Wednesday 09/30/09:
No rehab floor for Mike. What? That's right. After much discussion about Mike's care and how it would be a good thing for him to go to rehab, the end decision lies with insurance. Are you kidding? Yes, insurance will not pay for rehab. So Mike will stay in the BTICU (I had to sound it out too...burn trauma intensive care unit) until he gets released. They are happy to have him. They have a bed for him and people that he knows and trusts. The plan is to do an eye revision in about 10 days. They are giving him supplemental oxygen at night ( his sats drop down....maybe there's a wee bit of sleep apnea?) They aren't doing labs on a routine basis, only vital signs every four hours. Still have to check on his swallow study. There has been no change in diet yet.
Bette went to Idaho to check on the progress of the house. There today, back to the hospital tomorrow.
More later,
and so we go
JaCee
Wednesday, September 30, 2009
Tuesday, September 29, 2009
Tuesday 09/29/09
Karen said the plan is to have Mike transferred to the rehab unit today or tomorrow. Wow. He's not ICU qualified anymore! yippee! He may return to the burn unit for "touch ups" if they have to do more wound/grafts but he's good to go to rehab and get stronger. Yesterday he walked around the nursing desk. He toured the cafeteria and spent a lot of time outside with Bette. He has progressed by leaps and bounds in the last 3 to 4 days, amazing everybody. Bette thought she would have to feed him but they placed foam over the handle part of utensils and now Mike is feeding himself.
way cool!
More later,
and so we go
JaCee
Karen said the plan is to have Mike transferred to the rehab unit today or tomorrow. Wow. He's not ICU qualified anymore! yippee! He may return to the burn unit for "touch ups" if they have to do more wound/grafts but he's good to go to rehab and get stronger. Yesterday he walked around the nursing desk. He toured the cafeteria and spent a lot of time outside with Bette. He has progressed by leaps and bounds in the last 3 to 4 days, amazing everybody. Bette thought she would have to feed him but they placed foam over the handle part of utensils and now Mike is feeding himself.
way cool!
More later,
and so we go
JaCee
Monday, September 28, 2009
Monday 09/28/09
Mike was taken care of by Jill last night and she said he was doing great. This is the first time she's taken care of him since his trach came out. She said he has all sorts of ideas to make things easier for patients and they rigged up a call light system so he just has to tap it instead of finding the right button. He is on supplemental oxygen by nasal cannula (the one you see on TV with the tube under the nose) at night. He hasn't had to take any extra insulin to control his blood sugars. He walked past 3 patient rooms yesterday. oh, and he is talking up a storm!
Now is the time when the physical therapists get to soar. They will work on strengthening his body, being able to walk, do stairs, (run marathons?) and his fine motor skills of grasping and doing some of the things we take for granted, like holding utensils and feeding himself. Jill says it's very exciting and now Mike is going to get really busy with all of the people wanting to see him.(PT, wound care, speech therapists...not to mention visitors) He will have swallow studies every day to help strengthen his swallowing and coughing skills.
His face still has a couple of wounds that they are putting medicated cream on and watching. He has splints on his hands at night but they took off one so he could reach things. His graft sites are looking good and healing. Jill said the stoma (the place where the trach was) is covered with vaseline guaze and it is healing well. The rumour has it that once the trach comes out things progress pretty well. It means that he can maintain his airway and breathe on his own. If they do any more surgeries, they can either use conscious sedation or place a temporary tube during surgery that can be removed.
Thank God that I don't have to say "he's holding his own...status quo (for the extent of his injuries)"! Let the adventure continue forward and have continuing healing! Thank you all again for your ongoing prayers for Michael.
More later,
and so we go
JaCee
Mike was taken care of by Jill last night and she said he was doing great. This is the first time she's taken care of him since his trach came out. She said he has all sorts of ideas to make things easier for patients and they rigged up a call light system so he just has to tap it instead of finding the right button. He is on supplemental oxygen by nasal cannula (the one you see on TV with the tube under the nose) at night. He hasn't had to take any extra insulin to control his blood sugars. He walked past 3 patient rooms yesterday. oh, and he is talking up a storm!
Now is the time when the physical therapists get to soar. They will work on strengthening his body, being able to walk, do stairs, (run marathons?) and his fine motor skills of grasping and doing some of the things we take for granted, like holding utensils and feeding himself. Jill says it's very exciting and now Mike is going to get really busy with all of the people wanting to see him.(PT, wound care, speech therapists...not to mention visitors) He will have swallow studies every day to help strengthen his swallowing and coughing skills.
His face still has a couple of wounds that they are putting medicated cream on and watching. He has splints on his hands at night but they took off one so he could reach things. His graft sites are looking good and healing. Jill said the stoma (the place where the trach was) is covered with vaseline guaze and it is healing well. The rumour has it that once the trach comes out things progress pretty well. It means that he can maintain his airway and breathe on his own. If they do any more surgeries, they can either use conscious sedation or place a temporary tube during surgery that can be removed.
Thank God that I don't have to say "he's holding his own...status quo (for the extent of his injuries)"! Let the adventure continue forward and have continuing healing! Thank you all again for your ongoing prayers for Michael.
More later,
and so we go
JaCee
Sunday, September 27, 2009
Sunday afternoon:
I got to talk to Mike today on the phone! It was so good to hear his voice! He sounded weak but good. It took a couple of times for him to cough and clear his throat. He said that they are doing a good job with him in the burn unit. He also walked for the first time today! Bette said he walked about 20 feet. He has been touring the hospital grounds and looking at the food in the cafeteria. He can't quite hold the utensils yet so Bette has helped to feed him. Physical Therapy has worked with him a couple of times today, practicing dexterity of his grasping.
Mike was really talkative and said that he hasn't talked for a long time and now they will be sorry that they got him talking because he's not going to shut up! He says he's trying to keep the spirits high around there.
Cousin Kyle was there today and they had a nice visit.
Get strong, Mike! We are all praying and rooting for you!
More later,
and so we go
JaCee
I got to talk to Mike today on the phone! It was so good to hear his voice! He sounded weak but good. It took a couple of times for him to cough and clear his throat. He said that they are doing a good job with him in the burn unit. He also walked for the first time today! Bette said he walked about 20 feet. He has been touring the hospital grounds and looking at the food in the cafeteria. He can't quite hold the utensils yet so Bette has helped to feed him. Physical Therapy has worked with him a couple of times today, practicing dexterity of his grasping.
Mike was really talkative and said that he hasn't talked for a long time and now they will be sorry that they got him talking because he's not going to shut up! He says he's trying to keep the spirits high around there.
Cousin Kyle was there today and they had a nice visit.
Get strong, Mike! We are all praying and rooting for you!
More later,
and so we go
JaCee
Sunday 09/27/09
Talked to Holly tonight and she said Mike is doing great. They took out all tubes except his IV line. That includes his foley catheter so now he can urinate on his own! He has slept most of the night. Looks like the schedule for the day did it's job and tuckered him out. The nurses are loving his personality. They say he's joking around and laughing.
Bette says she thinks he's ready for visitors now.
What a gift. Thanks to all who have been following this and have offered your prayers. We aren't done yet, by any means, but we can breathe a little easier don't you think?
More later,
and so we go
JaCee
Talked to Holly tonight and she said Mike is doing great. They took out all tubes except his IV line. That includes his foley catheter so now he can urinate on his own! He has slept most of the night. Looks like the schedule for the day did it's job and tuckered him out. The nurses are loving his personality. They say he's joking around and laughing.
Bette says she thinks he's ready for visitors now.
What a gift. Thanks to all who have been following this and have offered your prayers. We aren't done yet, by any means, but we can breathe a little easier don't you think?
More later,
and so we go
JaCee
Saturday, September 26, 2009
Saturday afternoon/evening: (mom report)
WOW!!!! (friday afternoon)
Mike is TALKING and talking and talking. He wasn't talking when we (Aunt Judy, Tamme and Bette) went to the circus and then when be came back, Mike was talking. It was almost like Christmas! He talked to Judy and Tamme and seemed to really enjoy it. Bette went out to dinner with Judy and Tamme. Bette tried to call someone to tell them the good news but wasn't able to get anyone.
(saturday)
Bette came up this morning before he went to dressing change and he was doing great. Bette went to see Karla's (her friend) girl in a competition (she did great) and when she got back to the hospital he was allowed ice. We fed him one glass of ice but that wasn't enough so we had to rig up something so he could hold the spoon to feed himself. We put tape inside out around his finger and thumb so the spoon wouldn't slip out of his fingers. They were taking the "nose hose" out. Karla stayed this afternoon.
Judy and Tamme came back to see Mike before they went home to Blackfoot, ID. He was in physical therapy when they came, putting little round pegs in holes. (what does this mean? I don't have a clue...I am the scribe... oh yeah, this is literally putting pegs in holes for dexterity) They started him eating. First ice chips,water, juice, then applesauce. Bette has a smoothie that he almost drank half of. Then his supper: lasagne, green beans, chocolate pudding and a roll. Bette thought that was pushing that a bit but he handled it okay. She fed him until he was tired out. He didn't do too bad. They took the trach out earlier. He has the suction tube "jury -rigged" to his hand in case he coughs and needs his mouth suctioned. He went outside for a while and took a trip to the cafeteria to see what they had.
Bette's friends, Jason and Karla have the Birkenstock store in Pocatello., They are going to get Mike a pair of the soft birks since his were pretty much fried.
Bette sounds tired too. Sounds like they had a great and full day. Congratulations Mike on talking, drinking and eating today!!!! Well done!
More later,
and so we go
JaCee
WOW!!!! (friday afternoon)
Mike is TALKING and talking and talking. He wasn't talking when we (Aunt Judy, Tamme and Bette) went to the circus and then when be came back, Mike was talking. It was almost like Christmas! He talked to Judy and Tamme and seemed to really enjoy it. Bette went out to dinner with Judy and Tamme. Bette tried to call someone to tell them the good news but wasn't able to get anyone.
(saturday)
Bette came up this morning before he went to dressing change and he was doing great. Bette went to see Karla's (her friend) girl in a competition (she did great) and when she got back to the hospital he was allowed ice. We fed him one glass of ice but that wasn't enough so we had to rig up something so he could hold the spoon to feed himself. We put tape inside out around his finger and thumb so the spoon wouldn't slip out of his fingers. They were taking the "nose hose" out. Karla stayed this afternoon.
Judy and Tamme came back to see Mike before they went home to Blackfoot, ID. He was in physical therapy when they came, putting little round pegs in holes. (what does this mean? I don't have a clue...I am the scribe... oh yeah, this is literally putting pegs in holes for dexterity) They started him eating. First ice chips,water, juice, then applesauce. Bette has a smoothie that he almost drank half of. Then his supper: lasagne, green beans, chocolate pudding and a roll. Bette thought that was pushing that a bit but he handled it okay. She fed him until he was tired out. He didn't do too bad. They took the trach out earlier. He has the suction tube "jury -rigged" to his hand in case he coughs and needs his mouth suctioned. He went outside for a while and took a trip to the cafeteria to see what they had.
Bette's friends, Jason and Karla have the Birkenstock store in Pocatello., They are going to get Mike a pair of the soft birks since his were pretty much fried.
