Friday - Update (3/1)

It's been almost 30 days since the last major surgery and Scott is hanging in there despite the many challenges his recover is faced with.

I just spoke with Dr. A who gave me the following updates:

Thanks to the tracheostomy Scott has been entirely off sedation since the beginning of this week. Although he's not quite "with it" he opens his eyes with the nurses and shakes/nods his head as often as he can. He seems to be in a lot of pain, the source of which remains to be known; could be his discomfort in a bed for 30 days, the trachea,  something else or just the incision. The nurses administer pain killers when needed.

As for his incision, he still has a rather deep split toward the base of his sternum, and another (more aesthetic) half-way down his suture line. The wound seems to be healing, but slowly.

The reason for this slow healthy is cause by two main factors, which--to the doctor--are the only real obstacles Scott is facing right now: 1. Malnourishment, he needs calories to rebuild his body and get healthier; and 2. Liver functionality is critically poor.

So let's address point 1: they have been increasing his tube feeds quite steadily and have seen an increase in absorption in his cells from the calories and nutrients in the slurry. This is a good thing because Scott's GI tract seems to be ingesting the feedings, which increase nutrient levels in both blood, body and other cells. Dr. A mentioned that they will continue to increase tube feedings to help promote faster nourishment.

Point 2: the liver is very badly damaged, caused by the TPN feedings Scott was on for 6 months. Dr. A has never seen liver enzyme levels so high in any patient before, so this is a bit of unfamiliar territory for some of the staff at Passavant. His liver enzymes, which have been varying up and down (sometimes in the high teens, other times in the twenties), should be at 1. So anything above 1 is not good. The enzyme levels are measured when they seep from Scott's cells, the leaky cell is what causes jaundice. A main result when these enzymes seep from his cells is that his blood does clot as well as it should. So, Scott sometimes has light bleed in his GI tract, probably from his stomach (and other recently cut or irritated areas) but this is not a huge concern because it is related to a bad liver, not a bad stomach. The solution is giving Scott blood with healthy platelets and healthy liver enzymes that promote clotting, which stops the bleeding for a good amount of time. This doesn't happen often but one unit of blood was given last night.

Moving forward the doctor will begin to pull back anti-fungal and anti-biotic drugs that may impact liver function to help his liver kick back in action. Time will tell with this approach, as increase tube feedings hasn't improved liver function as anticipated.

They did mention earlier in the week they pushed 15 - 20 POUNDS of fluid from his body using diretics last week, after which he was able to practically breathe on his own for 6 hours. That was Wednesday, and he hasn't been able to breathe on his own again since but we're hopeful he just needs more strength.

The doctors are not overly concerned with Dad's current condition: he is stable, his other systems are stable (strong heart, regular BP, no fever, decreasing white blood cell count), his kidney is doing fine with a creatinine of 0.8, and he is moving about his bed. Not until other systems fail is there really a reason to worry; for now he is stable and simply needs time to recover. The increased feeds and decreased drugs should help. We should know more next week.