A New Plan...Thank God because the Vicious Cycle Plan was wearing thin.

Following my early post this am, I found out that he was actually +350 or more on his fluids for the day. 

And his x-ray looked slightly worse today than yesterday.

I nearly burst into tears.  I thought for sure he would have his beloved ice chips pulled again and it was going to be another hideous day of spinning our wheels trying to get his lungs cleared. 

But then I talked to NP Monica and she had a new plan. 

They decided that he is looking quite good, all things considered.  His BP is in a good place (currently 96/54) and his HR is excellent at 103 or so.  His CVP (Central Venous Pressures) are 5-6 and he is keeping SATS in the 99-100 with respiration rates in the teens to twenties. 

So if they were to continue to push with loads of diuretics to get every last little bit from his lungs, then The Kidney's could rebel again.  And we sure don't want them to go on strike again. So given the good place he is currently in, the new plan involves focusing on nutrition and conditioning to get him up and moving much more which should, in turn, help those lungs. 

Nutrition Plan:
Continue to take sips of liquid (water, juice or even milk).  He can have roughly 1/3 cup of that every 2-3 hours.  So we aren't going crazy here just yet.  We need to make sure he does okay with swallowing.  His voice is getting stronger each day but it is still a bit weak and it's hard to say how much damage they may have endured as a result of the extensive work Hanley did near them and then from the 7 day intubation period.  If they are happy with his progress, maybe we can party with some chicken broth tomorrow.

Right now we are pretty fixated on being thirsty.  It makes him happier than anything else when he can have his drink. 

He has a reverse milk moustache and a big grin.

 (FYI this is the high flow canula and the photo below is back on CPAP)





Conditioning Plan:
The hope is that Tiernan will be on High Flow for 4 hours in the morning and 4 hours in the afternoon.  He has been handling it really well today.  This also makes it easier to get him up and moving around to get that strength back.  Every day he does better than the last.  Today he walked about 25 feet while pushing a wheelchair.  Then he was done and we pushed him back to his room.  So not super far yet, but he had much better stability than yesterday.

The other thing that will help him get more mobile is that last chest tube is OUT!  So are the pacing wires, which he never. even. needed!   It will be SO nice! 

So that will leave only his POWER PICC (cue superhero theme), NJ tube and the O2!  So much better!  He feels so much better just with that last tube coming out.  He just pushed himself up to sitting in his bed all on his own.  He sat there unassisted for a good 10 minutes. That is an enormous change. 

Meds:
They are beginning the transition from Milrinone to the oral form, Enalapril (Ace Inhibitor).  That has been his standard med for the past 4 years.  So it's not much different.  They will also keep him on the Propranolol (beta blocker).  He will also stay on oral Lasix and maybe Aldactone.  He is still receiving Potassium because of all the diuretics. 
Once they get all his meds through his tube or in his mouth, then he won't really need anything beyond blood draws.  They will hopefully pull the PICC before he even goes up to the floor. 

Speaking of that.

In talking to NP Monica, she feels like another week here in CVICU is a safe estimate.  Lots to do before we go to 3 West but we are making great progress!