Bette sounds tired too. Sounds like they had a great and full day. Congratulations Mike on talking, drinking and eating today!!!! Well done!
More later,
and so we go
JaCee
Saturday 09/26/09
Yesterday, Bette said she got a dry erase board and the first thing he wrote was "I hate that bitch"(referring to a night nurse). Way to express your feelings, Mike! Anyway, Bette relayed the message so I figured it was safe to blog it! (it wasn't a surprise, either).
They plan to get Michael on a schedule so he is awake during the day and sleep at night. the plan: 8am wake up, breakfast (eventually), burn therapy, outside lunch, dressing change, therapy, rest, outside... It sounds like they plan to keep him occupied most of the day. It will be good to have a schedule and know what to expect. Bette says he can speak when you hold the trach tube.
Last night Jesse took care of Mike and said he slept some. He was very cooperative and they got along well. It was a calm night.
More later,
and so we go
JaCee
Yesterday, Bette said she got a dry erase board and the first thing he wrote was "I hate that bitch"(referring to a night nurse). Way to express your feelings, Mike! Anyway, Bette relayed the message so I figured it was safe to blog it! (it wasn't a surprise, either).
They plan to get Michael on a schedule so he is awake during the day and sleep at night. the plan: 8am wake up, breakfast (eventually), burn therapy, outside lunch, dressing change, therapy, rest, outside... It sounds like they plan to keep him occupied most of the day. It will be good to have a schedule and know what to expect. Bette says he can speak when you hold the trach tube.
Last night Jesse took care of Mike and said he slept some. He was very cooperative and they got along well. It was a calm night.
More later,
and so we go
JaCee
Friday, September 25, 2009
Friday 09/25/09
Gome, the night nurse, said that Mike wouldn't sleep last night. He really worried her because he was sitting up all night, trying to air out his back. She was afraid that he might decide he could get up and walk if she wasn't watching him all the time. They had to have a "little chat" about not taking such long naps during the day so he would sleep at night. Today, they may take him outside once or twice to get some fresh air! That would be a first time outside day! yay! More physical therapy and swallow studies and LITTLE naps are on the schedule today.
More later,
and so we go
JaCee
Gome, the night nurse, said that Mike wouldn't sleep last night. He really worried her because he was sitting up all night, trying to air out his back. She was afraid that he might decide he could get up and walk if she wasn't watching him all the time. They had to have a "little chat" about not taking such long naps during the day so he would sleep at night. Today, they may take him outside once or twice to get some fresh air! That would be a first time outside day! yay! More physical therapy and swallow studies and LITTLE naps are on the schedule today.
More later,
and so we go
JaCee
Thursday, September 24, 2009
Thursday pm: "mom report"
Bette went with them when they did wound care this morning. The grafts on his arms look okay. The shoulders look good. His poor back on the donor sites are still weepy and giving him fits. He doesn't want anything touching them. He has been sitting straight up in bed all day since he got back from wound care. A dermatology resident came to evaluate his rash right after he came back from getting all new dressings and ripped them all off so she could look at his rash. She did a punch biopsy from his belly and put a stitch in it. Now that the anesthesia has worn off the site is bugging him. He is making more sound around the trach tube today. It still seems to be a lot of effort to talk. PT had him up on his feet a couple of times today. The last time they were in, he felt nauseated and then he had a coughing fit that lasted about 10 minutes. He was exhausted after that. Needless to say, it did a lot for clearing the lungs.
Aunt Judy called and she is coming to SLC tomorrow with our cousin Tamme. They may take Bette to the circus. It will be a good distraction, I think.
More later,
and so we go
JaCee
Bette went with them when they did wound care this morning. The grafts on his arms look okay. The shoulders look good. His poor back on the donor sites are still weepy and giving him fits. He doesn't want anything touching them. He has been sitting straight up in bed all day since he got back from wound care. A dermatology resident came to evaluate his rash right after he came back from getting all new dressings and ripped them all off so she could look at his rash. She did a punch biopsy from his belly and put a stitch in it. Now that the anesthesia has worn off the site is bugging him. He is making more sound around the trach tube today. It still seems to be a lot of effort to talk. PT had him up on his feet a couple of times today. The last time they were in, he felt nauseated and then he had a coughing fit that lasted about 10 minutes. He was exhausted after that. Needless to say, it did a lot for clearing the lungs.
Aunt Judy called and she is coming to SLC tomorrow with our cousin Tamme. They may take Bette to the circus. It will be a good distraction, I think.
More later,
and so we go
JaCee
Thursday 09/24/09
Last night was uneventful, according to Gome. (short for Gomez). Mike slept in blocks and had a good night. There weren't any labs available yet but she said he didn't have a fever or anything concerning.
Sometimes it's good to get a short and sweet report!
More later,
and so we go
JaCee
Last night was uneventful, according to Gome. (short for Gomez). Mike slept in blocks and had a good night. There weren't any labs available yet but she said he didn't have a fever or anything concerning.
Sometimes it's good to get a short and sweet report!
More later,
and so we go
JaCee
Wednesday, September 23, 2009
Wednesday 09/23/09
Last night Mike did well. He was awake most of the night and finally went to sleep at around 4am. His labs were stable and he is not on any antibiotics. I was trying to wrap my head around the eyelid drooping thing. Karen explained that there is so much swelling around the eyes that sometimes it looks like they are drooping. There are eyelids there. Mike can open and, if he works at it, close them but there is so much swelling that the lower lids are sort of droopy. Sometimes they put lubricant in his eyes but one is an ointment and he can't see because it puts a greasy haze over his eyes.
George was the day nurse and said that Mike was up in a cardiac chair most of the day. He also stood up for about a minute and was able to shift his weight back and forth. He did that a couple of times. They had changed the trach from an 8 to a 6 and found that there was a lot of laryngioedema (swelling of the voice box) and he couldn't speak so well. They put in a trach that allows the air to move back and forth. George said he had a pretty good day.
Bette went with Paul (cousin) to have supper and will call me later.
More later,
and so we go
JaCee
Last night Mike did well. He was awake most of the night and finally went to sleep at around 4am. His labs were stable and he is not on any antibiotics. I was trying to wrap my head around the eyelid drooping thing. Karen explained that there is so much swelling around the eyes that sometimes it looks like they are drooping. There are eyelids there. Mike can open and, if he works at it, close them but there is so much swelling that the lower lids are sort of droopy. Sometimes they put lubricant in his eyes but one is an ointment and he can't see because it puts a greasy haze over his eyes.
George was the day nurse and said that Mike was up in a cardiac chair most of the day. He also stood up for about a minute and was able to shift his weight back and forth. He did that a couple of times. They had changed the trach from an 8 to a 6 and found that there was a lot of laryngioedema (swelling of the voice box) and he couldn't speak so well. They put in a trach that allows the air to move back and forth. George said he had a pretty good day.
Bette went with Paul (cousin) to have supper and will call me later.
More later,
and so we go
JaCee
Tuesday, September 22, 2009
Tuesday PM "mom" report:
Mike has done well today. His shoulder grafts look good. He has several patches of a special dressing on his face and the top of his head. The nurses clean and re-ointment his face several times a day. That helps the healing process. He is going to have hair on the back of his head and all around the edges. Today is the first time I've seen the back of his head. I thought it was burned, but it is just the top back, not the area where he rests his head. That's good.
They down sized his trach tube today and closed it with a finger and he said an audible "HELLO"!!! He had me tape a marker on his finger so he could write a note but it proved to be too much effort. He gave up on that. He sat up in a sitting position for about 2 hours. They are talking about standing tomorrow. Next step is walking!
I (Bette) went to Pocatello Monday to meet with the contractor to nail down the choice of cabinets for Mike's house, and the lay-out of appliances, tec. I don't think we're allowed much for replacements. The contractor was supposed to call me and let me know how much we are allowed. Chris still has some wiring to do in Mike's place and then some on my side to meet code. Much still to do.
That's it for the Mom report:
more later,
and so we go
JaCee
Mike has done well today. His shoulder grafts look good. He has several patches of a special dressing on his face and the top of his head. The nurses clean and re-ointment his face several times a day. That helps the healing process. He is going to have hair on the back of his head and all around the edges. Today is the first time I've seen the back of his head. I thought it was burned, but it is just the top back, not the area where he rests his head. That's good.
They down sized his trach tube today and closed it with a finger and he said an audible "HELLO"!!! He had me tape a marker on his finger so he could write a note but it proved to be too much effort. He gave up on that. He sat up in a sitting position for about 2 hours. They are talking about standing tomorrow. Next step is walking!
I (Bette) went to Pocatello Monday to meet with the contractor to nail down the choice of cabinets for Mike's house, and the lay-out of appliances, tec. I don't think we're allowed much for replacements. The contractor was supposed to call me and let me know how much we are allowed. Chris still has some wiring to do in Mike's place and then some on my side to meet code. Much still to do.
That's it for the Mom report:
more later,
and so we go
JaCee
Tuesday 09/22/09
Happy Fall!
After experiencing "blog withdrawal" here's the update on Mike:(these are from e-mails that Bette sent me)
Friday and Saturday "mom report":
Mike was pretty "with it" this AM. Tom had gotten TED hose for Mike's legs. The swelling looks much better. PT (physical therapy) has been here to work Mike's hands and fingers.. His left hand was pretty tender so he got a little more pain meds so they could be a little more aggressive. Tom also thought maybe the inner cannula on the trach tube may be a little long and, consequently, irritating the trachea and causing the terrible coughing spells. Dr. Cochran said she wold put a shorter one in. Also, they are going to use Presdex(sp?) to keep him relaxed after surgery.
The surgery to replace the grafts on his shoulders with auto-graft skin wnt well. There is only minimal dressings on them so it is imperative that he stay very still for 2-4 days. I hope we can keep himquiet for that long.
Saturday: Mike seems pretty calm. They have vaseline soaked gauze on his face to help debride some of the scabs and stuff from his face. Luke said he planned to keep it up most of the day to see if he can get his face cleaned up. They are using antibiotic ointment also.
more later, mom
PM report: Mike spent a pretty uneventful day. Has been on T-piece all day with O2 sats in the high 90's. He sometimes forgets to keep his hands still so Luke put loose restraints on them so he can't raise them too high. He's doing well today.
Sunday /9/20/09: (mom report)
Report is that Mike spent a very restless night. Maybe it's because he had such a long nap in the afternoon. He wasn't too bad when I got here a little after 9am. Kristy is his nurse. He trusts her and likes her, but she has a nurse intern with her and she agitates Mike. She couldn't make the feeding tube work when she went to give him some meds and she pulled on he tube. I don't think she was aware that she did it.. Anyway, that elicited a strong SOB!!! No mistaking that. After that, he got a wild look in his eyes every time she came near him. He wanted someone else to help him. I got Jesse to help a few times when Kristy was busy. One time he got so agitated he coughed the trach tube loose. His O2 sats went way down and he panicked even though he had 3 nurses right there.
He still gets frustrated when I can't read his lips. Sometimes he forgets where he is and what's going on. I plan to go to Idaho tonight to see if I can get a few things organized. I hope he gets someone he trusts to take care of him tomorrow.
