When I arrived this morning, Angela greeted me with a smile around her ET tube. It was a strange-looking but beautiful sight. She was alert most of the day. Physical Therapy came in and started her exercising her arms, back, and legs. She's not ready to stand yet, but that may come soon. Her rash and itching are much better. Her fever is somewhat better. Her bowels still aren't moving like they should. They tried a few things today, with limited success. One problem is that if things get backed up it can push on her lungs, and they don't need any squishing!
She was able to enjoy some get-well cards and a small bunch of flowers, which she isn't really supposed to have in ICU, but her nurse said that was just a "guideline". She also watched a little TV. I expect she is a little bit tired of the CDs I've been playing almost constantly for her, but I hope they did the job of helping her stay calm when she was unaware of what was happening.
We continue to marvel at God's blessing and our hearts are filled with gratitude.
Thursday, April 30, 2009
Wednesday, April 29, 2009
She's awake
Today Angela is awake. Not entirely, but definitely enough to communicate. She nods or shakes her head, points, and otherwise lets me know what she wants. It is great to have her back.
She was getting a little panicky this morning, but by evening seemed more calm. She is moving her head, exercising her neck, and also moving her legs and arms trying to give them some exercise. She had PT yesterday, but today she's still fighting this infection, so they held it. Hopefully, tomorrow she will resume.
She got a chance to breathe on her own this afternoon for about 20 minutes. She still has the ventilator tube in her throat, but there is a setting on it that lets her do all the work, and they had her on that. The rash that she has had was itching her today, so she got some Benadryl.
It seems so nice to have the major issues be things like fever, rash, and itchiness.
We continue to thank God for healing her and all of you who have kept her in your prayers. There are likely still issues to be faced, but I expect they will not be as significant as what she's been through.
She was getting a little panicky this morning, but by evening seemed more calm. She is moving her head, exercising her neck, and also moving her legs and arms trying to give them some exercise. She had PT yesterday, but today she's still fighting this infection, so they held it. Hopefully, tomorrow she will resume.
She got a chance to breathe on her own this afternoon for about 20 minutes. She still has the ventilator tube in her throat, but there is a setting on it that lets her do all the work, and they had her on that. The rash that she has had was itching her today, so she got some Benadryl.
It seems so nice to have the major issues be things like fever, rash, and itchiness.
We continue to thank God for healing her and all of you who have kept her in your prayers. There are likely still issues to be faced, but I expect they will not be as significant as what she's been through.
Tuesday, April 28, 2009
A Bump in the Road
Today, Angela developed a fever, and her blood culture showed bacteria. We were told this was not unexpected and is very treatable. She was started on Vancomycin and given Tylenol. Because of the infection, the PICC lines she had in her arms (they make it easier to give her IV fluids or medicines and draw blood for testing) were removed. According to the nurse, bacteria can hide on those lines so they needed to get outta there. That makes it much more difficult for her IV and for when she needs blood drawn - her veins are very difficult to stick. This evening the IV that was started this afternoon had to be removed because it wasn't working right and another one placed. They would like to wait 48 hours before reinserting another PICC line.
She isn't really conscious, though she sometimes appears to be able to answer simple questions or follow simple directions. She is very aware, though, when the nurse performs her "oral hygiene" and makes a very unhappy face. Being stuck for IVs and blood tests also provokes a reaction. She did seem to calm down some when I rubbed her feet. Her sedation medications continue to be decreased. Today, the Versed was stopped. The only thing left of that type is her pain medication.
Her extremities have an occasional sort of tremor or slight spastic movements - perhaps the result of the Ketamine she was on. Hopefully, this will decrease as it gets out of her body.
She has been quite stable on the ventilator and is trying to breathe on her own some, especially when she is agitated.
She appeared to be resting peacefully when I left, though she still had a fever.
I know we have to be prepared for some setbacks along the road, but they sure aren't as fun as yesterday was. Anyway, a new problem is another subject for prayer, and we sure continue to thank God that He has brought her this far.
She isn't really conscious, though she sometimes appears to be able to answer simple questions or follow simple directions. She is very aware, though, when the nurse performs her "oral hygiene" and makes a very unhappy face. Being stuck for IVs and blood tests also provokes a reaction. She did seem to calm down some when I rubbed her feet. Her sedation medications continue to be decreased. Today, the Versed was stopped. The only thing left of that type is her pain medication.
Her extremities have an occasional sort of tremor or slight spastic movements - perhaps the result of the Ketamine she was on. Hopefully, this will decrease as it gets out of her body.
She has been quite stable on the ventilator and is trying to breathe on her own some, especially when she is agitated.
