Changes

Sutton seems to be doing better today. Up until late yesterday afternoon he was still having a pretty rough time. Yesterday he vomited twice in the morning and again right before bed last night. He also vomited a very small amount this morning during rounds after a coughing episode. The problem is his feeds were cut off over the weekend and he was reverted back to IV nutrition only, so what is causing the vomit when it is unrelated to coughing? Also, the color has us wondering if it is just bile or old blood. If it is blood, at least it's old.

The answer to that question is: they aren't sure. We have discussed several possibilities and the changes that were settled on for today include increasing the medication that helps to dry his secretions. While this medication can also make them thick and difficult to move, it had been removed from his regimen entirely so we're going back to a low dose to see if it will help with the coughing fits and vomiting.

They have decided to go ahead and reintroduce tube feeds, at 1/15 the rate he was previously at, since that doesn't seem to be the root cause of the vomiting. They will slowly increase this rate and decrease the IV nutrition as his body allows.

He also remains on oxygen with PD from respiratory therapy. PD is a treatment from respiratory that he actually likes (unlike the IPV he got while he was intubated) since it feels a bit like a massage. They have increased the frequency of the PD during the day and have also initiated a breathing treatment due to changing vital signs. They had discussed high flow oxygen, but that was ruled out because of concerns over damaging the internal repairs in his neck. They decided heliox, a helium oxygen combination, would be a better choice because it doesn't require the high pressure, but it does decrease his cough. With the level of secretions he is battling right now the cough is the only thing saving him from major aspiration problems. So, since the breathing treatments seem to give him some relief they are going to hold off on the heliox for now.

Another chest x-ray and respiratory viral swab were unremarkable.

I feel better about today than I did yesterday morning. Yesterday was a bad day. But I still don't feel at ease about these breathing and vomiting issues. I am primarily concerned about how the vomiting is compounding the breathing problems and what these issues will mean for his respiratory status long term.

The good news is, his drug wean has continued to go without incident and he is now off of all continuous drips! The next step, though he isn't there just yet, is to move to oral medications through his button instead of the IV doses he is still getting. For the amount of medications he was on his drug wean has gone relatively fast and he has tolerated it well.

He also has windows of normalcy. He wants to sit up in his bed or on my lap and play and he is starting to fall back into his normal sleep routine as best he can here at the hospital. He is regaining strength and can pull himself around in his bed, though he has not quite regained enough strength to pull himself to standing. This is a saving grace, because it is pretty tricky to get him to sit still for any length of time when he is feeling well.

Additionally, his vocal cords sound as though they are getting stronger. He called out for me this morning and I was able to hear him from the chair behind his bed! Regaining movement in his cord or cords would alleviate many of the problems we are currently battling and we hope that he continues to improve in this area. At this time there is still no movement from the right cord. 

I just look forward so much to this time next week. Or next month. Or next year. I know the further we get out from surgery the more his body will have recovered and, hopefully, the more stable our days will become. Please pray for an improved respiratory status overall and to find a root cause of these problems so that we can work towards getting them resolved. Also, for continued improvement in his regaining strength in his vocal cords.

"A smooth sea never made a skilled sailor." -English Proverb