When I headed to the hospital this morning, after only 4 1/2 hours sleep, I expected the day to be busy with therapists and social workers and more paperwork. Instead I came in to find that Bill had to be placed on the vent about 6:30 this morning. He was really laboring to breathe and his heart rate was 132 when I came in. His day nurse Laura had already called Dr. Edwards but hadn't heard back, so she paged him again and found out he was scrubbing in for a procedure. I also gave her Dr. Yaranov's name. 

Cindy came in and ordered an EKG and she said it looked like it could be an AFIB episode. He's never had AFIB, with either heart, but who knows. She said he didn't sound any worse than he usually did so in her opinion he didn't need to be bronched. But, she's with cardiology, not pulmonary.

He seemed a little disoriented to me and kept making strange noises that could at times have been "ow" or "wow" or "help". He did ask me to "take the circle off" meaning the collar that holds the trach in place. He said it was too tight and hurting.

Stephanie from pulmonary came in and had already ordered a stat chest x-ray. In the meantime, Cindy came back and said that Dr. Edwards ordered dilaudid to calm him down some. Laura gave him that and then EKG and xray came back to back. Stephanie said that he shouldn't be able to talk with the cuff inflated, but Cindy and I both told her that he has figured out how to do it somehow. She was going to change the inner part of the trach, but held off until after the xray. She also ordered an ABG which is Arterial Blood Gases to see how he was oxygenating and ventilating. He is a very hard stick and it took the respiratory therapists three tries before they got it.

He had all of his breathing treatments, both the antibiotic and the regular one. Janet from Dr. Threlkeld's office came by and she said that the nebulized antibiotic could cause broncho-spasms so she was going to talk to Dr. T about that. 

He had a very slight temp and it has since come down, although his cheeks are red. It has come down without any meds so it might just have been from the stress or breathing.

When I got back from getting some lunch, I saw Stephanie and she said the xray was perfect, meaning no mucus plugs. She also said that the blood gases were good. They did change the inner collar of the trach and now he can't talk. But, his sats have gone up and his heart rate has gone down. So the thinking now is that because the original trach was leaking air, that was why he was laboring so hard to breathe.

Janet also called the nurse and said they wanted some blood work done, drawn from both his picc line and another site to see if there was any infection at the picc site. They also want a urine sample to make sure there's nothing going on there. So far he hasn't produced enough urine so they may have to straight cath him. I've notice he has now developed some thrush "down there" but they have some nystatin cream and powder to help with that.

The oxygen setting on the vent has been lowered to 60% and the respiration rate lowered from 25 to 20 which is breaths per minute. At my last check, which involves walking all the way across the room to see the monitor, his oxygen was 95 and his heart rate was 108. So now the thinking is that because the trach was leaking, he was laboring so hard to breathe that it caused is heart rate to go up.

I have talked to the social work and the nurse case manager and several of the nurses. The respiratory tech last night remembered us, as did the day and night nurses. Other nurses have come by to say hi. It was almost an exact year that he was brought up here. Last year it was on Jan 15, this year Jan 13.

I've also seen the speech therapist who came in with ice chips and we caught up with the fiasco of Dr. Edwards not wanting him to have any speech at all to when he last ate. I also spoke to the head physical therapist and he just asked some questions. Hopefully Bill will be better tomorrow and able to be evaluated.

When they weighed him last night he weighed 131, which is down 14 pounds from 145 when he was admitted. But, that was 60 days ago! Most people would love to lose 7 pounds a month if they were dieting! I know I would!

I had an awful bout of acid reflux almost from the minute I laid down last night. Probably due to eating dinner so late last night. And after I took the medicine for that, which is chewed, one little teeny crumb got caught in my throat and I coughed until after midnight. I didn't get to bed until after 10, which is very late for me lately, and then started waking up at 4:30 with the cats. I actually started feeling human by the time I got to West Memphis. But, I was not too sleepy to drive and had no trouble in that respect. The fog on the other hand...but it didn't get really thick until I was already at the hospital.

So, there you have today's update. Hopefully Bill won't be awake all night since he's sleeping most of the day. And if he gets agitated after I'm gone, maybe they'll be able to give him some more diluadid. I know they don't want to keep him totally sedated, but they also won't want him to get as worked up as he was this morning.

Hopefully tomorrow's update will be a happier one!