October 1, 2009 - Happy 3 Month Birthday

I wish I could say Gabe's 3 Month Birthday was a nice quite day, but unfortunately I cannot. Poor little Gabe did not have a very good day.

For the last three weeks Gabe has been pretty stable, and having many more good than bad days. Starting Tuesday afternoon, G started to show a few signs of instability. We weren't sure if he was just having a funky afternoon (quite often he is agitated in the afternoons. We call it his witching hour) or if something bigger was going on. When I arrived to see Gabe around 10am on Wednesday he was retracting (taking lots of quick shallow breaths) a lot, his respitory rate was high until late afternoon, he was requiring extra oxygen to keep his O2 sats where they usually are on room air, was desating more often (like he used too) and was taking longer to recover when he did desat. Gabe just wasn't himeslf although, other than his little desat episodes, all of his numbers looked pretty good. Today however was a whole different story.

When I arrived this morning, Gabe just didn't look as good as he ususally does. He was very squirmy, was requiring more oxygen then yesterday and his numbers were not very stable. He kept desatting and had trouble recovering without assistance. I also thought that it looked like Gabe was puffing a bit. His Albumin levels have been low so he has been receiving FFP (blood product) every six hours. This has been known to make him puff in the past. In rounds I learned that his Albumin was actually up since yesterday, although still low, so the FFP treatments would continue. I suggested chasing his FFP with Diurel (a diaretic). A concoction Dr. B found worked very well and kept G from puffing. Dr V said she would try this if he continued to puff (luckily, thus far he was not). His chest tubes hadn't put much of anything out and the morning x-ray looked a little hazy and did show a bit of fluid on his left side. In rounds we mostly discussed what could be causing G's bad day. Clogged chest tubes could be one thing; the hydracortizone wean could be part of it (in the past hydracortizone weans have brought his spiraling backwards); and there was one other factor they thought could be involved in his changes over the last couple of days but I am so fried from the craziness of today I can't remember what it was. They were able to get the chest tubes cleared out and pulled off 20 cc's from his right side; they stopped his hydracortizone wean and actually went up on his dose a bit; they went up on his vent settings; and he received some blood because his numbers were a little low there too. After all of these things were done he was doing a little bit better, but still not Gabe, and still not looking that great numbers wise. At this point I was starting to get really worried that there was something larger going on that we were missing. I stepped out for about 30 minutes to pump, and when I came back in Gabe was on his tummy, his numbers looked fabulous, he was barely requiring any extra oxygen and he was sound asleep. He was letting the vent do all of the work, but that was ok considering how hard Gabe has been working the last couple of days. What a relief to have Gabe back. Phew! What a day!

Thank you Nurse G for working so hard to help Gabe yesterday and today. Let's hope we never have another crazy diaper changing/desatting experience like we did today.

We can only hope that whatever caused Gabe to go backwards for the last 2-1/2 days has been fixed and we can start going forward again.

Thank you to all of our loved ones for your endless support over the last three months. We could not get through this without you.