He has been on the T-peice all day, and they were talking of getting him up in a chair this afternoon. I'm not happy about his eyes. At first, only the right eye (lower lid) was pulling down. Now, both lower eyelids have pulled down. Kristy said that usually the "pulldown" is one of the last things they worry about. They are still working to get his face cleared up. I guess it's the up and down thing. I wish there were some more ups. And that is non the UPS shipping I'm talking about.
It will be good to get a good medical report when JaCee gets back. I miss that!
take care,
Bette, AKA MOM
Tuesday:
And so, with "no pressure" to give a "good medical report", we go...
I talked with Karen early this morning for the night report on how Michael is doing. She said he's been on the T-piece for more than two days. The plan is to downsize the trach from an 8 to a 6 (the size of the radius of the tube) and then place a Passymuir valve there. That is a valve that can be covered up to allow Mike to breathe normally but still allow suction access and be there in case he gets in trouble and needs to have extra help breathing. The back up safety valve, as it were. The arterial line was discontinued last week sometime and they also discontinued the Central line to a Picc line. The translation for that is that a Picc line is more for long term venous access and is less likely to cause infection. It usually is inserted in one of the arms and there is a long tube that travels up and into the superior vena cava that goes into the heart and circulation system.
Karen said Mike was awake and interactive last night and she can generally get the "gist" of what he's saying. They are weaning his fentanyl (IV pain med) and using oxycodone every 3 to 3 1/2 hours with good results. He has been getting pretty good at repositioning himself. His labs look good. The white blood count is great at 7.4 and his sodium is finally not bad at 140. I was happy to hear his kidney function tests; BUN 13, creatinine 1.23. Much better than before.
The plan today is to get speech therapy to come in to do a swallow evaluation. Good swallowing equals weaning of the feeding tube and moving towards Mike's first drink of water and then food. It has been a very long time since he had a drink, and I am not talking Beer here! We can barely go a few hours without anything to drink, taking it for granted. Just think of how good it will feel for Mike to take his first sip of water. I am very excited to hear how it goes.
You may be wondering where I was that I couldn't blog on Mike. Randy and I took Willow (Mike's niece) to Mexico up in the mountains to be with the Indians there to pray and celebrate her graduation from a ceremony for children and the harvest/fall time. We went without food or water for what seemed eternity and it really reminded me of what Mike must be going through. At least we knew that, at the end of the ceremony, we could drink water and eat, but it was small compared to what Mike has endured. We prayed for Mike and the family there. We realize that we take so many things for granted here and it was a very humbling and life changing experience. Thank you all for your patience while we were away. It was one of the ways I know to help Mike, through prayer. It is good to be back where there is running water, showers, a bed to sleep in, showers, and a house that has a door on it and real windows...did I mention showers? We are thankful every day for our lives and that Mike is alive. (sorry for getting a bit sappy there)
We are now up to speed. Let the blogging continue!
More later,
and so we go
JaCee
Happy Fall!
After experiencing "blog withdrawal" here's the update on Mike:(these are from e-mails that Bette sent me)
Friday and Saturday "mom report":
Mike was pretty "with it" this AM. Tom had gotten TED hose for Mike's legs. The swelling looks much better. PT (physical therapy) has been here to work Mike's hands and fingers.. His left hand was pretty tender so he got a little more pain meds so they could be a little more aggressive. Tom also thought maybe the inner cannula on the trach tube may be a little long and, consequently, irritating the trachea and causing the terrible coughing spells. Dr. Cochran said she wold put a shorter one in. Also, they are going to use Presdex(sp?) to keep him relaxed after surgery.
The surgery to replace the grafts on his shoulders with auto-graft skin wnt well. There is only minimal dressings on them so it is imperative that he stay very still for 2-4 days. I hope we can keep himquiet for that long.
Saturday: Mike seems pretty calm. They have vaseline soaked gauze on his face to help debride some of the scabs and stuff from his face. Luke said he planned to keep it up most of the day to see if he can get his face cleaned up. They are using antibiotic ointment also.
more later, mom
PM report: Mike spent a pretty uneventful day. Has been on T-piece all day with O2 sats in the high 90's. He sometimes forgets to keep his hands still so Luke put loose restraints on them so he can't raise them too high. He's doing well today.
Sunday /9/20/09: (mom report)
Report is that Mike spent a very restless night. Maybe it's because he had such a long nap in the afternoon. He wasn't too bad when I got here a little after 9am. Kristy is his nurse. He trusts her and likes her, but she has a nurse intern with her and she agitates Mike. She couldn't make the feeding tube work when she went to give him some meds and she pulled on he tube. I don't think she was aware that she did it.. Anyway, that elicited a strong SOB!!! No mistaking that. After that, he got a wild look in his eyes every time she came near him. He wanted someone else to help him. I got Jesse to help a few times when Kristy was busy. One time he got so agitated he coughed the trach tube loose. His O2 sats went way down and he panicked even though he had 3 nurses right there.
He still gets frustrated when I can't read his lips. Sometimes he forgets where he is and what's going on. I plan to go to Idaho tonight to see if I can get a few things organized. I hope he gets someone he trusts to take care of him tomorrow.
He has been on the T-peice all day, and they were talking of getting him up in a chair this afternoon. I'm not happy about his eyes. At first, only the right eye (lower lid) was pulling down. Now, both lower eyelids have pulled down. Kristy said that usually the "pulldown" is one of the last things they worry about. They are still working to get his face cleared up. I guess it's the up and down thing. I wish there were some more ups. And that is non the UPS shipping I'm talking about.
It will be good to get a good medical report when JaCee gets back. I miss that!
take care,
Bette, AKA MOM
Tuesday:
And so, with "no pressure" to give a "good medical report", we go...
I talked with Karen early this morning for the night report on how Michael is doing. She said he's been on the T-piece for more than two days. The plan is to downsize the trach from an 8 to a 6 (the size of the radius of the tube) and then place a Passymuir valve there. That is a valve that can be covered up to allow Mike to breathe normally but still allow suction access and be there in case he gets in trouble and needs to have extra help breathing. The back up safety valve, as it were. The arterial line was discontinued last week sometime and they also discontinued the Central line to a Picc line. The translation for that is that a Picc line is more for long term venous access and is less likely to cause infection. It usually is inserted in one of the arms and there is a long tube that travels up and into the superior vena cava that goes into the heart and circulation system.
Karen said Mike was awake and interactive last night and she can generally get the "gist" of what he's saying. They are weaning his fentanyl (IV pain med) and using oxycodone every 3 to 3 1/2 hours with good results. He has been getting pretty good at repositioning himself. His labs look good. The white blood count is great at 7.4 and his sodium is finally not bad at 140. I was happy to hear his kidney function tests; BUN 13, creatinine 1.23. Much better than before.
The plan today is to get speech therapy to come in to do a swallow evaluation. Good swallowing equals weaning of the feeding tube and moving towards Mike's first drink of water and then food. It has been a very long time since he had a drink, and I am not talking Beer here! We can barely go a few hours without anything to drink, taking it for granted. Just think of how good it will feel for Mike to take his first sip of water. I am very excited to hear how it goes.
You may be wondering where I was that I couldn't blog on Mike. Randy and I took Willow (Mike's niece) to Mexico up in the mountains to be with the Indians there to pray and celebrate her graduation from a ceremony for children and the harvest/fall time. We went without food or water for what seemed eternity and it really reminded me of what Mike must be going through. At least we knew that, at the end of the ceremony, we could drink water and eat, but it was small compared to what Mike has endured. We prayed for Mike and the family there. We realize that we take so many things for granted here and it was a very humbling and life changing experience. Thank you all for your patience while we were away. It was one of the ways I know to help Mike, through prayer. It is good to be back where there is running water, showers, a bed to sleep in, showers, and a house that has a door on it and real windows...did I mention showers? We are thankful every day for our lives and that Mike is alive. (sorry for getting a bit sappy there)
We are now up to speed. Let the blogging continue!
More later,
and so we go
JaCee
Thursday, September 17, 2009
Thursday evening:
Tom says that Mike was off the fentanyl and propofol today and has done really well. His homografts have been doing well and he is scheduled for surgery tomorrow. He will be down for a few days when that happens. There may have to be a "release" on his right eye because the graft on the right goes on his cheek and up over his nose and his eyelid is drooping. They put ointment in his eyes to keep them moist. He was in the T-peice for about 7 hours. He then gave him some support on the vent. He was watching TV today. They took off his immobile splint on his right hand and he can wiggle his fingers. His left hand/fingers still have pins in them. He has swelling to his feet today. There is talk of ted hose but no action yet.
Mike is scheduled for surgery at noon (Bette says more like two).
well, we are off for a couple of days...back to blogging late on monday...I will get emails from Bette and post the daily update so we can all see what happened.... I will experience "longing" too.....
Oh, there was a request for the info for Potelco Credit Union for any donations for the family for travel and accomodations:
Potelco Credit Union
Account for Mike Lochridge
PO BOX 4909
Pocatello, ID 83205
More later,
and so we go
JaCee
Tom says that Mike was off the fentanyl and propofol today and has done really well. His homografts have been doing well and he is scheduled for surgery tomorrow. He will be down for a few days when that happens. There may have to be a "release" on his right eye because the graft on the right goes on his cheek and up over his nose and his eyelid is drooping. They put ointment in his eyes to keep them moist. He was in the T-peice for about 7 hours. He then gave him some support on the vent. He was watching TV today. They took off his immobile splint on his right hand and he can wiggle his fingers. His left hand/fingers still have pins in them. He has swelling to his feet today. There is talk of ted hose but no action yet.
Mike is scheduled for surgery at noon (Bette says more like two).
well, we are off for a couple of days...back to blogging late on monday...I will get emails from Bette and post the daily update so we can all see what happened.... I will experience "longing" too.....
Oh, there was a request for the info for Potelco Credit Union for any donations for the family for travel and accomodations:
Potelco Credit Union
Account for Mike Lochridge
PO BOX 4909
Pocatello, ID 83205
More later,
and so we go
JaCee
Thursday Mom report:
"Mike is doing sooo much better!"
For those of you with faint of heart, skip this part: He used the bedpan today! It is a huge step in the right direction.
Mike is starring in an educational video that Jesse and Jason were putting together to educate outlying hospitals on face burn wound care. Tom said Dr Morris is very pleased with the shoulder grafts. He thinks they might put autografts on in a few days.
Just wanted to share that little bit of info.
More later,
and so we go
JaCee
"Mike is doing sooo much better!"
For those of you with faint of heart, skip this part: He used the bedpan today! It is a huge step in the right direction.
Mike is starring in an educational video that Jesse and Jason were putting together to educate outlying hospitals on face burn wound care. Tom said Dr Morris is very pleased with the shoulder grafts. He thinks they might put autografts on in a few days.
Just wanted to share that little bit of info.
More later,
and so we go
JaCee
Thursday 09/17/09
Candy was the nurse again for Mike. She had just given him a sedation vacation when I talked with her (around 5:45am Utah time) She said we was very alert and wanted his wallet and a beer. She told him she was only able to give him nutrition through a tube right now. He was on the vent last night to give his lungs a break because he was on the T-piece for quite awhile yesterday. She said he slept well for about 5 hours and then woke up and that's when he got his "vacation". I really like hearing that nothing eventful happened and everything is status quo.
