hospital admission #24

hi, folks, heather here. thanks, wendy, for keeping everyone up-to-speed on the goings-on in asherland. :)

shortly after i got here (i went home to sleep... got about 3 hours, but i feel, um... not sore. tired, absolutely, but i'm not hurting, so i'm functional), i talked to liz (london cardiology NP). here's the deal:

the chest drain was placed last night around 10:00, and by the time i was called back in around 11, about 250 ml had drained already. that's a quarter of a liter. (for you non-metric/non-hospital-dwelling types, that's over 8 oz). by 9am today, the total that has drained is over 350 ml; approx 50 ml (almost 2 oz) since 7am. yeah. the drainage was very dark (bloody) last night, but it is slowly becoming lighter (straw-coloured). but because of the high amount of drainage, we are going to be here at least one more night, especially since the air entry in his right lung is still decreased to the base (doesn't go all the way down; basically, he's not taking in as much oxygen as he should be). but if there is a bed open on the ward today, we will be heading up there. otherwise, we're stuck in the unit for another day, but not because we need to be here. as the PCCU doc said to me this morning, "he certainly doesn't look like an ICU patient today." so we (by which i mean, i) are hoping to go upstairs today.

the tube will be staying in one more day at least. the drainage is simply too much to think that we can safely remove it yet. the problem, however, is that the tube they used is not a JP; the one they gave him is very stiff, making it very painful to move, since it gets stuck on things and tends to pull and rip (liz's words, not mine. i was busy trying not to vomit when she said that). so the tube we have now is not conducive to going home, which means that, as long as he has this tube in, we're here. but... liz is going to look into changing the tube to a JP, which is more flexible. if we can change the tube, we can go home with that. she said she could show me how to empty it; i laughed and told her i already know how to do that.

meanwhile, they're going to send some of the drained fluid to the lab today to test for a few things. i know there were three things they wanted to look for, but i only remember two:

1. culture. they want to see if anything will grow. liz thinks it's unlikely to grow anything, but hey, it's asher, and you never know with this kid, so we're trying to cover our bases.
2. re-test for chylo. the NP in toronto tested him on the very cusp of chylo-testability, so just to be sure, we're testing again.

another issue that has come up is that, this morning, asher's belly is round and hard. liz is going to consult nephro. because asher has a history of calcium in his kidneys (nephrocalcinosis, for those of us who like technical terms... which is probably just me... yes, i'm a nerd), we are limited with the diurretics we can use. lasix is the usual go-to for diuresis, but that med tends to cause calcium to build up in the kidneys. the very problem, you'll note, that asher has. yeah. so for a couple years now, asher has been on HCT, which has (generally) been doing well enough, but it's just not strong enough right now. so liz will be asking nephro if we can switch to lasix for short-term use. i'm anticipating that they will ok the switch. dr filler (asher's nephro) has told me a couple times that, if they max out the HCT and it still isn't enough, then they can switch him to lasix temporarily. here's hoping he still thinks that way.) we really need to get this fluid off; it can lead to very big problems for asher: heart issues and blood pressure, kidney issues, respiratory issues... yeah, it's not pretty. this fluid, both in his chest and in his cardiovascular system (which is where pee comes from, for those who wonder why i'd be talking about kidneys and pee but only refering to the CV system), absolutely has to go. we cannot keep it on board.

i will try to update here as often as possible, since i have found a delightful little computer in the unit's waiting room. however, if i can't do a full update, i will post on my facebook and/or text wendy, and she will update the blog for me. (yes, wen, you're forgiven for hijacking the blog last night. lol)