Monday, February 25, 2013

Monday - Update (2/25)

Scott did fine from the tracheostomy procedure last Friday, at least now the tube is no longer in his mouth.

After the surgery he seemed to be more agitated than ever. His brother noticed Scott experiencing more pain than usual--as did the doctors. To help him through this pain he was sedated again and restrained. This is the first time we think Scott has really felt serious "pain" during this entire experience. The tube in the mouth is discomfort, and the original surgery left him without much pain. However now, whether it be from the tracheostomy or the incision on his abdomen, he's feeling it.

I just spoke with the nurse who gave me updates that all of Scott's numbers are stable, meaning they haven't been changing one way or the other--it didn't sound like there was any concern.

The doctor's have increased his tube feeds to help stimulate his liver and promote absorption. His stool is getting thicker, which is a good sign that his body is receptive to the fiber and tube feed increases. Still no update on his liver, which is now (and always has been) considered liver failure (there was never any virus that caused the jaundice--it was simply due to TPN damage). His brother and daughter both say his color is getting better.

The incision on his abdomen does not seem to be pulling apart, and the surgeon thinks the healing is going well otherwise. He is currently restrained and heavily sedated to decrease a movement that might aggravate his incision. He does move around a bit, but the medication is used to allow the body to heal.

For now he remains sedated, restrained and in some pain. Stable otherwise.

He's almost at week 4 in the ICU, the longest he's spent here.

Friday, February 22, 2013

Friday - Update (2/22)

Scott has been on the ventilator for almost 3 weeks (with a day or two when he was off it just after the initial surgery). There is a risk when the ventilator has been in place for longer than 2 weeks inthat the tube could damage the vocal chords. Not only that but Dad has been mildly to heavily sedated over this 3 week period as well, and that takes a toll on the mind and body.

That being said, Scott's going back into surgery today. He will have a procedure known as a tracheostomy, which we consider a good thing. It will be done at 11:30 EST. The benefits of this surgery will be:

  • no tube in Scott's mouth and vocal chords
  • less, to no, sedation since the tube will no longer be present
  • the ventilator tube will be inserted beneath his larynx
  • he will be able to speak again
  • he will be able to drink again (when permitted)
  • he will be able to eat again (when permitted)
Since he is already intubated and sedated there is little risk with this surgery and should take 20 minutes.

Now onto other updates:

The doctors have found more blood in Scott's stool, some in/around his G/J feeding tube, and the other day Dad threw up blood. They have been administering plasma and platelets as needed.

The GI docs think it might be an old clot that just broke up, but other are worried it might be something else. They want to scope the GI tract but I have not heard back on that yet. Yesterday they said the tracheostomy was no longer an option because of the blood, but they are moving forward with this today. Getting some mixed signals, but we hope this quick surgery is enough to wake Scott up and keep him more aware and lively!

Allie was down on Wednesday and Scott's brother is heading down today, returning Saturday.

Wednesday, February 20, 2013

Wednesday - Update (2/20)

Scott remains intubated and continues to very slowly recover from last week's surgery (AND the surgery a week and half before that!). His progress is brief and not without setbacks, which is discouraging. Being intubated requires sedation, which is has been receiving for almost two weeks now and he's non-responsive most of the time.

Since being on the ventilator stresses the body in many ways the surgeons are considering a tracheostomy to remove the ventilator tube, which will allow the vocal chords to reflex and heal; it will also allow him to be less sedated and begin to take water (food, too if/when permitted) and to talk. The procedure will insert a breathing tube below his voice box in his neck, and once better should heal up just fine.

In the meantime Scott's sedation has been reduced from time to time to see how he can breathe on his own. Although he is able to breathe on his own, it is too rapid and shallow to remain unassisted. This rapid breathing also points to possible infection (along with supporting white blood cell count and a fever). The doctors do not know what might be infected (Scott is already on 5 very strong antibiotics)--today is the first fever he has had since admittance.

They have discovered a thin trace of blood in his stool, which they are not concerned about since it is not much. By administering additional platelets and plasma whatever might be bleeding (most likely sutures) should clot and heal on their own.

His wound, which was sewn entirely shut has begun to split--to the size of a quarter--right underneath his sternum. The doctors hope the tear doesn't continue, but for now this will have to heal on its own. Right now the biggest concern is infection.