Candy said that the night crew got a lovely surprise of Chocolate! Thanks Diana!!! They were very happy about that.
Thank you to everyone who is following this blog. There will be a report this evening and then a small break while we go out of town for a "thing" and we will be back to blogging on Monday around midnight upon our return. I tried to get Bette to take over while I am away, but she said she's doing good to send an email. I won't be within phone or email contact so please bear with us...or feel free to post comments....maybe that will work? Let me know what you all think....
More later,
and so we go
JaCee
Candy was the nurse again for Mike. She had just given him a sedation vacation when I talked with her (around 5:45am Utah time) She said we was very alert and wanted his wallet and a beer. She told him she was only able to give him nutrition through a tube right now. He was on the vent last night to give his lungs a break because he was on the T-piece for quite awhile yesterday. She said he slept well for about 5 hours and then woke up and that's when he got his "vacation". I really like hearing that nothing eventful happened and everything is status quo.
Candy said that the night crew got a lovely surprise of Chocolate! Thanks Diana!!! They were very happy about that.
Thank you to everyone who is following this blog. There will be a report this evening and then a small break while we go out of town for a "thing" and we will be back to blogging on Monday around midnight upon our return. I tried to get Bette to take over while I am away, but she said she's doing good to send an email. I won't be within phone or email contact so please bear with us...or feel free to post comments....maybe that will work? Let me know what you all think....
More later,
and so we go
JaCee
Wednesday, September 16, 2009
Wednesday evening:
Sarah said that Mike had a good day. He was on the T-piece without any ventilator support since 3pm. I spoke with her at about 6:45pm (right before shift change). She said he is more awake and alert and easily opens his eyes when addressed. She said that the mouthing words game is going pretty well. She started to see a little bit of his personality peeking through. She had to remind him to hold his arms still for a couple of more days. She said they did a video on face wound care today as an education piece. I'm not exactly sure what that means... it sounded like it was for family who would be involved in his care (an instructional video, I think) Anyway, it would be good to see, eh? I will try to find out more about it.
Sarah said Michael has definitely moved out of the "critically stable" condition. She sounded hopeful that, if he can keep breathing on his own, they can wean him from the vent and oxygen support, move to a nasal cannula (that tube that you see on TV that goes under the nose) and get him up and moving. Then the physical therapists get to really get going on him. Okay, that's all for now. Thank you for tuning in and praying for Mike. I know the prayers are making a difference.
More later,
and so we go
JaCee
Sarah said that Mike had a good day. He was on the T-piece without any ventilator support since 3pm. I spoke with her at about 6:45pm (right before shift change). She said he is more awake and alert and easily opens his eyes when addressed. She said that the mouthing words game is going pretty well. She started to see a little bit of his personality peeking through. She had to remind him to hold his arms still for a couple of more days. She said they did a video on face wound care today as an education piece. I'm not exactly sure what that means... it sounded like it was for family who would be involved in his care (an instructional video, I think) Anyway, it would be good to see, eh? I will try to find out more about it.
Sarah said Michael has definitely moved out of the "critically stable" condition. She sounded hopeful that, if he can keep breathing on his own, they can wean him from the vent and oxygen support, move to a nasal cannula (that tube that you see on TV that goes under the nose) and get him up and moving. Then the physical therapists get to really get going on him. Okay, that's all for now. Thank you for tuning in and praying for Mike. I know the prayers are making a difference.
More later,
and so we go
JaCee
Wednesday 09/16/09
Candy was the nurse tonight and said that Mike was sleepy but alert. The plan is to decrease sedation and increase alertness. Mike's vitals are stable,Yay!, and his sodium is within normal limits...double yay! Candy changed all of the vent tubing and IV lines, as well as aggressive cleaning. Mike is on a T-piece with pressure support ventilations. He has biograin (a white clear,porous, plastic "lycra" type material) which is able to be washed and cleaned and dried without difficulty, stapled over his graft sites. His blood pressures are in the 130's (good) and there is not too much skin breakdown on the backside, due to the repositioning schedule that they have.
He's moving into the "strong" category (for the extent of his injuries). He will probably have some more minor surgeries, but they can't wait for the physical therapy to get in there and really get moving!
More later,
and so we go
JaCee
Candy was the nurse tonight and said that Mike was sleepy but alert. The plan is to decrease sedation and increase alertness. Mike's vitals are stable,Yay!, and his sodium is within normal limits...double yay! Candy changed all of the vent tubing and IV lines, as well as aggressive cleaning. Mike is on a T-piece with pressure support ventilations. He has biograin (a white clear,porous, plastic "lycra" type material) which is able to be washed and cleaned and dried without difficulty, stapled over his graft sites. His blood pressures are in the 130's (good) and there is not too much skin breakdown on the backside, due to the repositioning schedule that they have.
He's moving into the "strong" category (for the extent of his injuries). He will probably have some more minor surgeries, but they can't wait for the physical therapy to get in there and really get moving!
More later,
and so we go
JaCee
Tuesday, September 15, 2009
Tuesday afternoon/eve:
Bette said that the surgery went well. Mike was awake for awhile afterwards. It was touching to talk to her this morning because she said she went there to see Mike before surgery and he mouthed the words "I love you" to her and gave kisses (I'm crying now). She said that his homografts were stapled on and there were snug bandages over. She said he was sleepy and slept quite a bit. He seemed itchy and tried really hard to reach a leg, lifting it up while reaching down. The nurse gave him some benadryl (ah, better living through chemistry!) and that seemed to help. Mike fell asleep again and Bette stayed for an extra hour and a half this evening before finally retiring. One more surgery down... how many more to go????
More later,
and so we go
JaCee
Bette said that the surgery went well. Mike was awake for awhile afterwards. It was touching to talk to her this morning because she said she went there to see Mike before surgery and he mouthed the words "I love you" to her and gave kisses (I'm crying now). She said that his homografts were stapled on and there were snug bandages over. She said he was sleepy and slept quite a bit. He seemed itchy and tried really hard to reach a leg, lifting it up while reaching down. The nurse gave him some benadryl (ah, better living through chemistry!) and that seemed to help. Mike fell asleep again and Bette stayed for an extra hour and a half this evening before finally retiring. One more surgery down... how many more to go????
More later,
and so we go
JaCee
Tuesday 09/15/09
Talked to Karen, who took care of Mike all night. She said that he's had an uneventful night. His white count is better, now 9, down from 13-ish. He is on Levaquin (antibiotic) and he has not been febrile (feverish) all night.
Yesterday, before shift change, Mike has a hypotensive event. Evidently, they were changing linens and they might have knocked something loose (some of those nasty bacterial critters having a party under one of his shoulders or head, no doubt) They think he had a bacterial storm and his blood pressure plummeted to a mean of 30-40's. Okay, that's the number that is supposed to be the top blood pressure, usually around 100-ish. Suffice it to say.. not good. Karen said is lasted for about 30 minutes. She also said that Dr. Morris said as long as he didn't have any more events, it was okay. (the sure sign of someone with experience...not getting excited about blood pressure events) Karen stopped Mike's propofol all night, which can contribute to lower blood pressures, and kept him comfortable with fentanyl and benadryl. His blood pressures are keeping stable at around 110 (that's more like it!). Oh yeah, keep Mike in your prayers this morning because he's going back to surgery and it sounds like it's not uncommon for patients to have bacterial storm events when they are messing around with bacteria laden areas. They are going to clean the areas and put homografts on to promote healing. Usually, you can get five to seven days of healing out of a homograft. So that means that he will have to go back to surgery in another 5-7 days.... and so we go again..... up, down, up, down, up.....
More later,
and so we go
JaCee
Talked to Karen, who took care of Mike all night. She said that he's had an uneventful night. His white count is better, now 9, down from 13-ish. He is on Levaquin (antibiotic) and he has not been febrile (feverish) all night.
Yesterday, before shift change, Mike has a hypotensive event. Evidently, they were changing linens and they might have knocked something loose (some of those nasty bacterial critters having a party under one of his shoulders or head, no doubt) They think he had a bacterial storm and his blood pressure plummeted to a mean of 30-40's. Okay, that's the number that is supposed to be the top blood pressure, usually around 100-ish. Suffice it to say.. not good. Karen said is lasted for about 30 minutes. She also said that Dr. Morris said as long as he didn't have any more events, it was okay. (the sure sign of someone with experience...not getting excited about blood pressure events) Karen stopped Mike's propofol all night, which can contribute to lower blood pressures, and kept him comfortable with fentanyl and benadryl. His blood pressures are keeping stable at around 110 (that's more like it!). Oh yeah, keep Mike in your prayers this morning because he's going back to surgery and it sounds like it's not uncommon for patients to have bacterial storm events when they are messing around with bacteria laden areas. They are going to clean the areas and put homografts on to promote healing. Usually, you can get five to seven days of healing out of a homograft. So that means that he will have to go back to surgery in another 5-7 days.... and so we go again..... up, down, up, down, up.....
More later,
and so we go
JaCee
Monday, September 14, 2009
Monday afternoon:
The Mom report:
Bette was with Mike all day (as almost every day) and she said he was really awake this morning. He kept forgetting to keep still and tried to move his arms around so the nurses finally sandwiched his arms between pillows and strapped them together so he couldn't damage his face. It's back to the OR tomorrow. Bette seems frustrated, and rightfully so, that he just starts to wake up and then it's back to surgery and sedation for another week. Roller coaster, remember? It's too bad Martin and Brenda (Mike's friends) weren't there today when he was awake. So if anyone visits Mike and plan to stay a day or two, check with Bette to see his status and to see if you should come back, kay?
One of the pins in the fingers is too deep so they will pull it out a bit tomorrow. They will probably do homografts on his shoulders. Temporary grafts to promote healing. They found a source for infection! yay! It's a urinary tract infection, so now they can treat it.
Bette says Mike says he's not in pain. He slept for about 3 hours in the afternoon. It's tough between wanting him to be sedated or awake and communicating. So let's just wish him pain free and infection free healing.
More later,
and so we go
JaCee
The Mom report:
Bette was with Mike all day (as almost every day) and she said he was really awake this morning. He kept forgetting to keep still and tried to move his arms around so the nurses finally sandwiched his arms between pillows and strapped them together so he couldn't damage his face. It's back to the OR tomorrow. Bette seems frustrated, and rightfully so, that he just starts to wake up and then it's back to surgery and sedation for another week. Roller coaster, remember? It's too bad Martin and Brenda (Mike's friends) weren't there today when he was awake. So if anyone visits Mike and plan to stay a day or two, check with Bette to see his status and to see if you should come back, kay?
One of the pins in the fingers is too deep so they will pull it out a bit tomorrow. They will probably do homografts on his shoulders. Temporary grafts to promote healing. They found a source for infection! yay! It's a urinary tract infection, so now they can treat it.
Bette says Mike says he's not in pain. He slept for about 3 hours in the afternoon. It's tough between wanting him to be sedated or awake and communicating. So let's just wish him pain free and infection free healing.
