Day 22 ~ Room 125, 3pm

Wound-Vac Dressing Change #6 

   Great news! Bob's wound is shortening/closing VERY nicely! No pictures here (as promised), but the measurements below show the improvement over the past 4 days:

   *Dressing change #6 (12/11, today): 18.5cm long x 7cm wide x 1.7cm deep

   *Dressing change #5 (12/7, Thur): 20.5cm long x 7.2cm wide x 1.7cm deep

   Removal of the sponge (right at the beginning) and re-initiating the negative pressure suction (right at the end) are the two most painful parts of the process, which takes about 30-45 minutes total. Bob experiences so much pain each time. Can't wait for this wound to close up.

The items required for the dressing change.

Physical Therapy

   Bob's still somewhat weak, but is building up his endurance and increasing strength. Today they OK'd him to walk without a walker, as long as he is being "supervised"! I visited him at PT and snapped a few pics to share...

His trusty vac-pac bag hanging over his shoulder and 

his vacuum tubing hanging around his neck.

Didn't think about the photo angle - 

surviving sepsis apparently leads to duck feet...

🤣

Day 21 ~ Room 125, 6pm

Smiles 

   Slowly but surely, Bob's plodding along. He's still anemic and therefore still tiring very easily. He's having some aches and pains in the muscles he's rebuilding, especially in his abdomen. Tylenol seems to be enough, unless it's a Wound-Vac dressing change day, and then he also takes Lortab. I'm arriving in late mornings, staying through most lunches and dinners with him each day (when he has visitors I might step out for a while) because he's becoming a bit lonely and needs encouragement. Watching his favorite football team and winning at Fantasy Football helped boost his spirits today.

Watched Minnesota Vikings play today

while tracking his fantasy team at the same time.

Recommendations?

   Bob's case manager met with us today and is ordering a Wound-Vac system to be used at home. They might let Bob return back home in as little as one more week, if we can have the house set up correctly to accommodate his needs. They can do dressing changes and also arrange to have Kindred Care come to do physical and occupational therapy sessions at home.
   So on that note, local friends, we're looking for references for a reputable, experienced & trustworthy carpenter/handyman to install permanent handicap grab bars in our bathroom and tiled shower. Please share contact info if you have any good recommendations. (Bob has the skills, but obviously right now isn't capable).   
   Thank you ~ much appreciated!

Smiles are good for the soul.

Day 20 ~ Room 125, 6pm

Plum Tuckered Out 
   Please continue to keep Bob in your thoughts. He's having to work hard to regain strength and endurance and gets tired so easily. It's difficult for him to have to spend his days realizing how weak he is from his sepsis and ICU stay. He hates having to sit waiting in his wheelchair for a transporter to come and bring him from therapy back to his room. And he's becoming frustrated at having to constantly depend on assistance from somebody else to get out of bed, use the bathroom, etc. It's hard to not be independent. I continue to encourage him and remind him how every day he's making great strides, and he'll be back at home before he knows it.

He's slowly regaining an appetite.

Thanks to everyone for your continued support and good wishes!

Day 19 ~ Room 125, 3pm

It's Time for a Christmas Tree!

He's strong enough to hold up his festive little decorated evergreen!

First Full Day of Therapy
   We're trying to adjust to a new schedule now with Bob relocated to Sea Pines. He had his first full therapy sessions today. He said he is shocked how weak he is and how little endurance he has. Once back to his room, he is in bed and asleep within just a few minutes of watching a little YouTube TV on his phone. I keep reminding him that his body needs to heal and rebuild, and his immune system is still on overdrive, keeping that belly wound free of infection and making new tissue. I keep reminding him how far he's come already, and that it's going to take small steps some days, but he's still moving in a positive direction.

Absorption
   Bob's digestive system is doing very little absorbing yet. Most of what he eats is vacated very rapidly. They removed around 18"-22" of intestine overall, but his entire digestive system has to heal and re-learn to process food efficiently. They've added some additional probiotics to help those intestines function better. They're also giving him glutamine and arginine supplements, iron (he is anemic, only 8.5, and for men normal is 13), Juven (therapeutic nutrition drink) and Ensure (nutrition supplement) to improve his overall health. It's going to take time for his digestive system to start correctly absorbing essential nutrients again. He also has no appetite, which is largely due to his shrunken stomach. He'll eat a half banana and about 2 ounces of meat and then he's full. They're going to work on him having supplements during the day when it isn't mealtime, to try to encourage more nutrient absorption.