She appeared to be resting peacefully when I left, though she still had a fever.
I know we have to be prepared for some setbacks along the road, but they sure aren't as fun as yesterday was. Anyway, a new problem is another subject for prayer, and we sure continue to thank God that He has brought her this far.
Monday, April 27, 2009
Three giant steps forward
Today the whole ICU had smiles on their faces. Angela tolerated changing to the "regular" ventilator very well, then she got off the rotating bed and onto a "regular" bed, and she was a little bit responsive, being able to nod her head in answer to a question and squeeze fingers in her hand. The ketamine that she has had for sedation is being tapered off at a fast pace, so tomorrow she will probaby be even more awake.
I am so full of thanks to God first, but also to the entire staff at the hospital. They have been nothing short of wonderful. I was reminded that she still will have bumps in her road to recovery, but for right now I will simply rejoice at what is today.
I am so full of thanks to God first, but also to the entire staff at the hospital. They have been nothing short of wonderful. I was reminded that she still will have bumps in her road to recovery, but for right now I will simply rejoice at what is today.
Sunday, April 26, 2009
Still Not Ready
Angela tolerated the reduced airway pressure down to 16 well, but when they tried to switch her to the conventional ventilator, they found that her compliance (this is the opposite of stiffness) was not even close to what they wanted. This can be measured directly when one is hooked up to a conventional ventilator but not on the Oscillator, so they didn't know that in advance. The respiratory therapist who tried, used a bag on her to manually ventilate her and said that she didn't seem stiff to him, but she's just not ready. Her doctor said we were probably just getting a little impatient and she'll be ready in a day or two.
Other than that, the Lasix is working - the other day you could barely tell she had eyelashes, her eyes were so swollen. Today, she was trying to open them. Her hands are also about half the size they were.
So, it has been a positive day, just not quite what we had hoped for. When I left she was breathing 35% oxygen and maintaining sats of around 94% at an airway pressure of around 16. They will try to lower that to 15 overnight, but I don't think anything else is planned except to wait until her lungs heal a bit more.
God is continuing to heal her, but in His time, not ours. We are continuing to praise Him.
Other than that, the Lasix is working - the other day you could barely tell she had eyelashes, her eyes were so swollen. Today, she was trying to open them. Her hands are also about half the size they were.
So, it has been a positive day, just not quite what we had hoped for. When I left she was breathing 35% oxygen and maintaining sats of around 94% at an airway pressure of around 16. They will try to lower that to 15 overnight, but I don't think anything else is planned except to wait until her lungs heal a bit more.
God is continuing to heal her, but in His time, not ours. We are continuing to praise Him.
Saturday, April 25, 2009
Another Good Day
Today, Angela's doctor said she is doing "good". Her chest x-ray is better. Her blood gasses are better. She is on 30-35% oxygen, and they are trying to bring the ventilator airway pressure down. It was, earlier on, as high as 35, I believe. Today it started at 20 and was at 19 when I left. The doctor says when it gets to 17, she will go on the regular ventilator. He didn't say "try" - he said she would be ready. The amount of pressure she needs is an indication of how stiff her lungs are. As they become less stiff, less pressure is needed.
I spent the day rubbing her feet and hands and even sat down and read a little. Her bed is tipped with the head up about 10 degrees. She has always scooted downwards, necessitating the nurses to pull her up a couple of times a shift, but today, she was doing it much faster, needing to be pulled up every hour or more. Her nurse today allowed me to help, and the two of us could accomplish the job. Previously, she had to call two other nurses and the three of them would move her. I am becoming "trained". I also replaced her sat probe many times. That is the thing that clips onto her ear and tells the percent oxygen saturation of her blood. Her head is positioned between two cushions and as she rocks back and forth, it falls off frequently. Sometimes they put it on a finger where it stays better, but today her fingers were a little cold, and cold fingers don't give as accurate a reading.
We continue to praise God for the healing he is giving her. Every day when I leave I tell her that Jesus will stay with her and keep his arms around her and keep healing her lungs. Maybe she hears and can understand. Anyway it comforts me.
I spent the day rubbing her feet and hands and even sat down and read a little. Her bed is tipped with the head up about 10 degrees. She has always scooted downwards, necessitating the nurses to pull her up a couple of times a shift, but today, she was doing it much faster, needing to be pulled up every hour or more. Her nurse today allowed me to help, and the two of us could accomplish the job. Previously, she had to call two other nurses and the three of them would move her. I am becoming "trained". I also replaced her sat probe many times. That is the thing that clips onto her ear and tells the percent oxygen saturation of her blood. Her head is positioned between two cushions and as she rocks back and forth, it falls off frequently. Sometimes they put it on a finger where it stays better, but today her fingers were a little cold, and cold fingers don't give as accurate a reading.
