Tuesday, October 13, 2009

October 13, 2009

Today is Jesse's thrid day back at work. The original plan was to drop Kayla off at Grandma and Grandpa Aguilar's house in the morning and then head over to spend the day with Gabe. After looking out the window this morning at the pouring rain and trees bent over sideways from the wind, I decided to stay home with Kayla. As we lounged around the house in our pj's I was aware of a growing feeling of guilt for not visiting Gabe today, so...I packed Kayla up, dropped her off to play with Grandma and Grandpa and braved the crazy, stormy conditions to see my little boy. I'm really glad I decided to stick with my original plan becuase I got to see all three (Jesse, Kayla and Gabe) of my favorite people today. What a treat!

Last night was a good night for Gabe. He required only two PRN's, which is a huge improvement compared to the last two weeks, and other than some vent adjustments that had to be done early this morning, because he started to get tachypenic (very rapid breathing), it's my understanding that G and Nurse "B" had a pretty mellow evening. This morning his labs showed his K (potassium) levels were quite high, and that he was too dry intravascularly. I'm having a complete Mommy-Brain moment and can't remember why you don't want high levels of K, but you don't, so they jumped on trying to lower them right away. They stopped his TPN (nutrients) drip, becuase it contains potassium, and changed his vent settings to over ventillate him a bit to get the stuff out of his system. I think they did a few other things as well, but I just can't remember what they were. All of this was a success, and his K levels got lower through the day and as of 6pm tonight were back down in the normal range. As for being too dry intravascularly, they stopped one of his diuretics, changed the other to every twelve hours instead of every six, and went back to using FFP instead of Albumin (which they switched to yesterday). Hopefully all of these changes will help and Gabe won't be as dry tomorrow. They are purposely keeping G pretty darn dry intravascularly becuase studies show this helps with hydrops and chylous babies. If there isn't anything to leak out, then hopefully the edema will get better and the chylothorax will heal. Of course you can't keep someone completely "dry" intravascularly, so there is a fine line that has to be walked in this area and today his was just too far on the "dry" side. So are you completely confused now? You probably didn't need all of these details. All you really wanted to know was how Gabe's day was. It sounds crazy and hectic, but all it really came down too was a lot of tweaking to get his K levels and dryness under control, and Gabe was completely oblivious to it all. He spent most of this rainy day snoozing. I wish I could have climbed in bed with him for a little nap myself. I wonder if I would fit in his bed with him? I bet I could make it work. I wonder if anyone would notice???

Overall Gabe had a good day. He was awake for about an hour while I was there, and we spent that time chatting, holding hands and just hanging out. His Albumin levels are back up to 2.6 (want them to be at least 2.4), he was breathing well all day, didn't require any PRN's, hardly needed any suctioning (this is usually needed every 1-2 hours), and as of 4pm this afternoon only had 40 mls out of his chest tubes. We don't know what this means yet? Is he drying up or is the fluid hiding? On Sunday his tubes drained a little over 200 mls; on Monday he had around 130 that came out; and so far today, even after the tubes were checked for clots, has only had 40. They did go up on his Octreotide today to 10, so it is now at its highest dose. Is it starting to work??? I guess we'll just have to wait and see...

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