We'll see what tomorrow (Saturday) brings. 

So happy to be able to look forward to another day!

Headphones in, TV on his phone...time for a nap!

Day 18 ~ Room 125, 7pm

Most important: Bob got to have a shower today! After 17 days!

His arms are getting a little skinny,

but his hair's been washed and his body's been showered!

Successful Relocation

   Bob is now moved into the inpatient rehab hospital, Sea Pines. It was not a simple move to make thanks to the insurance red tape. Our insurance company gave me a list of several rehab facilities, and based on their infection rates and overall individual ratings, I narrowed it down to 8 that were a possibility, and then only 3 that I would consider after speaking to a few friends of mine who are health care professionals. But we hit a snag: the insurance company would only approve Bob to transfer to a "Skilled Nursing Facility", which provides a lower level of care versus an "Acute Inpatient Rehabilitation Hospital". Yet none of the insurance-approved facilities would accept Bob with his wound care requirement!

   I explained to our insurance that it didn't matter what facility they "approved" if none of them would accept Bob as a patient due to his needs. He had to go to an inpatient facility that was also an actual hospital, with a complete hospital staff. Sea Pines had already accepted him and was simply waiting for an authorization. The insurance company said if Sea Pines is what we "wanted", it would cost us between $2,000 - $2,500 a day out of pocket. I immediately began dealing with a supervisor and initiated an appeal process. It didn't take long for me to explain, very respectfully but firmly, that it was not a personal preference; if Bob didn't get the correct level of care at the correct facility because our insurance company would not provide proper placement, I assured them that any out-of-pocket expense on our part would eventually be repaid back to us by them, but more importantly, any risk to Bob's health from inadequate care he received would also be their responsibility. Once I was able to speak to someone who understood the above-normal level of care Bob needed, we were approved and he got transferred to Sea Pines Rehabilitation Hospital. It can take so much effort sometimes, but you have to advocate for what's right.

Bob's new home away from home for the next few weeks.

Holistic Team

   Bob now has a team of health care professionals that will provide him the opportunity to readjust his entire health back to 'normal'. He is currently in his 'recovery phase' and will transition to his 'therapy phase' the longer he stays. Today we met with the medical director, the hospitalist, the charge nurse, the pharmacist, the dietician, the respiratory therapist, the wound care specialist, and his floor nurse. We were advised that Bob won't be rushed out of there; the goal is for him to build up his endurance, balance and strength at a pace that is successful for him. It will be interesting to see what they think about Bob's 'pace' once he gets going. I told him no more over-doing it like last night. I'm still recovering from his other scares over the last 16 days. 

Visitors

   Bob can certainly have visitors now. He's at Sea Pines, in Room 125, bed B. Visitation ends at 8pm, and we ask that everyone keep his therapy schedule in mind if planning to stop by.

Therapy Schedule

Bob will receive therapy every day, adhering to a strict schedule. 

   9a - 10a: Occupational Therapy

   10a - 11a: Physical Therapy

   1p - 2p: Physical Therapy

This fixed schedule helps to set goals and measure progress. He'll be plenty tuckered out once his therapy sessions have been completed for the day.

Wound Care

   A quick note about Bob's midline abdominal wound: it's healing wonderfully already! They removed the vacuum dressing this morning at the hospital, packed him with a wet-to-dry dressing for the trip, then reapplied a new vacuum sponge when he got to Sea Pines. The vacuum pump is now portable and can move with Bob from his room, to the wheelchair, and to the therapy rooms. The wound nurse estimated it will be an 8 - 12 week recovery time for a complete closure. 

   Here's the latest measurements:

   *Dressing change #1 (11/29, Wed): 21cm(8.5") long x 7.9cm(3") wide x 4cm(1.5") deep 
   *Dressing change #2 (12/1, Fri): 20.5cm long x 7.6cm wide x 3.8cm deep

   *Dressing change #3 (12/4, Mon): 20.5cm long x 7.4cm wide x 2cm deep

   *Dressing change #4 (12/6, Wed): not measured

   *Dressing change #5 (12/7, Thur): 20.5cm long x 7.2cm wide x 1.7cm deep

The portable wound-vac negative-pressure pump.