We continue to praise God for the healing he is giving her. Every day when I leave I tell her that Jesus will stay with her and keep his arms around her and keep healing her lungs. Maybe she hears and can understand. Anyway it comforts me.
Friday, April 24, 2009
More baby steps forward
This morning, Angela's CO2 was down to an acceptable level. Respiratory Therapy lowered her % oxygen to 40. Her chest x-ray looks better. So, things are looking up. She has gained something like 25 pounds of fluid since being admitted. Apparently, that is not unusual, but she is now to the point that they are giving her a slow Lasix drip so she can get rid of it. I think that will be another big help.
There was discussion about again trying her on a regular ventilator. They really want to change her over, but not before she is ready. It may be tomorrow, but most likely will be soon. When that is successful, they will try to get her off the rocking bed she's on and if she tolerates that, start decreasing the sedatives and let her begin waking up.
I was reminded again today that were it not for the Oscillator ventilator she is on, or a spectacular miracle, we would have lost her. She is still considered fragile, but to me she seems much more stable than even a few days ago.
We are so thankful to God for His continued healing of Angela. Even though she can't apparently hear me, I'm always telling her that Jesus is right there with His arms around her, healing her lungs. I wonder if she'll remember that when she wakes up.
We are also thankful to each of our friends, family, and even those we don't know for your prayers. So many people are praying for her, and we are so very grateful.
There was discussion about again trying her on a regular ventilator. They really want to change her over, but not before she is ready. It may be tomorrow, but most likely will be soon. When that is successful, they will try to get her off the rocking bed she's on and if she tolerates that, start decreasing the sedatives and let her begin waking up.
I was reminded again today that were it not for the Oscillator ventilator she is on, or a spectacular miracle, we would have lost her. She is still considered fragile, but to me she seems much more stable than even a few days ago.
We are so thankful to God for His continued healing of Angela. Even though she can't apparently hear me, I'm always telling her that Jesus is right there with His arms around her, healing her lungs. I wonder if she'll remember that when she wakes up.
We are also thankful to each of our friends, family, and even those we don't know for your prayers. So many people are praying for her, and we are so very grateful.
Thursday, April 23, 2009
Holding Her Own
Today started with an elevated CO2, again. More fiddling with ventilator settings brought it down a bit.
The respiratory therapists use this ventilator a lot for newborns, but not so much for adults. That makes this somewhat of a learning process for them, too. They have several values they can set, and the combinations of this one up a little and that one down a little are nearly endless.
They went ahead and tried her on the conventional ventilator again, and again she wasn't ready. After that trial, they changed another setting on the Oscillator, which really brought her CO2 down - it's only about twice normal now.
Her other numbers continue to look good - she is able to maintain saturations in the 90's with only about 50% oxygen. As I understand it, her main problem now is that her lungs are still very stiff, needing lots of pressure to force oxygen in and carbon dioxide out. The increased steroids yesterday were to help that, but mostly she just needs to start healing.
The doctor did say that she is improving, albeit very slowly. Each of her nurses continues to remind me, generally subtly, that she is very, very sick still, and not at all out of the woods yet.
She remains in God's hands, and we do so appreciate all the prayers on her behalf. He will continue to heal her if it is His will.
The respiratory therapists use this ventilator a lot for newborns, but not so much for adults. That makes this somewhat of a learning process for them, too. They have several values they can set, and the combinations of this one up a little and that one down a little are nearly endless.
They went ahead and tried her on the conventional ventilator again, and again she wasn't ready. After that trial, they changed another setting on the Oscillator, which really brought her CO2 down - it's only about twice normal now.
Her other numbers continue to look good - she is able to maintain saturations in the 90's with only about 50% oxygen. As I understand it, her main problem now is that her lungs are still very stiff, needing lots of pressure to force oxygen in and carbon dioxide out. The increased steroids yesterday were to help that, but mostly she just needs to start healing.
The doctor did say that she is improving, albeit very slowly. Each of her nurses continues to remind me, generally subtly, that she is very, very sick still, and not at all out of the woods yet.
She remains in God's hands, and we do so appreciate all the prayers on her behalf. He will continue to heal her if it is His will.
Wednesday, April 22, 2009
A Good Day
Today didn't start so good. Angela's CO2 was elevated again, then she got another plug in her ventilator. Her hemoglobin was down in the 7 range. The doctor said her lungs felt stiff again. But she responded to the treatments.
