Posted (Tina) in All Posts on September-19-2007

Ella turned down the wrong path today.

If you read the last post (yes, that was me writing in pirate talk and not Josh, although he is wacky too), then you already know that her chest x-ray was not good this morning. Her chest tubes had drained only 38 ccs total (11 left and 27 right) plus she had a poor blood gas at 11:30am (cO2=70, pO2=66).

So around 2pm, Dr. Kays replaced her right chest tube, in the hopes of getting more fluid reduction. Her drop in stats and overall stability is all related to the accumulation of fluid in her chest cavity.

Since the chest tube replacement, there has only been a total of 13ccs (8 left and 5 right). This is not much and does not indicate forward progress.

We ran into Dr. Kays around 8pm. He noted that the right chest tube replacement earlier did not gain us much, so he is getting closer to ordering a CT scan to assess what is happening with the fluid in her chest. He thinks that her body might be building protective pockets around the chest tubes and preventing the fluid from draining.

The CT scan will show this type of detail. But, it is a big deal to get a CT scan completed because they have to transport her to another area of the hospital. This is the main reason that Dr. Kays has held off on ordering the CT scan – – it is a production.

He did mention that he is pleased with how she is handling the food and he does not see that it is increasing her fluids or contributing to the fluid issue. Also, he increased Lasix to 4x per day (this helps with her overall urine output).

Once Dr. Kays left, they ran a blood gas at 9pm. This proved that she is still accumulating fluid and not feeling well (cO2=79, pO2=79). He was paged with the information and gave verbal orders to increase the ventilation and take another blood gas in an hour.

When we first went to Ella’s bedside tonight, one thing we noticed: the socks had been removed from her hands. She does tend to pull on the lines, plus her nails are very long and she has been known to scratch her face. So we asked the nurse to make sure and place the socks back on her hands at some point.

We just called and her 10:15pm blood gas was about the same (cO2=71, pO2=69), not too much improvement. No other changes for tonight.

Although the nurse did mention that somehow Ella got ahold of the line in her neck and pulled the dressing away. That is a bit scary.

Dr. Kays has been talking about how he wants to remove that neck line because it has been there a long time and carries a high risk of infection (this is the same place on her neck where the cannulas were inserted for ECMO, so it has been there for 8 weeks).

As a precautionary measure, the nurse ordered a chest x-ray to make sure that the line is still intact and nothing else occurred. Those socks have been put back on her hands. Maybe a note will go down on her chart to ensure that those socks remain intact!

Our hearts are heavy tonight. We are feeling a bit weary. We know that God is with us, He is present with us, He is sovereign and in control, all in His timing. Yet, we are feeling a bit discouraged since we cannot seem to overcome this fluid issue.

Now that the chest tubes are not appearing to make much impact, Dr. Kays already hinted that we might need to consider surgical intervention.

Please continue to pray for Ella as well as wisdom for Dr. Kays. We want to see the chest fluid issue resolve. We really are not excited about the idea of having to surgically go into her chest to try and resolve this issue, when Dr. Kays is not confident that he can fix it on his first try.

Also, please pray for us as Ella’s parents. We certainly want to be open to what the Lord wants us to learn through this experience. We want to be obedient to Him. In other words, we don’t want to be road blocks. Please pray that we would hear His voice during this trying time.

Psalm 61:2
From the ends of the earth I call to you,
I call as my heart grows faint;
lead me to the rock that is higher than I.

Posted (Tina) in All Posts on September-19-2007

In case ye did nay know, today be International Talk Like a Pirate Day.

Ella be doin` well today. Th’ monkeys an’ bears be keepin` th’ lass’ company. An`eyeball that smile o’ hers!

Her last blood gas at 4am be cO2=67, pO2=73, nay quite as good. Nurse Michelle did mention that she be fussy near th’ time th’ blood gases be performed, so maybe that be part o’ th’ lower numbers.

Nurse Angie be takin’ care o’ th’ lass’ today. Th’ lass’ next blood gas be at 12 high tide (12 noon). Hopefully them numbers be better although Ella seems t’ be fussy well into this mornin’ too.

Aye, we guarantee ye, that Ella tends t’ be more fussy when she be less comfortable. So, we be nay sure if she be retainin’ more fluid or why she might be more uncomfortable.

Nurse Angie reported that th’ lass’ stomach looks a bit more distended today. This be most likely due t’ th’ increased amount o’ Portagen they started last high tide’ (up t’ a continuous flow o’ 2ccs per hour). They be watchin’ that closely t’ make sure she be processin’ th’ formula an’ nay havin’ any other issues related t’ th’ digestion.

Her total chest fluid output fer last high tide’ be 35 fer th’ starboard side (right side) an’ 38 fer th’ port side (left side), fer a total o’ 73. Since 7am, she has output 6 fer th’ starboard (right side) an’ 5 fer th’ port (left side), fer a total o’ 11ccs.

We be goin’ t’ assume that th’ lass’ chest x-ray looked good since Dr. Kays has nay gi’en any other orders. Stay tuned sea dogs an’ land lubbers!

UPDATE (1:20pm EST): The nurse practitioner just called and Ella`s blood gases at 12 noon were worse. She has continued to be fussy. Also, she confirmed that the chest x-ray doesn’t look as good as the one yesterday and that the chest tube fluid output has been minimal so far. Therefore, Dr. Kays is going to be replacing the right chest tube this afternoon.

This news is not surprising. When the nurses mentioned that Ella was more fussy and not recovering well throughout last night and all day today, we had the sense that this was because she was uncomfortable. This typically indicates a build-up from fluid in her chest. Now our inclination has been confirmed!

We ask that ye continue t’ pray fer our wee lass’!