The last three days have been pretty non-eventful. One of the possibilities in the last post was the threat of pneumonia. Although not completely clear yet, doctors do believe that he has it. The hardware placed in Dad's back has come up positive for an infection, so the neurosurgery team is going to wait a few days to see if his spine has fused yet. If this is the case, which is unlikely, they would be able to take him in for surgery and have the rods and screws removed from his back. Again though, it is not only unlikely that the bone has fused, but it's also unlikely that Dad would be able to go through such a surgery in his current condition. The pressure support on his ventilator has been ranging between 60% and 100%. Which means he is still very dependent on the machine to do the breathing for him. Yesterday Dad was very alert and very agitated. Whenever Mom and I were in the room he would constantly be needing or wanting something from us. Today was about the same. He was back at 100% on the vent and he was constantly moving around, telling us he wanted to get up and walk out of here. It was hard for us to explain to him that he wasn't healthy enough to do that yet. I think he realized that before we even told him. They have decided to keep him up on 7th floor instead of trying to put him back in the MICU since Dad likes it better up there. The staff decided to go ahead and put a suction machine on his back so that they don't have to continuously roll him around and change the gauze out. When we called in tonight, his nurse told us that Dr. Klesney-Tait decided to give him a high enough dose of Ativan to make him sleep. Her thought process is that Dad has too many things wrong with him right now for him to be awake and struggle through the pain. After being home and talking to a lot of you already, I can tell that some of you are still a little confused about what exactly is wrong with Dad. So I will use this time to "debrief" you on all of his current problems:
Lungs: looked at the CT Scan today and his lungs have a moderate amount of inflamation and mucus build-up. This is caused probably by both his infection and the pneumonia. This is the reason he is on a ventilator through the tracheostomy.
Kidneys: Lately his kidney functions have been improving, although they are not back to normal yet. His creatine levels are at about 2.3...normal functioning is right at 1.0. He was at one time on dialysis, but he is no longer requiring that amount of assistance.
Back/Spine: Dad had to have emergency back surgery after he suffered a compression fracture of the Thoractic 11 vertebra. The fracture occured due to a combination of Prednisone use over the last 9 years, his recently diagnosed Ureaplasma, and a couple of falls while walking. Ureaplasma is a rare bone infection that can be found in transplant patients. Iowa City has had 8 cases in 25 years. Dad is currently on Zithromiacin and will have to be for the rest of his life as a preventative measure. His surgery was risky and involved the placement of two steel rods and screws to help fuse the vertebrae back together. His incision is still open because of the reoccurence of puss build-up. So Dad literally has an open wound in his back at this time that requires constant daily attention.
Shoulders: A few years ago, Dad suffered a torn rotator cuff in his right shoulder. They were never able to perform surgery on this due to his poor lung condition. Since he has been in the hospital, they also discovered some bone deterioration in his left shoulder. So at this time both of his shoulders are extremely weak and painful.
Stomach: While in the hospital, Dad complained of stomach discomfort. Following this, the doctors found that he had two ulcers. Although this is painful for him, they should heal on their own.
Cardiovascular System: Almost two months ago, Dad had some complications with his medications. When he was admitted into the MICU at that point, they discovered he had suffered from what appeared to be three small strokes. They in no way should have any affect on his life. This was later explained to us as being caused by a minor flaw in the sewing of the new lungs into the heart valves.
Infections: Dad has suffered from a variety of infections already. As I explained above, he still has the Ureaplasma infection in his back, but it is being treated with a drug called Zithromiacin. However, Dad is still breaking temperatures so there is still an infection in him that they haven't found yet. They are testing his blood every day in an attempt to pinpoint where it is coming from.
Overall: For those of you who don't know what's still keeping Dad from going home, this is my best explanation: The hardware (rods and screws) in his back are carrying an infection. They have to wait until his bone has fused before they can remove that and sew his incision back up. Dad's lungs are suffering from inflamation and fluid build-up due to the unknown infection, and pneumonia. These two things are the most important factors holding him back. His healing process will have to come one step at a time. First, they have to pinpoint the infection and eliminate all fevers. This will probably coiincide with the elimination of the pneumonia. Once they are able to do this, he will have to lose the infection in his back and go through surgery to have the hardware removed from his back. If he is able to make it through all of this, he will have to rehab and build strength back in his legs and basically learn to walk again. It's a long, scary road ahead of us and all we can hope is that we have as few stumbles along the way as possible. Thanks for your continued support and comments.