Thank you - from Me 
   Tonight I realized I am utterly exhausted. I went home this afternoon to get Bob his clothes for therapy, his phone and headphone chargers, toiletries, etc, and on my way back up to Sea Pines, I realized I've been running on adrenaline for over two weeks straight. From home, I woke up twice each night (midnight and 4am) to call the hospital and check on him. I stayed with him until 9 each night (many times later) and was back with him again between 7-8 each morning. I was constantly watching, asking questions, intervening when necessary, assisting, helping, communicating, coordinating, researching, working with care plans and social workers and insurance reps. Blogging was a release for me, helping me to realize all that's happened and allowing me to share my worries and my celebrations. I'll keep blogging until Bob's back to a regular daily routine; until then, I'll continue to update his progress. It's good for him to see and it's good for me to know he just keeps moving forward.
   I need to thank everyone, for everything. For your prayers, good vibes, tribal dances and any other method of choice that you've used to ask the universe to bless us. For your support, words of encouragement, kind cards, thoughtful emails and text messages. For the wonderfully delicious meals that have given me the freedom to never worry about dinner each night or lunch the next day. For the flowers, balloons, gift certificates and chocolate covered fruit! For your help with our house, our yard, our pool, our pets and anything else anyone has done for us. We are so fortunate to have so many wonderful people in our lives that truly care about us and have supported us like this. Thank you!

Day 18 ~ Moving on!

Sea Pines Rehabilitation Hospital 

   Bob is moving to an acute care inpatient rehabilitation hospital today! I'll update this blog with detailed information this evening after I'm back home, but wanted everyone to know he's leaving Holmes Regional Medical Center and moving on to the next phase of his getting-well journey.  More tonight!

Leaving HRMC 4th floor after 17 days!

Loading up and heading out!

Day 17 ~ Room 401, 9pm

Overdid It 
   Bob was feeling really motivated today, and was in and out of bed four times. He also took some steps using a walker while a physical therapist held him with a mobilization belt! However, he was a bit over-zealous, and a few hours after his PT and the wound-vac dressing change, he began complaining of an ache in his right flank area. The 5-inch incision from his initial surgery (11/20) had bled slightly, and that area of his abdomen started to swell and felt firmer than the rest of his belly. His temperature was 98F throughout the day, but tonight it was up to 99.7F. They placed an ice pack on his side, and are giving him pain medication and Tylenol throughout the remainder of the night. To be super over-cautious, they're going to run a few labs tonight, too.
   Since Bob's mentally 100% with it again, he's eager to move on to the next phase of this journey, which is transitioning from HRMC to an inpatient rehabilitation hospital. Because of that, I think he physically pushed himself too hard today, and his body had to remind him that he might have been trying to do too much too soon. This afternoon and this evening, he was pale, asking for pain meds, and completely spent, even skipping supper. I stayed late with him to be sure he finally fell asleep, and I'll be checking in with his nurse around midnight and again at 4am. Likely it's nothing serious to be concerned about - probably a pulled muscle or a little subcutaneous tear, but understandably I'm overcautious right now, considering the past 16 days!
   Looking forward to a new day tomorrow with less pain and more forward progress.

Not feeling too great tonight -

sometimes it's two steps forward, one step back.

Day 17 ~ Room 401, 3pm

Wound-Vac dressing change:

   Today was change #4 of the vacuum sponge in Bob's abdominal wound. It is managed by a wound care specialist who removes and replaces the vacuum dressing every Mon, Wed & Fri of each week. They anticipate it may take anywhere from 4-12 weeks for the defect to completely grow closed. Bob arranged pain medicine in advance with his nurse, but he said even with 4cc Morphine and 15mg Norco, the procedure was still terribly painful. Hoping that once the nerve endings begin to heal and granulation tissue continues to fill the wound, the pain during these vacuum sponge changes will decrease.

Wound Measurements: 

   *Dressing change #1 (11/29, Wed): 21cm/8.5" long x 7.9cm/3" wide x 4cm/1.5" deep 
   *Dressing change #2 (12/1, Fri): 20.5cm long x 7.6cm wide x 3.8cm deep

   *Dressing change #3 (12/4, Mon): 20.5cm long x 7.4cm wide x 2cm deep

    Now that Bob's wound care isn't being managed in the ICU, even though the dressing is changed on M/W/F, they will only be measuring the wound's actual size every Monday. But just looking at it visually today, it is apparent that the depth is decreasing as his body fills in from the inside out.

The sponge before it is measured to fit inside the wound.

The unused sponge pieces left over after the wound has been packed.

The pump that is connected to the wound sponge and creates

negative pressure which continuously pulls fluids out of the wound site.

