Thursday, September 29, 2005

Some big improvements

Here’s a long post covering two days, so get comfy, but not so comfy that you don’t want to jump up & cheer!

Top of the news is that Denise is doing better. Still critical (and in isolation... gown, gloves, mask needed when I'm with her), still not out of the woods, still weak, still dealing with some infection somewhere and resulting high fevers. But better. In fact one of the doctors described it as having "a different patient this afternoon than we had this morning." It's been encouraging to hear several people say that Denise can recover from this. So there's some pretty rapid things happening, and they seem to be in our favor.
The most dramatic improvements are a higher cardiac index (saw it go as high as 4.2, SVO2 in the 60s & 70s mostly) and increasing urine output. The ejection fraction according to the EKG was 10 (low... yikes!). But the doctor said that between judging the heart's condition based on the EKG (which I learned has some subjectivity in the reading) and the cardiac index & urine output (kidneys wouldn't work unless the heart can get enough oxygen pumped to them), he said he'd "listen to the urine." I just thought that sounded funny enough to quote. Anyway, her oxygen saturation has continued to be in the high 90s, heart rate still fast (127-152), blood pressure acceptable (I saw 118-127 systolic, PAP 52/31, CVP 15 for the nurses among our family & friends) with about 3 micrograms/minute of Dobutimine. I saw a drip for nitroglycerine as well. I could describe that bit of news as "Dynomite" but that would be horrible punnery.
As far as breathing, she's on 35% oxygen concentration & a PEEP of 5 from the vent (another one of those Servo-i vents that offered the bi-vent mode that was so beneficial earlier in her struggle). At times her breathing rate went to a nice 22.
She got 2 units of blood yesterday because the hemo count dropped to 8.? (sorry, don't remember the tenth). I don't know what any of the other hemo results were. Arterial line inserted yesterday.
J/G tube inserted, too. She already had the gastrostomy tube, but it was replaced with another one, then a tube inserted inside of that goes to the jeujenum. If I understand correctly, the hope is that putting food directly into the intestine(J-tube) rather than the stomach (G-tube) will reduce the vomiting. The feedings started today at 10cc to see how she tolerates the "food" (Novasource 2.0) that looks like liquid Silly Putty.
On Tuesday, Denise was injected with the isotope for a gallium scan, which they anticipted would be performed at USC. Turns out that this would be a last resort. Instead, (and I hope I remember this right) a scan with venous contrast might be on deck. She's already had an indium scan. But that was a nuclear medicine thing, and the venous contrast is apparently tracked with EKG equipment.
Yesterday they were not using Tylenol because of questionable liver function. Today it was used and it seems that the liver is doing somewhat better. The whites of her eyes look a little yellow to me, but hopefully things will progress toward healing.

The infection that’s causing the fever is quite the enigma. The fevers went up to 103.5, then an ice bath brought it down to 99.8. I’ve noticed that some of Denise’s skin is peeling off in places. I can’t help but wonder if the alternating heat of the fevers & then sudden harsh chill of the ice is blanching her skin, same as a peach or tomato. Anyway, throw everything you’ve got into lifting up the infectious disease doctor. These infections were/are the ultimate causes of the other problems. Once the infections are licked, the road to healing will have a smoother surface. He gave me a great deal of encouragement today. In spite of the cheerleading I’m doing when visiting Denise (which isn’t much, with all the times I’m turned away due to all the procedures), I started to crack a bit. The I.D. doctor said that pregnant women who have had disseminated Valley Fever (cocci going beyond a lung infection) have nearly a 100% mortality rate, and the cocci has gotten into the brain. Denise’s brain is uninfected, according to the spinal tap weeks ago and evidenced by her cognitive abilities & physical coordination when not loopy from sedatives & painkillers. That was a major boost to morale amid all the pressure of this ordeal. On a side note, the I.D. doctor has perhaps the best enunciation of anyone I’ve met in several years. If his gig as a doctor ever falls through (fat chance), he could make a living by narrating audiobooks.