More later,
and so we go
JaCee
Monday 09/14/09:
Karen was the nurse tonight and brought me up to speed over the past 24 hours. Mike has been running a fever and they are trying to find a source. They will look at the arterial line and maybe change it. There were some issues with blood pressure and so they decreased the propofol, which can lower blood pressure. The result is that the blood pressure stabilized (80's/40's) and Mike is a little more awake. The good thing about him being more alert is that he is able to cough. Coughing means he can clear all of the junk that's been deep in the lungs while he's been sedated. There is still elevation of the sodium level. He has had a slow litre of fluid(D-50) to try to decrease it. The level is still 151 (down only 2 from yesterday). He has a scattered rash that appears like yeast on his neck, back flanks and head. They are treating it with keeping the areas clean and dry and topical nystatin right now. His blood gases are good. His white count is 13.2 and his hematocrit is low-is at 23.
One of the nurses said this was going to be a roller coaster ride. Ups and downs with burn patients. They might not do surgery on Tuesday until they find the source of the fever. (then they can "fix" it)
More later,
and so we go
JaCee
Karen was the nurse tonight and brought me up to speed over the past 24 hours. Mike has been running a fever and they are trying to find a source. They will look at the arterial line and maybe change it. There were some issues with blood pressure and so they decreased the propofol, which can lower blood pressure. The result is that the blood pressure stabilized (80's/40's) and Mike is a little more awake. The good thing about him being more alert is that he is able to cough. Coughing means he can clear all of the junk that's been deep in the lungs while he's been sedated. There is still elevation of the sodium level. He has had a slow litre of fluid(D-50) to try to decrease it. The level is still 151 (down only 2 from yesterday). He has a scattered rash that appears like yeast on his neck, back flanks and head. They are treating it with keeping the areas clean and dry and topical nystatin right now. His blood gases are good. His white count is 13.2 and his hematocrit is low-is at 23.
One of the nurses said this was going to be a roller coaster ride. Ups and downs with burn patients. They might not do surgery on Tuesday until they find the source of the fever. (then they can "fix" it)
More later,
and so we go
JaCee
Sunday, September 13, 2009
Sunday afternoon:
Mike had visitors today. Martin and Brenda came down form Pocatello to see Mike. Bette thinks that Mike recognized their voices because he opened his eyes really wide. He has a fever. Around 102 or so. Haven't been able to figure out a source. They did blood cultures this afternoon around 5pm. His back has some little blisters that looked yeast-y. His feet are not nearly as swollen as before. they put isotoner gloves on his hands. He has a lot of secretions from his vent.
He is still sedated, but opened his eyes a couple if times today. He was a little restless and was swinging his arms around. The left arm doesn't track too well to his face. They had a time dodging his arms and finally put a bungee (bungie, bungy ???) cord on his arm so it wouldn't be able to get close to his face. His fingernails are black. Bette says the nurse said he would probably lose them but they will grow back. Bette sounded tired tonight.
Thank you for your continued prayers.
More later,
and so we go
JaCee
Mike had visitors today. Martin and Brenda came down form Pocatello to see Mike. Bette thinks that Mike recognized their voices because he opened his eyes really wide. He has a fever. Around 102 or so. Haven't been able to figure out a source. They did blood cultures this afternoon around 5pm. His back has some little blisters that looked yeast-y. His feet are not nearly as swollen as before. they put isotoner gloves on his hands. He has a lot of secretions from his vent.
He is still sedated, but opened his eyes a couple if times today. He was a little restless and was swinging his arms around. The left arm doesn't track too well to his face. They had a time dodging his arms and finally put a bungee (bungie, bungy ???) cord on his arm so it wouldn't be able to get close to his face. His fingernails are black. Bette says the nurse said he would probably lose them but they will grow back. Bette sounded tired tonight.
Thank you for your continued prayers.
More later,
and so we go
JaCee
Sunday 09/13/09
Karen was the night nurse. She has kept Mike sedated again without a sedation holiday. They changed Mike's central line yesterday afternoon to see if that will make an improvement in his fever. His urine and sputum cultures didn't show a definite infection so it looks like they will wait to treat for awhile. There was a slight improvement in his white count. Down to 12.41 from 13.71 yesterday. Bette says that the back of Mike's head looks like bad MRSA and the doctor will probably do a homograft on the back of his head to see if that will promote healing. That means surgery on Tuesday or Thursday of this week. That is all the information I have today.
More later,
and so we go
JaCee
Karen was the night nurse. She has kept Mike sedated again without a sedation holiday. They changed Mike's central line yesterday afternoon to see if that will make an improvement in his fever. His urine and sputum cultures didn't show a definite infection so it looks like they will wait to treat for awhile. There was a slight improvement in his white count. Down to 12.41 from 13.71 yesterday. Bette says that the back of Mike's head looks like bad MRSA and the doctor will probably do a homograft on the back of his head to see if that will promote healing. That means surgery on Tuesday or Thursday of this week. That is all the information I have today.
More later,
and so we go
JaCee
Saturday, September 12, 2009
Saturdy 09/12/09
Jason was the night nurse and said Mike was doing pretty good. It's funny that all of the ICU nurses say that. It is also good that they are still able to shed a positive light on things. Michael has a fever and his white count is elevated. (13.7, up from 10.3 yesterday) The grafts on the cheeks are still under scrutiny and they have kept Mike heavily sedated and did not do the sedation holiday due to the face grafts. There has been a lot of suctioning for the voluminous amount of secretions from Mike's lungs. The rest of his lab work is about the same, with slight improvement in electrolytes but his kidney function and glucose levels are pretty good.
So in short, he's pretty good...holding his own, status quo (for the extent of his injuries)
Jason can't wait for Mike to get better and see some of his personality peek through! ( I told him that Mike was a "talker")
Mom and Chris were with the inspectors yesterday. I guess there are beautiful hardwood floors in Mike's side. I put in my two cents worth and said they should use throw rugs and keep the hardwood. Didn't talk to Bette yesterday (oh yes I did, but she was in the middle of something) but I believe she's going back to Salt Lake today.
More later,
and so we go
JaCee
Jason was the night nurse and said Mike was doing pretty good. It's funny that all of the ICU nurses say that. It is also good that they are still able to shed a positive light on things. Michael has a fever and his white count is elevated. (13.7, up from 10.3 yesterday) The grafts on the cheeks are still under scrutiny and they have kept Mike heavily sedated and did not do the sedation holiday due to the face grafts. There has been a lot of suctioning for the voluminous amount of secretions from Mike's lungs. The rest of his lab work is about the same, with slight improvement in electrolytes but his kidney function and glucose levels are pretty good.
So in short, he's pretty good...holding his own, status quo (for the extent of his injuries)
Jason can't wait for Mike to get better and see some of his personality peek through! ( I told him that Mike was a "talker")
Mom and Chris were with the inspectors yesterday. I guess there are beautiful hardwood floors in Mike's side. I put in my two cents worth and said they should use throw rugs and keep the hardwood. Didn't talk to Bette yesterday (oh yes I did, but she was in the middle of something) but I believe she's going back to Salt Lake today.
More later,
and so we go
JaCee
Friday, September 11, 2009
Friday afternoon: 5pm Utah time:
Tom took care of Mike today and they have turned off the paralytic medicine but kept him heavily sedated today. When the paralytic wore off, he started coughing a lot and brought up some phlegm. They have sent it for culture. They also tested his urine, which was negative (yay). He is doing pretty good, according to Tom. The graft on his forehead looks good. The ones on his cheeks look questionable and so they are very fragile and only time will tell. That's one reason Mike is sedated so heavily. They don't want him moving too much and damaging the grafts. He is on pressure support ventilation. "He's holding his own" status quo....
More later,
and so we go
JaCee
Tom took care of Mike today and they have turned off the paralytic medicine but kept him heavily sedated today. When the paralytic wore off, he started coughing a lot and brought up some phlegm. They have sent it for culture. They also tested his urine, which was negative (yay). He is doing pretty good, according to Tom. The graft on his forehead looks good. The ones on his cheeks look questionable and so they are very fragile and only time will tell. That's one reason Mike is sedated so heavily. They don't want him moving too much and damaging the grafts. He is on pressure support ventilation. "He's holding his own" status quo....
More later,
and so we go
JaCee
Thursday, September 10, 2009
Thursday afternoon:
The "mom" report:
Aunt Edna went home yesterday.
Bette stayed until the dressing change at 2:30pm today..They got a bit of excitement when they were turning Mike to clean his back and change linens. His oxygen saturation went down to 69%. Bette says there was some quick scrambling by several people and they got it back fairly quickly. There was quite a bit of adrenalin for a couple of minutes. The grafts on his arms are coming along nicely. The back of his head and some on his shoulders still look pretty rough. His face grafts look good. The donor sites on his legs and thighs are healing well. His back is pretty well peeled. He has to stay on his back awhile longer until the face heals a bit more. He has thrush. (oral yeast infection).
While they are planning to have Mike in a continued sedated state tomorrow, Bette is heading to Idaho to check on things with the cleaning company and other stuff, like checking on cabinets for Mike's side of the house, etc. Chris is meeting with inspectors tomorrow and hopes to get started on the wiring. He is going to put the family to work: Karen, Steven (and his girlfriend) Thanks guys!
Just wanted to comment on Mike's condition. The day nurse, Sarah, said they had just loosened up a big mucus plug and he desaturated so they sucked him out. She said they had a little excitement but got him stabilized. His blood pressure was a little high. There are nor real other issues. They are paying attention to vitals. Urine output is great. They did a takedown on his arms. The left shoulder will most likely need regrafting. The biggest part is that his arms are healing As well. The face graft is too new to see what will happen. There are pins in the fingers, yes, right into the fingers...IN the bones.....Reminds me of a Bruce Lee film when the bad guys were torturing a person by putting bamboo skewers into the ends of someone's fingers....ouch (remember that Movie? was it the big boss? aagh...help!)
Okay, I guess the point that I try to remember is: You should never take anything for granted. Michael is alive. We are so thankful for that. Please keep praying for him. Thank you.
More later,
and so we go
JaCee
The "mom" report:
Aunt Edna went home yesterday.
Bette stayed until the dressing change at 2:30pm today..They got a bit of excitement when they were turning Mike to clean his back and change linens. His oxygen saturation went down to 69%. Bette says there was some quick scrambling by several people and they got it back fairly quickly. There was quite a bit of adrenalin for a couple of minutes. The grafts on his arms are coming along nicely. The back of his head and some on his shoulders still look pretty rough. His face grafts look good. The donor sites on his legs and thighs are healing well. His back is pretty well peeled. He has to stay on his back awhile longer until the face heals a bit more. He has thrush. (oral yeast infection).
While they are planning to have Mike in a continued sedated state tomorrow, Bette is heading to Idaho to check on things with the cleaning company and other stuff, like checking on cabinets for Mike's side of the house, etc. Chris is meeting with inspectors tomorrow and hopes to get started on the wiring. He is going to put the family to work: Karen, Steven (and his girlfriend) Thanks guys!
Just wanted to comment on Mike's condition. The day nurse, Sarah, said they had just loosened up a big mucus plug and he desaturated so they sucked him out. She said they had a little excitement but got him stabilized. His blood pressure was a little high. There are nor real other issues. They are paying attention to vitals. Urine output is great. They did a takedown on his arms. The left shoulder will most likely need regrafting. The biggest part is that his arms are healing As well. The face graft is too new to see what will happen. There are pins in the fingers, yes, right into the fingers...IN the bones.....Reminds me of a Bruce Lee film when the bad guys were torturing a person by putting bamboo skewers into the ends of someone's fingers....ouch (remember that Movie? was it the big boss? aagh...help!)