They have ordered Scott receive another CT scan this afternoon and will know the results soon to determine if fluid is increasing in his lungs or decreasing, or if there is an abscess in his abdomen or other localized area.

The doctor said Scott's recovery has been and will continue to be "horizontal"--whatever that means.

Allie is there with him today and will come back tonight. His brother plans to visit this weekend.

Tuesday, February 12, 2013

Tuesday Morning - Update (2/12)

Scott's surgery began at 5pm and last about 2 hours. The surgery was successful in that the hematoma was removed. Although, closing the wound was the greatest challenge. Last week the plastic surgeon spent 2+ hours repairs Scott's incision. It looked good from the outside for the past week. Although, during the surgery all of his work seemed to unravel. Dr. A mentioned that this would've eventually happened on its own (within days), and it was ultimately caused by a body that is just not strong enough or healthy enough to heal quickly.

After the surgery, since the fascia (the connective tissue around muscles that is commonly used as the base layer for sutures) was too fibrous and thin the doctor was unable to pull a protective wrap around Dad's organs; instead, he simply connected skin to skin. Of course, this type of closure is not ideal since it means less protection in the long run for Scott, an increase for potential infection and more prone to chronic hernia.

There were no major issues with the surgery. The hematoma is off to the lab to be cultured. Dad is recovering in the ICU again.

Also... I've added a feature to this blog which will allow you to subscribe to all updates. Please see the upper right hand side of this page, enter your email to receive instant email updates whenever I update this blog. It looks like this ==>

I hope this helps some of you keep tabs on Scott's progress.

Monday, February 11, 2013

Monday Afternoon - Update (2/11)


I've spoken with Dr. A and the decision was made to move forward with the surgery to remove the hematoma. The surgery is scheduled for later this evening (perhaps as soon as a few hours).

I've been told that the plastic surgeon will also be present to make sure he is stitched up correctly after the surgery is successful. 

Although absolutely none of Scott's cultures have come back as infected and he does not have a fever it is important to understand that Scott has not been improving; he is still intubated, his body is swelling with fluid, his white cell count is very elevated and he just has not been getting better. We hope this surgery will put him back on the path of progress. We also hope that the hematoma is in fact infected or else what would this surgery be about if it were not. Of course, we have every right to be concerned with Scott being in the condition he is in. The doctor feels comfortable with Scott's status and advised we move as quickly as possible.

Allie is there with him now and will be there until he is out of surgery through tomorrow. I will try my best to update the blog with the outcome of the surgery. Please wish him good health and strength!

Monday - Update (2/11)

Another day, another obstacle. Dad's white cell count has been increasing over the past several days. Even on 3 powerful antibiotics, this count continues to rise. This means there is an infection (a rather large one) somewhere in Scott's body. I received a call this morning from the PA and her news was not the greatest way to start a Monday.

Dr. A feels that it is necessary for Scott to undergo yet another surgery. This surgery would diffuse a potentially bad infection in his abdomen. As mentioned the other day, there is a hematoma that formed from surgery a week ago and the doctor believes this to be the source of Scott's infection. Surgery would mean resecting his staple line, which is healthy wonderfully, excising the hematoma, and cleaning his abdomen to reduce the likelihood of the infection returning.

The idea of this second emergency surgery is not comforting since it is exploratory in nature. Scott's body has also been slow to recover from the initial surgery and will be even slower when this second surgery is successful. Not only this, but he still in "liver failure" so the blood will not clot as it normally would otherwise, which may lead to additional abscess or hematomas post surgery.

I have not authorized the surgery until there is more discussion between the surgeon and the plastic surgeon and with myself to be sure Scott's body can even handle this surgery, or if there are other options to help determine the actual source of the infection.

I'll have more to update later this afternoon when I chat with the doctors.

Saturday, February 9, 2013

Saturday - Update (2/9)

** I hope everyone likes the new upbeat look and feel of the blog! -- Seems to be working! **

I spoke with the Surgeon's resident and the update is good, including a better outlook for Dad's recovery.

The results from his liver biopsy are still not back. The doctor's chose to biopsy for diagnostic reasons to be sure the TPN lead to his liver failure; therefore the results of this biopsy are not too important unless they point to viral infection, which in their opinion is unlikely.

