A new week

One week has passed and now on to the next. Logan slept well last night, meaning his sedation was at a good level. He continued to have a fever but was controlled with tylenol. His chest xray this morning was really no better at all. The pulmonologist today (a new one as they change over Monday's) said he thinks that his xray is showing signs of having ARDS (acute respiratory distress syndrome) and that he does see bilateral pneumonia but it is not the typical pneumonia that consolidates into areas of the lungs. He sees inflammation and edema (excess fluid). They will continue to give him a medication called lasix which is a diuretic (makes him pee) in order to keep him on the dry side to keep any excess fluid out of his lungs.

He still requires pressure support ventilation. He does not do well when his chest is constricted by his vest. Today they put the vest on him and his oxygen saturation dropped. By wrapping his chest it restricted the air flow. The respiratory therapist increased his oxygen concentration and his numbers quickly improved. To me, that was an example of how fragile he is right now. Even the slightest change can make a difference. The doctors continue to say, "more of the same". Support, support, support. And above all, TIME! This is the hardest part, the waiting.

As I waited this late afternoon and evening Logan had some struggle with the ventilator. The pressure  and oxygen concentrations continued to be increased and his sedation and muscle relaxer doses increased. His breathing became more labored and his oxygen saturations required an increase in the oxygen concentration to stay above 90%. The intensivist is at his bedside placing an arterial line. This is like an IV that goes into his wrist that will measure many things including his arterial blood gases. Honestly, I am not sure where this is taking us but I know we are in good hands. Dr. M has some tricks up his sleeves with interventions but he needs the line in order to gather more data about Logan's ventilatory status. Again, support, support, support! I will do my best to update the blog in the morning as I am sure a few things may change. Like I said, he is in good hands!

On to another topic of our day...I know I have eluded in past blog posts the possibility of Logan having a tracheostomy (opening thru the neck to the trachea that would act as his airway). During this hospitalization there has been a lot of talk between the physicians, my husband, and I regarding this. I have not talked at length about this because it has always been a distant possibility in the past. Now, it is not so distant and is in fact on the table right now. We are weighing this heavily and talking to as many people as we can to get perspective on this.

A tracheostomy would most likely be the best way to protect his airway from aspiration which has continued to result in aspiration pneumonia's which land him in the hospital. He would be at risk for other things such as chronic bronchitis and other airway related infections. It would provide us a way to better clear and protect his airway especially during illness. Right now, we find that the second he gets a fever he become lethargic. He then stops coughing and stops protecting his airway. From there it goes and you know the rest...steroids, antibiotics, and maybe the hospital. We cannot keep on this rollercoaster and my fear is that one day again, similar to the circumstances that landed us here now, we will not be able to provide adequate emergency care.

Like I said, this weighs heavily on Joel and I and we do not take this decision lightly. After much discussion we have made a decision. We may have not told all close family and friends and some of you may read this asking why we didn't call. We can only do so much right now.

Joel and I have decided that a tracheostomy is in the best interest of Logan. We have weighed the pros and cons for many days and I could go on and on telling them to you but I will spare you. This is the hardest decision we have ever had to make for Logan but we feel it is the right one. Right now we ask for your support as this is a life altering decision. In the long run, the hope is that Logan will only require the trach, no ventilator and that is the goal for his discharge. Over time we will become more comfortable with the trach and we are being told that it will become part of our daily routine as all other changes have. It sounds big, bad, and scary. But as our ENT doctor said, at first it is like changing a dirty diaper for the first time and then you just get used to it. So we will, but we may need a little help getting through it!

This will change the course of our stay. As we sit now, the best estimate for him to recover from the virus is a week or so. Once he is tuned up and ready, he will go under anesthesia and have the trach placed and then be on a ventilator for about a week and in that time be weaned off to get ready to go home. As always, these are rough estimates but it helps us try to plan ahead.

So now that my brain is fried, I am going to end this blog post and pass on my thank you's tomorrow.