The doctor increased her steroids, gave her 2 units of red blood cells, and was satisfied with her response. When I left at 6:30 or so, she was on 49% oxygen with a pressure of around 20 and maintaining sat rates in the high 90's. I'm not sure of her CO2 level, because they hadn't drawn a blood gases in awhile. Her kidneys were working overtime - I think they said she produced 3 liters of urine today. That is one way the body has of getting rid of excess CO2, so it is a good thing.
These are small steps, and she is still very sick, but it looks like she's heading in the right direction, and we continue to thank God for that.
The doctor increased her steroids, gave her 2 units of red blood cells, and was satisfied with her response. When I left at 6:30 or so, she was on 49% oxygen with a pressure of around 20 and maintaining sat rates in the high 90's. I'm not sure of her CO2 level, because they hadn't drawn a blood gases in awhile. Her kidneys were working overtime - I think they said she produced 3 liters of urine today. That is one way the body has of getting rid of excess CO2, so it is a good thing.
These are small steps, and she is still very sick, but it looks like she's heading in the right direction, and we continue to thank God for that.
Tuesday, April 21, 2009
Two steps forward, one step backward
This morning, Angela had problems getting rid of carbon dioxide, not a new problem for her. In the late morning the doctor and respiratory therapists tweaked the ventilator settings, and she started improving. The goal is to get her mean airway pressure to around 15 (I don't remember the units). They were able to lower it to around 22, but tried for around 21 and she wasn't able to tolerate that. Her % oxygen was down below 50, but had to be raised a bit after the failed attempt to lower her airway pressure. By 6:00 when I left, her airway pressure was around 24 and % oxygen at 54.
The doctor wants to try her on the regular ventilator again, maybe tomorrow or the next day, depending on how well she continues to do. He told me today that the alveoli that were so stiff are becoming more pliable. I take that to mean that the lungs are starting to heal.
I am still being reminded that she is one very sick girl, but I think a little bit less sick than yesterday. Praise God.
The doctor wants to try her on the regular ventilator again, maybe tomorrow or the next day, depending on how well she continues to do. He told me today that the alveoli that were so stiff are becoming more pliable. I take that to mean that the lungs are starting to heal.
I am still being reminded that she is one very sick girl, but I think a little bit less sick than yesterday. Praise God.
Monday, April 20, 2009
Baby steps forward
Today has been a better day. When we arrived at the hospital she was on 80% oxygen, maintaining her saturation level. When we left this evening, she was only needing 65%. Also, she was able to maintain her saturation while the bed was stopped rotating for the breaking it down and bathing her that is done daily, and it was much more steady while rotating from side to side.
We're praising God for her improvement but are aware that she is still not out of the woods, and we're not off the roller coaster yet.
We're praising God for her improvement but are aware that she is still not out of the woods, and we're not off the roller coaster yet.
Sunday, April 19, 2009
No Headway
Today, Angela appeared to be doing well. She tolerated a lowered oxygen pressure and percentage - down to 59%. Then, midafternoon, she got a piece of secretions hung up in her ventilator tube, so it had to be changed. She didn't recover as quickly from that as she should, so the doctor bronchoscoped part of her lungs, looking for other pieces of gunk, but didn't really find any. As of 6:30, there was no further change from 5:00, when we left - her oxygen percent has been raised to 75%, and she desaturates when the bed turns her to her left, recovering when the bed puts her on her right.
She continues to be in the Lord's hands, and we know He will do what is best.
She continues to be in the Lord's hands, and we know He will do what is best.
Saturday, April 18, 2009
Not Ready Yet
This morning, Angela was given a trial of switching to the regular ventilator. After a couple of hours of "fiddling", it was apparent that she wasn't doing well enough, so she was switched back to the rescue, Oscillator ventilator. After recovering from this attempt, she remained fairly stable at about the same settings as yesterday.
Her pastor came in the afternoon and annointed her.
She continues to be in God's hands, and we are truly as helpless as we feel.
Her pastor came in the afternoon and annointed her.
She continues to be in God's hands, and we are truly as helpless as we feel.
Ups and Downs
The hospital staff keeps reminding us how very sick Angela is, and she continues to improve, followed by crisis after crisis.
Thursday night, she had to be retubed and was set back quite a bit. By Friday night she was looking better.
This morning, the plan is to change her to a "regular" ventilator.
This afternoon, her Pastor plans to come and annoint her.
Thanks for your prayers.
Thursday night, she had to be retubed and was set back quite a bit. By Friday night she was looking better.
This morning, the plan is to change her to a "regular" ventilator.
This afternoon, her Pastor plans to come and annoint her.
Thanks for your prayers.
Thursday, April 16, 2009
History
I'm writing this blog to let those who are interested know how God is working in Angela's health.