   If anyone would like to see pictures of the actual wound, I do have them, and will share via private message with those who are interested. I find the healing functions of the human body to be fascinating, but I know not everyone shares in my fascination. It is pretty amazing that we can live with parts of us not yet closed up!

Day 16 ~ Room 401, 6pm

Lung Update: 

   The congestion in Bob's right lung is almost gone! Hoping soon his breathing treatments won't be needed as frequently (every 4 hours). The audible coarseness in his left lung is all gone, and in the right lung is extremely faint.

Not many more of these treatments left to do!

Standing!
   There's so many things our bodies do automatically each day without a second thought. Today I watched Bob working on re-training his weakened muscles how to stand up again, without any assistance. He tried a few times before he succeeded, and when I think back to just 13 days ago, I'm still in shock as to how grave his condition was and how quickly he's coming back. I promise I won't post a video of every little accomplishment he makes in therapy, but this particular achievement was a big deal, for him, for me and for his caregivers; he really, really wants to be walking around very soon!

Day 16 ~ Room 401, noon

ADL's: 

   A huge part of Bob's rehabilitation will be his ability to independently complete his ADL's, which are Activities of Daily Living. Things we do without even thinking each day, like getting out of bed, taking a shower, brushing our teeth, putting on clothes, etc. With the negative pressure wound vac dressing, he's not permitted to fully submerse under water, so instead he had a warmed shower cap with shampoo and conditioner massaged into his scalp for 5 minutes, and then a complete head-to-toe scrub down this morning. He was even able to brush his own teeth, with only a minimal hand tremor compared to yesterday. Even with the improving steadiness of his hands today, they decided to have a nurse handle the razor and shave his face. He said he feels human again.

No more IJ (Internal Jugular) Central Line:

   What was once a direct portal into a major blood vessel that literally pumped life saving antibiotics into Bob's body, is now just scars from three sutures. Each day he is less tethered.

Day 15 ~ Room 401, noon

Up and At 'Em!:

   Out of bed for the first time in almost 2 weeks! Bob's shocked at how weak he is, especially his legs. He said this first time was incredibly difficult. He told me now he understands why he will be transferring to an inpatient skilled nursing facility for a short time after he is discharged from the hospital.

  Occupational Therapy (OT) worked on his hands and arms this morning. He has about a 20° lag in the range of motion of his upper appendages. His right side is slightly stronger than his left, but she said he has a good amount of work ahead of him.

  Physical Therapy (PT) evaluated his lower body, got him sitting up (with assistance) and even shuffled him a step over to his "recliner". It's too early to determine what degree of lag his lower appendages have, but she said he'll likely have more work to do on his lower half than on his upper body.

   Respiratory Therapy (RT) wants him to sit vertically for an hour at least three times today. He still has congestion and coarseness in both lungs (more in the right) and the sitting will definitely help with that. They're continuing his breathing treatments every 4 hours.

Wound-Vac dressing change:

   Today will be change #3 of the vacuum sponge in the abdominal defect. Bob's got pain medicine already on board in anticipation... He remembers last Friday's dressing change, and he said that the process is excruciatingly painful.

Edit: 

   Wound Measurements: 

   *Measurements at dressing change #1 (11/29): 21cm long x 7.9cm wide x 4cm deep
   *Measurements at dressing change #2 (12/1): 20.5cm long x 7.6cm wide x 3.8cm deep

   *Measurements at dressing change #3 (12/4): 20.5cm long x 7.4cm wide x 2cm deep

One last thing...

   When asked by the physical therapist how long he's been here, Bob told her two months. I told him it had been a day over two weeks, not two months, and he said he didn't believe it was only 15 days. He was serious when he said he was sure it had been two months...he's still got a bit of confusion to work through.

Day 14 ~ Room 401, 8:30pm

Some celebrations:

   * Temperature - Today was the first day Bob's temperature has stayed consistently at or below 99F since Tuesday, 11/21! Not even 100F. He's still receiving IV antibiotics, so they must be finally kicking the bacteria to the curb.

   * Bye-bye, thickened clear liquids - The surgeon is happy with the activity of Bob's intestines (to quote Dr. Talbert: "We celebrate blow-outs around here!") so he gave the clear for Bob to try some jello, and if no coughing (which there wasn't) Bob could transition to a carbohydrate concentrated diet (good for the gut). After successfully not choking on orange jello, Bob invited me to have dinner with him tonight - the cafeteria brought him/us caesar salad, baked ziti and jello. And WATER. Bob was elated with his water and ice chips. It was a pretty good date.