Okay, I guess the point that I try to remember is: You should never take anything for granted. Michael is alive. We are so thankful for that. Please keep praying for him. Thank you.
More later,
and so we go
JaCee
Thursday 09/10/09
Liz was the night nurse and said that Mike did pretty well. He is chemically paralyzed to protect the grafts. His white blood count is a little elevated 10.4 (up to 10 is normal) He has been gently repositioned every two hours to prevent bed sores. There is a new order in place to gently use a Q-tip to get the extra moisure and fluids from around the new graft sites. Some sites lood good and some are in a holding pattern. His lungs sound a little wet but suctioning has not helped that. okay....EMS is rolling in the door at work so I must go....
More later,
and so we go
JaCee
Liz was the night nurse and said that Mike did pretty well. He is chemically paralyzed to protect the grafts. His white blood count is a little elevated 10.4 (up to 10 is normal) He has been gently repositioned every two hours to prevent bed sores. There is a new order in place to gently use a Q-tip to get the extra moisure and fluids from around the new graft sites. Some sites lood good and some are in a holding pattern. His lungs sound a little wet but suctioning has not helped that. okay....EMS is rolling in the door at work so I must go....
More later,
and so we go
JaCee
Wednesday, September 9, 2009
Wednesday afternoon:
Okay, so the next couple of posts will, hopefully, be really boring.
Mike is on a paralytic right now so the grafts can have a chance. He's been trying to run a fever but hasn't succeeded yet. The graft on his forehead has pinked up but they are waiting on his cheeks. His vitals and labs have been stable. That's about all.
More later,
and so we go
JaCee
Okay, so the next couple of posts will, hopefully, be really boring.
Mike is on a paralytic right now so the grafts can have a chance. He's been trying to run a fever but hasn't succeeded yet. The graft on his forehead has pinked up but they are waiting on his cheeks. His vitals and labs have been stable. That's about all.
More later,
and so we go
JaCee
Wednesday 09/09/09
Mike has been paralyzed all night. Cheryl was the nurse tonight and said that his vitals are stable. He got two units of blood at surgery. He has been moved to a room that is closer to the nurses station so they can keep an eye on him. They plan to keep him still for a couple of days.
More later,
and so we go
JaCee
Mike has been paralyzed all night. Cheryl was the nurse tonight and said that his vitals are stable. He got two units of blood at surgery. He has been moved to a room that is closer to the nurses station so they can keep an eye on him. They plan to keep him still for a couple of days.
More later,
and so we go
JaCee
Tuesday, September 8, 2009
Tuesday evening:
Mike did well in surgery. His face looks good. They did some grafts on it from cheeks, nose forehead and up over the top of his head. He got pins in his left index, ring and pinkie fingers. They left his shoulders alone to see if they would shape up.
He will be sedated for a few days...maybe until Saturday.
Aunt Edna goes home tomorrow.
More later,
and so we go
JaCee
Mike did well in surgery. His face looks good. They did some grafts on it from cheeks, nose forehead and up over the top of his head. He got pins in his left index, ring and pinkie fingers. They left his shoulders alone to see if they would shape up.
He will be sedated for a few days...maybe until Saturday.
Aunt Edna goes home tomorrow.
More later,
and so we go
JaCee
Tuesday afternoon
Bette says that Mike is in surgery now. (2:30pm Utah time). She said he can move his right arm really well but is frustrated with the splints on his hands. He wasn't going to let the nurse do oral care but finally gave in and the nurse painted some nystatin in his mouth. He then thought it wasn't so bad and let her finish.
Mike wants a beer. Doesn't understand why he can't have one.
Apparantly, there are a couple more fingers that need to be pinned. Bette will give me an update this evening.
More later,
and so we go
JaCee
Bette says that Mike is in surgery now. (2:30pm Utah time). She said he can move his right arm really well but is frustrated with the splints on his hands. He wasn't going to let the nurse do oral care but finally gave in and the nurse painted some nystatin in his mouth. He then thought it wasn't so bad and let her finish.
Mike wants a beer. Doesn't understand why he can't have one.
Apparantly, there are a couple more fingers that need to be pinned. Bette will give me an update this evening.
More later,
and so we go
JaCee
Tuesday 09/08/09
Tom said Mike had a pretty good night. He is awake now. (5:30am SLC time) He was put back on the vent last night at about 11pm so he could get some more rest. The T-piece was on for about 7-8 hours yesterday. He coughs up quite a bit of phlegm with the T-peice and it usually ends up in his mouth, passing by the vent because he has a forceful cough. Tom said that Michael has been off the propofol since yesterday afternoon. (He's going to get back on it after surgery) He was doing pretty well with holding still but thinks he should be able to get up and move around normally. After Tom explained to him why he couldn't and reminded him where he was he calmed down and tried to relax. He still wanted to move, though. Every couple of hours he would forget, get restless, and Tom would explain things again and he would calm down.
His sodium has remained elevated, even with the water flushes. His urine output remains steady, but the kidney function values are creeping up. (they have been worse)
Michael is scheduled for surgery today. He is the third case so he won't go in until later this morning or early afternoon. They have a couple of units of blood ordered for him for the surgery.
So there have been at least three nurses that have commented on how nice of a family Mike has and how refreshing it is to see a caring family and a "functional" family. It is so important to have an advocate when one family member is ill or non-verbal. The nurses cannot be there all the time so it is wonderful that Bette is there throughout the day. When Michael is unable to clear the phlegm and needs to be suctioned, Bette is very good about asking for him. She is a positive and comforting person to have and I am so thankful that she is able to be there. Thanks to Aunt Edna, who has been tremendous support for Bette and Mike. She will be missed when she goes home this week. Thanks for the rest of our family that go down to see Mike.. Chris and Karen, Ted and Mary... we love you!
So much for my soap box ramblings...
Please think of Michael today for his surgery.
More later,
and so we go
JaCee
Tom said Mike had a pretty good night. He is awake now. (5:30am SLC time) He was put back on the vent last night at about 11pm so he could get some more rest. The T-piece was on for about 7-8 hours yesterday. He coughs up quite a bit of phlegm with the T-peice and it usually ends up in his mouth, passing by the vent because he has a forceful cough. Tom said that Michael has been off the propofol since yesterday afternoon. (He's going to get back on it after surgery) He was doing pretty well with holding still but thinks he should be able to get up and move around normally. After Tom explained to him why he couldn't and reminded him where he was he calmed down and tried to relax. He still wanted to move, though. Every couple of hours he would forget, get restless, and Tom would explain things again and he would calm down.
His sodium has remained elevated, even with the water flushes. His urine output remains steady, but the kidney function values are creeping up. (they have been worse)
Michael is scheduled for surgery today. He is the third case so he won't go in until later this morning or early afternoon. They have a couple of units of blood ordered for him for the surgery.
So there have been at least three nurses that have commented on how nice of a family Mike has and how refreshing it is to see a caring family and a "functional" family. It is so important to have an advocate when one family member is ill or non-verbal. The nurses cannot be there all the time so it is wonderful that Bette is there throughout the day. When Michael is unable to clear the phlegm and needs to be suctioned, Bette is very good about asking for him. She is a positive and comforting person to have and I am so thankful that she is able to be there. Thanks to Aunt Edna, who has been tremendous support for Bette and Mike. She will be missed when she goes home this week. Thanks for the rest of our family that go down to see Mike.. Chris and Karen, Ted and Mary... we love you!
So much for my soap box ramblings...
Please think of Michael today for his surgery.
More later,
and so we go
JaCee
Monday, September 7, 2009
Monday(LaborDay) 9/07/09
So I totally missed waking up to get report from the night crew. It was report time and then when I did call, the nurse was in with wound care ..."could you call back in 20 minutes?"... Then we did stuff that needed to be done and I went to work in the pediatric ED. When I did finally talk to Mary, she said that Michael had a restful day and he was pretty calm. Chris and Karen, Bette and Aunt Edna surrounded him most of the day. He was more alert with periods of being fidgety...waving his arms and legs about. His night last night was good and stable. They were mostly getting ready for tomorrow's surgery.
He spiked a fever today but they think it might be due to his homo graft. The doctor wants to wait until surgery tomorrow before getting fancy with cultures. The white blood count is not elevated so they are giving him Tylenol for his fever. There are a couple of areas on his shoulders that look MRSA-ish so the doctor (Dr. Morris) changed the way they did dressings to see if that will improve it. There is a problem with Michael's left index finger and something about the tendon being exposed. There will be an external pin placed to keep the finger extended. One thing you have to be really careful about on the hand is contractures. If a digit is allowed to stay bent, it could potentially scar that way and never be able to function or extend and flex normally. So it sounds like Mike has had a busy and good day. What with dressing changes, repositioning, physical therapy, doctor visits, family visits, repositioning, oral care...and whatever more we forget, he had a full day.
Remember Mike tomorrow as he goes back to surgery to remove the homo grafts, replacing them with auto grafts... and finger thing, and whatever more grafting needs to happen (shoulders?) Thank you for your prayers.
More later,
and so we go
JaCee
So I totally missed waking up to get report from the night crew. It was report time and then when I did call, the nurse was in with wound care ..."could you call back in 20 minutes?"... Then we did stuff that needed to be done and I went to work in the pediatric ED. When I did finally talk to Mary, she said that Michael had a restful day and he was pretty calm. Chris and Karen, Bette and Aunt Edna surrounded him most of the day. He was more alert with periods of being fidgety...waving his arms and legs about. His night last night was good and stable. They were mostly getting ready for tomorrow's surgery.
He spiked a fever today but they think it might be due to his homo graft. The doctor wants to wait until surgery tomorrow before getting fancy with cultures. The white blood count is not elevated so they are giving him Tylenol for his fever. There are a couple of areas on his shoulders that look MRSA-ish so the doctor (Dr. Morris) changed the way they did dressings to see if that will improve it. There is a problem with Michael's left index finger and something about the tendon being exposed. There will be an external pin placed to keep the finger extended. One thing you have to be really careful about on the hand is contractures. If a digit is allowed to stay bent, it could potentially scar that way and never be able to function or extend and flex normally. So it sounds like Mike has had a busy and good day. What with dressing changes, repositioning, physical therapy, doctor visits, family visits, repositioning, oral care...and whatever more we forget, he had a full day.
Remember Mike tomorrow as he goes back to surgery to remove the homo grafts, replacing them with auto grafts... and finger thing, and whatever more grafting needs to happen (shoulders?) Thank you for your prayers.
More later,
and so we go
JaCee
Sunday, September 6, 2009
Sunday afternoon:
Jesse says that Mike has had one of the best days since he's been here. He has been on less propofol and fentanyl and has been more awake. There are a couple of spots on his shoulders that have potential for infection and they are trying to keep on top of that. His arms look really good. The back of his head will take awhile because of the pressure of his head.
