Day 7 ~ ICU, 10pm

Revised Surgery Plans

  This Sunday evening the surgeon met with me and revised some of the upcoming surgical plans. Tomorrow (Monday) Bob is on the OR schedule for 12:45pm. The goal in this operation is to re-attach the two intestine ends, and to also be able to close just the muscle and fascia layers, not the skin and underlying tissues. The actual steps that can be completed in tomorrow's surgery still depend on the degree of the swelling that remains in Bob's abdomen.
  However, the surgeon does not want Bob to have yet another surgery after tomorrow's, so instead of closing the skin and underlying layers in an operation, the wound will be left open and then covered with a type of vacuum dressing that will slowly encourage the skin to close on its own. Bob's incision is very large, and this final process of wound care will take quite a while. This is all just a plan right now and there aren't any confirmed arrangements yet, other than Bob will definitely be back in the OR tomorrow afternoon, starting at 12:45pm.

Third-Spacing
  The excess fluids that have been filling the "third spaces" in Bob's body are finally beginning to be expelled! The Flexbumin (diuretic) and the TPN (IV liquid nutrients) have been pulling the fluid into the vessels and sending it along to his kidneys, which have started to perform great! Yesterday (Sat), over the entire day, his total urine output wasn't even 650ml. Between 10am and 4pm today, Bob's kidneys had already processed double that amount! Less edema means less abdominal pressure, easier BP regulation, slower heartbeat, and faster healing.

Respiratory
  The fluid that was in the lowest lobe of Bob's right lung is no longer present. It was also a product of the third-spacing, and the respiratory therapist and I practically hugged when he could no longer hear any crackles today! There also wasn't any mucous at all when they suctioned his lungs, so that's even more good news.
  They've started to wean Bob from the ventilator (he will not miss that tube down his throat), and today they had him on the lowest percentage yet - he's down to 35%, and he had started at 100% after the emergency surgery. They hope to wean him completely off the vent by Tuesday or Wednesday of next week, which will be one to two days after tomorrow's surgery.

Vitals/Stats

 - Fever: His temp was at 38.6C/101.5F all day today. Hopes are that a few more days on the antibiotics will help that fever to come down even more. He is still receiving the antibiotic cocktail of Flagyl once an hour, and Vancomycin every two hours, both via IV. 

 - Blood pressure: Dropped just a little bit today. It was averaging 100/55, but they did increase his Versed (sedative) slightly so that he could get some rest this afternoon in preparation for facing another operation tomorrow. He was alert for several hours this morning, so it was good he had some nice deep naps this afternoon and evening.

 - Heart Rate: His pulse has been steadily slowing down, and was only in the mid-to-high 90s for most of the day today. Less fluids in his body means his heart can relax a little!
 - Blood Sugar: The TPN is helping to get his nutrients back into balance. His blood sugar was only 115 today.

  Aside from getting the news that Bob will be facing a very long healing time for his incision and the wound care associated with managing the vacuum dressings, today revealed several very positive trends. What a relief! Hard to believe those terrible events of Thursday & Friday were just two days ago, and Bob's already come so far.
  Thank you to everyone for your continued well wishes, kind thoughts and prayers.

Bob snoozed as I sat and addressed Christmas cards today in the ICU.