Tuesday, January 18, 2005

Will's condition is taking its toll on all three of us today. Will is doing better, but has had a rough 36-48 hours thanks to an infection, his edema and the fact that even at his healthiest he has sick, immature lungs. Mary is home with a stomach bug, tired and not feeling well, and I'm in the best shape, simply exhausted having stayed up all night to keep an eye on Will. Mary seems to be feeling better, there's nothing wrong with me a good long nap won't fix and Will is very slowly coming around.

Will's main issues the past couple of days have been a low blood pressure, no peeing and the need for significantly increased ventilator support. All of this can be attributed at least in part to an infection that seems to have settled in as pneumonia. Meanwhile, he continues to take on fluid and hasn't been peeing it off, so he is incredibly puffy and very uncomfortable. Every movement seems to make him miserable, so he is on morphine and a sedative that help to keep him calm. To fight the infection -- there could be more than one, actually -- he is now on six different antibiotics. That way he has pretty serious blanket coverage that should knock out whatever he has. They also have started him again on the dexamethasone, a steroid that in the past has really helped his lungs because it can reduce inflammation and open the airways. He is on two medicines designed to increase his blood pressure, a diuretic and the usual slate of medicines that just help him to get through each day.

Yesterday he was OK, but by evening he was needing a lot of ventilator support and just wasn't doing well. They made some changes that stabilized him, but after a decent night, he had some trouble again around dawn, so they increased his ventilator support again. That seemed to help, and now he is requiring less oxygen than before (though still considerably more than he does when healthier). His blood pressure has improved and that, coupled with the diuretics finally led to some pee. It wasn't much, and it hasn't happened again since that small burst at about 9 this morning, but it was more than he'd had in the previous 24 hours, so it was a good sign. He needs to do that a lot more to get rid of his excess fluid. He's locked into another of those vicious cycles: His lungs aren't filling well because of the fluid, so the blood return to his heart isn't as efficient, so that blood isn't getting to his kidneys, so he isn't peeing, so the fluid doesn't go away, and so on and so forth. If they can get him peeing better, they can break that cycle and put him back on the path to recovery.

There still is good news. The chylothorax output has plateaued, if not decreased, and they continue to wean the octreotide. I'm still skeptical, but he so desperately needs to get hurdles out of the way that I'm willing to suspend disbelief and just hope that they're right. One less thing to deal with.


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