I'm glad there's been a turn for the better. I (and I'm sure lots of you that are medically-inclined) would like to know what was done medically to help her out. Different meds, equipment, techniques, timings... what? I've heard of lots of switching around of meds (I've heard just about all the names before in our ordeal). I heard a suggestion that she may have been just pulling out of the trough of sepsis as she was handed off to USC. I heard that the p/a catheter might have been giving inaccurate readings. Indeed, while at Arcadia Methodist, that was suspected and they were planning to replace the p/a catheter but knew USC would just pull it out and put in a new one anyway, so it wasn't done. Actually, I heard many things that might have been the case in explaining why there's been such a rapid improvement in some of her numbers. I hope that as a few more days pass, there might be a definite answer. If not, I'll still be happy, of course.

It's been an adjustment at this hospital. Extremely busy, and as such, sometimes hard to catch someone to find out exactly what's going on (actually, it's so busy, I feel like I'd be bothering someone if I asked my usual number of dumb questions). There are uber-doctors teaching residents, fellows, interns... peppering them with questions at an astonishing pace. It's intense. I listen in whenever I can. I tried taking notes and then finally gave up because my writing was so sloppy, I wouldn't be able to read it. Now I know why doctors write that way. There are questions, suggestions, scenarios, facts and theories all jumbled together. So it was difficult for me to determine what exactly was going on with Denise. During one of these exchanges yesterday I heard someone ask when the gastrostomy tube was put in. I butted in and said that I have been recording such things on this blog, and they pointed out a computer & told me to find the g-tube insertion date. So I did, and it seemed to be something that mattered to them. I was elated that this web site might in some way help the doctors heal my wife faster. Later, a funny thing happened (read: I made a fool of myself). Amid fast & furious questioning & answering, I heard something about attempting bi-level ventilation. Emboldened by my previous perceived usefulness, I blurted out (as fast as I could, to keep pace with them) everything I could remember about Denise going from the "old" vent to the new Servo-i vent in bi-level vent mode, how beneficial that was, then attempting CPAP mode, how long she tolerated that mode, at what oxygen concentrations, PEEPS, and everything else I could remember. There was a short pause. Silence. Somewhere in the distance, a coyote howled. Then the "teacher" doctor said that he was asking that question primarily so that the residents could answer it, for educational purposes.
Doh!

What else today...
Oh! At one point Denise indicated that she wanted to touch my face & hold my hand without the gloves. That was a drag. But at another point, she had her forearms up. Usually she's raising & lowering her forearems repeatedly, but this time they were just up, perpendicular to the floor. I asked if she was exercising (shook head "no"), stretching (no), in pain or discomfort (no), trying to draw my attention to something (no), if it just felt good to do that (no), praising God (yes). That's my girl. Along these spiritual lines, I forgot to mention something that the chaplain from Arcadia Methodist brought up quite some time ago. I told him how, even though Denise was sedated, couldn't move, talk, eat, or do anything, even though she was near death, God was still using her to draw people nearer to Him. I told him that some friends have told me that their entire church congregations would pray for her during services sometimes. The chaplain said, "Across denominations... Wow, God's even using Denise to unite the Baptists! He can't do that alone." Just thought my Baptist buddies would get a kick out of that.

12 Comments:

Anonymous Anonymous said...

YEAH YEAH YEAH .... Keep your spirits up. Phil - you have no idea how many people (Christian and non) are being blessed by Denise. Praise God for every blessing he bestows on us. Romans 8:28 - And we know that in ALL things God works for the good of those who love us, who have been called according to his purpose. The longer I follow God the more apparent this extremely hard concept becomes. Keep pulling! Glad to see a GOOD POST.

September 30, 2005 3:28 AM  
Anonymous Anonymous said...

Wonderful news! I was concerned when you didn't post on Weds after the move and was elated for you when I read this post! Excellent! I'm now praying for the I.D. doctor! You are doing a wonderful thing, Phil, with this blog!

September 30, 2005 6:51 AM  
Anonymous Anonymous said...

