller about it tomorrow.

Thursday, November 25, 2010

waking up some

Dad is still having his breathing assisted by the ventilator.  For most of the day he was still sedated and unconscious, as he has been since before he arrived at Baptist East on Tuesday, but they are trying to reduce his sedation and wake him up.  Last night, they did this by completely stopping the sedative, but Dad would get agitated and have tremors when he became conscious.  Sounds like they tried this approach multiple times.  Then today, we had a excellent nurse who began tapering the sedative.  This evening, dad began twitching and opening his eyes.  At about 8 PM, while we were not in his room, the nurse got dad to respond to a couple of commands, such as squeezing his hand.  Throughout the day, Dad didn't respond negatively to being woken up gradually.  The nurse said earlier this evening that they had cut his sedattive to less than half what it had been.  I met his nurse for tonight and I thought she seemed like she's on the ball and well infomed about what's going on.

Dad's vitals are all looking good according to the nurse. but he is still pretty swollen in his hands and legs.  They're giving him Lasix to try to reduce the swelling.  Also since my last post, they did xrays on Dad's back and confirmed that he has a compressed disk (compressed vertebrae?), and that he has a couple of small fractures in his spine, I think due to osteoporosis.  The neurologist that read his xrays indicated on Dad's chart that Dad isn't a candidate for surgery.  To my knowledge, the only treatment option they see is pain killers.  I hope we'll be getting other opinions on this.

It's about 10:30 ET and we just heard from Robin at the hospital.  He's waking up more and doing ok so far.  Hopefully the trend will continue.

Wednesday, November 24, 2010

Holding Steady Kindof

I'm at the hospital but haven't seen Dad yet today.  Dad has been sedated since my last post.  He is breathing ok and resting, but he's sedated and still getting help from the ventilator, so who knows if his condition has really improved or worsened.  The staff did some tests... they did an xray on his head and back.  My understanding is the head xray didn't show anything bad.  The back xray is going to be evaluated by a specialist.  They feel it's likely that his back pain is due to a compressed disk.  They are thinking about treating it with an experimental technique, but if they can't do that, they're not sure what they can do.  Another thing worth mentioning is that Dad's heart rate has gone down into the 40's since last night.  I don't think they've offered an explanation of the cause or the consequences.  Like many things that have happened to Dad in the ICU this time and several years ago, it seems like we're left to come up with our own theories.

Tuesday, November 23, 2010

Dad's in room 381 in the ICU
We're at baptist east. Transfer went smoothly.

Moving Dad to Baptist East Soon

Robin just told me that the ambulance is on its way to take Dad to Baptist East.

Here's a link to the hospital: http://www.baptisteast.com/Patients+%26+visitors


Here's a link to the location on google maps:

http://maps.google.com/maps?f=q&source=s_q&hl=en&q=Baptist+Hospital-East,&sll=38.237759,-85.638986&sspn=0.01323,0.033023&ie=UTF8&rq=1&ev=zi&radius=1.08&split=1&hq=Baptist+Hospital-East,&hnear=&ll=38.237978,-85.638986&spn=0.012809,0.033023&z=16

The Latest

Dad had a pretty good night according to Amy and Mom, who were in his room overnight.  This morning, though, he started shaking uncontrollably.  When I got to the hospital, his breathing was more rapid than last night and he was shifting around in bed more.  He was sedated but semi awake.  He wasn't communicating.  He wasn't shaking anymore as of when I got here.
 
We are moving Dad to Baptist East in Louisville.  Dad's heart doctor -- and I will make an attempt to spell his name though I don't expect this to be remotely accurate -- Dr. Xenopolous, is making the arrangements at Baptist East.  We're now in a holding pattern until a room is available at Baptist East.

First Post

I just got home from spending the day at the hospital.  Dad is was sleeping comfortably when I left, BUT he's on a lot of medication for pain and sleeping, and he's hooked up to a ventilator.  He did well most of the day, but early this evening he starting to have difficulty breathing, and the doctor in charge decided to assist his breathing with the ventilator.  Currently he's able to breathe on his own whenever he can and wants to.  But the vent pushes air into him when he doesn't breathe enough.  We've been told he can come off the vent tomorrow if he's doing well.  Also tomorrow we're expecting to make decisions about how to feed him.  My understanding is we'll need to have a tube go directly into his stomach.  Also, we considered moving him to Baptist East hospital in Louisville when things went downhill this evening, but for now we've decided to stay at the hospital in Frankfort.  The main reason is that we can be in the room with him 24/7 even though he's in the ICU.  Also we think most of the staff are doing a good job there.

Summary: he's currently not suffering, but by no means out of the woods.  Besides getting him back on track with his breathing, eventually we have to figure out why he has so much pain in his back and how (if possible) to fix whatever's wrong.

John