   * Visitors and Phone Calls - Today was the first day Bob got to visit with visitors from the outside world (other than me and Jessica/Bruce). A few people saw him when he was in the ICU, but he didn't get a chance at all to interact, and most visitors from those stressful days he isn't able to remember. He was also able to talk to his nephew and brother on the phone tonight. Of course they've been horribly worried; they were both so relieved to chat with Bob. It was great to see him crack jokes and talk like himself again! 

Dinner date.

Water!

Talking to his nephew and brother.

Some lingering concerns:

   * Upper Right Lung - Still struggling with the mucus blocking the upper portion of Bob's right lung. They can hear coarseness/consolidation in that top lobe. They're giving him breathing treatments (Duoneb, which is a combination of Albuterol and Atrovent, two bronchial dilators) four times a day. He's using the inspiration spirometer and the flutter valve each hour, as well. Keeping a close eye on this.

   * Low Electrolytes - Potassium remains extremely low. They've been giving him IV electrolytes (via his Central Line) and oral potassium since early this morning, but every four hours when the blood draw comes back from the lab, K is still too low. This is holding him back a bit from progressing to the next phase, which is starting some physical therapy.

   * Not yet sitting up - Bob's intestines, although happily finally joined together and working again, are a bit out of whack. His innards don't know how much fluid to hold and how much to give away, which is likely causing a lot of the electrolyte loss. This is making Bob pretty weak still, so consensus was he needed another day of bedrest before they start sitting him up and moving him around. They don't want to risk him fainting or falling and injuring himself - can you imagine???

Day 14 ~ Room 401, 8am

Electrolytes

   Ran into another challenge yesterday that was unexpected: Some of Bob's important electrolyte levels are very low! So yesterday they started him on IV potassium, magnesium and sodium. This morning they're continuing the IV electrolytes, but he is also now taking them orally every 4 hours. They draw his blood from his Central Line (they also refer to it as his "IJ", Internal-Jugular) and send it off to the lab every four hours to check the levels and then adjust quantities he is receiving accordingly.

Activity:
   With his electrolytes so low, they didn't work on sitting Bob up in the bed yesterday. The hopes are that today he'll be less weak and will be able to do so. As soon as I walked in this morning, he asked me if I brought his tennis shoes, because he wants to go walking outside today. I told him when he gets to walking, he can go out in his sock feet to start. He still wants his shoes by the bed so they can be there when he's ready to go.

Confusion:
   Bob's been able to take much less pain medication. He can go several hours without any narcotics, unless they're doing a wound-vac dressing change. But he's still very confused. Today he wants to know why he can't see his feet, and asks me repeatedly if he still has feet, because he wants to go walking soon. He also saw me on my phone, so he asked for his phone (I've been waiting for that request!). When I handed it over, he told me it must be broken. He couldn't understand it had to be turned on first. We'll try again another time.

*Edit 10am: Bob's now using his cellphone to update the roster of his fantasy football team. His clear-headedness is returning by leaps and bounds!

Next Steps?
   I'll be meeting with the social worker today to discuss next steps. I want to be sure everything's in place (inpatient facility, etc) before Bob tries to run out of this hospital's front door. 🤣

He asked for his glasses to see the TV. Yay!

Day 13 ~ Moved!

8am - Bob's been moved out of ICU

   Another long day ahead...hoping to get Bob sitting up. He still has humidified oxygen, a wound vacuum pump, blood clot pressure cuffs, jugular IV, heart/lung monitor, IV antibiotics, several additional medications, clear liquid nectar-thickened diet, lung breathing treatments and a Foley, but he's out of the ICU! Huuuuuge step.
   We'll see what the next phase will be after he's cleared to leave this floor of the hospital. The location and length of further inpatient care hasn't yet been determined.
   We (Bob and I, his health care surrogate sidekick) are now in Room A-401, bed 2, at HRMC. Not certain how long we'll be here before we venture to another locale.
   Thanks all for your continued support, love, prayers, good thoughts, happy vibes and delicious food train meals!

Still carefully monitoring all his vitals.

Greetings from A401-2!

Day 12 ~ ICU, 8pm

Apologies in advance for the length of today's post. I try to capture as much as I can, both to adequately share with everyone, and to thoroughly document everything so when Bob's ready and able, he can read about all that's happened. Today was a long day (I stayed 13 hours) and a LOT happened!