Mike has had some water and IV fluids to help bring down the sodium and potassium levels down. Bette and Aunt Edna were there all day again. (Jesse said it was nice to see "normal family members" with a patient....oh, how I could comment based on ER experience, but he is right. It is so refreshing to see "normal" people and realize that there are good people out there!)
I hope you all have a good and SAFE holiday.
More later,
and so we go
JaCee
Jesse says that Mike has had one of the best days since he's been here. He has been on less propofol and fentanyl and has been more awake. There are a couple of spots on his shoulders that have potential for infection and they are trying to keep on top of that. His arms look really good. The back of his head will take awhile because of the pressure of his head.
Mike has had some water and IV fluids to help bring down the sodium and potassium levels down. Bette and Aunt Edna were there all day again. (Jesse said it was nice to see "normal family members" with a patient....oh, how I could comment based on ER experience, but he is right. It is so refreshing to see "normal" people and realize that there are good people out there!)
I hope you all have a good and SAFE holiday.
More later,
and so we go
JaCee
Sunday 09/06/09
I was surprised to talk to Tom, who works days, this morning. He will be working for the next 3 night. He said that Mike was moving around a lot. Bette said that he had quite a time with moving about yesterday. She said he would wave his arms around and his legs would come off the bed and he just wouldn't settle down. Tom finally figured out that Mike was itchy, not in pain. So after a little benadryl, he calmed down. The last four hours have been better and a lot of it was due to the patience of the nursing staff in trying to effectively communicate with Mike. One thing that he is not happy about is that they won't give him a drink of water. Bette says that with all the junk he's coughing up, it is hard to get it out. When they use the pink sponges for oral care, Mike grabs onto it with his teeth and sucks out the moisture.
Bette went to lunch with Aunt Edna at the hospital cafeteria and got a phone call. It was Uncle Ted and Mary on the other side of the cafeteria calling her. They went up to see Mike for a little while and Ted said he looked really good. Ted was there the day after Mike first got to the hospital. Thank God for family and friends.
His blood work is shaping up, except for the sodium, chloride, and potassium levels. The kidney function labs are much better and his urine output is great. His oxygenation is pretty good. It sounds like they are working on a lot of areas. One spot that they have figured out that bothers Mike is his back. The donor spots on the back can be painful and don't heal as well because the donor sites are difficult to dry out and they get macerated (mushy) even with frequent dressing changes.
When they get him comfortable, and pressure supported vent settings, blood work shaping up, ....... then they will send him back to surgery on Tuesday. The process sounds like a dog chasing his tail to me. Once they get things shaping up, back to surgery, back to paralytics, back to vent settings being raised, back to no water, (did I mention he hates that part?) oh yeah, he hasn't had a drink of water for three weeks. They are giving him water through his tube now to help with the electrolyte imbalance. (NOT the same thing!) So the next time you get a drink of water, be sure to think of Mike at least once, waiting for his first drink.
More later,
and so we go
JaCee
I was surprised to talk to Tom, who works days, this morning. He will be working for the next 3 night. He said that Mike was moving around a lot. Bette said that he had quite a time with moving about yesterday. She said he would wave his arms around and his legs would come off the bed and he just wouldn't settle down. Tom finally figured out that Mike was itchy, not in pain. So after a little benadryl, he calmed down. The last four hours have been better and a lot of it was due to the patience of the nursing staff in trying to effectively communicate with Mike. One thing that he is not happy about is that they won't give him a drink of water. Bette says that with all the junk he's coughing up, it is hard to get it out. When they use the pink sponges for oral care, Mike grabs onto it with his teeth and sucks out the moisture.
Bette went to lunch with Aunt Edna at the hospital cafeteria and got a phone call. It was Uncle Ted and Mary on the other side of the cafeteria calling her. They went up to see Mike for a little while and Ted said he looked really good. Ted was there the day after Mike first got to the hospital. Thank God for family and friends.
His blood work is shaping up, except for the sodium, chloride, and potassium levels. The kidney function labs are much better and his urine output is great. His oxygenation is pretty good. It sounds like they are working on a lot of areas. One spot that they have figured out that bothers Mike is his back. The donor spots on the back can be painful and don't heal as well because the donor sites are difficult to dry out and they get macerated (mushy) even with frequent dressing changes.
When they get him comfortable, and pressure supported vent settings, blood work shaping up, ....... then they will send him back to surgery on Tuesday. The process sounds like a dog chasing his tail to me. Once they get things shaping up, back to surgery, back to paralytics, back to vent settings being raised, back to no water, (did I mention he hates that part?) oh yeah, he hasn't had a drink of water for three weeks. They are giving him water through his tube now to help with the electrolyte imbalance. (NOT the same thing!) So the next time you get a drink of water, be sure to think of Mike at least once, waiting for his first drink.
More later,
and so we go
JaCee
Saturday, September 5, 2009
Saturday 09/05/09
Ericka said that Mike was very "wiggly" all night and she had quite a time getting him to stay on the bed. His vitals are stable and it appears that we are in a holding, hurry up and heal, waiting....waiting... pattern.
There was no other report other than the night crew saw no signs of chocolate! (note to self: when sending food to a 24 hour nursing staff, make sure to label Day and Night staff, otherwise, the crew who gets the food delivered will scarf it up. They enter a me me me phase and the thought of saving it for anyone else totally exits their minds....we see it all the time in the emergency department. It is not their fault! They truly get amnesia and forget about everything for the brief moments when the chocolate is passing over their lips and they are in utter heaven. However, there is Total Respect and a Hands Off acceptance for a box of chocolates that is labeled for another shift. It's totally amazing. Don't ask why....I have stopped trying to figure it out after years of observing this odd behaviour!)
Okay...Holding pattern. Stable. Holding his own...status quo!
More later,
and so we go
JaCee
Ericka said that Mike was very "wiggly" all night and she had quite a time getting him to stay on the bed. His vitals are stable and it appears that we are in a holding, hurry up and heal, waiting....waiting... pattern.
There was no other report other than the night crew saw no signs of chocolate! (note to self: when sending food to a 24 hour nursing staff, make sure to label Day and Night staff, otherwise, the crew who gets the food delivered will scarf it up. They enter a me me me phase and the thought of saving it for anyone else totally exits their minds....we see it all the time in the emergency department. It is not their fault! They truly get amnesia and forget about everything for the brief moments when the chocolate is passing over their lips and they are in utter heaven. However, there is Total Respect and a Hands Off acceptance for a box of chocolates that is labeled for another shift. It's totally amazing. Don't ask why....I have stopped trying to figure it out after years of observing this odd behaviour!)
Okay...Holding pattern. Stable. Holding his own...status quo!
More later,
and so we go
JaCee
Friday, September 4, 2009
Friday afternoon/evening:
The paralytic didn't get turned off until this afternoon at about 4:10pm. Bette was told that it would wear off in about an hour and, sure enough, one hour later Mike started to wake up! He was answering yes/no questions and wanted a drink of water (he didn't get it due to the trach) He got a dose of vitamin K because he was oozing all over. Bette says that Mike has one little patch of red hair between the graft they did yesterday and the one from the week before. He might have some eyebrows and possibly some eyelashes. He has a bulky dressing on the back of his head so it protects the graft there. They had him sitting up a little today and he was able to cough up a lot of secretions.
The nurses got a lovely surprise from Diana in Texas! Godiva Chocolates!!! yummy! The nursing staff was totally happy! Thank you! Thank you thank you!!!!
The water to the house in Pocatello was turned off today because there was a leak. Chris has been so wonderful to watch over the demo and repairs. He thinks that some plumbing needs to be done and he will rewire and update the electrical system. It sounds like the insulation in the attic needs to be removed and replaced. He's also taking care of the garden and Gypsy, Bette's dog.
Bette was going to try to stay for shift change and meet the pm staff. She usually gets run off due to visiting hours. Hopefully she can put a face to the names. Here's wishing Michael a healing and peaceful evening.
More later,
and so we go
JaCee
The paralytic didn't get turned off until this afternoon at about 4:10pm. Bette was told that it would wear off in about an hour and, sure enough, one hour later Mike started to wake up! He was answering yes/no questions and wanted a drink of water (he didn't get it due to the trach) He got a dose of vitamin K because he was oozing all over. Bette says that Mike has one little patch of red hair between the graft they did yesterday and the one from the week before. He might have some eyebrows and possibly some eyelashes. He has a bulky dressing on the back of his head so it protects the graft there. They had him sitting up a little today and he was able to cough up a lot of secretions.
The nurses got a lovely surprise from Diana in Texas! Godiva Chocolates!!! yummy! The nursing staff was totally happy! Thank you! Thank you thank you!!!!
The water to the house in Pocatello was turned off today because there was a leak. Chris has been so wonderful to watch over the demo and repairs. He thinks that some plumbing needs to be done and he will rewire and update the electrical system. It sounds like the insulation in the attic needs to be removed and replaced. He's also taking care of the garden and Gypsy, Bette's dog.
Bette was going to try to stay for shift change and meet the pm staff. She usually gets run off due to visiting hours. Hopefully she can put a face to the names. Here's wishing Michael a healing and peaceful evening.
More later,
and so we go
JaCee
Friday 09/04/09
6am (5am SLC time)
Okay, it's my day off so I can "sleep in" but I find myself up and calling the Burn Unit.... what's up with that? Anyway, Ericka said that Mike has been paralyzed all night since his surgery because they didn't want him to move around after having grafts on the face. The payalyzing agent was turned off at 4:30am so he should start to wake up pretty soon.
The grafts they used were processed somewhere back East so they don't know who donated the graft. Thanks to the person who decided to be a donor. By the way, for those of you who are freaking out about having cadaver skin as a donor graft, don't freak. It is not going to be permanent. They use donor grafts as a temporary patch to help the blood vessels to be stimulated and to help lay a granulation foundation and to speed up the healing process. The patient will eventually reject the graft and usually the doctors will have used autografts (by the patient, for the patient) to replace the donor graft site by then. This takes usually days to about a week. Sometimes it takes a couple of rounds of donor grafts to prepare the tissue underneath to be ready to accept a permanent graft. (We are all learning about this. Pretty cool eh?)
Mike has been on the ventilator all night. Back up to 50% on the oxygen setting. They have been working with his oxygenation and blood pressure all night. Ericka says that overall "he's doing pretty good". In other words: He's holding his own...status quo (for the extent of his injuries)
More later,
and so we go
JaCee
6am (5am SLC time)
Okay, it's my day off so I can "sleep in" but I find myself up and calling the Burn Unit.... what's up with that? Anyway, Ericka said that Mike has been paralyzed all night since his surgery because they didn't want him to move around after having grafts on the face. The payalyzing agent was turned off at 4:30am so he should start to wake up pretty soon.
The grafts they used were processed somewhere back East so they don't know who donated the graft. Thanks to the person who decided to be a donor. By the way, for those of you who are freaking out about having cadaver skin as a donor graft, don't freak. It is not going to be permanent. They use donor grafts as a temporary patch to help the blood vessels to be stimulated and to help lay a granulation foundation and to speed up the healing process. The patient will eventually reject the graft and usually the doctors will have used autografts (by the patient, for the patient) to replace the donor graft site by then. This takes usually days to about a week. Sometimes it takes a couple of rounds of donor grafts to prepare the tissue underneath to be ready to accept a permanent graft. (We are all learning about this. Pretty cool eh?)
