The Pee Gates Have Opened!

And I got a grand total of 7 hours of decent sleep.  WOOHOO!

Back to the pee.  I finally decided his nurse had things WELL under control and since nothing was happening I decided to go get some MUCH needed rest.  I came back down at 5:15 and still nothing was flowing, and my eyes kept shutting.  At this point J was up and so I went back to bed.  I arrived just after shift change (7A) and the Attending, Dr. Cisco was discussing next course of action since his kidneys were still not doing a whole lot.  The creatinine levels were up to 3.3 overnight and they should be right around 0.2. This is an indicator that The Kidneys are more than a little ticked off. 
In addition, his LAP (Left Atrial Pressure) in his heart was up to 22 when it should be more like 10-12.  This has to do with the volume of blood in the upper left chamber of his heart.  There are numerous reasons the number may elevate like Tiernan's did, but in his case, all signs point to volume overload. 

So all of this prompted Cisco and the Cardiac Surgical Fellow, Ali be considering taking some more coercive messures to get The Kidneys on the job.  They began explaining the increasing likelihood that they may need to start some form of dialysis to help him before things got too much worse.  They also decided to draw some blood off of the heart through the chest tube.   But right at the start of this discussion, they noticed a small amount of urine had appeared.  So they proceeded to drain the blood (about 30mLs) and within a short time, Tiernan really started to pee!  And the LAP went down.  So that number is now hovering right around 12 or 13 and the pee hasn't stopped.  His volume out has been right around 100 mLs the last two hours and he's peed nearly 60 so far this hour.  This was also mostly without a Lasix drip.  Just a bolus (one time dose). 

So thank God and thank YOU for all your pee dances and prayers.  GREAT JOB!

In other news....

The surgical team is going to come in and remove the packing in the chest since the bleeding has slowed to normal volumes.  (around 25 mLs total per hour through the chest tubes.)  They will still leave the chest open while we wait for the edema to go down, so maybe tomorrow that will occur. 

The team has put him on another "vec holiday".  The vecuronium is the paralytic medication.  They give him a holiday from that to see him start moving his limbs (neuro check) and to get a better read on the pain management.  So he did that yesterday and he twitched everything a little bit and we are waiting to see what he does today.  They may even discontinue (D/C) that med if it seems like he is comfortable and his numbers don't change. 

His sats are dropping a little, they think due to some changes with the ventilator.  They lowered his PEEP numbers.  This has to do with the amount of oxygen at the end of each respiration.  Normal is 5.  He was at 10 and this morning they moved it down to 9.  So this is a probable reason for the lower sats.  And by lower sats, I mean 96.  So it's difficult for me to even register that it would be cause for concern. 

They also removed his femoral arterial line.  (in the groin)  This, along with one in his wrist were placed to measure pressures from the inside.  It wasn't really working properly even in the OR, so they have been relying on the wrist and his cuff BP since those were correlating.  So one line out, many more to go.  Still, we celebrate each and every little step towards recovery.

Overall today seems to be busy, but everything looks to be on the right trajectory.  Dialysis is not totally out of the question, but it's looking more and more unlikely. 

Oh, and I have to mention how happy we have been with all of his nurses and doctors.  They have been outstanding.  I was just watching his current nurse, Gina do some basic care with him and I love how she talks to him and tells him what she is doing, even if he is heavily sedated.  It's the little things that make it all easier. 

REAL TIME UPDATE:
Gina just said he is peeing so well that he is leaking around the foley.  YESSSSS!