Yipee!!!!! Phil, I hope you will be ready to travel when Denise is sharing her testimony across the world. (She'll need you to carry her luggage!) The Lord is most assuredly using both of you to touch zillions of lives. I am so proud of you both and contine to pray for healing, for both of you.Hope you are feeling better. I bet the "teaching" Dr. will use you for years, as the perfect example of a well informed and diligent husband that should have humbled them all. Many patients don't have an advocate that is so well versed plus wears a cheerleading skirt with such flair. (Just let them know you're a teacher - what do you expect!) Keep it up, you're doing great! Love you all bunches, Diane Evans and Family

September 30, 2005 8:05 AM  
Anonymous Anonymous said...

PRAISE GOD FOR HIS EVERLASTING LOVE AND FAITHFULNESS!!!

Lord, please continue to heal Denise. LORD - GIVE SPECIAL INSIGHT TO THE INFECTIOUS DISEASE DOCTOR!!!

YIPEE!!!

September 30, 2005 8:19 AM  
Anonymous Anonymous said...

Thank you for posting such great news! I worried yesterday with no post, and was so happy to see this here this morning.

May God bless the I.D. doctor, and all of the staff at USC, and may he continue pouring his blessings on you, Denise & your family.

September 30, 2005 8:23 AM  
Anonymous Anonymous said...

We too were concerned that there was no post yesterday, but am certainly glad to hear the news today. Couldn't wait to get to the computer this morning to see if there was anything. Glad to hear that things are looking up.


Shirley and Paul

September 30, 2005 9:03 AM  
Anonymous Anonymous said...

Rejoice in the Lord always, and again I say Rejoice...:)

God is using you and Denise through this blog to bless many many people. This allows us to pray very specifically and see God answer specifically. What a precious blessing.

Our prayer's continue to be with you, Denise, the kids and rest of the family and all the staff working with Denise at USC Medical Center.

God bless you both...with our love from GA

September 30, 2005 11:26 AM  
Blogger Call Me Grandma said...

Thank you God, Thank you God. Still praying for a total recovery. I am so glad to have read this good news. YEAH! YEAH! YEAH!

September 30, 2005 11:42 AM  
Anonymous Anonymous said...

This is wonderful news phil! SMCC MOPS prayer team continue to pray for Denise and your family. I am so thankful that you were able to move Denise to USC. I am a former ICU nurse from USC. The doctors and nurses there are wonderful people. You are right about it being a busy environment but don't hesitate to slow them down to answer your questions. We will pray for the Lord to guide the doctors and nurses as they care for Denise.

September 30, 2005 5:21 PM  
Anonymous Anonymous said...

Phil,

I am at the National Youth Workers Convention in Sacramento, CA, with 4,000 other youth pastors... I posted up a pic of Denise with a "Please Pray for my Friend" & Blog address on several of the message boards.... thought it was a quick way to try to get 4,000 more people praying :) Love,Mel (Danny say "Hi" & he's praying,with a capital
P R A Y I N G.

September 30, 2005 7:20 PM  
Anonymous Rekedal Family said...

We were elated with a good report today. Like many others, we noticed no post on Wed after the move, and doubled our prayers. Your outlet to us on this blog about Denise's progress has become a family staple for us morning and night. We pray for you and Denise's strength and encourgement; wisdom and insight for the doctors and med staff; and for God's Holy Spirit to reign. Denise praising God brought tears when we read it to each other today. Our kids are actively praying too. It's such a blessing to us when you share, both the good and the bad. THANK YOU for all you do to give us an opportunity each day to be obedient in praying for you two.
Love,
The Rekedals (from PCS)
Vicki, Rick, Ingrid (9), Ellen (7), and Audrey (2)

September 30, 2005 9:34 PM  
Anonymous Anonymous said...

Thank you, Phil, for being willing to take the time to share what is happening.You are a blessing to us as God makes His way in this.My husband had the gallian scan and was at 4 different hospitals before finding out that he had an abcess on his spine, for three months.He was septic and his organs were shutting down.USC saved his life.We had another baby after he came home.Have hope, my friend!

I remember watching the moniters and waiting and waiting.

I am praying your children will have their mommy home to care for them.They need that and I ask God, the Almighty, to provide that for them as He is our Provider.In Jesus Name, Chris Blair

September 30, 2005 11:25 PM  

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