Mike has been on the ventilator all night. Back up to 50% on the oxygen setting. They have been working with his oxygenation and blood pressure all night. Ericka says that overall "he's doing pretty good". In other words: He's holding his own...status quo (for the extent of his injuries)
More later,
and so we go
JaCee
Thursday, September 3, 2009
Thursday afternoon:
the "mom" report:
They had to use homograph (cadaver) skin for his graft today. The face does look a lot better with the graft skin on. They did his cheeks and about 1/3 of his scalp. Bette doesn't think they are going to do much more on his head.
The paralytic had been changed so it is better for his kidneys. He looks fairly comfortable. He is getting fentanyl for pain. Bette says he is sensitive to it and it drops his blood pressure, so they are working towards a happy medium.
Michael has been moved from his original room with curtains to a room with walls and two windows. (the Luxury Accomodations) Bette is happy with the windows and walls because it will give Mike a great view when he wakes up. I do recall that the mountainside was very beautiful behind the hospital. I wonder if people still walk and jog there?
Aunt Edna is still there with Bette. I think it is good that she is not alone. Thank you!!!
Diana (our step-mom) has all of the Eastern Star ladies in Texas praying for Michael! Yay ESL! She sent us all a handout on critical incidents and how to cope with crisis and loss and it has been wonderful! Lots of prayers, worry and crying has all occurred...probably on a daily basis. I figured out what Mike must be saying when he is mouthing words....other than colorful exclamations...I would imagine that it has something to do with a tube in a place where no tubes should be (those of you who know Mike should be laughing now)...actually, I have no idea what he is thinking but it makes me feel better to think that he would think this at some point. ya think?
More later,
and so we go
JaCee
the "mom" report:
They had to use homograph (cadaver) skin for his graft today. The face does look a lot better with the graft skin on. They did his cheeks and about 1/3 of his scalp. Bette doesn't think they are going to do much more on his head.
The paralytic had been changed so it is better for his kidneys. He looks fairly comfortable. He is getting fentanyl for pain. Bette says he is sensitive to it and it drops his blood pressure, so they are working towards a happy medium.
Michael has been moved from his original room with curtains to a room with walls and two windows. (the Luxury Accomodations) Bette is happy with the windows and walls because it will give Mike a great view when he wakes up. I do recall that the mountainside was very beautiful behind the hospital. I wonder if people still walk and jog there?
Aunt Edna is still there with Bette. I think it is good that she is not alone. Thank you!!!
Diana (our step-mom) has all of the Eastern Star ladies in Texas praying for Michael! Yay ESL! She sent us all a handout on critical incidents and how to cope with crisis and loss and it has been wonderful! Lots of prayers, worry and crying has all occurred...probably on a daily basis. I figured out what Mike must be saying when he is mouthing words....other than colorful exclamations...I would imagine that it has something to do with a tube in a place where no tubes should be (those of you who know Mike should be laughing now)...actually, I have no idea what he is thinking but it makes me feel better to think that he would think this at some point. ya think?
More later,
and so we go
JaCee
Thursday 09/03/09
Spoke with Luke at about 6:30am (5:30am SLC time). He said that Mike has been on the vent all night to give him a rest. He is scheduled to go to surgery for his face today. They have finished his antibiotics and his white count is good. Labs are good. "He's good" Status quo, he's holding his own.....
Good prayers for surgery today please....
More later,
and so we go
JaCee
Spoke with Luke at about 6:30am (5:30am SLC time). He said that Mike has been on the vent all night to give him a rest. He is scheduled to go to surgery for his face today. They have finished his antibiotics and his white count is good. Labs are good. "He's good" Status quo, he's holding his own.....
Good prayers for surgery today please....
More later,
and so we go
JaCee
Wednesday, September 2, 2009
Wednesday afternoon:
Bette says that they had Mike on a T-piece earlier today but switched him to the vent after they did a lot of dressing changes. She isn't so good at figuring out what words Michael wants to say yet. She said the nurses wore him out with all of the stuff they did. If all continues well, Michael will go to surgery again on Friday to work on his face.
That's about all. Will be posting more as I get it.
More later,
and so we go
JaCee
Bette says that they had Mike on a T-piece earlier today but switched him to the vent after they did a lot of dressing changes. She isn't so good at figuring out what words Michael wants to say yet. She said the nurses wore him out with all of the stuff they did. If all continues well, Michael will go to surgery again on Friday to work on his face.
That's about all. Will be posting more as I get it.
More later,
and so we go
JaCee
Wednesday 09/02/09
Thane was the nurse tonight and said Mike is doing pretty good. They let him stay on the T-piece until about 10pm and switched him to the vent so he could rest during the night. His lung secretions have increased with the T-piece so they spent most of the shift suctioning. His labs have been about the same. His blood gases have been good and there is not much to report other than his communication is increasing. Go Mike!
There are no big plans for today. Trying the T-piece again, suctioning, wound care, antibiotics, wound care, suctioning....you get the picture.
Thank you to all who are praying for Michael. We appreciate it.....keep the prayers coming!!!!
More later,
and so we go
JaCee
Thane was the nurse tonight and said Mike is doing pretty good. They let him stay on the T-piece until about 10pm and switched him to the vent so he could rest during the night. His lung secretions have increased with the T-piece so they spent most of the shift suctioning. His labs have been about the same. His blood gases have been good and there is not much to report other than his communication is increasing. Go Mike!
There are no big plans for today. Trying the T-piece again, suctioning, wound care, antibiotics, wound care, suctioning....you get the picture.
Thank you to all who are praying for Michael. We appreciate it.....keep the prayers coming!!!!
More later,
and so we go
JaCee
Tuesday, September 1, 2009
Tuesday afternoon:
Talked with Hailey and she said they took off some of the bio grain dressing covering Mike's upper extremities. The right and left arm and right shoulder look good. The bio grain (don't know if it's hyphenated, all one word or what) is a type of mesh that covered the graft sites and keeps it moist, but must be removed after a few days. The left shoulder looked a bit mushy (macerated for the medical term).
Michael was taken off the vent today and placed on a T-piece about 4 or 5pm today. He is tolerating it well. That means that he has supplemental oxygen but all of the breathing is on his own now. YaY!!!!
He has had less sedation and increased interactive actions. They are still weaning sedation meds while adding oxycodone and seroquel. His last day of zosyn (antibiotic) is tomorrow, but they will continue vancomycin (antibiotic) for awhile. He's geting extra calcium and potassium due to some of the physiological things that happen with burned patients. They have been doing a lot of face care.
I did not talk to Bette today yet because her phone minutes are precious! I trust she is settling into her hospital housing room with the very uncomfortable beds now and turning off her brain enough to get some much needed rest.
Thank you all for your kind words and prayers. I guess Michael is on many many prayer lists... Everyone I know has him on their list here in Wichita and East coast and West coast and some Germans too! thanks ever so
More later,
and so we go
JaCee
Talked with Hailey and she said they took off some of the bio grain dressing covering Mike's upper extremities. The right and left arm and right shoulder look good. The bio grain (don't know if it's hyphenated, all one word or what) is a type of mesh that covered the graft sites and keeps it moist, but must be removed after a few days. The left shoulder looked a bit mushy (macerated for the medical term).
Michael was taken off the vent today and placed on a T-piece about 4 or 5pm today. He is tolerating it well. That means that he has supplemental oxygen but all of the breathing is on his own now. YaY!!!!
He has had less sedation and increased interactive actions. They are still weaning sedation meds while adding oxycodone and seroquel. His last day of zosyn (antibiotic) is tomorrow, but they will continue vancomycin (antibiotic) for awhile. He's geting extra calcium and potassium due to some of the physiological things that happen with burned patients. They have been doing a lot of face care.
I did not talk to Bette today yet because her phone minutes are precious! I trust she is settling into her hospital housing room with the very uncomfortable beds now and turning off her brain enough to get some much needed rest.
Thank you all for your kind words and prayers. I guess Michael is on many many prayer lists... Everyone I know has him on their list here in Wichita and East coast and West coast and some Germans too! thanks ever so
More later,
and so we go
JaCee
Tuesday 09/01/09
Thane, the night nurse, said he continued with the good work that Melanie has done on Mike's face. There was a lot of suctioning that happened and he is sill on 40% fiO2 for his pressure support and he seemed to do a lot of over-breathing last night. They tried to see if it was a response to pain but found that he continued over-breathing so they turned down the pressure a bit and that seemed to work. in other words, his breathing is getting stronger and he may not need the support of the ventilator much longer. The next step is to put a T piece on. That is a T shaped tube that is connected to the trach opening that blows by humidified oxygen so Mike can draw his own breath. Cool! Depending on how he does, he may only need ventilator support at night or if he gets tired. The humidified air will help to keep the lung secretions moist so they can suction and things don't get bogged down. After that, they will try to go down on the oxygen level until it is that of room air.... the next step is to put him on a nasal cannula and voila! no more trach! I may be jumping ahead but wanted you to know the upcoming steps to Michael's healing process.
The labs were done late due to suctioning but his blood gas is pretty stable. His blood sugars were 161, a little high, but that's to be expected with the high calorie nutrition formula needed for healing. The propofol is continuing to be weaned, along with the fentanyl. Oxycodone has been initiated as an oral pain medicine and it seems to keep him comfortable. (15 mg was the last dose) Mike is a lot more awake and can answer questions by nodding or shaking his head. He is mouthing words and the nurses are trying to figure out what he means so he can get his needs met.
There are three attending doctors that rotate through the burn trauma unit. Dr. Morris came onto the service as of yesterday.
That should bring you up to speed today.
More later,
and so we go
JaCee
Thane, the night nurse, said he continued with the good work that Melanie has done on Mike's face. There was a lot of suctioning that happened and he is sill on 40% fiO2 for his pressure support and he seemed to do a lot of over-breathing last night. They tried to see if it was a response to pain but found that he continued over-breathing so they turned down the pressure a bit and that seemed to work. in other words, his breathing is getting stronger and he may not need the support of the ventilator much longer. The next step is to put a T piece on. That is a T shaped tube that is connected to the trach opening that blows by humidified oxygen so Mike can draw his own breath. Cool! Depending on how he does, he may only need ventilator support at night or if he gets tired. The humidified air will help to keep the lung secretions moist so they can suction and things don't get bogged down. After that, they will try to go down on the oxygen level until it is that of room air.... the next step is to put him on a nasal cannula and voila! no more trach! I may be jumping ahead but wanted you to know the upcoming steps to Michael's healing process.
The labs were done late due to suctioning but his blood gas is pretty stable. His blood sugars were 161, a little high, but that's to be expected with the high calorie nutrition formula needed for healing. The propofol is continuing to be weaned, along with the fentanyl. Oxycodone has been initiated as an oral pain medicine and it seems to keep him comfortable. (15 mg was the last dose) Mike is a lot more awake and can answer questions by nodding or shaking his head. He is mouthing words and the nurses are trying to figure out what he means so he can get his needs met.
There are three attending doctors that rotate through the burn trauma unit. Dr. Morris came onto the service as of yesterday.
That should bring you up to speed today.
More later,
and so we go
JaCee
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