Day 6 ~ ICU, 6am

Surgery Update
  Right now, Bob is scheduled to go back into the OR at 4pm today. The purpose of this surgery is to go back into the abdomen again, flush everything once more, and possibly re-attach the small intestine back to the large intestine. If this reattachment can be done, they will also close the muscle wall, but will keep the fascia and skin layers open, with a sponge wound-vac on again until the final surgery, which could possibly be Monday. Today's surgery will depend on his vitals remaining stable.

Comfort

  They have finally been able to balance Bob's sedation and pain medications in such a way that he can rest and "ignore" the breathing tube and the pain, yet his blood pressure remains in a safe zone. He only had two times (midnight and 6am) where they had to re-administer the coma-inducing drugs. His pain medications are being given continuously via IV. 
  
Concern
  His body is still being plagued by the terrible diaphragm spasms, and he becomes more alert when they happen, responding to the pain they cause. The nurses tell me with all of his medications, he'll likely not remember the pain he feels when the spasms hit. The surgeon shared he thinks the spasms are being caused by two issues: 
 - the combination of the fluids filling his abdomen and even creeping up into the bottom of his right lung are putting pressure both above and below the diaphragm, and
 - during the surgeries both on Monday and Thursday, some direct irritation of the diaphragm muscle and its nerves definitely took place.
  If the spasms continue after today's 4pm surgery, they will change the amounts and frequency of the sedatives (Versed and the Compazine) he is receiving to try to quiet the diaphragm, as long as his blood pressure remains high enough.

Vitals/Stats
-Fever: Temp is down to 38.2C/100.8F this morning!
-Blood pressure: Averaging any where from 100/50 to 120/60. So much better than the low pressures he has had over the past few days.
-Heart Rate: His pulse is the best it has been in days - down to only 110 so far this morning (normal is around 80bpm). That is a direct result of the fever lowering and the blood pressure coming up high enough.
-Hemoglobin: Hemoglobin down to 6.6 (normal is 13.5 - 17.5). It was 8.8 before the second surgery, so it was already low when he had to go back to the OR Thursday night. They are giving him 1 unit of packed red blood cells this morning.

-WBC: White Blood Cell count is 5.54 (normal is 4.5). His count indicates he has an infection and that his immune system is working to destroy it, but it's not too high, it's expected, so that's a good thing.

-Fluids: They have been forcing a high amount of fluids to keep his blood pressure up enough that they can give him sedatives to combat his fighting the breathing tube and reduce some of his reacting to the high pain. Now his body is experiencing third-spacing, which is when too much fluid moves from inside the blood vessels into the interstitial or "third" space around the blood vessels, which is the nonfunctional area between cells. This fluid is causing edema in his abdomen and legs, so they are trying to cut back on the forced fluids while continuing to use BP medications to maintain a healthy blood pressure.
-Kidney Function: Unfortunately his urine output has dropped, even with the large amount of fluids he has received over the last 24 hours. They hope the kidneys have just become sluggish from all of the trauma to the abdomen, and are encouraged that there is still some urine output, even though it is concentrated.
-Blood Sugar: Latest level was 192. This will continue to remain high until his body is no longer under stress and his insulin levels will stop reacting incorrectly to the stress-hormones in his blood. They give him injected insulin (2 units) each time his reading is over 150, to combat this.

Working towards being stable enough for today's followup surgery

"Look ma, no bite guards!"