Angela is in Mercy Hospital in Redding, CA with Adult Respiratory Distress Syndrome, apparently caused by viral pneumonia. She is getting better, but by baby steps, some forward and some backward.
Her life support consists of an oscillator ventilator, a rotating bed, a feeding tube, and nearly a dozen IVs.
The oscillator ventilator breathes for her, but not anything like normal breathing - it's probably around four times a second, and very shallow, making her belly look a little like she is laughing heartily. It is being used because the regular ventilator was not keeping her stable. This type of ventilator is used often for premature babies, but the ICU staff tells us they only use them on adults about every six months - they are reserved for people that fail the regular ventilator. Oxygen is forced into her lungs and then out. As of this evening, she was on 70% oxygen. Considering that she started at 100%, this is an improvement, but considering that room air is about 21% oxygen and that the 2 liters per minute she previously used at home translates to about 29% oxygen, she still has a ways to go. Her saturation rates are staying between 87 and 92, more or less. The goal is to lower the percent oxygen that she is given while maintaining those saturation levels. It is done in small increments, and sometimes has to be set back because her saturation rate lowers.
Yesterday, she had a very good day, with saturation levels remaining in the desired range while percent of oxygen was gradually decreased, to as far as 60%.
Today was a more challenging day. She is sedated for several reasons, one of which is to keep her from fighting to breathe on her own. She wants to be awake, and the staff is having a difficult time keeping her sedated. She has tried to talk, but we can't understand what she says, and that is very frustrating for her.
Mike's sister Kathryn came up from Turlock to stay with me for a few days, and I really appreciate that.
Tonight, when we left the hospital, Angela was sedated and seemed peaceful. We left her CD player with some music on for her. Her oxygen percent was at 70, and she seemed to be maintaining her saturation. I guess because of the difficult day, the plan was to just maintain her over night, without necessarily trying any further to lower her oxygen percent. I have learned, however, that plans are very fluid.
She had some visitors from her church today. I don't think she was aware they were there, but they had prayer with her and me. It was nice to know that others also care.
The physicians, nurses, respiratory therapists, and everyone else we have met at Mercy are superbly competent and caring, and we know she is in the best place she could be. Of course, she is in the Lord's hands, and we know He will keep her and heal her if that is His will.
I'll try to post here at least daily, to keep you informed of her progress.
Angela is in Mercy Hospital in Redding, CA with Adult Respiratory Distress Syndrome, apparently caused by viral pneumonia. She is getting better, but by baby steps, some forward and some backward.
Her life support consists of an oscillator ventilator, a rotating bed, a feeding tube, and nearly a dozen IVs.
The oscillator ventilator breathes for her, but not anything like normal breathing - it's probably around four times a second, and very shallow, making her belly look a little like she is laughing heartily. It is being used because the regular ventilator was not keeping her stable. This type of ventilator is used often for premature babies, but the ICU staff tells us they only use them on adults about every six months - they are reserved for people that fail the regular ventilator. Oxygen is forced into her lungs and then out. As of this evening, she was on 70% oxygen. Considering that she started at 100%, this is an improvement, but considering that room air is about 21% oxygen and that the 2 liters per minute she previously used at home translates to about 29% oxygen, she still has a ways to go. Her saturation rates are staying between 87 and 92, more or less. The goal is to lower the percent oxygen that she is given while maintaining those saturation levels. It is done in small increments, and sometimes has to be set back because her saturation rate lowers.
Yesterday, she had a very good day, with saturation levels remaining in the desired range while percent of oxygen was gradually decreased, to as far as 60%.
Today was a more challenging day. She is sedated for several reasons, one of which is to keep her from fighting to breathe on her own. She wants to be awake, and the staff is having a difficult time keeping her sedated. She has tried to talk, but we can't understand what she says, and that is very frustrating for her.
Mike's sister Kathryn came up from Turlock to stay with me for a few days, and I really appreciate that.
Tonight, when we left the hospital, Angela was sedated and seemed peaceful. We left her CD player with some music on for her. Her oxygen percent was at 70, and she seemed to be maintaining her saturation. I guess because of the difficult day, the plan was to just maintain her over night, without necessarily trying any further to lower her oxygen percent. I have learned, however, that plans are very fluid.
She had some visitors from her church today. I don't think she was aware they were there, but they had prayer with her and me. It was nice to know that others also care.
The physicians, nurses, respiratory therapists, and everyone else we have met at Mercy are superbly competent and caring, and we know she is in the best place she could be. Of course, she is in the Lord's hands, and we know He will keep her and heal her if that is His will.
I'll try to post here at least daily, to keep you informed of her progress.
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