The CT scan results are back and revealed that Scott does NOT have pneumonia, although he does have fluid in his lung, which is why he is on the ventilator. The doctor says he may be intubated for up to another 5 days (we'll see how things go--today they are trying to get him breathing on his own again, baby steps). Scott also has a pool of blood in his abdomen. This is not uncommon after a surgery like the one Scott went though, and because his liver function was very poor before the surgery, his blood was not coagulating or clotting during the surgery. The risk surrounding this pool of blood is infection. To prevent this, the doctors have him on 3 antibiotics that are helping to ward of infection.

His jaundice seems reduced since last week--I'm happy to see that. And since they are trying to get him breathing on his own his sedation is less so he's been a bit more responsive during the day. He's listening to his music again, which seems to put him at ease and comfort him.

His levels are stable without the use of blood pressure drugs or pain killers, his platelet count is up and his vitals seem good. Another important thing to note is that his heart is strong and healthy, his kidney is healthy and producing a good amount of urine.

..and the MOST important thing to note is that, after a few dye tests administered through the NG tube, the intestines seem to be connected, healing and functioning just fine. The nurses plan to increase Scott's feeding (through his j tube) with each day. This means more nutrients will be absorbed, thus nourishing his liver allowing the liver to clean itself and Scott's blood. His liver will begin to purge the poisons that are present and he will get better, it's just a matter of time.

Friday, February 8, 2013

Friday - Update (2/8)

There have been some major set-backs with Scott. I do not intend for that to scare anyone, but here are the details:

**I'm changing the theme and background of this blog so that things are a bit more uplifting, instead of that dark black. Maybe it'll help!**

Two days ago, Scott was talking (just briefly) with the nurses and seemed to be on the mend. Although, later Wednesday night and early Thursday morning Scott's health declined rather rapidly. His breathing became shallow and his white cell count was up. By mid-afternoon Scott's lungs were filling with fluid and they determined that pneumonia had set in. Fortunately, I was flying back to Rochester from business in New Orleans and was able to redirect my flight to Pittsburgh. Scott's brother picked me up from the airport to be with him during this new delay in recovery.

Scott was intubated just after lunch yesterday. Now a machine is regulating his breathing and the doctors hope this will help the fluid dissipate. He's on high doses of antibiotics to rid the infection in his lungs, his kidneys are producing less urine but his creatinine is 1.0. They are also pushing more potassium through him. The nurses mention that his liver still does not appear to be functioning well.

He went in for a CAT scan earlier today (10 EST) and the results STILL are not back. They will identify if the infection is in the lung or elsewhere in the body (they would not rule out infection in the abdomen). I'll update here when we know more about this scan.

Furthermore, the liver biopsy is STILL not back either and it has been over a week since the samples were submitted for review. We're following up on this as well.

He is being "fed" through his j-tube and they say his intestines are complete and functioning as expected--good news.

He currently has an NG tube, a breathing tube, two small sub-skin drains and a deeper abdomen-drain (both present after surgery). He is almost entirely out of it, however I got about 15 solid minutes (over the whole day today) with him when I knew he could hear me and his subtle nods gave me confidence that he'll get out of this jam, like all the others.

I will be here until tomorrow afternoon, waiting for the snow storm in the Northeast US passes (we're fine in PA). After that Allie will be here Sunday and Monday.

Monday, February 4, 2013

Monday - Update (1/4)

This weekend was quite uneventful--no major issues or improvements. Here are some updates:
  • Scott is still in the ICU (day 4)
  • He has received around 11 units of blood since his surgery. His HH (hematocrit & hemoglobin) levels are very low. It doesn't appear that his liver is working as well as it should. It was only until yesterday that they began to ween him off donor blood, and although his levels are still low they remain stable
  • His creatinine is right around 1.2 which means it's been on a steady decline over the weekend--a good sign. His kidney is getting stronger!
  • He is still very tired and weak, and he is not yet entirely lucid
We are still waiting to hear the results from his liver biopsy (maybe tomorrow we'll know more).

Hopefully Scott is discharged from the ICU, but we think there is still a lot to recover from.

Thursday Late AM - Update (1/31)


The nefrologist came by just now and mentioned Dad's creatinine went from 0.9 before the surgery to 1.4 today. Even though his blood pressure is stabilized, the doctor mentioned it may take a couple days to even out the kidney's functionality.

Scott's creatinine reached 1.7 later this evening.