Swallowing Trials

   Bob wasn't able to pass his first swallow screening this morning - his esophagus' muscles and epiglottis were too weak and he began coughing. Aspiration is a big concern, so they had a speech therapist come in the afternoon to administer his second attempt. That one he passed! They've removed the NG tube and are now giving him a nectar-thickened clear liquid. He says it's terrible - it tastes like lemon flavored water with cornstarch and he can't believe that it's better for you than plain water is. It's hard for him to understand right now about aspiration precautions. And since he passed the second swallow screening, his NG tube is OUT!

Lung Treatments

   Although there's not too much fluid remaining in his lungs, this morning's chest Xray showed that a mucus plug has formed in the upper lobe of Bob's right lung. This causes his lung to not expand as large as it should (called atelectasis) which decreases volume and oxygen exchange. They've started him on Chest Physical Therapy (CPT) where his lungs are being drained through mechanical percussion and vibration that is applied to his back. Noisy but effective!

   They're also giving him nebulizer treatments of Albuterol to dilate his bronchial tubes, and having him breathe into a "flutter valve" that mechanically vibrates the air he's exhaling, causing alveoli to pop back open. They're combining therapies to hopefully break up and remove the mucus so his lung will open more fully.

Wound Vac Dressing Change

   Today was the second time the vacuum sponge in Bob's belly wound has been removed and replaced. They stopped part-way through and gave him 2cc of Morphine for the pain. Hopes are when the wound begins healing and there aren't as many exposed nerve endings, the dressing changes will be less painful.

Edit: 

   Wound Measurements: 

   *Measurements at dressing change #1 (11/29): 21cm long x 7.9cm wide x 4cm deep

   *Measurements at dressing change #2 (12/1): 20.5cm long x 7.6cm wide x 3.8cm deep

ICU Delirium (aka ICU Psychosis)

   This is hard for me to write about. Bob began having apparent comprehension problems this morning, very similar to temporary dementia. It's from so many days of paralytics, sedatives and decreased brain oxygen while on the vent. He is confused about who people are, his birth date, what's happening, where he is. It's strange that he almost seemed better yesterday than today, but previously he was only "surface chatting", and now he's being asked to comprehend and effectively process what is being said to him or asked of him. This is a temporary condition, and could last six days or six weeks, depending on the severity of the infection, fever, etc that accompanied his treatment in the ICU. I'm patiently waiting for all of his sharp mind to return, and feel confident that will happen very quickly.

Physical and Occupational Therapy

   Bob's left side (arm, hand, neck) is markedly weaker than his right, and much of his hand-eye coordination has to be re-learned (his brain has to be reminded). Today they worked with him lifting an empty styrofoam cup off of his table and bringing it to his mouth. He had a few failures before he finally got the cup to his mouth, and then was so exhausted he couldn't set the cup back on the tray without assistance. 

   Tomorrow they're going to try to get him to sit up with support. For now they are periodically adjusting the head of his bed from 30°, to 45°, to 85°, and then back down again, to familiarize his muscles with the feel of those positions. The more physically capable he becomes, the quicker we'll get him moved out of the ICU.

Current Medications

   As of 6pm today, Bob now receives only the following (he's finally receiving less than 20 medications!):

   * Antibiotics: IV Micamine continuous drip; IV Maxipeme every 12 hours

   * Anti-fungals: Nystatin mouth rinse for thrush (fungal infection on tongue and gums) 4 times a day; IV Flagyl drip for skin around belly wound

   * Pain meds: Oral Norco every 4 hours; IV Morphine 2cc per hour when needed

   * Insulin: Levemir (long term insulin); Novalog (short term insulin). Blood sugar has been in high 200s. Sepsis in the abdomen messes with all the organs!

   * Digestion: IV Pepcid twice a day, oral probiotics, nectar-thickened clear fluids, IV Lasix twice a day to continue to flush excess fluids from abdominal cavity and lower body

   * Respiratory: Albuterol nebulizer treatments every 4 hours; CPT (vibration & percussion) every 4 hours; inspiration spirometer and flutter valve sessions once an hour; continuous humidified oxygen 4% via nasal cannula

   * Circulatory: Heparin injection every 4 hours; oral Lisinopril

   * Temperature: Of course, Tylenol for any fever over 101F. Today he stayed between 99F - 100F for the entire day.