Sunday, October 10, 2010

Jameson has had two great days! He had an abdominal drain placed to slowly draw some of the fluid that's been accumulating and distending his stomach. He didn't seem to get any worse, and then after about 16 hours and (3) 100 ml fluid removals his body just seemed much happier. He's ventilating better, his heart rate has come down, he's urinating much more efficiently, he requires less sedation, his feeds have been increased, his dilated pupil has returned to normal, his stools are no longer mucous-like diarrhea, and his chest xrays are better. Almost makes us wonder if we could have gotten around the tracheostomy had we tried to remove fluid from his belly first. So he's traded the basketball in his tummy for a cantaloupe and it's made a huge difference. Since we're removing this fluid and he's not able to recycle it through his intestines, it complicates his feeding requirements, blood dynamics, and blood product requirements. But it seems to be allowing his body to operate better, particularly his kidneys and GI system. Now if only we could get the lymphatic leak into his belly to subside. Tomorrow he'll get a new trach and an MRI after the replacement to get a better picture of the state of his abdomen. Hopes for tomorrow are ill-defined: we would love to see diminished lymphatic nodules in his abdomen suggesting effective drug therapy, but based on the steady build up of fluid this is unlikely; so despite our wishes to keep his spleen, perhaps the second best outcome would be to see heavy involvement of nodules in just his spleen such that a splenectomy might be the battered silver bullet to get him home... or maybe everything will just resolve overnight?!?!?!?! A man can pray, right? A Happy Birthday and Happy Anniversary to a couple readers, and a Happy Sunday to the rest!

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