Surgery #4 completed
Bob's fourth (and hopefully last!) surgery finally took place today, lasting from 3 to 5pm. We had to wait for clearance from the respiratory therapist, since fluid was in the bases of both Bob's lungs this morning. Amazing how much can change in the human body in just 10 or 12 hours; we went from clear lungs yesterday to "junky" lungs today.
Biggest news is that the surgeon did reattach the small and large intestines together in today's procedure! Again, he removed a few inches from each end before they were rejoined. He is cautious, because there was still a substantial amount of swelling in the intestinal tissue, but he feels this step was necessary to get Bob moving in the right direction. He was also able to close the abdominal muscle layers, but Bob's skin and underlying (subcutaneous) tissue will remain open, with his body literally healing from the inside out. He now has a wound-vac dressing (covering a 9 to 10 inch vertical opening) that will need to be changed every other day. How long this vacuum dressing will remain depends on how long it takes Bob's body to heal and close.
Biggest news is that the surgeon did reattach the small and large intestines together in today's procedure! Again, he removed a few inches from each end before they were rejoined. He is cautious, because there was still a substantial amount of swelling in the intestinal tissue, but he feels this step was necessary to get Bob moving in the right direction. He was also able to close the abdominal muscle layers, but Bob's skin and underlying (subcutaneous) tissue will remain open, with his body literally healing from the inside out. He now has a wound-vac dressing (covering a 9 to 10 inch vertical opening) that will need to be changed every other day. How long this vacuum dressing will remain depends on how long it takes Bob's body to heal and close.
Big Changes
The next 24 hours could hold many changes for Bob, but the biggest modifications they're shooting for will be:
- Remove ventilator: They are beginning to wean him off the ventilator, starting tonight. The quicker his body breathes all on its own, the less his chances are of coming down with pneumonia. Based on the fluid findings in his lungs this morning, the sooner he is vent-free, the better.
With the ventilator being removed, the sedatives and paralytics will no longer be administered, either. Even with a Fentanyl drip (which he's had since last Thurs), there is going to be a lot of pain over the next several days.
- Stop Vancomycin: Based on the Infectious Disease doctor's orders, tonight they discontinued the strongest antibiotic Bob has been receiving. This was concerning to me, because we know he's still fighting the blood infection. But it does make sense: The stronger the antibiotic, the more damage it does to the body's own natural flora while it is killing off infection. In Bob's case, a fungal infection has started growing in his abdominal tissue. They have been giving him Flagyl (an anti-fungal) as part of his antibiotic cocktail to try to prevent this, but the Vancomycin was mightier at killing the flora than the Flagyl was at protecting it. So they've removed the strongest antibiotic, but still may add back a lesser powerful one over the next day or two.
Have I mentioned that the culture also found E-Coli in Bob's wound? Yes, that bacteria exists everywhere in our environment, but if your immune system is compromised because you have sepsis and mega-antibiotics are killing any natural defenses your body may use to fight e-coli, that disgusting bacteria will find a nice spot to settle in and grow. They're confident that the e-coli is no longer a threat, so I'm going to trust them.
- Transition from most IV access: Specifically, they want to remove the access to Bob's jugular vein via the Central Line. He has had 8 ports traveling into his circulatory system via that large vessel; he even has the line sutured directly into the jugular because they knew it would be used to administer many medications over several days. They can't transition him to oral medications yet, because he still cannot take in anything by mouth, but they will start giving him injections or using just a standard IV line in his hand instead (he actually has 4 IV sites right now, in addition to the Central Line and the Arterial Line). With most of these intravenous accesses removed, he'll have a little more freedom to move his head, hands and arms. For now, he'll stay on TPN (IV nutrition).
The hopes are that these changes are going to take place quickly. Of course, they'll continue to monitor him for any increase in fever (he is still at 38.6°C/101°F), any drastic drop in blood pressure, or any sign at all that the infection is strengthening. Hopefully he'll be free from the paralytics and the sedatives tomorrow and I'll be hearing his scratchy voice tell me how he can't believe this happened. Good thing I have photographic evidence. 😃
The next 24 hours could hold many changes for Bob, but the biggest modifications they're shooting for will be:
- Remove ventilator: They are beginning to wean him off the ventilator, starting tonight. The quicker his body breathes all on its own, the less his chances are of coming down with pneumonia. Based on the fluid findings in his lungs this morning, the sooner he is vent-free, the better.
With the ventilator being removed, the sedatives and paralytics will no longer be administered, either. Even with a Fentanyl drip (which he's had since last Thurs), there is going to be a lot of pain over the next several days.
- Stop Vancomycin: Based on the Infectious Disease doctor's orders, tonight they discontinued the strongest antibiotic Bob has been receiving. This was concerning to me, because we know he's still fighting the blood infection. But it does make sense: The stronger the antibiotic, the more damage it does to the body's own natural flora while it is killing off infection. In Bob's case, a fungal infection has started growing in his abdominal tissue. They have been giving him Flagyl (an anti-fungal) as part of his antibiotic cocktail to try to prevent this, but the Vancomycin was mightier at killing the flora than the Flagyl was at protecting it. So they've removed the strongest antibiotic, but still may add back a lesser powerful one over the next day or two.
Have I mentioned that the culture also found E-Coli in Bob's wound? Yes, that bacteria exists everywhere in our environment, but if your immune system is compromised because you have sepsis and mega-antibiotics are killing any natural defenses your body may use to fight e-coli, that disgusting bacteria will find a nice spot to settle in and grow. They're confident that the e-coli is no longer a threat, so I'm going to trust them.
- Transition from most IV access: Specifically, they want to remove the access to Bob's jugular vein via the Central Line. He has had 8 ports traveling into his circulatory system via that large vessel; he even has the line sutured directly into the jugular because they knew it would be used to administer many medications over several days. They can't transition him to oral medications yet, because he still cannot take in anything by mouth, but they will start giving him injections or using just a standard IV line in his hand instead (he actually has 4 IV sites right now, in addition to the Central Line and the Arterial Line). With most of these intravenous accesses removed, he'll have a little more freedom to move his head, hands and arms. For now, he'll stay on TPN (IV nutrition).
The hopes are that these changes are going to take place quickly. Of course, they'll continue to monitor him for any increase in fever (he is still at 38.6°C/101°F), any drastic drop in blood pressure, or any sign at all that the infection is strengthening. Hopefully he'll be free from the paralytics and the sedatives tomorrow and I'll be hearing his scratchy voice tell me how he can't believe this happened. Good thing I have photographic evidence. 😃
Back into his room in the ICU after operation #4
(hopefully one of the last pictures of him with the ventilator)
Do you think he will remember any of this?
ReplyDeleteSome have said yes, others have told me no. I know after his first surgery on 11/20, he was very alert very quickly after the anesthesia. But five straight days of max narcotics and sedatives and paralytics leads me to think he won't remember most of it, if any at all.
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